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Senate Republicans’ latest ploy to choke off all federal funding to Planned Parenthood failed, as expected, on Monday afternoon in a 53-46 procedural vote. The measure fell short of the 60 votes needed to move it forward. It shouldn’t have been anywhere near that close. But the perennial conservative effort to cripple the nation’s largest family-planning organization got a boost last month from a string of grainy, edited undercover videos released by an anti-abortion group, and purporting to show Planned Parenthood officials discussing the illegal sale of fetal tissue. (Jesse Wegman, 8/3)

But the biggest change from last week in the odds of a government shutdown is because of the emergence of the one big thing that has been missing so far from the appropriations debate: a highly emotional, politically toxic and take-no-prisoners issue. In the past that line-in-the-sand issue has been budget-related: the national debt, the federal deficit and taxes. This time it’s the new GOP push to defund Planned Parenthood – a highly emotional social issue that has quickly become a political litmus test for Republicans. Republicans are vowing with ever-increasing vehemence to vote against legislation – including a CR — that includes funding for Planned Parenthood and that means that a continuing resolution that simply extends existing funding at current levels won’t be acceptable to the GOP majorities in the House and Senate. (Stan Collender, 8/3)

[S]ome conservatives outside Congress are demanding a government shutdown as a way to force Democrats to agree to defund Planned Parenthood. There's a good chance that these activists, led by Erick Erickson, can get many Republican presidential candidates, both inside and outside of Congress, to join them. They haven't been particularly clear on the mechanism this would take, but presumably they would insist that any temporary funding measure to keep the government running beyond Sept. 30 include a provision ending all funding to Planned Parenthood. ... Never mind that government shutdowns invariably end badly for Congress. It's possible the Tea Party radicals just reject that reality. (Jonathan Bernstein, 8/3)

Health care spending growth has moderated in recent years, but it’s still putting tremendous strain on state and local governments. A recent analysis by The Pew Charitable Trusts revealed that it consumed 31 percent of state and local government revenue in 2013, nearly doubling from 1987. But Medicaid — the state-based health care program for low-income Americans — is not the chief culprit. Health care benefits for public employees and retirees, not Medicaid, account for a majority of the growth in state and local health care spending. (Austin Frakt, 8/3)

More than two years ago, when Chris Christie finally decided to accept federal money to expand Medicaid in New Jersey, he said, "I will make all my judgments as governor based on what is best for New Jerseyans." My, how times have changed. Christie the presidential candidate has since pitched a draconian plan to cut federal Medicaid spending nationwide, which would land like a grenade on our state budget, and utterly devastate our health care safety net for the one in five New Jerseyans on Medicaid who are poor, elderly and disabled. (8/3)

Montana’s plan for covering all very low income adults with Medicaid is a mixture of health care expansion and political compromise. To enact a law that makes 70,000 Montanans eligible for Medicaid, health coverage proponents had to agree to charge monthly premiums to impoverished people and to contract with a private company to administer the coverage and premium collections. The state must convince federal health authorities that the usual provisions of federal law should be set aside to let Montana demonstrate how its plan works. The Centers for Medicare and Medicaid Services should grant Montana the waivers. The agency has already allowed similar exceptions for five other states. (8/2)

Gov. Paul LePage’s five vetoes of bipartisan Medicaid expansion bills have shortchanged the recovery community of [a detox center coupled with either an inpatient or outpatient rehabilitation program] ... in the Bangor area. This governor, however, has seen fit to extend legislation expanding law enforcement and prosecution at the expense of treatment. This mentality of incarceration as a means of curbing drug use has utterly failed. (Arthur Adoff, 8/2)

In tandem, Medicare and Medicaid — with important expansions in coverage through subsequent legislative efforts such as the Affordable Care Act — have made great strides in promoting health equity in America. Yet while many states have expanded Medicaid through the ACA, the states that have elected not to expand coverage continue to exacerbate health disparities, disproportionately affecting poor African-Americans. Currently, there are 2.9 million African-Americans nationwide without coverage as a result. Medicaid expansion would ensure coverage to six in 10 uninsured African-Americans. (Rep. Robin Kelly, D-Ill., 8/3)

Fifty years ago last week, President Lyndon Baines Johnson signed Medicare (and Medicaid) into law. Medicare’s relationship with physicians since then can best be described as a complicated one. First, recall that Medicare became law notwithstanding the American Medical Association’s fierce opposition to it. Three years prior to its enactment, AMA President Ed Annis warned that "We doctors fear that the American public is in danger of being blitzed, brainwashed, and bandwagoned" by the Kennedy administration’s proposal to provide compulsory health insurance to the elderly. The AMA continued to fight tooth-and-nail against Medicare, even after the Johnson administration took up the cause following President Kennedy’s assassination. (Bob Doherty, 8/3)