Anti-abortion-rights group Operation Rescue has released its most recent undercover look at the American abortion industry, using excerpted audio recordings to show “millions of tax dollars are already paying for abortions each year.” Operation Rescue released a summary of its findings on Wednesday, the day before the U.S. House of Representatives is due to vote on House Resolution 358, or the “Protect Life Act,” which would amend the Patient Protection and Affordable Care Act (PPACA) to prohibit federal funds from going toward any health care plan that also covers abortion services. (Under current law, federal funds cannot be used for abortion services, and plans that cover abortion must segregate federal funding from abortion services.*)

In conjunction with Albuquerque, N.M.-based anti-abortion-rights group Project Defending Life, Operation Rescue’s team claims to have called abortion clinics in 12 states and learned that Medicaid — using state taxpayer funds, not federal taxpayer funds — would pay for abortions in each case, despite the fact that the hypothetical pregnancies described by the callers were not the result of rape or incest or deemed to be potentially fatal. New Mexico is among several states that allow Medicaid funds to pay for abortions in cases beyond those specified in the Hyde Amendment, which affects only the federal spending portion of the state-federal joint program.*

The group released the audio recordings from several of these conversations including one with the Southern Women’s Options clinic in Albuquerque, where the receptionist told (PDF) the caller certain Medicaid coverage would likely cover her abortion at 26 weeks of gestation, amounting to approximately $8,000 to $9,000. In the recording, the caller explains there is nothing physically wrong with her pregnancy but that she and her husband just changed their mind because he lost his job.

“It’s shocking that our tax dollars would pay $9,000 for a third-trimester abortion simply because of a lost job,” said Operation Rescue President Troy Newman in a statement. “The vast majority of the American people strongly object to their tax money being used in this way.”

As the Kaiser Family Foundation explains, the federal Hyde Amendment, passed in 1977, prohibits states from using federal Medicaid dollars to pay for abortions unless the pregnancy is the result of rape or incest, or the mother’s life is at risk; however, states can use their own funds to cover other “medically necessary” abortions for Medicaid recipients, usually defined by states as those “to protect the physical or mental health of the woman.” The goal of the Protect Life Act, which is expected to pass in the House but not receive a vote in the Senate, is to steer funds away from insurance plans that cover abortion services, making it more difficult for women to afford abortions. The White House released a veto threat (PDF) against the bill Wednesday:

The Administration strongly opposes H.R. 358 because … the legislation intrudes on women’s reproductive freedom and access to health care and unnecessarily restricts the private insurance choices that women and their families have today. Longstanding Federal policy prohibits Federal funds from being used for abortions, except in cases of rape or incest, or when the life of the woman would be endangered.  The Affordable Care Act preserved this prohibition and included policies to ensure that Federal funding is segregated from any private dollars used to fund abortions for which Federal funding is prohibited.  The President’s Executive Order 13535 reinforces that Federal funding cannot be used for abortions (except in cases of rape or incest, or when the life of the woman would be endangered) and ensures proper enforcement of this policy.

The new Rasmussen health care poll found that 47 percent said they were for repeal of the health reform legislation, compared to 42 percent in favor of continuing to implement the program. This is far below the numbers found in earlier versions of the same Rasmussen poll, in which up to 63 percent of Americans said they believed health care reform should be repealed.

Rasmussen has come under fire in the past over allegations that its results are consistently skewed toward a conservative ideology. After the November elections, its pre-election polls were found to have put Republican candidates an average of nearly 4 percentage points above the vote tallies they ultimately received. This analysis includes the Hawaii Senate race, where there was a 40-percentage-point difference between Rasmussen projections for a close race and actual results — incumbent Democrat Daniel Inouye coasted to victory.

