KHN Morning Briefing

Summaries of health policy coverage from major news organizations

Viewpoints: Stop ‘Bailout’ Of Obamacare; Health Law Not To Blame For All Insurance Woes; ‘Theft’ Of Medicare Advantage Money

The Washington Post: Stop The Bailout — Now 
Shrinking revenues and rising costs could bring on the "death spiral" — an unbalanced patient pool forcing huge premium increases (to restore revenue) that would further unbalance the patient pool as the young and healthy drop out. End result? Insolvency — before which the insurance companies will pull out of Obamacare. Solution? A huge government bailout. It's Obamacare's escape hatch. And — surprise, surprise — it's already baked into the law. Which is why the GOP needs to act (Charles Krauthammer, 1/2).

The Washington Post: The Affordable Care Act Is Here To Stay
Opponents of the law can hardly advocate going back to a system in which those who really need insurance can't get it. What they can do, and surely will, is make lots of noise by pretending that any problem with anyone's health insurance is due to the Affordable Care Act. Before Obamacare, millions of Americans had their policies canceled by the insurance companies every year. Millions more had their premiums raised, their coverage reduced or both. Now when these things happen, critics will try to blame the new law. ... The real problem with the ACA, and let's be honest, is that it doesn't go far enough (Eugene Robinson, 1/2).

The Washington Post's The Plum Line: The Three Stages Of Obamacare Acceptance
Now that Obamacare is clearly moving forward, Republicans are adjusting to a new reality: it may no longer be a realistic option to simply wait until the law collapses under its own weight and vanishes entirely. GOP lawmakers are increasingly discussing a range of responses, from proposing profound changes to finally embracing a comprehensive alternative. Which raises a question: Is it possible to envision a future in which Republicans and Democrats do enter into real negotiations over the future of the law and the health system, in which each side gets some changes it wants, in exchange for accepting some of the other's proposed changes? (Greg Sargent, 1/2). 

The New York Times: No Burden on Religion
Adding a level of absurdity to the controversy, Little Sisters of the Poor’s insurance plan qualifies as a self-insured "church plan" under an insurance statute known as Erisa. The Justice Department has conceded that it has no authority to compel a third-party administrator of such a plan to provide contraceptive coverage. In this case, contraceptives would not be made available even indirectly to the nuns' employees. Like the cases of the private employers, the suit by the nuns' group boils down to an unjustified attempt by an employer to impose its religious views on workers (1/2).

The New York Times' Economix: Medicare Advantage And The 'Theft' Of $156 Billion
A theft of $156 billion should catch one's attention, especially if government is the thief. It warrants a closer look. For starters, what is the time frame of this $156 billion "theft"? Greater clarity on this point would have been helpful, lest readers think that this is an annual figure. In fact, it is the sum of projected future annual cuts off projected future total payments to Medicare Advantage plans over the decade 2013-2022 (see line 8 of Table 2, page 5 in this Congressional Budget Office projection). That point aside, what the Affordable Care Act has done to the Medicare Advantage plans lies, like beauty, in the eyes of the beholder (Uwe E. Reinhardt, 1/3).

Forbes: New Oregon Data: Expanding Medicaid Increases Usage Of Emergency Rooms, Undermining Central Rationale For Obamacare
For years, it has been the number one talking point of Obamacare supporters. People who are uninsured end up getting costly care from hospitals' emergency rooms. "Those of us with health insurance are also paying a hidden and growing tax for those without it—about $1,000 per year that pays for [the uninsureds'] emergency room and charitable care," said President Obama in 2009. Obamacare, the President told us, would solve that problem by covering the uninsured, thereby driving premiums down. A new study, published in the journal Science, definitively reaches the opposite conclusion. In Oregon, people who gained coverage through Medicaid used the emergency room 40 percent more than those who were uninsured (Avik Roy, 1/2).

