A leading House Democrat said this week that the party's signature healthcare reform law was largely the reason the Democrats were trounced in the midterms.

But, Rep. James Clyburn (D-S.C.) added, the law was worth the political costs because it "was the right thing to do."

"We got in the place that we're in because of healthcare reform," Clyburn told MSNBC's "Morning Joe" on Monday. "But you know what? … A lot of people lost their seats over Social Security, but that was the right thing to do.

"A lot of people, in fact — Democrats in the South — we lost the South because of civil rights back in the 1960s, but that was the right thing to do.

"And so I do believe that healthcare was the right thing to do."

Clyburn, the majority whip, is making headlines this month for his contest with Majority Leader Steny Hoyer (D-Md.) for minority whip in the next Congress. 

Speaker Nancy Pelosi (D-Calif.), who's running unchallenged to lead the party next year, will sit down Monday with Hoyer and Clyburn, Politico is reporting.

House Ways and Means Chairman-to-be Dave Camp (R-Mich.) is making his case for repealing and replacing the healthcare overhaul, touting his own version of a bill that he says would reduce premiums. 

In a USA Today editorial, Camp said the House Republican alternative was the only bill certified by the Congressional Budget Office "as reducing premiums across the board by up to 10 percent."

"By putting an end to junk lawsuits, encouraging small businesses to band together to provide health plans, forcing insurance companies to compete by allowing Americans to shop across state lines, and giving states the flexibility to make changes that best meet the needs of their residents, we can reduce premiums and still provide important patient protections," Camp said in the editorial. 

The Republican plan also would guarantee that those with pre-existing conditions can obtain affordable coverage, prohibit insurers from "unjustly canceling policies" and allow dependents to remain on their parents' policies through age 25, he said.

"We can reform health care, provide better patient protections and lower costs. It doesn't take $1 trillion in new government spending, $500 billion in new taxes and $500 billion in cuts to Medicare over the next decade," he said. 

Blaming congressional inaction, the nation's largest doctors' lobby is urging lawmakers this month to block a steep cut scheduled to hit Medicare doctors at the start of December.

The American Medical Association (AMA) is warning that a failure to prevent the cut would be "a catastrophe for seniors" because many doctors would stop seeing Medicare patients altogether. Physicians are facing a 23 percent cut on Dec. 1, and an additional 1.9 percent cut is scheduled for Jan. 1. 

"This is not about doctors," AMA President Cecil Wilson told reporters on a press call Monday. "It's about access to care for senior citizens."

Wilson minced no words about where the blame for the cuts should rest. "It's not AMA that's not fixing the problem. This is a congressional problem."

Lawmakers, he added, "are putting the lives and health of seniors at risk."

AMA is endorsing a temporary pay patch, delaying the cuts for 13 months and providing a 1 percent pay increase for doctors instead. The time cushion will allow Congress next year to consider ways to scrap the 13-year-old formula — the Sustainable Growth Rate (SGR) — that dictates Medicare physician payments, replacing it with a system that better reflects the true cost of delivering care, AMA says.

It's hardly a new argument. 

The SGR was designed to prevent Medicare doctor payments from bankrupting the program by indexing reimbursements to the growth of the economy. Because healthcare inflation has risen much faster than GDP in recent years, the SGR has called for physician cuts every year since 2002. Congress, however, has usually stepped in with temporary patches to prevent those cuts.

Years of kicking the can down the road, though, has caused the cuts to compound, leading to next month's scheduled 23 percent reduction.

Fixing the problem — even patching it — doesn't come cheap. The cost to delay the cut by 13 months is estimated at $15 billion. A permanent fix would run well above $200 billion — so expensive that Democrats never even tried to include it as part of the new healthcare reform law.

Lawmakers on both sides of the aisle agree the SGR is flawed and needs reforming, but cost concerns have always prevented a permanent fix — a hurdle that only got higher after Tuesday's elections, which were largely a referendum on deficit spending.

To prod lawmakers to action, AMA is taking out a full-page ad in USA Today this week, with others to follow next week in various Capitol Hill papers. 

A Republican-controlled House is unlikely to extend the enhanced Medicaid funding for states in last year's Recovery Act, the head of a nursing home trade association said Monday. A return to the initial federal share (known as FMAP) would be particularly painful for nursing homes and assisted living facilities, who rely on Medicaid to pay about two-thirds of their patients' bills.

"I just have a very hard time" seeing Republicans pass an FMAP bill, said Bruce Yarwood, president and CEO of the American Health Care Association.

