Republicans are criticizing the Department of Health and Human Services for signing a $20 million contract with a public relations firm to educate Americans about the preventive health benefits included in the Affordable Care Act. The campaign — mandated by the law — “must describe the importance of prevention while also explaining preventive benefits provided by the healthcare law,” essentially informing the public about the availability of preventive services without additional co-pays.

The GOP touted the benefits of preventive medicine before Obama signed health reform into law and claimed that it could help lower the nation’s skyrocketing health care costs. But they’re now denouncing this campaign as an “unconstitutional” “propaganda” effort:

– SARAH PALIN: “This is one of the stupidest things I’ve heard coming out of the Obama administration. Not only is this, of course, pending in court, and I think it will be deemed unconstitutional, but this is a propaganda piece, which I think violates many of the procurement laws and other laws applicable to government contracts. This is propaganda. It’s just promoting ‘ObamaCare.’” [Fox News, 5/22/2012]

– JOHN MCCAIN: “Outrageous waste of taxpayer $ to promote #Obamacare – ‘HHS signs $20M PR contract to promote healthcare law’ [Twitter, 5/22/2012]

– ROY BLUNT: “It’s unacceptable that Pres Obama intends to waste $20M on the taxpayer’s dime to sell U.S. on unpopular #ObamaCare” [Twitter, 5/22/2012]

– RON JOHNSON: “$20M for marketing #ObamaCare? This is a wasteful & inappropriate use of taxpayer dollars.” [Twitter, 5/22/2012]

President George W. Bush also used federal funds to promote the 2003 Medicare Modernization Act (MMA), which established the existing prescription drug benefit. In that case, however, an investigation by the Government Accountability Office and HHS’s own inspector General concluded that the federally funded campaign was “misleading” and “may also have illegally used public money to make what in effect were fake news reports about the law that did amount to propaganda.”

In February of 2004, the administration distributed brochures and launched a $12 million radio, television, and Internet ad campaign to promote the Medicare reforms. “We’re going to provide seniors with straight answers,” said then-Health and Human Services Secretary Tommy Thompson. “We’re going to let them know what benefits are coming and when.” Critics charged that the ads were misleading and some stations even stopped showing the spots.

In 2009, the GOP also defended Humana’s alleged use of federal dollars and data to send deceptive brochures warning Medicare customers that health reform will cut “important benefits and services.” Republicans rallied behind the insurer and accused Democrats of “trying to keep seniors in the dark about the consequences of congressional Democrats’ costly government-run health care bills.” But now they’re trying to undermine a campaign that will shine a light on prevention. Perhaps they’re worried that the more Americans learn about the law, the more they’ll like it.

In their first debate, Rep. Joe Walsh (R-IL) and his Democratic competitor Tammy Duckworth, an Iraq War veteran, clashed over the budget debate that is dividing Congress. Among the issues debated, Walsh and Duckworth accused each other of trying to destroy Medicare.

Duckworth correctly pointed out that approving Rep. Paul Ryan’s (R-WI) budget proposal would end Medicare as we know it, but Walsh insisted that passing massive tax cuts for the rich would help save Medicare, according to the Chicago Sun-Times:

Duckworth continued: “You are on the front lines, giving money to people who don’t need it. Why are you so obsessed with ending Medicare? You call it a ‘Ponzi scheme.’”

“Tammy, I want to save it!” Walsh interjected. “Every Republican and Democrat in D.C. knows it’s gone in 10 years. What do you propose to do?”

“I propose to end the tax cuts for millionaires and billionaires to pay for it,” Duckworth said.

“Oh, Holy Cow, I would much rather be standing with a plan than with a president who has ignored Medicare,” Walsh told Duckworth. “If you’re going to continue down this road as the president is and say, ‘I’m just going to ignore Medicare,’ you, my dear, are ending it as we know it. And that is so wrong.”

Ryan’s budget plan would dramatically reshape Medicare and charge seniors more: led by Ryan, House Republicans voted to cut funds to Medicare, Medicaid, and other social programs so that they could protect defense spending. The Washington Post reports that Ryan’s plan is still a difficult issue on the campaign trail as Democrats continue to attack Republicans for supporting the plan.

But even if it may be proving a difficult topic for congressional Republicans, likely GOP presidential candidate Mitt Romney has staked out the same budget plan as Ryan.

One of the goals of the Affordable Care Act is to keep health care costs from ballooning. So far, it has done some good; the law has already helped push Medicare costs lower, required insurers to keep administrative spending low or pay customers rebates, and created prevention programs to fight chronic diseases like heart disease or diabetes.

Now, a new report from Fidelity Investments shows that the law is already lowering future costs for retirees. Health care costs have increased for years, but in 2011, the firm projected a decrease as a result of the changes included in the health law. Seniors will now pay $20,000 less for their medical bills through retirement:

Fidelity has calculated an annual estimate of medical expenses for retirees for more than a decade. For many Americans, health care is likely to be among their largest expenses in retirement. The estimate, which is calculated by Fidelity’s Benefits Consulting business, does not include any costs associated with nursing-home care and applies to retirees with traditional Medicare insurance coverage.

