Bush HHS Secretary and former Wisconsin Gov. Tommy Thompson (R) — who is strongly considering running for the Senate — appeared on ABC’s Top Line this afternoon and denied supporting portions of the Affordable Care Act, unequivocally stating, “I do not support Obamacare”:

KlEIN: President Obama himself was out there touting the support of fomrer HHS Secretary Tommy Thompson, this is obviously something you know. Were you supportive of this when it made its way through Congress?

THOMPSON: No. I supported a bipartisan approach for health care. I did not support Obamacare. I’ve come out against Obamacare time and time again. In fact, I gave another speech against it in Chicago this past Friday evening. Obamacare is one of the problems facing Wisconsin and America’s economy. I do not support it. I support health care reform, I got my solutions and I will be articulating those if in fact I do become a candidate.

Watch it:

But the truth is far more complicated. In June, Thompson penned an editorial for the Huffington Post urging Republican governors to adopt the Affordable Care Act’s health insurance exchanges, just months before he praised the law’s payment reform provisions. “The Affordable Care Act gives great discretion to the CMS Administrator to experiment with alternative payment systems. CMS has created an ‘innovation center’ and is looking for ideas,” Thompson wrote on April 20, 2011. In fact, he even tried to dissuade Republicans from repealing the measure, saying during an appearance on CNBC in November 2010, “When it’s all said and done, you’re not going to be able to repeal health care because President Obama is not going to sign it…And they don’t have enough votes to override a veto, so why push a cart uphill when you know it’s not going to be able to get to the top?”

Thompson’s steadfast support for the measure has even raised questions if he’s profiting from it. Currently out of government, Thompson is a partner for Akin/Gump, where he “focuses on developing solutions for clients in the health care industry, as well as for companies doing business in the public sector.” His clients potentially include America’s Health Insurance Plans — the powerful health insurance lobby — Aetna, and other sectors of the health care industry that may stand to benefit from the very exchange structure he’s advocating.

Austin Frakt has a good post explaining that market concentration may sometimes be a good thing in health care and that too much competition between insurers could allow providers to dictate prices, leading to higher premiums. The trick is to find the right balance between insurer strength (so that insurers can negotiate for cheaper reimbursement rates with hospitals and doctors, but still feel pressured to pass those savings on the consumers) and provider concentration — ensuring that doctors and hospitals aren’t so dominant that they can just dictate reimbursement rates.

“This all implies there is a sweet spot, a degree of market concentration of insurers relative to hospitals that leads to the lowest premiums. That’s what my figure illustrates,” Frakt writes:

So what would this have meant for the public option, which many progressives touted as the answer to breaking up concentrated health insurance markets and realizing some real premium savings? Well, Frakt is suggesting — as many economists did throughout the health reform debate — that the public plan’s success would have depended on its size, meaning that a plan with millions of members could have gotten away with paying Medicare-like rates that providers wouldn’t have been able to turn down given its very large number of beneficiaries. And, if the plan simply piggybacked on Medicare and relied on its claims processes and fees it would have been able to lower premiums and attract more enrollees. Meanwhile, smaller insurers would didn’t have those kinds of advantages and would have been likely stuck paying providers higher rates.

One of the most common Republican narratives during the health care reform debate argued that lowering the subsidy to private insurers participating in Medicare Advantage would force companies to stop offering coverage, causing 10 million seniors to lose their Medicare benefits. Republicans introduced numerous amendments instructing Congress to remove the cuts to the Medicare Advantage program and Sen. John McCain (R-AZ) even urged seniors to rip up their AARP cards in protest of the organization’s support for the reductions.

But on Friday, a new report from the Kaiser Family Foundation found that the GOP’s dire predictions are not coming true. In fact, “enrollment in Medicare Advantage continued to rise despite changes in the law that froze Medicare Advantage payment rates to 2010 levels”:

Despite concerns about the effects of the 2010 health reform payment reductions on Medicare Advantage plans, enrollment has continued to rise, average premiums have declined, and many large national firms are keeping a strong foothold in this marketplace. As in past years, Medicare Advantage enrollees appear to be attracted to plans as a source of relatively affordable supplemental coverage, with lower premiums than beneficiaries typically pay for Medigap supplemental policies.

