While the Senate toned down the House's language on abortion restrictions, it may have ratcheted things up with another controversial reproductive-health issue: abstinence-only education. Sec. 2954 of the Senate health-reform bill, released Wednesday evening, restores funding for abstinence education. 

Their provision would restore a program called Title V, which, since the Welfare Reform Act of 1996, has allocated a yearly $50 million in grants to abstinence-only education programs. Obama let the program lapse in June, leaving some abstinence-only groups in dire straits. So in September, Sen. Orrin Hatch offered an amendment to restore Title V via heath-care reform, which (much to the outrage of liberal groups) just squeaked through the Senate Finance Committee with a 12–11 vote. A similar amendment, offered in the House by Rep. Terry Lee from Nebraska, died in committee.

Another day, another development in the debate over abortion in health-care reform. This time, it’s a swing in favor of the abortion-rights side: pro-life Democrat Sens. Ben Nelson and Bob Casey Jr., both staunch abortion opponents and Stupak-amendment supporters, are toning down their demands.

It was just last week that Nelson was telling Politico he was “sure” he would not support a health-care reform bill without a Stupak amendment. But late last night, CNN put this small item on its political ticker: “Sen. Ben Nelson, D-Neb…now says he would be satisfied with the less restrictive language approved by the Senate Finance Committee.” Read: no more Stupak.

In my Newsweek column this week ("Obama's Malpractice: Why the health-care bill isn't reform"), I argued that-contrary to the Administration's claims-none of the various proposals now floating around Congress would reduce future budget deficits or the rapid rise in national health spending. Quite the opposite: the proposals would probably increase both deficits and national health spending. Now comes Richard Foster, chief actuary of the Centers for Medicare and Medicaid Services (CMMS), a federal agency, making the same points with a lot more detail. In a study published after my column was written, Foster estimates that H.R. 3962, which passed the House of Representatives on Nov. 7, would raise national health spending by about $289 billion from 2010 to 2019.  He also casts considerable doubt on whether the "savings" in Medicare that are used to pay for expanded insurance coverage would actually materialize; if not, the expansion of health-care would lead to higher federal budget deficits.

By Foster's estimates, H.R. 3962 would substantially reduce the number of uninsured Americans, from a projected  57 million in 2019 to 23 million. Most of the newly-insured would receive coverage under a liberalized Medicaid, the joint federal-state program aimed at the poor; many others would entitled to federal subsidies to buy insurance on "exchanges" where a number of insurers would offer competing plans. The costs of the expanded coverage would total about $935 billion over the 2010-2019 decade (some other non-insurance provisions would add slightly to costs). Meanwhile, "savings" mainly from Medicare would cover slightly more than half those costs. High taxes, not included in Foster's analysis, would pay for most of the rest. (Though Foster's office is an arm of CMMS, it provides independent analyses of proposals and costs.)

By Jerry Adler

Horatio athwart the bridge

The Yanks on Cemetery Ridge

Oprah standing at the fridge—

Were heroes, in their way.

Mandela shackled behind bars,

Odysseus, lashed to the spars,

DeLay, foxtrotting with the stars

Inspire us today.

But it takes a special Joe

To swim upstream against the flow

To stand alone (if not quite tall)

To listen to the urgent call

Of conscience and of indignation

And Meet the Press and Face the Nation,

Defy the media to get ya

And speak out on behalf of Aetna.

And Cigna, of PA.

Every now and then there comes a piece of news so shrouded in the stench of hypocrisy that it renders satire unnecessary, news that exemplifies the twisted logic of the political calculation. With that in mind, I offer you this nugget, masterfully uncovered by the skilled headline-grabbers over at Politico:

The Republican National Committee’s health insurance plan covers elective abortion–a procedure the party’s own platform calls “a fundamental assault on innocent human life.” Federal Election Commission Records show the RNC purchases its insurance from Cigna. Two sales agents for the company said that the RNC’s policy covers elective abortion.