The estimate has increased an average of 6 percent annually since Fidelity’s initial calculation of $160,000 in 2002, with the exception of 2011 when the estimate declined $20,000. That one and only decrease in the history of the estimate was due to a one-time adjustment driven by Medicare changes that reduced out-of-pocket expenses for prescription drugs for many seniors.

Those Medicare changes included alterations to the so-called “donut hole,” the coverage gap for prescription drugs for older Americans. Under the law, generic medications in the “donut hole” will be discounted until 2020, when the gap will be eliminated. So far this year, that provision has saved Medicare recipients $3.4 billion, more than for all of 2010 and 2011 combined. Millions more have cut costs by taking advantage of free preventive health services.

This estimate can still change, however. According to the Associated Press, if the Supreme Court strikes down the health care law this summer, Fidelity analysts say they will “update” the number. In all likelihood, that revision would be considerably higher.

– Zachary Bernstein

MOUNT PLEASANT, Wisconsin — At a town hall meeting last Friday, Rep. Paul Ryan (R-WI) was confronted by a constituent over his endorsement of “premium support,” a plan that would give future retirees a voucher with which to purchase coverage from private insurers or traditional Medicare. When asked whether he would alter the plan in light of experts “backing away” from it, Ryan claimed that prominent scholars – including Henry Aaron – still supported the general framework of his proposal:

CONSTITUENT: The two men that were your co-creators of your privatization of Medicare plan, Robert Reischauer and Henry Aaron, were on the hill last week. I think they spoke to the House Ways and Means Committee. [...] What’s interesting though, Brennan was on and they’re backing away from your plan, privatization of Medicare, basically because they’re saying it’s going to cost more and give us fewer services than the traditional plan. [...] Are you going to change your plan or how do you stand on that?

RYAN: Hank [sic] Aaron is an economist at Brookings Institute who has been in favor of a different version of what we call “premium support.” [...] Henry Aaron doesn’t agree with the way we’re doing it, but these other Democrats that have been working on the Medicare law for literally a couple of decades, would come to agreement on the best way to save and strengthen Medicare.

Watch it:

Ryan claims that his differences with Aaron are only in the implementation of the policy. In fact, Aaron has said that he no longer believes “premium support” is good policy at all. In testimony before the House Ways and Means Committee on April 27, Aaron conceded that there is no strong evidence the plan would lower the growth of health care costs; in fact, he claimed, private “Medicare Advantage plans are more expensive than is traditional Medicare.” Last year, he also said that “gains from being able to choose among competing insurance plans have been exaggerated.” In an email to ThinkProgress, Aaron confirmed that he has totally backed off the plan.

Instead, Aaron now believes that the Affordable Care Act can do a better job reducing costs and protecting beneficiaries. As he told the Ways and Means Committee, “The passage of the Affordable Care Act means we have put in place a key element of the premium support idea for the rest of the population, namely health insurance exchanges.” Aaron noted that those exchanges are similar to what advocates of “premium support” want to see for Medicare, except these do not put “the burden of cost control on beneficiaries.”

ThinkProgress intern Zachary Bernstein contributed to this post.

Republicans are absolutely gleeful about the possibility that the Supreme Court may strike down the Affordable Care Act, despite the fact that doing so would increase premiums, cause millions to lose health insurance, and ultimately raise health care spending.

Now, several health experts are warning of another unintended consequence: Medicare might not be able to function properly, potentially putting patient care and payments to doctors at risk. As some experts told NPR, the program could be thrown into complete chaos:

“The Affordable Care Act has become part and parcel of the Medicare system, encouraging providers to deliver better, more integrated, better coordinated care, at lower cost,” says Judy Feder, a public policy professor at Georgetown University and former Clinton administration health official. “To all of a sudden eliminate that would be highly disruptive.”

Sara Rosenbaum, a professor of health law and policy at George Washington University, puts it a bit more bluntly: “We could find ourselves at kind of a grand stopping point for the entire health care system.”

And it’s not just Democrats warning of potential problems. Gail Wilensky, who ran Medicare and Medicaid under President George H.W. Bush, says she doesn’t think it’s likely that the court will strike down the entire health law. But if it does, she says, “it seems like it takes everything with it, including those aspects that are only very peripherally related to the expansion of coverage.”

As Rosenbaum noted, if the law is ruled unconstitutional, “Hospitals might not get paid. Nursing homes might not get paid. Doctors might not get paid. Changes in coverage that have begun to take effect for the elderly, closing the doughnut hole might not happen. We don’t know.”

This uncertainty is already spilling over into the market: the ratings service Moody’s reported earlier this month that for-profit hospitals could be hit particularly hard if the law is overturned. As the report said, “Uninsured patients enter the health care system through the emergency room and often wind up admitted and accumulating bills they don’t have the means to pay. The continued rise in uncompensated care costs would limit operators’ revenue growth and profit margins and constrain cash flow.”

-Zachary Bernstein