Citing increasing costs, Sens. Lindsey Graham (R-SC) and John Barrasso (R-WY) have introduced the Medicaid Flexibility for States Act, which would allow states to opt out of the Affordable Care Act’s expansion of the Medicaid program and effectively deny health insurance coverage to the poorest Americans:

“I’m confident that if given the chance a large number of states would opt-out of Obamacare’s forced Medicaid expansion,” said Graham. “In South Carolina, expansion of Medicaid under Obamacare will add an additional $1 billion in state matching funding requirements. When fully implemented nearly 30 percent of South Carolinians will be eligible for Medicaid. States like South Carolina can simply not afford this burden. Our bill takes the issue out of Washington and puts it back in the states. I would hope every Senator, regardless of party, would give the people of their home state a chance to be heard.”

Supporters of reform have always found this position a bit bizarre, since Medicaid expansion — up to 133 percent of the federal poverty line in the ACA — provides states with a lot of extra cash, insures more residents and allows states to reduce their uncompensated care costs. Under the Affordable Care Act, the federal government pick up the entire tab of Medicaid expansion between 2014 and 2017 and will pay for 95 percent of the expansion in 2017, 94 percent in 2018, and 93 percent in 2019. Beginning in 2020, the states will still receive a 90 percent match for the expanded population.

Yes, they’ll have to kick in some of their own funds, but the increases in state spending are small compared to increases in coverage and relative to what states would have spent if reform had not been enacted. In fact, as a recent report from the Robert Wood Johnson Foundation concluded that while state spending will rise by $80 billion on new enrollees, “the federal government will largely offset these costs with an anticipated $66 billion in new federal spending on existing Medicaid enrollees.” Also, state spending on uncompensated care could fall by 12.5–25 percent, “saving the federal government up to $87 billion, while states would collectively save $52 billion.”

The actuary in charge of the Affordable Care Act’s Community Living Assistance Services and Supports (CLASS) program has “sent an email to colleagues Thursday informing them that HHS is closing down his office on Friday,” The Hill’s Julian Pecquet reports. The news, which the administration is publicly denying, comes after a Republican investigation revealed that economists had warned HHS about the program’s insolvency.

If true, the demise of CLASS represents a substantial setback for the nation’s long-term care structure. Americans spend more than $200 billion a year on long term care services in nursing homes, at home, or in assisted living facilities. With limited private insurance options, “Medicaid is now the largest single provider of long-term care costs — it spent more than $100 billion last year, over one-third of its budget” and “paid more than 40 percent of the nation’s total long-term care bill.” By mid-century, the Congressional Budget Office predicts that Medicaid will use 16 percent of anticipated federal revenues to fund care for the baby-boom generation.

Impairment is generally very hard to anticipate or save for (about four in 10 people who need long-term care are actually under the age of 65), and families rarely purchase coverage or falsely assume that Medicare will cover their needs. Add to that the fact that the private long-term care market is highly unstable and expensive and as a result individuals often spend down to “$2,000 in financial assets” to qualify for Medicaid coverage.

CLASS, originally championed by Ted Kennedy, sought to fix the system by establishing a national insurance program financed by voluntary payroll deductions. The benefit was to be meaningful but limited — an average of at least $50 per day that recipients could use to pay for home-based or institutional service without becoming impoverished. But from the very beginning, economists worried that the program would have a hard time attracting healthier applicants and eventually pay out more in claims that it would collect in premiums. Secretary of Health and Human Services Kathleen Sebelius had responded to the criticism by reassuring Congress that “the program will not start unless we can absolutely be certain that it will be solvent and self-sustaining into the future” — a promise that, if this latest development is true, she is intent on keeping.

For all of the GOP’s efforts to demonize and underfund public health care programs, Medicaid, the Children’s Health Insurance Program (CHIP), and Medicare have played an absolutely crucial role in filling the gaps in America’s very broken health care system. They’ve kept millions of people from becoming uninsured and have helped “offset the continuing decline in job-based coverage”:

As this CDC report demonstrates, children have also greatly benefited from CHIP, which has actually picked up the slack from private insurers:

These are pictures to keep in mind the next time GOP offers drastic cuts to public insurance or argue for the repeal of the Affordable Care Act, which would only strengthen safety-net providers and expand Medicaid eligibility.

Radical anti-abortion groups including the Christian Defense Fund have come up with another over-the-top spectacle to try to shame pregnant women and make anti-choice legislators feel self-righteous. This time they’ve chosen Capitol Hill as the venue for the stunt, called “Voices from the Womb,” where the public and all 535 representatives are invited to the Capitol Visitors Center Auditorium to witness the groups performing live ultrasounds on pregnant women.

The Christian Post reports on the event, which they describe as “Pre-Born to ‘Speak’ Through Live Ultrasounds on Capitol Hill”:

Through the use of “real time” ultrasounds performed on women in the first through third trimesters of pregnancy, the public and members of the Congress will be able to hear for themselves what the beginning of life sounds like, straight from the womb.

Beginning at the Congressional Auditorium in Washington, D.C., “Voices From the Womb” will launch its national campaign in October “to let the children of America ‘speak’ for themselves about ending abortion,” according to a statement.

The Oct. 13 event, which is sponsored by The Stanton Project, the Christian Defense Coalition and the National Pro-life Center, is open to all 535 members of Congress and the public to witness history in the making.

The “show” on Capitol Hill is just the first step for the groups, which plan to take “Voices from the Womb” on the road with a “tour performing ultrasounds throughout nation, in schools, churches, state capitals, parks and legislative hearings.” Christian Post chirps that thanks to technological advances, “ultrasound machines are now much more compact and mobile than ones made previously” so the organization can “take its message to the streets, giving the unborn a unique opportunity to ‘speak’ for themselves.”

ThinkProgress contacted the Capitol Visitors Center to find out more information about the event. According to Director of Communications Tom Fontana, outside groups cannot use the Capitol Auditorium unless they’ve secured the sponsorship of at least one member of Congress. This suggests that “Voices From the Womb” is being hosted and attended by at least one elected official, although Fontana couldn’t comment on which members might be sponsoring the event, or even confirm it was happening.

That anti-abortion groups and lawmakers would be comfortable making a spectacle out of pregnant women in front of crowds belies their claim to care about the dignity of life.

Idaho may be part of a multi-state lawsuit challenging the constitutionality of the Affordable Care Act, but that isn’t stopping Republican Governor Butch Otter (R) from applying for millions of dollars in federal funding to set up health insurance exchanges. Otter — who has previously tried to claim credit for that particular provision of reform — announced on Tuesday that his state would be better off building its own marketplace than turning it over to the federal government:

“It’s a difficult choice, but one I find far preferable to submitting to a federally established insurance exchange, with all the loss of control over our own destiny that entails,” Otter said in a statement. [...]

“My goal is to establish a state-based exchange emphasizing free-market principles and create a competitive marketplace for individuals and businesses to obtain the coverage they need rather than imposing a one-size-fits-all solution that may not be suitable or even workable for Idaho.”

Idaho has until Sept. 30 to apply for the funds, which will help the state construct a market place where individuals and small businesses can compare and purchase comprehensive insurance plans beginning in 2014. The Idaho Association of Commerce & Industry lauded Otter’s decision, saying, “By requesting the grant dollars, Idaho will have the ability to carefully evaluate the actual cost of the development of an exchange and will only use those dollars as necessary.”

In 2010, 31 percent of Idaho residents between the ages of 18 and 34 lacked health insurance. Overall, 17 percent of Idahoans are uninsured, and years of rising costs have pushed the healthiest population to drop coverage.