Our guest bloggers are Jessica Arons, the Director of the Women’s Health & Rights Program at the Center for American Progress.

International Women’s Day is a good time to hit the pause button on all the debate swarming around abortion and contraception in Congress, the states, and on the campaign trail, and consider what our country would look like if antichoice zealots had their way in further restricting access to contraception and abortion.

Right now, around the world, women are suffering in countries where they have no access to basic reproductive health care and no say over when, whether, and under what circumstances they have children.

Let’s start with the unmet need for family planning. According to the United Nations Population Fund, at least 200 million women want access to safe and effective contraception but lack information, services, and family or community support. Even worse, this unmet need is expected to grow by 40 percent over the next 15 years. The lack of access to voluntary family planning services means that these women cannot plan the timing and spacing of their pregnancies in order to improve health outcomes for themselves and their children. The result: high rates of maternal and infant mortality, fewer opportunities for women to obtain education and income to support their families, and significant strain on family and community resources.

In much of the world, childbirth is also still a highly dangerous event. Globally there are approximately 350,000 maternal deaths per year, averaging out to about 1,000 deaths per day. Hemorrhaging, infections, eclampsia (a condition that may involve seizures or coma), obstructed labor, and unsafe abortion are the most common reasons women die in pregnancy or childbirth. And all could be averted with timely access to skilled care. But only 58 percent of women in the developing world are able to labor with assistance from a doctor or midwife and only 4 in 10 give birth in a health facility.
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House Republicans, the loudest proponents of deficit reduction, are pursuing a measure that would greatly increase the deficit: repealing the Affordable Care Act’s Independent Payment Advisory Board. The 15-member cost-cutting commission is tasked with making binding recommendations to Congress for lowering health care spending if costs increase beyond a certain point. But House Republicans claim that IPAB will “ration” care to seniors and have advanced legislation to eliminate it.

Today’s score of that bill from the Congressional Budget Office (CBO) finds that repealing the board would increase the national deficit by $3.1 billion” and grow health care expenditures:

CBO estimates that enacting H.R. 452 would not have any budgetary impact in 2012 but would increase direct spending by $3.1 billion over the 2013-2022 period. That estimate is extremely uncertain because it is not clear whether the mechanism for spending reductions under the IPAB authority will be triggered under current law over the next 10 years. However, it is possible that such authority would be triggered in one or more of those years; thus, repealing the IPAB provision of the ACA could result in higher spending for the Medicare program than would occur under current law.

So far, the House Ways and Means and the Energy and Commerce Committees have voted to repeal the board and House GOP leadership hopes to vote on it by late March. In a statement after the Ways and Means Committee approved the bill, Rep. Paul Ryan (R-WI) argued repeal would protect seniors from “waiting lists.”

But many of those in Congress who want to get rid of IPAB now have previously supported an IPAB-on-steroids plan. And the panel would not cut payments for seniors’ Medicare benefits, but would rather encourage providers to adopt best practices and offer care more efficiently.

So despite all the fear-mongering about limiting health care for seniors, repealing IPAB would wildly increase the deficit and health spending — the opposite of what the GOP claims.

Health care costs are the biggest long-term driver of national debt, but that growth has decelerated a lot over the past couple of years and is likely to continue falling as health care providers adjust to the payment changes in the Affordable Care Act.

We’ve already seen the slowing trend in Medicare spending, where, as Chapin White and Paul Ginsburg point out, monthly Part B premium are slowing and Medicare outlays per enrollee “in 2010 and 2011 was roughly in line with growth in the economy.” In January 2012, “the Congressional Budget Office (CBO) made a $69 billion downward revision to its 10-year Medicare spending projection — a technical correction that reflects emerging data showing surprisingly slow growth in outlays. Similar slowing trends have led to positive earnings surprises for publicly traded insurers.”

