Inside Health Policy’s Sahil Kapur notices that Sen. Orrin Hatch (R-UT) is arguing that Congress should repeal the health care law in order to reduce the deficit, dismissing the debt savings from the measure and the Congressional Budget Office’s projections that eliminating the law would “would worsen the budget outlook.” From Hatch’s press release:

With the national debt more than $14.5 trillion and unemployment still over nine percent, U.S. Senator Orrin Hatch (R-Utah) called for the repeal of ObamaCare to be considered as a means to reduce the deficit and create jobs.

“We all knew that ObamaCare was going to be disastrous for our economy and every day that goes by proves that point,” Hatch said. “Whether it be the trillions of dollars in tax hikes or the sheer number of job losses directly from ObamaCare itself, it’s clear that repealing ObamaCare must be on the table during any talks to slash our nation’s debt and create much-needed jobs.”

When Kapur confronted Hatch’s office with CBO data which found that repeal would increase the deficit by $230 billion over 10 years, raise the number of uninsured by 32 million, eliminate subsidies, and force millions of American families to pay higher premiums, and increase premiums for employer-based coverage, Hatch spokeswoman Julia Lawless called its projections “gimmicks.” “That includes all of ObamaCare’s gimmicks,” she said in an email. “The true cost of the bill is $2.6 trillion and that’s a real budget-buster.”

The Hill’s Sam Baker pulls out this nugget from the latest Kaiser Family Foundation tracking poll:

People seem to be forgetting what the healthcare reform law does, according to a new poll from the Kaiser Family Foundation.

The monthly tracking poll found a sharp decline in the number of people who are aware that the new law will offer financial help to people who must buy insurance on their own, rather than getting it from an employer. Last summer, 72 percent of those polled were aware of that benefit. Now it’s down to 58 percent.

Fewer than half of the respondents knew the law expands Medicaid, down from two-thirds just over a year ago. Only 29 percent knew that the law eliminates cost-sharing for some preventive services, and half said the law did not provide that benefit.

When all you hear about are the lawsuits challenging the constitutionality of reform and fear-mongering about increased costs and erosion of coverage, naturally you’d be reluctant to support reform. Which is why Nancy Pelosi’s now infamous statement — “We have to pass the bill so you can find out what is in it” — may not be the most eloquently expressed sentiment, but remains true: the real test of the measure’s support will come once it is implemented and Americans actually experience its benefits.

The same, by the way, holds for all of the employer surveys about dumping coverage. Asking businesses what they’ll do about a provision that doesn’t go into effect until 2014 today — when some 40 percent are unfamiliar with its details — is just begging for the worst-case scenario that’s grounded in rumors about “big government regulation” than any serious consideration of the actual provisions in the text of the law.

Last month, a federal judge blocked Kansas from enforcing a state law imposing overly rigorous licensing standards on abortion providers pending the resolution of a lawsuit filed by two doctors who perform abortions in the state. Attorneys representing the Kansas abortion providers are alleging that officials drafted the regulations “without independently compiling data or studies on how the new rules would make the procedures safer for the women seeking them,” but they may have a hard time proving their point, since the state is now “battling to keep from revealing details about how it developed” the new rules:

Lawyers for the Kansas Department of Health and Environment and the attorney general want to prevent two abortion clinics from learning how the rules were crafted, as well as the mind-set behind them, according to their court filings.

They are asking a judge to limit the scope of what is shared with the clinics’ lawyers to prevent overly broad requests that don’t lead to relevant evidence, the court documents say.

The state also has denied open-records requests from The Kansas City Star and The Associated Press, which asked for documents that could have shed light on the drafting of the rules.

The licensing rules — which are far more stringent and specific than what the state currently requires of hospitals and ambulatory surgical centers — established new standards for exits, lighting, bathrooms, and equipment and would allow the states to fine clinics or go to court to shut them down. The state had initially denied licenses to two of the three abortion providers, but all are now operating until the lawsuit against the regulations is resolved.

The public timeline suggests that the new rules — which are only a small part of Kansas’ effort to eradicate abortion in the state and create a direct court challenge to Roe v. Wade — were issued hastily with little time to study their effectiveness or need. The state legislature passed the standards in April and Gov. Sam Brownback (R-KS) signed it into law on May 16. Kansas’ Department of Health and Environment issued the final version on June 17 and informed clinics that they would have to comply with the rules by July 1.

House Majority Leader Eric Cantor has identified the Affordable Care Act’s so-called grandfather rules — that exempt health insurance plans in existence before the law went into effect from many of the new benefits standards and consumer protections that new plans now have to abide by — as one of 10 job destroying regulations Republicans will try to repeal as they “continue to focus on the jobs crisis”:

Grandfathered Health Plans (November/December): We all remember when President Obama promised Americans that if they liked their health care plan they could keep it. Now, the Obama Administration has been issuing further restrictions against those previously protected plans. The result, by the Administration’s own estimates, will be a loss of 49 to 80 percent of small employer plans, 34 to 64 percent of large employer plans, and 40 to 67 percent of individual insurance plans. Meanwhile, employers losing their grandfathered status will face steep penalties, increasing their costs and negatively affecting wages and job growth. The Energy and Commerce, Ways and Means, and Education and Workforce committees will soon be working on legislation to repeal these ObamaCare restrictions.

