But don’t try to convince the Republicans. After months of blasting the Democrats’ reform proposals for allegedly bankrupting the country with expensive new programs, Republicans now have a brand new message: The deficit savings aren’t enough to justify passing the bill. From The New York Times:

Republicans moved quickly to throw cold water on the claims, noting that government debt is piling up so fast that the health care legislation would barely make a dent. “Any projected savings over 10 years have already been wiped out five times over in just the first five months of the current fiscal year,” said Don Stewart, a spokesman for the Senate Republican leader, Mitch McConnell of Kentucky.

Mr. Stewart cited budget office data showing that the federal government had “incurred a budget deficit of $655 billion in just the first five months of fiscal year 2010.”

Mr. Stewart didn’t mention that their own multi-billion dollar health reform accomplishment of this decade — the creation of Medicare’s (unfunded) prescription drug benefit — has contributed no small amount to the nation’s budget crisis.

House Majority Leader Steny Hoyer (D-Md.) told reporters Thursday that the legislation is “the largest deficit-reduction bill that members will have a chance to vote on” in most of their congressional careers — a key enticement for a bloc of undecided Democratic lawmakers who fear the legislation would run up the mounting federal deficit.

Though the Congressional Budget Office has yet to release the official score, Democratic leaders are saying today that the bill will cost $940 billion over the next decade, offset by a series of tax hikes and spending cuts that will reduce the deficit by $130 billion over the same span.

Their reason for emphasizing the deficit side of things is clear: There are more than 30 House Democrats considered to be on the fence about whether to support the bill, which will require 216 votes to pass the House. Most of those lawmakers represent conservative districts where criticisms of the nation’s $1.4 trillion deficit run high. But if they can go back home and say they supported reforms that expanded coverage to millions of uninsured folks (which most Americans support) and reduced the deficit by more than $100 billion, well, that might not be such a burden come November.

Democrats are expected to release the full details of the proposal today at noon.

Today, House Minority Leader John Boehner (R-Ohio) was asked point-blank how Republicans, given their track record, can criticize others for over-spending.

“Republicans will accept our fair share of the blame,” Boehner said. “But over the course of the last several years, Republicans have stood up on fiscal responsibility issues each and every time.”

I think this is important, because we have to prove to the American people that we are who we say we are. And I think when all of us voted against the stimulus bill twice last year, when all of us voted against their trillion-dollar budgets for as far as the eye can see twice last year, we began the process of not just talking about fiscal responsibility, but showing the American people that we are who we say we are.

Writing in Forbes last November, Bruce Bartlett — former advisor to Ronald Reagan, George H.W. Bush and Rep. Ron Paul (R-Texas) — had another take on Republicans who, as the minority, suddenly see themselves as budget hawks.

It astonishes me that a party enacting anything like the drug benefit would have the chutzpah to view itself as fiscally responsible in any sense of the term. As far as I am concerned, any Republican who voted for the Medicare drug benefit has no right to criticize anything the Democrats have done in terms of adding to the national debt. Space prohibits listing all their names, but the final Senate vote can be found here and the House vote here.

And yes, Boehner voted in favor of Part D.

Defending America is a number one responsibility and money’s not the first consideration. The first consideration is winning….

But we have always, one way or the other, raised the money to defend America, and in this case to defend America from a different kind of war, the war on terrorism. And it will be done.

He’s right on one account. You fight a war because you must, and the budget concerns should be immaterial. But the original question was, effectively, “Why aren’t lawmakers willing to ask Americans to pay for the costs of protecting the homeland, either through tax hikes or spending cuts elsewhere in the government?”

Grassley ducked it, and his argument that Congress has “always … raised the money to defend America” ignores the truth that, since 2001, the wars in Iraq and Afghanistan have been funded primarily by borrowing from abroad — a particularly curious whitewash in the context of Republican criticisms that health care reform will break the federal budget.

The costs of that failure to ask for shared sacrifice have been tangible. When George W. Bush was elected to the White House in 2000, the nation’s debt was $5.7 trillion. Eight years later — after several rounds of tax cuts and two unfunded wars — the number had jumped to $10.0 trillion.

It’s worth noting that most of the Republicans now criticizing the costs of health care reform, Grassley included, also supported those mid-war tax cuts.

