Doctors are reluctant to give nurses more authority to treat patients, according to findings in a New England Journal of Medicine study released on Wednesday. But doctors’ skepticism about nurses having expanded roles isn’t based on the facts — and it ignores the reality that nurse practitioners must take on such responsibilities if health care reform is to succeed.

The new study finds that many doctors don’t trust nurses to lead patient-centered “medical homes,” with only 17 percent of surveyed primary care physicians viewing it positively. “Medical homes” are arrangements encouraged by Obamacare in which nurses, doctors, pharmacists, and specialists work together to provide patients with better and more efficient care in a unified setting.

There is also a striking chasm between doctors and nurses on the issue of nurse practitioners’ ability to provide safe, quality patient care:

When researchers asked whether they felt the quality of care provided by physicians in exams and consultations was higher than that provided by nurse practitioners, more than 66 percent of doctors agreed, while 75 percent of nurses disagreed.

Doctors also overwhelmingly disagreed with many nurses’ position that they should receive the same level of pay as doctors for performing similar services.

But this position is an untenable one in the era of Obamacare, with more than 25 million Americans expected to gain health coverage in the coming decade. Since the bulk of these Americans are expected to consume primary care — rather than specialty — services, it’s important that the U.S. medical system have enough medical workers to serve them. And there simply aren’t enough primary care doctors to tackle that burden on their own.

Instead, nurse practitioners will have to take on additional responsibilities. There’s no reason to suspect that this will compromise patient care quality — in fact, multiple studies have shown that the quality of care that nurse practitioners provide for acute primary care is on par with doctors. One randomized trial comparing nurses’ versus doctors’ ability to manage complex care regimens for HIV-positive patients receiving antiretroviral therapy also found no evidence of professional inferiority. As David Hebert, CEO of the American Association of Nurse Practitioners, told Kaiser Health News, “[N]urse practitioners have been practicing safely and providing great outcomes for decades.”

Doctors — and patients — would be well served by an expanded role for nurse practitioners. Primary care doctors tend to be concentrated in urban areas, creating a major barrier to rural and isolated communities’ access to basic medical services. But nurses are more numerous and could have greater access to such populations, making them ideal candidates for heading medical homes and seeing to the day-to-day aspects of patient care.

A Senate Republican has seized on the growing controversy surround the IRS scandal to introduce a bill that would effectively repeal a huge chunk of the Affordable Care Act and significantly increase health care costs for millions of Americans.

Sen. Dean Heller’s (R-NV) “IRS Accountability Act” would prohibit “the IRS from receiving any ObamaCare funding that would otherwise be used for implementing the massive healthcare law,” preventing the agency from enforcing the law’s individual health care mandate, determining eligibility for affordability credits, and collecting taxes to help pay for the coverage expansion.

“Nevadans are already concerned about ObamaCare, so the fact that Congress could hand over even more power to an agency under intense scrutiny to enforce the health care law is deeply concerning,” Heller said in a statement. “The ‘IRS Accountability Act’ suspends funding for new ObamaCare IRS agents because right now we can’t trust the IRS to do its job.”

By 2014, the health care law will require the agency to assess fines on individuals who can afford to purchase health care coverage, but choose not to, and distribute tax subsidies for families who make no more than four times above the federal poverty line, approximately $94,200 for a family of four. Should Heller’s bill become law, the government wouldn’t be able to collect the penalties or pay out subsidies. It would also struggle to capture revenues from fees on medical devises, health care insurers and high-cost plans.

The penalty for going uninsured — which will be gradually phased in from 2014 to 2016 and then increase annually by the cost-of-living adjustment — is designed to encourage young and healthy people to buy coverage and spread the cost and risk of coverage across a wider population, thus lowering premiums. Though it’s unclear how many fewer people would purchase insurance if they were not penalized for not doing so, a 2012 study from the Urban Institute indicated that without a mandate, “nongroup premiums overall would increase by roughly 10 percent with high exchange participation and by 25 percent with low participation.”

Heller’s office did not respond to requests for comment.

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.

During an interview with World Net Daily, former Republican presidential aspirant Rep. Michele Bachmann (R-MN) raised the question: could Obamacare allow the IRS to “deny or delay” conservatives’ access to medical care?

Bachmann’s musings come on the heels of an ongoing IRS scandal centering on the agency’s improper scrutiny of conservative political groups. While right-wing commentators and politicians are already using the incident to smear the health law by raising questions about IRS access to Americans’ private medical data, Bachmann took things one step further:

Since the IRS also is the chief enforcer of Obamacare requirements, [Bachmann] asked whether the IRS’s admission means it “will deny or delay access to health care” for conservatives.