If the new health care poll is an accurate barometer of public opinion regarding reform, it’s unclear what caused the sudden drop in opposition in the week between April 23 and 29. One possible answer lies in the U.S Supreme Court’s April 25 refusal to fast-track Virginia Attorney General Ken Cuccinelli’s legal challenge to health care reform. The public, to the extent that it was aware of the Court’s decision, may have taken it as a sign that “Obamacare” repeal is losing traction. The Rasmussen poll didn’t go into the details of why people’s opinions were starting to change.

A simpler answer, however, may just be that Rasmussen, despite those allegations of conservative bias, is merely getting closer to reality in its most recent poll than it has in the past. In January, an AP poll found that opposition and support for health care reform were on approximately equal footing among the American public.

Results then showed 40 percent of Americans in favor of continuing health care reform, a number in line with what Rasmussen has reported. But the same poll indicated that just 41 percent were opposed to health care reform, well below 58 percent, the January high reported by Rasmussen. Meanwhile, the AP poll had just around one in four Americans saying they wanted outright repeal, a far cry from Rasmussen’s results.

The alleged conspiracy involves “forced-place insurance,” by which banks offering home loans force uninsured homeowners to adopt home insurance policies as part of qualifying for a loan. The former employee behind the leak says that because banks both hold the loans and own the forced-place insurance companies, they’re free to charge astronomical premiums.

The emails, however, don’t seem to be quite the smoking gun they were advertised to be. They depict an approved request from an employee at Balboa Insurance, a subsidiary of Bank of America, to remove identification numbers from a series of insurance policy documents that were evidently sent to policyholders in error. The last email from anyone at Balboa questions the practice, as Jason Vaughn, a middle manager in one of Balboa’s Arizona’s offices, says that mismatched documents could be a “red flag” for auditors.

So, essentially the emails demonstrate a request to conceal an error from insurance policyholders. This certainly may be unethical, and may even be criminal fraud — though to what end the Balboa employees sought to do so is unclear, as is whether the practice was actually executed in light of the concerns brought up by Vaughn. But it also appears on the surface to have little connection with the larger claims made by the anonymous leaker, whose grievances range from vague (“They took everything from me.”) to oddly specific (for example, he claims that his employers spilled soil on his American flag when they were packing up his belongings after he was fired).

The person behind the leaks does say that there are more to come, so time will tell if there is substantive evidence for the allegations of fraud and conspiracy.

The Huffington Post has a succinct explanation of forced-place insurance, while the New York Times’ Dealbook has a clear detailing of all the allegations. Business Insider is critical of the hype over the emails and says that Bank of America’s explanation is likely the correct one. The blog Public Intelligence has the full text of the internal emails. A site started by Anonymous, bankofamericasuck.com, originally posted the emails as well as a statement from the leaker and correspondence between him and Anonymous moderators, but the site has been down most of today due to heavy traffic.

NPR, however, presents a less optimistic take on what the next few years of health care is America could look like:

[Jamie] Court, the consumer advocate, says he’s happy the law now says policies can’t be rescinded unless companies can prove that a policyholder lied on his or her application, but that until 2014, when the requirement for everyone to have insurance kicks in, he’s still worried that rescissions could continue.

“It’s a great thing, but it’s not a panacea,” he said. “Words in a bill don’t mean enough to insurance companies until they’re backed up by a lot of big verdicts or the wrath of a regulator.”

What kind of lies can prompt an insurer to rescind a patient’s insurance? One example in the NPR story has a patient losing her insurance because the height she reported on her application was an inch off her measured height and her weight five pounds different.

“I just had been by this corner a thousand times, and I had never noticed it’s right there,” [one resident] says. “I feel like that’s what happens here. You don’t think about Katrina. You don’t notice Katrina. Then all of a sudden it’s right next to you.” Twenty-five cent martinis are an offer at Commander’s, and much of the city has been rebuilt. But traces of Katrina are still around.

One of those traces, some people argue, is the suicide rate in Orleans Parish. In 2008 and 2009, the rate of suicide was about twice as high as it was the two years before the levees broke. The rate of suicides in Orleans Parish has basically doubled.

