A second House committee has voted to repeal the long-term care health care program in the Affordable Care Act, the Hill’s Sam Baker reports, “clearing the way for a floor vote next month.”

The Department of Health and Human Services announced in October that it did not believe Secretary Kathleen Sebelius had the discretion necessary bring the program in compliance with the health care law’s sustainability provision, which stipulates that CLASS has to remain solvent for a period of 75 years. But administration officials and many Democrats also oppose repealing the measure outright, arguing that it represents an important first step towards reducing the nation’s long-term care crisis and could eventually be modified into sustainability. Under today’s system, Medicaid has evolved to become the nation’s primary payer for long-term services “and supports, financing nearly half (43 percent) of all spending on long-term care services.” The Congressional Budget Office (CBO) predicts that by mid-century 16 percent of anticipated federal revenues will be used to fund care for the baby-boom generation.

The ACA’s long-term care program, CLASS, was designed to minimize beneficiaries’ reliance on Medicaid by encouraging younger Americans to establish a cash benefit in their working years that would be made available to them should they become disabled.

One Democrat voted for repeal this morning on the House Ways and Means Committee, while three supported eliminating the program when it passed the Energy and Commerce Committee in November. “The measure will come to the floor next month, an aide to House Majority Leader Eric Cantor (R-VA)” told the Hill.

A provision in the health care law that allows young adults to stay on their parents’ health care plans until the age of 26 is working, new analysis from the Employee Benefits Research Institute confirms. According to the Institute, “the percentage of people between ages 19 and 25 being carried as a dependent on a parent’s employment-based coverage increased from 24.7 percent in 2009 to 27.7 percent in 2010. The number of young adults with employment-based coverage as a dependent increased from 7.3 million to 8.2 million” as uninsured teens find coverage or shift into dependent insurance if they lose their employer-sponsored insurance.

However, the economic recession and increasing health care costs are still causing Americans over the age of 50 — or those who actually use more care — to skip health care services. Relying on data from the 2009 Internet Survey of the Health and Retirement Study (HRS), the Institute found that almost 22 percent of “households reported that they have made some changes in their prescription drugs to save money, and nearly as many report that they have either skipped or postponed doctor appointments to do so.” Twenty seven percent of households “reported difficulty in paying their monthly bills”:

The Obama administration has released a new report tracking the progress of states in building the health care exchanges that are part of the Affordable Care Act. Twenty-eight states and the District of Columbia “are on their way toward establishing their own Affordable Insurance Exchange,” the report notes and have received three rounds of grants from the federal government to set-up the new regulated marketplaces where small businesses and individuals will be able to compare and shop for comprehensive insurance beginning in 2014. States that fail to build their own exchanges will have to turn over their markets to the federal government.

The theoretical concept of encouraging insurers to compete on a level playing field within a new regulated market was originally developed by the Heritage Foundation in the 1990s and later embraced in Mitt Romney’s Massachusetts health care reform law. As the administration’s report notes, it’s also gaining momentum in some right-leaning states, many of which are also suing over the constitutionality of the Affordable Care Act:

– Nevada: The Silver State Health Insurance Exchange was authorized through bipartisan legislation passed unanimously by both chambers of the Nevada Legislature and signed into law by Governor Brian Sandoval (R) on June 16, 2011. [...] Its seven-member board was appointed on September 23, 2011 and met for the first time on October 26, 2011.

– Alabama: Governor Robert Bentley (R), a physician, issued an Executive Order that created the Alabama Health Insurance Exchange Study Commission on June 2, 2011. [...] Alabama received an Exchange establishment grant of $8.6 million on November 29 from HHS. The State also is participating in a technical assistance program run by the Robert Wood Johnson Foundation. The legislature, which meets in February, is expected to take up legislation to establish an Exchange.

– Mississippi: The State created a Mississippi Health Insurance Exchange Study Commission in 2010, and used its $1 million planning grant to fund research and outreach. On April 26, 2011, then-Governor Haley Barbour (R) signed a law that allowed the Study Commission to continue its work through 2011. [...] After legislation authorizing an Exchange failed to pass, the State determined in October 2011 that the previously authorized non-profit high-risk pool association could broaden its mission to run the State’s Exchange.

– Michigan: On September 14, 2011, Governor Rick Snyder (R) announced his intent to create a State-based Exchange called MIHealth Marketplace. [...] The Senate passed bi-partisan exchange legislation in November, however the House failed to act. On November 29, the State was awarded $9.8 million to establish its Exchange and is seeking the legislature’s authority to spend the funds

— Pennsylvania: On November 23, 2011, Governor Tom Corbett (R) announced his commitment to establishing a State-based Exchange. [...] Pennsylvania used the majority of its Exchange planning grant to award a contract to a consulting firm to conduct extensive background research. This resulted in a comprehensive analysis of Exchange governance models, business operations, structure, plan management and financial management.

Federal regulators have also been eager to allow states additional flexibility in forming the exchanges. States can choose to share responsibilities with the federal government and use their establishment grants “to test their systems for their Exchanges that start later than 2014.”

On the campaign trail, Mitt Romney distances himself from his signature health care law by highlighting the eight vetoes he made to the measure the day he signed it, and blaming Massachusetts Democrats for failing to keep costs under control and implement it correctly. As he explains in his book No Apology, “So I vetoed measures I felt were expensive or counterproductive, but there were overridden by the legislature.” He echoed this message on Fox News Sunday: “There are some features I didn’t like that the legislature put in place,” he said, referring to the employer mandate, and they essential health benefits provisions. “I vetoed it, they overrode it, that’s the nature of the legislative process.”

But as Sen. John McCain’s 2008 opposition book on Romney points out, the former Massachusetts governor felt satisfied with the law he ultimately signed. A June 7, 2006 Newsweek article quotes Romney as saying:

“The final legislation incorporates about 95 percent of my original proposal. So I think, overall, it is a major step forward. We will have health insurance for all our citizens without a government takeover and without new taxes required.”

Indeed, as Boston Globe reporters Michael Kranish and Scott Helman write in The Real Romney, the GOP candidate had been pleased with the final version of the law, telling reporters, “We are where we’d hoped we’d be.” “This isn’t 100 percent of what anyone in this room wanted,” Romney said at the signing ceremony in April 2006. “But the differences between us are small.”

Romney explained that the law would be “a big part of the legacy I will have personally for my four years of service as governor.” “But,” he added, “I have no way of telling if it’s going to be a help or a hindrance down the road.”