At this point, she said, that “is a reasonable question to ask.” […]

[S]hould Americans fear their government may try to harm them if they are conservative?

“It now is an entirely reasonable question for the American people to ask,” she said. “Will Obamacare be so politicized and misused?”

The IRS has been processing information about Americans’ health care for decades, since approximately 160 million Americans write off their tax-deductible employer-provided health benefits each year. There has been no evidence of any kind of privacy impropriety in all of that time.

Under Obamacare, the IRS will be responsible for determining whether or not Americans have insurance so that it can use household income data to provide consumers with government subsidies to buy health coverage. The agency will not determine if, when, or what benefits are provided to Americans.

This isn’t the first time Bachmann has made outlandish comments about Obamacare or health care in general. The congresswoman has previously asserted that Obamacare will “literally” kill people and propagated debunked conspiracy theories claiming that the HPV vaccine causes young girls to become “sexually promiscuous.”

Faith leaders were an important group pushing red state leaders to accept Obamacare’s Medicaid expansion. And with open enrollment for Medicaid and the law’s insurance marketplaces inching closer, they’ll be crucial to making sure that Americans know how, where, and when to sign up.

To that end, Maryland officials are currently holding a summit with over 150 faith leaders in which they explain the nuances of the law — and urge religious leaders to distribute that information by educating their congregants and communities. Faith leaders are enthusiastic about the plan, since their day-to-day dealings with their communities gives them a unique perspective on Americans’ needs and struggles:

The Rev. Janet Craswell, of the Salem United Methodist Church in Brookeville, described the summit as very helpful. Although her church is in a small Maryland community, Craswell said she has been hearing from a wide variety of people who will be impacted by the overhaul, including families with unemployed and uninsured young adults, people with disabilities and small business owners who are confused and concerned about how the law will impact their businesses.

“We see people every day,” Craswell said. “I mean, we are dealing with people week to week, and we’re also dealing with people at the point of crisis where they’re in hospitals and in hospice and they’re having to deal with major life issues.”

In fact, coordinating Obamacare enrollment efforts with faith leaders could be great news for another population that has largely been ignored in all the hubbub and politics of the expansion: Americans who already qualify for the program, but have never enrolled. In a 2006 report, the Commonwealth Fund estimated that 62 percent of Medicaid or CHIP-eligible children were not enrolled in either program, and 66 percent of Medicaid-eligible low-income parents were not enrolled.

Much of that discrepancy has to do with underwhelming state outreach efforts stemming from a lack of adequate funding, as well as the reality that many Medicaid-eligible populations simply don’t know they have the resource available to them. “Even in states that have more of a commitment to bringing new populations in, they don’t have the budget to do outreach and take out ads,” said Melinda Dutton, a partner at a health consulting firm assisting states with Obamacare implementation, in an interview with American Medical News.

But with the renewed national push for Medicaid enrollment ramping up this year, some health advocates hope that these previously unenrolled Americans will get swept up in the effort and “come out of the woodwork.” That’s where faith leaders are crucial to the undertaking, since they have greater access to the rural or isolated communities that Medicaid may have overlooked.

For example, the homeless — or those on the cusp of entering transitional housing programs — often do not enroll in Medicaid due to barriers such as a lack of proper identification or a Social Security card. These populations also tend to distrust government institutions — but faith leaders and community organizations could help walk them through the process in a way that the government can’t, helping secure their medical stability. And with over 25 million Americans expected to gain coverage under Obamacare in the coming decade, state, federal, and public health officials will need all the help that they can get.

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.

On Wednesday morning, Fox News seized on the developing story about the IRS improperly targeting conservative groups applying for tax exempt status to argue that the agency may be unable to implement key aspects of the Affordable Care Act.

Fox Business’ Stuart Varney joined host Martha MacCallum to warn viewers that the IRS “will soon be collecting even more of your personal information to decide whether you are eligible for the subsidies allowed under the healthcare program.” Two Republican lawmakers — Rep. Diane Black (R-TN) and Sen. Dean Heller (R-NV) — have pledged to stop the agency from hiring additional agents to ensure compliance with the individual health care mandate and weaken its role in implementing the law. “It’s possible the IRS scandal will delay the implementation of Obamacare. That’s where this is heading,” Varney exclaimed:

MACCALLUM: It’s a dangerous and slippery slope when their credibility comes into question. They know what you make. They know what your income is. Now they are supposed to marry that information with whether you are eligible for a healthcare subsidy. And that raises questions because you have got to keep them posted on every change that may lap in our employment picture.

