PolitiFact has just announced its finalists for 2011′s Lie of the Year. Oddly, the year’s most significant policy claim — the Democrats’ charge that the Paul Ryan budget will end Medicare — made the list, even though it’s 100 percent true!

Here is why: Ryan’s plan ends traditional fee-for-service program and forces seniors to ultimately enroll in private coverage.

Under his proposal, beginning in 2022, people turning 65 will receive a pre-determined “premium support” payment to purchase private coverage. The insurers will offer a basic package of benefits, but traditional Medicare — the program that President Lyndon Johnson enacted in 1965 — will literally stop enrolling new beneficiaries. Rather than paying health care providers directly — and using its market clout to secure better bargains and other efficiencies for enrollees — the government would now pay multiple private health insurers pre-determined amounts per beneficiary to act as middle men between patients and providers.

It will no longer guarantee seniors a defined package of benefits, but will instead only offer a defined contribution towards their health care costs. As the Congressional Budget Office (CBO) analysis of Ryan’s proposal explains, “the payment for 65-year-olds in 2022 is specified to be $8,000, on average, which is approximately the same dollar amount as projected net federal spending per capita for 65-year-olds in traditional Medicare.” However every subsequent year, as health care costs increase, the government’s contribution “would grow at a slower rate,” inflation, and the age of the enrollee. By 2030, under the proposal, the premium support would “only cover 32 percent of a typical 65-year-old’s total health care spending” and would decrease every subsequent year.

PolitiFact concedes that this is, in fact, “a huge change to the current program.” But it’s more than that. Capping costs to beneficiaries, closing the traditional fee-for-service program, and forcing seniors to enroll in new private coverage, ends Medicare by eliminating everything that has defined the program for the last 46 years

As Newt Gingrich surges to the head of the GOP presidential field, he is running headlong into some of his former positions. Slammed by conservatives and competitors for previous support of the national health insurance mandate and universal coverage, climate change, and foreign policy, Gingrich is backpeddling towards more right-wing positions. It appears to be no different with women’s reproductive rights.

Revealing how far right the GOP has shifted, fellow contender Michele Bachmann and others blasted Gingrich for holding tempered and standard GOP positions on abortion, including supporting federal funding of abortions for victims of rape or incest, or to protect the life of a mother. Apparently feeling the heat, Gingrich is taking a major step to his right. Not only did he recently endorse fetal personhood, but he told ABC’s Jake Tapper he now believes that life begins at the implantation of a fertilized egg:

TAPPER: Abortion is a big issue here in Iowa among conservative Republican voters and Rick Santorum has said you are inconsistent. The big argument here is that you have supported in the past embryonic stem cell research and you made a comment about how these fertilized eggs, these embryos are not yet “pre-human” because they have not been implanted. This has upset conservatives in this state who worry you don’t see these fertilized eggs as human life. When do you think human life begins?

GINGRICH: Well, I think the question of being implanted is a very big question. My friends who have ideological positions that sound good don’t then follow through the logic of: ‘So how many additional potential lives are they talking about? What are they going to do as a practical matter to make this real?’

I think that if you take a position when a woman has fertilized egg and that’s been successfully implanted that now you’re dealing with life. because otherwise you’re going to open up an extraordinary range of very difficult questions

TAPPER: So implantation is the moment for you.

GINGRICH: Implantation and successful implantation.

Gingrich’s implantation position is not as radical or ambiguous as that of some “personhood” activists whose “life begins at conception” view could criminalize birth control. Still, his new-found idea that life begins at implantation is a sharp contrast to his previous positions. Implantation occurs 7 to 14 days after conception — well before most women even know they’re pregnant — and defining life at this point will essentially ban all abortions.

Gingrich’s radical step backward is still not enough for Bachmann. At her book signing in Rockville, SC this afternoon, she insisted that life begins at conception (even before implantation) and that Gingrich’s new view “will put a doubt in people’s mind as to his commitment to standing up to the pro-life cause.”

The Obama administration has come under considerable pressure from religious organizations to broaden the definition of which institutions can avoid the Affordable Care Act’s mandate to provide preventive health care services to women without additional cost sharing. These groups are accusing Democrats of waging a religious war against Christians by requiring they provide services — such as birth control — that may violate Church teaching. But as NPR’s Julie Rovner reports this morning, Christian affiliated groups already offer coverage for contraception in 28 states, eight of which don’t include the kind of conscience protections that are part of the administration’s proposed regulation:

But while some insist that the rules, which spring from last year’s health law, break new ground, many states as well as federal civil rights law already require most religious employers to cover prescription contraceptives if they provide coverage of other prescription drugs.

While some religious employers take advantage of loopholes or religious exemptions, the fact remains that dozens of Catholic hospitals and universities currently offer contraceptive coverage as part of their health insurance packages.

