As governor of Massachusetts, Mitt Romney instituted health reforms that have expanded coverage to almost all residents and created a successful model for increasing access across the nation.

But Romney has walked away from that plan as a Republican candidate for president and has instead adopted a traditional market-driven approach that encourages the uninsured to purchase coverage in the unregulated individual market, push the sick into state-based high-risk insurance pools, and do little to lower health care costs or encourage providers to deliver care more efficiently. Below are the people who are advising him in this effort:

SCOTT ATLAS

Atlas is a senior fellow at the Hoover Institution and a professor and the chief of neuroradiology at the Stanford University Medical Center. He opposes Obamacare, writing in a Politico op-ed that “continued access to the world’s best medical care…is certain to dramatically decrease” if the Affordable Care Act is not stopped. But in 2007, when Atlas supported former New York City Mayor Rudy Giuliani’s presidential campaign, Atlas also attacked Romney’s “federalist” health care plan, trying to discredit the plan by pointing to Romney’s support of an individual mandate in Massachusetts. “Mitt Romney’s legacy is the creation of a multi-billion dollar government health bureaucracy that punishes employers and insists middle income individuals either purchase health insurance or pay for their own health care,” Atlas said in 2007.

PAUL HOWARD

Howard is a senior fellow at the Manhattan Institute and director of the institute’s Center for Medical Progress. And like Atlas, Howard has gone on the record in opposition to Romney’s signature health care reform law in Massachusetts. “It’s no secret that the template for President Obama’s health-reform legislation was the Massachusetts health-care plan enacted in 2006,” he wrote in 2010. And Howard added that “small businesses face higher health-insurance costs” as a result of Romneycare.
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When an Obamacare regulations goes into effect tomorrow, 47 million women will benefit from the guaranteed coverage of preventive services — including contraception coverage — without co-pays. The new rules will require most insurance plans to begin including the services at no additional cost at the next renewal date that falls on or after August 1, according to a news release from the Department of Health and Human Services.

The Center for American Progress graphic breaks down what will be covered and how women will benefit:

But even as millions of women will benefit from even more provisions of the Affordable Care Act, nine states are attacking the contraception coverage requirement because of the claim that the provision violates religious liberty. Even though President Obama announced an “accommodation” for religious institutions so that the employer does not have to pay for the birth control coverage, states have considered legislation or ballot measures to either reject the federal regulation or undermine contraceptive coverage in state law. And ongoing challenges against the contraception regulation continue in federal courts.

A new poll from the Kaiser Family Foundation reports that a majority of Americans support the Obamacare provision that expands Medicaid coverage to an estimated 17 million low-income people, with 67 percent of Americans in favor of expanding Medicaid nationwide. Rising public support for the program is also reflected in the public hospital employees who have come out in strong favor of the Affordable Care Act’s Medicaid expansion and the 16 Democratic governors who have already pledged to implement it in their states.

Kaiser found that broad support for the expansion dropped off when respondents were asked about the policy in their own state, mainly because “people had an exaggerated sense of the likelihood they would face a penalty in 2014 for not carrying insurance”:

However, the Kaiser Family Foundation has estimated that only one in 10 Americans will end up in the position of needing to choose between buying insurance or paying a penalty. Furthermore, the Obama administration will ensure that low-income Americans in states that have opted out of Medicaid expansion will not be penalized.

Outsized concern about the penalty that state residents may incur for not carrying insurance may stem from the Republican governors who are currently leading a crusade against Medicaid expansion in their states, despite the significant benefits to expanding the program. Republican governors in states including Florida, Mississippi, Texas, Wisconsin, South Carolina, and Louisiana have threatened to refuse the Medicaid expansion.

For years, hospitals in northeastern Wisconsin have billed sexual assault victims as much as $1,200 for the cost of their examinations, according to a new investigation.

The Post-Crescent newspaper found that, despite the availability of government funds to cover the cost of sexual assault examinations, many hospitals were sending the bill to victims. The AP has more:

When someone is sexually assaulted, the process of collecting forensic evidence can include taking pictures of bruises, swabs of sexual fluids or hair. Other expenses, which can include a pregnancy test, antibiotics and medical supplies, can bring the final price tag to about $1,200. [...]

For example, hospitals in the ThedaCare system used to absorb the cost for years as part of their charity care, said Jean Coopman-Jansen a program coordinator at Appleton Medical Center. After a change to comply with the health system’s billing rules, some victims last year were forced to pay the costs themselves, she said.

Fortunately, Wisconsin officials appear to be addressing the problem. Jill Karofsky, who heads up the Wisconsin Department of Justice’s Office of Crime Victim Services, said the state government recently began working with hospitals to educate them on how to properly use government funds so victims wouldn’t be charged for their examinations.