VARNEY: There is more to it than that. Your doctor is going to put on file electronically your entire medical history. And the IRS wants to know about your health insurance. There is no wall between those two areas of information. And bearing in mind what they have done politically there is no assurance they won’t jump that wall and go into your personal medical history. That’s where the lack of trust comes in.

MACCALLUM: We were told you didn’t have to fear anything about your privacy and having your healthcare record online wasn’t an issue. But people have been scanning document for catch words you wonder what they will scan in terms of healthcare and health records. It’s a legitimate question.

Watch it:

In reality, there is no evidence that the impropriety in the IRS office responsible for granting tax-exempt status to social welfare groups has bled over into other parts of the agency.

Sixty percent or approximately 160 million Americans who receive health care coverage from their employers already write-off the cost of their health care benefits through the IRS and have done so without widespread privacy issues. Families who enroll in nongroup policies and itemize their deductions have been deducting a portion of their medical expenses and the self-employed are receiving a deduction from the IRS “when calculating their income tax for the amount paid for health insurance for themselves and their spouse or dependents.”

The Affordable Care Act will increase the IRS’ involvement in health care while strengthening existing privacy protections by expanding the Health Insurance Portability and Accountability Act of 1996 (HIPAA).

That didn’t take long.

A mere four days after news broke that the Internal Revenue Service (IRS) had improperly targeted conservative political groups for scrutiny, GOP Sen. Dean Heller (NV) is threatening to introduce legislation that would “deny the IRS funds to hire new agents to implement Obamacare.” The bill would effectively make it impossible for the agency to provide millions of Americans with federal subsidies to buy the very health coverage they are required to have under the law.

Heller argues that this extreme measure may be necessary in light of the unfolding IRS scandal, echoing a growing trope among conservative politicians and right-wing commentators. Since last Friday, big-name conservatives including House Oversight Committee Chair Rep. Darrell Issa (R-CA), former presidential contender Newt Gingrich, former vice presidential candidate Sarah Palin, and various right-wing media outlets have questioned whether or not the IRS can be trusted to implement Obamacare. The implication is that if the IRS singles out conservative political groups, what’s to stop them from snooping through Americans’ private health care information or imposing fines on companies they don’t like?

This is a reduction to the absurd. The IRS has been collecting health care taxes and compliance information from employers for decades. In fact, it has to, seeing as most Americans receive their insurance through their employer and the employer health insurance tax credit is the single largest tax credit in the federal budget. That system seems to have worked without gross invasions of medical privacy since the the 1950s, and there’s no reason to assume anything will change in 2014.

Furthermore, officials with the Department of Health and Human Services have actually spoken out about the importance of protecting Americans’ medical data, and the Obama Administration has taken action to ensure it. The Health Information Technology for Economic and Clinical Health (HITECH) Act widens existing privacy and data-security protections on patients’ protected health information as more of their health records are digitized. The 2009 stimulus bill also included updates to HIPAA rules that limit “the use of patient-identifiable medical data for marketing.”

The IRS requires information from individuals and businesses that will help them determine whether Americans have insurance, and how much help they need from the government to be able to buy it. Some critics have latched onto the fact that the IRS will have access to more household income data than before when making those determinations, and that it can share this information with the statewide Obamacare marketplaces and government health agencies. But it would be impossible to implement the law without at least some data-sharing — and without it, many Americans could not receive the benefits they are due. Legislative threats such as Heller’s might make for good politics — but in reality, all it would do is prevent the 26 million Americans expected to gain insurance through the Obamacare marketplaces from receiving the tax credits that would allow them to afford it.

In light of Republican-led states’ entrenched opposition to Obamacare’s Medicaid expansion, safety net hospitals around the country have expressed fears that they could go bankrupt as their government funding gets cut. On Monday, the Center for Medicare and Medicaid Services (CMS) announced that it would help these embattled hospitals by paring back planned cuts to their federal reimbursements.

In an attempt to cut government health expenditures, Obamacare included fairly deep cuts to so-called “disproportionate share” hospitals’ (DSHs’) — safety net facilities that cater mostly to the poor and uninsured — reimbursement payments. These cuts were intended to be offset by an influx of newly-insured Americans covered under the states’ expanded Medicaid programs.