A second, very different story focuses on how the cost of insurance for buildings, homes and businesses has skyrocketed, slowing the recovery, though the government has tried to step in to help:

“Katrina obviously exposed the fact that the state is riskier than had been previously assumed,” said Robert Hartwig, who heads the industry-sponsored Insurance Information Institute. “Insurers look at models. The models suggest that we are in a period of heightened hurricane activity. Not just for one year or two years, but over the long run. That makes Mississippi and every other coastal state more vulnerable.”

Katrina cost insurance companies $45 billion in today’s dollars, he said. Claims for the entire year were $70 billion in today’s dollars. “In order to be prepared for years like that,” Hartwig said, “insurers simply have to charge a rate that reflects the risk.”

“It’s a re-evaluation of the risk, but it’s also a recognition of the risk. Katrina made it pretty obvious what that risk was.”

Critics contend the industry has overestimated that risk. Nevertheless, insurance rates continue to climb. The state’s willingness to work with insurers has helped the market, Hartwig and others say. Commercial rates, in particular, have declined from post-Katrina highs and coverage is more widely available.

For the average worker who has lost her job since May 31, the cost of COBRA has tripled. (Flickr, Steve Rhodes)

In the first week of July, Andie Davis’ husband, who worked in manufacturing, lost his job, as hundreds of thousands of Michiganders have since the onset of the recession. Soon after, he started collecting unemployment insurance benefits that might last the family of four as long as 99 weeks. Davis hopes that the benefits will keep the family afloat — the mortgage paid, school lunches made, the electricity on — without forcing her to tap into the family’s savings.

[Economy1] But to keep the family financially stable while both she and her husband look for work, she has decided to forgo health insurance. The Davis family looked at how much COBRA would cost them, thinking the government would help pay for it. Had her husband lost his job just six weeks earlier, Washington would have footed about two-thirds of the premium bill. But since Davis’ husband lost his job after May 31, the young couple is on their own.

The change has gone little-noticed, both by the press and by the laid-off persons impacted by it. But a popular stimulus provision, the federal subsidy of COBRA benefits, expired for newly unemployed workers as of the first day of June. That means, for the average worker who has lost her job since May 31, the cost of COBRA has tripled.

COBRA — a provision created in the Consolidated Omnibus Budget Reconciliation Act of 1985 — gives workers the option of buying into their old health-care plan when they lose their job. Before the recession, COBRA let workers who lost their job through no fault of their own pay the entire health-care premium plus a two-percent administrative fee to keep coverage, about $8,800 per year for the average enrollee. (Generally, COBRA lasted 18 months.)  As part of the American Recovery and Reinvestment Act, or the 2009 stimulus, Congress subsidized this coverage, given the massive number and economic hardship of laid-off workers. The subsidy paid for 65 percent of health-care premiums for up to 15 months, meaning an average enrollee paid less than $3,000 a year.

For the Davises, under COBRA, coverage might have been a manageable $400 a month. When Davis looked into enrolling her husband and herself, she found it would cost more than $1,100 a month — leaving the family just a few hundred dollars for the mortgage, utilities, gas and food. She sought information on other private plans, but considered all of them too expensive. For now, the Davises are purchasing barebones coverage that will help pay hospital bills in case they are in an accident.

She rationalizes: “Me and the husband, we’re young enough that we can go without visits to the dentist and the [gynecologist] for a year,” and she argues, “I just do not see how it would be worth paying that much money for coverage, when we’re looking at a lot of other problems.” She argues that if the choice is between routine care and paying the electric bill, she will choose the latter. In the meantime, she is praying that her husband’s asthma does not flare up in the fall and hoping that they find jobs soon.

The Davises are one of hundreds of thousands of families doing the same. According to a study of 200 very large employers by Hewitt Associates, the COBRA provision doubled the proportion of laid-off workers enrolling in the program. In the fall of 2008, before the subsidy, about 19 percent of laid-off employees enrolled in COBRA. During the first six months of the subsidy, 38 percent of laid-off workers chose to. Now, with the subsidy’s end, enrollment rates are plummeting.

