The conservative think tank American Action Network (AAN), a lobbying group partly funded by insurance companies, is pushing for repeal of the Affordable Care Act. And to back up that effort, the group today announced a $1.2 million advertising campaign that urges Republicans to repeal the Affordable Care Act. AAN will have a full force push for repeal in the coming weeks, with insurance companies footing the bill:

The national initiative includes direct mail, print advertising and robocalls, as well as web videos targeted at “select liberal members.”

“The Supreme Court has upheld Obamacare,” reads the mailer. “Congress has only one option: Repeal the President’s government takeover of your healthcare. In addition to billions in new taxes, Obamacare also includes over $500 billion in cuts to Medicare. If the Obama government takeover of healthcare is not repealed, seniors across America will suffer.” [...]

AAN is planning to spend at least $10 million during the 2012 election cycle in districts where there are “competitive House races but state parties with little ability to provide a lift,” Politico reported on Sunday. The group already has organizers on the ground in specific districts, and it plans to build out “a broader, issues-specific grassroots network with endurance.”

The ad blitz is the latest in a trend of insurers, like Aetna, who seem to be hedging their bets on either side of the repeal debate.

The U.S. Chamber of Commerce experienced a similar divide during the run-up to the health care vote: The largest insurer lobbying group in the country, America’s Health Insurance Plans, gave $102.4 million in just 15 months to prevent the law from passing.

But AAN isn’t known for successful advertising — just two years ago, the group was forced to pull two ads after they were found to be false or misleading. One ad claimed that the ACA would allow rapists access to Viagra.

A 2011 Indiana law, which would have prevented Planned Parenthood from receiving Medicaid funds, has been blocked by a Centers for Medicare and Medicaid Services administrative ruling. An initial CMS ruling, made in June, found the law unacceptable, and Indiana asked the agency to reconsider. The CMS administrator blocked the law on the grounds that it denies women the freedom to choose their health care providers.

The law would have made Indiana the first state to deny Medicaid funds to Planned Parenthood funds for general health screenings. According to one estimate, 9,300 Indiana women rely on Planned Parenthood for their health care, which includes cancer screenings, STD testing, and birth control. Indiana is trying to deny Medicaid funds to Planned Parenthood because they also perform abortions:

Indiana had argued that Medicaid funds intended to help groups like Planned Parenthood provide general health care would indirectly subsidize abortions. The Hyde Amendment, a 1976 provision named after the late Rep. Henry Hyde, R-Ill., bans all federal funds for abortion except in cases of rape, incest or when the life of the mother is at risk.

The state also said Planned Parenthood could continue to receive Medicaid funding if it established separate fiscal entities for abortion and other health care. But CMS said such an option was premature.

Hearing officer Benjamin Cohen wrote that the Indiana law violated the federal requirement that individuals must have the freedom to obtain care from any qualified provider. Restricting that choice just because a care provider also offers non-covered care isn’t allowed, he wrote.

The law is being challenged on parallel tracks, both administratively at CMS and in federal court. The challenge in federal court is ongoing, but a lower court ruling agreed with CMS that Indiana is likely to lose the challenge.

If CMS maintains its position that Indiana’s plan to defund Planned Parenthood violates federal law, Indiana may have to choose between their plan and receiving federal Medicaid dollars. In order to receive the federal funds, states must have their plan to provide medical assistance approved by CMS.

Earlier this year, Texas lost all federal Medicaid funding for the Women’s Health Program because of its decision to exclude abortion providers, including Planned Parenthood. A federal appeals court later ruled that Texas cannot block Planned Parenthood from receiving state funds because it is likely that preventing them from participating in the Women’s Health Program is unconstitutional.

–Alex Brown

Texas Gov. Rick Perry (R) has decided that the easiest way to cope with the number of uninsured people in his state — one out of every four Texans lacks an insurance plan — is to pretend that there is no problem at all.

Today, Perry announced that Texas would turn down millions in federal funding offered under the Affordable Care Act to expand the state’s Medicaid program, despite the 25 percent of Texans without insurance. But pressed by Fox News anchor Jenna Lee, Perry couldn’t come up with a good way to cover those who don’t have insurance in the state.

Instead, Perry danced around the question and argued that the government had misrepresented the quality of care in Texas in a recent report that ranked the state last. He went on to say that the Medicaid expansion isn’t about getting coverage for the people who need it — it’s about freedom:

LEE: So let’s talk about solutions then. According to a new federal government report, I know you’ve seen this, Texas has ranked last when it comes to health services provided by the state. I know your folks have come out and aggressively said, ‘Hey, this is not something that we necessarily agree with for obvious reasons.’ But the facts are one out of four Texans is without health insurance, one out of four Texans is on Medicare or Medicaid. The health crisis, the big cris for the country and for your state, what is the solution?

PERRY: Well, let me address this issue. You don’t have people come from all over the globe to the state of Texas for their health care. We’ve got some of the finest health care in the world whether it’s MD Anderson or UT Southwest, some incredible health care facilities in the country. So the idea that this federal government which doesn’t like Texas to begin with to pick and choose and come up with some data and say somehow Texas has the worst health care system in the world is just fake and false on its face. The real issue here is about freedom.

