Kaiser Health News looks into the consequences of a possible default for the health care sector and finds that while providers wouldn’t feel an impact over several days, given their dependence on Medicare and Medicaid payments, a prolonged crisis could be “apocalyptic“:

But the worst case scenario here would be more apocalyptic, he says. That’s because health care providers would lose revenues from Medicare and Medicaid at the same time. Plus, a debt default could also unnerve the capital markets, making it difficult or impossible for providers to borrow money to stay afloat. And states are having so many financial problems that they’re not in a position to fill in the gaps.

Matt Salo, executive director of the National Association of Medicaid Directors, says that in the “worst-case scenario, Aug. 2 comes around with no deal, Medicaid is not going to shut down.” But if the bond markets melt down, states could face higher interest rates on money they’ve already borrowed from investors, making it even harder for states to pay their share of Medicaid, which is generally about half, he says. The federal government on average pays about 56 percent of Medicaid costs.

The administration will also be in a tough spot, having to figure out “which checks to issue and when after Aug. 2, since it will be missing about 40 percent of the cash required to pay its bills.” Experts expect for that order to look something like this: 1) pay interest on the debt, 2) send Social Security checks. Medicare payments could be held back, since a short delay is not expected to “jeopardize access as long as the crisis did not drag out too long and they were paid after the crisis ended.”

The debt ceiling negotiations highlighted the great disconnect between public opinion and political reality, as lawmakers from both parties went after the very programs — Medicare, Medicaid, Social Security — that an overwhelming majority of voters are hoping to preserve. And no program was more easily discarded than the Affordable Care Act’s long-term health insurance program (CLASS). Lawmakers, government officials, and some advocates have all but given up defending the initiative, conceding that its somewhat problematic financial structure will eventually lead to its repeal. The Senate’s bipartisan Gang of Six (or seven) proposed eliminating the program in their debt ceiling package, as did the president’s Bipartisan Fiscal Commission.

This attitude persists despite seniors’ anxieties about growing old and being unable to pay their medical bills:

Many of the nation’s 77 million boomers are worried about being able to pay their medical bills as they get older, a new poll finds. The concern is so deep that it outpaces worries about facing a major illness or disease, dying, or losing the ability to do favorite activities.

Another major concern among the boomers: losing their financial independence.

The struggling economy, a longer life expectancy, ever-increasing health care costs and challenges facing Social Security are putting added pressure on the boomers, those born between 1946 and 1964.

According to the Associated Press-LifeGoesStrong.com poll, 43 percent of boomers polled said they were “very” or “extremely” worried about being able to pay for their medical costs, including long-term care. Almost the same number, 41 percent, said losing their financial independence was a big concern.

One wonders if CLASS would still be traded so nonchalantly in negotiations if members of Congress were of the same economic class as their constituents, were stripped of the government-sponsored long term insurance they currently enjoy, or knew of how desperately they needed its benefits.

Julian Pecquet reports that 19 senators from rural states have written a letter to the heads of four federal agencies demanding that they “justify their call for stringent voluntary restrictions on marketing food marketing to children”:

The letter to the agency heads, spearheaded by Sen. Mike Johanns (R-NE), requests the agencies to explain how they linked marketing to obesity. It also questions their nutritional recommendations and inquires about the economic impact to certain food sectors such as cereals, meats and cheese.

And it raises concerns with possible restrictions on the food industry’s support for “school and community philanthropic activities, including sports teams, literacy programs, and other health-promoting youth activities” and the “economic impact to schools and communities.”

A good place to look for answers about the links between advertising and obesity may be the White House’s obesity report, which found that food and beverage companies rely on a “full range” of marketing techniques to attract young consumers and that some — like the use of licensed characters — are particularly “effective and pervasive”:

Research conducted by the Sesame Street Workshop in 2005 found a strong influence of popular licensed characters on preschoolers’ food preferences. When preschoolers were asked if they would rather eat broccoli or a Hershey’s chocolate bar, 78% of the children chose the chocolate bar and only 22% chose broccoli. When an Elmo sticker was placed on the broccoli, however, 50% of the children chose broccoli. Not surprisingly, food marketers’ use of licensed characters in cross promotions targeting children has increased in recent years. At the same time, the nutritional quality of the products promoted by these characters has decreased.

