The decision, which is still being considered before it is finally included, would require all health insurers to provide contraceptive services without co-payments. The decision includes an exemption for religious employers. However, Catholic groups believe that the exemption is “too limited” and would thus require many Catholic groups to provide services that are banned by the Catholic Church.

Catholic bishops and some Catholic groups have been condemning the decision. They have  asked that the exemption be open to more objectors, or that the decision be stricken in its entirety.

Now, the St. Petersburg Times reports that if the decision is not changed, Bishop Robert Lynch says ”the Diocese of St. Petersburg would drop health insurance for its approximately 2,300 employees, and instead give them money to find coverage themselves.”

Officials in the diocese believe that they would be one of the groups that would not be included in the exemption.

According to the Times, “Frank Murphy, spokesman for the Diocese of St. Petersburg, said church operations such as Catholic Charities serve people of all faiths. And not all employees are Catholic, including many teachers at diocesan schools.”

The Times reports:

“For the first time in my adult life, I foresee the possibility of some form of civil disobedience, and I am extremely uncomfortable at even the hint of such a thing,” Lynch said during Wednesday’s annual Red Mass at Tampa’s Sacred Heart Church, attended by two dozen judges and about 300 lawyers.

…

On his blog (blogs.dosp.org/bishoplynch) Lynch noted that diocese employees have a “generous” health care plan, one that does not cover contraceptives, the “morning-after” pill, or drugs like Viagra.

He also expressed fear that because the diocese is self-insured, that might disqualify it from the religious exemption. But a federal health official said Thursday that isn’t the case.

In his homily, which appears in full at his blog site, Lynch told the jurists of conflicts between church teachings and the laws of the land. “I have such a fear at this moment in time,” he said.

“As employers, we would be forced to provide in health care plans services and procedures which clearly are contrary to our beliefs and teachings,” he said.

“If they fail to shift in their present positions,” he said of federal officials, “then 2,300 employees of the Diocese of St. Petersburg will lose their health care coverage which they have come to treasure and rely upon.”

For many women, steep co-payments levied by their health insurers have deterred them from purchasing family planning services such as birth control pills in the past, a problem exacerbated by the country’s economic troubles.

A recent Kaiser Health Tracking Poll conducted by Public Opinion and Survey Research Program showed that two-thirds of Americans agree with the federal government’s recent decision to include birth control in its list of preventive services.

Furthermore, according to research conducted by the Guttmacher Institute, about “98 percent of sexually active Catholic women have used contraceptive methods banned by the church.”

Republicans have posited the initiative as a reform on Medicaid, claiming the transformation will save $180 billion within the next 10 years, according to Kaiser Health News. The Kaiser Family Foundation estimates that the state-federal health program currently covers approximately 50 million poor and disabled Americans.

Many Republican governors are rallying around the initiative. At the National Governors Association Winter Meeting late last month, U.S. House Republican leaders pushed their proposal to turn Medicaid into a block grant for states, an idea that was introduced last November by Rep. Paul Ryan (R-Wis.), the House Budget Committee chairman, and Alice Rivlin, a Brookings senior fellow. Their unofficial proposal is to convert Medicaid’s federal share into a block grant in 2013, to be indexed to increase with the size of the Medicaid population and the growth in gross domestic product per capita plus 1 percentage point. Under their plan, states would be given more flexibility with how the money is distributed.

Last week, Mississippi Gov. Haley Barbour, who is a likely presidential contender for 2012, testified (PDF) before the U.S. House Energy and Commerce Committee, saying that block-granting Medicaid was necessary because states need more flexibility to design Medicaid programs that fit local needs.

From Barbour’s testimony :

The states need the flexibility and authority to craft innovative programs to provide medical care to our neediest citizens. But to do so, we need Congress to cut the red tape states must wade through to implement new programs and save money on what we already do. Through greater flexibility in the management of Medicaid, states might be able to reduce substantially the hidden tax increases that forced expansion of the program will impose. Our citizens should not have to wait years for agencies in Washington to green light new healthcare solutions. We need relief now.

Recently, the Oklahoma Gov. Mary Fallin called for a Medicaid overhaul and was backed by her state’s congressional delegation, according to Tulsa World. According to the paper, both the governor and Republican U.S. Rep. John Sullivan, quoting an Oklahoma Healthcare Authority report, said that President Obama’s health care law will raise Oklahoma’s Medicaid spending by about $440 million.

At the NGA meeting, Florida Gov. Rick Scott was quoted by The Hill saying: “You give me a block grant, let me do whatever I want, and I will cover the right people. If I don’t, I won’t get re-elected.”

Critics of the proposals have said turning Medicaid into federal lump-sum payments that are sent to states could have many negative consequences, one of them being a loss in health care coverage for millions of people. As Kaiser Health News reports, in return for the federal government paying nearly 60 percent of Medicaid cost, states are required to cover certain groups of people, such as children and pregnant women, and to provide specific benefits. A block grant would give states more freedom to run the program as they pleased. However, states would also be on the hook for covering costs beyond what the federal government provides: Kaiser Health News estimates that 16 million more people will become eligible for Medicaid in 2014. In addition, the Congressional Budget Office (PDF) predicts Medicaid spending has increased by $23 billion since 2009, from $366 billion. The CBO also predicts Medicaid will grow 7 percent annually within the next 10 years.