NBC News: How Not To Argue Against Medicaid Expansion
There are, by everyone's estimation, several hundred thousand folks in Mississippi who would benefit from Medicaid expansion. According to [Gov. Phil] Bryant, the state could help them, but he doesn't want to – because in his mind, Congress might repeal the health care law at some point in the future, and the state wouldn't be able to afford to pick up the slack. But even by GOP standards, it's impossible to take this seriously. For one thing, it's pretty obvious Congress isn't going to repeal the law, as even the most right-wing lawmakers on Capitol Hill are grudgingly conceding. For another, even in the extraordinarily unlikely event that the law is repealed sometime after 2017, Mississippi could simply revert back to its current policy once the federal well runs dry (Steve Benen, 1/2).

Journal of the American Medical Association: Realizing The Promise Of The Affordable Care Act—January 1, 2014
Never has the landscape of US health care changed so dramatically in a single day as on January 1, 2014. The challenges facing the website notwithstanding, the implementation of key provisions of the ACA will proceed apace in the upcoming year. Whether one cheers or jeers the transformational events of January 1, 2014, the US health care system will never be the same again (John E. McDonough and Dr. Eli Y. Adashi, 1/2).

Politico Magazine: Not One Penny In New Debt For Obamacare
There has been much acrimony and infighting within the Republican Party of late. But in the coming year, there are many upcoming battles that should be able to unite the party, most prominently, the effort to repeal the Affordable Care Act, more commonly known as Obamacare. Republicans agree that Obamacare must be repealed and replaced with policies that eliminate the burdensome interventions that drive up the cost of healthcare. And as the national debt continues to soar over $17 trillion, there must be an immediate push to reduce the size of government. That means there is no better opportunity to unite in the fight against both Obamacare and the growing national debt than with the upcoming debt-ceiling deadline in February (Ryun, 1/2).

And on other issues -

Los Angeles Times: The Gap In Medical Education
Since its inception more than a century ago, modern medical education has undergone a series of quiet revolutions, stretching and scaling to accommodate advances in biomedical science. Yet this comprehensive expansion in one critical area masks a relative neglect of another. Despite their staggering scope — spanning genetics to geriatrics, and everything in between — medical curricula today largely omit training on health policy (Rahul Rehki, 1/3). 

Los Angeles Times: Polio's War Foothold
Once virtually eradicated, polio again stalks the Horn of Africa, the Middle East and South Asia. The innocent victims are mostly young children. The perpetrators are insurgents and indifferent governments. The polio resurgence is preventable and it is time to pull out an old but proven technique to halt its spread: Days of Tranquility (Nancy A. Aossey and William Garvelink, 1/3). 

Bloomberg: Make Those Cows Pay For Their Penicillin
America's animals take more drugs than its people do. About 80 percent of the 51 tons of antibiotics consumed each day in the U.S. are used in agriculture and aquaculture. Such unrestrained use of the drugs may help farmers grow bigger cattle, but it has a drastic side effect: It prods bacteria to evolve defenses, so that the drugs don’t work so well when given to people (or fish or animals, for that matter) suffering from bacterial infections. The loss of these drugs as medical weapons is also astoundingly expensive. The current stock’s potential to prolong human life is worth upward of $60 trillion, according to a new report in the New England Journal of Medicine. And so it is welcome news that the authors of that report also have a novel way to protect this pharmaceutical treasure: Impose a fee on all uses of antibiotics outside of human medicine. Their market-based strategy is worth a try (1/2).

The Star Tribune: Let's Have A Full Debate On Medicaid Costs, Changes
Gov. Mark Dayton made a compassionate and politically savvy decision this week when he asked state officials to delay for a year cost-saving changes that would have phased in reduced home and nursing care for about 3,300 Minnesotans in 2014. ... It also gives the 2014 Legislature time to reconsider the long-delayed changes — expected to save about $50 million over the next four years — that were passed with bipartisan support in 2009 as legislators and then-Gov. Tim Pawlenty grappled with sobering budget deficits and soaring Medicaid costs (1/2).

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