Last year, Republican campaigned on a promise to repeal all of President Obama’s health reform law, the Affordable Care Act. Realizing that many of the well-publicized provisions are wildly popular, like ending discrimination of so-called preexisting diseases, GOP leaders promised to “replace” the repealed bill with a solution of their own. However, after voting to repeal the entire bill, GOP lawmakers have done nothing to advance an alternative.

Freshman Rep. Sean Duffy (R-WI) promised during his campaign that he would only repeal health reform after finding a solution to replace it. However, he told a town hall meeting in his district this week that GOP leaders had convinced him to vote for repeal first, ensuring him that a replacement would be on its way. GOP leaders, Duffy said, told him that a replacement bill would be ready by the Spring. The fact that nothing has been proposed or debated all year has Duffy “very concerned”:

DUFFY: I believe, if we’re going to repeal the president’s health care plan, we should replace it. I still believe that. [...] As I dealt with the leadership, that was a concern of mine. And I got a commitment from leadership that we were going to come up with a replacement. And they told me we were going to do it in the Spring. In the Spring we haven’t come out with our replacement proposal and that has me very concerned. Because that what was we had talked about before we had the vote, “repeal and replace.”

Watch it (video courtesy of Americans United for Change):

Duffy’s frustration is understandable. As Jared Bernstein has noted in March, Republicans still had not brought up a bill outline or even begun the steps in the relevant committees to propose a comprehensive health bill. Moreover, the “alternative” offered by the GOP last year did nothing to cover tens of millions of uninsured and rein in widespread industry abuses. In fact, the GOP’s bill increased the number of uninsured.

As states across the country cut back on Medicaid spending — leaving many Americans with nowhere to go to get proper medical care — health care advocates in states like Washington, North Carolina, and Arizona are filing lawsuits to try to reverse the reductions. But the Obama administration is standing in the way.

On May 26, acting Solicitor General Neal Katyal filed an amicus brief in a Supreme Court case “arguing against Medicaid patients and providers suing California over changes to its Medicaid program.” As Lester Feder reports in the Politico, the move shocked many in the health care policy community, including Secretary of Health and Human Services Katheleen Sebelius, who had been working behind the scenes to head off the opinion:

Advocates for Medicaid beneficiaries say the case, Douglas v. Independent Living Center of Southern California, is important because it will be very difficult to enforce states’ obligations under Medicaid if the Supreme Court accepts Katyal’s argument. This could not only hurt beneficiaries who would have little recourse if Medicaid denies life-saving benefits, but it could also undermine the Patient Protection and Affordable Care Act, which relies on states to implement key components. The court will hear the case in the next term. [...]

The ACA will add an estimated 16 million people to Medicaid rolls. If the court follows Katyal’s argument, Rosenbaum said, “It would be like having an insurance policy on paper and no real way to enforce the kind of assistance that real people in the real world are supposed to get.”

And, she added, there’s “no stopping point … in terms of its spillover effects” if the Supreme Court broadly restricts individuals’ access to the courts over state implementation of such a federal program.

The administration says that it is opposing the right of individuals to challenge state because that would create “unmitigated litigation clogging up the courts,” but such lawsuits are already restoring health care cuts to the neediest Americans.

Last week, the Washington Supreme Court court found that the state Department of Social and Health Services “made broad assumptions based on children’s age and living conditions instead of examining the need in each individual case” and unfairly cut benefits. The ruling will restore care to as many as 3,000 children who are served by the state’s children’s health care program. The court also affirmed a lower court decision that reversed cuts to 1,000 seniors receiving in-home care.

Greg Sargent notices that the GOP’s campaign to attack Democrats from the left on health care has once again jumped the shark with this ad from the National Republican Congressional Congressional Committee (NRCC) accusing Rep. Jerry Costello (D-IL) of supporting a “Democrat plan” that would “decimate” Medicare, “shred the social safety net,” and “leave seniors at risk”:

The awful plan Costello supported — otherwise known as the Affordable Care Act — extended the solvency of the Medicare trust fund by eight years and provided drug rebates to seniors who are in the Medicare Part D doughnut hole. The law also stabilized the program by instituting a board of health care experts and consumer advocates to make recommendations for lowering out of control spending in a transparent and accountable way. The House Republicans voted against all of these measures without offering any proposals for slowing down the rate of growth in the health care sector, so I’m sure they have a lot of very important things to say about how health care costs are going to bankrupt America.

A new survey of employers is suggesting that “only 7% of employees will be forced to switch to subsidized-exchange programs,” but “at least 30% of companies say they will ‘definitely or probably’ stop offering employer-sponsored coverage” once a new ACA provision requiring businesses with workers receiving subsidies in the exchanges to pay a fee or offer coverage takes affect in 2014:

The survey of 1,300 employers says those who are keenly aware of the health-reform measure probably are more likely to consider an alternative to employer-sponsored plans, with 50% to 60% in this group expected to make a change. It also found that for some, it makes more sense to switch.

