The Republicans’ super committee proposal to reduce the deficit would make much deeper cuts to Medicare and Medicaid and achieve less deficit reduction that the plan offered by Democrats last week, the Center for Budget and Policy Priorities (CBPP) concludes in a new report. For instance, “four-fifths of the Republicans’ proposed Medicare cuts— $400 billion — would directly affect beneficiaries through higher premiums, higher cost sharing, and more restrictive eligibility criteria,” while Democrats include $200 billion in reductions to beneficiaries.

As a result, the GOP’s plan — when coupled with the reductions to Medicaid — would substantially impact lower-income beneficiaries:

Since half of Medicare beneficiaries had incomes below $21,100 in 2010, it would be virtually impossible to achieve this level of beneficiary cuts without imposing substantial increases in out-of-pocket costs on near-poor elderly and disabled people — those between 100 and 200 percent of the poverty line (about $11,000 to $22,000 for an individual). Yet the typical Medicare beneficiary in this income range already pays 23 percent of income for out-of-pocket costs, a percentage that would increase significantly under both plans — especially under the Republican plan. [...]

The Republican plan also would make far deeper cuts in Medicaid — $185 billion versus $75 billion over ten years under the Democratic plan. Cuts of this depth would shift substantial costs to state governments, which would lead to state actions that limit care for the low-income children, parents, seniors, and people with disabilities whom Medicaid serves.

Look:

During a roundtable with voters in Iowa this morning, Rick Santorum explained how Paul Ryan’s plan to privatize the Medicare program for future enrollees would “ration” care to seniors by capping the amount of money beneficiaries would have to spend on health care services:

SANTORUM: There will be a rationing of care, there has to be. There is a rationing of every economic resource. There is not unlimited amounts of money to spend on anything…[Obama] has put a cap. Now, that’s one way of solving the problem. The other way of solving the problem is to put a cap in a different place and what Paul Ryan suggested and I believe in — in fact advocated for in 2003 as part of Medicare….which is putting a cap on the amount of money we give you to buy your own insurance. So instead of capping the overall budget and making you wait, thinking you got a card, but the card isn’t going to be worth anything, because you got to wait for it, we’re going to put the cap on the other end — on you.

Watch it:

Santorum attempted to establish equivalency between the Affordable Care Act’s Independent Payment Advisory Board (IPAB) — a 15-member commission that would make recommendations to Congress about lowering Medicare reimbursements if costs increase beyond a certain point — and Ryan’s plan to “limit the government’s exposure” by giving seniors pre-determined vouchers with which to purchase private coverage. But the differences couldn’t be greater: while health reform will begin to change not just how much providers are paid for their services, but how they’re paid for delivering them, the Ryan plan shifts simply some of the costs borne by the federal government to the individual without improving the system’s efficiency or removing its many redundancies. As a result, the federal “cap” that Ryan imposes will fail to keep up with skyrocketing health care spending and force seniors to pay more for the same package of benefits every year.

After an exhausting number of flip-flops on the issue, GOP presidential candidate Herman Cain once again changed his position on a woman’s right to choose. Asked at the National Press Club under what circumstances abortions should be allowed, Cain reiterated, “I am pro-life, from conception. End of story.” This is what he’s held all along. However, when asked whether he’d back legislation that bans abortions without exceptions, he said, “Yes I would.” Watch it:

This is in direct conflict with his own campaign, which insisted that he — like President George W. Bush — supported exceptions for rape, incest, and to save the life of the mother. When asked whether he’d support such a ban on the state or federal level, he said, “I can’t determine the state level, but I would support that at a federal level if that legislation were to come to my desk.” This, incidentally, also contradicts his statement that he’d sign a constitutional amendment that would mandate an abortion ban on all states.

Conservative blogs and Fox News lit up this weekend after House Minority Leader Nancy Pelosi (D-CA) told CNBC on Friday that the businesses that received government waivers from the Affordable Care Act are “small,” gleefully pointing out that large corporations like McDonalds also applied for and were granted exemptions. Watch the segment:

The story perpetuates two important Republican myths — one completely unsubstantiated and refuted charge that Democrats inappropriately influenced HHS to grant waivers to politically-connected unions or companies in Pelosi’s district, and the second that the waivers themselves are proof that the law is not working as intended.

