House Republicans are launching a coordinated campaign against Obamacare, hoping to emphasize the negative effects of the health law to their constituents at upcoming town hall meetings. At the same time, however, they’re fully prepared to tell those same constituents to enjoy all the benefits available to them under health reform — ultimately taking advantage of Obamacare funding in their home districts.

As Politico reports, several of the GOP members of the new coalition — called the “House Obamacare Accountability Project,” or HOAP — went on the record to confirm they will help their constituents figure out how to get the benefits funded through the health reform law. The Republicans said that if they’re asked, they will help people get access to the insurance premium subsidies or the Medicaid coverage that’s available to them under Obamacare. “That’s an important part of constituent services,” Rep. Kevin Brady (R-TX) explained.

They’re not the only lawmakers who have advocated for getting rid of the health law even while simultaneously enjoying its benefits. As Lee Fang reports in the Nation, several anti-Obamacare Republicans like Sens. John Cornyn (R-TX) and Rob Portman (R-OH) have requested grants funded through the health reform law for their districts. GOP lawmakers who decry Obamacare in public have requested Obamacare money to bolster their states’ health clinics, extend health services to uninsured residents, and launch public health campaigns.

In their letters requesting Obamacare funds, Republican lawmakers have praised the positive long term effects of the health reform law’s initiatives. Cornyn wrote that a grant from the Affordable Care Act would “improve the health and quality of life of area residents.” In reference to the same grant, Rep. Michael McCaul (R-TX) called the effort a “crucial initiative to achieve a healthier Houston/Harris County.” Rep. Aaron Schock (R-IL) praised a local nonprofit for winning Obamacare funds that will help give “people the tools to live healthier and longer lives.”

That reflects a larger trend when it comes to Obamacare: Although Americans may say they oppose the health law as a whole, they support its individual provisions. That seeming contradiction may partly be thanks to GOP-led initiatives like HOAP. Since political controversy has swirled around the health reform law for the past three years, Americans remain confused about what Obamacare actually does — and over 40 percent of the public isn’t even sure whether it’s still law.

The GOP-controlled states who continue to resist expanding their Medicaid programs under Obamacare are making a short-sighted financial decision, according to a new analysis from the Rand Corporation. The 14 states whose governors have indicated that they won’t accept the optional Medicaid expansion will lose out on $8.4 billion in federal funding while leaving an additional 3.6 million Americans uninsured.

The federal government currently pays for about 57 percent of the cost of each state’s Medicaid program — but under Obamacare, it will pick up the total cost of expanding the program to cover additional uninsured Americans, gradually reducing that federal contribution to 90 percent. That increased federal funding, as well as the savings that result from fewer uninsured patients unable to foot their medical bills, could ultimately save all 50 states as much as $18.1 billion a year by Rand’s estimations.

“Our analysis shows it’s in the best economic interests of states to expand Medicaid under the terms of the federal Affordable Care Act,” Carter Price, the study’s lead author, explained in a press release. “State policymakers should be aware that if they do not expand Medicaid, fewer people will have health insurance, and that will trigger higher state and local spending for uncompensated medical care.”

And Rand’s $8.4 billion figure could actually be an underestimation. The study focused on the 13 states that have already flat-out refused to participate in Obamacare’s Medicaid expansion as well as another state, Iowa, that is pursuing an alternative to the policy. But it didn’t include the six states that are leaning toward rejecting the Medicaid expansion — Alaska, Kansas, Nebraska, Utah, Virginia and Wyoming — which could also end up losing money if they officially decide against expanding their public insurance programs.

This is just the latest study to document the significant financial benefits for states that choose to expand Medicaid coverage under Obamacare. Nevertheless, stubborn Obamacare opponents in red states are still refusing to cooperate with any aspect of health reform — even at the expense of their most vulnerable constituents. Some of the nation’s most highly-uninsured states have resisted extending health coverage to additional low-income Americans simply to make a political statement against the health reform law.

That’s why the Republican governors who have already indicated their support for expanding Medicaid, like Arizona’s Jan Brewer and Ohio’s John Kasich, continue to encounter significant resistance from the rest of the members of their party. But that fierce opposition to Medicaid expansion stands in sharp contrast to public opinion. Most Americans strongly support this Obamacare provision, even in the Deep South.