Conservatives love to use Obama’s “keep your coverage” statement against him, but realistically employers change their health care plans all the time — they did before reform and will continue to do so after. What the administration has tried to do is discourage employers and insurers from avoiding the standards in the law and dramatically changing their plans: cutting benefits, raising co-pays, or lowering the employer contribution.

Employers can make some changes — but they don’t have a blank check to increase costs and reduce benefits. In fact, HHS has loosened these regulations, not tightened them. On Nov. 15, 2010, the Department of Health and Human Services accepted employers’ concerns and updated the rules to allow more plans to keep their grandfather status. Under the original regulation, for instance, some group insurance plans would have been penalized for making small administrative changes, but the updated standards allowed “plans to switch insurance companies and shop for the same coverage at a lower cost while maintaining their grandfathered status.”

Eventually, most plans will lose these protections — and that’s a good thing. The whole point of grandfather rules is to serve as a bridge to gradually move everyone into plans that are required to meet a basic floor of standards. The GOP’s effort to repeal the rules would allow carriers and employers to drastically change their plans and deny insured beneficiaries the benefit of the law’s new consumer protections.

This Thursday marks the beginning of Texas’ new fiscal year, and with it a slew of conservative legislation signed by Gov. Rick Perry (R) takes effect.

Among those laws is the highly controversial sonogram law Perry signed in May, forcing pregnant women seeking abortions to undergo a medically unnecessary ultrasound at least 24 hours before an abortion and to hear a description of the fetus:

One new law requires a doctor to attempt to show a woman seeking an abortion a sonogram of the fetus, to describe the image and to provide the sound of the fetal heartbeat before the procedure. Federal Judge Sam Sparks is expected to rule before Thursday on a challenge to the law by the Center for Reproductive Rights.

“This law is intrusive, patronizing to women and unconstitutional,” said Julie Rikelman, the center’s lead attorney on the case. She said patients should be given only the information and medical tests appropriate for the circumstances and that a doctor should not have to act as a “government agent.”

The sonogram law is a transparent attempt by anti-abortion activists to chip away at women’s constitutional right to end a pregnancy. The Senate sponsor of the bill, Dan Patrick (R) hailed it as “the beginning of the end for abortions,” and said he was so proud that he was “inspired to wear my cowboy hat” when Perry signed the bill.

Perry, a self-described “small government” conservative, has no problem inserting the government between women and their doctors. Facing the state’s worst budget crisis in modern history, he dubbed the sonogram bill an “emergency priority” that allowed the legislature to expedite its passage. Texas conservatives initially refused to include exceptions for cases of rape, incest, and fetal abnormality in the bill.

In the last legislative session, Perry also approved drastic cuts of $74 million to family planning services in Texas, which experts say will result in tens of thousands of additional unwanted pregnancies in coming years. The cuts could also result in 180,000 Texans losing access to cancer screenings and basic contraception.

On Friday, Virginia state health officials released draft regulations requiring existing state abortion providers to meet the physical plant requirements of hospitals. The new rules — the result of a TRAP (Targeted Regulations Against Abortion Providers) law passed by the General Assembly this spring — threaten to shut down Virginia’s abortion clinics, which only handle first-trimester abortions and are currently subject to the same regulations as physician practices.

The draft guidelines were formulated through an ‘emergency’ process that bypasses the normal public notice and rely on standards that were only “intended for brand new construction in the process of being built,” not existing clinics for whom compliance would be completely cost prohibitive. From the Virginia Coalition to Protect Women’s Health:

In particular, the draft regulations require existing women’s health centers in Virginia to meet extensive, significant physical plant requirements found in the 2010 Guidelines for Design and Construction of Health Care Facilities – including Guidelines for Outpatient Surgical Facilities, otherwise called ambulatory surgical facilities. These Guidelines are intended for brand new construction in the process of being built. These standards were never intended for existing health care structures and are not intended to apply to office-based surgical procedures. By relying on the 2010 Guidelines and imposing them on existing structures, the Virginia Department of Health would force substantial architectural changes by women’s health centers in order to be in compliance. Rather than protect women’s health, the regulations could endanger women because they could limit access to safe abortion by driving legitimate providers out of practice, which could place the health of women in Virginia in jeopardy.

The proposal also “allows the state’s health commissioner to suspend or revoke a clinic’s license, requires that a facility has an infection prevention plan and mandates that anesthesia be administered by a doctor.” The state’s Board of Health will vote on the rules on Sept. 15 and they will go into effect on Dec. 31. These “emergency rules will remain in effect while permanent regulations are crafted.”