Suffering the recession’s painful squeeze, more states are eying cuts to low-income health care programs to salvage their budgets.

At least 19 states have already proposed or installed cuts to public health programs, including Medicaid and the State Children’s Health Insurance Program (SCHIP), according to a report updated this week by the Center on Budget and Policy Priorities, a liberal policy analysis group. Those programs provide health coverage to the states’ most vulnerable residents, leaving state officials and health care advocates worried that affected patients will be left dangling without access to treatment.

Illustration by: Matt Mahurin

“It’s adding enormous hardships for those who rely on Medicaid for their health care needs,” Ron Pollack, executive director of Families USA, a consumer health care advocacy group, said of the trouble facing state budgets. Families USA released a report earlier this month finding that 1 million people would lose their health coverage if the cuts were realized in just eight of the 19 states that have proposed or enacted them.

Pollack said the problems will only get worse if the recession deepens, as many expect it will next year. “With each passing week we’re hearing of more states [proposing health cuts],” he said, “and I expect we’re going to see that accelerate in January.”

The threat to these public health programs arrives as most states are caught in an ugly economic cycle. Unemployment is up, creating greater demand for expensive social programs like food stamps and Medicaid, while home values and consumer spending are down, leaving less revenue from sales and property taxes for states to fund those programs. And the fiscal gaps are growing.

At least 41 states and the District of Columbia face 2009 budget shortfalls totaling $42 billion, CBPP has found. Looking ahead to 2010 and 2011, the number of struggling states rises to 44, while the shortfall figure skyrockets to $350 billion.

Compounding these troubles, almost every state in the country has some form of legal balanced budget requirement, meaning that, unlike the federal government, they can’t simply fall back on deficit spending to survive the recession. Instead, legislators have been forced to hike taxes, lay off state employees and cut back on services. Medicaid and SCHIP, because they represent one of the largest chunks of state budgets, have been early targets for cuts.

Indeed, California is increasing co-payments and reducing dental services under SCHIP, CBPP found. In Maine, some patients will be hit with a $25 Medicaid enrollment fee, which will likely discourage participation. In South Carolina, new income-eligibility rules are expected to push 3,700 folks out of Medicaid, CBPP reports. Arizona is forcing some Medicaid patients to reapply more frequently, which is expected to reduce the rolls, even among those eligible for the program, CBPP said.

Ann Kohler, director of the National Association of State Medicaid Directors, said states that are traditionally reliant on the finance industry for revenue — New York, New Jersey, Rhode Island and Connecticut — have had a particularly tough time balancing their budgets as that industry has collapsed. “It’s become very dire,” said Kohler, who once headed the Medicaid programs in New York and New Jersey.

There are many other examples. In Michigan, another state that’s been crushed by the downturn, Medicaid enrollment is up 70,000 in the last year, said James McCurtis Jr., spokesman for the state health department. In Colorado, Medicaid enrollment is increasing by 2,000 each month, said Joanne Lindsay, spokeswoman for the Dept. of Health Care Policy and Financing.

In New Mexico, where Medicaid enrollment jumped from 408,000 in August 2007 to 450,000 a year later, the legislature has plans to meet next month to weigh potential cuts to the program. As options, officials will consider benefit cuts, rate hikes and reduced outreach efforts, according to Betina Gonzales McCracken, spokeswoman for the state’s Health and Human Services Dept. “We’re seeing the need to reduce our budget across the state,” she said.

Some state officials say the recession’s effects on Medicaid and SCHIP aren’t tangible just yet. Karen Smigielski, spokeswoman for Minnesota’s Dept. of Human Services, said it’s “too soon” to gauge the ultimate impact of the recession on low-income health programs. “It takes awhile for people to get poor enough to become eligible,” she said.

President-elect Barack Obama is piecing together an enormous spending package designed to boost the economy and tamper rising unemployment. Early reports indicate that the package could be in the range of  $800 billion, with roughly $100 billion of that earmarked to help states cover their Medicaid costs.

Many experts warn that the budget problems — and their effects on public health — will only get much worse if that stimulus funding is held up for any reason.

“The longer we go without it,” said Kohler, of NASMD, “the more we’re going to need.”