The Politico Pulse reported this morning that Sens. Tom Carper (D-DE), Tom Coburn (R-OK), Michael Bennet (D-CO), Mike Enzi (R-WY), Bob Corker (R-TN), Scott Brown (R-MA), and Amy Klobuchar (D-MN) all “plan to introduce a bill today that they say would enact stronger penalties for Medicare fraud, curb improper payments and establish stronger fraud and waste prevention strategies, curb the theft of physician identities, identify more Medicaid overpayments and improve fraud data sharing.” The measure would “improve security of the database of Medicare providers to ensure “dead” doctors can’t place Medicare orders.”

All this is well and good — anti fraud legislation can save a significant amount of money and usually attract bipartisan support. But these measures can also provide cover for politicians to argue that Medicare (aka “government health care”) is full of the kind of waste and fraud that is absent in market-driven private health insurance.

The National Health Care Anti-Fraud Association (NHCAA) estimates that 3 percent of all health care spending — or $68 billion — is lost to health care fraud, but notes that fraud is a “systemic problem affecting public and private insurers alike, in the individual market, the employer-sponsored group market, and public programs.” Medicare patients may be particularly susceptible to fraud given their age and vulnerability. As a recent report from George Washington University concluded, “Medicare and Medicaid fraud may reflect the vulnerable nature of the populations that depend on the program rather than any failing on the part of either program. As a result, simply moving away from Medicare and Medicaid coverage and toward a system of private health insurance subsidies would in and of itself do nothing to curb fraud; it simply would privatize the victimizing of the poor and vulnerable.”

The 2010 Republican wave is bearing a multi-pronged attack on women’s reproductive rights. Pushing nearly 1,000 anti-choice bills through legislatures, Republican lawmakers across the country are finding significant success in demonizing Planned Parenthood. Indiana Gov. Mitch Daniels (R) recently beat out four GOP governors and House Republicans to make Indiana the first state to defund the health and family planning organization to the detriment of thousands. However, because providing family planning services is a mandated requirement for health providers, Indiana is running afoul of federal law and stands to lose $4 billion in Medicaid funding.

Seemingly undeterred by such consequences, Florida Gov. Rick Scott (R) and the GOP-led legislature are now attacking family planning through Medicaid. Earlier this month, Scott signed into law “a landmark Medicaid overhaul” that jeopardizes quality health care for thousands of Floridians. Now, the Florida Independent reports that the state’s Agency for Health Care Administration (AHCA) is moving forward with a new rule allowing Medicaid providers to opt out of providing family planning services — which includes birth control — on “moral or religious grounds.” Citing a federal provision that allows providers to opt out of “counseling or referral service” for similar reasons, AHCA and state Republicans want to exempt moral and religious objectors from providing family planning services entirely:

Florida’s Medicaid bill contains a list of required minimum benefits that should be covered by providers. Under the section for “family planning services and supplies” the bill’s sponsor added:

Pursuant to 42 C.F.R. s. 438.102, plans may elect to not provide these services due to an objection on moral or religious grounds, and must notify the agency of that election when submitting a reply to an invitation to negotiate.

The federal provision in questions reads:

(2) Subject to the information requirements of paragraph (b) of this section, an MCO, PIHP, or PAHP that would otherwise be required to provide, reimburse for, or provide coverage of, a counseling or referral service because of the requirement in paragraph (a)(1) of this section is not required to do so if the MCO, PIHP, or PAHP objects to the service on moral or religious grounds.

The provision was added to the state’s Medicaid bill at the request of Catholic Services, “which is looking to become a Medicaid provider.”

In defense of the radical rule, AHCA argues that if a plan elects not to provide family planning services, “the plan enrollees will have access to these very same services through fee-for-service provision outside of the plan.” However, as Florida Planned Parenthood policy director Judith Selzer notes, there is no provision in the bill that makes sure there is at least one provider of family planning in every region. As low-income Medicaid patients are already a “very vulnerable population,” the requirement to go outside of their provider network “makes it even less likely that they will get these important services.”