Undoubtedly, the the Elmo sticker is more frequently appended to the Hershey’s bar than the broccoli. A recent study found that some of the nation’s’ largest food companies have “nearly doubled the use of licensed characters over the past four years, increasing from use in 8.8% of advertisements in 2005 to 15.2% in 2009. Roughly half of all advertisements with these characters are for foods in the lowest nutritional category,” it concluded.

The increases occurred despite the food industry’s voluntary pledge to advertise healthier foods, suggesting the senators may right in raising concerns about the restrictions. Only, they’re asking the wrong questions to the wrong crowd — their inquiry should focus on how the industry can “justify” the advertising increases, not why the government is demanding tougher — but still voluntary — advertising rules.

Yesterday, NARAL Pro-Choice America released the first of what would be several reports analyzing how the potential GOP presidential candidates threaten women’s access to reproductive services. As Julie Rovner notes, “For the first time, many, if not most of the candidates have come out not just for the defunding of Planned Parenthood (which is at least arguably about abortion). Some have also voted against — and spoken out against — any kind of federal funding for contraception,” which the overwhelming majority of women support (and many) rely on. Below is a small compilation of their records:

– MICHELE BACHMANN: Bachmann has cast 12 “anti-choice” votes during her time in Congress: the No Taxpayer Funding for Abortion Act, prohibiting the District of Columbia from using local revenue to provide abortion services for low income women, and blocked the Food and Drug Administration from using funds for testing, approving or regulating the abortion-inducing drug mifepristone. In the Minnesota state Senate in 2001, she co-sponsored a constitutional amendment to block public funding of any organization associated with an organization that provides, counsels or refers for abortion.

– RICK SANTORUM: As a member of the House of Representatives, Santorum cast 27 “anti-choice” votes on reproductive-rights related issues; in the Senate he cast 72 out of 74 “anti-choice” votes. “He has voted for ‘personhood’ rights of an embryo, in favor of the Federal Abortion Ban and in favor of two Supreme Court and six lower court justice nominees with outspoken anti-abortion rights positions.”

– MITT ROMNEY: Romney’s record is mixed, as the former Massachusetts governor has shifted to his current anti-aboriton position. “In 2005 he vetoed a measure that would have increased access to emergency contraception by allowing pharmacists to dispense the pill without a prescription. From 1998 to 2006, the state used ‘abstinence-only’ funds for public service announcements, not classroom courses.”

– TIM PAWLENTY: While in Congress, “Pawlenty co-sponsored a bill that criminalized some abortion services and carried a 15-year prison sentence for doctors. As governor, he signed into law a measure that prohibits organizations receiving state funds from referring women for abortion services.” He has also signed several pro-choice measures, including “a bill ensuring access to emergency contraception for rape victims, a bill improving access to family-planning services for low-income women and a bill expanding Medicaid to cover more pregnant low-income women in Minnesota.”

– JON HUNTSMAN: As governor, “Huntsman signed into law measures that established a state fund to defend abortion restrictions in court, criminalized some abortion services and required minors seeking abortions to notify their parents even if they come from purportedly ‘violent, abusive, or neglectful homes.’” Huntsman also enacted pro-choice reforms: “a bill that promotes sexually transmitted disease prevention by establishing a public education campaign and a bill that ensures that sexual assault victims receive information on and access to emergency contraception.”

Our guest blogger is Neera Tanden, Chief Operating Officer at the Center for American Progress, who most recently served as senior advisor for health reform at the Department of Health and Human Services, advising Secretary Kathleen Sebelius and working on the president’s health reform team to pass the bill.

Yesterday as Washington was gripped by the contentious debt limit debate, Doug Schoen, a pollster by trade, took to the Huffington Post to assault the Independent Payment Advisory Board (IPAB) — a 15-member board of medical experts that was created by a provision in the Affordable Care Act. The board, whose members will be appointed by the President and confirmed by the Senate, is tasked with making binding recommendations to reduce expenditures in the Medicare system, unless Congress acts to alter the proposal or discontinue automatic implementation.

Schoen argues that IPAB will have to make steep cuts to meet annual targets. However, today, Republicans are proposing initiatives to dramatically cut Medicare, as the Ryan plan does and House Speaker John Boehner’s debt ceiling measure will likely do. Schoen says that changes to Medicare should be decided by elected officials, who will be held accountable for their decisions. But right now, members of Congress can lobby the Centers for Medicare and Medicaid Services to pay for unnecessary or untested treatments that drive up costs.