Transforming Medicaid into block grants is has been proposed in the past, according to Kaiser Health: by President Ronald Reagan in 1981, by former House Speaker Newt Gingrich in 1995 (Congress actually did pass legislation that year to turn Medicaid and the welfare system into block grants, but President Bill Clinton only agreed to turn the welfare system into block grants, forming the Temporary Assistance for Needy Families program), and by President George W. Bush in 2003.

The Center on Budget and Policy Priorities says the Republicans’ argument that block grants would improve the predictability and stability for Medicaid and state budgets is flawed because block grants are intended primarily to create federal savings.

From the CBPP:

Converting Medicaid to a block grant is attractive to some federal policymakers because it could produce large federal budgetary savings (and, in doing so, potentially ease pressure on certain other parts of the federal budget — such as the tax code, where, for example, policymakers will face a decision on whether to extend the Bush tax cuts for high-income households beyond 2012).  But a block grant would almost certainly shift substantial costs to the states.  Instead of the federal government picking up half to three-quarters of unanticipated Medicaid cost increases that result from a recession, the onset of a new disease, or the development of new pharmaceutical or other treatments, states would have to bear all of those costs themselves (once they exhausted their block grant allocation).  A block grant would make Medicaid much more financially unpredictable and risky for states.

A block grant may also appeal to some federal policymakers because it would force the states to “be the bad guys” — making the decisions about which people to drop from coverage or which medical services to curtail when federal funding proved inadequate.  States would essentially be left “holding the bag” — they would either have to contribute more state funding (by raising taxes or cutting other programs) or, more likely, exercise their increased flexibility to institute wide-ranging cuts in eligibility, benefits, and/or provider reimbursement rates.  Those cuts could add millions to the ranks of uninsured.  They also could impede access to care for tens of millions of people who continued being covered, as a consequence of substantial increases in co-payment and premium charges or cuts in reimbursements that cause substantial numbers of providers to leave the program.

Kaiser Health predicts a bill to transform Medicaid into a block grant won’t clear the Democratic-controlled Senate, but it might have a chance in 2012 if the GOP takes control of Congress and/or the White House.

Although Medicaid enrollment growth may have peaked in the first half of 2009, enrollment increases during the recession continue to place additional strain on state budgets. This growth would likely have been much smaller, and many more Americans would likely have become uninsured, without the added federal support and maintenance of effort requirements provided through the 2009 fiscal stimulus, the financing portion of which has been extended to June 30, 2011. Financing and maintaining the program will continue to be a challenge for state and federal policymakers as they prepare for the Medicaid eligibility expansions beginning in 2014 under health reform and the 16 million new enrollees estimated to gain Medicaid coverage.

Six in 10 Americans say they have heard little or nothing about budget reconciliation. And many people continue to struggle with health costs, with nearly one in five saying cost increases have caused them or their employer to switch to a less comprehensive health plan.

Like yesterday’s CBO score, the figures fly directly in the face of Republican talking points, which claim that the Democrats’ reform bills not only would add to deficits, but are grossly unpopular among Americans.

h/t: The Hill.

An example: The Kaiser Family Foundation today released the results of a poll finding that 42 percent of Americans support reform, while 41 percent oppose it. Yet the approval numbers leap when certain elements of the bill are described to the respondents.

After hearing that tax credits would be available to small businesses that want to offer coverage to their employees, 73 percent said it made them more supportive of the legislation. Sixty-seven percent said they were more supportive when they heard that the legislation included health insurance exchanges, and 63 percent felt that way after being told that people could no longer be denied coverage because of pre-existing conditions. Sixty percent were more supportive after hearing that the legislation would help close the Medicare “doughnut hole” so that seniors would no longer face a period of having to pay the full cost of their medicines.

You can hear the criticisms already: Kaiser is a liberal group that probably skewed the figures. OK, fine. Then take this poll from NBC and the decidedly un-liberal Wall Street Journal — conducted in the middle of last August’s town-hall conflagrations — which found that, while just 36 percent of Americans supported the Democrats’ reforms, the number jumps to 53 percent “when respondents were read a paragraph describing Obama’s plans.”

As Nate Silver asked yesterday, how seriously should Washington lawmakers treat a public opinion that’s been largely formulated by lies coming from Republicans?

Put another way: Should the nation’s lawmakers craft legislation according to the ignorance of their constituents, or does their responsibility as leaders transcend the popularity contest of Washington politics?

Waiting for a reply …

The report, conducted by the Kaiser Family Foundation and the Pew Research Center’s Project for Excellence in Journalism, found that the largest chunk of those health-related stories (42 percent) focused on individual ailments, while just 27 percent dealt with health policy or reform. That means that — even while nearly 46 million Americans are uninsured; while the country’s infant mortality rates are higher than 28 others around the world; and while Medicare’s hospital fund is projected to go belly up in precisely 11 years — less than 1 percent of all news coverage targeted these things.

Is there any wonder why there’s been little pressure on Congress to fix the problem?