Earlier today, the Obama administration unveiled regulations to create standardized forms for health coverage that health insurers and employers will be required to use starting next year. The forms aim to help families clearly understand information about their coverage and compare different insurance options. Below is a sample page:

The form is a significant improvement from today’s insurance environment in which companies rely on various forms and often don’t disclose key information about how coverage works or what services are even covered. In fact, terms and definitions vary across policies, confusing beneficiaries and making it very difficult to know if needed benefits will be provided and at what cost. In May 2009, the Center for American Progress put out this report explaining the complexity of the marketplace and stressing the importance of developing consumer-friendly comparison tools We recommend developing standardized health plan comparison tools “that could help consumers appreciate the kinds of medical events for which health insurance may be needed and relative levels of protection provided under different policies.”

Politico’s Lester Feder has an important piece about one of the problems the federal government will run into once it starts trying to establish insurance exchanges on behalf of the states that refuse to build their own: lack of funding. That’s because, while the Affordable Care Act allows the HHS secretary to “use such sums as may be necessary” to create these insurance market places in the states, it remains silent on where funding for the federal government should come from. And that will require HHS to get “creative”:

“What you’d have to do is probably get creative about the financing,” perhaps enticing contractors to do development for free in the expectation that they would get paid once the exchange started collecting fees, Kingsdale said. [...]

The general pot of money that the ACA makes available for implementation is surprisingly small, given that it is ushering in a series of new regulations covering a sector that accounts for a major chunk of the American economy. It only appropriates $1 billion for all federal administrative costs.

Indeed, it seems that the only sensible solution — even if it’s not entirely politically practical — is for Congress to authorize and appropriate additional funds for implementation. Otherwise, we’ll face a situation where residents in a handful of conservative states already suffering from serious access problems — including place like Louisiana and Florida that have already rejected exchange grants — won’t be able to obtain coverage. I suppose it’s also possible to somehow encourage the health care sector (which will profit from growing the number of insured) to help build the marketplaces. But those kinds of structures will likely be geared toward maximizing industry profit rather than protecting the interests of consumers.

Gov. Rick Perry (R-TX) may have solidified his reputation with small-government conservatives when he described Social Security, Medicare, and Medicaid as “a Ponzi scheme” that he would consider opting out of, but he also tarnished his credibility by accepting additional federal funding for the program. In 2009 and then again in 2010 Perry publicly complained about the “strings attached” to some of the federal dollars, but ultimately took — even requested — the money. From the Texas’ Health and Human Services Commission website:

– SEPTEMBER 2009: The Center for Medicaid & Medicare Services (CMS) has notified HHSC that Texas qualified for Tier II FMAP reimbursement starting in July 2009. This allows the state to draw a higher federal match for Medicaid expenses. The Tier II federal match rate is 69.85 percent for Texas, up from the Tier I rate of 68.76 percent.

– JANUARY 2010: Texas Qualifies for Tier III Medicaid Match The Center for Medicaid & Medicare Services (CMS) notified HHSC that Texas qualified for Tier III FMAP reimbursement starting in October 2009. This adjustment is based on recent unemployment data and allows the state to draw a higher federal match for Medicaid expenses. The Tier III federal match rate is 70.94 percent for Texas, up from the Tier II rate of 69.85 percent.

– OCTOBER 2010: The ARRA FMAP was set to expire on December 31, 2010 but has been extended for six-months at phased-down rates. The phased-down state fiscal year 2011 FMAP rates are 68.11 percent from January 2011 through March 2011 and 66.23 percent from April 2011 through June 2011. With the FMAP extension, the average state fiscal year 2011 FMAP is 67.33 percent.

The original stimulus package included $87 billion in enhanced federal Medicaid funding, which meant that the federal government had increased its contribution to state Medicaid programs by 6.2 percentage points through December 31, 2010. In August, at the request of 42 governors, Obama signed a 6-month phase-out extension of that increase through June 2011.

Perry was one of eight Republican governors who didn’t publicly lobby for the additional dollars in February of 2010, but asked the federal government for the extra funds once they became available. A Perry spokesperson explained that Texans “paid their share of taxes and should get some of that money back” — which is the same argument that Democrats used to dissuade the governor from opting out of the program entirely.

In early 2011, however, Perry also spearheaded a state effort asking the federal government to allow the states to Medicaid “as they see fit” — finding savings by curbing mandatory benefits or limiting eligibility among Medicaid populations.

Longtime political operative Eric O’Keefe has a new plan to undermine health reform. Called the “Health Care Compact,” the effort is a legally dubious campaign to enroll states in an interstate compact to take control of all federally funded health care programs. As reporter Stephanie Mencimer notes, the law would not only unravel the Affordable Care Act, but also major health programs like Medicare. The Compact, once approved by Congress, would allow states with Compact laws to use Medicare, Medicaid, and other federal health program funds any way they wish, with no “strings” attached, like reimbursing doctors at a fair rate or ensuring program money is spent on actual health services.

