In an attempt to win back some ground on the student loan battle, Republicans have proposed legislation which would keep the interest rate on federally subsidized Stafford Loans at 3.4 percent. However, they would pay for it by repealing the Affordable Care Act’s Prevention and Public Health Fund. The Fund is designed to support states and communities in fighting chronic diseases like heart disease, stroke and diabetes – a plan Republicans used to support.

Yesterday, the House Energy and Commerce Committee released a list of projects paid for by the law’s prevention program, slamming it as a “slush fund” and touting their votes to repeal it. But an analysis of national health care data shows that states represented by Republican members of the committee suffer from disproportionately high obesity and smoking rates and stand to benefit from additional investment in prevention. For instance, 14 of the states represented by a Republican are home to residents who smoke at rates at or above the national average (which stands at 19.3 percent), while eight have an obesity rate above 30 percent (national average is 35.7 percent):

State	Obesity Rate (%)	Smoking Rate (%)
California	24.0	12.9
Colorado	21.0	17.1
Florida	26.6	17.1
Georgia	29.6	17.7
Illinois	28.2	18.6
Kansas	29.4	17.8
Kentucky	31.3	25.5
Louisiana	31.0	22.1
Michigan	30.9	19.6
Mississippi	34.0	23.3
Nebraska	26.9	16.7
New Hampshire	25.0	15.8
New Jersey	23.8	17.9
North Carolina	27.8	20.3
Ohio	29.2	20.3
Oklahoma	30.4	25.5
Oregon	26.8	17.9
Pennsylvania	28.6	20.2
Tennessee	30.8	22.0
Texas	31.0	17.9
Virginia	26.0	19.0
Washington	25.5	14.6
West Virginia	32.5	25.6

As the committee’s own press release noted, several grants have been made to encourage Americans to engage in more physical activity, like biking, walking or “urban gardening,” which is designed to increase access to affordable fresh food. Others have been used to push for higher cigarette tax rates or a moratorium on fast food construction. As the data shows, obesity and smoking are at epidemic levels in these states; the programs the committee scoffed at could actually do a lot of good by bringing those rates down and lowering health care costs.

The White House has promised to veto the bill should it pass both houses of Congress, which is considered unlikely.

-Zachary Bernstein

As congressional Republicans are deciding on a substitute for the Affordable Care Act, Rep. Todd Rokita (R-IN) has introduced the State Health Flexibility Act, which could prohibit states from providing abortion coverage to their residents.

Currently, the federal government matches state Medicaid spending on a per-claim basis and pays a fixed percentage of each state’s Medicaid costs so long as they adhere to certain federal guidelines. For instance, the Hyde Amendment already prevents states from spending any federal Medicaid funding on abortion services, with exceptions for rape and incest or when the life of the woman is threatened. Seventeen states have elected to provide more comprehensive abortion benefits, but pay for these procedures with state funding.

Rokita’s bill would dramatically change this. Like most Republican proposals, his legislation turns Medicaid into a block grant program that would give states a set amount from the federal government, letting them shape their own Medicaid programs with fewer federal standards and requirements. But states would be banned from covering abortion services, even with state funds, unless they buy separate health plans that include abortion insurance or only cover abortion care. As Mother Jones’ Nick Baumann explains, this would cost the 17 states that provide abortion coverage millions of dollars:

Those states do not generally purchase separate plans that cover abortion, several current state Medicaid officials and former state Medicaid directors told Mother Jones. Instead, they simply use state money to foot the abortion-related portion of the cost of the insurance. [...] Under the GOP proposal, that practice would be illegal.

Rokita’s bill “would be a significant change from how current law operates today,” adds Judy Waxman, the vice president for health and reproductive rights at the National Women’s Law Center. [...]

Requiring states to purchase separate abortion-only plans “would be a change and one that would be harmful to women in those states,” Waxman says, noting that the current structure has stood for decades without interference from Republican or Democratic administrations.

So far, 30 House Republicans have co-sponsored the bill, and the Republican Study Committee included the proposal in its official budget.

As part of the December deal to avoid a government shutdown, Congress banned funding for abortion services in D.C. The anti-abortion policy rider prohibited D.C. from even using local taxes to pay for abortion services, reinstating a 13-year ban on abortion funding in D.C. that President Obama overturned in 2009.

Rokita touted his plan as a way to get the federal government out of the way and to give states greater flexibility — so long as that flexibility does not include letting the states create their own policies on providing abortions for low-income women.

Last week, Republicans on the House Energy and Commerce Committee voted to slash $400 million from a program that would offer states performance bonuses if they enrolled more children in CHIP or Medicaid. Twenty-three states have already taken advantage of those bonuses, including 16 that increased their enrollment by more than 10 percent.