It barely warrants commentary. Suffice to say, the party, which agitated so strongly to prevent predominantly low-income women from having elective abortions covered by their government-subsidized health insurance, allows their own staff members to have the same procedure covered by their employer-based insurance. Is anyone surprised that Congress has such low approval ratings?

When Planned Parenthood President Cecile Richards addressed a private phone call of bloggers yesterday, she had to apologize for her hoarse voice: "I've spent the last few days yelling at members of Congress."

Richards, alongside other liberal pro-abortion rights groups, has launched an all-out war on the Stupak amendment, the anti-abortion rights provision approved by the House in Saturday's health-care vote. In yesterday's conference call, she described Planned Parenthood's strategy to insure the Stupak amendment's exclusion from the final health-care bill as two-pronged: "Smart lobbying strategies in Washington [and] very robust grassroots engagement."

The grassroots engagement part kicked off nearly overnight. On Tuesday, Planned Parenthood hosted a "standing room only" meeting with "dozens" of progressive groups at its office in Washington. Politico reported that MoveOn.org, the American Civil Liberties Union, and Service Employees International Union were in attendance. They have logged thousands of calls to members of Congress and, last night, launched an online petition. Next week Planned Parenthood will host a meeting with CEOs from reproductive health groups, labor movement, and broader progressive movement.

House Minority Whip Eric Cantor promised Capitol Hill protesters on Friday that not one Republican would approve the Democrats' health-care bill. But Cantor's vow of unanimity slipped Saturday night when the final vote tally, 220 to 215 in support of the bill, revealed Rep. Anh (Joseph) Cao, a Republican from Louisiana, cast a yes vote.

His reason for being the lone GOP nod? "I have always said that I would put aside partisan wrangling to do the business of the people. My vote tonight was based on my priority of doing what is best for my constituents," he said in a statement quickly released by his office. Earlier in the evening, he also supported a controversial amendment (which also passed) from Democratic Rep. Bart Stupak prohibiting any federal money from funding abortion.

Earlier this week Holly wrote a really interesting piece about the electoral parallels between now and 1993—and the fact that the GOP is hoping for a dramatic Democratic defeat in next year's midterms, similar to what happened in 1994. Holly points out several flaws in the analogy: Republicans have more baggage going into next year's elections than they did in' 94, congressional Republicans have exceptionally low approval ratings, the GOP lacks strong national leadership, and there's damaging infighting between conservatives and moderates. But I'd like to add another difference to the list: health-care reform.

We have yet another study that disputes the Obama administration's claims that the various congressional health proposals will somehow muffle the relentless rise in medical spending. In the past week, both Peter Orszag, head of the Office of Management and Budget, and Christina Romer, head of the Council of Economic Advisers, have repeated earlier assertions that health-care "reform" amounts to "deficit reform" because it will reduce the health-spending spirals that contribute to bulging budget deficits. So far, their arguments aren't resonating with the economic models.

The latest study, done by the health-consulting firm Lewin Group (which is part of a company owned by United Healthcare Group), focuses on the proposal passed by the Senate Finance Committee (S 1796, "America's Healthy Future Act of 2009). The study estimates that it would increase national health spending in the program's first decade (2010 to 2019) by $114 billion. Without the proposal, health spending is projected to increase from 17 percent of gross domestic product (GDP) in 2010 to 25.2 percent by 2030; with the Senate proposal, the increase in 2029 would be slightly greater, about 0.3 percent of GDP. That's not a huge gain, but it's no decline. The study was commissioned by the Peter G. Peterson Foundation, a research-and-advocacy group that focuses on the nation's long-term budget problems.

photo by Tim Sloan/AFP/Getty

You’ve gotta hand it to Nancy Pelosi: She is queen of the photo op. Four days after Harry Reid unveiled his version of health-care reform in a windowless room deep inside the U.S. Capitol, Pelosi chose perhaps the most dramatic setting in Washington to make her own health-care pitch: the west front steps of the Capitol building. You’ve seen it on TV. It’s where presidents are sworn in—though this morning’s events looked and sounded a little more like a convention speech than an inauguration event. Case in point: Pelosi marched into the event to her own personal soundtrack, “Elevation” by U2. (She loves that Bono, remember?) Reid had, well, the sound of reporters typing away on their laptops. Throwaway details aside, there is one major optical difference between the Pelosi and Reid events: when the senator spoke, he did it alone. At Pelosi’s event, almost every member of the House Democratic caucus stood behind her. Who do you think has more sway on Capitol Hill?

