Republicans have a lot of reasons why the Affordable Care Act is unconstitutional, even if most of them don’t hold water. That means, every now and then, opponents of the law have to trot out theories that have already been ruled meritless.

Rep. Steve King did just that in a town hall meeting in Le Mars, Iowa on Monday. King, who opposes even some of the most popular provisions of the law, claimed that its requirement for all Americans to obtain insurance is unconstitutional because some Americans never, ever pay for health care:

Most advocates for Obamacare are arguing that, whether or not you have health insurance, you’re engaging in interstate commerce, because sooner or later, whether you actually go to the doctor or not, somebody’s gonna haul you to the emergency room and then somebody else is going to have to pay for it. So that’s the argument that compels you to buy insurance? I’d say that doesn’t fit the interstate commerce definition that I know. And that argument came before the Supreme Court.

What i’ve said is that, in every decade, in every state, there have always been babies that were born, lived, and died, and some of them a long and healthy life, without ever using a dollar worth [sic] of health care expenditures. That would mean that they didn’t engage in interstate commerce with regard to health care.

Watch:

King has made this argument before to attack the health care law, and it has been rejected. In an opinion upholding the law, conservative Sixth Circuit Judge Jeffrey Sutton wrote, “Even dramatic attempts to protect one’s health and minimize the need for health care will not always be successful, and the health care market is characterized by unpredictable and unavoidable needs for care. The ubiquity and unpredictability of the need for medical care is born out by the statistics. More than eighty percent of adults nationwide visited a doctor or other health care professional one or more times in 2009.”

-Zachary Bernstein

Just one day after President Obama declared that the Republican budget proposed by Rep. Paul Ryan (R-WI) would “ultimately end Medicare as we know it,” his likely Republican opponent appeared at the Newspaper Association of America and threw the accusation right back at him. Obama, former Massachusetts Gov. Mitt Romney said, “has taken a series of steps that end Medicare as we know it” and “is the only President to ever cut $500 billion from Medicare”:

ROMNEY: I’d be willing to consider the President’s plan, but he doesn’t have one. That’s right: In over three years, he has failed to enact or even propose a serious plan to solve our entitlement crisis.

Instead, he has taken a series of steps that end Medicare as we know it. He is the only President to ever cut $500 billion from Medicare. And, as a result, more than half of doctors say they will cut back on treating seniors. He is destroying the Medicare Advantage program, eliminating the coverage that millions of seniors depend on and reducing choice by two-thirds.

To control Medicare cost, he has created an unelected, unaccountable panel with the power to prevent Medicare from providing certain treatments. The result will be fewer treatments and services available to patients in need, and nowhere else to turn.

Watch it:

Romney rarely lets the facts get in the way of his rhetoric, but these oft-repeated accusations ring particularly hallow — and are hardly rare. The savings achieved in Medicare through the Affordable Care Act will help stabilize Medicare by eliminating overpayments to private insurers and slowly phasing in payment adjustments that encourage greater efficiency. As a result, the law extends the life of the Medicare trust fund by eight years and allows seniors to retain all of their guaranteed Medicare benefits. Medicare beneficiaries are already paying less for prescription drug coverage and receiving preventive care as a result of the law, while enrollment in Medicare Advantage has increased and premiums have fallen. The law, in other words, does exactly the opposite of Romney’s claim: it expands Medicare “as we know it.”

That doesn’t mean that it solves all of our health care cost problems. It doesn’t and Obama has proposed accelerating some of the law’s cost-control mechanisms to further lower the growth of spending. But Romney has labeled such efforts “rationing” and is offering an alternative “premium support” scheme that transforms senior’s guaranteed Medicare benefit into a voucher and significantly reduces the government’s contribution to the program. As a result, seniors will likely pay more for their health care, while the market clout and purchasing power of traditional Medicare — which has led on delivery reform and efficiencies — will shrink. So if the question is, which candidate ends Medicare for seniors, it’s hard to see how Romney’s plan to push future retirees into private insurance doesn’t fit the bill.