The White House is arguing that this survey is out of step with other projections by the Congressional Budget Office (CBO) the RAND corporation. Those reports suggest that the numbers of employers dropping coverage are much smaller since “firms would need to compensate the workers from whom they remove a current benefit, particularly higher income workers, who would lose the valuable tax advantage of ESI.” Indeed, other business surveys have demonstrated that employers would be reluctant to drop coverage.

But if we’re really interested in preserving employer-based coverage — which I’m not sure makes a lot of sense — then we should be talking about repealing the free-rider requirement that Democrats included in the law to please Sen. Olympia Snowe (R-ME) and replacing it with an employer mandate that would require companies to continue offering health insurance coverage. Experiences in Massachusetts have demonstrated that such an approach would increase employer coverage rates without leading to job loss.

Via Jeanne Whalen and Alistair McDonald at the Wall Street Journal:

U.K. Prime Minister David Cameron is scrambling to rescue his proposed overhaul of the state health system amid strong resistance from doctors, nurses and even members of the coalition government he heads, who say it amounts to a partial privatization that will weaken the taxpayer-funded system.

Mr. Cameron on Tuesday is expected to give a speech defending the proposed legislation and arguing that it is needed to “avoid a crisis” in future funding of the National Health Service, according to an excerpt. He also will promise that the changes won’t create “some American-style private system.”

The major problem for Cameron is that he actually won power by promising to protect the National Health System from privatization:

Mr. Cameron has won support for the Conservative Party in part by convincing voters that it is more committed to core public services than it was in the 1980s, when Margaret Thatcher headed the party. Being cast as someone intent on privatizing the health service undermines that strategy.

All this only serves as a reminder that only in America do conservative politicians see America’s fragmented market-driven health system where 15 percent of the nation is without health insurance and costs are far higher than anywhere else in the world as some kind of prize that other nations are clamoring towards and we should preserve — and even privatize further. As the British know all too well, the comparisons tell a far different story.

Critics of the Affordable Care Act have long played the double-edged game of criticizing the law for offering the nation a one-size-fits all solution to the health care crisis while slamming the federal government for providing states and businesses with greater flexibility to comply some of the new provisions of the legislation. It’s a cynical game and one that Republicans are playing in order to portray the nearly 1,400 waivers distributed by HHS as evidence that the law isn’t working or that the administration is using the process to grant exemptions to and reward its political allies.

The Associated Press considered some of these claims :

Q: Unions are getting these waivers. Doesn’t that show that the Obama administration is rewarding political supporters?

A: Several unions have gotten waivers, but most seem to be going to employer plans, according to statistics from the Health and Human Services Department.

Q: So an office headed by an administration bureaucrat is able to waive the entire health care law?

A: Actually, no. Mainly its two provisions. And the waivers are time-limited. One is a regulation that says insurance plans can’t impose a per-patient limit of less than $750,000 a year for medical care, including hospital stays, doctor visits and medications. So far, about 1,400 annual limit waivers have been issued, an approval rate of more than 90 percent. They cover plans that serve about 3 million people, or 2 percent of those with private insurance.

The other provision is a requirement that insurance companies spend at least 80 percent of the premiums they collect on medical care and quality, as distinct from overhead and profits. Three states — Maine, New Hampshire and Nevada — have gotten what the administration calls “adjustments” to the 80-percent standard. Insurers in those states will be held to a lower requirement, say, 65 percent. State officials had feared that some insurers who sell coverage directly to individuals would be unable to meet the higher standard and would just leave.

Q: Why do they even need to issue waivers for these things?

A: The explanation is the same in both cases: Without waivers, several million people would be at risk of losing their coverage.

In other words, the waivers are acting as a “safety valve” until the coverage expansions go into effect in 2014. What’s really happening is that the administration is in a tough spot. If companies respond to the early regulations by dropping insurance coverage, low-wage employees will have to either go uninsured until 2014 or try to enroll in Medicaid or the new high-risk insurance pools, for which they may be ineligible and may have some trouble affording. As Aaron Carroll of the Incidental Economist explains it, Democrats are facing the three-legged-stool problem. You can’t give people access to affordable coverage without regulating the insurers, getting everyone into the risk pool through the mandate and providing subsidies for those who need them, but the law implements the regulation leg four years before the subsidy and mandate legs are even attached. And so what you’re seeing now is a stool that just can’t find its balance.

Consequently, the government is exempting these companies for a year to give them an opportunity to gradually adjust their plans so they can meet the new requirements. As Paul Ginsburg put it, “I wouldn’t see that as special deals as much as bowing to reality.”