Children at risk of abuse, patients in need of long-term care, poor residents eligible for Medicaid — they all could have benefited from greater access to health care if Florida Gov. Rick Scott (R) had accepted millions of dollars in grants from the federal government. Instead, he followed the state legislature’s “well-established policy of not implementing any portion of federal heath care reform through the Patient Protection and Affordable Care Act.”

And yet lawmakers were willing to forego that prohibition to accept over $2.5 million in ACA money to fund abstinence-only sex education, even though the program offers students very little by way of health-related information. The New York Times delved into Scott’s rationale for rejecting millions in federal cash and refusing to pursue millions more in grants made available under the health law:

“In interviews, Mr. Scott, a Republican, and state legislative leaders were clear about their rationale. They said they detested everything about the federal health law, which was declared unconstitutional by a federal judge in a case filed by the state. Unless ordered to do otherwise by an appellate court, they said, they had no intention of putting it in place, even if that meant leaving money on the table.

“There are a lot of programs that the federal government would like to give you that don’t fit your state, don’t fit your needs and ultimately create obligations that our taxpayers can’t afford,” said Mr. Scott.”

The abstinence program that Scott is willing to support, however, is not working. Florida ranked sixth among states for its teen pregnancy rates in 2009. Among 2008′s teen mothers, 57 percent reported they weren’t using birth control, and 45 percent thought they couldn’t become pregnant. Furthermore, Florida had the fourth largest population of people living with HIV in the nation, with a 2006 HIV-incidence rate of 45.9 among 16-19 year-olds–nearly twice the national rate at that time.

Scott’s refusal to accept most ACA health grants has drawn sharp criticism from Health and Human Services Secretary Kathleen Sebelius. As she put it, ”there are some newly elected officials on the Republican side that have decided that their political ideology is more important than anything — more important than the health needs of their citizens, more important than the economic stability of the economy, more important than the future of jobs in America — so I think it is very unfortunate for citizens of Florida,” Sebelius said. “It is very troubling.”

–Sarah Bufkin

During his speech at the Western Conservative Summit this weekend, Republican presidential candidate Rick Santorum leveled another outlandish accusation against the Affordable Care Act. Santorum, who has a history of fear-mongering, told the crowd that thanks to the health care law, “every single American will have an IV hooked up to them and will now be dependent upon Washington DC for whether they get their tests, whether they see a doctor, whether they get their procedure done.”

There are many problems with Santorum’s statement that make it flat out ridiculous:

1. America does not have a single payer health care system, and the vast majority of Americans will remain on private health insurance plans after the health care law goes into effect. So how would anyone be dependent on bureaucrats to gain access to health care if they are not using a government health care plan? After all, a single-payer system was never even proposed by the Obama administration during the health care debate last year and a public option, which would have given anyone the opportunity to enroll on a government plan, was defeated amid protests from conservatives and some democrats.

2. Millions of people are already enrolled in a government health care plan including Medicare and Medicaid beneficiaries, public employees, and members of Congress, and federal and state government’s are responsible for 45 percent of health care spending. Medicare and Medicaid remain enormously popular, which suggests their beneficiaries have no problems getting health care services. Ironically, Rick Santorum should know this firsthand, since he has held government health insurance since entering Congress in 1991, without ever being “dependent upon Washington” or “hooked up to Washington’s IV.”

3. The law did not increase government rationing of health care, which already exists in the private sector whenever an insurer refuses to pay for a treatment.

4. As a result of the new law, more Americans will be able to afford health care coverage, more choices will be available through state based exchanges, and more services will be required to be offered than before.

–Sean Savett

In yet another sign that the debt ceiling negotiations have re-ignited conservatives’ fervor to privatize the Medicare program, Reuters is reporting that Tea Party activists are planning to descend on the town halls held by members of Congress while on recess this month to demand that the new super committee and future legislative proposals to reduce entitlement spending incorporate Rep. Paul Ryan’s (R-WI) plan to push future beneficiaries into private insurance plans:

Thousands of Tea Party movement activists are expected to descend this month on town hall meetings across key battleground states as part of an intensifying campaign ahead of the 2012 presidential and congressional elections.

Their priority is a plan to slash Medicare costs proposed by House of Representatives Budget Committee Chairman Paul Ryan, which could gain momentum now that a debt-limit deal between President Barack Obama and Congress has made potential Medicare cuts a centerpiece of the deficit debate. [...]

