One of the most common Republican narratives about the new health care reform law argued that eliminating the subsidy to private insurers participating in Medicare Advantage would force insurers to stop offering coverage, causing 10 million seniors to lose their Medicare benefits. Throughout the debate, Republicans introduced numerous amendments and motions instructing Congress to remove the $136 billion in cuts to the Medicare Advantage program. Sen. John McCain (R-AZ) was so sure that the cuts would leave seniors dry, he urged them to rip up their AARP cards to protest the organization’s support for the bill.

Immediately after reform became law, however, some industry observers saw indications that the fears were overblown. Earlier this month, BNet’s Ken Terry wrote that “If these companies were really concerned about the impending cuts, they’d be heading for the exits right now.” “The insurers’ decision to stick with Medicare Advantage undermines Republicans’ assertion during the reform debate that the Medicare cuts would hurt seniors.” Indeed, now even insurers are admitting that they may very well survive the cuts. From Business Week:

Stephen J. Hemsley, chief executive officer of UnitedHealth Group Inc., told analysts on an earnings call this week that reduced payments won’t keep the company’s products from competing with Medicare insurance offered directly from the government. Kathleen Sebelius, the Health and Human Services secretary, told a House Appropriations subcommittee that she expects “a robust array of choices for Medicare recipients.” [...]

“Sebelius is right” about Medicare Advantage, said Elizabeth A. McGlynn, associate director of Rand Health at the Rand Corp., a research institute in Santa Monica, California. “We’re going to see a variety of responses from plans. We may see plans that choose to go out of the business, and I think we’ll see plans that get very creative in how they choose to position themselves.”

The expectation is that the competitive bidding requirements eliminating the subsidy will force inefficient Medicare Advantage plans to follow the model of the efficient ones. Insurers may respond to the cuts by pressuring providers to lower their prices and take advantage of the law’s bonus payments but few will simply pull out and leave the market. Under reform, Medicare Advantage plans that provide quality benefits efficiently, would receive a 5 percent bonus on top of their competitive bid to pay for extra benefits.

Even with the loss of the subsidy, insurers aren’t exactly going bankrupt. As Terry observed, “The $13 billion a year reduction isn’t so much if you compare it to the insurers’ total revenues or consider all of the new business they’ll get as baby boomers start signing up for Medicare. The shortfall will also be covered by increased business from people under 65 who will have to buy insurance under the reform legislation. That windfall will start in 2014, right around the time that the decrease in Medicare Advantage payments starts to bite.”

Health care reform has shifted the abortion debate to the states, where conservative lawmakers are using the law’s opt-out language as an opportunity to prohibit insurers from offering abortion coverage in the new exchanges, but also severely restrict women’s ability to purchase abortion services with private dollars. Tennessee became the first state to pass legislation stripping abortion coverage from the new exchanges and Missouri, Mississippi, Oklahoma and now Louisiana are not far behind.

Last week, the Louisiana House passed a bill by a vote of 76-13 which “Prohibits all health insurance issuers from including abortion in any health care coverage available in the state,” while insisting that the law is still unconstitutional. “Nothing in this Act shall be construed or implied to recognize any independent right to abortion under the constitution or laws of this state, nor shall it be construed or implied to recognize the constitutional validity of the Patient Protection and Affordable Care Act of 2010, P.L. 111-148,” the bill states.

But conservative lawmakers are not simply opting their states out of providing abortion coverage in the exchanges, they’re taking advantage of the renewed debate to pass other pet restrictions. “At least 22 U.S. state legislatures are seeking new ways to restrict abortions.” They include:

- OKLAHOMA: Gov. Brad Henry (D) vetoed two separate abortion measures. One would have “required women seeking abortions early in their pregnancies to undergo an invasive form of ultrasound and listen to a detailed description of the fetus before having the procedures,” while the other would have banned wrongful birth lawsuits.

- NORTH DAKOTA: “A North Dakota grassroots pro-life organization is announcing the official beginning of an effort to circulate petitions for an initiated measure that would prohibit physicians from decapitating and crushing the skulls of living unborn children.”

- KANSAS: Doctors must give a medical diagnosis justifying late-term abortions under a new bill, which was vetoed by the governor April 15. An override attempt is expected.

- UTAH: “A new law makes self-induced abortion a homicide. It was prompted by a girl who paid a man $150 to beat her to try to induce a miscarriage.”

- MISSOURI: The state Senate passed a bill requiring the physician to provide materials “detailing the risks of an abortion and the physiological characteristics of an unborn child at two-week gestational increments” at least 24 hours prior to an abortion. The bill also requires women to be informed about fetus’ possible ability to feel pain. It now moves to the state House.

- NEBRASKA: Governor Dave Heineman (R) signed legislation “banning most abortions 20 weeks after conception or later.” Another measure discourages providers from offering abortion by allowing women to sue doctors that don’t follow a meticulous pre-abortion review process.

- VIRGINIA: “On a 20 to 19 vote, the Democratic-led Senate agreed to an amendment proposed by McDonnell (R) that would limit state funding for abortions to those performed in cases of rape or incest or when the life of the mother is at risk.”

Jessica Arons says that all of this is “a predictable outcome of the Nelson language in the health reform bill.” “It reignited the abortion wars in the states.” “Nelson opened the door for them to legislate away private insurance coverage of abortion and the states are walking right through. This is no longer about public funding for abortion (and in fact, it never really was); this is about making abortion impossible to obtain for women of all means.”