Inside Health Policy’s Sahil Kapur reports that Republicans on the Super Committee continue to insist on lowering the health spending by increasing it — that is, repealing the one law that will not only reduce the deficit over 10 years, but also slow the rate of growth in national health expenditures. From yesterday’s inaugural meeting of the committee:

House Energy and Commerce Chair Fred Upton (R-WI) floated two specific proposals: reforming medical malpractice laws and cutting some spending from the Affordable Care Act.

“We can eliminate nearly $60 billion in federal spending by reforming our broken medical liability system and we can save tens of billions more by simply wiping out some of the unaccountable spending in the health care law,” Upton said in his opening statement.

House Republican Conference Chairman Jeb Hensarling (R-TX), who kicked off the hearing, said he believes the Medicare, Medicaid and health spending are the “biggest drivers of the debt.”

Again, Republicans aren’t wrong to argue that Medicare spending — all of health care spending — must be contained if we want to strengthen the economy, but the way to do that is to bolster the cost containment provisions in the Affordable Care Act, not repeal them. There is certainly some middle ground to be found on reducing malpractice costs (although those savings are relatively modest), but the real compromise has to come from expanding the bipartisan cost containment provisions already in the law.

After all, both Republicans and Democrats support the excise tax (Republicans wanted to do away with the entire employer health subsidy, while the ACA only eliminates the tax break for high-cost plans), a cost containment commission (the GOP calls the IPAB rationing, but Paul Ryan proposed very similar boards in his health bills), and delivery system reform (here is Newt Gingrich praising the efficiency improvements of CMS administrator Don Berwick). But Republicans are now seeking to repeal these measures because 1) they’re part of a Democratic bill signed by President Obama and 2) the current crop of Republicans is really more interested in privatizing the entire health care system — which would actually INCREASE health care spending — than they are in lowering health expenditures.

On Wednesday, responding to strong criticism, Florida’s Legislative Budget Commission approved Gov. Rick Scott’s request to accept millions of dollars it initially rejected from the Affordable Care Act to fund a home visitation program to help curb child abuse. The state has also kept more than “$13 million for a four-year abstinence education grant and for another program coordinating background checks for long-term care workers.”

But it is still turning a lot of money down, the Associated Press is reporting, declining to pursue more than $106 million in federal grant money and returning another $4.5 million “for programs linked to federal health care initiatives.” Republicans claim that they are rejecting funds to implement provisions of the Affordable Care Act, which the state is challenging in court, but critics are accusing lawmakers of cherry-picking programs that further their ideological goals. For instance, while accepting abstinence funding, the the state turned down:

– $875,000 over five years for a program that aids in cancer prevention and increases access to quality care for cancer patients

– $8.3 million allowing Osceola County Health Department to expand community health centers

– $500,000 to counsel patients on long term care options

– $2.1 million federal grant that would have fully paid for administrative costs to pave the way for an additional $35.7 million in Medicaid funding to pay for nursing home diversions of disabled and elderly patients over the next five years

– $50 million over five years for community health programs focusing on disease prevention

Florida is also refusing to accept federal funds to establish a health insurance exchange, despite having already established a similar structure in 2008 that could easily be converted to meet federal requirements. That marketplace, which had been championed by then state House Speaker Marco Rubio, is not yet operational. Meanwhile, the state has the country’s fourth-highest unemployment rate, second-highest rate of people without insurance, and a $3.7 billion budget gap this year.

Politico’s Susan Jaffe reports that just as progressives are trying to pressure President Obama to back off his support for raising the Medicare eligibility age, the American Hospital Association will be lobbying Congress to do just that — gradually raise the age to 67 and push more seniors to “buy their own health insurance through state insurance exchanges starting in 2014″:

Nevertheless, some state hospital officials traveled to Capitol Hill during the recess to pitch the idea to one House Democrat, ignoring a staffer’s stern warnings that the boss was firmly against it. “Every week we hear from someone who is just hanging on, waiting for Medicare coverage,” the staffer said.

The message was clear, the staffer says: “If you’re going to cut money out of Medicare, cut them, not us.” If budget negotiators don’t come up with $1.2 trillion in alternative cuts, Medicare payments to health care providers would be automatically reduced by two percent. AHA estimates that its members would lose an estimated $45 billion over nine years. And that’s on top of the $155 billion in Medicare cuts hospitals are facing under the health law.

You can read why raising the Medicare age is such a bad idea here, but the AHA’s push for the measure goes beyond simply avoiding painful cuts — the industry is also looking to make more money. The truth is, pushing 65 to 66 year olds off of Medicare — which can negotiate far lower reimbursement rates with providers — means that hospitals can score higher reimbursements from private payers in the exchange and earn more for providing the same services to the same patients.

