NBC’s Carrie Dann and Matt Loffman are reporting that Rick Perry railed against the Affordable Care Act during a stop in Florence, South Carolina this morning, arguing that the law will bankrupt the states and promising to repeal it if he’s elected to the presidency:

“If I’m so fortunate to be elected the president of the United States, on Day One, when I walk into the Oval Office, there will be an executive order on that desk that eliminates as much of ObamaCare that I can have done with an executive order,” he said in remarks at at a hospital complex here. “Now hopefully, Lord willing, the 11th Court of Appeals has already found that that individual mandate is unconstitutional, and hopefully that will be gone to the Supreme Court, and I won’t have to deal with that.” [...]

Perry also said the costs of implementing the health-care law would force Texas to raise taxes — and that other states will be bankrupted as a result of “ObamaCare.”

Perry may certainly disagree with the way the health care law expands coverage, but he can’t honestly say that Texas will go bankrupt if it implements the measure.

Consider the provision that Perry is most concerned about — expanding the Medicaid program to 133 percent of the federal poverty line. Texas, with its narrow Medicaid coverage levels, will experience large reductions in the uninsured and could see up to 1.4 million Texans enroll in the program by 2019.

Under the law, the federal government picks up the full costs of expansion for the first two years and the states begin contributing on a sliding scale thereafter. Fortunately for Texas, “states with low coverage levels today will see the vast majority of the costs of new enrollment financed by the federal government over the 2014 to 2019 period because most of their increased enrollment is from individuals made eligible by health reform who qualify for the high newly eligible match rate.” More federal dollars will be coming into the program and they’ll cover the overwhelming majority of the cost for the newly insured. The Kaiser Family Foundation estimates that if Texas experiences an enrollment increase of 46 percent, it will see a 39 percent spike in federal spending and just a 3 percent increase in state spending. That means that the federal government will be picking up 95 percent of the tab for Medicaid expansion between 2014 and 2019.

The states’ costs could also be offset. For instance, insuring more people means that the state would also have to spend less on uncompensated care and according to the Urban Institute, those costs could decline by 55 percent between 2014 and 2019, from $21.3 billion without reform to $9.6 billion with it. In fact, if the law is fully implemented, Urban estimates that state savings would exceed states’ new costs and Texas could actually achieve a savings of $554 million.

Herman Cain claimed that he would “be dead” if he had been treated for his cancer under the Affordable Care Act. Speaking in Lexington, SC on Thursday, Cain explained that the health care law would have limited his choice of doctors and prevented him from receiving medical treatment:

CAIN: If ObamaCare had been fully implemented when I caught cancer, I’d be dead and here is why. I was able to go to the doctors that I wanted to go to, as fast as they could do the test. I didn’t have to wait six months like they do in other countries before they get a CAT scan. And sometimes people die before they get the CAT scan, because the cancer spread so fast. But because I was able to get the treatment as soon as I could and get quality care that I did, that’s what kept me alive today.

Watch it:

The Center for Budget and Policy Priorities’ Paul N. Van de Water has a blog post up articulating what I’ve been saying for some time: before making any additional reductions to the Medicare program, lawmakers on the deficit super committee should allow the existing cost-cutting provisions in the Affordable Care Act to go into effect:

These reforms will take time to plan, test, and implement. But they can succeed only if we give them a chance, and that won’t happen if health reform opponents succeed in repealing them.

Even if all of the ACA’s savings materialize, we’ll need to do more over the long run to slow the growth of health care costs in the private and public sectors alike. In the near term, however, achieving large additional savings will be difficult, since the ACA includes most of the good ideas for slowing the growth of Medicare spending. Other proposals, like increasing the age of eligibility for Medicare or replacing the program with vouchers that wouldn’t keep pace with health costs, would generally just shift costs to beneficiaries, states, and employers — and in many cases would increase total health care spending.

Given the limited possibilities for more Medicare cuts in the next five to ten years, the congressional “supercommittee” needs to develop a balanced package of deficit-reduction measures, including significant additional revenues, to reach its goal of achieving $1.2 to $1.5 trillion in deficit savings over the next ten years.

Policy-wise this makes a lot of sense. Many of the provisions included in the Affordable Care Act tackle the kind of system inefficencies and redundancies that both members of political parties say they want to eliminate and so one would think that they are focusing their energies on ensuring that those provisions are implemented to maximum affect. But politically, we’re at a place where Republicans are demanding full and complete repeal of the law — including the very modernization provisions they say they support — and are advancing far deeper cuts to entitlement programs. Some of those reductions are very similar to what’s already in current law, others (like the Ryan plan) would shift the cost of health care to beneficiaries. This approach would allow the federal government to spend less on health care, but would do very little to actually lower the growth rate of costs system wide.

So, given all that, it seems that the obvious compromise — and one that will actually accomplish the goal of slowing down the cost growth — is to keep the law intact, allow for the implementation of the modernization provisions and maybe bolster their effectiveness by enhancing some of the delivery reforms and other payment alternatives. But making any other significant changes on top of the existing cuts is probably risky and could undermine the integrity of the programs.