A lot of this can probably be attributed to a slowing economy and falling utilization of care — but there are some promising signs that the trend could continue, if not accelerate, under the significant payment reductions and reforms in the ACA. The law includes reductions “for almost every category of provider other than physicians and makes additional targeted cuts to home health agencies and some other providers” and those changes may already be motivating hospitals and doctors to begin delivering care more efficiently. For instance, the Los Angeles Times reported earlier this week that in preparation for the healthcare overhaul, many hospitals in California “are replacing paperwork with electronic record systems and working more closely with physicians to improve care and reduce the number of unnecessary tests”:

Some hospitals are going a step further and partnering with physicians to form accountable care organizations, groups that agree to offer coordinated care for Medicare patients. Under the reform law, the organizations will share the savings from lowering costs and improving care. [...]

Hollywood Presbyterian is working with nearby hospitals to identify the best and most cost-effective treatments. In addition, the hospital is trimming expenses and entering new partnerships with outpatient clinics to keep discharged patients from returning to the hospital unnecessarily.

Providence Health & Services, Southern California, which operates five hospitals, has offered voluntary buyouts and streamlined supply purchases. The hospital group also is trying to reduce the chances of medical complications and is standardizing treatment of some illnesses to improve efficiency.

Of course there is ample precedent for government payment policy paving the way for broad scale change — and savings. After lawmakers adopted prospective payment system in the 1980s — “replacing cost reimbursement with the inpatient prospective payment system (IPPS) — hospitals sought “efficiencies, and when they found those efficiencies, it allowed the federal government to share in the savings.” The hope today is that if ACOs and other payment reforms prove effective, “they will provide broader opportunities to increase the efficiency of delivery beyond shortening lengths of stay, such as managing chronic disease more effectively so as to keep beneficiaries out of the hospital in the first place.” The trend lines so far look promising and if reforms don’t reduce costs as anticipated, the Independent Payment Advisory Board (IPAB) will act as a backstop to keep costs in check.

Coming on the heels of Rush Limbaugh’s twisted concepts of education, sex, and contraceptives, new data out from the Guttmacher Institute today suggest that men and women who receive sex education demonstrate more responsible sexual behavior. On the whole, the study showed that they wait longer before having sex for the first time, tend to have safe sex compared to their counterparts who receive no sex education, and usually have sexual partners around their age. From the study (PDF):

Respondents receiving instruction about abstinence and birth control were significantly more likely at first sex to use any contraception … or a condom … and less likely to have an age-discrepant partner … Among female subjects, condom use at first sex was significantly more likely among those receiving instruction in both [abstinence and sex education] as compared with only abstinence education.

This is not the first(PDF) study of its kind, but in the renewed culture wars, contraception and sex education has come back under the public microscope. Both Rick Santorum and Mitt Romney have pledged to fund abstinence-only if elected president and new bills are popping up at the state level not just on contraception, but also sex education policies.

Several months ago, Wisconsin state Sen. Glenn Grothman supported a bill promoting abstinence in the state, arguing that single parenting is the “choice of women” who need to be “educated that it is a mistake.” The Utah legislature passed a similar measure just yesterday.

Twenty-six states currently require that schools stress abstinence in their sexual education programs.

Accusing the GOP of waging a war against women, the Democratic women of the Georgia senate staged a walk out yesterday to protest two measures that would significantly limit access to abortion services and contraception. The bills, passed yesterday, prohibit state employees from using their state health benefits to pay for abortions and stipulate that “employees of private religious institutions have no right to demand that their insurance policies pay for contraceptives, as the Obama Administration wants to require.”

“What we’re seeing here,” Sen. Nan Orrock said, “is an ideological battle that’s being waged to make women a target, to take our access to our Constitutional right of privacy and also our ability to make our health decisions with our doctor and our own best judgment. And it’s government intruding into that decision. The origins of this bill are ideological, it’s coming from an extreme, right, fundamental point of view. And that doesn’t bode well for women in Georgia.” Watch a local news story:

Republican Sen. Josh McKoon insisted that “the war that’s being waged is on a religious minority in this country that has strong beliefs” and predicted that both measures would pass the House, where the GOP has control.

The Guttmacher Institute estimates that “about 430 abortion restrictions that have been introduced into state legislatures this year, which is pretty much in the same ballpark as 2011.” Follow the key bills moving through the states, here.