Fred Bauer has poured over the new health care data in John F. Cogan’s, R. Glenn Hubbard’s, and Daniel P. Kessler’s “The Effect of Massachusetts’ Health Reform on Employer-Sponsored Insurance Premiums” report and points out that health care premiums in the Bay State have grown at a lower rate since the passage of Massachusetts’ signature health care law in 2006.

Relying on data “for average health-insurance premiums from the federally sponsored Medical Expenditure Panel Survey (MEPS), this report suggested that, up until 2008, these reforms led to a relative increase in health-insurance premiums.” But new numbers through 2010 shows that “Massachusetts’ health-insurance premium growth declined relative to the nation as a whole in the years since Romneycare has been enacted“:

Increase in employer-sponsored family premiums 2002-2006: MA: 40%; US: 34.50%
Increase in employer-sponsored family premiums 2006-2010: MA: 19%; US: 22%

Increase in individual premiums 2002-2006: MA: 32.70%; US: 29.10%
Increase in individual premiums 2006-2010: MA: 21.70%; US: 20%

Look:

While it’s difficult to know how much of the decrease can be attributed to the Massachusetts law — which focused on expanding access rather than controlling costs — (versus decline in utilization as a result of the recession and other factors), the very fact that the law did not meet the doomsday scenario of critics and cause premiums to skyrocket is significant. (In fact, Massachusetts had the third-lowest average family premiums in New England by 2010, Bauer notes).

Ezra Klein notes that we may already be seeing a very similar trend with the Affordable Care Act, which grew out of the Massachusetts experience. The latest spending projections found a “$275 billion (5.6 percent) reduction [in health care spending] for 2020, compared with pre-reform estimates. Moreover, that projection represents a cumulative reduction of $1.7 trillion over the 10 years from 2011 to 2020.” The numbers suggest that providers may be becoming more efficient in preparation for the ACA’s reductions in Medicare reimbursements and updates.

When a woman in Alabama seeks an abortion procedure, she already has to sign that her doctor has performed an ultrasound and that she either viewed the ultrasound image or rejected seeing it. But state Sen. Clay Scofield (R) is pushing SB 12, a bill in the Alabama legislature that would mandate the physician “to perform an ultrasound, provide verbal explanation of the ultrasound, and display the images to the pregnant woman before performing an abortion.” The physician could also require the woman to submit to a transvaginal ultrasound — “in which a probe is inserted into the vagina, and then moved around until an ultrasound image is produced” — if she or he determines it necessary.

A Senate committee voted 4-1 on Friday to approve the measure, and the state Senate is expected to vote on it early this week. Even though studies have proven that viewing an ultrasound does not lead women to not have abortions, the bill’s sponsor says he hopes it will:

Scofield said he hopes that, if signed into law, his bill will stop some abortions. Though the bill states a woman can look away from the ultrasound image, Scofield wants her to see it.

“So she sees that this is not just a clump of cells as she is told,” he said. “She will see the shape of the infant. And hopefully, she will choose to keep the child.”

The bill wouldn’t require an ultrasound if an abortion is necessary to save a woman’s life, but it does not allow the victims of sexual assault to opt out of viewing the ultrasound.

Last week, Virginia Gov. Bob McDonnell backed away from supporting the same measure after almost 1,000 women protested the measure and national media mocked the extreme bill. He explained that he backtracked after the state’s attorney general told him that “these kinds of mandatory invasive requirements might run afoul of Fourth Amendment law.” The Virginia House and a Senate committee have passed the ultrasound bill with substitute language from the governor that would not require women to receive a transvaginal ultrasound.

Last Friday, the Colorado state senate advanced legislation requiring hospitals with religious objections to procedures such as abortions “to tell patients that any service not provided because of religious beliefs or moral convictions can be obtained from another hospital.” The measure passed second reading, despite “vigorous objections from Senate Republicans, who called the notification bill a thinly veiled attempt to stigmatize religious hospitals.”

The GOP described the requirement as “religious persecution” that would force some hospitals into a “special little ghetto.” Sens. Kevin Lundberg (R) and Ted Harvey (R) even compared the measure to “Communist Vietnam” and Nazi Germany:

HARVEY: I went to Vietnam a couple of years ago, it’s a Communist country, and they tell everybody they have religious freedom… Is that what where’s saying here in the land of the free and the home of the brave? That you have to affirm that you are a religious hospital here? To have the freedom to be able to provide the services that you think that you should or to have the freedom not to provide the services that go against your religious beliefs. This is religious bigotry, doesn’t matter how you look at it and that is the way the Communist Vietnam government is.