“The message to victims is when someone sexually assaults them, their body becomes a crime scene and they are submitting to a very invasive exam and the state frankly ought to pay for it. … It’s forensic evidence,” Karofsky said.

Arizona’s new 20-week abortion ban goes into effect Thursday, with very real effects for families expecting babies with fatal fetal defects. The Arizona Republic reports on volunteer services rising to the challenge of helping parents cope with the trauma of watching infants die within minutes, hours, or days of birth.

House Bill 2036, which measures a fetus’ gestational age from the first day of the woman’s last period, prevents abortion after 18 weeks of pregnancy, making it the most extreme ban in the nation. Most fetal abnormalities are detected during this period, but the ban forbids abortions even when the doctor discovers a fatal defect. The woman must then carry to term a baby who will almost certainly die as soon as it is born.

MISS Foundation and Embrace are non-profits specifically working to develop birth plans for such families, provide counseling, and prepare funeral services. The Legislature has allocated no funding for these services, which are expected to kick into high demand once the abortion ban goes into effect.

About 100 pregnancies are terminated after 20 weeks in Arizona each year. According to Joanne Cacciatore, the CEO of MISS Foundation, one or two families a month currently seek their help preparing for a fatal birth. But they expect their resources to be stretched past maximum capacity soon. Cacciatore said:

This law may have intended to do good, but it can really adversely affect non-profit organizations that desperately want to help people but maybe can’t help the number of people who now come to us. We are already stretched very, very thin. I don’t know where this money would come from. [...] They’re finding us on their own. I don’t know what will happen when the Legislature opens this up.

One family highlighted in the Republic’s report is working with Embrace to prepare for the birth of their daughter, who is missing most of her skull and brain. Julia Gonzales, a devout Catholic, refused to get an abortion but is now terrified of what her baby will look like:

I didn’t even have the idea in my mind to stop the pregnancy. And then two weeks after they told us, we saw her. She was a girl. But we never expected it would be this bad. Sometimes I wonder why I didn’t stop the pregnancy…I’m so scared about seeing her. When I remember her, I don’t want to remember her looking like that.

The Gonzales family’s tragedy is just a hint of what is to come for the unknown number of women whose options have been eliminated by the Arizona Legislature.

Throughout his presidential campaign, Mitt Romney has been running away from the individual insurance mandate in the Affordable Care Act — even though a mandate is a cornerstone of the former Massachusetts governor’s health care reform law. “If I’m President of the United States, we’re gonna get rid of Obamacare and return, under our constitution, the 10th Amendment, the responsibility and care of health care to the people in the states,” Romney said during a GOP presidential debate.

But during his trip to Israel, Romney inadvertently praised the individual requirement and universal health care. “[F]or an American abroad, you can’t get much closer to the ideals and convictions of my own country than you do in Israel,” he said. And according to The New York Times, Romney spoke favorably about the fact that health care makes up a much smaller amount of Israel’s gross domestic product compared to the United States:

“Do you realize what health care spending is as a percentage of the G.D.P. in Israel? Eight percent,” he said. “You spend eight percent of G.D.P. on health care. You’re a pretty healthy nation. We spend 18 percent of our G.D.P. on health care, 10 percentage points more. That gap, that 10 percent cost, compare that with the size of our military — our military which is 4 percent, 4 percent. Our gap with Israel is 10 points of G.D.P. We have to find ways — not just to provide health care to more people, but to find ways to fund and manage our health care costs.”

Israel spends less on health care because of a universal health system that requires everyone to have insurance. Every Israeli citizen has the obligation to purchase health care services through one of the country’s four HMOs since government officials approved the National Health Insurance Law in 1995. People pay for 40 percent of their HMO’s costs through income-related contributions collected through the tax system, and the state pays the remaining 60 percent. And by many standards, Israelis are getting better health care than U.S. citizens. The infant mortality rate is much lower, and its mortality rate due to heart disease is half the U.S. rate.

Orly Manor, dean of the Hadassah-Hebrew University Braun School of Public Health, said U.S. officials could “learn a lot from the Israeli system. The quality is high, and the outcomes are good.” And it seems that, following his trip to Jerusalem, Romney would agree.

With one of the most dire healthcare situations in America, advocates for healthcare reform in Mississippi are turning to an unexpected source for inspiration: The Islamic Republic of Iran. Like Mississippi, pre-revolutionary Iran did little in terms of providing healthcare services to rural areas. But after the 1979 Islamist takeover, Iran installed a system of community health centers and workers who give primary care with a focus on preventative medicine.

In a fascinating story for the New York Times Magazine, journalist Suzy Hansen explored how advocates in Mississippi are drawing on lessons of the Iranian experience to improve rural healthcare in their own state. One such advocate, a consultant to the Mississippi project name James Miller, told Hansen:

When the Iranian system was developed in the 1980s, there were no doctors in rural Iran. And this is similar to the problem in the [Mississippi] delta today.

