A new health care tracking poll from the Kaiser Family Foundation finds that as the opposition to the Affordable Care Act has fallen (from 46 percent to 43 percent), a majority of Americans (53 percent) want lawmakers to expand the law or keep it, and 46 percent say they are still confused by it:

On the debt debate, Americans “see a role for reducing spending in deficit reduction,” but majorities continue to say they would not support any reductions to spending on Social Security (62 percent) or Medicare (59 percent), and almost half (48 percent) say the same about Medicaid:

A new report from the Medicare Office of the Actuary estimates that “health spending will grow by an average of 5.8 percent a year through 2020, compared to 5.7 percent without the health overhaul.” As a result, the nation is expected to spend “$4.6 trillion on health care in 2020, nearly double the $2.6 trillion spent last year”:

In 2014, when the major coverage expansions of the health law begin to take effect, national health spending is expected to grow 8.3 percent, according to the new analysis. But spending growth should return to its 6 percent historical average from 2015 to 2020 as some employers drop coverage and the so called “Cadillac tax” on high-cost insurance plans takes effect in 2018. “The effect is likely to be a slowdown in the growth of health services, health insurance premiums and health spending overall,” the study said.

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Election-centric Orrin Hatch is already out with a statement claiming that reform makes “sky-rocketing healthcare costs worse,” but he would be well served to read the report more closely. CMS is saying that the law expands coverage to 30 million Americans while increasing the average annual growth in national health spending by just 0.1 percentage points over 10 years and predicts that expenditures will fall as cost-controls like the excise tax decelerate health care spending over the long haul. That’s a good deal that establishes a more sustainable and stable health care system, and it will likely only improve as provisions like the Independent Payment Advisory Board (IPAB) kick into higher gear. The report also found that in 2014, “out-of-pocket spending is projected to decline 1.3 percent, largely as a result of the uninsured attaining health coverage through Medicaid or health insurance exchange plans.” Overall, “out-of-pocket share of national health expenditures is projected to fall from 12 percent in 2009 to 9.6 percent in 2020.”

The CMS projections may also underestimate the savings from the delivery reforms and productivity adjustments — which will encourage providers to deliver quality care more efficiently. Those kinds of changes have led to real savings in the Geisinger Health System, Health Partners, Denver Health, and if properly implemented, could result in larger reductions in national health care spending than what the actuary is predicting.

So-called “crisis pregnancy centers” are established by anti-abortion activists with the sole objective of shaming women out of having abortions. Despite receiving federal and state funding, they have a history of preying on and misleading pregnant women who are seeking abortions and giving them false medical information to dissuade them from making their own decisions. Now, a report by the Texas Independent finds that many of these centers have a history of violating state safety and ethics codes as well:

Over the past five years, evaluators have found violations at state-funded subcontractors for Texas’ Alternatives to Abortion Services Program, which reimburses nonprofits — typically faith-based groups — to provide mentoring, counseling and material assistance to pregnant women.

But while those site visits were conducted by a contractor for the state, the Texas Health and Human Services Commission (HHSC) has never conducted a review of its own during the life of the program, according to an HHSC spokeswoman.

Evaluators from the nonprofit Texas Pregnancy Care Network (TPCN), which conducts the site visits, found at least one violation — not counting billing errors — during more than half of their pre-announced site visits to subcontractors, according to documents obtained by the Texas Independent.

Funding for the Alternatives to Abortion Services Program was upped from $4 million per year to $4.15 million, even while the rest of the state budget was slashed, particularly in the areas of family planning and community mental health services.

Official records show violations ranging from fire safety to possible breaches of client privacy to failure to obtain proper public safety checks. During 15 percent of inspections, subcontractors had failed to separate and label spiritual and educational materials properly. About 22 percent of the time, evaluators found that at least one counselor did not have proper public safety clearance. In total, subcontractors were found committing violations 66 percent of the time during 71 initial site visits. The Texas Independent notes that all but one of the state’s 33 subcontractors has overt religious affiliations.

