The Center for American Progress (CAP) today released a new study highlighting the devastating effect that raising the Medicare eligibility age would have on America’s seniors.

CAP’s study finds that if lawmakers were to raise the eligibility age to 67, as many as 5.4 million 65- and 66-year-olds would have to search for alternative coverage sources — either by postponing retirement, enrolling in an individual plan on one of Obamacare’s statewide insurance exchanges, or qualifying for Medicaid. This dynamic alone will drive up all Americans’ costs by making existing insurance pools older, sicker, and costlier to treat.

The report further estimates that while the federal government would save a net $5.7 billion, raising the eligibility age would end up costing states, employers, and Americans an added $11.4 billion in health care spending. Worse still, seniors living in GOP-run states that have very high concentrations of poor, elderly Americans yet have refused to take part in Obamacare’s Medicaid expansion would be hit hardest by the eligibility hike, and as many as 435,000 seniors could end up uninsured by 2021 if lawmakers end up following through on the proposal:

Unfortunately, GOP governors have been digging in their heels against health care reform by refusing to take part in Obamacare’s Medicaid expansion. Just last week, while announcing that South Dakota would not be expanding its Medicaid program, Gov. Dennis Daugaard (R) dismissed the plight of poor, uninsured Americans off-hand, saying, “I want to stress that: these are able-bodied adults. They’re not disabled; we already cover the disabled. They’re not children; we already cover children. These are adults — all of them.” While it is certainly true that these poor Americans — who must make ends meet on less than $12,000 per year — are “adults,” Daugaard’s assurance that they are able-bodied is dubious.

Raising the Medicare eligibility age from 65 to 67 is fundamentally un-serious entitlement “reform.” It’s the kind of proposal that sounds logical — after all, it’s true that Americans are living longer on average — and makes for a quick and easy political pitch. But a brief dive into its mechanics and consequences shows it for what it really is: a shoddy political deal that ends up costing double what it saves by shifting the cost of health care from the federal government onto states, employers, and Americans’ premiums — all while doing absolutely nothing to address the actual roots of America’s skyrocketing health spending.

After surviving a Supreme Court challenge and a presidential election, Obamacare is truly here to stay. But the federal government, states, and health care providers now have their work cut out for them as they begin implementing the biggest overhaul of the American health care system since the establishment of Medicare.

One of the biggest challenges will be making sure that Americans have accurate information about their health coverage options so they can successfully enroll in the health plan that’s right for them in 2014. Between states and the federal government instituting health insurance exchanges, expanding Medicaid pools, and issuing insurance subsidies to qualifying Americans, that’s a whole lot of change in a relatively small period of time — and it’s ripe for confusion and misinformation.

Luckily, some health insurers — who were once the most vocal opponents of Obamacare — are accepting health reform’s reality and teaming up with the nonprofit group Enroll America to make sure that the law is enacted properly and that Americans have the right information about which plans and subsidies they qualify for. As Bloomberg reports, the move has as much to do with health insurers’ rational self-interest as it does with the looking out for the American people’s well-being:

Enroll America, a nonprofit created two years ago, has gathered support from the insurers that opposed the law and consumer organizations such as Washington-based Families USA that supported it. The new organization plans a broad-based educational campaign to make uninsured people aware of the health-care law’s benefits and help them sign up, said Ron Pollack, Enroll America’s chairman.

The group will reach out to the 43 million uninsured whose participation will help strengthen the funding formula that holds the 2010 Affordable Care Act together. The new customers are expected to help offset added costs for the insurers from new regulations and taxes included in the law.

“Business people in the end have to be pragmatic,” Robert Laszewski, a health insurance industry consultant based in Alexandria, Virginia, said of the companies’ efforts to help the law succeed. “The industry has gotten over it.” [...]

“You want to mimic the success of employer plans, in which everyone is enrolled when they take a job,” said Sara Collins, a vice president at the Commonwealth Fund in New York, in a telephone interview. “It will be essential that everyone comes in to get the coverage that they’re eligible for.”

Since Obamacare ensures that insurers will no longer be able to partake in odious practices like denying Americans coverage based on a pre-existing condition, those firms now have a very real financial stake in making sure that Americans are insured and able to pay for their medical services. Otherwise, insurers run the risk of not having enough healthy Americans participating in their risk pools and helping to mitigate the costs of insuring the sicker Americans that they must now cover. The partnership between Enroll America and health insurance providers is one that will benefit insurance companies and the uninsured alike.