LUNDBERG: Here we have a bill that discriminates. That forces hospitals to put a little patch on them that says, ‘excuse me, but I have religious values and principles and scruples therefore you should consider me to be in this special little ghetto….How about we amend this bill to just put a big star, a big sign. To say this is the building we designated. Would that be appropriate? No. Neither is this bill.

Listen:

The measure needs one more vote in the Senate before moving to the Republican controlled House.

Wendy Long, a conservative judicial activist challenging Sen. Kirsten Gillibrand (D-NY) said yesterday that no one would miss Roe v. Wade, the landmark Supreme Court case that legalized abortion, if it were overturned. Long clerked for Supreme Court Justice Clarence Thomas and served as a counsel for the conservative Judicial Confirmation Network, but is perhaps best known for spearheading several inaccurate race baiting attacks against Justice Sonia Sotomayor during her confirmation process.

Long made the abortion comment to Capital New York’s Reid Pillfant at the Manhattan GOP’s annual Lincoln Day Dinner last night:

“I think there is a universal understanding among the legal community that Roe v. Wade was a very flawed legal decision,” she said. “It’s a horrible decision from a constitutional law standpoint, and even liberal law professors will tell you that.

“I believe that the issue of abortion should be left to the people to decide. The Constitution doesn’t mention the word abortion. So I think that’s what it’s really all about. And if Roe v. Wade were overturned tomorrow, nobody would even notice, because the states are legislating their own laws about abortion, completely independent.”

Republican-controlled legislatures are attempting to restrict women’s access to abortion services, but Roe is preventing them from outlawing abortion entirely. Should the precedent be overturned, a lot of women would almost certainly notice as plenty of states would criminalize the procedure.

Rick and Karen Santorum claimed that fears about how the Affordable Care Act would affect their youngest daughter’s medical condition inspired them to embark on their campaign for the presidency and suggested that the law would ration care to sicker or disabled Americans. “What did it for me was Obamacare,” Karen said in explaining her support for Rick’s decision to pursue the White House on Glenn Beck’s show. “Because we have as you know a little angel, little Bella, special needs little girl, and when Obamacare passed, that was it, that put the fire in my belly.” Rick agreed, arguing that the law would ration care based on the “usefulness” of an individual:

BECK: How much of a danger are the most vulnerable in our society if Obamacare actually kicks in and the whole bell curve…

R. SANTORUM: It’s all about utilization, right? It’s all about how do we best allocate resources where they are most effectively used? [...] Government allocating resources best on how to get the best bang for your dollars and it’s all about utility. It’s all about the usefulness of the person to society, instead of the dignity of every human life and the opportunity for people who love and care for people to give them the best possibility to have the best possible life.

Watch it:

But the Affordable Care Act actually prevents insurance carriers from denying coverage to individuals with pre-existing conditions (and disabilities), prohibits health plans from putting a lifetime dollar limit on benefits and specifically invests in programs for people with disabilities. For instance, The Centers for Medicare and Medicaid Services has “announced $2.25 billion to extend the existing Money Follows the Person Rebalancing Demonstration Program, which is designed to facilitate people with disabilities staying in their communities instead of being placed in institutional settings” and has provided additional funding for aging and disability resource centers and other programs for sicker Americans. This why groups like the American Association of People with Disabilities, National Organization For Rare Disorders, and The Arc of the United States not only support the law, but have filed an amicus brief in its defense.

Fortunately, the ACA already prevents insurers from limiting or denying benefits to children, meaning that Bella would be able to find insurance coverage if the family loses their policy.

Women’s health care has dominated political discussions as GOP-controlled state legislatures consider legislation to extremely curtail women’s access to abortions and right-wing leaders claim the Obama administration is infringing on religious liberty for requiring employer insurance plans to cover contraception at no charge (even though accommodations exempt churches and religiously affiliated institutions).

But it seems that some Republicans think their party has gone too far. Yesterday, Virginia legislators backed away from a “personhood” measure and the state’s conservative governor removed his support for an extreme ultrasound bill. Even Pat Buchanan, a leader on social issues within the party and a former GOP presidential candidate, this morning warned that Republicans like Rick Santorum are overreaching in their opposition to contraception.

On C-SPAN’s Washington Journal, Buchanan described the debate over contraception as “beyond the political realm”:

I think if you get down into where [Santorum's] been discussing it on the merits and demerits of contraception…that’s a moral issue. [...] We talked about that in college endlessly, but I think you move into an area where people don’t understand yet and where it’s beyond the political realm. And I think that’s where Santorum has gone and gotten himself. He’s gotten himself tied up in some of these arguments, and I don’t think he’s handled them with clarity.

