Politico’s Jennifer Haberkorn has written sobering report that has some progressives rethinking the argument that the sequestration trigger in the debt ceiling deal may do more to protect health care funding than the super committee’s spending proposal. As it turns out, those triggers — to go into effect if the super committee fails to agree on the necessary savings — would shield Medicare benefits, Medicaid and Social Security from spending cuts, but could still target the discretionary and mandatory spending used to finance implementation of the Affordable Care Act. As a result, the debt ceiling agreement could significantly reduce access to health care for millions of Americans.

Sen. John Barrasso claims that “there are at least 15 provisions of the Obama health care law that will find themselves subject to this trigger if the committee is not able to come up with other cuts”:

The funds for prevention programs and community health centers, grants to help states set up insurance exchanges and co-ops, and money to help states review insurance rates could be slashed across the board if the panel can’t find enough cuts this fall.

Funding for the temporary high-risk pools for pre-existing conditions could be sliced, too, as well as grants to improve maternal and child health. And as previously reported by POLITICO, the law’s cost-sharing subsidies — which are supposed to help low-income people pay their out-of-pocket expenses — could face the ax, too. [...]

Senate Republican leadership aides identified the potential funding cuts shortly after the law passed and are talking with the Congressional Budget Office to determine what parts of the law would be subject to sequestration.

As CBPP’s Edwin Park explained it to me — he is also quoted in Haberkorn’s piece — “the sequestration applies to any mandatory spending not specifically exempted. For example, low-income programs like Medicaid and refundable individual tax credits are exempt, so the ACA’s federal funding for the Medicaid expansion and the premium credits are not subject to the automatic cuts. But other ACA mandatory spending wouldn’t fit within those exemptions so things like the grants to states for setting up exchanges, the public health prevention fund, mandatory funding for community health centers, etc wouldn’t be protected.”

It’s worth noting that many of the targeted provisions — prevention, community health centers, high-risk insurance pools — have received bipartisan support and had been touted by Republicans as commonsense solutions for expanding access, creating jobs, and reducing health care costs (particularly during the Bush years). Now, they’ll be used as pawns to appease conservatives who want to see the health law defunded and completely eliminated. And that goal — unraveling the health care law — could very welcome become a reality if individuals are required to purchase coverage (once the mandate kicks in) without sufficient help from the government.

If I see any silver lining in this it’s that Office of Management and Budget — which is housed within the White House — will be responsible for determining how it will carry out the sequestration and HHS Secretary Kathleen Sebelius may have some discretion in how to apply the proportional across-the-board cuts.

Last month, anti-abortion activists in California kept Planned Parenthood from receiving a license to operate a new clinic in Redwood City by bullying Enterprise-Rent-A-Car into reneging on its contract to provide the center with the parking spots it needs to satisfy local zoning regulations. Now, as Planned Parenthood tries to find alternative off-site parking arrangements, abortion foes are promising “that any business that helps the women’s health services provider come up with the city-required spaces will find protesters with graphic pictures of fetuses on its premises”:

Belmont resident Ross Foti, who has already rallied outside the currently empty office building with other anti-abortion activists, said Tuesday that a woman he knows already approached Enterprise Rent-A-Car and other nearby businesses to express concern about Planned Parenthood moving into the neighborhood.

“No other business will even think about it, they know we’ll protest,” Foti said. “I know I will be there.”

An Enterprise spokeswoman is denying that the abortion activists influenced the company’s decision, however, saying that it backed out of the contract because Planned Parenthood wanted a longer-term agreement than it could provide.

If approved, the clinic would offer “preventative health care services, family planning, reproductive health, prenatal, and primary care services” and could dispense “chemical abortions” but “was not approved for surgical abortions.”

American doctors spend “nearly four times as much per physician as doctors in Ontario dealing with health insurers and payers,” and the additional time and labor drive U.S. per-physician costs to $82,975 annually versus $22,205 in Ontario, a new study published this morning in Health Affairs concludes. Most of Canada’s savings can be attributed to its single-payer system, one of the study’s authors Dante Morra told me, noting that American physicians have to incur substantial time and staff hours “interacting with multiple insurance plans about claims, coverage, and billing for patient care and prescription drugs.”

In fact, if U.S. physicians had administrative costs similar to those of Ontario physicians, the total savings would be approximately $27.6 billion per year. Just look at the difference in how American and Canadian doctors spend their time:

Morra told me that the study’s $27.6 billion in administrative efficiencies only reflects the savings attained from office physicians and does not include the potential cost reductions if other providers — like hospitals and physicians working in hospitals — spent less time processing claims for multiple payers. The real problem here is that a lot of this is out of reach. The United States isn’t moving toward a single-payer system any time soon, and while the President’s Affordable Care Act provides the Secretary of Health and Human Services with some discretion to simplify interactions between providers and health plans, any real long-term savings would have to come from the delivery and payment reforms that are still in the very early stages of development.

We’re still far-off from realizing any part of that $27 billion in savings, but Morra did mention one payment model that could achieve the efficiencies of Ontario’s single-payer system — all-payer rate setting. Under that structure, insurers can negotiate with providers for a single price for their services, thus saving providers the trouble of dealing with every single payer individually.