The Affordable Care Act — which cut $145 million over 10 years from Medicare Advantage– froze the 2011 reimbursements to health plans at 2010 levels, meaning that insurers were paid 10 percent more than rates to health care providers in traditional Medicare, compared with 13 percent more in 2009. Beginning in 2012, the growth in payments will continue to decrease by different amounts in different parts of the country. But ultimately, offering benefits will still be profitable, Democrats argued, and will encourage inefficient Medicare Advantage plans to follow the model of the efficient plans without undermining access to guaranteed benefits. The law also introduced a system of bonus payments to reward plans with superior performance.

Executives from firms that participate in Advantage told Kaiser that even with the cuts, “the amount of money that flows to Medicare plans is significant. A single Medicare enrollee draws about $910 a month for private plans, according to Barlcays Capital analyst Joshua Raskin. Plans expect to earn about $41 a month per member, after paying medical expenses. That’s more than double the average earnings from commercially insured members, according to Raskin’s analysis.” The analyst said “he expects plans to continue to remain profitable and grow, despite the cuts, albeit more slowly than they would have without the health law.”

I hadn’t seen this poll from the University of Maryland (via @SarahKliff) showing that 59 percent of Americans said that gradually raising the Medicare eligibility age from 65 to 68 was either acceptable or just tolerable, but if I were a super committee member considering this policy as a means for reducing the deficit, I wouldn’t put too much credence into it. First, an overwhelming majority of Americans support Medicare — particularly those who benefit from it — and a majority also favor expanding the program to younger generations (recall that this option was briefly considered during the health care reform debate):

Second, once Americans actually learn about the consequences of raising the age — namely that it simply shifts costs to employers that provide health coverage for their retirees, to Medicare beneficiaries, to younger people who buy insurance through the new health insurance exchanges, and to states and would have little effect on the trajectory of Medicare’s long-term spending — I suspect that any favorable views towards the policy will diminish.

Former presidential candidate and Minnesota Gov. Tim Pawlenty formally endorsed Mitt Romney for president this morning, telling Fox News’ Fox & Friends that Romney is “unmatched in his skills, and experience, and talent when it comes to turning around this economy and growing jobs.” Pawlenty also walked back his past criticism of Romney’s Massachusetts health care law — a plan he had dubbed “Obamneycare” — and explained that Romney was committed to repealing the Affordable Care Act:

PAWLENTY: Mitt Romney is 100 percent dedicated and committed to repealing Obamacare. He has said on day one and when he’s president, he’s going to issue executive orders that will give states waivers from Obamacare and then he will take the additional steps to repeal it. He understands and believes and has asserted himself, while it was right for states to take different approaches, that it was wrong for President Obama to bring that to a national plan and Mitt Romney is committed to repealing that and I know and trust that that’s what he’ll do.

Watch it:

But back in June, while still a candidate for the presidency, Pawlenty was singing a different tune, arguing that “President Obama designed Obamacare after Romneycare and basically made it Obamneycare.” “We now have the same features, essentially the same features,” Pawlenty said. “What I don’t understand is that they both continue to defend it. I took a different approach in Minnesota, we did market based reforms”:

With today’s announcement, Pawlenty isn’t only patching over his claims that Romneycare laid the foundation for President Obama’s law — he’s defending Romney’s Massachusetts health reforms and parroting his illegal pledge to opt states out of the Affordable Care Act if he’s elected president. The reality is that under the national law, the executive branch and the Department of Health and Human Services (HHS) don’t have the authority to grant blanket waivers — those powers are reserved for Congress.

Still, this isn’t the first time Pawlenty has praised Romney’s leadership on health care. In 2006, the former Minnesota governor — fresh off a close election victory for his second term — said his administration has been “studying very diligently the Massachusetts model about how that would apply to Minnesota” and pledged to “move in stages” toward “universal coverage.” “Everyone should be in a health plan of some sort…but I think as a goal we should start with covering all kids,” he said. Pawlenty also called the mandate a “potentially helpful,” if incomplete, solution to covering the uninsured but “one that we’re intrigued by and I think at least open to.” He considered the mandate option, but ultimately rejected it.