Considering the fact that rejecting the Medicaid expansion represents a bad fiscal move for states, some Republican leaders have suggested that it’s not actually a conservative position. This week, Kasich pointed out that Ronald Reagan — who approved several expansions of the federal insurance program to additional populations, like pregnant women and low-income children, during his time in office — would likely be in favor of expanding Medicaid.

As the political fight over Obamacare continues, Republican legislators in highly uninsured states have turned their back on Medicaid expansion — despite the fact that expanding the public insurance program could extend coverage to millions of their constituents. Of course, even if stringently anti-Obamacare politicians refuse to cooperate with health reform, the law will still take effect. But that doesn’t necessarily mean those red states won’t feel the impact of refusing to add more residents to their Medicaid rolls.

Health care outcomes already vary widely across states. Unfortunately, health policy does too. The states that are already among the nation’s healthiest are the ones taking steps to ensure their low-income residents will have the insurance coverage they need — while the unhealthier, more highly uninsured GOP-led states are refusing to do the same. As an analysis from the Los Angeles Times points out, the health care reform law can’t change the fact that the stubborn lawmakers resisting Medicaid expansion are likely going to deepen the health disparities that already exist across the country:

With nearly every GOP-leaning state on track to reject an expansion of the government health plan for the poor, the healthcare law’s goal of guaranteed insurance will become a reality next year mostly in traditionally liberal and moderate states. These states already have higher rates of health coverage.

Residents of these states — concentrated in the Northeast, upper Midwest and West Coast — also have better access to doctors and are less likely to die from preventable illnesses.

Colon cancer deaths in states opposing Medicaid expansion, for example, are an average of 16% higher than in pro-expansion states, according to a Los Angeles Times analysis of state health data.

Deaths from breast cancer are 8% higher on average in anti-expansion states. And adults under 65 are 40% more likely on average to have lost six or more teeth from decay, infection or gum disease.

An earlier analysis found that the governors for the most unsinsured cities in the United States have been resistant to expanding Medicaid. And even after some of those governors started to come around — most notably, Florida’s Rick Scott — the Republicans in the state legislature have continued to block the initiative. Opposition persists despite the fact that the poor Americans in the South, who are already being forced to delay their medical care because they can’t afford it, stand to gain the most from Medicaid expansion.

This isn’t the only example of health disparities becoming sharply divided by region. Abortion access, another area of health policy that’s largely been left up to states’ interpretation, also varies widely from California to Mississippi to North Dakota to New York. “It shouldn’t be that simply because you live in Mississippi that you don’t have the same health care that you can get if you lived in California,” one abortion doctor who travels to practice at Mississippi’s last remaining abortion clinic recently pointed out. Nonetheless, that’s the growing reality for the entire health care sector.

The chief executive of a Miami, Florida hospital has pledged to begin addressing one of the most dysfunctional aspects of the American health care system, according to MedCity News. He’s striving for greater price transparency — giving patients and doctors the ability to easily see, before purchase, just what hospitals charge Medicare and other insurers for a given procedure.

A recent report gave over half the states in the U.S. a grade of “F” when it comes to price transparency. And after the Center for Medicare and Medicaid Services recently provided a huge data dump on what hospitals charge government health care programs for common procedures, they found a staggering amount of variation across the country with no discernible justifications on economic or quality-of-care grounds. But the prices charged to private insurers still remain secret.

So in the wake of mounting pressure following the government’s data release, Steve Sonenreich — the chief executive of Mount Sinai Medical Center in Miami Beach — promised on a radio show on Monday that his hospital will reveal the contractual rates that it charges private insurers:

“We will post our prices relative to Blue Cross, and Aetna, our contractual prices, and we’ll challenge Baptist and the other systems in the community to do the same,” said Sonenreich, who made his pledge during a studio interview on WLRN 91.3-FM with host Tom Hudson.

Also in the radio studio was Brian Keeley, chief executive of Baptist Health South Florida, which manages seven hospitals in the region. Keeley declined to accept Sonenreich’s challenge for price transparency, but acknowledged “That’s where the whole industry is going, undoubtedly.”

