In an attempt to free Kansas “from the strings attached” to federal dollars, Gov. Sam Brownback (R) is returning $31 million he previously accepted from an Early Innovator Grant made available to the states under the new federal health care law. GOP leaders criticized Brownback’s original decision to accept the money as a validation of the Affordable Care Act, whose constitutionality Kansas is currently challenging in court.

In a statement released today, Brownback defended returning the money by saying the state needed to practice belt-tightening measures:

“Every state should be preparing for fewer federal resources, not more. To deal with that reality Kansas needs to maintain maximum flexibility. That requires freeing Kansas from the strings attached to the Early Innovator Grant.”

Ironically, Brownback will entangle Kansas in greater federal control by refusing the grant, which supports states as they develop the logistics needed to create their own health insurance exchanges. As Department of Health and Human Services Secretary Kathleen Sebelius has made clear, if states refuse to set up their own exchanges, HHS will do it for them, thereby ceding the governor’s “authority to the federal government.”

But the announcement also represents a 180-degree reversal for Brownback, who defended the state’s acceptance of the ACA dollars just last month against Tea Party opposition.

“What I thought we could do is use the innovator grant not to do Obamacare — I am not supportive of us doing Obamacare — but to use that to do an exchange that provides a market mechanism,” Brownback said. “It’s not required that we use it to comply with Obamacare.”

Apparently even that possibility is out of the question now as Kansas will return millions of dollars that could have been spent on improving its health care system for its residents, over a tenth of whom were without health insurance in 2009.

–Sarah Bufkin

The Daily Caller’s Neil Munro is out with a report claiming that the government will have to spend an additional $50 billion a year subsidizing insurance as a result of an oversight in the Affordable Care Act. Under the law, people between 133 and 400 percent of the federal poverty line and insured individuals who have to spend more than 9.5 percent of their household incomes on their employer sponsored plans qualify for subsidized coverage within the exchanges. Munro points to a study published by Richard Burkhauser (for the Employer Policy Institute), which argues that employers and employees will be encouraged to collude and bump up the employee’s contribution past the 9.5 percent threshold in order to qualify for subsidized coverage. It’s a win-win for both parties: the employer could cut back health care costs; the employee may find a better deal in the exchanges. Here is Burkhauser ‘s explanation:

But companies and their employees share great incentives to rearrange workers’ compensation to win more of these federal subsidies, he said.

For example, he explained, an employee can ask his employer to raise the price of company-provided insurance in exchange for an equal increase in salary. In many cases, that would boost the share of his income spent on health insurance to a percentage above the 9.5 percent threshold.

Such an arrangement, Burkhauser added, would make the employee, his spouse, and his children all eligible for federal health care subsidies while enriching both employer and employee — even after the Treasury Department collects fines from U.S. workers.

Burkhauser’s research found that because of the law’s incentives, an extra one-sixth of workers who get their health insurance from employers — or roughly an additional 12.7 percent of all workers — would gain by transfering themselves and their families into the federal exchanges.

Current projections suggest 75 percent of all employees will avoid the federal subsidies and stay in employer-backed health insurance plans. Burkhauser’s estimate, however, suggests that only about 65 percent of employees would have an adequate incentive to remain in privately funded health plans.

Burkhauser also claims that a new interpretation from the Joint Committee on Taxation strengthened the incentive of employees to jump into the exchange. On May 4, 2010, that agency issued a memo explaining that an employee could only qualify to receive federal subsidies through the exchange if the cost of their individual policies exceeded 9.5 percent of income. Such an interpretation excluded the costs of family plans and could result in far fewer people being eligible for subsidized insurance. It would, Burkhauser argues, encourage employees to ask their employers to charge them more for health care (pushing them past the 9.5 percent threshold) and make up the difference by offering higher wages.

But how practical is this? Well according to page 29 of Burkhauser’s own report, not very:

For example, employers and employees may have incentives to renegotiate compensation packages, but they may not be able to because of institutional rigidities. This could also occur because there may not be pass-through of health insurance costs in the form of higher wages at the individual level. Employers may not know the family income of their workers and whether workers are potentially eligible for subsidies in the exchange. Employers may fear that a consequence of raising employee contribution rates may be to incent their non-smoking workers to leave the employer risk pool (since tobacco use is an allowed rating factor that we do not consider in our work), and this may reduce their incentive to increase premium contributions. Employers may also fear that despite the tight regulations on what are now allowed rating factors under insurance reform, they may be denied coverage if their employee take-up rate drops beyond a certain level, a concern especially for small firms that may lead them to drop coverage entirely. Workers may not understand that the reason their wages increased is because employers increased their employee contributions.

And, not to mention the fact that employers whose employees have to spend more than 9.5 percent of their incomes on health care are penalized and pay a fine (which they would presumably pass on to the employee). So yes, if employees and employers can overcome all of these hurdles then maybe the costs of subsidizing coverage would be higher than expected. But economists I spoke to say that they would be nowhere near the $50 billion figure — even if the government issues a final regulation that would allow the cost of family health insurance plans to count toward the 9.5 percent threshold.