Even though first responders’ important work may put them at risk for physical injuries and exposure to harmful substances — especially in the wake of natural disasters such as Hurricane Sandy — not all rescue workers are eligible for the health benefits they need to counteract those occupational hazards.

Since about 70 percent of FEMA’s workforce serves as temporary, part-time rescue workers during times of disaster — often through the Reservist Program, FEMA’s branch of on-call disaster relief workers — they don’t qualify for employer-sponsored insurance. Only 770 of the 9,106 disaster assistance employees employed by FEMA currently receive federal health insurance in their positions, while the rest are left to fend for themselves on the private insurance market.

But one woman is trying to change that by circulating a Change.gov petition aimed at securing health coverage for the large percentage of part-time responders who are currently forced to forego it:

Reservists are paid a flat rate of between $11.29 and $42.03 per hour when they are in travel, on duty or training – usually about 30 days at a time. The jobs do not include health insurance, annual leave or retirement benefits since they are meant to be temporary. [...]

Dena Patrick, founder of a social charitable website, Wishadoo, started a Change.org petition on Monday to argue for FEMA reservists to get health benefits. “I feel that our priorities are skewed,” said Patrick.

Patrick said she was motivated to act by her friend, a reservist, who she said works 300 days a year and is not insured. When Hurricane Sandy hit, Patrick realized that other first responders were not covered unless they had a separate insurance plan. As of Saturday morning the petition had more than 4,900 signatures.

One of the barriers to comprehensive health benefits for these workers is the loose application of their “part-time” status. Even the first responders who serve 10 months out of the year do not qualify for full time benefits — despite the fact that their career is fraught with medical risk.

Specific groups of rescue workers have won victories on this front in recent years. This fall, 9/11 first responders gained coverage for 50 different types of cancer that may have been caused by their exposure to Ground Zero contaminants. But thousands of federal relief workers who lead the charge in rescue efforts for disasters such as Hurricane Sandy are still waiting.

The conservative think tank American Action Network (AAN), a lobbying group partly funded by insurance companies, is pushing for repeal of the Affordable Care Act. And to back up that effort, the group today announced a $1.2 million advertising campaign that urges Republicans to repeal the Affordable Care Act. AAN will have a full force push for repeal in the coming weeks, with insurance companies footing the bill:

The national initiative includes direct mail, print advertising and robocalls, as well as web videos targeted at “select liberal members.”

“The Supreme Court has upheld Obamacare,” reads the mailer. “Congress has only one option: Repeal the President’s government takeover of your healthcare. In addition to billions in new taxes, Obamacare also includes over $500 billion in cuts to Medicare. If the Obama government takeover of healthcare is not repealed, seniors across America will suffer.” [...]

AAN is planning to spend at least $10 million during the 2012 election cycle in districts where there are “competitive House races but state parties with little ability to provide a lift,” Politico reported on Sunday. The group already has organizers on the ground in specific districts, and it plans to build out “a broader, issues-specific grassroots network with endurance.”

The ad blitz is the latest in a trend of insurers, like Aetna, who seem to be hedging their bets on either side of the repeal debate.

The U.S. Chamber of Commerce experienced a similar divide during the run-up to the health care vote: The largest insurer lobbying group in the country, America’s Health Insurance Plans, gave $102.4 million in just 15 months to prevent the law from passing.

But AAN isn’t known for successful advertising — just two years ago, the group was forced to pull two ads after they were found to be false or misleading. One ad claimed that the ACA would allow rapists access to Viagra.

Roll Call reports that a new group called “Partnership for America” has announced a $3 million campaign to repeal health reform. The stated goal is to “‘freeze, investigate and replace’ the health care law known as the Patient Protection and Affordable Care Act.”

The website for the group describes itself as a “grassroots” uprising to “ensure a new era of American greatness.” But an examination of the group’s backers reveals more of the same: health care industry consultants using a front group with a lofty name to accomplish a corporate lobbying goal.

Kaiser Health News reports that the team behind the Partnership for America includes former Republican bureaucrats-turned-industry lobbyists Bob Wood, James Capretta, James Wootton and Chuck Cooper. The leadership biography page on the Partnership for America website lists the men involved, but makes significant omissions about their current lobbying clients that stand to benefit from the group’s irresponsible repeal campaign:

– Partnership for America leader Bob Wood is a lobbyist whose portfolio of clients include Eli Lilly, Pharmaceutical Research and Manufacturers of America (better known simply as PhRMA, a lobbying association for drugmakers), Select Medical, and XL Health Corp, a Medicare Advantage provider.

