When Texas Republicans cut off Planned Parenthood from the state’s Women’s Health Program — losing millions in federal funds and endangering access to health care for women in the program — Gov. Rick Perry (R) promised to keeping the program going with only state funds and without Planned Parenthood.

Now it’s clear what groups he wants to include in the program for low-income women instead: anti-abortion crisis pregnancy centers that do not provide the same women’s health services. In fact, the Women’s Health Program doesn’t even cover pregnant women, so there is no clear reason why crisis pregnancy centers should be included.

Perry laid out his idea earlier this week at the opening of a new crisis pregnancy center in Houston, according to RH Reality Check:

“The Source for Women clinics, in fact, will be part of Texas’s own Women’s Health Program, and Planned Parenthood will not be,” Perry told the crowd. [...]

Despite the fact that the Source currently provides only limited, pregnancy-related medical care and STI screenings, Gov. Perry is holding up the ideologically-motivated crisis pregnancy center as the future of comprehensive reproductive medical care for low-income Texas women. He even told the crowd gathered on Tuesday that Texas is excited about helping them spread their beliefs.

“The opening of this latest medical center will enable you to spread your message,” he said, “and do your vital work, on a significantly larger scale in the years to come.”

The Source’s CEO Cynthia Wenz told RH Reality Check that they will provide pap smears and some forms of contraception in order to participate in the Women’s Health Program, but no “abortifacients” will be provided. At crisis pregnancy centers, though, that term can be misconstrued to apply to almost all forms of hormonal birth control and even intrauterine devices (IUDs) — the most effective form of birth control.

Although cigarette taxes are a very effective way to encourage people to stop smoking — as well a potential source of important revenue for some cash-strapped states — a new study suggests that they also work to highlight income inequality among American smokers.

New York places a $4.35 tax on each pack of cigarettes, the highest rate in the country, and researchers used data from the state health department to calculate how much money its residents are spending on cigarettes each year. They found that that smokers in New York who earn less than $30,000 a year spent an average of 23.6 percent of their annual income on cigarettes, while the state’s wealthier smokers — defined as those earning over $60,000 a year — spent an average of just 2.2 percent of their earnings to support their smoking habit.

Because of this discrepancy, researchers pointed out that this tax may be disproportionately straining low-income New Yorkers:

“Although high cigarette taxes are an effective method for reducing cigarette smoking, they can impose a significant financial burden on low-income smokers,” Matthew Farrelly and his co-authors wrote in the conclusion of their paper, which was published this month in Plos One, an online, peer-reviewed journal. [...]

The low-income now spend twice as much of their earnings on cigarettes as they did in 2003, when the state imposed a tax of $1.50 [compared to the current $4.35 tax] on each pack.

The researchers concluded that to make the cigarette tax less regressive, the state should spend more of the resulting revenue on programs that help low-income smokers quit the habit, although both the researchers and the health department say this would be a challenge.

The study acknowledged that low-income populations tend to have higher percentages of smokers, highlighted by the fact that smoking rates among low-income New Yorkers did not decline at all between 2003 and 2010, even though smoking rates dropped by about 20 percent among all income groups during the same period. According to 2010 figures from the Centers for Disease Control, 28.9 percent of adults below the poverty level were smokers, a full 10 points higher than the rate for the adult population at or above the poverty level. Anti-smoking advocacy groups have also noted the correlation between smoking and income level, pointing out that encouraging lower-income Americans to quit smoking can help save states money on their Medicaid program expenditures, since approximately 10 to 20 percent of all Medicaid funds — totaling more than $30 billion each year — is spent on costs related to smoking-related illnesses.

But as the researchers noted, states could attempt to combat some of these issues by choosing to use the revenue generated by their cigarette taxes to invest in programs to help lower smoking rates among low-income populations. Turning a smoking habit into a bigger financial investment may deter some smokers, but cigarette taxes only represent one part of a broader public health strategy that should also include preventative education and support programs.

