Politico’s Manu Raju is reporting that the so-called Gang of Six senators looking for a bipartisan agreement on a package of spending reductions that could be paired with a vote to increase the national debt ceiling may have reconvened “after Oklahoma Sen. Tom Coburn unexpectedly rejoined the group — and more senators are now coalescing around a new proposal that would cut the debt by as much as $3.7 trillion over the next decade.” The group is looking at a two-prong strategy that would make some $500 billion in cuts now and fast track the process of finding more savings in Congress. The health care portions of the package include:

– Unspecified health care cuts to Medicare and Medicaid

– Repeal of the the CLASS Act, a provision of the Affordable Care Act which would provide long-term care insurance

– Instructs the Senate Finance Committee to reform or replace Medicare’s Sustainable Growth Rate (SGR) to save up to $298 billion and an additional $202 billion/$85 billion in health savings

– Instructs the Health, Education, Labor and Pensions (HELP) committee to find $70 billion in cuts

– Instructs the Budget Committee to “review total federal health care spending starting in 2020 with a target of holding growth to GDP plus one percent per beneficiary and require action by Congress and the President if exceeded”

– Instructs the Judiciary Committee to find an unspecified amount through medical malpractice reform.

President Obama seemed to endorse the plan’s general approach during an appearance in the White House press briefing room this afternoon, calling it “balanced.” “It would not match perfectly with some of the approaches that we’ve taken, but I think we’re in the same playing field,” he said.

In a major win for women’s health advocates, the National Journal is reporting that the Institute of Medicine will recommend that “health insurers should pay for a range of services for women at no cost, including birth control, counseling on sexually transmitted diseases, and AIDS screening.” In accordance with the Affordable Care Act, the Department of Health and Human Services commissioned the report to determine a “coverage floor” or services insurers should provide without additional cost-sharing. The groups was expected to release its official report tomorrow.

Some of the recommendations include:

– screening for gestational diabetes

– HPV testing as part of cervical cancer screening for women over 30

– counseling on sexually transmitted infections

– counseling and screening for HIV

– contraceptive methods and counseling to prevent unintended pregnancies

– lactation counseling and equipment to promote breast-feeding

– screening and counseling to detect and prevent interpersonal and domestic violence

– yearly well-woman preventive care visits to obtain recommended preventive services

HHS is not required to adopt the group’s recommendations and can expect a rush of lobbying from anti-abortion groups that also oppose contraception. Organizations like the Family Research Council maintain that “requiring insurers to cover contraceptives violates the conscience rights of people who belong to religions that don’t believe in artificial contraception” and that some forms of contraception “can cause very early abortions.”

A recent national poll found that 78 percent of Americans believe the government “should subsidize birth control and other family planning services, excluding abortion, at government-funded clinics for low-income women.” Contraception improves women’s health and can help reduce the need for abortions. According to data from the Guttmacher Institute, 54 percent of women who have abortions “had used a contraceptive method,” but 76 percent of birth control pill users and 49 percent of condom users “report having used their method inconsistently.” Forty-six percent of women “who have abortions had not used a contraceptive method during the month they became pregnant.”

Maine Governor Paul LePage (R) — a vocal opponent of the Affordable Care Act — is proposing reforming MaineCare, the state’s Medicaid program, by reducing eligibility to the level in place in most states, thereby throwing off some 30,000 Mainers off the rolls. “This is what the level is in 47 other states,” LePage said in an interview. “We should not be more generous than these other states, but we are and we have been and it needs to stop.”

LePage predicted that the newly uninsured population will be able to find coverage though a new state insurance law that allows consumers to buy health insurance across state lines and through employer-based captives, insurance companies that are allowed to finance and leverage risk without having to buy additional insurance to cover that risk. The measure is part of LePage’s market-based approach to health care, but even Republicans are skeptical that it will be able to offer affordable coverage to lower income residents. Sen. Richard Rosen (R), co-chairman of the Appropriations Committee that has rejected similar proposals from LePage, told the Bangor Daily News that while “he agreed with the concept the governor is pushing of having individuals and families pay for part of the their health care costs,” forcing Medicaid beneficiaries to go out and purchase insurance “may be premature.” Democrats argued that the proposal is not feasible:

LePage said the new state health insurance law has provisions to make health insurance more affordable, and he believes many of those who are between the current 200 percent of poverty level and 133 percent can help pay for their own insurance coverage.