Conservatives states like Texas have poured money into crisis pregnancy centers in recent years even as they slash funding for family planning centers and try to defund Planned Parenthood. Just this year, Texas lawmakers took $70 million from family planning funding to give to these “abortion alternative” centers. Yet despite receiving government money, these clinics are not subjected to regular inspections like abortion clinics and often avoid any scrutiny of their practices, which blur the line between religious advocacy and medical counseling beyond distinction.

Meanwhile, for several months anti-abortion activists in states like Kansas have been using inspections and codes as a tool to shut down the few remaining abortion clinics by claiming they do not meet rigorous licensing requirements. New laws require abortion clinics to be inspected numerous times each year and adhere to codes that are more stringent than even those required for hospitals.

As the Texas Independent has reported, Texas reimburses “abortion alternative” subcontractors at a higher rate for providing “mentoring” than it pays nurses to provide family planning services or master’s-level mental health professionals to provide crisis counseling. Subcontractors are paid $63 per hour for their counselors, who do not require any formal education or certification.

While the administration’s interim regulations governing the operation of state-based exchanges in the Affordable Care Act received generally positive reviews for their “flexibility,” some consumer advocates argued that the federal government could be doing more to protect consumers. At today’s “Health Insurance Exchange Development” event sponsored by the Bipartisan Policy Center, Stephen Finan, Senior Director of Policy for the American Cancer Society Cancer Action Network, laid out his concerns of where HHS has fallen short:

1) No minimum standards for the governance of the exchange, marketing rules, and network adequacy.

2) The partnership between the states and the federal government could allow states to opt out of establishing critical regulations and leave the federal government in charge of governing essential elements of the new market place.

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Indeed, consumer advocates have expressed some disappointment that the rule establishes governing standards that only stipulate that a majority of voting governing board members not have a financial conflict of interest. “Even in a voting minority, insurer representatives may dominate a board. It is also hard to imagine conflict of interest standards that have integrity that would not keep them from voting, even from being present for the discussion of, most of the important issues that exchanges will deal with,” Timothy Jost has pointed out.

Meanwhile, Steve Larsen, Director of the CMS Center for Consumer Information and Insurance Oversight, remained optimistic that the proposed regulations would inspire more states to establish their own exchanges, thus keeping the federal government out of the business of running them. The Affordable Care Act requires the federal government to intervene if the state fails to build an operable exchange.

“I think we anticipate with the release of the most recent regulation that lays out this hybrid partnership model that the level of activity will increase significantly this summer,” Larsen said. “And then in terms of the appetite some states have in moving forward….I have never met a governor that didn’t want to control their own destiny in their state. And I think that as states look more closely at the regulations that we put out and then the next phase that will come, I think you’ll see a lot more activity to build on what’s already going on.”

So far, “virtually every state has made at least some progress toward setting up [the] health insurance marketplaces,” including states like Indiana, Mississippi, and Alabama — which are also challenging the the constitutionality of the health law. In total, 16 states have “passed exchange-related legislation,” 39 states have introduced exchange legislation this year, and “48 states (all except Louisiana and Florida) plus the District of Columbia are engaged in some level of exchange planning.” Only Louisiana has publicly announced that it won’t set up an exchange.”

In what may be one of the most under-reported stories of the debt ceiling talks, Politico’s Jen Haberkorn notes that before negotiations broke down on Friday evening, President Obama and Speaker of the House John Boehner tentatively agreed to gradually raise the Medicare eligibility age as part of a “grand bargain” to increase the nation’s borrowing limit:

Details of the plan were not yet finalized before the Obama-Boehner talks collapsed on Friday. But in general, the agreement called for very gradually increasing the eligibility age from 65 to 67 over about two decades, according to administration and Republican congressional sources.

One pathway would call for increasing the age by one month per year beginning in 2017 until it reached 66 in 2029. In 2030, it would increase two months per year until it hit 67.

The administration’s willingness to entertain the idea may have given “a controversial idea more legitimacy and high-profile support than it’s ever gotten before,” Haberkorn observes, and it is likely to rile progressives who question the wisdom of the compromise.

