Mitt Romney unveiled his economic policy today and in case you’re wondering his position on Medicare reform is this: he’ll propose something that’s similar but different from Paul Ryan’s Medicare privatization scheme. ‘Medicare’ — one of the single biggest drivers of government spending — is mentioned just twice in the 88-page report:

Any serious attempt to rein in spending will have to include entitlement reform. This issue is among the most complex facing policymakers, but some basic principles guide Mitt Romney’s position. First, we must keep the promises made to our current retirees: their Social Security and Medicare benefits should not be affected. But second, we should ensure that the promises that we make to younger generations are promises we can keep. [...]

Similarly, with respect to Medicare, the plan put forward by Congressman Paul Ryan makes important strides in the right direction by keeping the system solvent and introducing market-based dynamics. As president, Romney’s own plan will differ, but it will share those objectives.

Romney also reiterates his proposal to block grant the Medicaid program, which Republican governors recently rejected as a one-size-doesn’t -fit all solution. As Mississippi Gov. Haley Barbour (R) recently explained at the unveiling of the Republican Governors Association’s health policy report, “not all Republican governors may want a block grant. … It’s up to the states to decide.” Indeed, as a recent Kaiser Family Foundation report has pointed out, converting the existing matching rate formula into a block grant would give states less money that they would have otherwise received and force local governments to cut eligibility to the program. Kaiser examined different scenarios for state responses to reduced federal Medicaid spending and estimated 31 to 44 million Americans could lose their health insurance coverage.

In the final days of the Bush administration, the Department of Health and Human Services (HHS) adopted a “conscience rule” permitting federally funded health care providers to opt out of health care services they found objectionable. Then Health and Human Services Secretary Michael Leavitt argued that the new rule was necessary to protect the “freedom of expression and action” of medical professionals, even if its supposed beneficiaries disagreed. The American Psychiatric Association and the American Academy of Pediatrics, for instance, claimed that “doctors and nurses are already not required to perform abortions or sterilizations” and raised concerns about the rule’s vague definitions of “abortion” and the possibility that the redundant and unnecessary regulation could allow practitioners to deny women access to commonly used methods of birth control like “oral contraceptives, emergency contraception, and the IUD.”

President Obama condemned the rule and eventually reversed it. But yesterday, in an effort to strengthen his social conservative credentials and new-found pro-life position, Mitt Romney pledged to restore and strengthen the conscience protection:

Q: Would you restore them and perhaps even strengthen them?

ROMNEY: Absolutely. We have to allow people to practice their faith and when they have a matter of conscience that they can’t participate in some form of activity which violates their faith, then they should be able to abide by their faith, particularly when there are plenty of opportunities for people to have a service provided.

Watch it:

Under Bush, the additional conscience protection represented an ideological overreach, and it’s unclear why it would be any more necessary in 2012. In fact, during the rule’s open comment period, six medical associations issued a joint statement warning the Bush administration that expanding the existing standards would “effectively allow health care providers’ personal beliefs to override patients’ right to full disclosure of accurate information and available health care resources.” In a separate letter to the Department of Health and Human Services, 13 state attorneys generals also argued that “the rule was too vague about what health care procedures may be withheld.” “The proposed regulation completely obliterates the rights of patients to legal and medically necessary health care services in favor of a single-minded focus on protecting a health care provider’s right to claim a personal moral or religious belief,” they wrote.

But for Romney — and the social conservatives he hopes to please — conscience regulations are a means of limiting women’s access to reproductive services. They hope to muddy the waters and threaten both the diversity of beliefs in “our pluralistic society and the health and well-being of patients seeking care.”

When it comes to caring for our nation’s veterans, Republican presidential candidate Rep. Michele Bachmann (R-MN) has undergone an astonishing transformation in the last nine months. In January, she proposed a wildly unpopular plan to slash $4.5 billion in veterans services and reduce disability compensation for 150,000 veterans. Veterans groups blasted the proposal as “heartless,” “totally out of step with America’s commitment to our veterans,” and “showing contempt for American servicemembers’ sacrifices.” Facing an avalanche of criticism, Bachmann eventually withdrew her proposal.

But now that she’s running for president, Bachmann is billing herself as a great defender of veterans benefits. The Washington Independent reports that during a speech at the annual convention of the American Legion in Minneapolis last Thursday, Bachmann vowed to support and strengthen veterans medical care:

“It is our duty, first and primarily, to protect our veterans and to make sure that you receive not only the respect, but also the care that you have paid for very heavily with your service to our nation,” Bachmann told members of the American Legion Thursday.

“As president, I will assure that those who serve today as well, and in the past, have the highest access to the best care, both of health, mental health and rehabilitative care that the world has to offer.”

But Bachmann’s January plan, which was touted as a way to avoid raising the debt ceiling, would have brought about dramatic cuts to veterans services.

Bachmann’s plan would have frozen the Veterans Affairs Department’s health care spending and reduced the amount veterans receive in Social Security Disability Income. The congresswoman offered no explanation for her sharp reversal on the issue, but it’s hard to interpret her promise to strengthen veterans benefits nine months after trying to cut them as anything other than empty pandering to an important political constituency.

But regardless of the circumstances, it’s nice to see Bachmann embrace the sort of government-run health care program she typically denounces during her campaign stops as “unconstitutional” and “the crown jewel of socialism.” The Department of Veterans Affairs health care program is perhaps the best example of an entirely government-administered health care system, complete with its own doctors and hospitals.