The new rule must still receive approval from the Centers for Medicare & Medicaid Services (CMS) and ACHA has until Aug. 1 to finalize the proposal. But given CMS’s reception to Indiana’s attempt to obstruct family planning services, the Florida GOP’s dogma may not fare so well.

A new film called “Gates of Hell” is the latest to jump on the abortion as black genocide bandwagon. The film, produced by right-wing filmmaker Molotov Mitchell violently depicts the African American community rising up and systematically executing all abortion doctors for decades of genocide. Mitchell, an outspoken abortion rights opponent who referred to the murder of Dr. George Tiller as a “fourth-trimester abortion, a lethal lead injection,” calls this a “pro-life film” that “casts casts a cinematic vision of what a post-abortion America could look like.”

Watch it:

-Jen Kalaidis

Dave Weigel notices that former House Majority Leader Richard Gephardt (D) — who now spends his time lobbying on behalf of health care providers — is opposing the Independent Payment Advisory Board (IPAB), a 15-member commission that would make recommendations to Congress about lowering Medicare spending if costs increase beyond a certain point. From Gephardt’s op-ed:

Under the new law IPAB has been made responsible for suggesting and implementing cuts to Medicare. It is critical that Congress continue to be able to fulfill its duty to the American people and maintain direct oversight of Medicare on behalf of their constituents. Changes to Medicare’s payments should be based on careful consideration of the Medicare program itself — and not arbitrary budget targets.

Under the current law, IPAB will be an unelected and unaccountable group whose sole charge is to reduce Medicare spending based on an arbitrary target growth rate. It will propose cuts to Medicare that Congress can override only with supermajority votes, an unnecessarily high and unrealistic bar. Just as important, these cuts are likely to have devastating consequences for the seniors and disabled Americans who are Medicare’s beneficiaries because, while technically forbidden from rationing care, the Board will be able to set payment rates for some treatments so low that no doctor or hospital or other healthcare professional would provide them.

Since groups like the American Chiropractic Association — which could face cuts under the IPAB — are now signing the front of Gephardt’s paychecks, his opposition is expected, even if his tone isn’t. (There is nothing “unelected” or “unaccountable” about a body that is confirmed by the Senate and sets rates in a transparent manner, for instance.)

But there’s one other problem with his critique. As a long-time proponent of controlling health care costs, Gephardt has supported greater government intervention in the health sector and in 1994 proposed empowering the Secretary of Health and Human Services to establish “target rates of growth” for health costs that included the private sector (thus going further than the IPAB). The following is from the Congressional Budget Office’s (CBO) description of his plan:

The proposal would set target rates of growth for the Medicare program (Parts A, B, and C, together) and for the private sector. It would set Medicare’s payment rates accordingly and would establish a standby system of cost containment for the private sector.

Medicare’s cost controls would go into effect in 1996 for Parts A and B and in 1999 for Part C. The target for total Medicare spending per capita would increase by the rate of growth of gross domestic product (GDP) per capita plus 1.8 percentage points in 1996 and by lesser amounts thereafter. In 2000 and beyond, the target would increase by the five-year average rate of growth of GDP per capita. The per capita estimates would be allocated among 10 or more classes of health care services using complex procedures specified in the proposal The Secretary of Health and Human Services (HHS) would set reimbursement rates for providers, with the goal of meeting the targets.

Spending targets would also be established for the private sector. The per capita targets would be allocated by class of service, as in Medicare, and by state of residence, and the Secretary of HHS would determine maximum payment rates that corresponded to the targets. The maximum payment rates would be only advisory through 2000. Starting in 2001, however, they would become mandatory in states that exceeded their per capita spending target.

