Rep.  Michele Bachmann, the Republican presidential hopeful from Minnesota, wants you to know that if you’re gay, she might not love you just the way you are.

An undercover investigation conducted by Truth Wins Out found that Bachmann & Associates – the counseling firm owned by Bachmann’s husband Marcus – employs therapists offering “reparative” ex-gay therapy that promises to wash that gay away. Awkwardly for Michele, the anti-government Tea Partyer, not everyone who seeks the clinic’s services enjoys coverage from an insurance plan sponsored by a private employer, meaning that the clinic may have billed the government’s Medicaid program for thousands of dollars in reimbursements for counseling services aimed at turning gay people straight.

Subjecting gay people to pseudoscientific “therapy” (and billing Medicaid for it) does more than put Dr. Bachmann’s unlicensed clinic in the crosshairs of an investigation into both his psychotherapy credentials and his wife’s anti-government bonafides. Ex-gay therapy of the kind practiced by Bachmann & Associates isn’t just hypocritical and widely discredited as ineffective – it’s dangerous. Professional associations such as the American Psychological Association, the National Association of Social Workers, the American Academy of Pediatrics, and the American Psychiatric Association have all condemned reparative therapy. According to the American Psychiatric Association, “the potential risks of ‘reparative therapy’ are great, including depression, anxiety, and self-destructive behavior.”

The good doctor Bachmann isn’t alone in his professed belief that gay people are “barbarians” in need of discipline and punishment. This attitude feeds pervasive discrimination against gay (and transgender) people and their families in employment, relationship recognition, health care, education, and housing. The constant stress of coping with this discrimination contributes to significant health issues for gay and transgender people, including higher rates of substance use, anxiety, depression, and suicide.

Beliefs that gay people need to be “cured” of their sexual orientation also contribute to harassment and violence against gay people and anyone else who doesn’t conform to rigid stereotypes of gender and sexuality. In 2008, more than 2,400 lesbian, gay, bisexual, and transgender people were victims of crimes perpetrated against them on the basis of their real or perceived sexual orientation, gender identity, or gender expression. Significant underreporting means that the actual number of hate crimes against gay and transgender people is probably much higher than the statistics show.

Ex-gay therapy tears at the mental health of gay people while contributing to the poisonous attitudes that mark them as targets for violence and discrimination. And for this “therapy,” it’s society as a whole that foots the bill: every blow at the ability of gay people to take care of themselves and their families has its costs, whether in the loss of a job because of harassment, days missed at school because of bullying, or medical bills for dealing with depression or the aftermath of violence.

And while we all pay, Dr. Bachmann profits.

Last week, Inside Health Policy’s Sahil Kapur wrote that negotiators may consider 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, and today Sam Stein confirms the report, noting that five separate sources with knowledge of negotiations have said that “the president offered an increase in the eligibility age for Medicare, from 65 to 67, in exchange for Republican movement on increasing tax revenues”:

The proposal, as discussed, would not go into effect immediately, but rather would be implemented down the road (likely in 2013). The age at which people would be eligible for Medicare benefits would be raised incrementally, not in one fell swoop.

Sources offered varied accounts regarding the seriousness with which the president had discussed raising the Medicare eligibility age. As the White House is fond of saying, nothing is agreed to until everything is agreed to. And with Republicans having turned down a “grand” deal on the debt ceiling — which would have included $3 trillion in spending cuts, including entitlement reforms, in exchange for up to $1 trillion in revenues — it is unclear whether the proposal remains alive.

“That is one of the things they put on the table as part of a big solution,” said one senior Republican Hill aide.

“It was considered in the context of the big deal,” added a top Democratic source briefed on the deliberations.

At his press conference this morning, Obama repeatedly highlighted his willingness to include cuts to entitlement programs in a final agreement. “And it is possible for us to construct a package that would be balanced, would share sacrifice, would involve both parties taking on their sacred cows, would involved some meaningful changes to Medicare, Social Security, and Medicaid that would preserve the integrity of the programs and keep our sacred trust with our seniors, but make sure those programs were there for not just this generation but for the next generation,” he said.

If the provision ends up in the final package, however, 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.

The new federal exchange regulations use the word “flexibility” at least 38 times to describe the wide latitude states will have in both establishing their exchanges and choosing which insurance plans should offer health care coverage within them. The much-anticipated rules will govern the Affordable Care Act’s central provision: the new state-based insurance markets that will allow individuals, families, and small businesses to compare and purchase quality coverage from an array of private health insurance plans all competing for their business. The federal government will establish exchanges in states that choose not to build their own markets.

“These proposed rules set minimum standards for Exchanges, give states the flexibility they need to design Exchanges that best fit their unique insurance markets,” the Department of Health and Human Services press release reads. “[I]t allows states to decide whether their Exchanges should be local, regional, or operated by a non-profit organization, how to select plans to participate, and whether to partner with HHS to split up the work.”

On the question of which plans could be certified as Quality Health Plans (QHPs) and sell their policies in the exchange, the federal government establishes minimum standards, but allows states a strong voice in forming their own rules. For instance:

– States determine the number of plans offered: “This could mean that any health plan that meets the standards can participate, that health plan issuers with successful competitive bids can participate, or anywhere in between.”