“Enrollment rates will likely decline over time as workers can’t, or aren’t willing to, afford the high premiums associated with COBRA coverage,” Hewitt’s Karen Frost said in a statement. “It’s possible these laid off workers are simply seeking coverage with a new employer or through their spouse’s employer. Unfortunately, it’s also likely that some are just foregoing health insurance altogether.” The National Employment Law Project estimates that 144,000 individuals and families per month have lost out on the subsidy.

It wasn’t supposed to be this way, but the extension of the COBRA subsidy became caught up in the tax extenders bill — also known as the jobs bill or H.R. 4213 — a large package of popular stimulus provisions that eventually died at the hands of a Republican filibuster. Senate Democrats managed to move unemployment insurance benefits, but few other portions of the popular bill made it through a Senate allergic to deficit spending.

The COBRA subsidy is highly popular: Hart Research found that 70 percent of Americans support extending it.  And many on the Hill fought to keep it in the tax extenders bill or to push it through other provisions. “Millions of Americans have been hard hit by the recession and lost their jobs through no fault of their own,” Sen. Robert Casey (D-Pa.) argued. “If Congress turns its back on them, they will have an even more difficult time making ends meet. With no premium assistance, COBRA health care benefits would consume 75 percent of the monthly unemployment payment for a Pennsylvania family.”

He offered an amendment to keep the subsidy within the jobs packages, and along with Sen. Sherrod Brown (D-Ohio) has offered it as a standalone bill. The Extend COBRA Premium Assistance Program Act of 2010 provides a six-month subsidy for workers laid off between May 31 and Nov. 30. The provision is entirely deficit-neutral, eliminating a tax break on annuity trusts as a pay-for. (The bill is one of many that would extend COBRA. On the House side, Rep. Susan Davis (D-Calif.), for instance, introduced a bill doing so until relevant portions of Obama’s health care bill come into effect in 2014.)

Casey and Brown’s bill is popular — cosigned by Democratic Senators John Kerry (Mass.), Carl Levin (Mich.),  Sheldon Whitehouse (R.I.), Debbie Stabenow (Mich.), Patrick Leahy (Vt.), Christopher Dodd (Ct.), Al Franken (Minn.), Roland Burris (Il.) and Daniel Akaka (Hi.) and supported by a slew of others. But it is caught in committee, and its likelihood of passage any time soon is small.

That means that the popular provision is likely dead, and for families like the Davises, health care coverage will remain an unaffordable luxury.

It’s been trumpeted as one of the key elements in the Democrats’ plan to expand access to health care for tens of millions of vulnerable Americans.

Yet a provision of the newly passed health reform bill that raises doctors’ payments under Medicaid is both temporary and limited in the scope of medical services it covers. The restrictions have left a number of health care advocates and doctors’ groups concerned about patients’ long-term access to care under the reform legislation.

[Congress1] The concerns are hardly trivial. The Democrats’ health reforms rely heavily on the successes of Medicaid, which will be expanded to include all non-seniors earning up to 133 percent of the federal poverty level (about $24,350 for a family of three). The bill is estimated to cover 32 million uninsured Americans over the next decade, and roughly half of those folks would fall into the Medicaid program.

Yet Medicaid rates are so low that many doctors refuse to see patients insured by the program. Indeed, doctors treating Medicaid patients in 2008 were paid just 72 percent of what Medicare paid for the same services, according to analysts at the Urban Institute, a Washington-based policy shop. As a result, only about 40 percent of physicians accept all new Medicaid patients, versus 58 percent for Medicare beneficiaries, according to a 2009 study from the Center for Studying Health System Change, which randomly surveyed more than 4,700 physicians.