The waivers — some 1,800 in all — are part of the law itself and speak more to its success than failure. The ACA provides HHS with flexibility to grant businesses and states additional time to comply with the law’s requirements, permitting these entities to gradually transition beneficiaries from subprime insurance into more comprehensive basic coverage. In other words, the waivers are a bridge to 2014: businesses with insurance plans that are structured in such a way as to make it impossible to meet the regulations surrounding annual limits and medical loss ratios will have additional time to redesign their benefit packages and won’t dump coverage for their existing employees before they can enroll in insurance through the state-based exchanges.

If anything, the flexibility that waivers provide undermines the GOP’s main criticism against reform — that the ACA is a one-size-fits-all law designed by bureaucrats without taking the needs of business into consideration. And conservatives are now pretending that in following the letter of the law, the administration is actually allowing businesses to circumvent it.

More than a hundred members of both parties are urging the super committee to avoid tinkering with the employer tax subsidy for health care coverage, warning that any changes to the long-standing system “would have far reaching consequences that would not only reduce health coverage for millions of Americans, but would also increase long-term federal spending obligations,” the Hill’s Julian Pecquet reports. From the letter:

Considering the tax exclusion is the lynchpin of this framework, capping or eliminating it would erode our largest system of health coverage and incentivize employers to drop or to curtail coverage. For their workforce, substitute coverage would only be available through the individual market, where comparable coverage is more expensive for most consumers– even as new options become available under the Affordable Care Act. And, due to the realities in our insurance system, the change would impact more vulnerable demographics of working Americans to a greater degree than others. [...]

A study on the high-cost health plan tax conducted by the American Academy of Actuaries concluded that the proposal would disproportionately impact early retirees by a striking margin, not because their plans are more generous, but because they are actuarially more expensive to cover. The report also concluded that small businesses and high-risk professions would also be disproportionately impacted, again, not based on generosity of benefits, but because of longstanding actuarial realities.

The GOP’s opposition to ending the tax exclusion is significant, since several prominent Republicans have proposed replacing the Affordable Care Act with a “market based” health care solution that ends the employer tax subsidy and provides tax credits that would allow families and individuals to purchase health insurance coverage on the individual market. Republicans in the House also voted for a very similar plan in 2009 as part of their alternative to Obama’s health reform legislation.

During a speech at the Heritage Foundation earlier this month, Sen. Orrin Hatch (R-UT) strongly came out against the idea, arguing that such a proposal would “disrupt this whole country.”

Anti-choice activists are driving an increasingly radical and successful attack against a woman’s constitutional right to choose. Be it through “personhood” measures or anti-contraception bills, Republican lawmakers are trying to ban abortions under any circumstances, including rape, incest, or even when the mother’s life is in danger.

Following anti-choice activists down this radical road, GOP presidential candidate Herman Cain recently declared, “I am pro-life from conception. [No] abortions, no exceptions.” Cain’s campaign has since insisted that he in fact does support exceptions. Yesterday on Capitol Hill, Rep. Gwen Moore (D-WI) bemoaned Cain and Republicans increasing extremism on abortion. Noting that most Americans agree “that you shouldn’t have to die in order to bring a child into the world” and that “it was OK to have birth control,” she blasted the GOP for “branding themselves” as anti-government intrusion while trampling a woman’s privacy as obviously “hypocritical”:

MOORE: I think that people have overreached. This is a debate where really good decent people on either side of a woman’s right to choose can disagree. And I think where people had gotten to, people at least decided that you had the right to terminate a pregnancy if your life was in danger. That you shouldn’t have to die in order to bring a child into the world, I think people had gotten to that point. I think people had gotten to a point that if you were a victim of a traumatic rape or incest or some unusual circumstances like that that you deserved to have an abortion. [...]

And I think we’re seeing a defiance here, that really overrides the majority of American opinion, that this is something that is a private issue between a woman and her family, her doctor, and certainly an issue between a woman and her relationship with God. So Republicans who like to brand themselves as being independent of government control and regulations certainly are hypocritical with respect to this issue.

