Later this month, House Budget Chairman Paul Ryan (R) will release his proposed budget, likely including his plan with Rep. Ron Wyden (D-OR) to transform Medicare. But while some see the revamped plan, which Mitt Romney has embraced, as an improvement over Ryan’s previous plan to privatize Medicare, critics argue the changes could be too drastic. As Kaiser Health News explains, promising future beneficiaries that they could also choose a program like Medicare could drive up health care costs even more:

“The real question is what it would cost,” and whether seniors would pay more out of pocket than they do now, said Jonathan Gruber, an economist at the Massachusetts Institute of Technology. He cited the risk the government-run plan would attract the sickest people, driving up its costs, while private plans lure the healthiest. In addition, medical providers could abandon the program if Medicare cuts their rates to curb costs. [...]

Still unanswered, though, is whether the traditional program guaranteed in the GOP proposals would look anything like it does today.

The Romney and Ryan-Wyden plans would replace the current guaranteed benefits with a subsidy, paired with a minimum set of benefits. Federal spending would be capped, with beneficiaries expected to be on the hook for additional expenses – exactly how much is unclear since neither Romney, nor Ryan and Wyden have provided many details.

Republicans “want to be able to say they’re not eliminating the traditional program as we know it. But a lot of experts are saying, ‘Yes you are, by design,’” said Chris Jennings, a health care consultant and former senior health care adviser to President Bill Clinton. “If the policy works as constructed, seniors who wish to stay in fee-for-service will pay more. Moreover, having [fewer] beneficiaries in the traditional program could diminish its bargaining leverage to contain cost growth.”

Along with Romney, Newt Gingrich has also embraced a plan like Ryan’s proposal that keeps traditional Medicare in place; Rick Santorum favors abolishing the program. The outcome of the budget fight will likely influence the GOP presidential conversation about health care, but ahead of that debate, polls still show that Democrats have the upper hand. According to the Kaiser Family Foundation, more people — including 53 percent of Republicans — agree with the Democrats’ position that preserves a defined set of benefits for Medicare rather than a “defined contribution” structure.

All four remaining Republican candidates for President have made repealing the Affordable Care Act a centerpiece of their campaigns, and Rick Santorum is no exception, even if he had a different opinion about health care earlier in his political career.

And recently, Santorum has ratcheted up his attacks, claiming last month that the health care law will lead America to the “guillotine,” and saying the Obama administration is a “drug dealer” pushing its health care reform plan. Santorum took another swipe at the law yesterday during a campaign stop in Huntsville, Alabama, arguing that the Affordable Care Act is the “death knell for freedom”:

Republican presidential hopeful Rick Santorum’s main message to Republican voters in Huntsville Thursday was simple. “Obamacare is, in fact, the death knell for freedom, and that’s why it must be repealed,” Santorum told a large crowd at the U.S. Space & Rocket Center five days before the state’s GOP primary. He referred to the Affordable Care Act passed by Congress and signed into law by Obama in 2010.

Santorum said the law is the “linchpin, if you will, that would tip the scales toward a country that would no longer be free.” Mitt Romney, the GOP front-runner who signed a similar health care law while governor of Massachusetts, “is singularly the worst person to make that case,” Santorum said.

But Santorum is ignoring one crucial fact: The law is already yielding benefits for millions of Americans. And more provisions of the Affordable Care Act are still falling into place. Some states have not yet implemented the law, but if they do, those benefits could extend to hundreds of thousands more. Meanwhile, Republican efforts to repeal parts of the bill are projected to add billions of dollars to the federal deficit.

Santorum has made repeal of the health care law a top campaign promise, even though he accidentally defended the law. Increasingly, people are not as concerned about health care reform, and repealing it would be devastating to millions of Americans.

-Zachary Bernstein

Ever since he jumped into the presidential campaign, Mitt Romney has tried to distance himself from his health care reform plan in Massachusetts that’s strikingly similar to the Affordable Care Act. He has gone from suggesting that Romneycare in Massachusetts could be a model for the entire nation to insisting that it was only an appropriate plan for one state. He even inadvertently defended President Obama’s health care reform plan while outlining how he’d fix health care during a GOP debate.