HHS Secretary Kathleen Sebelius endorsed President Obama’s jobs bill in today’s Huffington Post, writing that the plan would “provide an immediate boost to America’s economy.” She argued that the Affordable Care Act will also improve job growth and touted a new round of community health care grants: “the availability of $700 million in new funding to support the renovation and construction of community health centers — an investment that will create thousands of good jobs in construction and health care while enabling more Americans to get the kind of affordable primary care that can keep them healthy and out of the hospital.”

Indeed, investing in CHCs — one area of health reform both Democrats and Republicans can agree on — totals $11 billion over 5 years and could “generate $54 billion in economic activity in 2015, with $33 billion of this a direct result of the additional investment in the new law” — that’s 457,300 jobs by 2015. The additional dollars will set off a job spiral: 1) health centers directly employ people in their communities, including key entry-level jobs, training, and other community-based opportunities and 2) health centers then purchase goods and services from local businesses and expand and build new locations. Thus, every dollar spent and every job created by health centers has a direct impact on local economies.

Republicans have long supported CHCs as a means of expanding health care coverage — despite proposing massive cuts to centers in the last year. Former President George W. Bush doubled U.S. financing for community health centers and Appropriations Committee Chairman Hal Rogers (R-KY) has described CHCs as “essential,” regularly touting new federal funds for CHCs in his district.

Despite concerns that any additional cuts to Medicare would muddy the Democrats’ political opposition to Paul Ryan’s privatization scheme, President Obama pledged to reduce Medicare and Medicaid spending as part of his new jobs plan last night. The $447 billion American Jobs Act will include an expansion of a cut in payroll taxes and new investment on public infrastructure projects that will be “paid for” through spending cuts, tax reform, and “by making modest adjustments to health care programs like Medicare and Medicaid“:

OBAMA: Now, I realize there are some in my party who don’t think we should make any changes at all to Medicare and Medicaid, and I understand their concerns. But here’s the truth: Millions of Americans rely on Medicare in their retirement. And millions more will do so in the future. They pay for this benefit during their working years. They earn it. But with an aging population and rising health care costs, we are spending too fast to sustain the program. And if we don’t gradually reform the system while protecting current beneficiaries, it won’t be there when future retirees need it. We have to reform Medicare to strengthen it.

Watch it:

The administration will release the details of the plan next Monday, but during an appearance on Rachel Maddow after the speech, senior White House adviser Valarie Jarrett explained — in terms that sounded remarkably similar to the rhetoric used by Republicans — that the Medicare cuts would not affect existing retirees. “If you listen carefully to what the President said, and if you look at the bill — he intends to strengthen Medicare, he intends to protect existing beneficiaries,” she said, adding, “the President is fighting to make sure that Medicare is available for future generations and that we protect those who are depending on those right now.”

Obama has already proposed billions in Medicare and Medicaid savings in April 2011 — as part of a broader deficit reduction proposal — and they may offer a hint as to the kind of off-sets he would include in the American Jobs Act:

– Strengthening the Independent Payment Advisory Board (IPAB) created by the Affordable Care Act by setting a new target of Medicare growth per beneficiary growing with GDP per capita plus 0.5 percent. Allow the board to “promote value-based benefit designs that promote proven services like prevention without shifting costs to seniors” and give it “additional enforcement mechanisms such as an automatic sequester as a backstop for IPAB, Congress, and the Secretary of Health and Human Services.”

– Adopting a “blended” rate for Medicaid reimbursements by replacing the series of federal matching formulas with a single matching rate for all program spending.

– Investing in “patient safety” to prevent patients from getting injured or sicker while they are in the hospital and helping patients heal without complication. Achieving the initiative’s goal would mean more than 1.6 million patients will recover from illness without a preventable complication, reducing costs by up to $50 billion in Medicare and billions more in Medicaid over the next 10 years.

– Prescription drug reform: limiting payments for prescription drugs by leveraging Medicare’s purchasing power and possibly extending Medicaid drug rebates to dual eligibles in Part D.

– Reducing abuse and increasing accountability in Medicaid and Medicare: prevent states from using provider taxes to lower their own spending “while not providing additional health services through Medicaid; recover erroneous payments from Medicare Advantage; establish upper limits on Medicaid payments for durable medical equipment; and take other actions to improve program integrity.”

These are just some of the options — a detailed walk through the many commissions that have offered their own deficit reduction plans would reveal even more savings. One would only hope that Obama also stays away from raising the Medicare eligibility age and considers strong progressive alternatives like aggressively implementing and expanding payment reform pilots.