But since the Supreme Court ruled the expansion optional, red states with a large number of low-income and uninsured residents have largely refused to take part in the Medicaid expansion, thereby creating a disastrous funding problem for safety net hospitals in these states. The CMS’s new proposed regulations represent an effort to avert those disastrous cuts as states get their acts together:

The Centers for Medicare & Medicaid Services proposed on Monday that for the next two years, the DSH dollars be reduced based partly on a state’s percent of uninsured residents (states with the lowest percent of uninsured receive larger reductions). CMS also seeks in the proposal to protect state DSH funding that is used to increase coverage under Medicaid demonstration waivers. [...]

“… since some states have yet to decide whether to expand Medicaid, this proposed rule will not discourage expansion, nor will it penalize hospitals in those states that have yet to make a decision,” [Rick Pollack, executive vice president of the American Hospital Association,] said.

However, CMS’s new proposal is a funding band-aid, not a permanent fix. The far more responsible and efficient way to take the heat off of America’s safety net hospitals — while securing low-income Americans’ medical and financial well-being — would be for highly uninsured states to accept the health law’s generous funding to expand Medicaid.

In fact, that’s exactly why some GOP governors such as Arizona’s Jan Brewer and Florida’s Rick Scott have reversed course and decided to endorse the Medicaid expansion — because hospital associations in their states have been warning that noncompliance in the face the upcoming payment cuts would cost them tens of billions of dollars and possibly force them out of business, leaving millions of America’s poor without recourse for medical care. Unfortunately, not all Republican state leaders and legislators seem to be swayed by that argument, forcing the CMS to take action and stave off safety net hospitals’ fiscal ruin.

But seeing as even the GOP governors who have endorsed expansion are struggling to convince skeptical legislators in their own party, the temporary fix is crucial to making sure that safety net hospitals — and the millions of poor Americans who rely on them — don’t end up as the collateral damage of a political fistfight over Obamacare. Arizona, Florida, Texas, and Louisiana — four GOP states that appear increasingly unlikely to expand Medicaid this year — have close to 12 million uninsured residents alone, approximately half of whom live below 138 percent of the Federal Poverty Level (FPL) and would likely gain Medicaid coverage under the expansion.

A top Republican senator is comparing Health and Human Services Secretary Kathleen Sebelius’ ongoing effort to implement the Affordable Care Act in partnership with the health care industry and nonprofit organizations to the Iran-Contra scandal, during which officials secretly sold arms to Iran to fund a resistance movement in Nicaragua.

Sen. Lamar Alexander (R-TN) made the comments on Saturday, after the Washington Post reported that Sebelius is asking industry groups and other community organizations to support efforts encouraging people to enroll in the new health care exchanges established under the health care law.

Alexander said Sebelius’ actions should “cease immediately and should be fully investigated by Congress.” He cited a report by the Iran-Contra Congressional Joint Select Committee, which says “Congress’s exclusive control over the expenditure of funds cannot legally be evaded through the use of gifts or donations to the executive branch.” Sen. Orrin Hatch (R-UT) agreed, telling the Post, “I will be seeking more information from the Administration about these actions to help better understand whether there are conflicts of interest and if it violated federal law.”

Administration officials insist, however, that Sebelius was following authority laid out in the Public Health Service Act and “has made no fundraising requests to entities regulated by HHS.” “For the last several months the Secretary has been working with a full range of stakeholders who share in the mission of getting Americans the help they need and deserve,” Jason Young, Deputy Assistant Secretary for Public Affairs, told ThinkProgress.

He explained that Sebelius is operating under a special section of the Public Health Service Act that allows the secretary to “support by grant or contract (and to encourage others to support) private nonprofit entities working in health information and health promotion, preventive health services, and education in the appropriate use of health care.”

Indeed, officials from Republican administrations appear to have relied on similar authority to promote health initiatives, suggesting that the GOP’s attacks may be motivated by politics rather than preventing wrongdoing.

Shortly after President George W. Bush’s Medicare Part D reforms went into effect in January of 2006, Mark McClellan, administrator of the Centers for Medicare & Medicaid Services (CMS), told the House Ways and Means Committee that the Bush administration “began reaching out to develop partnerships” with industry and community groups since 2004, “held training sessions around the country to education our partners” and ran “print, radio and television advertisements” to “raise awareness and assist beneficiaries and their care givers in making decisions about prescription drugs.”
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