Watch the video:

And Buchanan weighed in on the ultrasound legislation from which Virginia Gov. Bob McDonnell (R) had backtracked earlier this week. “I can understand why McDonnell did what he did,” he said. “To support that invasive procedure would probably politically costly undeniably, and Gov. McDonnell is not a foolish politician.”

When even Buchanan, who has his own history of extreme opinions, thinks it’s a wise move to back away from an anti-abortion measure, social conservatives have gone too far in their opposition to women’s health.

Virginia Gov. Bob McDonnell (R) disputed the notion that he’s spending too much time legislating social policy during this morning Politico forum, as he continued to distance himself from a measure that would have required women to undergo an invasive transvaginal ultrasound before receiving an abortion. Under the proposed policy, most women seeking seeking an abortion would have been forced to have a procedure, “in which a probe is inserted into the vagina, and then moved around until an ultrasound image is produced.”

The governor explained that he has focused on “getting our budgets under control” and “jobs,” not social policy, and claimed that he hadn’t read the original provision before publicly endorsing it. McDonnell also added that Attorney General Ken Cuccinelli, a conservative powerhouse within the Republican party, advised him that the measure was unconstitutional:

MCDONNELL: We realized there were different kinds of ultrasounds and so what I recommended to the General Assembly, and they adopted the other day, is let’s make the requirement for the abdominal ultrasound… I also got legal advice from various people, including my Attorney General, that these kinds of mandatory invasive requirements might run afoul of Fourth Amendment law. So those were the reasons…After talking to lawyers and doctors on my own, after we started hearing some concerns int he legislature, I personally looked at it. I mean, normally a governor would review these hundreds of hundreds of bills when they get to your desk. You’re so busy advocating your own agenda, you don’t read every legislator’s bill. But I was certainly supportive of that concept.

Watch it:

Until the bill attracted national media attention and frustrated some in the Republican party, however, “McDonnell and his aides had said the governor would sign the measure if it made it to his desk.” Since then, he issued a statement claiming that “Mandating an invasive procedure in order to give informed consent is not a proper role for the state” and offered an amendment that would not force women to receive the procedure. Studies have shown that viewing an ultrasound does not change a woman’s mind before an abortion and only adds to the cost of the procedure.

The Virginia House and a Senate committee have passed the ultrasound bill with the governor’s substitute language.

Indiana Republican Rep. Bob Morris has become the butt of late night jokes and ridicule after he wrote a letter to colleagues claiming that the Girl Scouts was a “radicalized organization” that supports abortions and the homosexual agenda. Morris initially stood by his remarks, saying on Tuesday, “My family and I took a view and we’re sticking by it. … My girls are no longer Girl Scouts. They’re now going to join American Heritage Girls.” But now, as the pressure has mounted, Morris is apologizing for the tone of his comments, even as some pro-life groups are rallying to his cause.

In a written statement to The Journal-Gazette of Fort Wayne on Thursday, Morris said, “I realize now that my words were emotional, reactionary and inflammatory. For that I sincerely apologize. … I certainly should not have painted the entire Girl Scouts organization with such a wide brush.” He explained, “Had I known this letter would have gone to a wider audience, I would have cited further evidence for my position,” adding that he still stood by his decision not to sign on to a resolution honoring the organization.

But conservative groups like Indiana Right to Life and the American Family Foundation are coming to Morris’ defense, claiming that a Planned Parenthood sexuality educator “developed programs for young Scouts”:

Specifically, the group, which opposes abortion rights, cites a link from the city of Bloomington’s website where a woman was nominated posthumously for a lifetime achievement award in the community.

“(She) started with Planned Parenthood in Bloomington where she worked for many years as a health and sexuality educator, and helped initiate the Family Life Education program for Girl Scouts ages five to 18 throughout a twelve-county area,” the website read.

Mike Fichter, Indiana Right to Life president and chief executive officer, said the ties between the groups could not be clearer.

The American Family Association also attacked Republican House Speaker Brian Bosma “for mocking the controversy surrounding Morris” by buying 278 cases of Girl Scouts Cookies and distributing them to fellow lawmakers. In an email sent to its members, the group asks them to contact Bosma and question his actions. “It appears as though Speaker Bosma has more zeal for bad behavior than he does for doing what is right,” the association’s email read. “Or perhaps it is just that he seems to be more interested in mocking a conservative more than he is fighting his true ideological opponents on the political left.”