Meanwhile, it is already difficult to access abortion services in the Commonwealth, “with 86 percent of Virginia’s counties lacking any abortion providers at all.”

The Incidental Economist has done some fantastic blogging explaining why the super committee should reject a proposal to raise the Medicare age from 65 to 67. The policy shifts costs to employers, beneficiaries, young people, and state governments, but most importantly the savings it generates are minuscule — $5.7 billion. Doesn’t sound all that small? Well, as Austin Frakt explains, “the Trustees of Medicare have estimated that the total spending by Medicare in that year will be $643.4 billion. Thus, the savings we might obtain by delaying eligibility until 67 is a mere 0.9% of total program spending”:

The point is that we can probably get much better savings — and actually reduce the rate of growth in health care — if we really step up the system modernization provisions in the health law.

Byron York is out with a new column touting an employer survey which found that some businesses will stop offering health insurance coverage as a result of the Affordable Care Act. He argues that this so-called employer “dumping” of employees into the new exchanges is all part of a Democratic conspiracy to move the nation towards a single-payer health care system:

So when it takes effect in 2014, the law will give employers a choice: Continue to offer increasingly expensive health coverage, or pay a relatively small fine, save a lot of money, and let employees buy their own subsidized coverage on the exchange. The incentive seems pretty clear.

Now, it should surprise no one that more and more companies are exploring the possibility of dropping their employee health coverage in 2014. A new study from the benefits-consulting firm Towers Watson finds that nearly 10 percent of midsized to large companies are seriously considering doing just that, and another 20 percent are thinking about it. Still others don’t know. “Many are uncertain how they will respond to the looming impact of state-based insurance exchanges in 2014,” says Towers Watson.

How many companies will actually drop their employee coverage? It’s impossible to say. But from the latest surveys — the Towers Watson report is just one of several that have found employers contemplating the move — it’s safe to say that some will, and more could follow….He couldn’t pass a single-payer system, or even a public-option system, even when he had filibuster-proof majorities in Congress. But he could enact a system that will take a slower route in that direction.

Employers have been dropping coverage since before the ACA became law and will continue to make changes after. What’s important is that academic studies and real world experiences with mandate policies have shown that health reform will have very little impact on coverage rates. For instance, when Massachusetts employers were working to comply with Romneycare in 2006, they were given a choice between paying a very low penalty or continuing to offer coverage. The majority of businesses decided that health benefits made up an important part of their compensation package and continued to provide the service, so much so that the number of employers with coverage increased since the law passed. Massachusetts ESI (employer sponsored insurance) rates are higher than the national average.

This is because employers aren’t only looking at the cost-benefit of offering coverage or paying a penalty. They’re considering the long history of using benefits to attract top-tier employees, the burden of increasing employees’ wages to make-up for the benefit loss and a whole host of other factors. As the Urban Institute has concluded, “[T]here is little scope for firms being able to save money from dropping ESI coverage except perhaps in firms where most workers have low wages as well as low family incomes, and these types of firms are the least likely to offer ESI today.”

But what’s particularly rich about York’s argument is his new found love for employer based insurance. Remember that this critique is emanating from the very people who just two years ago rallied around proposals to eliminate the employer based system entirely by converting the federal tax subsidy for employer-sponsored benefits into a tax credit for individuals and families to go out and buy coverage on the individual market. Now, they’re using the prospect of that erosion to stroke fears of yet another government-takeover.

Inside Health Policy’s Rachana Dixit reports that Florida Gov. Rick Scott’s (R) opposition to establishing a state-based exchange may have more to do with partisan politics than the policy included in the Affordable Care Act. As it turns out, Florida is “slowly moving ahead to provide small group coverage to Florida’s small businesses,” but it’s doing so through 2008′s Florida Health Choices Act rather than the federal health care law.

Florida has refused to integrate the measure — which was spearheaded by then-state House Speaker Marco Rubio and expanded by Scott — into the requirements of the ACA, claiming that it is unconstitutional and does not “fit in with what we’re trying to do“:

An exchange consultant said Florida Health Choices, though created in 2008, has taken some time to get up and running. Rose Naff, Florida Health Choices’ CEO, told Inside Health Policy that the program is moving forward on planning a small group market pilot program that would test offering health insurance to small businesses for at least six months, and expects to have an estimated launch date soon. Participation in the choices program by employers is voluntary. [...]

But the exchange consultant said that the $1 million planning grant Florida denied likely would have been spent on things the state has already done in planning for Florida Health Choices. Florida Health Choices is not the Florida exchange but the consultant said it appears that nothing would preclude it from becoming that.

While Florida will likely have to adapt to the federal law’s more stringent requirements, the exchange does compliment (and could even benefit from) the provisions in the Affordable Care Act. So far, Rubio’s law to allow employers to offer employees access to health insurance plans has not sold any policies, despite receiving a $1.5 million appropriation from the state. In 2008, Rubio championed the plan in the rhetoric of health reform advocates, saying “it’s about competition, it’s about choice, and it’s about the marketplace.”