“We’ve always had contraceptive birth control included in our health care benefits,” said Michelle Michaud, a labor and delivery nurse at Dominican Hospital in Santa Cruz, Calif. “It’s something that we’ve come to expect for ourselves and our family.”

In other words, for religious groups to argue that the existing conscience provision stifle their religious expression would require one to believe that Christians are oppressed in almost half the states and are practically persecuted in eight of them. The reality on the ground is far less gloomy: religiously-affiliated institutions already offer birth control coverage to millions of secular women who work in their hospitals or teach in their colleges because their First Amendment amendment rights don’t allow them to pick and choose which laws they want to follow. As the Supreme Court concluded in 1990′s Employment Division v. Smith, if religious organizations can ignore regulations they disagreed with, then “the professed doctrines of religious belief [would be] superior to the law of the land, and in effect…permit every citizen to become a law unto himself.”

Rick Santorum sounded like a representative from the health insurance industry when he addressed a small group of high school students in Merrimack, New Hampshire this morning. The former Pennsylvania senator not only defended insurers for denying coverage to people with pre-existing conditions, he also argued that individuals who are sick should pay higher premiums because they cost more money to insure:

SANTORUM: I had insurance under my employer. And when I decided to run for president, I left my job, I lost my insurance, I had to go out and buy insurance on the open market. We have a child who has a pre-existing condition and we went out and we said, we like this plan…we have to pay more because she has a pre-existing condition. Well, we should pay more. She’s going to be very expensive to the insurance company and, you know, that cost is passed along to us…I’m okay with that.

Comparing health insurance coverage to auto insurance, Santorum explained that beneficiaries could reduce insurance premiums by paying for services out of pocket, and only rely on their health insurance coverage for the most catastrophic expenses:

SANTORUM: Health insurance, you turn everything in. You turn in every claim, you turn in your oil change, you turn in your tires, you turn in filling up your gas tank, everything is turned in to insurance and then people wonder why, ‘oh my insurance rates are going up?’ Insurance rates shouldn’t pay for your general maintenance any more than they should pay for the general maintenance of your car. [...] Should they pay for the operation, well just as much as they should pay for the car accident.

Watch it:

The Affordable Care Act eliminates the pre-existing condition exclusion by requiring everyone to purchase health insurance coverage, thus greatly reducing the number of so-called free riders, or people who wait before they become ill to purchase health coverage. By creating an incentive for younger and healthier people to purchase coverage, reform expands the risk pool so the costs of the sick people are paid for with the premiums of the healthy. Once they fall ill, their costs will be borne by the next generation of healthy beneficiaries.

As for forcing struggling families to pay the full costs of their health care “maintenance,” that would (at the very least) discourage people from investing in prevention and have a limited impact on reducing health care spending, the overwhelming majority of which is borne by the sickest beneficiaries with multiple chronic conditions. If anything, costs will likely increase since middle and lower income Americans would forgo care that could prevent the further — more expensive — medical complications.

Inside Health Policy’s Rachana Dixit reports that Sen. Orrin Hatch (R-UT) — weary of being challenged on his record of opposing affordable health care coverage — has penned a letter to Treasury Secretary Timothy Geithner and IRS Commissioner Douglas Shulman questioning their interpretation of a provision in the Affordable Care Act that would allow individuals enrolled in a federal health exchange to receive premium and cost sharing subsidies when purchasing health insurance.

Democrats and the administration insist that Congress had intended to provide federal assistance to everyone buying insurance through the new regulated marketplaces, even if “the law says that the exchange subsidies… are available for those purchasing health insurance through a state exchange but makes no mention of their availability through exchanges operated by the federal government.” But a group of House Republicans had questioned this interpretation last month and Hatch is now joining their ranks in arguing that Americans enrolled in federal exchanges should be denied access to more affordable health coverage:

“Simply put, under current statutory law, there is no premium assistance amount…to the extent that an exchange is a federally-facilitated exchange. But contrary to the clear wording of the statute, your proposed regulations suggest otherwise, extending the availability of premium credits to those participating in federal exchanges,” Hatch writes in a Dec. 1 letter to Treasury Secretary Timothy Geithner and IRS Commissioner Douglas Shulman.

Hatch says he is concerned that the rules as proposed, if finalized, would exceed the IRS’ regulatory authority, and if a change needs to be made in the law then Congress needs to be the one to pursue it. Hatch goes on to say that, “This excessive use of regulatory authority is only the continuation of a trend by the Treasury Department and IRS of violating the constitutional principle of separation of powers by usurping Congress’ exclusive role in law-making.”

Hatch hasn’t always stood in the way of more affordable coverage. This is coming from the same man who not only worked with Sen. Ted Kennedy (D-MA) to extend health care coverage to lower income children as part of the Children’s Health Insurance Program (CHIP) in 1997, but also supported subsidizing health care coverage for lower income Americans in 1993 when he co-sponsored Sen. John Chafee’s (R-RI) Health Equity and Access Reform Today Act of 1993 as an alternative to Hillarycare.