Last month, a Catholic parish in Virginia banned local Girl Scout troops from parish facilities over its alleged ties to Planned Parenthood. “St. Timothy Catholic Parish in Chantilly says Girl Scouts will not be permitted to meet or wear uniforms on church property, including at St. Timothy School, which covers preschool to grade 8.”

Both the Girl Scouts and Planned Parenthood deny any affiliation.

The Affordable Care Act’s Pre-Existing Condition Insurance Plan (PCIP) is credited with providing comprehensive health coverage to nearly 50,000 Americans with high-risk pre-existing conditions, according to a report released today by the Department of Health and Human Services. The PCIP is a temporary program intended to make health coverage available and more affordable for individuals who are uninsured — and were likely denied coverage based on their pre-existing conditions — and are ineligible to receive Medicare and Medicaid. Once the health reform law is fully implemented, in 2014, insurers will be prohibited from refusing coverage to any American with a pre-existing condition.

Since its launch in November 2010, there has been an approximate 400 percent increase in PCIP enrollment — specifically amongst older uninsured Americans, who’s serious pre-existing conditions require more intensive and ongoing medical care — with the PCIP program attracting 8,000 new applications every month from August through November 2011.

PCIP enrollees are immediately granted access to the most basic medical treatments, including primary and specialty care, hospital care, prescription drugs, home health and hospice care, skilled nursing care, preventive health and maternity care, but because of the severity of many of the enrollees’ conditions, 78 percent of the total cost to run the program is spent on providing care for four types of potentially life-threatening medical needs, such as: cancer, circulatory diseases (i.e. coronary artery disease), degenerative joint diseases, and rehabilitative care/aftercare (i.e. radiation and chemotherapy).

In 2011 the Federally-administered PCIP served 628 enrollees with cancer, including 333 enrollees diagnosed with breast cancer, and covered more than 1,000 enrollees with a diagnosis of either ischemic heart disease or heart failure. Assuming that the risk profile of the Federally-administered PCIP population is reflective of the program as a whole, we estimate that the PCIP program served nearly 1,900 individuals with cancer and approximately 4,700 people with heart disease in 2011.

A recent study examined a sample of 1,485 enrollees in 10 state-based PCIPs and found that 18.7 percent of individuals had joint disease, 16.8 percent of individuals had diabetes or other disorders of the endocrine system, and 15.4 percent had cardiovascular disorders. The top five diagnoses or procedures by cost vary by State, but typically include cancers, ischemic heart.

Some states have had trouble getting the high risk pools off the ground and have either relied on existing state programs or offered patchy benefit packages“. The transition to the new pools has been less than flowing, with enrollment failing to meet the Obama administration’s projections, and while most states still have yet to exceed their operating budgets, at least nine have burned through their money and are currently requesting additional funding — Alaska has spent $13 million on just 45 people. Costs have also stunted enrollment rates, as premiums remain impossibly high, even after the federal government’s decision to reduce them in an attempt to appeal to more people.

– Fatima Najiy

Sen. Roy Blunt (R-MO) has offered an amendment that would allow employers to deny coverage of health services to their employees on the basis of their personal moral objections. Women’s groups warn the measure will severely limit access to needed care and now Brent Bozell, founder of the Media Research Center, is providing a sneak preview to the kind of discrimination employees will experience if the amendment becomes law.

Upon hearing news of President Obama’s regulation requiring all employers to offer contraception coverage without additional cost sharing, Bozell examined his own organization’s insurance policy and was “horrified” to learn that MRC’s plan has long provided contraception (and abortion) coverage. Bozell asked his employees to stop using “contraception/abortifacient/abortion services” and promised to eliminate the benefits at once:

“[W]e are working to change our insurance policy so as not to have to comply with this administration’s disgusting mandate to provide contraceptive, sterilization and abortifacient services. In the course of looking into this I have learned our insurance policy provides abortion services. I cannot begin to tell you how horrified I am by that. I never would have approved this had I known. It is the taking of a human life. That will change.”

If Congress approves Blunt’s amendment, employers like Bozell would be able to make health decisions for their employees on the basis of their own personal beliefs. About two-thirds of Americans oppose this idea, but Bozell is already putting it into practice.

The incident is reminiscent of the Republican National Committee’s reaction upon discovering — through an article in Politico — that its health insurance plan covered abortion in 2009. Like Bozell, the RNC did not change its policy until it contradicted its political rhetoric, suggesting that women’s health care benefits are standard insurance benefits and that the GOP’s sudden outrage is nothing more than a manufactured political issue designed to rally the Republican base.