The purpose of the IPAB is to ensure policies are not based on the special interests of legislators. Indeed, the IPAB will be comprised of medical experts who can spend the time crafting policies to lower Medicare expenses while improving quality of care and Congress can override the recommendations if they choose. The question really is, do we prefer Congress making decisions on health care delivery instead of doctors, consumer leaders and other medical experts? By taking the politics out of the equation, meaningful payment reform and cost containment can be achieved, as it will not be hindered by payment providers’ undue influence. In fact, lawmakers who oppose the IPAB have received hundreds of thousands of dollars in campaign contributions from health care companies. This political sway was one of the key reasons Senator Jay Rockefeller (D-WV) constructed the IPAB model, stating “It is long past time that Medicare payment policy is determined by experts, using evidence, instead of by the undue influence of special interests.” To further ensure independence, a majority of members must be non-providers and cannot hold any other jobs. Read more

House Minority Leader Nancy Pelosi (D-CA) said Americans can “kiss Medicare goodbye” if House Speaker John Bohener’s (R-OH) debt ceiling compromise is passed into law, during a press conference earlier today. Pelosi was likely referring to a 12-member bipartisan committee in Boehner’s proposal that will be tasked with finding at least $1.5 trillion in savings from programs like Medicare, Medicaid, and Social Security:

PELOSI: This bill, in one fell swoop, just pulls the plug on progress for America’s families. Progress made in the last 50 years. As you know, we served the 46th anniversary yesterday of the signing of the Medicare bill. You can just kiss Medicare goodbye.

Watch it:

Robert Greenstein of the Center on Budget and Policy Priorities (CBPP) has described Boehner’s proposal as “tantamount to a form of ‘class warfare’” that “if enacted, it could well produce the greatest increase in poverty and hardship produced by any law in modern U.S. history.”

The American Action Network — a conservative group backed by Republicans with close ties to Wall Street — “is launching a large-scale mail and newspaper ad campaign” to shore up Republicans by attacking Democrats for allegedly balancing the budget “on the backs of seniors” and introducing “radical” “Medicaid-style rebates to the Medicare Part D program.”

“The mail campaign will reach 22 congressional districts in 14 states, all of them represented in Congress by Republicans,” Politico reports. Below is a sample:

The Medicaid Part D changes are a reference to Rep. Henry Waxman’s (D-CA) proposal (and Sen. Jay Rockefeller’s (D-WV) companion Senate bill) to extend Medicaid drug rebates to dual eligibles — beneficiaries who qualify for both Medicare and Medicaid — and is only as “radical” as, well, health policy in 2003.

Waxman introduced the legislation after the 2003 Medicare part D law moved the 6 million dual eligibles into the Medicare part D program, thus creating a windfall for the industry. Whereas Medicaid obtained an average discount of about 34 percent from pharmaceutical companies that participated in the Medicaid program, “the average discount obtained by the Part D plans was 14 percent,” according to a report issued by Waxman. As he put it, “The drug companies are making the same drugs. They are being used by the same beneficiaries. Yet because the drugs are being bought through Medicare Part D instead of Medicaid, the prices paid by the taxpayers have ballooned by billions of dollars.” CBO estimates that if drug manufacturers provided the Medicare Part D program with the same prices that Medicaid receives, the government could save $112 billion over 10 years.

And if anyone is looking to balance the budget on the back of seniors, it’s not the Democrats — whose current proposal (Sen. Harry Reid’s plan) excludes any cuts from entitlement programs. It’s the Republicans who will benefit from AAN’s flyers.

The GOP voted against the Affordable Care Act — which extends the life of Medicare by 9 years and provides rebates to seniors who fall into Medicare Part D’s doughnut hole — and they supported Paul Ryan’s budget. That plan eliminates the supplemental Medicaid coverage that dual eligibles enjoy and replaces it “with a medical savings account” that, based on CBO estimates, would result in a 65-year-old who lives at the poverty line to pay “$4,700 more in 2022 than he or she would under the programs as they exist today.”

If the 22 Republican members vote in favor of Speaker John Boehner’s (R-OH) debt ceiling proposal later today, seniors will fare even worse. They’ll face cuts of billions of dollars from a commission that would tasked with finding $1.5 trillion in savings by “cutting Social Security and Medicare benefits heavily for current retirees. ”