Hansen described an Iranian system of building “health houses” that served anyone within an hour’s walking distance. She wrote:

Today, 17,000 health houses serve 23 million rural Iranians. Health disparities between rural and urban Iranians have narrowed; the Iranians have reduced rural infant mortality by 75 percent and lowered the birthrate.

Health statistics reveal an abysmal situation in rural Mississippi, with high infant mortality and teen birth rates, little access to nutritional food, deaths due to AIDS at rates 64 percent higher than the U.S. average, and the lowest ratio of doctors to residents in the country. As with many of the nation’s poor, Mississippians without insurance go to emergency rooms for primary care when health problems arise — and many don’t pay, increasing the burden on taxpayers.

That’s why Dr. Aaron Shirley helped found HealthConnect, a community-based healthcare system inspired by Iran’s reforms, in 2010. The budding community centers — where trained staff administer primary care, make home visits and encourage patients to undertake crucial preventative steps toward more healthy lives — are an inexpensive to set-up and operate, but pay huge dividends in savings on health care costs.

Hansen noted that the Affordable Care Act (ACA) — commonly known as “Obamacare” — stands to benefit “8,300 centers serving 20 million” across the country, including in Mississippi:

[T]he Affordable Care Act will give $11 billion to community health centers, a sum that will double the numbers and capacity of centers nationwide….

The Affordable Care Act has created “accountable care organizations” that include doctors, social workers, nurses and pharmacists working together to serve patients. Since May, also as part of health care reform, the Centers for Medicare and Medicaid Services announced more than 100 multimillion-dollar grants to organizations that proposed new ways to prevent illness and save money. Its Innovation Center awarded grants to a large number of experimental programs that involve community health workers.

By harnessing these innovations in healthcare from abroad with a 30-year working track record, the ACA stands to both improve health care and reduce the costs of reactive care for the uninsured.

Rep. Larry Kissell (D-NC) voted against the Affordable Care Act in 2010 and was one of five Democrats to support repeal of the law earlier this year. But opposition to health care reform hasn’t stopped this two-term Congressman from taking credit for it.

In June, Kissel bragged about helping secure $379,167 in federal money provided by the Act “for a new health care clinic near China Grove in Rowan County.” “I’m glad to have worked to help secure this funding and will continue to make sure that our tax dollars are being spent here at home to put people to work and take care of our citizens,” Kissell said in a release and then dodged reporters who pressed him on the hypocrisy:

Asked about the source of the funding, Kissell’s office issued a statement.

“We leave no stone unturned in helping our local communities bring resources home, and are unapologetic about anything we can do to bring our tax dollars home and have them working for us here in North Carolina.”

Christopher Schuler, the Biscoe Democrat’s spokesman, said Kissell was too busy Wednesday and Thursday with House votes and meetings to take questions about the funding.

Kissel voted against the GOP’s first effort to fully repeal reform in January of 2011, noting that “It is quite clear that the Senate will not act on any repeal measure, nor will the President sign such a bill” and promising to fix the law. “We have a choice: we can look backward and have the same fight all over again, or we can move forward determined to make things better and focus on our economy,” he said in a press release explaining his vote.

Kissel has also “refused to endorse Obama’s re-election bid” and joined Republicans in voting to hold U.S. Attorney General Eric Holder in contempt of Congress.

All hospitals in the U.S. are legally obligated to provide for anyone seeking emergency care, and the federal government spends billions annually to reimburse hospitals that treat the uninsured. Unfortunately, as the New York Times points out, the amount of federal aid to these hospitals — many of which are in poor areas of the country — will significantly drop as the Affordable Care Act is implemented, and undocumented immigrants could find it more difficult to access affordable care as a result:

The federal government has been spending $20 billion annually to reimburse these hospitals — most in poor urban and rural areas — for treating more than their share of the uninsured, including illegal immigrants. The health care law will eventually cut that money in half, based on the premise that fewer people will lack insurance after the law takes effect.

But the estimated 11 million people now living illegally in the United States are not covered by the health care law. Its sponsors, seeking to sidestep the contentious debate over immigration, excluded them from the law’s benefits.

As a result, so-called safety-net hospitals said the cuts would deal a severe blow to their finances.

In other words, because the mandate is meant to increase the number of people insured, the federal government estimates that hospitals won’t have to cover as many uninsured seeking emergency care. As a result, hospital budgets are put under strain as they lose money but must continue to provide care for the uninsured.

For some hospitals, nearly 50 percent of the patients they treat are undocumented.

The New York Times notes that the sponsors of the Affordable Care Act largely sidestepped the immigration issue in an effort to avoid the conversation. Alan Aviles, president and chief executive of the Health and Hospitals Corporation, said that “it is a difficult time to really advocate around this issue, because there is so much antipathy against new immigrants.”