“The August town halls are going to be, potentially, a referendum on Democrats who don’t care and Republicans who’ve dared to offer real policy solutions, particularly on things like entitlements,” said Matt Kibbe, president of FreedomWorks, the small-government advocacy group organizing the initiative. “The Ryan plan is the only one out there so far, and what we need is an adult conversation with all politicians talking about the real issues.”

House Majority Whip Eric Cantor (R-VA) is also promoting the plan with renewed vigor, telling the Wall Street Journal that Republicans will focus on “the better way” for Americans is to “get the fiscal house in order” and “come to grips with the fact that promises have been made that frankly are not going to be kept for many.” He then went on to promote the Ryan plan as a means of lowering government spending on health care.

To recap, the Ryan plan doesn’t actually lower the nation’s health care spending by eliminating beneficiaries or encouraging insurers, hospitals, and doctors to deliver more efficient care. Rather, it reduces government expenditures by asking future enrollees to pay more for their health care coverage. As the Congressional Budget Office (CBO) concluded in its analysis of the Ryan proposal, “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.”

But given the GOP’s effectiveness in obscuring these concerns and their past success overtaking town halls to build political momentum for conservative priorities, Medicare activists shouldn’t take comfort in Americans’ strong support for the existing Medicare system. If anything, they should be prepared with their own ground game so the nation doesn’t have to live through anything approaching the town hall insanity that occurred at the height of the health care reform debate.

Earlier this week, Citizens For Life, an anti-abortion group operating in Massachusetts, announced that it was gearing up a campaign to place a question on the state’s 2012 ballot asking voters if they would support repealing the requirement for individuals to purchase health insurance coverage. The mandate is part of former Gov. Mitt Romney’s signature health care reform law and has successfully lowered the state’s uninsurance rate. But abortion groups oppose the measure because it provides government-sponsored abortion coverage — as just one service within a comprehensive benefit package — to residents who participate in the state’s Commonwealth Care exchange. “RomneyCare covers abortions, and the mandate forces citizens to participate in a system which strives to make the murder of unborn children as cheap as $50,’’ the group explained on its website yesterday. “There are, however, many more ways which this requirement offends against both the sanctity of human life, principles of ethical medicine and simple common sense.’’

But as the Boston Globe’s Michael Levenson reports, the group has since stripped the abortion criticism from its site at the request of Romney’s presidential campaign:

Yesterday, Citizens for Life removed the statement from its website and immediately began distancing itself from that line of attack, after being contacted by Peter Flaherty, Romney’s liaison to social conservatives. Fox blamed the statement on a staff member at Citizens for Life, and said it did not reflect the group’s views.

“I was extremely upset,’’ she said. “He has removed it. I thought, ‘Where did this come from, because it had my name on it, and I never wrote it.’ ’’

Romney supported preserving access to abortion until 2004, when — among rumors that he was gearing up for a presidential bid — he declared himself “pro-life” and began opposing the procedure. By the time he enacted health care reform in 2006, Romney had no say over the health care benefit package offered by Commonwealth Care — that was determined by an independent public board called The Connector Authority and grounded in established state court precedent.

In response to the group’s ballot effort, Romney’s spokeswoman Andrea Saul released a statement saying that that the governor still supported his health law, including the requirement to purchase coverage. But if Romney’s position on abortion is any indication, that too may soon be subject to change.

Fox host Bill O’Reilly has worked himself into a lather over the Obama administration’s recent decision to require new health insurance plans to cover birth control without co-pays. Last week he declared that women don’t deserve government subsidized birth control because they’re too “blasted out of their minds” during sex to use it. Yesterday during an interview with Rep. Dennis Kucinich (D-OH), O’Reilly went a step further in his tirade against women’s health care and said it was the reason businesses aren’t hiring:

O’REILLY: Now the federal government is ordering the health insurance companies to pay for all breast feeding stuff, all female birth control stuff, all preventative measures for doctors for ladies that go in. What do you think that’s gonna do? That’s going to inhibit hiring even more!

KUCINICH: Frankly, we ought to be very concerned about women’s health care.

O’REILLY: I am concerned, but they’re not going to expand and hire if they have to pay higher health care premiums for workers! Businesses aren’t going to do it…You can’t have both. You can’t have a welfare state and a robust capitalist system.