Jacob Hacker, political science professor at Yale University, has called the scheme “the single worst idea for Medicare reform” since it “saves Medicare money only by shifting the cost burden onto older Americans caught between the old eligibility age and the new, as well as onto the employers and states that help fund their benefits.” Worse still, some seniors between the ages of 65 and 67 could “end up uninsured,” the Center on Budget And Policy Priorities’ Edwin Park predicted. Individuals “with incomes too high for premium subsidies in the exchange and those who qualify for only modest subsidies” could be priced out of affordable coverage, he warned.

According to the Kaiser Family Foundation, raising the eligibility age to 67 would cause an estimated net increase of $5.6 billion in out-of-pocket health insurance costs for beneficiaries who would have been otherwise covered by Medicare. Seniors in Medicare Part B would also face a 3 percent premium increase, the study found, since younger and healthier enrollees would be routed out of Medicare and into private insurance. Beneficiaries in health care reform’s exchanges would see a similar spike in premiums with the addition of the older population.

Federal cost savings, meanwhile, would be slim. The Congressional Budget Office studied the proposal when it was part of the House GOP’s budget plan and found it “would have little effect on the trajectory of Medicare’s long-term spending…because younger beneficiaries are healthier and thus less costly than the program’s average beneficiary.”

Earlier this month, the House Foreign Affairs Committee passed an amendment that would restore and expand the so-called global gag rule, a provision prohibiting foreign organizations receiving U.S. development assistance from using their own funds to perform abortions or provide women with information and referrals for the procedure. The rule, which unlike past variations does not even make exceptions for HIV/AIDS programs, was approved in a vote of 25-17.

Now, the measure is popping up elsewhere in the House. The Hill is reporting that the House Appropriations Committee will hold a mark-up today on a draft of the 2012 State Department spending bill that also includes the policy as well as other restrictions that would undermine women’s health:

The bill also contains a number of riders directed at the practice of abortion. It reinstates the so-called Mexico City Policy, which opponents call the “global gag rule,” that prohibits U.S. assistance to foreign nongovernmental organizations that “promote” or perform abortion.

The bill also prohibits funding for the U.N. Population Fund, as well as needle-exchange programs.

“It is unacceptable that the majority proposes to reinstate the Global Gag Rule, which prohibits recipients of U.S. health assistance from providing the most truthful and comprehensive healthcare possible to women in need,” subcommittee ranking member Nita Lowey (D-N.Y.) said in reaction.

Conservatives will argue that they are protecting tax payer dollars from being spent on abortion, but in reality, the gag rule and any additional cuts to programs that seek to improve women’s reproductive health would deny NGOs access to the very contraceptives that can help prevent the need for abortions in the first place and undermine efforts to fight the spread of sexually transmitted diseases, including HIV/AIDS.

Ultimately, women’s lives are put at risk. As CAP’s Peter Juul pointed out in a recent column, women with limited options are “forced to seek out abortion providers that may lack necessary medical skills or an environment that conforms to minimal medical standards. These unsafe abortions constitute 48 percent of all abortions, leading to the hospitalization of 5 million women due to complications and the deaths of 47,000 more every year.

This morning, former Utah Sen. Bob Bennett (R) reminded a meeting of the Bipartisan Policy Center that conservatives supported the individual health insurance mandate during the 1990s, a policy they now condemn as unconstitutional. He said that he still supports the provision — now part of the Affordable Care Act — and noted that the only way the country can continue to provide care to those who can’t afford it is “to have an individual mandate so that everyone who can and everyone who can afford it, is required to have his or her own health insurance. ”

While in the Senate, Bennett sponsored the bipartisan Wyden-Bennett health care bill, which sought to expand coverage by requiring everyone to purchase health care coverage:

BENNETT: I first got involved in it when Mrs. Clinton was the first lady and started putting forth some ideas. And at that time, the conservative approach, to which I gravitated quite naturally, was to have an individual mandate. Now, I am condemned for supporting the individual mandate. I still do, because if you are going to take the position that we do in this country that if someone is ill, we will take care of them regardless of their ability to pay. If someone shows up in the ER bleeding we don’t say, ‘if you don’t show me an insurance card we are going to throw you out in the snow and let you bleed to death.’

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Sens. Lindsey Graham, Mike Crapo, Chuck Grassley, Orrin Hatch, and Lamar Alexander also supported the health care bill.