Watch it:

Perry’s opposition to the Medicaid expansion is for tragic the state’s uninsured, but it’s not surprising — he has previously said that there is “nothing in the constitution” that allows Medicaid to exist, and claimed “everyone in America has access to health care.” But despite his rhetoric, Perry is no stranger to using federal funds in the state. In November, the governor took time off his failed presidential campaign to celebrate the expansion of MD Anderson, a multi-million medical center he regularly cites as exemplary, but one that is also the beneficiary of millions of dollars in federal grants.

The governor’s only other solution for helping those without insurance is to block grant the Medicaid program. But analysis by the Center on Budget and Policy priority found that block-granting Medicaid would lead to huge cuts in the program’s funding, a larger cost burden on health care providers and beneficiaries.

In April, a Center for Disease Control investigator warned Florida health officials that a Jacksonville tuberculosis outbreak was one of the worst he had seen in 20 years. The CDC’s letter cautioned state leaders — who were in the process of shrinking the Department of Health and closing the leading TB hospital in the state — that the epidemic required immediate mitigating action. According to the Palm Beach Post:

Had they seen the letter, decision makers would have learned that 3,000 people in the past two years may have had close contact with contagious people at Jacksonville’s homeless shelters, an outpatient mental health clinic and area jails. Yet only 253 people had been found and evaluated for TB infection, meaning Florida’s outbreak was, and is, far from contained.

The public was not to learn anything until early June, even though the same strain was appearing in other parts of the state, including Miami.

Since taking office, Florida Gov. Rick Scott (R) has slashed health and human-services agencies while offsetting costs with corporate tax cuts. During last year’s legislative session, the Florida Department of Health took a total budget reduction of $55.6 million, eliminating hundreds of full-time positions and cutting children’s medical services.

Officials cut almost $4 million from Florida’s infectious disease control budget and the A.G. Holley State Hospital — where tough TB cases had historically been treated — was closed. The Florida Department of Health has released figures alleging that statewide TB figures are on the decline. The CDC’s report, however, suggests the strain has moved beyond Jacksonville’s homeless shelters, spreading across the entire state and reaching the general population.

One-third of contacts reached for the CDC’s report tested positive for TB exposure in areas like homeless shelters. Treatment for TB, especially among the homeless population where the disease often germinates, is costly and complicated. Patients must take a cocktail of several drugs for 6 to 9 months, and failure to adhere leads to a drug resistance that makes the disease increasingly difficult to treat.

– Steven Perlberg

On Wednesday, the House will vote for the 31st time to repeal President Obama’s health care reform law. Rep. Marsha Blackburn (R-TN) defended the repeal vote on CNN’s Starting Point, arguing that it is more than “political theater,” and that she wishes they could vote to get rid of Obamacare every day:

RICHARD SOCARIDES (CO-PANELIST): You’ve voted [to repeal] 30 times already this year!

BLACKBURN: And we’re going to do it again. We’re going to do it again. We’re going to do it again.

SOCARIDES: How many times?

BLACKBURN: I wish we’d go do it every single day. It is a terrible piece of legislation.

Watch it:

The Congressional Budget Office estimates that if Republicans eliminated Obamacare in its entirety, more than 30 million Americans would go without coverage, “people would end up paying more for health insurance,” “the average insurance policy in this market would cover a smaller share of enrollees’ costs,” “premiums for employment-based coverage obtained through large employers would be slightly higher,” and the deficit would grow by $230 billion.

Igor Volsky contributed to this report.

Early Monday morning, Gov. Rick Perry (R) announced that Texas won’t create a state insurance exchange nor accept expanded Medicaid funds outlined in the Affordable Care Act. In a statement, Perry said, “Neither a ‘state’ exchange nor the expansion of Medicaid under this program would result in better ‘patient protection’ or in more ‘affordable care.’”

Perry’s announcement is an especially harmful move because Texas will benefit more from the Affordable Care Act than any other state. Texas was recently ranked worst in the country for health care delivery by the federal Agency for Health Care Research and Quality, scoring “weak” or “very weak” in nine of 12 categories. Perry’s office discounted the study as overly broad, and has argued that Texans’ real problem is personal health choices, not lack of health insurance.

More than 25 percent of Texans – 6,234,900 people – are uninsured, the highest rate in the nation. After five years of health reform, Texas would be able to insure 1,798,314 more Americans under the Medicaid expansion alone – more than any state in the nation. Setting up a state health insurance exchange would enable the remaining millions of uninsured Texans to purchase affordable health insurance. Thus, despite Perry’s claims, implementing the law would result in better patient protection and greater access to coverage.

Though the Supreme Court ruled that states can reject the expanded Medicaid funds without any penalty, any state that refuses to set up a health insurance exchange will have one set up for them by the federal government. This doesn’t lessen the impact of Perry’s decision to deny 1.8 million uninsured Texans the opportunity to be covered under Medicaid. He joins other Republican governors across the country in pledging to or considering turning down $258 billion in Medicaid funds and leaving 9.2 million Americans uninsured. A new study by the Brookings Institution found that states led by Republican governors have the most uninsured Americans, making political moves like Perry’s particularly harmful to Americans’ health.

– Ben Sherman