Healthcare battle greets returning lawmakers: While it's clear by now that passage of healthcare reform won't be Democrats' saving grace in the mid-term elections, the messaging battle is still red hot despite the renewed focus on the economy.

Late last week, Health and Human Services Secretary Kathleen Sebelius warned insurers not to blame the new law for their rate increases: http://bit.ly/9lnqwk. The warning came after insurers in recent state filings tied increases of between 1 percent and 9 percent to more generous coverage mandated by the new law.

Adding fuel to the fire, the Centers for Medicare and Medicaid Services (CMS) reported that the new law would increase healthcare spending by 0.2 percentage points over 10 years. But the law also covers 32 million people and the rate of growth in spending slows after 2015. http://bit.ly/9aQx8x

Several congressional reporters have pointed out that no Democrats are known to be running campaign ads highlighting their votes for reform - and at least four are touting their 'no' vote. But that doesn't mean the party is running away from its signature domestic achievement: The New York Times' FiveThirtyEight political blog took an in-depth look at the Web sites of Democratic and Republican candidates in 33 toss-up districts and found that healthcare was the most frequently mentioned issue — by an overwhelming 97 percent of Republicans and a healthy 79 percent of Democrats. http://bit.ly/cimuZg

Meanwhile, senior White House adviser David Axelrod said on Sunday on NBC’s "Meet the Press" that he still thinks voters will eventually come around.

States are reporting lower than expected participation, raising concerns that a lack of public engagement could affect the program's success.

Health and Human Services Secretary Kathleen Sebelius on Friday announced funding to help rural hospitals switch to electronic health records.

As the Justice Department (DOJ) mulls new rules designed to prevent sexual assaults in the nation's prisons, New York Times editorialists on Friday offered a suggestion: "The policies … need to be as tough as possible."

"A recent report from the Justice Department’s Bureau of Justice Statistics makes that clear, suggesting yet again that sexual violence is frighteningly commonplace in the nation's prisons and jails," the Times writes. 

That report, released last month, found that roughly 88,500 inmates in the nation's prisons and jails were sexually assaulted last year by fellow inmates and prison staff. 

"But rape victims in prison are often hesitant to report their assaults out of shame or fear of reprisal," the Times notes, "and these numbers may actually underestimate the problem." 

A 2003 law created an expert commission to study the problem and make recommended solutions. Fifteen months ago, after four years of study, that panel submitted its suggestions to the DOJ. Still, the agency missed its June deadline for finalizing the new rules, amid concerns from the prison lobby that installing them will be too expensive.

Behind Attorney General Eric Holder, DOJ expects to issue proposed rules in the fall.

The delay, the Times writes, has led to concerns from prison reformers that the DOJ might dilute the commission's suggestions during the public comment period. 

"Mr. Holder," the paper says, "needs to ensure that doesn't happen."

President Obama on Friday defended the Democrats' healthcare law, saying the enormous expansion of insurance coverage made an increase in healthcare spending inevitable.

"As a consequence of us getting 30 million additional people healthcare, at the margins that's going to increase our costs — we knew that," the president told reporters during a White House press conference. 

"We didn't think that we were going to cover 30 million people for free." 

Obama was responding to questions about new cost projections, crunched by economists at the Centers for Medicare and Medicaid Services (CMS), revealing the nation's healthcare spending, as a share of the economy, will be 0.3 percentage points higher in 2019 than estimated before the law was passed.

That CMS report, published Thursday in the journal Health Affairs, also revealed healthcare spending will grow by an average of 6.3 percent each year over the next decade, whereas pre-reform projections pegged annual growth at 6.1 percent. 

Republicans have latched onto the figures as evidence that the new reform law has failed in one of its central purposes: to bend the health cost curve down to sustainable levels.

But Obama rejected those criticisms, arguing his pitch for reform included warning that the process would be a long one. 

"I said at the time it wasn't going to happen tomorrow, it wasn't going to happen next year," Obama said. "It took us decades to get into a position where our health care costs were going up 6, 7, 10 percent a year. And so our goal is to slowly bring down those costs."

Obama has at least one statistic working in his favor: CMS says the annual rise in health spending between 2015 and 2019 — after the enormous insurance expansion of 2014 — will average less than the agency estimated pre-reform.

It's not as low as he wants, Obama said Friday. But it's getting there.

"If we can get — instead of healthcare costs going up 6 percent a year — it's going up at the level of inflation, maybe just slightly above inflation, we've made huge progress," he said.

The anti-abortion group Americans United for Life released a legal memo Friday to defend its political ads that call the healthcare reform law the "largest expansion of taxpayer-funded abortions ever."

The radio ads target House Democrats John Boccieri (Ohio), Christ Carney (Pa.) and Baron Hill (Ind.). This week, The Associated Press's ADWATCH questioned the ads' accuracy, calling some of their predictions — that President Obama's executive order restricting abortion coverage could be overturned, or that the courts could mandate abortion coverage — "hypotheticals."

In response, AUL released a legal memo objecting to the government's rationale that federal subsidies for healthcare plans that offer abortion coverage aren't subsidies for abortion if the act itself isn't subsidized. The memo also argues that the president's executive order does not constitute a comprehensive prohibition on the use of federal funds for abortion coverage.

"The pro-abortion Obama Administration has the opportunity to expand federal funding for abortion through multiple programs in the Affordable Care Act," the memo concludes. 

Healthcare economist Uwe Reinhardt writes in a new column that health insurance agents and brokers might thrive under health reform despite much hand wringing within the industry.

The column comes in response to recent arguments that the new law's health exchanges will simplify the purchase of insurance to such a degree that brokers will become irrelevant, much like online flight ticketing bankrupted travel agents. Brokers say their predicament is worsened by the law's medical-loss ratio requirements that will encourage health plans to stop paying broker commissions and instead spend more on care.

"If I were a broker..." Reinhardt writes on The New York Times' Economix blog, "I would not despair at the prospect of the state-based insurance exchanges for one simple reason: administrative simplicity and efficiency is decidedly not America's strong suit, in either the private or the public health sectors.

"So it's a pretty safe bet that the state-based exchanges envisaged in the Affordable Care Act will be so complicated and bewildering that the services of brokers will still be needed. In fact, the Affordable Care Act anticipates this by requiring that the exchanges award grants to 'navigators,' tasked with educating the public about qualified plans, available subsidies, enrollment procedures and so on."

GOP candidate Pat Toomey on Thursday went after Rep. Joe Sestak (Pa.), his Democratic opponent, over a provision of healthcare reform.

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