Two weeks ago, the House Republicans voted for the 31st time to repeal the Affordable Care Act. Today, the Congressional Budget Office released yet another reminder to the GOP that such a move would add even more unpaid-for spending to the nation’s deficit:

Assuming that [repeal] is enacted near the beginning of fiscal year 2013, CBO and JCT estimate that, on balance, the direct spending and revenue effects of enacting that legislation would cause a net increase in federal budget deficits of $109 billion over the 2013–2022 period. Specifically, we estimate that H.R. 6079 would reduce direct spending by $890 billion and reduce revenues by $1 trillion between 2013 and 2022, thus adding $109 billion to federal budget deficits over that period.

In other words, cutting the health care reform’s new spending — the subsidies for Americans shopping on the exchanges, the expansion of Medicaid, tax credits for small employers, etc. — will indeed yield budget savings. But those savings will be washed out by additional spending created by repealing the reform’s cuts Medicare spending, and by the revenue lost when policies like new taxes on high-income earners and the excise tax on high-value insurance plans are undone. The Republicans’ repeal bill would also strip health insurance coverage from 30 million non-elderly Americans who will receive it under the Affordable Care Act.

While estimates beyond the 2013-2022 period are highly uncertain, CBO also anticipates a repeal would continue adding to the deficit beyond 2022. Given their initial estimates anticipated the health care reform law would reduce deficit spending by something in the neighborhood of $1 trillion over its second decade, this makes sense.

The Congressional Budget Office (CBO) has updated its analysis of the Affordable Care Act in the aftermath of the Supreme Court’s decision upholding the constitutionality of the individual mandate, but ruling that the federal government cannot withhold federal funds from states that refuse to expand their Medicaid programs.

Since some states are refusing to open their Medicaid programs to their residents, the CBO concluded that costs to the federal government would drop by $84 billion over 11 years and 6 million fewer people will be covered by Medicaid and the Children’s Health Insurance Program. Half of that population will find insurance in the state-based health insurance exchanges, while the remaining 3 million will likely remain uninsured:

– Federal spending during that period for Medicaid and CHIP is now projected to be $289 billion less than previously expected

– Estimated costs of tax credits and other subsidies for the purchase of health insurance through the exchanges (and related spending) have risen by $210 billion.

– The reductions in spending from lower Medicaid enrollment are expected to more than offset the increase in costs from greater participation in the exchanges.

– The number of additional people entering the exchanges as a result of the ruling is projected to be only about half the number who will not be obtaining Medicaid coverage, many of whom will be ineligible to participate in the exchanges.

– Two-thirds of the people previously estimated to become eligible for Medicaid as a result of the ACA will have income too low to qualify for exchange subsidies, and roughly one-third will have income high enough to be eligible for exchange subsidies.

– For the average person who does not enroll in Medicaid as a result of the Court’s decision and enrolls in an exchange instead, estimated federal spending will rise by roughly $3,000 in 2022—the difference between estimated additional exchange subsidies of about $9,000 and estimated Medicaid savings of roughly $6,000.

Below is a comparison of previous CBO estimates:

	Deficit	Uninsured	Medicaid	Exchanges
March 2010	– $138B over 2010–2019	-32M in 2019	+16M in 2019	+24M in 2019
March 2011	- $210B over 2012–2021	- 34M in 2021	+17M in 2021	+24M in 2021
March 2012	- $210B over 2012–2021	-33M in 2021	+17M in 2021	+23M in 2021
July 2012	-$109B over 2012–2022	-30M in 2021	+11M in 2021	+25M in 2021

When the HIV epidemic began in the U.S. in 1981, the cases appeared mainly in major coastal cities, like New York and San Francisco, among gay and bisexual men and injecting drug users. And interactive maps showing current HIV cases from AIDSvu at Emory University shows the geographic path of how the disease expanded through the U.S.:

Cases are still concentrated in population centers, so Los Angeles, for example, has a high rate of HIV infections even though the Southwest appears to have had less impact than other regions. And as NPR points out, one of the reddest sections of the map — showing the highest rate of adults living with HIV — stretches through the Southeast:

The Southeast has been hard hit by HIV, with infections concentrated along the I-95 corridor from Washington to Florida, and in the Mississippi Delta. Eight of the 10 U.S. states with the highest rates of new HIV infection are located here. High rates of poverty factor in as well, as does the region’s low ranking on many basic health measures. Nearly 50 percent of newly diagnosed U.S. AIDS cases each year are reported in the South.

The map also shows a large concentration of cases in New York along the Canadian border. These deep red counties house state and federal correctional facilities, and prisoners tend to have a higher rate of HIV infections. Prisons are also high risk environments for HIV transmission.

This week, activists and officials are meeting for the 19th International AIDS conference. To kick off the conference — meeting in the U.S. for the first time since 1990 — Health and Human Services Secretary Kathleen Sebelius laid out four new public-private initiatives to help people living with HIV/AIDS in the U.S., like research to help HIV/AIDS patients stay on their medications and a texting program to help them manage their health. This is in addition to nearly $80 million in grants ensure that low-income people living with HIV/AIDS have access to health care and medication.

At the peak in the mid-1980s, the United States saw about 130,000 new HIV infections. Now, roughly 50,000 new cases are added annually, according to the Centers for Disease Control. African Americans and Latinos are the most affected, and the HIV infection rate among African American gay and bisexual men is 50 percent higher than for white men who have sex with men.

Caleb Medley was shot in the eye in the Aurora movie theater shooting and remains in the intensive care unit in an induced coma. Medley sustained the terrible injuries only days before his wife Katie was due to give birth to a baby boy they plan to name Hugo. She now joins him in the same hospital — just one floor away — where she was set to be induced.

But even if Caleb makes a full recovery and meets his son, what happened late Friday evening at the movie theater could ruin the young family’s finances. Caleb doesn’t have health insurance, and his medical bills could amount to $2 million, according to his family.

Longtime friend Michael West has created a website to raise money for Caleb, who has been an aspiring stand-up comedian since the eighth grade. “He needs to get better because he needs to be a dad,” West said.

According to the website, Caleb performed in Denver’s biggest stand-up contest at the Comedy Works on July 18, advancing to the next round. The next night, Caleb and Katie decided to treat themselves to the midnight movie before the couple “officially” became parents.

In addition to the fundraising website, friends have set up a Facebook page dedicated to Caleb’s full recovery.

Caleb’s life will be forever altered by this unexpected and horrific event, a constant fear of many uninsured Americans. The Affordable Care Act — much of which will not be fully implemented until 2014 — extends health insurance to millions of uninsured Americans like Caleb.

– Steven Perlberg