– Partnership for America leader James Capretta is no longer a registered lobbyist, but is currently listed as a “Principle” at a government affairs firm that represents health insurers like CIGNA, UnitedHealth, and America’s Health Insurance Plans (a trade association for the entire health insurance industry).

Other Partnership for America leaders, like James Wootton and Chuck Cooper, have a history of working for health care industry-related interests. Wootton was a former lobbyist for and an official at the U.S. Chamber of Commerce, a trade association with a sordid past of secretly funneling health insurance cash into far right anti-patient and anti-health reform causes. Cooper is an attorney at a law/lobbying firm with an active health care practice that has counted PhRMA as a client in the past.

Fronts like the Partnership for America thrive when media outlets report on them as bonafide citizens groups. It doesn’t appear that there is anything authentic about the organization. Even the office location listed for the group is actually an anonymous mailbox/corporate conference room service two blocks from K Street.

In California, Democrats in the legislature proposed a bill to add greater oversight over the health insurance industry. The rate regulation bill, proposed by Assemblyman Mike Feuer (D-Los Angeles), would have allowed the Insurance Commissioner to review rate hikes proposed by insurers, and block hikes if they are without justification.

The bill, which mirrors similar policies for the auto insurance industry and health rate review laws in other states, died a sudden death yesterday as health care industry lobbying intensified:

Groups representing insurers, hospitals and doctors lobbied against the bill, saying the regulations would add bureaucracy and do nothing to address high and fast-rising medical costs that help drive rate increases. Ultimately, they argued, rate regulation could reduce access to care.

As ThinkProgress reported back in June, health insurers mobilized opposition through a number of third party groups funded by health insurers and other health care industry businesses. For instance, the California Chamber of Commerce slated Feurer’s bill, AB 52, as a “Job Killer,” but obscured the fact that Kaiser Health Plans, UnitedHealthcare of Southern California, and Anthem Blue Cross of California are major donors to the Chamber’s political coffers.

Although Feurer’s bill is dead for now, the fight has not yet ended. Next year, advocates will push again for the bill, which passed the Assembly earlier this year and died due to obstruction in the Senate.

Rate regulation might also see momentum in the form a ballot initiative drafted by California Watchdog for the polls next year. According to reports, California Watchdog’s rate review initiative would not only include elements of Feuer’s bill, but also require a 20 percent rollback of existing rates. “We’re preparing an initiative to be ready to go on health insurance reform if we’re not able to get satisfactory results in the Legislature,” said Doug Heller, executive director of the group.

The San Francisco Chronicle is reporting that Kaiser Permanente plans to raise rates by more than 10 percent for about 300,000 Californians enrolled in policies offered through small businesses. Kaiser Permanente, which operates as a quasi-nonprofit, has reported record profits of $921 million in the first quarter of 2011 alone. The company reportedly has healthy reserves, and has filed disclosures noting that it has rewarded top executives with million-dollar bonuses in recent years.

While public outcry temporarily stalled California insurers from forcing through egregious rate hikes last year, pending legislation may provide a better path. This week, the California state Senate is expected to vote on AB 52, legislation sponsored by Assemblyman Mike Feuer’s (D-Los Angeles) to allow regulators to review proposed rate hikes by health insurance companies. However, California health insurance companies are fighting back with an onslaught of lobbying.

Like the national legislative battle over President Obama’s health reforms, insurance companies in California are attempting to undermine AB 52 by showcasing widespread opposition to the bill. The California Association of Health Plans — the trade association representing major insurers in the state like Kaiser Health Plans, Anthem Blue Cross (WellPoint), Aetna, UnitedHealth, HealthNet, and Cigna — is leading the charge, firing off press release after press release noting the “diverse group” of California organizations against the rate review bill. However, a closer look at the groups the insurers are touting reveals multiple financial ties to insurers opposed to AB 52:

– The California Chamber of Commerce has announced that AB 52 is on the top of its list of “Job Killers,” meaning they will make killing the legislation a top priority. The Chamber purports to represent all businesses in the state, but its board membership reveals mostly multinational corporations. Health insurers have a seat at the table. California Chamber board members include Greg Adams, a top Kaiser Health Plans official, David Anderson, CEO of UnitedHealthcare of Southern California, and Pam Kehaly, President of Anthem Blue Cross of California. Diamond membership to Chamber requires annual dues of at least $100,000, suggesting that top insurers have funneled hundreds of thousands of their customers’ premium money to a right-wing lobbying group, rather than spending it on actual medical services. Although the Chamber has not registered with the Secretary of State for grassroots lobbying, the Chamber’s e-lobbying platform is calling for members to contact legislators to oppose the bill.