Yarwood said the FMAP situation will force a discussion on long-term care, which he said was hardly addressed during the healthcare reform debate. As lawmakers respond to voters' concerns about the deficit and cut back on Medicaid and Medicare, a long-term care sector that relies on government spending to cover about 85 percent of its patients faces a crossroads.

"We stick out like a giant target because of the deficit problem," Yarwood said.

The healthcare reform law did create a voluntary contribution program known as the CLASS Act, but Yarwood said that while he hopes it works, it's still untested and few businesses have signed up so far to enroll their employees. And some Republicans want to repeal the provision out of concerns that it could turn into another entitlement program if beneficiaries' contributions can't cover its costs.

To address the industry's funding challenges, Yarwood said, AHCA has reached out to the Centers for Medicare and Medicaid Services and the Brookings Institution to create pilot programs where the federal government would reimburse providers based on the "condition, needs and characteristics of the patient rather than the post-acute care setting."

AHCA is also lobbying to get technical changes to Medicare payments in the physician payment bill that Congress will have to take up during the lame-duck session to prevent a 30 percent cut in Medicare payment rates. AHCA's other priority in that so-called "doc fix" bill will be passage of a year-long exemption from reimbursement caps on physical, speech/language pathology and occupational therapy services, which were capped at $1,860 each for 2010.

Yarwood added that, even if enhanced Medicaid funding is off the table next year, AHCA would still fight for a continuation of a provision in the Recovery Act requiring states pay most claims within 30 days.

Senate Republican Leader Mitch McConnell (Ky.) says he is looking for ways to defund the implementation of healthcare reform.

“I think ObamaCare is one of the worst pieces of legislation passed in modern history,” Minnesota Gov. Tim Pawlenty said.

The Centers for Medicare and Medicaid Services (CMS) on Friday proposed new rules for the use of private contractors that work for states to audit Medicaid payments. The Recovery Audit Contractors (RAC) will function similarly to the way they do in the Medicare program, where they audit payments that may have been underpaid or overpaid, and recover overpayments or correct underpayments.

"Reducing improper payments is a key goal of the Administration, and the tools provided by the Affordable Care Act will help us achieve that goal," CMS Administrator Donald Berwick said in a statement announcing the rules. "We are using many of the lessons that we learned from the Medicare RAC program in the development and implementation of the Medicaid RACs, including a far-reaching education effort for health care providers and State managers."

Under the new law, states must establish Medicaid RAC programs by submitting state plan amendments to CMS by Dec. 31. The proposed rule details how states can get extensions or exceptions and outlines federal contributions to the program as well as the requirements that states must meet.

Sen. Chuck Grassley (R-Iowa), ranking member on the Senate Finance Committee, slammed AARP on Friday after news broke that the powerful seniors' lobby was blaming the health reform law for an increase in employee premiums slated for next year. AARP's support of the law was crucial because of the fierce opposition from many seniors to the cuts to Medicare Advantage that helped pay for the overhaul.

In an e-mail to employees obtained by The Associated Press, AARP says healthcare premiums will increase by 8 percent to 13 percent next year because of rapidly rising medical costs. AARP is also making its plans' benefits less generous to avoid the taxes on generous "Cadillac plans" starting in 2018.

"Most plan co-pays and deductibles have been modified," Jennifer Hodges, AARP's director of compensation and benefits, wrote employees in the Oct. 25 e-mail. "Plan value changes were necessary not only from a cost management standpoint but also to ensure that AARP's plans fall below the threshold for high-cost group plans under health care reform."

"AARP supported a partisan health care overhaul that cut Medicare by almost $500 billion," Grassley said in a statement. "That will result in less choice, fewer benefits and decreased access to care for millions of its members. But now we hear that AARP’s members aren’t the only ones who will bear the brunt of the new health care law.

"Like companies across the country," Grassley continued, "AARP is shifting more costs onto employees in reaction to the health care overhaul. Despite their employer’s support, AARP employees are learning that the health care law is not going to address the top priority of making health care coverage less expensive. Supporters of the law tend to have tunnel vision and focus on how it will affect narrow groups of people, rather than recognizing that most people will just end up paying more. But the big picture is clear.  Employers and employees nationwide will pay more for health care because of the new law."

AARP legislative affairs director David Certner told the AP the new law was "a small part" of the reason for the changes and added that "(t)he impact on AARP employees is not a factor at all in our policy making, which is directed at the impact on our membership and on all older Americans."

The announcement comes after HHS revealed only 8,011 people had enrolled in the high-risk pools as of this week.