Kaiser Health News’ Phil Galewitz examines the denial rates for insurance policies purchased in the individual market — published for the first time as a result of the provisions in the Affordable Care Act — and finds that insurers turn down applicants for coverage at different rates depending on geographical location and for almost any reason. For instance, a review of the 20 most populous states find that “denial rates routinely exceed 20 percent and often are much higher” and seem to contradict industry claims to the contrary:

The information provides fresh evidence of the challenges facing people buying individual health insurance. It also shows the likelihood of whether consumers are approved for a policy depends on which state they live in and the insurer they choose.

Denial rates can vary widely within individual states. In Georgia, for example, Aetna’s denial rate is 15 percent compared with 47percent for Kaiser Permanente and 67 percent for John Alden Life Insurance. [...]

Using the data from the website, a Government Accountability Office study of 459 insurers published earlier this year found an average of 19 percent of applicants nationally were denied coverage. But the study showed a wide range of denial rates. A quarter of insurers had denial rates of 15 percent or below and a quarter had rates of 40 percent or higher.

A recent government analysis found that “50 to 129 million (19 to 50 percent of) non-elderly Americans have some type of pre-existing health condition” and would have a hard time enrolling in individual insurance or finding an affordable coverage option. Under the new health law, insurers will be prohibited from denying coverage due to pre-existing conditions or imposing waiting limits on less profitable applicants. Still enterprising issuers will engineer new ways to avoid taking on less healthy patients who spend more on care than they contribute through premium dollars, meaning that regulators and lawmakers have to remain vigilant of industry cherry picking if the sickest Americans are to have access to the coverage they need.

HHS to announce new health IT regs: “Health and Human Services Secretary Kathleen Sebelius plans to announce today rules making it easier for patients to see, use and add information to their personal electronic health records….The new regulations mean a doctor will be able to send prescriptions directly to a pharmacist instead of using a paper prescription. Specialists will be able to see what tests and prescriptions other doctors have ordered.” [USA Today]

Will Obama’s jobs bill undermine growth in health industry? “Health care providers are warning that President Barack Obama’s new jobs plan could actually siphon jobs from one of the few industries still hiring — because the only way to pay for it would be to make deeper cuts in the health care entitlement programs.” [Politico]

Virginia moving forward with exchanges: “Virginia’s Health Reform Initiative Advisory Council is busy prepping final recommendations on how to set up a state health benefits exchange as mandated by President Obama’s health care overhaul — even as the commonwealth remains locked in litigation over the constitutionality of the law.” [Washington Times]

New York is lagging behind: “Although Gov. Andrew M. Cuomo proposed creating the insurance exchange, and the State Assembly, with a Democratic majority, approved it, the Republican-controlled Senate refused to take it up before the Legislature adjourned its regular session at the end of June. Now, Republican lawmakers are balking at returning to Albany to consider the matter, as deadlines pass, and Mr. Cuomo, despite an unexpectedly harmonious relationship with Senate Republicans, appears to be unwilling to force the issue at this time.” [NYT]

Federal role likely in exchanges: “Across the country, states are lagging in preparations to erect the health insurance market­places at the heart of the 2010 health-care overhaul, bogged down by a combination of partisan hostility and practical hurdles.” [Washington Post]

Bachmann attacks Perry over Social Security ‘Ponzi scheme’ comments: During an interview with Radio Iowa, Bachmann didn’t mention Perry by name, “but she left no doubt he was in her sights when she said it was “wrong to make senior citizens believe that they should be nervous about something they have come to count on.” [NYT]

Fetuses don’t feel pain at 20 weeks: A new study shows that “preemies begin to feel pain around a woman’s 35th week of pregnancy, about two to four weeks before delivery,” undermining conservative claims that a fetus can feel pain after 20 weeks. [ABC News]

Doctors using social media to connect with patients: “Two-thirds of physicians are using social media for professional purposes, and see potential in the use of these channels to facilitate patient-physician communication. The survey found a cadre of “Connected Clinicians” who use multiple media sites to positively impact patient care. Over 20% of clinicians use 2 or more sites.” [Health Populi]