D.C. loves nothing more than insider intrigue about closed-door meetings. Exhibit A: TPM's Brian Beutler is stirring the pot with his reporting that last week's White House health-care meeting between the president and Senators Reid and Schumer was more acrimonious than we've been led to believe. Days after the meeting Reid announced the inclusion of a public option in his health-care bill, amid speculation that the White House still favored a trigger option. Beutler writes that in the days leading up to the meeting, relations between Reid and the administration inched toward the breaking point. His sources describe "the back and forth between Senate health-care principals and the White House as a "sort of stare-down where the two sides were saying, 'you be the face of pulling it out.' Reid wants Obama to do it to give cover to his caucus. Obama wants Reid to do it so he's not the bad guy on the public option and can still walk away with a win with reform, with bipartisanship, and with a card for everybody running for reelection." He also reports that Schumer was the one tasked with pitching Reid's opt-out-option strategy to the president. When he did, Beutler's source says,"Obama was less than responsive and asked questions that suggested he preferred an option that could get the trigger and bipartisan support." 

In true D.C. fashion, however, my sources paint a different picture. Senior Democratic sources close to the discussions tell me that the White House meeting was all about Olympia Snowe and how to secure her vote. It's no secret that the president is eager to call reform a bipartisan effort, and Snowe holds the one last candle of hope. But by the time Reid and Schumer entered the White House, Snowe was no longer the topic du jour for them. They were operating on a different calculus.

House Speaker Nancy Pelosi unveiled her long-awaited health-care bill today. There aren't any real surprises. Most of the newsy provisions have been well known for weeks now. The bill will likely extend coverage to 36 million Americans, and it will prevent insurers from dropping or denying coverage. It also won't add to the deficit, thus satisfying one of the president's primary objectives. The CBO estimates the cost at under $900 billion. Here are a few of the key points you need to know about the bill:

• The change that will perhaps have the most impact on Americans is the expansion of Medicaid. Under Pelosi's bill, anyone earning up to 150 percent of the poverty line will be eligible for Medicaid. This is an increase on previous iterations─and the Senate bill─which only covered people up to 133 percent of the poverty line.
  
• The bill includes a public option but not the so-called robust plan. Hospitals and providers will be able to negotiate their rates with the government insurer.
• A surtax will be leveled on wealthy Americans─those earning over $500,000 for individuals or $1 million for families─to help offset costs. This differs from the Senate bill which relies on a tax on "Cadillac," or expensive, insurance plans. Medical-devices companies will also be subject to a new tax.
  
• The bill removes the health-insurance industry's exemption from antitrust laws, which will no doubt upset insurers.
• Like her Senate colleagues, Pelosi won't be offering a "doc's fix," that is, she won't offer a long-term solution to a problematic Medicare formula that causes reimbursement rates for physicians treating Medicare patients to decrease.
• Medicare expenditures will be cut by approximately 1.3 percent, with the pharmaceutical industry bearing the brunt.

The bill currently has no Republican support. Abortion remains a sticking point for some Democrats, like Bart Stupak of Michigan, who want to see the language tightened to prohibit any federal funds being used to fund abortions, meaning that government subsidies can't be put toward plans that cover abortion.

Politico reports that Pelosi has reneged on a deal she made with Anthony Weiner of New York to allow a vote on a single-payer system on the floor. The vote would have failed by a large margin, but its symbolism was important to liberals who feel that they've already compromised enormously in backing a public option over single payer.