– Nina Liss-Schultz

GOP presidential candidate Mitt Romney has campaigned as an anti-choice candidate. He endorsed an amendment that would allow employers to deny contraception coverage and promised to support radical measures to define life as beginning at conception. He would likely carry these views with him into the White House, where the president “wields more power over reproductive rights than anyone else in the country,” said Donna Crane, NARAL Pro-Choice America’s policy director.

And when it comes to selecting his running mate, Romney will pick a vice presidential candidate who is just as anti-choice as he is. “The person that I would select in that position would share my views on those important issues,” Romney said at the 2011 Palmetto Freedom Forum.

So how anti-choice are the most likely picks to be Romney’s vice president? NARAL Pro-Choice America broke down where 13 potential nominees stood on reproductive rights, access to abortion services, and women’s health, and it is clear that each is just as anti-choice as Romney. Several have supported giving legal rights to a fetus at some point during a pregnancy, thus limiting a woman’s ability to access abortion services. For example, South Carolina Gov. Nikki Haley (R), who is on the list, co-sponsored “personhood” legislation while serving in the South Carolina legislature.

Here are some of the anti-choice actions highlighted in NARAL’s report by the politicians frequently mentioned as top vice president picks:

TIM PAWLENTY: The former Minnesota governor signed a mandatory 24-hour delay for women seeking abortion care into law, and while serving in the state House, he wrote a bill to require women to be told medically inaccurate information about abortion services. But Pawlenty also approved a bill ensuring that women who have been sexually assaulted have access to emergency contraception — a measure similar to one Romney vetoed.

ROB PORTMAN: While serving in the House of Representatives and Senate, the current Ohio senator has voted on 115 bills related to abortion and reproductive rights — 114 of which were anti-choice. He repeatedly voted for the Federal Abortion Ban, which criminalizes some abortion services, and Portman co-sponsored a bill to effectively ban abortion coverage in state health insurance exchanges.

KELLY AYOTTE: The first-term New Hampshire senator has never cast a pro-choice vote. In 2003, Ayotte argued a case before the U.S. Supreme Court defending New Hampshire’s law requiring a girl who is a minor to notify a parent before she has an abortion.

MARCO RUBIO: The Florida senator has sponsored two bills that would gut the expansion of contraception coverage in the Affordable Care Act. He also voted to prevent Planned Parenthood from receiving federal funding, which would have denied health care and preventive services to millions of women.

BOBBY JINDAL: While serving in the House of Representatives, Jindal voted eight times to limit abortion access and other reproductive rights issues. And just last month, the current Louisiana governor signed three anti-choice bills into law.

JOHN THUNE: The senator from South Dakota co-sponsored a bill to allow hospitals to deny emergency abortion care, even when a woman’s life is in danger. And while serving in Congress, Thune has voted repeatedly to deny military women the right to use their own, private money for abortion care in military hospitals.

While there used to be a larger number of pro-choice GOP politicians, now “the pool is very small” as the party has grown more conservative, said NARAL’s Crane. And that leaves Romney with a slate of possible vice presidents who are “all equally threatening to a woman’s right to choose,” explained NARAL deputy policy director Lissy Moskowitz.

Olympic athletes are among the millions of Americans who have trouble finding affordable and comprehensive health care. In fact, the Elite Athletes Health Insurance Plan, administered by Blue Cross Blue Shield, covers only basic preventative care and charges higher premiums for out-of-network care.

But even though Olympians are some of the healthiest people on earth, their specific health needs are not covered by EAHI’s health insurance. The plan does not cover the expensive sports injuries top athletes incur regularly. The plan also does not cover the frequent check-ins athletes require to stay healthy, nor the early and meticulous treating of illnesses and injuries, which can keep athletes on the sidelines.

The insufficient USOC health insurance also isn’t guaranteed to all Olympic-level athletes, who must navigate a byzantine system to determine whether they are eligible for insurance. The Kaiser Health Foundation explains:

The 1,000 or so policies offered by the USOC are divided among the national groups that govern individual sports – for summer, winter and Paralympic Games – and each group sets its own requirements for eligibility. USA Swimming, for example, is allocated 56 policies. Olympic team members are given the first crack at the coverage, followed by the top-ranked swimmers in each event who did not make the team.

Even athletes who qualify for insurance often have to seek additional insurance coverage. Almost all top athletes purchase back-up health insurance to cover the catastrophic injuries they are particularly prone to, or they use insurance through a spouse or parent’s plan. Gymnasts in particular, who are usually the youngest Olympians, are likely to be included under a parent’s health coverage, and thanks to Obamacare, more Olympians who are under 26 could stay under their parents’ insurance to supplement coverage.

– Ben Sherman