Watch it:

By “breast feeding stuff,” O’Reilly was railing about the fact that under the administration’s ruling, health insurers will be required to pay for a range of preventative care services, including HPV, DNA, and HIV screening, and the costs for renting breastfeeding equipment. Women’s premiums will actually pay for the services. But apparently conservatives like O’Reilly only support “family values” as long as the government never has to spend a dime to help poor women care for their children.

It’s also surprising that a professed fiscal conservative would be opposed to preventative health care for women, which not only improves the health of women and their families, but saves the government money when illness is caught and treated early on.

O’Reilly is wrong to suggest that women’s health care is the reason businesses aren’t hiring. Corporations are reaping enormous profits and sitting on a record pile of cash, but are still sending jobs overseas or hiring less than they were before the recession. Additionally, according to a recent Wall Street Journal survey, “the main reason U.S. companies are reluctant to step up hiring is scant demand, rather than uncertainty over government policies.”

(HT: Business Insider)

Health and Human Services Secretary Kathleen Sebelius is going after Florida Governor Rick Scott (R) for failing to accept the much-needed health grants offered through the Affordable Care Act. Scott has turned down the funds over his objections to the constitutionality of the measure, but as Sebelius points out in this interview with iVillage, the state’s refusal to implement the law would only invite greater intervention from the federal government:

SEBELIUS: I think it’s unfortunate. We have certainly seen this play out here in Washington in the past month or two, where there are some newly elected officials on the Republican side that have decided that their political ideology is more important than anything — more important than the health needs of their citizens, more important than the economic stability of the economy, more important than the future of jobs in America — so I think it is very unfortunate for citizens of Florida. [...]

The irony in the way the law is written is that if Governor Scott chooses in Florida not to move ahead, the Affordable Care Act directs the Department of Health and Human Services to [implement it]. So the citizens of Florida will have the advantage of an exchange… The women of Florida will have the same kind of preventive health plans that everyone else will around the country….The governor has really just ceded his own authority to the federal government. Kind of an irony for someone who believes that the states should be deciding what’s going on.

Scott has missed out on up to $52 million in federal funding and is one of the few governors to reject funds with which the state could establish an insurance exchanges. Florida has also come under harsh criticism for refusing to accept $3.4 million for home health visits that could have been used to reduce widespread child abuse and neglect. It suffers from the fourth-highest unemployment rate and has the second-highest rate of people without insurance. Here is a list of some of the grants Scott has rejected:

I’ve enthusiastically urged the new bipartisan super committee established by the debt ceiling agreement to consider delivery system and payment reforms in its health care cuts, while accepting the likelihood that it will likely propose a series of reimbursement cuts to providers and privatization schemes that will only shift the costs of health care to beneficiaries. The Incidental Economist’s Austin Frakt offers these nine sensible proposals:

1. Competitive bidding, also known as competitive pricing. This idea really puts the market to work to buy Medicare benefits for the lowest possible price on a market-by-market basis. Participants can be public and private entities. It piggybacks on the exiting, hybrid structure of Medicare (FFS Medicare + Medicare Advantage) and makes all participating plans compete directly in a way they never have. Scholars have estimated the savings to be 8% of Medicare spending. I’ve written a lot about this elsewhere. Perhaps this post is the best place to start.

2. Competitive bidding can be put to work for durable medical equipment too. See the work of Peter Crampton.

3. Part D formulary design and drug pricing. Did you know the VA buys drugs for 40% less than Medicare? True! That alone suggests Medicare could spend a lot less on drugs. There are many possible Part D reforms that would lower program spending. Kevin Outterson wrote about some. For more about what it would take and mean to make Medicare’s drug benefit more like the VA’s see my post, which links to my paper with Steve Pizer and Roger Feldman.

4. Reference pricing. This idea came to me via David Leonhardt and Peter Orszag (smart guys, by the way; you should talk to them). The basic idea is that Medicare should only spend an amount on therapy for a condition equal to the lowest cost, effective one (that’s the “reference price”). If individuals want more costly therapies that are no more effective, they should pay the difference out of pocket. There’s more to this. See this prior post and related links therein.

5. There are lots of things Medicare shouldn’t even be paying for at all because they don’t work. See Rita Redberg’s NY Times op-ed on this.

6. Support comparative effectiveness research so we can learn more about which therapies are most effective. There is too much we don’t know and it is costing us.