After campaigning on the GOP position that states should reject federal stimulus money with “strings attached,” New Jersey Gov. Chris Christie (R) yesterday touted his commitment to health care by visiting a community health center that has benefited from two federal health grants made available through the American Recovery and Reinvestment Act:

“The Burlington City Health Center and all of our New Jersey community health centers are an essential part of our health safety net for those who otherwise would not have a medical home,” Christie said. “These centers offer affordable, high-quality care to residents and families in need. I am proud of the strong support my administration has provided for community health centers in the budget – $113 million in Medicaid and $46.4 million for the uninsured. With this assistance, we are making sure the people and communities who rely on these services lead healthy lives now and in the future.”

But the Burlington City Health Center and its parent organization, the Southern Jersey Family Medical Centers, owe their success to more than state funds; the health centers — which provide health services to over 51,000 of New Jersey’s low-income residents — accepted $1.8 million and $3 million in federal funding through the ARRA’s Capitol Improvements grant and the Health Information Technology Implementation grant, respectively.

Through the combination of grants, the Southern Jersey Family Medical Centers acquired the resources to expand their electronic health records and to improve their facilities through construction or renovation, thereby improving the quality of care for thousands of people.

Ninety-seven percent of health leaders surveyed perceive providers like community health centers as address “a critical need by serving individuals who remain uninsured and by being best equipped to meet the special needs of vulnerable populations,” according to a new Commonwealth Fund/Modern Healthcare report.

Since passing its universal health care law under former Gov. Mitt Romney (R) in 2006, Massachusetts has seen its community health centers rise to meet this need. Clinics saw a surge of 31 percent in the number of patients seeking treatment between 2005 and 2009, health researchers reported in the Archives of Internal Medicine. The uninsured portion of Massachusetts’ population has tumbled from 7 percent in 2006 to 1.9 percent just last year.

–Sarah Bufkin

As ThinkProgress reported last June, the Washington Supreme Court reversed damaging cuts to Medicaid, arguing that the cuts were made in too broad a fashion. This ruling restored care to thousands of people, mostly indigent children.

The case in Washington has become a rallying cry for health advocates, who are taking to the courts to reverse the cuts made to the program by state governments eager to close gaping budget deficits. But the Obama administration’s Department of Justice is opposing their efforts and has actually filed an amicus brief in a Supreme Court case “arguing against Medicaid patients and providers suing California over changes to its Medicaid program.” Obama’s position surprised many in the health care policy community, including Secretary of Health and Human Services Katheleen Sebelius, who had been working behind the scenes to head off the move.

But now the New York Times reports that health care advocates have gained powerful new allies: congressional Democrats in leadership positions have filed a friend-of-the-court brief defending the rights of Medicaid recipients to go to court to try and stop broad-based cuts to the program:

In an unusual break with the White House, the Democratic leaders of Congress told the Supreme Court on Monday that President Obama was pursuing a misguided interpretation of federal Medicaid law that made it more difficult for low-income people to obtain health care. [...] The Democratic leaders said Medicaid beneficiaries must be allowed to file suit to enforce their right to care — and to challenge Medicaid cuts being made by states around the country. [...] The brief was filed by seven influential Democrats, including Representative Henry A. Waxman of California, an architect of Medicaid; Representative Nancy Pelosi of California, the House minority leader; Senator Harry Reid of Nevada, the Senate majority leader; and Senator Max Baucus of Montana, the chairman of the Finance Committee.

A number of high-profile interest groups, such as the American Association of Retired Persons, the American Medical Association, and the U.S. Chamber of Commerce also filed briefs supporting the same position. These developments continue to isolate the administration’s position.

As Texas Gov. Rick Perry (R) recently suggested, the standard Republican line on abortion is repeal Roe v. Wade and return the task of regulating abortion to the states. Perry eventually walked back his remarks and came out for a full federal ban, but this “states’ rights” argument has been used by Sen. John McCain (R-AZ) during the 2008 presidential run and it will likely come up again as the eventual Republican nominee tries to strike a middle ground that will appeal to independent voters.

But as NARAL’s Nancy Keenan points out, there is nothing “moderate” about the “leave it to the states” position. Were it to be adopted and Roe v. Wade is repealed, access to abortion could be jeopardized in 22 states:

States with near-total abortion bans:

Fifteen states have currently unconstitutional and unenforceable near-total bans on abortion already on the books, either from before Roe (13 states), or in the case of 2 states (LA and UT), from the early 1990s when they seized on a close vote in the Supreme Court to try to overturn Roe. Bans in the following states may become enforceable if Roe falls: AL, AZ, AR, CO, DE, LA, MA, MI, MS, NM, OK, UT, VT, WV, and WI.

States with “trigger” bans:

Four states have laws that would impose near-total criminal bans on abortion if the Supreme Court overturns Roe v. Wade (sometimes known as “trigger” bans): LA, MS, ND, and SD.

Two of these states, ND and SD, are not in the first group of 15. Thus, the number of states under threat goes from 15 to 17.

States with fully anti-choice governors and legislatures:

Fifteen states have anti-choice legislatures and governors and would likely outlaw abortion if Roe falls: AL, AZ, GA, ID, LA, MI, MS, NE, ND, OH, OK, SD, TX, UT, and WI.

Five of these states, GA, ID, NE, OH, and TX, are not in the two previous categories.

Indeed, states have experienced an explosion of anti-abortion legislation following the passage of the Affordable Care Act — which seemed to have opened the floodgates for these efforts. As the Guttmacher Institute has pointed out, in the first six months of 2011, states enacted 80 abortion restrictions, “more than double the previous record of 34 abortion restrictions enacted in 2005—and more than triple the 23 enacted in 2010.”