The Budget Control Act of 2011 includes a sequestration process that will make automatic cuts to domestic and defense spending in January 2013 unless Congress can agree on a proposal to lower the national deficit by at least $1.2 trillion over 10 years. Since the demise of the super committee, both parties have signaled their displeasure with the automatic mechanism and Republicans have promised to draft legislation that would eliminate or disperse the $600 billion of proposed reductions to military spending on to other federal agencies.

But today, a group of seven House Democrats led by Rep. Edolphus Towns (D-NY) beat the GOP to the punch and introduced H.R. 3519 in an effort to exempt Medicare from the $123 billion in cuts to provider reimbursements:

“Hospitals in New York are already slated to experience $15 billion in Medicare and Medicaid cuts under the Affordable Care Act over the next ten years,” Towns said. “If sequestration occurs, hospitals will lose another $2.6 billion — or over $116 million in my district alone.

“Cuts like these will severely harm patient access to care and undermine an employment base that supports over 700,000 jobs in New York State,” he said. “We simply cannot balance the nation’s budget on the backs of seniors, while simultaneously harming jobs.”

Meanwhile, a group of 40 other Democrats have penned a letter to President Obama urging him to maintain the sequestration cuts. Obama has threatened to veto any measures that reduce sequestration without making corresponding reductions to the deficit.

House Assistant Democratic Leader Rep. James Clybrun (R-SC), the House whip, is not an official sponsor of H.R. 3519, but has recently said, “I would love to see us do something that would not require that those triggers get pulled.” He added, “Because if those triggers get pulled, it’s across the board. It is going to be nasty. It would be a meat-ax approach, and I don’t think that’s the best way to do it. So there’s still time.”

The Washington Posts’ Jennifer Rubin is attributing the failure of the super committee to Democrats’ refusal to accept partial Medicare privatization and any cuts to the Affordable Care Act. It’s a meme first advanced by super committee co-chairman Rep. Jeb Hensarling (R-TX) and echoed by conservatives like James Capretta:

In this regard, nearly all of the mainstream reporting has taken for granted that ObamaCare is off limits from budget cutters. Reporters and the left punditocracy have declined to even recognize that the real “intransigence” was not on the part of Republicans (who offered up more revenue) but on the part of Democrats who insisted that ObamaCare remain pristine (despite the serial revelations that the plan is not unfolding as anticipated) and who refused respond with a serious counteroffer on tax reform.

The second issue revolves around Medicare. The Republicans last spring presented Rep. Paul Ryan’s premium support plan. Then in the supercommittee they offered the Rivlin-Domenici plan that would have allowed seniors to opt for traditional Medicare. But, as Capretta points out, the Democrats’ answer is to keep traditional Medicare and simply limit fees to providers, a recipe for shortages and denial of care.

First, it’s unclear why unwinding the Affordable Care Act — which reduces the deficit by billions of dollars — would make for good policy if you’re truly interesting in lowering the federal debt. That kind of thing would only be of use to partisans seeking to squash the President Obama’s signature accomplishment during an election year. Anyone truly interested in reducing health care spending should be looking for ways to ratchet up the cost savings already included in the law, rather than tear them down. (As is, the ACA is “projected to reduce aggregate spending by 6 percent over the 10 year period.”)

And as for the Medicare privatization plan, if Rubin or Capretta can explain how the ever-depreciating premium support proposal isn’t a cost shift to beneficiaries, I’d like to hear it. For the time being, Democrats — who themselves offered billions in Medicare and Medicaid cuts — are fighting with Republicans to preserve the sequestration process in the the Budget Control Act. The triggers will apply to any mandatory spending not specifically exempted, meaning that health reform provisions like grants to states for establishing exchanges, the public health prevention fund, and mandatory funding for community health centers could all be vulnerable to reductions. How is that for “off limits”?

The Kaiser Family Foundation is out with this helpful brief explaining what the failure of the super committee could mean for health care spending. As a reminder, the Budget Control Act of 2011 includes a sequestration mechanism of cuts that go into effect if lawmakers fail to reduce the deficit by $1.2 trillion over 10 years — the reductions are in addition to the savings already included in the Affordable Care Act, which are “projected to reduce aggregate spending by 6 percent over the 10 year period.”