Paul Ryan was not well received when he spoke at the American Association of Retired Persons (AARP) Friday afternoon, getting booed for supporting the repeal of the Affordable Care Act and transforming Medicare’s benefit guarantee into a “premium support.”

But the animosity appears to be mutual. Throughout the health care reform debate, Republicans regularly lashed out at the AARP for backing the effort, with Sen. John McCain (R-AZ) famously calling on seniors to rip up their membership cards. Ryan also got into the act, deriding the organization as a “left-leaning pressure group” that is more interested in financially benefiting from reform than protecting seniors. As Steve Benen pointed out:

But House Budget Committee Chairman Paul Ryan (R-Wis.), responsible for shaping his caucus’ agenda, appears to be have been rattled by all of this. He lashed out at AARP this week, blasting the organization as “a left-leaning pressure group with significant business interests in the insurance industry,” which is “intentionally misleading” the public. As Ryan sees it, AARP is in insurers’ back pocket, making it both corrupt and unreliable in the debate.

Speaking before the organization as a vice presidential nominee, however, Ryan struck a more conciliatory tone. “You can get to common ground on these problems if you treat people with respect without compromising your principles,” he noted.

– Greg Noth

The cost-benefit analysis of the Republican governors opting out of the Medicaid expansion under the health care reform law has always been questionable. Although foregoing the Medicaid expansion allows governors to avoid a slight burden on their state budgets — one that will be modest even under pessimistic predictions — it also means failing to provide as many as 17 million currently uninsured Americans with health care coverage.

Wonkblog’s Sarah Kliff flagged a brief that brings up yet another factor for governors to consider when weighing the Medicaid expansion. By some estimates, opting out could drive premiums up 2 percent or higher for Americans covered by private insurers:

Using CBO data, the brief estimates that those higher health-care costs will be 2 percent higher than “projections made under the assumption that all states do expand Medicaid.” Those premium increases would be borne by both the federal government, which helps buy coverage for subsidized individuals, as well as the individual purchasers themselves.

The expansion of the Medicaid program would expand eligibility to everyone up to 138 percent of the federal poverty line (FPL). Until now, eligibility has maxed out at 100 percent of the poverty line. At the same time, the health insurance exchanges created by Obamacare will cover anyone from 100 to 400 percent of the FPL who isn’t already covered through either Medicaid or their employer. So in any state that opts out of the Medicaid expansion, those in the 100 to 138 percent range will wind up on the exchanges instead of in the Medicaid program. According to the CBO’s logic, these individuals will likely have more expensive health care needs in comparison to the rest of the population in the exchanges, which in turn will drive up premiums. Because all these markets are intertwined — providers that work with Medicaid also work with private insurers, and private insurers that offer plans on the exchanges will offer them outside the exchanges as well — this premium increase will occur in both opt-out and opt-in states, and for consumers both in and out of the exchanges.

As Kliff’s analysis demonstrates, the Republican governors who are resisting the Obamacare Medicaid expansion aren’t just impacting the low-income residents in their own states who could benefit from increased access to health insurance. In fact, opting out of the Medicaid expansion could have consequences that spill over into other states across the country.

According to a new report from the U.S. Department of Health and Human Services, the health care reform law will help the average American under a traditional Medicare plan save $5,000 from 2010 to 2022.

Medicare beneficiaries who have high prescription costs will save even more — over $18,000 in the same time period — since Obamacare will help make Medicare prescription drug coverage more affordable for seniors by working to close the “donut hole” coverage gap. Already, in the short time period since the law was enacted, 5.5 million seniors and Americans with disabilities have saved over $4 billion on their prescription drugs.

Mitt Romney has pledged to repeal the Affordable Care Act “on day one,” undermining the cost controls in the law and increasing the costs for seniors’ preventative, hospital, and physician services. His own proposal to transform the Medicare program from a guaranteed benefit to a guaranteed contribution — providing seniors a pre-determined “premium support” credit that will not keep up with health care costs — would increase premiums by nearly $60,000 for seniors reaching the age of 65 in 2023, a recent study found.