Watch it:

Of course, Cain may yet again be switching his position on abortions. If given a few hours, he’ll undoubtedly be on the radical road again.

With federal money drying up for Medicaid, states are shouldering a greater cost burden and making significant cuts to balance their budgets — just as the economic downturn is expanding the pool of eligible applicants. Since federal stimulus money ran out in June, states have spent 28.7 percent more this year on their Medicaid programs and have turned to cost-cutting strategies as a result. A study from the Kaiser Family Foundation released yesterday provides a breakdown for how many states are cutting services and benefits to contain costs:

– 46 states Introduce new provider rate restrictions, up from 39 states in 2011.

– 48 states Add provider taxes to hospitals and nursing facilities to compensate for the provider rate cuts.

– 18 states Cut benefits for consumers.

– 13 states Expand benefits, the same number as this year.

– 3 states Cut eligibility, up from two in 2011.

– 14 statesIncrease copays, up from five states in 2011.

– 33 states Expand long-term care, compared to 32 last year.

– 13 states Expand benefits, the same as this year.

– 15 states Expand eligibility, compared to 28 in 2011.

Meanwhile, state economies also feel the impact of the cuts. A June report from Families USA shows that a 5 percent cut in federal Medicaid cut means a $3.8 billion loss to New York’s economy and almost 30,000 jobs lost.

This Kaiser Family Foundation brief about the nation’s ballooning spending on long-term care insurance is particularly pertinent in the aftermath of the administration’s decision to abandon the Affordable Care Act’s CLASS program. To be clear, CLASS was never designed as an alternative to comprehensive insurance — it offered only a modest benefit, but advocates hoped that the program could serve as a first step towards a more serious (and sustainable) government investment in long-term care. As former CAP fellow Judy Feder put it during a recent interview with NPR, “What a government program, even a limited one offers, is an opportunity to put government behind an education, a marketing effort. It can actually support the purchase of private long-term care insurance alongside a modest public benefit.”

Most importantly, the program offered some sort of an answer to the nation’s current reliance on Medicaid for long-term needs, which as Kaiser explains, is simply unsustainable. Consider:

- Medicaid has evolved to become our nation’s primary payer for long-term services and supports, financing nearly half (43 percent) of all spending on long-term care services.

- Among those using long-term services and supports, the average annual spending per Medicaid beneficiary was $43,296 compared to just $3,694 for Medicaid beneficiaries who did not use long-term care services.

- Sixteen percent of Medicaid beneficiaries with disabilities used long-term services and supports, but they accounted for fifty-eight percent of all Medicaid spending on people with disabilities.

Look:

Democrats may not be very interested in investing in CLASS and Republicans are eager to peel off another layer of the Affordable Care Act, but the reality is that government spending on long-term care will only increase if lawmakers don’t deal with it. Financing long-term care through a self-sustaining insurance program, rather than Medicaid, is concept both parties should be able to agree on and as Rep. Frank Pallone (D-NJ) has suggested, Democrats should be promoting.

The Center on Budget and Policy Priorities is out with a damning new analysis of the Democrats’ $3 trillion deficit proposal to the super committee. Republicans have already rejected the plan, despite the fact that it “stands well to the right of plans by the co-chairs of the bipartisan Bowles-Simpson commission and the Senate’s ‘Gang of Six,’ and even further to the right of the plan by the bipartisan Rivlin-Domenici commission,” Robert Greenstein, Richard Kogan, and Paul N. Van de Water argue.

“The Democratic plan contains substantially smaller revenue increases than those bipartisan proposals while, for example, containing significantly deeper cuts in Medicare and Medicaid than the Bowles-Simpson plan,” they point out. Look:

One wonders why Democrats continue to bend over backwards to GOP demands and accept reactionary policies when Republicans don’t even appreciate the effort, dismissing the plan as “outrageously absurd” and a “non-starter.”