But if lawmakers don’t produce a proposal before January 15, 2012, “the Director of the Office of Management and Budget (OMB) would calculate the sequestered amounts that would be needed to ensure that savings total $1.2 trillion for FY2013 to FY2021,” including a 2 percent reduction every year from 2013 to 2021 to the provider side of Medicare spending. A report from Avalere estimates that hospitals will bear the brunt of the cuts and could face a 32 percent reduction to inpatient hospital care. Medicare Advantage plans, physicians, nursing homes, and home health agencies would could also be trimmed, though Medicare benefits, the Children’s Health Insurance Program (CHIP), and Medicaid will not be affected.

The sequestration will apply to any mandatory spending not specifically exempted, meaning that health reform provisions like grants to states for establishing exchanges, the public health prevention fund, and mandatory funding for community health centers could all be vulnerable to reductions. In August, Republicans claimed to have identified at least 15 ACA provisions that could be subject to cuts. And that’s not all. As the Washington Post’s Sarah Kliff explains, doctors participating in the Medicare program could also see an additional 27 percent reduction in reimbursement at the beginning of next year as a result of the Sustainable Growth Rate (SGR).

Health care lobbyists are already working over lawmakers to soften the effects of the trigger, to be sure, and if their past success in patching up the SGR is any indicator, the triggers may very well change before any of the cuts go into effect.

Rep. Jeb Hensarling (R-TX) faults the Democrats’ refusal to accept partial Medicare privatization for the super committee’s inability to come up with a bipartisan plan to lower spending in today’s Wall Street Journal. He writes, “Democrats on the committee made it clear that the new spending called for in the president’s health law was off the table” and pretends that the spending in the Affordable Care Act added to the deficit (it actually reduces it). “Republicans offered to negotiate a plan on the other two health-care entitlements—Medicare and Medicaid—based upon the reforms included in the budget the House passed earlier this year,” he continues and lays out the premium support proposal offered by Alice Rivlin and Pete Domenici:

The Medicare reforms would make no changes for those in or near retirement. Beginning in 2022, beneficiaries would be guaranteed a choice of Medicare-approved private health coverage options and guaranteed a premium-support payment to help pay for the plan they choose….These seniors would be able to choose from a list of Medicare-guaranteed coverage options, similar to the House budget’s approach—except that Rivlin-Domenici would continue to include a traditional Medicare fee-for-service plan among the options.

This approach was also rejected by committee Democrats.

The Congressional Budget Office, the Medicare trustees, and the Government Accountability Office have each repeatedly said that our health-care entitlements are unsustainable. Committee Democrats offered modest adjustments to these programs, but they were far from sufficient to meet the challenge. And even their modest changes were made contingent upon a minimum of $1 trillion in higher taxes—a move sure to stifle job creation during the worst economy in recent memory.

Hensarling doesn’t mention that the Rivlin-Domenici premium-support proposal doesn’t so much lower national health care spending as it shifts it to the beneficiary. The plan reduces the federal contribution to Medicare by capping costs for each beneficiary and offering premium support credits that won’t keep up with actual health care spending. The federal government spends less, but seniors will pay more out of pocket for health care benefits every year. The proposal also breaks up the market clout of traditional Medicare and rather than ratcheting up some of efficiencies and payment reforms in the Affordable Care Act, it sets the nation on an untested path of private competition — leaving seniors vulnerable to the manipulations of for-profit health insurers.

Democrats, for their part, offered rather substantial concessions on Medicare spending. As the Center on Budget and Policy Priorities argued, the Democrats’ $3 trillion deficit proposal to the super committee “stands well to the right of plans by the co-chairs of the bipartisan Bowles-Simpson commission and the Senate’s ‘Gang of Six,’ and even further to the right of the plan by the bipartisan Rivlin-Domenici commission.” The plan contained “substantially smaller revenue increases than those bipartisan proposals while, for example, containing significantly deeper cuts in Medicare and Medicaid than the Bowles-Simpson plan.” For instance, Bowles-Simpson offered $383 billion in Medicare and Medicaid, while Democrats put $475 billion on the table.

President Obama introduced $320 billion in health care savings, mostly from the pharmaceutical industry and other providers, including rural hospitals, teaching hospitals, and biotechnology firms. But the plan even incorporated the GOP’s push for greater means testing in Medicare, asking some wealthier beneficiaries to pay more for coverage and sought to give beneficiaries “skin in the game” — as the GOP puts it — to discourage over treatment.

All of these are significant concessions — as are the health cuts included in the trigger mechanism — but Hensarling and Republicans aren’t interested in bipartisan agreement. They’re not accepting anything short of Medicare privatization.