Rep. Peggy Rotundo, D-Lewiston, the lead Democrat on the [Appropriations] committee, disagrees.

She said the 133 percent level is $14,484 for a single adult. For a family of four, it is $29,726. She said families and individuals at those income levels simply can’t afford health insurance at current rates.

“The more health care we take away from people, the more those costs are shifted to people who have health insurance and more shifts to local communities and local hospitals,” she said. Rotundo said covering those families and individuals with Medicaid is cost-effective for the state with the federal government paying about two-thirds of the bill.

That last point isn’t even up for debate. LePage would transfer beneficiaries from a fairly efficient government program to the highly inefficient private market, where policies are incredibly expensive (particularly before the Affordable Care Act reforms are implemented). One recent study found that “after controlling for health status, age, gender, income, and other factors, the average per person annual cost of serving an adult on Medicaid was 20 percent less than under private insurance and the annual cost of serving a child on Medicaid or CHIP was 27 percent less than under private insurance.” LePage’s new law — which would allow insurers to cherry pick the healthiest beneficiaries — will likely go even further in dividing the health insurance market and increasing costs for those former Medicaid patients who need the most coverage. Meanwhile, limiting eligibility would “save the state less than $7 million a year–costs they claim will simply be shifted to local governments, hospitals and those with health insurance.”

The Incidental Economist’s Austin Frakt wonders if the Affordable Care Act will truly reduce the growth of health care spending (i.e. bend the cost curve down) given our history of treating health care as a luxury good, “one on which we spend more of our wealth as that wealth grows.” “With such overwhelming evidence from our past that, despite our efforts, this national health spending curve has not bent, why do we think the future will be much different,” he asks, pointing to this rather startling chart:

On a rather partisan note, it’s worth noting that if the Republicans get their way and repeal the health care law or the cost containment provisions included in it — the Independent Payment Advisory Board, the excise tax on high-cost policies — this line will continue to skyrocket upwards. Under their budget, beneficiaries will be shouldering a greater portion of the health costs.

Rep. Paul Ryan’s (R-WI) budget would find savings in the Medicare program by shifting a greater share of its costs to beneficiaries, who would receive a fixed “premium support” credit to go out and purchase health care in an exchange of private health care plans. According to the Congressional Budget Office, under the Ryan plan, “a typical beneficiary would spend more for health care…[because] private plans would cost more than traditional Medicare.” ”This would more than double out-of-pocket health-care spending by a typical senior to $12,500 per year.”

Ryan’s isn’t the only proposal to lower the growth in Medicare spending that’s asking seniors to pay more, and that’s precisely what has health care advocates so concerned. They point out that nearly “half of Medicare recipients have incomes at or below 200 percent of poverty — $21,780 for an individual, $29,420 for a couple” and that many simply can’t afford to spend more on health insurance:

Only 5 percent of Medicare beneficiaries have incomes of $80,000 or above, a figure that includes any income from a spouse. As for the 47 percent who are at or close to poverty, on average they are already spending nearly a fourth of their budgets on health care, according to an analysis of Medicare survey data by the Kaiser Family Foundation.

“There’s this impression that there’s a great deal of wealth among the Medicare population, this image of wealthy seniors playing golf and enjoying their retirement years,” said Tricia Neuman, director of the Kaiser Family Foundation’s Medicare Policy Project. “But while some are lucky to do so, many are living on a fixed income, struggling to make ends meet…with really limited capacity to absorb rising costs.”

Last week, the LA Times’ Noam Levey observed that saving costs by shifting them from the federal government to beneficiaries — once seen as taboo — has become all the rage in Washington, with pundits eagerly applauding the bold “leadership” and “tough decisions” of such proposals. They would do well to note, however, that many of the beneficiaries being asked to pick up the costs have less than $50,000 in savings, and that shifting costs don’t actually address the problem of unsustainable health care costs — it only does what it says, shifts them.