It remains to be seen whether other hospitals will follow Sonenreich’s lead. But the inability of consumers, doctors, and even many insurers themselves to compare different rates and charges openly is one of the key factors hamstringing the American health care market. With greater price transparency, it’s possible health care could begin behaving a bit more like markets are traditionally supposed to behave, and drive down prices through open competition.

There’s new evidence to suggest that Obamacare is impacting the health industry for the better by successfully encouraging a greater emphasis on primary care. Ensuring that Americans are receiving regular preventative care is an important tenant of the health law, since it can ultimately help lower costs by preventing people from delaying medical treatment until they’re already very sick.

For the first time ever, Americans are now spending more money on primary care physicians than they are on specialists, according to a new survey by the physician recruiting firm Merritt Hawkins. In what Merrit Hawkins’ president referred to as a “seismic shift” in medicine, primary care doctors are now the greatest source of revenue for the hospitals where they work:

For the first time, primary care physicians are driving more revenue on a per-doctor basis to hospitals than are specialists, according to a survey of hospital chief financial officers by physician recruiting firm Merritt Hawkins. It’s expected that this result is not a fluke, but a reflection of the growing emphasis on primary care by hospitals and the health care system in general. [...]

Merritt Hawkins said there were major shifts in the health care system from 2010 to 2013 that put pressure on all physicians, particularly specialists. One major factor is the 2010 Affordable Care Act, which has several pieces that put more onus on primary care to cut overall costs and keep patients healthy, especially those with chronic conditions or who otherwise would delay care until they are seriously ill. The rise in primary care contributions came as overall per-physician revenue for hospitals fell — from more than $1.5 million in 2010 to more than $1.4 million in 2013. It’s the lowest median in the 11 years Merritt Hawkins has conducted the survey.

As more than 25 million previously uninsured Americans gain coverage under Obamacare, the trend toward primary care is expected to continue. Those people likely avoided expensive medical treatment while they didn’t have insurance, but they’ll have the opportunity to seek regular check-ups once they become covered in 2014. In order to tackle the influx of Americans who will require primary care services, there will be opportunities for nurse practitioners to expand their role as health care providers.

As state and federal officials work toward the full implementation of Obamacare, politicians on both sides of the aisle have blasted the ongoing effort as a “train wreck.” But there’s mounting evidence to suggest those concerns are overblown. Although there’s still more work to be done to prepare for the state-level insurance marketplaces that will open to the public in 2014, much of the health reform law is already in effect — and it’s already having a demonstrable impact on the United States’ health industry. In addition to the shift to primary care, Obamacare has also already ensured that health care will be cheaper for many Americans by forcing private insurers to lower their premiums.

Which hospital in the United States charges its patients the highest bills for common medical procedures? It turns out that the nation’s most expensive hospital is located in Bayonne, NJ, where you’ll pay nearly $100,000 dollars to treat your case of chronic lung disease — five times as much as what others hospitals charge for the same procedure.

Last week, the Center for Medicare and Medicaid Services (CMS) released first-of-its-kind data detailing the prices that hospitals charge for common procedures. The new numbers revealed that there’s a huge range of price fluctuations between different hospitals, with no good reason for why some places are charging so much more than others. Bayonne Medical Center topped the list, billing at a rate more than four times the national average for the 100 most common types of medical treatments.

Does that mean that, since patients at Bayonne are paying extremely well for their time in the hospital, they’re receiving particularly good care? Not really. The New York Times points out that Bayonne Medical Center ranks about average in terms of the quality of its care, no better or worse than most other hospitals in New Jersey. That fits into the broader national trends regarding health costs and health quality — spending more on care isn’t actually correlated with better treatment.

The Obama administration, which is encouraging greater price transparency in the health care industry as one of the central tenets of Obamacare, hopes that making hospital costs public could help encourage Americans to shop around. If New Jersey residents decide they’d rather not receive the particularly expensive care at Bayonne Medical, maybe they’ll decide to go to a different hospital in the area — and maybe that will force Bayonne to lower its prices to stay competitive.

But addressing the United States’ sky-high medical costs isn’t just about better educating patients. In fact, there’s evidence that teaching doctors more about the actual costs of the procedures they’re recommending can also help. Studies have shown that doctors are less likely to order unnecessary tests and procedures when they know how expensive they are. And, in order to further continue to cut down on wasteful medical spending, the U.S. needs to do more research on which specific types of health spending could be pared down without sacrificing the quality of Americans’ health care.