The Health Care Compact campaign started earlier this year, when O’Keefe’s new group donated $250,000 to a Tea Party Patriots convention for a kick-off event. However, ThinkProgress has found that the group isn’t only reaching out to Tea Party members; it’s deceptively recruiting Democrats as well. The “About us” section of “Democrats for the Health Care Compact,” a group affiliated with O’Keefe, lists three influential Republicans, and no actual Democrats, as members:

– “Democrats For Health Care Compact” Member Leo Linbeck III: Born into an elite Texas family, Linbeck is the head of Aquinas Companies, LLC, the Houston-area construction and building management company connected to the fortune of Linbeck’s grandfather. Currently acknowledged as one the major financiers of the Health Care Compact campaign, Linbeck was a George W. Bush donor and has provided funds to a recently formed Republican political action committee called Citizens PAC. Linbeck’s father, Leo Linbeck Jr., is a major Republican fundraiser who helped create the groups to reduce liability for corporations and drastically reduce taxes on upper income individuals.

– “Democrats For Health Care Compact” Member Eric O’Keefe: O’Keefe has made a career out of orchestrating anti-government front groups, some with no actual members. He has played a pivotal role in the U.S. Term Limits “movement” (bankrolled by the Koch brothers and investor Howie Rich), the Sam Adam Alliance (a Tea Party mobilization group and planning group), the Center for Competitive Politics, a group that filed briefs in support of the Citizens United decision, and a sprawling network of TABOR groups designed to cripple state governments. Recently, O’Keefe has gained attention for his role in the Wisconsin Americans for Prosperity network and the Wisconsin Club for Growth, two groups that have aggressively promoted the right-wing agenda of Gov. Scott Walker (R-WI). He is also a regular presenter at the secretive Koch brothers gatherings that have acted as fundraisers for Republican attack groups.

– “Democrats for Health Care Compact” Member Michael Barnhart: Barnhart is currently the head of the Sunshine Review, a libertarian nonprofit closely linked with O’Keefe’s Sam Adams Alliance and the GOP training organization called American Majority. Barnhart’s career makes for a strange Democrat: he began his career working for various Republican members of Congress, moving on to work a Republican lobbying firm and the Washington Times.

The trio of Republicans are playing doctor as well. A group called “Physicians for the Health Care Compact” lists only Leo Linbeck III, Eric O’Keefe, and Michael Barnhart as members, despite the fact none of them are physicians. The contact for the group, Meghan Tisinger, is a political operative working for the Franklin Center, a fake news site set up by O’Keefe and other Sam Adams Alliance political staffers. Tisinger doesn’t appear to be a doctor either.

It’s not clear if the fake Democrats’ site, registered in March of this year, or the fake physician site has attracted any actual Democrats or doctors yet. But the larger Health Care Compact campaign has caught fire with Republicans.

Last month, Gov. Rick Perry (R-TX) was the latest to sign the measure into law. So far, Oklahoma, Georgia, and Missouri have already passed O’Keefe’s Health Care Compact law, and several other states may follow suit.

Well, the phrase he prefers is “personal responsibility”, but here is Rick Perry strutting his stuff at an economic roundtable in Dubuque, Iowa on Tuesday, explaining why everyone should be paying for their own health care costs rather than free riding on emergency room care:

“I think personal responsibility is one of the very important traits historically of America….One way to improve personal responsibility, he said, would be “having even a small co-payment for those that are on limited or fixed incomes on their hospital visits — just a little co-pay where they got a little skin in the game, if you will.”

“Rather than just showing up in the emergency room because they know the government is going to pay for it is really beginning to teach people again there is a cost associated with all these programs,” he continued, “and that personal responsibility, you know, really begins with each one of us and helping people understand better that the government is not there to be the be all and end all for everything.”

To be clear, Perry is saying that people would use less care if they had to pay every time they went into the doctor’s office or received a treatment. This “skin in the game” approach is very popular in conservative circles, even if it hasn’t been shown to actually lower health care spending and may discourage people from obtaining the kind of preventive care that can forestall chronic conditions. But, Perry’s basic underlining philosophy of taking “personal responsibility” for one’s health care spending is actually very similar to the kind of thinking that underlies the individual mandate provision in the Affordable Care Act and the GOP’s push for the policy in the 1990s.

As former Republican Senator Bob Bennett recently explained it, “I first got involved in it when Mrs. Clinton was the first lady and started putting forth some ideas. And at that time, the conservative approach, to which I gravitated quite naturally, was to have an individual mandate.” He went on to justify the policy in the same exact terms as Perry: “if you are going to take the position that we do in this country that if someone is ill, we will take care of them regardless of their ability to pay. If someone shows up in the ER bleeding we don’t say, ‘if you don’t show me an insurance card we are going to throw you out in the snow and let you bleed to death.’”