7. Let ACOs be tested. We don’t know if they’ll work, but they’re worth a try.

8. Support the IPAB. Isn’t it obvious by now that Congress itself can’t control Medicare costs?

9. Consider all-payer rate setting. More on that here. Perhaps this post is a good starting point.

Meanwhile, I’m wondering how long it will take before Republicans start pressuring McConnell and Boehner to only appoint members who publicly commit to defunding the Affordable Care Act, ensuring — yet again — that the committee won’t produce a unified plan and triggering up to 2 percent in cuts to providers participating in Medicare. In that case, all of these recommendations are for naught.

Last month, a federal judge temporarily blocked Kansas from enforcing a state law imposing overly rigorous licensing standards on abortion providers pending the resolution of a lawsuit filed by two doctors who perform abortions in the state. But now, a Michigan-based group represented by the son of anti-choice activist Phyllis Schlafly, is trying to appeal the injunction. The American Association of Pro-Life Obstetricians and Gynecologists has filed a motion to intervene in the case, claiming that it is losing business to the Kansas abortion providers:

The American Association of Pro-Life Obstetricians and Gynecologists filed a motion to intervene in the case Monday, along with a notice of its appeal of the injunction. The group claims it has legal standing in the case because its members in Kansas are losing childbirth-related business to abortion clinics. It also says its members are placed at a competitive disadvantage because abortion providers pass along the costs of any complications or medical care after abortions to other doctors. [...]

The Center for Reproductive Rights, whose lawyers represent the Kansas abortion providers who filed the lawsuit, said in an email that it does not see how AAPLOG can appeal the court’s decision when it is not a party in the case. It plans to oppose the motion to intervene, which it believes is groundless.

“In any case, the Court granted an appropriate injunctive based on the clear evidence that the Defendants’ actions had nothing to do with patient health or safety and everything to do with political shenanigans,” said Bonnie Scott Jones, deputy director for the Center for Reproductive Rights. “We feel confident that any appeal of that ruling would be unsuccessful.”

Kansas’ Attorney General has decided against appealing the court’s injunction, since the decision has “no direct cost or loss to the state if they don’t apply them until the process has run its course.” Gov. Sam Brownback’s (R) administration is also considering enacting permanent regulations that may be identical to the temporary rules being challenged in court. In his ruling granting the injuction, U.S. District Judge Carlos Murguia found that the abortion clinics challenging the rules are likely to succeed on claims that “they were denied due process and would suffer irreparable harm if the rules took effect July 1.”

In a separate case, Kansas is appealing a temporary injunction that is preventing the state from stripping Planned Parenthood of federal family planning funds.

Conservatives are lashing out at the Obama administration’s decision to listen to the experts at the Institute of Medicine and approve their recommendation to require new health insurance plans to cover birth control with no co-pays. During a floor speech last night, Rep. Steve King added his voice to the conservative chorus denouncing the very idea of birth control. In apocalyptic tones, King warned that free birth control would “prevent a generation” from being born and make America a “dying civilization”:

KING: They’ve called it preventative medicine. Preventative medicine. Well if you applied that preventative medicine universally what you end up with is you’ve prevented a generation. Preventing babies from being born is not medicine. That’s not— that’s not constructive to our culture and our civilization. If we let our birth rate get down below replacement rate we’re a dying civilization.

Watch it:

As astonishing as it might seem that Republicans would object to something as widely accepted and used as birth control, King illustrates that many conservatives despise contraception altogether for “preventing babies from being born.” King goes so far as to say that birth control “is not medicine.” Some Republicans have decried birth control as tantamount to abortion and signed on to legislation that would effectively outlaw it. These so-called “personhood laws” would make criminals out of the 15.3 million women in the U.S. who use hormonal birth control.

King’s dire predictions are laughably uninformed. Contraception and other family planning services dramatically reduce the number of abortions and save states billions of dollars each year. In other words, facilitating women’s access to birth control benefits society at large and is the fiscally conservative position, which is why 78 percent of Americans support government-subsidized birth control.

Media Matters points out that there are three million unintended pregnancies in the U.S. each year, 20 percent of which end in abortion. “But, according King’s logic, all those accidental pregnancies are actually the desired outcome.” Apparently nothing upsets conservatives more than the idea of women being able to control their own reproductive health.

(HT: Political Correction)