– States establish rules relating to provider adequacy and marketing standards: The exchanges will set “standards to ensure that consumers have a choice of health care providers within each qualified health plan rather than proposing a national standard. As with network adequacy standards, marketing standards would be set by States and Exchanges in the proposed rule.”

– States can operate reinsurance even if they don’t establish an exchange: They can “modify the payment rules to tailor them to their States. States can also tailor the risk adjustment program, for example, using their own methodology if approved by HHS and determine when and how payments to plans get made.”

Allowing states maximum flexibility should encourage governors — even Republican governors who oppose large sections of the law — to design their own exchanges that not only meet the needs of their unique markets but also are also in line with their ideological inclinations. For instance, we’ll see blue states allowing exchanges the authority that governs the exchange to bargain with insurance companies on behalf of consumers, while red states would open the exchange to a wide variety of health plans. These markets may also be slow to adopt conflict of interest rules that prohibit powerful players in the health care sector — like insurance companies — from influencing the operations of the new markets.

For a map of where all the states stand in establishing their exchanges, click here.

Rep. Tom Price (R-GA) is denying reports that Republicans have abandoned efforts to replace the Affordable Care Act, telling Newsmax.TV that House Republicans are still focused on developing GOP alternatives to reform and will introduce health care legislation “in the next couple of weeks”:

PRICE: Our replace process is moving forward, we’re having hearings at all sorts of different committee levels. [...] We’re working in our office right now on a new version of the Empower Patients First Act, which will get folks covered, solve the insurance challenges, and address the lawsuit abuse issues that we hope to introduce in the next couple of weeks.

HOST: Representative, well Politico says that six months later Republicans hardly mention it any more and there are nowhere close to replacing the law. Is that an inaccurate report?

PRICE: Well, I think that is an inaccurate report. I think all of the wind and enthusiasm is being sucked up by the deficit ceiling debate. No, we’re working diligently on the committee level…and we will continue to push for the kinds of appropriate reforms…we’ll continue to highlight it and look forward to putting in place patient-centered reforms.

Watch it starting around 4:00:

Price may soon re-introduce his replacement legislation, but as Jen Haberkorn reported in the Politico piece that Price is now describing as inaccurate, the leadership has relatively little appetite for re-opening the health care debate in the wake of the political debacle over Paul Ryan’s budget. And that conversation is even harder to have as Americans are already enjoying some of the most popular elements of reform — the very same provisions that many Republicans endorse and would keep in place.

Reports have swirled about all the possible health care savings on the table in the debt ceiling negotiations: from raising the Medicare eligibility age, to spending less on the Medicaid program, to extending Medicaid drug rebates to dual eligibles. Now, Reuters is writing that lawmakers are also considering “limiting the tax break for employer-provided health insurance“:

“Limiting the deduction for the higher income brackets is something that is on the table,” Representative Sandy Levin told Reuters. He is the senior Democrat on the tax-writing U.S. House Ways and Means Committee.

The employer-provided healthcare income exclusion cost about $117.3 billion this year. Limiting it could bring in considerably more new government revenues than other, smaller options that have been discussed by negotiators. [...]

A cap could be politically feasible because it would not register as a tax increase. The initial pain would be minimal and those affected would be higher-income employees rather than the elderly or the poor, analysts said.

The idea has floated around health policy circles for some time, but has been traditionally opposed by Democrats who are worried that limiting the tax exemption could push employers to stop offering health insurance and leave more people without a stable source of coverage. Health care reform minimizes this concern and even sets the stage for moving away from employer-sponsored insurance (ESI) by taxing the most expensive expensive “Cadillac plans.” If this policy is included in the final package, it would build upon that investment and send a strong signal that ESI’s days are even more numbered than previously thought.

“Planned Parenthood has stopped providing birth control pills and other contraception in New Hampshire after the state’s executive council rejected up to $1.8 million in funding for the group” because it also provides privately-funded abortions. After losing its contract — which paid for education, distributing contraception, and the testing and treatment of sexually transmitted infections — the centers have “turned away 20 to 30 patients a day who have arrived to refill their birth control prescriptions”:

Last year, Planned Parenthood provided contraception for 13,242 patients in New Hampshire, [CEO of Planned Parenthood of Northern New England Steve]Trombley said. The organization also provided 6,112 breast exams, 5,548 screenings for cervical cancer and 18,858 tests for sexually transmitted infections. If the contract is not renewed, Planned Parenthood will drastically reduce its services, Trombley said. The organization employs 80 people in New Hampshire. [...]

Stephanie Hiltunen, a 26-year-old who lives in Hanover, said she picked up a monthlong supply of birth control last Thursday, the day before the center stopped dispensing it. But future refills will require an inconvenient trip to Enfield, she said. Hiltunen said she would like to have a child but cannot afford it, and she worries there will be a public cost if contraception is inaccessible to low-income women.

“If they can’t afford to have a baby, then we’ll be paying for them in the long run,” she said.

Some women have told the center that the will likely “stop taking birth control because they cannot afford the higher prices charged by pharmacies” and an estimated 70 percent don’t have insurance to cover the prescriptions.

New Hampshire’s Council rejected the contract in a 3-2 vote, arguing that taxpayers should not fund abortions or so-called irresponsible behavior. “I am opposed to abortion,” said Raymond Wieczorek, a council member who voted against the contract. “I am opposed to providing condoms to someone. If you want to have a party, have a party, but don’t ask me to pay for it.”