Aetna CEO, Chairman and President Mark Bertolini praised the Affordable Care Act during the HIMSS12 Conference in Las Vegas this week, arguing that while the new law and its regulations have “pulled [the insurance industry] through the crucible” and “reshaped” the health care market, “For most of what has already been implemented, it has been a pretty good thing”:

So what will the health insurers look like in the future? Bertolini offered a strong endorsement of the accountable health organization model, positioning health insurers as uniquely suited to usher in an era of coordinated care. “We need to move the system from underwriting risk to managing populations,” he said. “We want to have a different relationship with the providers, physicians and the hospitals we do business with.” [...]

Pondering the future of the health care exchanges, Bertolini foresees the brands of health systems superceding those of health insurers. “We want to leverage or technologies and capabilities to allow you to be the face in marketplace,” he said.

Indeed, Bertolini says this new arrangement makes great sense from the perspective of the customer. The lack of coordination inherent in the current system stems largely from the various stakeholders acting rationally in their own self-interest. “For the patient it’s a nightmare. Think of a hockey game where everybody has their own puck.”

The Aetna chief also “discounted the prospect that the results of the 2012 presidential election or a Supreme Court decision striking down aspects of the ACA would deter the change,” noting, “Reform is not going to stop. It won’t go away.”

Insurers have generally accepted the inevitability of the ACA and have worked to shape its implementation to meet their needs. For instance, health lobbyists are pressuring Congress to repeal taxes on the industry, and have urged the Department of Health and Human Services to adopt exchange regulations that would allow almost all private insurers to participate in the new marketplaces and provide greater leeway for plans to design the standard essential health benefits package that will be offered in 2014. Insurers have also lobbied conservative governors to establish health care exchanges.

At the same time, the industry is preparing for the expansion of new customers. Last September, Cigna — one of the nation’s largest health insurers — kicked off a $25 million ad campaign designed to attract the individual consumers who will begin shopping for their own policies and the industry joined forces with health care and consumer groups to form the “Enroll America” campaign, an effort to “encourage states to make it easy for people to sign up for coverage, by providing model regulations” and “get the word out among the uninsured, through advertising and community outreach.”

Democrats on the House Democratic Steering and Policy Committee held a special hearing Thursday morning in response to the GOP’s decision to prevent women from testifying in support of an Obama administration rule requiring employers to provide birth control without additional cost sharing. The committee invited just one witness, Sandra Fluke, the third year Georgetown Law student, who House Oversight Committee Chairman Darrell Issa (R-CA) dismissed as an “energized” “college student” who was not “appropriate and qualified” to testify before his committee.

Democrats received over 300,000 requests for women to testify on the issue, House Minority Leader Nancy Pelosi (D-CA) said during today’s hearing, and the GOP’s male-only contraception hearing was widely spoofed in the press and on late-night comedy shows. Fluke herself responded to Issa’s snub in jest, noting, “Well, I will confirm that I was energized, yes” she said to laughter from the committee, “as you can see from the reaction behind me, many women in this country are energized about this issue.” “I’m an American woman who uses contraception, so let’s start right there. That makes me qualified to talk to my elected officials about my health care needs,” she added.

In her testimony, Fluke reiterated the story of her friend who was denied contraception coverage from Georgetown, despite technically qualifying for an exception that provided students who use birth control for health reasons with the benefit, and had to undergo invasive surgery. She also highlighted the confusion such policies cause, noting that while Catholic employers may claim that their insurance plans include loopholes for women who use birth control for non-reproductive purposes, beneficiaries still interpret the policy as a blanket exclusion of reproductive health benefits. One woman, for instance, did not seek medical treatment after being raped because she believed Georgetown did not provide coverage for women’s “sexual health care”:

FLUKE: One student told us that she knew birth control wasn’t covered, and she assumed that’s how Georgetown’s insurance handled all of women’s sexual healthcare, so when she was raped, she didn’t go to the doctor even to be examined or tested for sexually transmitted infections because she thought insurance wasn’t going to cover something like that, something that was related to a woman’s reproductive health.

Watch it:

Pelosi criticized Republicans for denying her request to have Fluke’s testimony covered by House-operated TV cameras and argued that the GOP was seeking to silence women on the issue in order to frame the discussion as a matter of religious liberty. Rep. Elijah Cummings (D-MD) pointed out, however, “if this was a hearing on prostate cancer and there was a lot of women and no men, I guarantee you men would not have stuck around.”