The fate of the Affordable Care Act now rests with the nine justices on the Supreme Court, but win or lose, the health care law has already changed the health care market and set the industry on a path of delivering and paying for health care more efficiently. Just as “49 states and the District of Columbia have already taken action supporting the law’s implementation” and are unlikely to backtrack on those efforts, health care payers and providers are moving forward with reforms that suggest that the law is definitely here to stay:

PHYSICIANS REDUCING WASTEFUL CARE: “Nine medical societies representing nearly 375,000 physicians are challenging the widely held perception that more health care is better, releasing lists Wednesday of tests and treatments their members should no longer automatically order. The 45 items listed include most repeat colonoscopies within 10 years of a first such test, early imaging for most back pain, brain scans for patients who fainted but didn’t have seizures, and antibiotics for mild- to-moderate sinus distress.”

PROVIDERS ADOPTING DELIVERY MODELS: As Sarah Kliff has reported, the Affordable Care Act has “already significantly catalyzed the health-care system.” With the law’s changes in how Medicare reimburses for care, providers now “have a sense of direction of where the country’s biggest payer is headed” and are now moving in that direction. Chas Roades, chief research officer at consulting firm the Advisory Board Co, recalls that when the Board “surveyed 69 hospital executives in November, just 16 percent said they had bundled payments in place. But of those who didn’t, 75 percent expected to within two years. Two-thirds expected they would have such payment arrangements with Medicare.” Similarly, “the health-care system has become increasingly integrated, with hospitals and insurance plans buying up doctors’ offices.” Consulting firm Irving Levin Associates saw health-care “merger activity shoot up 11 percent, from $205 billion in 2010 to $227 billion. Their analyst, Stanford Steever, attributed that largely to the Affordable Care Act.”

INSURERS WORKING WITH PROVIDERS ON DELIVER REFORM: Karen Ignagni, CEO of America’s Health Insurance Plans, the industry lobby, says insurers are “working with hospitals and doctors to change the way care is paid for and to keep costs down, just as Cigna’s [CEO David] Cordani wants.” She cites two studies that say Medicare plans run by private insurers are succeeding at keeping seniors from being readmitted to the hospital after procedures. “We’re leading the way, according to government data on readmissions,” she says. “That’s a win-win on both sides. There’s real data now to support the contention that these strategies and these tools work very, very effectively.”

In other words, the the law has already created an unstoppable momentum towards change. As the Huffington Post’s Jeffrey Young has pointed out, “health insurance companies, hospitals and the rest of the health care system already have made deep changes to the way they operate: adding new consumer protections to health plans, altering the way medical providers get paid and beginning to work closer together to improve health and save money” — and it’s very unlikely that they will take away these new benefits or obtain efforts to modernize their operations (in an effort to reduce spending). Regardless of the Supreme Court’s anticipated ruling on the law in late June, the changes the ACA inspired are here to stay — in one form or another.

Attacks on women’s reproductive rights were only the beginning in House Republicans’ war on women. Now they are attacking women’s economic security. The House-passed GOP budget targets poor women and their families, from gutting programs that help low-income children receive nutrition and educational opportunities to cutting the Supplemental Nutrition Assistance Program (SNAP), which primarily helps women, children, the disabled, and the elderly. And proposed Medicaid cuts would hurt women and families supporting elderly loved ones in nursing homes and people who rely on Medicaid for preventive health services.

Despite claims that the budget “empower[s] individuals with greater control over their futures,” the Republican budget written by Rep. Paul Ryan (R-WI) does the opposite. As CAP’s Katie Wright explains, “By choking off opportunity for women and children of all ages, the budget leaves poor women to fend for themselves and puts the American Dream further out of reach.”

Here’s a chart that outlines how the GOP’s war on women’s economic security hits women at every stage of life: