Via the AP: Democratic New Hampshire Gov. John Lynch “has allowed two Republican bills that set limits on implementing the federal health care law to become law without his signature”:

One bill says no New Hampshire resident can be required to obtain or be fined for failing to be covered by health insurance. An exception is made for people required by a court or the state who are named in a judicial or administrative proceeding.

The second bill establishes an oversight committee whose approval the insurance commissioner must obtain before implementing the federal law. The bill directs the commissioner to return a $666,000 federal grant to plan a health exchange to promote competition among insurers and request that the money be used to reduce the federal deficit.

The first bill is almost meaningless, since federal requirements — to purchase health insurance coverage beginning in 2014, in this case — trump state laws. Returning federal grant dollars earmarked for establish health care exchanges, however, would likely impede the state’s ability to meet the requirements of the Affordable Care Act and turn over the new marketplaces to the federal government.

Currently, 10 percent of New Hampshire residents are uninsured.

As lawmakers consider including Medicare cuts in a deal to raise the nation’s debt ceiling, a new public poll round-up from the New England Journal of Medicine shows that most Americans “think it is possible for the federal government to balance the budget without cutting Medicare spending.”

In fact, “when people are given a list of options for reducing the deficit and asked whether they favor or oppose each item, cutting Medicare spending is one of the least favored,” with majorities supporting “raising taxes on people with annual incomes above $250,000.”:

We’ve long known that many Republican governors are working to enact the health care exchanges in the Affordable Care Act out of a desire to keep the federal government out, but now Politico’s Sarah Kliff reports that some red states are also looking to enact rate review legislation to forestall the Department of Health and Human Services from conducting its own audit:

But in the 10 states that do not meet the federal review requirements – which include weighing a dozen factors related to rate increases, posting insurance filings and allowing for public comment – HHS must now prepare to handle the process.

Pennsylvania and Alabama, two states that do not have “sufficient” review authorities under the federal regulation, are both looking at enacting legislation to address the issue and keep the federal government out, POLITICO has learned. Both states are helmed by Republican governors.

The move to comply with an Affordable Care Act requirement to head off federal intrusion could be a harbinger of things to come. Particularly in states that oppose the law, it could signal a begrudging willingness to set up a health exchange as a means of retaining more state control over the marketplace.

So for the Obama administration, it’s certainly an encouraging sign: Officials have repeatedly emphasized their desire that states handle as much of the implementation process as possible – as well as their interest in bringing increasing scrutiny to insurance rate increases.

I’ve long been of two minds on this — on one hand, it certainly makes sense for states to be writing rules that govern their unique marketplaces. But forcing reticent governors or legislators to write rate review or even exchange regulations just to get the federal government off their backs probably won’t make for very consumer-friendly reforms (see South Carolina), and in those cases, it may make for better policy if the federal government stepped in and ran things.

A new report from PricewaterhouseCoopers finds that far from “ending” the private health sector — as some GOP opponents of the Affordable Care Act predicted — Obama’s health care reform law will actually serve as a boon to private insurers, confirming fears that excluding the public option from the final bill could undermine affordability.

According to the new report, the law’s state-based health care exchanges provide private insurers with a lucrative new market in which they stand to gain up to $200 billion in revenue by 2019:

In 2014, an estimated 12 million consumers will choose health insurers in a new, tightly regulated marketplace where choice will be king.

That marketplace will encompass different state health insurance exchanges (HIXs) where health insurers compete for nearly $60 billion in premiums. And that’s just the start. By 2019, an estimated 28 million Americans will buy health insurance through this new online channel.

PwC estimates that by then, the HIXs will have grown to nearly $200 billion in premium revenue. Insurers will compete head to head for individuals who will be required to buy their product but be able to comparison shop like never before. [...]

More than half of insurance executives surveyed by PwC expect to see an increase in their individual business, and nearly half expect growth in their small group business.

Look:

To maximize profits, the insurers surveyed in the study are also “hoping that states opt for a variation of the open market model, such as the one used in Utah, where any insurer can sell policies on the exchange as long as it meets certain minimum benefit requirements.” Additionally, the study reported, “Only 10 percent of insurance executives surveyed prefer the active purchaser model where the state evaluates and selects insurers in a competitive bidding process.”

Read the full report here.

The Obama administration issued a policy statement last night opposing several sections of a DC appropriations bill that would deny funding for needle exchanges, prohibit the District from spending local funds on abortions, and prevent the IRS from using any funds appropriated by the bill to begin implementing the system of premium credits and other provisions that are part of the Affordable Care Act:

District of Columbia Needle Exchange Restriction. Section 807 of the bill restricts the use of Federal funds for the District’s needle exchange programs. This is contrary to current practice and the Administration’s policy to allow funds to be used in locations where local authorities deem needle exchange programs to be effective and appropriate.

District of Columbia Abortion Restriction. Section 810 of the bill prevents the District of Columbia from using its own funds for abortions, which undermines the principle of states’ rights and of D.C. home rule. Longstanding Federal policy already prohibits Federal funds from being used for abortions, except in cases of rape or incest, or when the life of the woman would be endangered.

Department of the Treasury. The Administration opposes sections 107 and 108 of the bill, which would place significant restrictions on the Department’s ability to adequately implement the Affordable Care Act, and would delay the planning and construction of a system to administer the critical premium assistance tax credit and the ability to reconcile it with IRS’s core systems. These sections would prevent both appropriated and transferred funds from the Department of Health and Human Services from being used by the Department to administer the law.

Republicans had included the needle exchange proposal in their 2011 budget, even though the program actually reduces federal spending and helps lower health care costs. As an example, the cost to prevent a single HIV infection by needle exchange “has been calculated at $4,000 to $12,000, considerably less than the estimated $190,000 (listed in 1997 dollars) medical costs of treating a person infected with HIV.” The public health benefits are also substantial. A 2003 study of 99 cities found that HIV prevalence in addicts fell by 18.6 percent in cities which started needle exchanges, while those that failed to do so saw an 8.1 percent increase. Between 1990 and 2001 in New York, the HIV prevalence rate amongst IV drug users entering addiction treatment similarly fell from 54 percent to 13 percent and Hepatitis C prevalence fell from 90 percent to 63 percent.

Meanwhile, denying the District the right to appropriate its funds as it sees fit — in this case to pay for abortions — would disproportionately impact poor women and expose the hollowness of the GOP’s rhetoric about local control and state rights, not to mention their hypocrisy about preventing the federal government from interfering in the doctor-patient relationship.

In its statement of policy, the administration did not threaten to veto the bill over the DC issues, however.