For the 37th time since 2011, House Republicans will hold a vote to repeal Obamacare on Thursday, bringing the total cost of all of their failed repeal votes to roughly $55 million in taxpayer money, according to one estimate.

Last year, CBS News calculated that the number of hours spent on 33 repeal votes — then roughly 80 hours, or two full work weeks — cost taxpayers an estimated $48 million. Since then, Republicans have held three more votes (another $4.5 million) and will add another $1.5 million with their latest.

At a time when lawmakers have implemented $85 billion in across-the-board cuts on top of $1.5 trillion in spending cuts over the next decade, no dollar can be spared. And the country has serious health-related needs that could use funding. Here are some better health care uses for the more than $50 million these symbolic votes against the Affordable Care Act have wasted:

1. Restore cuts from sequestration to Title X family planning programs and Title V maternal and child health services. The National Women’s Law Center calculates that a 5 percent cut to the budgets of each program will reduce them by $15 million and $32.5 million, respectively. Rather than voting to repeal a bill that expands women’s access to preventative services, the House could use the money to expand them.

2. Double the Department of Justice’s budget for sexual assault services, which has currently been authorized a $50 million budget. The program gives money to states so that they can support rape crisis centers and other nongovernmental organizations that provide direct intervention, core services, and other assistance to the victims of sexual assault. Current funding is inadequate, as some states receive less than $300,000 and many programs lack the resources to meet victims’ needs.

3. Grant a request for $50 million to train 5,000 new mental health professionals as part of a new initiative to expand mental health treatment and prevention services. This proposal came in the wake of the Sandy Hook shooting to address gaps in the mental health system.

4. Help states implement paid leave policies. President Obama included a $50 million State Paid Leave Fund in his 2011 budget to provide start-up support for states that want to enact paid leave for workers. More than 40 percent of workers don’t have access to paid sick leave, heading to work when they or their family members experience an illness, but this funding could help give them a better option.

The current Congress is on track to be the most unproductive since the 1940s, but still has time to hold votes that won’t result in actual legislative change. There are many other priorities lawmakers could focus on instead and better ways to spend taxpayer dollars.

Last week, House Majority Leader Eric Cantor (R-VA) promised to schedule the first full Obamacare repeal vote for this legislative session. That vote, which will likely come on Thursday, will give freshman Republicans in the 113th Congress the opportunity to cast their own purely symbolic vote against health care reform. It will also mark the 37th time that the GOP-controlled House has voted to get rid of the health law.

And, as the New York Times points out, House Republicans’ obsession with repealing Obamacare becomes even more apparent when the amount of time they’ve devoted to that issue is calculated as a percentage of the total time they’ve spent on the floor:

The repeal vote, which is likely to occur Thursday, will be at least the 43rd day since Republicans took over the House that they have devoted time to voting on the issue.

To put that in perspective, they have held votes on only 281 days since taking power in January 2011. (The House and Senate have pretty light legislative loads these days, typically voting only three or four days a week.)

That means that since 2011, Republicans have spent no less than 15 percent of their time on the House floor on repeal in some way. [...]

Michael Steel, [Speaker John Boehner's spokesman], said that spending 15 percent of their time on the issue was hardly a waste for Republicans. “Given that the bill amounts to a takeover of roughly 15 percent of the American economy,” he said, “that sounds about right.”

By some earlier estimations, Republicans in the 112th Congress wasted about 90 hours and $50 million dollars on their multiple failed efforts to get rid of the health reform law. This new Congress is shaping up to be no different. Even though Republicans have admitted they have lost on Obamacare, and are even acknowledging that their future repeal efforts will fail, they have continued to block legislative efforts to amend the health reform law in favor of stubbornly opposing it altogether.

The House conservatives who are focused on pushing the leadership further to the right have been particularly intent on scheduling a full Obamacare repeal vote this session. “It’s something that we wanted to move up on the list of priorities,” Rep. Steve Scalise (R-LA) told the New York Times. “And I’m glad they listened to us.”