Recognizing that problem, House Democrats passed legislation in December hiking certain payments under Medicaid to at least the level paid by Medicare, the federal program for seniors and the disabled. The bill initially passed by the House of Representatives allocated $57 billion to those rate increases over 10 years — a cost that Democrats more recently rejected as too high.

Instead, the health reconciliation bill signed by President Obama this week hikes Medicaid rates only for the years 2013 and 2014. The federal government would pay the entire tab of the increase, which the Congressional Budget Office estimates will cost $8.3 billion. From 2015 onward, it would fall to states to pick up the difference in cost — a tough sell in a frail economy, when state budgets are already strapped.

There are other concerns. The rate hikes, for example, apply only to some primary care and pediatric services. Emergency room and other critical care services wouldn’t be subject to the increase. Nor would counseling, disability examinations, services delivered over the phone or a long list of other procedures.

Dawn Horner, a health policy expert at Georgetown University’s Center for Children and Families, said the Democrats’ reform bill goes a long way to improve access to care for Medicaid patients, “but it would be better if the Medicaid increases were across the board.”

That’s not the only problem. Because the bill ties the Medicaid pay hikes to the senior-centered Medicare program, procedures not covered by Medicare won’t be included. That stipulation has led some children’s care providers to worry that youngsters on Medicaid won’t have access to services specific to their age group. The flushing of kids’ ears, for example — a procedure common in pediatricians’ offices — wouldn’t qualify for the enhanced rate.

Providing some comfort to health care advocates, CBO has projected that some federal funding will go toward the Medicaid pay hike for a few years after 2014 — indicating that some states would likely phase out the higher rates instead of dropping them immediately, even if they have to cover a percentage of the costs themselves. By 2019, however, CBO projects that, without additional federal help, all states will have abandoned the increased payments, putting Medicaid patients in the same uncertain spot they were in prior to the reforms.

The concerns among some powerful stakeholders in the health care arena — including governors, doctors and patient groups — mean that there will be plenty of pressure on Congress to prevent the Medicaid pay increases from evaporating in 2015.

“It will be a fight … to extend it,” William Vaughan, a health policy consultant for Consumers Union, a consumer advocacy group, wrote in an email. “And that’s a fight worth making!”

In the meantime, though, patient advocates and doctors’ groups are celebrating the increase they got.

The latest tally on the public option in the Senate: 50 likely supporters and 40 likely opponents, with 10 members — all in the Democratic caucus, and all necessary “yes” votes to overcome a filibuster — on the fence.

You’ve heard from the American people these past couple of weeks and as a consequence, the bill that Democratic leadership thought was going to be the be-all and end-all piece to change health care in this country forever now doesn’t look so viable. So maybe it is a good thing that we go back and we try to focus on those things that are clearly important to a lot of people. And that is helping people deal with the preexisting conditions problem.

Forgotten in this debate is the inconvenient fact that, in 34 states, such a solution is already in place. They’re called state-sponsored risk pools, which gather up those who’ve been denied private insurance coverage because of preexisting conditions, pooling them together and offering them the chance to buy into state-backed insurance plans.

In other words, they’re public plans that sweep up the mess left behind behind the private insurers — more evidence (as if 45 million uninsured Americans weren’t enough) that decades of competition between private insurers hasn’t done the trick.

The Senate HELP Committee has passed a uniquely American bill, one that cuts costs, protects patient choice, and guarantees every citizen access to affordable, quality health care. It also includes a strong public option that has earned the support of moderates in both the House and the Senate.

That is significant and undeniable progress – but it took a lot of hard and serious work. In drafting the bill, we considered hundreds of ideas, accepting 161 Republican amendments over the course of the most thorough markup in committee history.

Although President Obama has said for months that he wouldn’t draw a line in the sand on the public option, comments by White House officials over the weekend inspired headlines insinuating that the administration has caved on the issue. Dodd’s statement doesn’t mention that episode, but the timing is telling.

It might not matter. Even if Democrats agree to drop the public, Republican leaders are vowing to oppose the Democrats’ reform plans for a host of other reasons.