– The Pacific Research Institute (PRI), a conservative think tank based in San Francisco and Sacramento, has attacked the legislation. PRI fellow John Graham has claimed there is “little or no evidence” rate review provides relief to consumers. In fact, numerous studies, like this one from Families USA, have found broad benefits to consumers through rate reviews instituted in other states. Perhaps PRI’s opposition is partially rooted in the fact that Michael Carpenter, a top lobbyist for Kaiser Health Plans, is a former board member of the group who has been featured at PRI events.

– A number of the other local chambers of commerce touted as opponents of AB 52 are funded by health insurance companies. For example, the Los Angeles Area Chamber of Commerce receives annual donations of at least $50,000 from Kaiser Health Plans.

– The Civil Justice Association is paraded around as an opponent of the AB 52. Health insurers like Kaiser Health Plans and Anthem Blue Cross are among the dues-paying board members.

ThinkProgress has learned that the lobbying firm Fiona Hutton and Associates has been charged with helping to recruit and push these insurer allies.

Earlier this month, Los Angeles Times columnist Mike Hiltzik absolutely eviscerated the policy arguments insurers have advanced to discredit AB 52. But policy arguments are only part of the equation when it comes to legislative debates. According to disclosures filed with the state, health insurers like UnitedHealth, Cigna, and Anthem are hiring top Sacramento lobbyists and pouring more than $1 million dollars into lobbying. As the Courage Campaign highlighted in a recent letter, despite its registration as a nonprofit, Kaiser is spending vast amounts of money on direct lobbying as if they were a normal for-profit insurer. Sadly, the searchable donations reveal only part of the picture. Health insurers have not only purchased lobbyists with their customers’ premium money, they have purchased friends to build their anti-AB 51 “coalition.”

Throughout the health care reform debate, Congressional Blue Dogs lobbied then-House Speaker Nancy Pelosi (D-CA) to adopt provisions that would lower health care spending and reduce the deficit, but curiously opposed the so-called robust public option. That measure reimbursed providers 5 to 10 percent above Medicare rates and would have reduced the deficit by as much as $110 billion over 10 years. In July of 2009, the fifty-member Blue Dog Coalition wrote a letter to Pelosi revealing “strong reservations” about an earlier House version of the health care bill. “After reviewing the draft tri-committee health care reform proposal, we believe it lacks a number of elements essential to preserving what works and fixing what is broken,” they wrote, noting:

A “Medicare-like” public option would negatively impact hospitals, doctors and patients…using Medicare’s below-market rates would seriously weaken the financial stability of our local hospitals and doctors.”

That argument was debunked repeatedly by MedPAC — which argued that Medicare rates are adequate and consistent with the efficient delivery of services — and relied heavily on insurance industry talking points. The industry feared that it would lose market share if forced to compete against a more efficient public plan. In March 2009, he industry’s chief lobbying arm, AHIP, provided lawmakers with this presentation, ‘What you should say when asked about the public option“:

You could end up not being able to see the doctor of your choice as the government plan would reimburse doctors so little for their services they stop accepting or dropping patients by the government plans.

And so, given all this, it is perhaps not surprising that today’s Politico Pulse reports that Erik Komendant, the policy director for the Blue Dog Coalition, has now accepted a job at AHIP as “VP for federal affairs.” After all, it’s like he was working for them already.

The health sector has kept quiet throughout the GOP’s futile effort to repeal the Affordable Care Act in the House, saving its ammunition for the more serious campaign of changing and tweaking parts of the law. This morning Karen Ignagni, the insurance industry’s chief spokesperson, offered a glimpse into what insurers will be lobbying for in the months and years ahead. She hinted that the industry isn’t interested in repeal and is instead focusing on the following issues. Watch it:

Let’s go through it piece by piece:

- Eliminating new taxes on the health insurance industry: Beginning in 2014, the health law imposes an annual fee on the health insurance sector, but Ignagni refers to this as “an unprecedented sales tax on small businesses and individuals” — “a health care sales tax.” Unless the industry offsets the increase through innovation, some of the costs may be passed down to employers and employees — but both of these groups will be receiving tax credits to offset the purchase of coverage. Generally speaking, in a law that pays for its coverage expansions and reduces the deficit, somebody has to pay more if others get more.

