In a new report out today, Scott Lilly dismisses the popular conception that Medicaid cuts would mostly affect lower income Americans who won’t go to the polls and therefore don’t pose much of an electoral threat to lawmakers. He argues that the massive Medicaid reductions in Paul Ryan’s budget (and any other cuts that the deficit ceiling negotiators are currently considering) would actually impact “a very broad swath of middle-class families who are far more likely to become reliant on Medicaid benefits at some point in their life than most currently realize.” Future seniors and disabled Americans use the most care, and would have the most to lose from any proposed reductions:

Read the full report here.

McKnight’s is reporting that Senate Finance Committee Chairman Max Baucus (D-MT) — who has long supported instituting greater entitlement cuts — “said Wednesday that a proposal to implement ‘blended’ payment rates for Medicaid is ‘on the table‘ in negotiations over raising the federal debt limit.” The comments come on top of Baucus’ claims last month that negotiators are also considering repealing the Affordable Care Act’s maintenance of effort provision and allowing states to purge certain beneficiaries from their Medicaid rolls.

The blended rate plan, which also has the backing of the White House, would simplify the current Medicaid reimbursement system by converting the various rates the federal government pays for different Medicaid populations into a single “blended rate.” But because the new rate would be “set at a level that provided the state with less federal funding than under current law,” states, which face their own budget problems, would likely “compensate for the reduction in federal funding by scaling back” services. The Center for Budget and Policy Priorities (CBPP) predicts:

A related concern is that the blended rates could be “dialed down” as federal policymakers assemble a deficit-reduction package, in order to maintain the overall level of federal savings as other spending or tax proposals that negotiators have tentatively agreed upon come to light and ignite opposition from powerful interest groups. At the behest of interest groups, policymakers could face strong temptation to drop or scale back savings from, for example, reforming farm subsidies — and to dial down the Medicaid/CHIP blended rates instead. Such actions would increase the cost shift to states.

The bottom line is that policy makers looking to Medicaid for savings must realize that the program is already run fairly efficiently — provider reimbursement rates are already too low — and any additional cuts in the federal government’s contribution would only achieve “savings” by throwing lower income beneficiaries off their health insurance plans and severely inhibiting their access to health providers.

As Kellan Baker added yesterday, such an outcome would also have a disproportionate effect on certain minority communities — including LGBT Americans — who rely heavily on Medicaid for their health care needs.

Inside Health Policy’s Sahil Kapur is reporting that negotiators may be considering raising the Medicare eligibility age from 65 to 67 as part of an effort to reach a deal with Republicans on increasing the debt ceiling:

Key negotiators in the debt limit talks are mulling a proposal to raise the Medicare eligibility age from 65 to 67, a source familiar with the discussions says. Due to the volatility and sensitivity of the negotiations, Inside Health Policy could not confirm whether the White House and Republicans have agreed to include the provision in a final deal.

The idea was floated in a deficit reduction plan recently offered by Sens. Joe Lieberman (I-CT) and Tom Coburn (R-OK). The Congressional Budget Office found that raising the Medicare age to 67 would save $124.8 billion between 2014 and 2021.

Although House Democratic leaders say they’ll reject any Medicare benefit cuts, Republicans are eager to scale back the program and President Obama reportedly hasn’t taken any aspect of Medicare off the table.

If the provision ends up in the final package, Democrats won’t only cede the political debate about the efficacy of privatizing Medicare, they’ll be accepting a portion of the Paul Ryan budget and effectively forcing Americans between 64 and 65 years of age to purchase coverage from private insurers in the state-based exchanges. As a recent study from the Kaiser Family Foundation points out, this would “result in an estimated net increase of $5.6 billion in out-of-pocket costs for 65- and 66-year-olds, and $4.5 billion in employer retiree health-care costs.” The influx of older people into the exchanges would increase premiums by 3 percent in the exchanges and Medicare Part B, the study concluded.

And the savings themselves are slim. According to the Congressional Budget Office, “this option would have little effect on the trajectory of Medicare’s long-term spending…because younger beneficiaries are healthier and thus less costly than the program’s average beneficiary.” Even if policy makers increase the age to 70 in 2043, “outlays for Medicare would rise to 7.7 percent of GDP by 2050.”

The Wall Street Journal reports that with Republicans controlling 25 state legislatures — the most in at least five decades — lawmakers enacted at least 26 abortion restrictions in 2011:

Interestingly, the passage of the Affordable Care Act not only helped sweep more Republicans into power, but it also re-opened the entire abortion debate. As Center for American Progress’ Jessica Arons observed earlier this year, the state rush to enact anti-abortion legislation is “a predictable outcome of the Nelson language in the health reform bill.” “It reignited the abortion wars in the states.” “Nelson opened the door for them to legislate away private insurance coverage of abortion and the states are walking right through. This is no longer about public funding for abortion (and in fact, it never really was); this is about making abortion impossible to obtain for women of all means.”

Earlier this year, anti-choice advocates in Wisconsin secured a provision in the state budget to classify University of Wisconsin as a “state agency,” thus prohibiting the organization from using public funds to pay or train medical residents to perform abortions. And now, conservatives in the state are asking Wisconsin Attorney General J.B. Van Hollen to take “immediate steps” to enforce the measure:

“Our University of Wisconsin public entities should not be ground zero for training abortionists,” said Virginia Zignego, communications director of Pro-Life Wisconsin and a UW-Madison graduate. “Residents need to be instructed how to save, preserve and respect life, not how to kill preborn children at Planned Parenthood of Wisconsin, the state’s number-one abortion provider.” [...]

Medical residents in the UW School of Medicine Ob/Gyn Department have two four-week rotations at Planned Parenthood, where they view and participate in abortions. To view the rotation schedule, click here. To view the signed contract between UW and Planned Parenthood of Wisconsin, click here.

University of Wisconsin argues that it already allows residents with moral objections to opt out of the abortion rotations and points out that without proper abortion residency, “its gynecology and obstetrics training program could lose its accreditation and women in Wisconsin could lose access to many health services across the state, not just abortions.” Wisconsin doctors would also lack critical medical skills that could endanger women’s lives. As Dr. Fredrik Broekhuizen, the medical director for Planned Parenthood of Wisconsin, says, “There are situations where patients have fetal death in utero at 16 to 18 weeks of gestation. The mode of delivery in the case of a dead fetus is exactly the same procedure as an abortion procedure. So learning these techniques is an essential part of what an ob/gyn needs to know in order to provide comprehensive care to women, regardless of where they choose to practice.”

In May, Republicans in the House of Representatives approved a similar residency measure “that would prevent a federal healthcare education fund from being used for abortion or to provide for training for abortion procedures.” Thirteen Democrats voted for it, and 10 Republicans voted against it.