Under the Affordable Care Act, 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. Last month, the Obama administration decided that the government would only provide subsidies to individuals whose single employer plans exceed the 9.5 percent threshold, preventing far larger numbers of families who pay more than 9.5 for group policies from receiving federal assistance. Now, First Focus, a child advocacy organization, is expressing concerns about the regulation:

Conversely, we are profoundly disappointed with the preliminary rules from the Treasury Department related to the cost of family coverage and how affordability will be assessed for subsidies. The proposed rule would make the cost of individual employer-offered coverage the basis for determining affordability for a whole family. This would exclude millions of families from eligibility for subsidies in the exchange and reduce the number of children currently covered under family plans. This interpretation of the law is a serious concern and would disproportionately harm children and women. We urge the Treasury Department to reconsider this preliminary rule.

On this, it seems that the federal government had a choice between increasing government spending on federal subsidies (since more families would become eligible) or staying within the cost estimates and keeping families off the rolls. It’s certainly a tough decision given the political climate, but one that may put a damper on coverage rates as families choose to pay the mandate penalty over maintaining their expensive insurance coverage. [H/T: Politico Pulse]

Three new editorials are condemning Virginia’s controversial draft regulations requiring state abortion providers to meet the physical plant requirements of hospitals. The guidelines — the result of legislation Gov. Bob McDonnell (R-VA) signed earlier this year — were formulated through an “emergency” process that bypassed the normal public notice procedures and require existing abortion clinics to meet the standards of brand new construction.

The Washington Post:

No justification has been given for such fast-track treatment. Abortions are among the safest of medical procedures. Virginia’s Department of Health does not keep track of complications associated with the 25,000 or so abortions performed in the commonwealth each year. But the Guttmacher Institute, a nonprofit think tank that focuses on reproductive health and supports legal abortion, reports that less than one-half of 1 percent of all abortions performed in the country result in complications and require follow-up medical treatment. The abortion clinics targeted by the Virginia legislation perform only first­ trimester abortions — the safest of all procedures.

Virginia Pilot:

Supporters’ claims that legislation requiring the new regulations was animated by concern for patient safety aren’t fooling anyone. If that were the motive, the law would have been aimed at raising the level of care at every outpatient surgical center across the state rather than simply those that perform five or more first-trimester abortions each month. [...]

Supporters of these regulations could’ve shown they were serious about the health and care of women dealing with unexpected pregnancies by working just as hard for an adequate support system. They could’ve pushed for more funding for prenatal care for low-income expectant mothers or greater public awareness campaigns about the effects of unintended pregnancies. They could’ve demanded more resources and more social programs, including greater access to childcare assistance, to show single mothers and teenage parents that they needn’t choose between ending an unintended pregnancy or resigning themselves to a life of poverty.

Richmond Times Dispatch:

If there’s one thing Virginia’s leading Republicans agree on, it’s government regulation. They’re against it. “Keep taxes and regulation and litigation low,” Gov. Bob McDonnell said in 2009 when he was asked how to make Virginia business-friendly. [...] The same goes for state Sen. Ryan McDougle. When he was sworn in for his second term in 2008, McDougle promised, among other things, to ensure that “you are not burdened with intrusive new government regulations.”

But a commitment to the principle of laissez-faire evidently goes only so far. Because this year McDougle sponsored the legislation requiring the Department of Health to write tough new regulations for abortion clinics. The board has now done so, and will vote on them next Thursday. McDonnell signed McDougle’s measure into law — apparently without a qualm and perhaps even enthusiastically.

The Virginia Board of Health will vote on the draft regulations — which may close as many as 17 of the state’s 22 abortion clinics — on Sept. 15, and if approved, they will go into effect on Dec. 31.

Mitt Romney defended his signature health care reform law during yesterday’s Palmetto Freedom Forum in South Carolina, insisting that the 2006 legislation requiring everyone to purchase insurance coverage would be “one of my best assets.”

“Our bill dealt with eight percent of our population — the people who were uninsured — and said to them, ‘hey, if you can pay don’t count on the government, take personal responsibility,’” Romney said. He articulated some of the differences between his law and President Obama’s approach and accused Obama of being the first president to make cuts to the Medicare program:

ROMNEY: We didn’t raise taxes, Mr. President. You raised taxed $500 billion dollars. We didn’t cut Medicare — one President in modern history cut Medicare, this President. And I’ll say to him, why didn’t you give me a call, and I would have told you what to do right and what not to do. And the critical thing is this, we dealt with 8 percent, he dealt with 100 percent of the American people.

Watch it:

But many presidents have made changes to Medicare since 1965, including Republican idol Ronald Reagan — who initially opposed the creation of the program, likening it to “socialism” and “communism.” But by the 1980s, Reagan, had come around to supporting the measure and instituted a series of reforms which are strikingly similar to some of the payment changes proposed by the Affordable Care Act (policies Romney now refers to as cuts or price controls.)

Reagan instituted DRGs or Diagnosis Related Groups for paying hospitals under Medicare. As David Henderson explains, “the idea was to get out of cost-based reimbursement, which gave an incentive to have high costs, and replace it with a system of prices,” in which hospitals were paid a pre-determined rate for each Medicare admission. “But what made it a system of price controls was that the government, along with DRGs, made it illegal for hospitals to charge even a penny more than the price the government came up with.” As a result of the changes, Medicare saved $49 billion by 1986, far exceeding what even the Congressional Budget Office had predicted.