Successfully repealing Obamacare would put more than 30 million Americans’ health coverage at risk, as well as increase the national deficit by billions. It would also ignore the opinion of the majority of the American public, who think that implementing Obamacare should be a top priority in their state. At this point, now that the bulk of the health law has already gone into place, most Americans aren’t interested in defunding it or repealing it altogether — they would rather tweak it to make it better.

One of the most important ongoing stories in the realm of budgets and health care economics is the remarkable drop in how much health care costs are projected to grow over the next decade. Back in March, David Cutler and Nikhil Sahni released some preliminary work arguing that, thanks to this slowdown, projections of government spending on health care for the next decade were overshooting by hundreds of billions of dollars. Now they’ve released a more complete paper (gated) with a specific number: if the lower growth rate continues, the federal government could save $770 billion by 2021. Furthermore, Cutler and Sahni concluded that as much as 55 percent of the slowdown has been driven by factors other than the recession.

That last point is especially important. If the slowdown in growth is due to the recession, then it’s temporary. Health care costs will once again rise at their previous rate once the economy recovers, driving health-related spending to ever greater heights and further straining the budgets of both the government and American families. But if the slowdown is due to deeper, structural changes in health care markets, then at least some portion of the slowdown may be long-term. And the government’s projections of future debt and deficits rely heavily on those previous assumptions of high health care cost growth. So if the slowdown sticks, the outlook for America’s fiscal future could improve radically, all without lawmakers cutting a dime.

Here’s Bloomberg with a nice summary:

Cutler’s research compared the U.S. government’s growth projections for health spending from 2004 to 2012 with actual increases in the period. It found that the real growth rate was about half of the government’s prediction, leading to a gap of more than $500 billion in 2012 between the projections and spending.

The paper calculates that the recession accounted for about 37 percent of the slowdown in health costs from 2003 to 2011. Declining private insurance coverage and cuts in payments byMedicare, (USBOMDCR)the government health plan for the elderly and disabled, accounted for another 8 percent and the remaining 55 percent is “unexplained,” Cutler wrote. That’s where the structural changes come in, he said.

If the current lower-than-expected rate of growth continues, the country may reap savings of as much as $770 billion through 2021, the research found.

As always, there’s a lot of uncertainty built in here. Another recent study by Kaiser, for instance, suggested that as much as 77 percent of the slowdown is a temporary result of the recession. Also, there’s a lot of complexity in the category of “structural” changes. Some of it’s improvements in the efficiency of health care delivery, quite possibly thanks to reforms in Obamacare that encourage providers to change the way they do business. Other parts of it may be one-time shifts in the market, such as the rise of generic drugs to replace more high-cost brand-name medicines.

The broader point, however, is that there are more ways to balance the budget than just slashing the aid and benefits Americans need to buy. A better-designed health care system could very well deliver lower and more efficient government spending than austerity ever could.

The Center for Medicare and Medicaid Services (CMS) released highly-anticipated data on Wednesday that outlines what hospitals across America charge for common inpatient medical services. The takeaway from the new numbers? There is no rhyme or reason to what different hospitals charge for the same procedures across geographic regions (or even within the same region), and prices can fluctuate by over $100,000 in the most extreme cases.

The CMS data is comprised of charge records from over 3,300 hospitals spanning 306 localities, and detail the costs of many of the most common inpatient procedures, such as treatments for heart failure, chest pain, respiratory infections, and lower limb replacements. The Huffington Post has a helpful graphic mapping the prices that hospitals throughout the New York and New Jersey areas charge patients for treating chronic obstructive pulmonary disease (COPD), which helps illustrate just how significant the disparities can be:

These numbers confirm a recent Time Magazine investigative report that found much of the same trend throughout the U.S. And the biggest victims of this rampant price variation — and apparent price-gouging — are the poor, the uninsured, and the underinsured. Public entitlements such as Medicare are relatively protected, since the government has the power to negotiate blanket prices and reimbursement rates for specific services. But private insurers — and, of course, the uninsured — don’t have that same capacity, making them subject to the whims of the hospitals they do business with. In essence, that means that poor people’s medical and financial stability are left up to pure luck, dependent on whether or not the hospital they visit charges reasonable rates.

As Obama Administration officials explained, there isn’t any feasible economic reason for this cost variation — and reformers are hoping that the publication of the data will shame hospitals into changing these practices and acting in good faith:

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