Americans may be postponing or forgoing medical care, but health insurance companies “continue to press for higher premiums,” the New York Times reported last Friday, severely complicating the GOP’s argument that giving seniors more “skin in the game” will lead individuals to use less care, spend less, and eventually lower health care costs. Jared Bernstein explains:

The story goes like this: insurers have been raising co-pays (the amount you contribute out-of-pocket when you get medical treatment) which should make people more cost conscious, and in fact, recession-battered families have been responding by seeking less care. So far, basic econ 101.

But despite the cost shifting and resulting demand contraction, premium prices have gone up as fast as ever. [...]

In competitive markets, sellers can’t typically set today’s prices based on where they expect demand to be in the future. If one of them did so, others would capture their market share by pricing based on current supply and demand conditions.

The dynamic should lead you to be particularly skeptical about plans that depend on private insurers responding to market signals (are you listening, Rep Ryan?). Republicans go on about how once everyone’s out there on their own shopping for insurance in unregulated, private markets, competition will drive prices down.

That’s how it works for bananas. It’s not the way it works for health insurance–folks are locked into plans through their jobs, there’s huge information disparities (their business model is to know who’s risky and avoid them), and most importantly, individuals have minuscule bargaining clout. So if you wanna shop for health insurance by yourself, just make sure your policy covers masochism.

Bernstein says that insurers are justifying their increases based on projects of future demand, but the other factor here may be the looming regulations that insurers will be expected to follow once the Affordable Care Act is more fully implemented in 2014. As incoming Federal Insurance Office director Michael T. McRaith put it to Kaiser Health News last month, insurers are using the interim period between passage of the Affordable Care Act and when most of the insurance regulations are enacted in 2014 to increase profits and force the sickest (and costliest) beneficiaries off their rolls. “They are using the absence of rate regulation to price out existing policyholders. That is designed to lead to the accumulation of capital, so that by 2014, when insurers have to cover everyone, they’ll be starting from a point of extreme financial strength,” McRaith explained.

This only goes to show that Congress will need to pass additional legislation to control health care premiums (Sen. Dianne Feinstein (D-CA) has a bill that could help do just that), rather than offer legislation that would deregulate the industry and push individuals to try and find affordable coverage within it.

Lost in all the coverage of Newt Gingrich’s Sunday follies about Paul Ryan’s Medicare reforms and his support for an individual health insurance mandate is this little goodie from Gingrich telling supporters that he had signed a pledge to repeal the Affordable Care Act:

Yesterday in Mason City, Iowa, I signed the Obamacare Repeal Pledge, sponsored by the Independent Women’s Voice and American Majority Action.

Obamacare is such a massive and complex power grab of a law that there are countless specific reasons to oppose the law.

I’ll spare you the reasons — which you can read by clicking over to his newsletter — and just reiterate that any effort to repeal the health law would greatly increase the number of uninsured and blow up the deficit — complicating the GOP’s spending discipline persona.

In fact, according to the Congressional Budget Office (CBO), the GOP’s much-touted repeal would “cause a net increase in federal budget deficits of $210 billion over the 2012-2021 period” and increase the number of uninsured by 33 million, “leaving a total of about 57 million nonelderly people” without coverage. The CBO also offers its own bit of irony for Gingrich: by repealing the coverage provisions in the Affordable Care Act, the he may be lowering the government’s commitment to health care over the first ten years, but because he’s also going after the cost control measures in the law (and growing Medicare outlays), Gingrich would increase the government’s involvement over the next ten:

However, CBO projects that enactment of H.R. 2 would increase the federal budgetary commitment to health care in the decade following the 10-year projection period. The estimated effect in later years differs from that in the first decade because the effects of those provisions that would tend to increase the federal budgetary commitment to health care (such as the increase in Medicare spending and the repeal of the excise tax on insurance policies with relatively high premiums) would grow faster than the effects of provisions that would tend to decrease it (primarily the repeal of the coverage expansions).

“I am unequivocally for repealing the whole bill. I don’t trust the Washington process. I wouldn’t want to try to repeal part of it, because I wouldn’t trust the folks who are around at two o’clock in the morning cutting the final deals,” Gingrich clarified yesterday during an appearance on Hugh Hewitt radio show.

Jordan Fabian is reporting that former Minnesota Governor and likely presidential candidate Tim Pawlenty (R) is the latest influential Republican to endorse a discredited story implying that House Minority Leader Nancy Pelosi (D-CA) used her influence to protect businesses in her district from certain regulations in the Affordable Care Act.

The charges originated from the administration’s announcement last month that it had granted an additional 204 waivers to businesses and policyholders from the Affordable Care Act, excluding those entities from having to offer a minimum amount of coverage annually. In a story published on Tuesday, the Daily Caller’s Matthew Boyle implied that since “Of the 204 new Obamacare waivers President Barack Obama’s administration approved in April, 38 are for fancy eateries, hip nightclubs and decadent hotels in House Minority Leader Nancy Pelosi’s Northern California district — Pelosi must have swayed the decision. She did not:

House Minority Leader Nancy Pelosi (D-Calif.) played no role in the process by which health care waivers were granted to a number of businesses in her district, according to the company that actually requested the waivers on behalf of its clients.

Flex-Plan Services, a third-party benefits administrator based in Bellevue, Wash., made the formal applications for waivers from President Barack Obama’s health care law, said it founder, Hilarie Aitken. [...]

In actuality, Aitken explained, the high percentage of waivers is the byproduct of local law rubbing against the new national legislation. In April 2008, San Francisco passed an ordinance requiring employers to spend a minimum amount per hour on health care for their employees who work in the city. In response, a number of eateries chose to set up Health Reimbursement Arrangements, which are essentially pools of funds set aside by employers to reimburse medical expenses paid by employees.

HRAs are serviced by a third-party administrator or plan service provider. They are also subject to the annual limit provision in the national health care law, which is set at $750,000 in 2011 before it is eliminated fully in 2014.

Like many self-insurance policies and union organizations, employers using HRAs have been applying for a waiver from this provision, arguing that application of the requirements would “completely eliminate the benefit” of setting up the HRA in the first place, Flex-Plan Services said. When they do so, they turn not to lawmakers like Pelosi or to the employers themselves, but to third-party administers like Aitken’s company. (And, as she hinted, political donations by Flex-Plan have leaned Republican, according to data collected by the Center for Responsive Politics.)

Putting aside this particular misguided attack against Pelosi, the GOP is using the waiver “story” to argue that the health care law is so strenuous that even businesses in Pelosi’s heavily Democratic district are trying to find a way out. They’re saying that while also claiming that the Affordable Care Act is a one-size-fits all government monstrosity that doesn’t take the different needs of individual businesses or states into consideration — after all, that’s the entire basis of Mitt Romney’s rejection of the health care law.

But these two arguments can’t both be true and Republicans shouldn’t be getting away with claiming that the law is too didactic while simultaneously attacking the government for providing greater flexibility to businesses and individuals.

A more interesting question to ask would be — should HHS be granting waivers that — at least on their face — undermine the goals of the law. HHS believes that since employees won’t have new coverage options until the exchanges become operational in 2014, the best way to avoid coverage drops is to ensure that employers have flexibility to gradually meet the requirements of the new reforms and transition from subprime insurance that has low annual limits and all kinds of coverage exemptions into comprehensive basic coverage. These waivers are good for a year, but could be extended until 2014, if employees continue to face a coverage cliff.