Republicans have attacked him for his flip-flopping on health care, and most recently fellow GOP candidate Rick Santorum has taken aim. In an interview with CNN’s Piers Morgan last night, Santorum said the former Massachusetts governor has misled voters about his position on health care reform:

SANTORUM: For someone to go out and deliberately misrepresent his record, what he did at a very critical time when people were making decisions on the issue of health care, for him to go out and to recommend that to President Obama and then tell the voters in debate after debate that he never did any such thing, not only is his policy bad, not only did he recommend the wrong policy for the country, then he didn’t tell the truth about what he did.

Watch his comments:

But when Morgan pressed Santorum several times about if he thought Romney had lied, the presidential candidate deferred. “He clearly did not tell the truth,” Santorum said, stopping short of calling Romney a liar.

Back in January, though, Newt Gingrich said Romney was “a liar” for suggesting he had no role in the negative ads that targeted the former House speaker in Iowa. “He’s not telling the American people the truth,” Gingrich said in a CBS News interview.

The lead plaintiff in the legal case against the Affordable Care Act filed for bankruptcy after accruing nearly $5,000 in medical debt. According to the Los Angeles Times, plaintiff Mary Brown was uninsured last fall when her husband’s medical bills stacked up to $4,500. That, combined with other debt they had accumulated, led the couple to file for bankruptcy:

Brown, reached by telephone Thursday, said the medical bills were her husband’s. “I always paid my bills, as well as my medical bills,” she said angrily. “I never said medical insurance is not a necessity. It should be anyone’s right to what kind of health insurance they have.

“I believe that anyone has unforeseen things that happen to them that are beyond their control,” Brown said. “Who says I don’t have insurance right now?”

Brown “doesn’t have insurance. She doesn’t want to pay for it. And she doesn’t want the government to tell her she has to have it,” according to Karen Harned, a lawyer for the National Federation of Independent Business.

Brown may be focused on health care choices, but American taxpayers have another concern. Sixty-two percent of people who file for personal bankruptcy do so because of medical bills, placing those debt burdens on the American taxpayer. And while Brown’s husband may have run up his medical bills, others take the less medically responsible road and decline preventive treatment so they can avoid high medical bills in the short term (but risk more problems later).

Other opponents of the Affordable Care Act may argue for a consumer-driven market on health care plans, the fact is that the plans people chose, or their choice not to have one, effects everyone. The Affordable Care Act, on the other hand, may already be slowing health care costs.

In some “hot spot” U.S. cities, the HIV infection rate for African-American women is five times higher than the national rate — close to the rate in some African countries.

Researchers who conducted the study expected the rate to be higher in these urban areas, but after one year, 0.24 percent of the women in the study tested positive for HIV. That’s five times higher than the Centers for Disease Control’s previous estimate for African-American women. And the rate for African-American women surprised researchers in a field that focuses more on African-American and gay men.
The study showed that the annual rate of infection was 24 per 10,000 African-American women in six cities: Baltimore; Atlanta; Newark, New Jersey; New York City; Raleigh-Durham, North Carolina; and Washington, D.C. Nationally, African-American women’s rate is 5 per 10,000. In the Congo, it is 28 per 10,000.

“This disease is alive and well in this country,” said Dr. Carlos Del Rio, principal investigator for the Atlanta area of the study. “But this epidemic is the face of the forgotten people.” And the cities highlighted by the 2009 study, which included 88 percent African-American women and 12 percent Latina women, have high poverty rates:

“Along with the results, a lot of other statistics came out of this study,” said Dr. Sally Hodder, lead author of the study and professor of medicine at New Jersey Medical School in Newark. “Slightly more than 40 percent of the women did not know the HIV status of their last sexual partner. And more than 40 percent of our participants had an annual household income of $10,000 or less.”

And out of all the women enrolled, after a one-year follow-up, 10 had died of reasons unrelated to HIV.

“This just goes to show that women don’t just have HIV risk to worry about in these areas of the country,” Del Rio said. “I’ve had women look at me and say, ‘OK, I’m at high risk for HIV, but I’m also at high risk of getting shot.’”

Del Rio pointed out that other factors such as poverty, food insecurity, and substance abuse also increase the HIV risk. Rather than only offering information about AIDS, he said these cities also need better access to medical care for HIV screenings, substance abuse treatment, education, and job availability to lower the risk.

Dr. Patrick Chaulk, Baltimore’s assistant commissioner for HIV and STD services in the Health Department, said the city is targeting all high-risk groups in its plan to cut the HIV infection rate by 25 percent by 2015. He said much of the city’s resources go toward men because they account for two-thirds of new cases. Nationally, the CDC reports that men make up three-quarters of new cases.