KHN Morning Briefing

Summaries of health policy coverage from major news organizations

Viewpoints: Ryan’s ‘Thoughtful Blueprint’ To End Poverty; GOP Challenges After Health Law Rulilng

Bloomberg: Welcome Back, Paul Ryan
The Republican chairman of the House Budget Committee today released a thoughtful blueprint for overhauling $800 billion worth of U.S. anti-poverty programs. He doesn’t get every detail right, but [Rep. Paul] Ryan has put forth a politically brave and economically sound proposal. ... As the House Republicans' fiscal-policy expert, Ryan's budgets proposed deep cuts in Medicare, Medicaid, food stamps and other social programs to appeal to those in his party whose overriding desire seems to be to cut spending on social programs. This time, he has avoided such kowtowing (7/24).

Reuters: Paul Ryan’s Promising New Plan To End Poverty
Though Ryan is known for having devised budgets designed to shrink deficits by aggressively — some would say too aggressively — trimming the growth of Medicaid and domestic discretionary spending in the coming years, the first and most important thing to note about Ryan’s new anti-poverty agenda is that it is deficit-neutral. Rather than reduce anti-poverty spending in the immediate future, Ryan’s proposal aims to make anti-poverty spending more effective by leveraging the strengths of the federal government (the resources at its disposal) and of states, local governments, and private organizations (their local knowledge) (Reihan Salam, 7/24).

The Wall Street Journal: A 2014 Health-Care Strategy: Freedom
Contradictory rulings this week by the D.C. and Fourth Circuit Courts of Appeals mean that ObamaCare will probably return to the Supreme Court. The crucial issue is whether the government can subsidize premiums for health insurance bought on federal exchanges, though the Affordable Care Act's plain language authorizes subsidies only for policies purchased on "an Exchange established by the State." If the Supreme Court decides that ObamaCare must be implemented as written, Democrats will have to bring the legislation back to Congress. This gives Republicans an opportunity to develop a new strategy to rid the country of ObamaCare (Phil Gramm, 7/24).

The Wall Street Journal's Political Diary: GOP Governors And ObamaCare
Republican governors have been among the most vociferous critics of ObamaCare, but they ought to count themselves lucky that the Supreme Court won't be deciding the legal challenges to insurance subsidies for the 36 states participating in the federal exchange this year. A ruling that strikes down the subsidies would be victory for conservatives but could also trigger some political headaches (Allysia Finley, 7/24).

The Washington Post: Supreme Court May Not Protect Obamacare This Time
Don't be so sure that the Supreme Court is going to save Obamacare. Again. The question is enormously important: Are health-care consumers entitled to subsidies if they buy coverage on insurance exchanges established by the federal government, as they are with insurance from state exchanges? (Ruth Marcus, 7/24). 

Los Angeles Times: Obamacare Court Ruling Is Nonsensical And Cynical
At last count, more than 8 million people are getting healthcare through an Obamacare exchange. Almost three-quarters of them are using the federal exchange. These millions of Americans ought to be able to finally leave behind the stress of living with no insurance or inadequate or unaffordable insurance. But thanks to two cases decided by federal appeals courts Tuesday, their security and peace of mind remain at risk. The courts in those two cases, Halbig vs. Burwell and King vs. Burwell, reached opposite decisions, and the ultimate outcome will probably be determined by another contentious decision from the Supreme Court (Jill Horwitz and Samuel Bagenstos, 7/24). 

The New York Times: Left Coast Rising
On health care, some people — basically healthy young men who were getting inexpensive insurance on the individual market and were too affluent to receive subsidies — did face premium increases, which we always knew would happen. Overall, however, the costs of health reform came in below expectations, while enrollment came in well above — more than triple initial predictions in the San Francisco area. A recent survey by the Commonwealth Fund suggests that California has already cut the percentage of its residents without health insurance in half. What's more, all indications are that further progress is in the pipeline, with more insurance companies entering the marketplace for next year (Paul Krugman, 7/24). 

The New York Times: The Phony 'Narrow Network' Scare
Republicans contend that the Affordable Care Act is a failure because many of the plans sold on the online health exchanges limit a consumer’s choice of doctors and hospitals. Many plans do, indeed, limit choice — deliberately so, to keep premiums down. But a vast majority of consumers can almost always buy a plan with a broad array of doctors, hospitals and other providers if they are willing to pay more for the policies (7/24). 

The Wall Street Journal: Beggar-Thy-Neighbor Medicine
To understand how ObamaCare is already bending the future of U.S. medical progress, consult the furor over specialty drug prices, as an alliance of convenience among third-party payers assails pharmaceutical innovation as too costly. Maybe patients should give up on cures and, as President Obama once put it, just take the painkiller. This new defeatism has been triggered by the fake crisis of one of the most successful drug launches in modern history, the Gilead Sciences therapy for Hepatitis C. About 3.2 million Americans are infected with this blood-borne disease of the liver, which kills about 80,000 people a year, or five times the death rate of AIDS. Now a biologic drug called Sovaldi cures the virus in at least nine of 10 patients, and perhaps even 98% (7/24). 

The Wall Street Journal: The ObamaCare-IRS Nexus
One of the big questions out of the IRS targeting scandal is this: How can an agency that engaged in such political misconduct be trusted to implement ObamaCare? This week's Halbig v. Burwell ruling reminded us of the answer. It can't. The D.C. Circuit Court of Appeals ruled in Halbig that the administration had illegally provided ObamaCare subsidies in 36 insurance exchanges run by the federal government. Yet it wasn't the "administration" as a whole that issued the lawless subsidy gift. It was the administration acting through its new, favorite enforcer: the IRS (Kimberley Strassel, 7/24).

Bloomberg: The Surprise Obamacare Ruling That Wasn't
Ryan Radia at the Competitive Enterprise Institute seems to have uncovered the closest thing we’re going to get to a smoking gun. Jonathan Gruber, an economics professor at the Massachusetts Institute of Technology, is widely known as one of the architects of both Romneycare and Obamacare. ... In January 2012, Gruber apparently gave a talk at some sort of conference .... At that talk, Gruber made the following observation: "What’s important to remember politically about this is if you're a state and you don’t set up an exchange, that means your citizens don't get their tax credits -- but your citizens still pay the taxes that support this bill. So you’re essentially saying [to] your citizens you’re going to pay all the taxes to help all the other states in the country. ..." Gruber, one of the law’s architects, clearly had an understanding of the provision that liberals now say no one shared (Megan McArdle, 7/24).

The Star Tribune: Obamacare Ruling: 2 Judges, 6 Words And Millions At Risk
How many Americans are anti-Obamacare hard-liners willing to harm in their war against the landmark health reform law? The answer — millions — became shamefully clear after a conflicting set of federal appellate rulings this week cast an unnecessary cloud over the Affordable Care Act’s future. About 4.6 million people who obtained private health insurance this year through, the federal insurance marketplace serving 36 states, received tax-credit subsidies to lower the cost of their monthly premiums. That number is expected to rise to 7.3 million over the next two years, according to a recent analysis by the Robert Wood Johnson Foundation and the Urban Institute (7/24).

CNN: Why Court’s Blow to Obamacare Won’t Stick
The D.C. Circuit's decision got basically everything wrong. It misunderstood the text, structure and purpose of the Affordable Care Act. The Justice Department has already indicated that it will ask the entire D.C. Circuit to review the Halbig v. Burwell decision, and when it does, it will no doubt reverse it (Brianne Gorod, 7/24).

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.