Ezekiel Emanuel is a former special adviser to the White House on health care, a world-renowned biothesist, and now a senior fellow at the Center for American Progress.

During the health care reform debate, conservatives manipulated his work on end-of-life care and health system modernization in order to support their narrative about government “rationing” and “death panels.” On Wednesday, I spoke with Emanuel about the GOP’s rhetoric about cost-control, where the health care debate stands today, and what kinds of policies progressives should be advancing.

Q: Are you concerned that the debt ceiling agreement will undermine the Affordable Care Act?

EMANUEL: What’s proposed in the agreement is sort of an across-the board 2 percent cut. Almost anyone who has run any kind of organization knows that across the board cuts are rarely prudent or wise — you don’t distinguish between good programs and bad programs, between things that are really essential and are really superfluous or are worse. So it may be necessary as a deal, but I think there are smarter ways to cut Medicare, and by the way, beyond the Super Committee, we are going to have to examine Medicare and modernize it and make it most efficient in what it does.

Q: It seems like the entire conversation about cost-control is focused on shifting costs to Medicare beneficiaries, whether it be through the Ryan voucher, or raising the Medicare eligibility age. As someone who has written about modernizing the system by getting rid of its inefficiencies — not paying for procedures and treatments that don’t work — what do you make of today’s public conversation about cost control?

EMANUEL: We don’t have to cut the bulb here in Medicare. There are smart ways of doing things and many alternative ways that get rid of what is classically waste or inefficiency in the system. So I think that beneficiaries — if we do the proper thing — don’t have to be stuck with unnecessary costs. They do not have to shoulder more of the burden. And or we have to raise taxes to pay for this. That’s a false choice and I think that one of the things that bothers me about the discussion is that we’re either rationing care or we’re cost-shifting. That’s a completely false dichotomy in my opinion. We have to actually modernize the Medicare health care system.

You got these Republicans who want to voucherize the system or do other things, and our response is don’t touch Medicare. No, we have to reform it. It’s not a perfectly running system and there are things that can be done. Let’s start with just a few, one is you could stop paying for care that is proven not to be beneficial or expensive. There are other changes we can also make. People floated an auction to bring down the prices of medial durable equipment. Unfortunately, the way the first auction was structured was not well, our job is to structure that well.

Q: Are you talking about ramping up some of the cost containment policies already in health care reform? Some of the demonstration protects in the law?

EMANUEL: Absolutely. This is the funny thing. Republicans want to undercut the bill, but some of the best cost containment measures, certainly over the next decade are right in the Affordable Care Act and they get everything everyone has been championing. Better coordinated care that’s cheaper, focusing on keeping people out of the hospital rather than on “sick care.” All that’s in the bill. Part of what we need to do is focus on its proper implementation rather than challenging its constitutionality or trying to prevent it from happening.

Q: How should we be talking about these things? It seems that in the beginning, people tried to have that conversation and then you started hearing a lot from people like Betsy McCaughey, who took your work and distorted it. On Wednesday, Michele Bachmann was in Iowa and explained that Obama would end Medicare and that all health care decisions will be made by the 15-member Independent Payment Advisory Board (IPAB). If you’re advising Obama, how should he frame this discussion?

EMANUEL: I think the first thing is, it’s important for people who are defending the Affordable Care Act not to leave the playing field to people like Michele Bachmann. We need responsible voices out there, I think. This is one of the areas I don’t think the administration has been particularly adapt at communicating — a) what’s in the Affordable Care Act and b) why it’s going to be helpful to people. Otherwise, you do get death panels, rationing, and all of that. The public, the medical profession are apprehensive, and a major reason they’re apprehensive is the Affordable Care Act and how it’s going to modernize the health care system has not been explained to them. That is a major challenge.

Tom Coburn is really on a roll this summer. He has suggested that taking care of the elderly is unconstitutional, speculated that President Obama is created a culture of dependency because of his race and now Kevin Drum notices that ‘s even said that American health care system was better off before Medicare was enacted in 1965:

He went on to say that government programs such as Medicare are primarily responsible for rapidly rising health-care costs, and that Medicare has made the medical system worse.

“You can’t tell me the system is better now than it was before Medicare,” he said.

Coburn agreed that some people received poor care — or no care — before Medicare was enacted in the 1960s, but said communities worked together to make sure most people received needed medical attention.

He also conceded that doctors and hospitals often went unpaid for their efforts, or accepted baked goods or chickens in partial payment.

Here are the facts: since 1965, “the health of the elderly population has improved, as measured by both longevity and functional status,” and senior poverty rates have plummeted. According to a study from Health Affairs, life expectancy at age 65 increased from 14.3 years in 1960 to 17.8 years in 1998 and the chronically disabled elderly population declined from 24.9 percent in 1982 to 21.3 percent in 1994.”

Prior to Medicare, “about one-half of America’s seniors did not have hospital insurance,” “more than one in four elderly were estimated to go without medical care due to cost concerns,” and one in three seniors were living in poverty. Today, nearly all seniors have access to affordable health care and only about 14 percent of seniors are below the poverty line.

And so, the system isn’t only “better off” with Medicare, but the program is so popular that seniors continue to support it in overwhelming majorities and would expand it to younger populations.