- Wants to charge younger people more for insurance: Ignagni claims that “anyone under 40 would see a huge increase” in costs and the industry has already been lobbying the Department of Health and Human Services to adopt a transition period for the age-rating provision of the Affordable Care Act. Under the law, beginning in 2014, insurers will have to guarantee coverage to everyone who applies and charge older people no more than three times what younger individuals would pay. But the industry is saying that if it had to adopt that change instantaneously in January of 2014, younger individuals would face big price increases. This argument isn’t particularly convincing, however, since many young people will actually pay less for coverage because they’ll qualify for subsidies and possibly even Medicaid. That will significantly increase participation among young adults, improve the risk pool, and probably outweigh any negative effects due to age rating. My post on that here.

- Essential benefits packages should be very narrowly defined: Ignagni claims that “if the essential benefit package is so broadly structured that these individuals and small businesses are going to find that the current proposals are unaffordable and they’re going to have to buy up, that is going to be a third leg of the stool in terms of cost increases. ” While there is a reasonable argument that regulators shouldn’t overfill the minimum benefit package and give insurers flexibility in design, you don’t want them to have so much flexibility that they can “continue to compete based on risk-selection, rather than price and quality as intended by the ACA and what is critical for a better functioning health insurance market.” My post on that here.

During the interview, Ignagni was also asked about Wendell Potter’s new book criticizing the industry and its PR practices. Ignagni — who Potter describes in the book as an incredibly effective spin-master — said she hadn’t read the book and didn’t address Potter’s accusations.

The Affordable Care Act prevents health insurers from cherry picking only the youngest and healthiest applicants by requiring insurers to accept anyone who applies without regard for prior conditions and charge applicants a modified community rate. But the industry is now trying to work its way around this goal and is lobbying the government for more flexibility in designing benefit packages:

America’s Health Insurance Plans and the Blue Cross Blue Shield Association both said in their comments that HHS should tread lightly when defining essential benefits, saying an overly broad policy could raise costs and make the process more confusing for consumers. “General principles and criteria should allow for plan innovation and flexibility to meet evolving market and consumer needs,” BCBSA stated. And AHIP said HHS should “only seek to identify general categories of care, rather than specific health care services.” [...]

But a health policy expert who reviewed the industry groups’ comments said too much flexibility could lead to adverse selection. If the regulations on essential benefits are too lax, the source said, insurers would be able to design their plans to appeal to healthy patients. She said that if HHS only sets broad principles for an essential benefit, leaving it largely to individual plans to determine which services meet those principles, plan design would become a tool for the same type of underwriting that health reform otherwise curtails or prohibits.

Indeed, if one designs a health plan without coverage for an expensive treatment or condition, patients who suffer from that particular ailment will go elsewhere for coverage. Conversely, a plan that offers discounts for gym memberships and focuses on primary care and prevention and is light on everything else, will likely appeal to healthier (read: less expensive) individuals. Given too much latitude, insures have an economic incentive to design the more profitable plan.

As the Center on Policy and Budget Priorities’ Edwin Park put it, “While there is a reasonable argument on the part of insurers that they continue to retain flexibility to design benefits that can improve quality while lowering costs (i.e. value-based insurance design based on comparative effectiveness research), you don’t want them to have so much flexibility that they can continue to compete based on risk-selection, rather than price and quality as intended by the ACA and what is critical for a better functioning health insurance market. ” He added that beneficiaries “wouldn’t want a particular plan claiming it covers one of the enumerated essential benefits like inpatient care and only cover one hospital day, or cover prescription drugs except for all the drugs used by people with HIV/AIDS, cancer, severe heart disease, or certain chronic illnesses like diabetes, etc, or charge much higher co-payments or co-insurance for certain higher cost services required by people in poorer health.”

Of course, all of this is a ways away, but it’s worth reiterating that while the legislative fight may be over, the various interest groups are now gearing up for ways to shift the law in their favor. For their part, insurers are already lobbying to, among other things, delay lowering rates for older people.