A new analysis released today looks at how those bonuses have increased enrollment nationwide. The study from the Georgetown University Center for Children and Families examined the 23 states that received performance bonuses for enrolling more children, and found that this program has already had better-than-expected effects:

Data on the bonuses show that in the 23 states that received bonuses in FY 2011, an additional 1.1 million kids were enrolled above expected levels. The most (123,000) can be found in the state of Ohio. While we can’t say that the bonuses fully explain this jump in enrollment, it would certainly be fair to say that they get some of the credit for supporting states in reaching these kids.

As we’ve seen over the years, Medicaid and CHIP have been responsible for driving the uninsured rate of children down to record lows. These bonuses have been an important incentive in making this progress and dismantling them threatens to undercut the great success we’ve seen in Medicaid and CHIP.

Over 12 million children were enrolled in the program in all 23 states combined. Altogether, those states boosted their enrollment numbers 10 percent higher than the expected level, and earned close to $300 million in bonus money for doing so. Thanks in large part to CHIP, the rate of uninsured children is at the lowest-recorded level ever.

As ThinkProgress reported yesterday, the cuts are not expected to pass the Senate this time around, but there is worry among children’s health advocates that they may be reintroduced at a later date. President Obama’s recent budget proposal did call for a change in the federal matching rates for CHIP beginning in 2017.

-Zachary Bernstein

A new report out today from the Commonwealth Fund examined health care spending among 13 developed nations, including the United States. According to the report’s findings, the United States spent far more on health care than any other developed nation – “nearly $8,000 per person in 2009.” But the researchers found that the higher level of spending did not correspond to a higher quality of care:

High U.S. spending on health care does not seem to be explained by either greater supply or higher utilization of health care services. There were 2.4 physicians per 100,000 population in the U.S. in 2009, fewer than in all the countries in the study except Japan. The U.S. also had the fewest doctor consultations (3.9 per capita) of any country except Sweden. Relative to the other countries in the study, the U.S also had few hospital beds, short lengths of stay for acute care, and few hospital discharges per 1,000 population. On the other hand, U.S. hospital stays were far more expensive than those in other countries—more than $18,000 per discharge. By comparison, the cost per discharge in Canada was about $13,000, while in Sweden, Australia, New Zealand, France, and Germany it was less than $10,000.

“It is a common assumption that Americans get more health care services than people in other countries, but in fact we do not go to the doctor or the hospital as often,” said Squires. “The higher prices we pay for health care and perhaps our greater use of expensive technology are the more likely explanations for high health spending in the U.S. Unfortunately, we do not seem to get better quality for this higher spending.”

Prescription drugs were also found to be far more expensive in the United States than several other countries, and Americans used expensive technology like CT or MRI scans more frequently. According to the researchers, meanwhile, while the U.S. had the best survival rates for breast and colorectal cancer, the survival rate for cervical cancer was below average. The rate of asthma-related deaths among people aged 5 to 39 was also high, as were amputations for people with diabetes.

This chart details how much the United States spends on health care per capita compared to other developed nations:

This one compares survival rates for three types of cancer:

Previous studies have cast doubt on the effectiveness of more expensive treatments. Meanwhile, the health care reform law encourages physicians to focus on quality rather than quantity of care in an effort to bring down health care costs.

-Zachary Bernstein

Democrats are accusing Sen. Scott Brown (R-MA) of hypocrisy after the Massachusetts Republican and staunch opponent of the Affordable Care Act revealed to the Boston Globe on Tuesday that he relies on a provision of the law to keep his 23-year-old daughter “on his congressional health insurance plan.” Brown ran as the 41st vote against President Obama’s health care reform bill in a special election to replace the late Sen. Ted Kennedy and voted three times to repeal the law.

But now, he’s brushing off the criticism by insisting that “he was actually taking advantage of the law in Massachusetts that allows children to remain on their parents’ insurance plan until age 24.” “You can do that in Massachusetts, I voted for that,” Brown said. “For (Warren) to call me a hypocrite as to how Gail and I provide for our family, it’s sad,” Brown said, referring to his wife, Gail Huff.

Brown may have taken advantage of Massachusetts reform while serving in the Bay State, but as a senator, he’s benefiting from the ACA’s most popular provision.

According to the Office of Personnel Management’s (OPM) website, Brown’s congressional health care plan (the Federal Employees Health Benefits Plan) is regulated by federal law, not state legislation — “The FEHB Program is a Federal program and preempts state law requirements,” the site says — and the program allows dependents to stay on their parents’ insurance plans until age 26 as a result of Obamacare:

An official at OPM confirmed to ThinkProgress that “As long as the parent has a self-and-family enrollment, dependent children are covered under that enrollment until they reach age 26, as a result of passage of the ACA. Before the ACA, the dependent age was by FEHB law up to age 22.”

The Brown campaign did not return multiple requests for comment.