Gephardt is not the only critic of the IPAB who supported it in a past life. In 2009, House Budget Chairman Paul Ryan (R-WI) also proposed a plan which sought to establish “two governmental bodies to broadly apply cost effectiveness research in order to develop guidelines to govern the practice of, and payment for, medical care.”

ThinkProgress intern Sean Savett contributed research to this post.

Tim Pawlenty has long criticized the individual mandate provision in the Affordable Care Act, a policy that’s designed to encourage healthier people to purchase coverage and one that he previously considered. Now, in an interview with Politico, Pawlenty is sharpening his attack against reform and speaking out against the exchanges — a central provision of President Obama’s health care law:

Pawlenty also expanded his attack to another key provision of the Affordable Care Act: the health insurance exchanges, new marketplaces meant to increase access to insurance and drive down costs. He called health exchanges “utterly worthless,” noting that he’d rejected such a proposal during his tenure as Minnesota governor.

Pawlenty faced serious criticism after last week’s Republican debate, when he appeared uncomfortable when given a chance to stand by the term he’d coined the day before — “Obamneycare” — to highlight the similarities between the federal health law and the Massachusetts reform Romney signed four years earlier.

But this argument is specious for two reasons. First, the structure of the exchanges are determined by the individual states, and it’s up to them to build a system that would allow customers to compare a reasonable number of comprehensive insurance choices. The exchanges have already succeeded in Massachusetts, where the coverage rate is approaching 100 percent and public support for the law is only increasingly. States like California are now building on the Massachusetts exchange model.

Secondly, Pawlenty actually advanced exchanges in Minnesota in 2007, arguing that the non-profit Minnesota Insurance Exchange could “connect employers and workers with more affordable health coverage options.” “If just two of your employees go out and buy insurance through the exchange, the benefits to the employer on a pre-tax basis — because of their payments to Social Security and otherwise into the 125 plan — more than cover the cost of setting up the plan,” Pawlenty explained at the time. The proposal was part of the governor’s “Healthy Connections” health care plan and he described the Exchange as a structure that “will create another option for employers who would like to provide health insurance as a benefit for their employees.” “All individual health insurance policies in Minnesota will be required to be purchased through the Exchange. Individuals will also be able to pay for coverage with pre-tax dollars. The products will continue to be regulated by the state,” a press release for the proposal read.

A trio of reports from Families USA argue that the consequences of adopting the House GOP budget and transforming Medicaid into a block grant program go beyond coverage erosion for the most vulnerable; the policy would also lead to substantial job loss. As Ron Pollack, the group’s director, explains, “Every federal Medicaid dollar that flows into a state stimulates business activity and generates jobs. Conversely, cutting Medicaid funds not only hurts seniors, people with disabilities, and children who count on this program as their lifeline, but also results in fewer jobs”:

The budget proposal adopted by the U.S. House of Representatives, sponsored by Rep. Paul Ryan (R-WI), calls for cuts in federal funding to current state Medicaid programs of 5 percent in 2013, 15 percent in 2014, and 33 percent in 2021.

The report looks at the economic impact of a 5 percent, 15 percent, and 33 percent cut in current Medicaid funding levels. Implementing a 5 percent cut in Medicaid spending in 2011 would:

- Cost Florida more than $566.1 million in federal Medicaid dollars and put at risk more than $1.2 billion in business activity and 11,320 jobs;

- Cost Florida and the remaining 49 states and the District of Columbia the $13.75 billion needed to support health care for vulnerable residents, including funding for nursing home care and other long-term care for seniors and people with disabilities.

Indeed, for all the GOP’s groaning about increasing Medicaid costs, additional federal dollars help spur job creation in the health care industry and other related service sectors. Growth in the health care industry is already driving job growth, and that trend is expected to continue as the health care law expands coverage and invests directly in local community clinics. According to one estimate, health care reform could create as many as 250,000 to 400,000 jobs a year over 10 years.

Click to see Families’ three separate analysis for how block granting would effect Florida, Colorado, and New Mexico.