A new Kaiser Family Foundation poll finds that a drop in enthusiasm among Democrats has soured the public on the Affordable Care Act, with 51 percent of respondents now saying they dislike the law and only 34 percent in favor of it. The scores represent the law’s highest unfavorability rating in the 19 months the Kaiser Family Foundation has been tracking public opinion and shows a dramatic 8 percent drop in favorability for the month of October:

Democrats’ lack of enthusiasm is behind the low numbers, Kaiser found, as support among party dropped from 65 percent to 52 percent in just one month:

Kaiser attributes the low numbers to the general dissatisfaction with the direction of the country and the GOP’s “heavy criticism of the law during recent debates.” The poll also found that health care reform is low on the list of issues that deserve more attention, as economy and jobs are still driving the national conversation and remain central to voters’ concerns.

Earlier this month, the Department of Health and Human Services announced that it was abandoning CLASS (the Affordable Care Act’s long-term care program), a development that received widespread press attention and may have raised frustrations among the law’s strongest advocates — including some Democrats in Congress. The Obama administration’s willingness to defend the law in the upcoming campaign, however, suggests that support among Democrats will likely rebound.

Health care consultant and expert Bob Laszewski offers this rather humorous analysis of Mitt Romney’s promise to repeal the Affordable Care Act by issuing waivers to states and pushing a repeal bill through the reconciliation process.

Romney aides claim the former Massachusetts governor will allow states to ignore the requirements of the ACA by trying to expand the scope of the law’s “flexibility” waivers — which allow states that agree to provide health care coverage to their residents to opt out from implementing the individual mandate, the employer penalty for not providing coverage, and the exchange regulations. Romney will attempt to stretch the law to its breaking point by redefining the terms of the waiver:

For example, the Romney camp is suggesting that the requirement to provide coverage to a comparable number of people doesn’t refer to how many people are covered but instead allows them to interpret that as just making a comparable number of health insurance plans available in the market.

Say what?

It is possible that a Romney administration could try to delay implementation of critical parts of the law from the scheduled January 1, 2014 implementation date. With so much of the implementation of the law up in the air waiting for a Supreme Court ruling and the 2012 election results, it is not out of the question that there will have to be delays past 2014, no matter who is president. But if Romney tried any delays intended to derail the law, I would have to believe that about every liberal and progressive group in America would instantly be in front of about every federal judge in the land—likely with success.

The reconciliation bit works no better. Without the necessary 60 votes in the Senate for full repeal, “budget reconciliation bill would have to apply only to the budget-related elements of the new law” and would leave many portions intact. “Romney could end up creating a chaotic environment driven by enormous uncertainty over just which parts of the new health care law would be implemented–for consumers, health care providers, and insurers,” Laszewski argues before asking, “Doesn’t that make you feel better?”

HHS has announced that the annual increases in premiums for seniors in Medicare Part B will be somewhat lower than expected and is attributing the change to “historically low healthcare utilization rates, due in part to the health reform law’s investment in prevention; and the 3.6 percent Social Security cost-of-living hike announced earlier this month.” Washington Post’s Sarah Kliff has the details:

Most seniors will see a $3.50 bump in their monthly premiums in 2012, from $96.40 up to $99.90. That’s lower than the $106 premium that the Medicare Trustees Report had projected in May. About a quarter of Medicare beneficiaries, particularly those who are newer enrollees and have higher income (and had been paying higher premiums), will actually see a reduction in their monthly payments.

This is the third piece of good Medicare news that the administration has rolled out this year. Earlier, the White House announced decreases in the average premiums for Medicare’s prescription drug plan as well as for Medicare Advantage, the managed-care alternative to traditional fee-for-service coverage.

Now recall that premiums in employer-sponsored health insurance market increased more than expected — by 9 percent — despite the historically low utilization rates (a result of the recession). As Austin Frakt has explained, the causes of premium changes are somewhat complex, but it makes one wonder about the wisdom of the GOP’s plan to shift seniors from Medicare into private coverage. At the very least this comparison isn’t very flattering for private insurers or their abilities to control health care spending.

And note one more thing: while the increases in private premiums attract waves of media attention — and no shortage of Republicans happy to blame the spikes on the Affordable Care Act — the small increase in Medicare premiums will likely go underreported and uncredited.