KHN Morning Briefing

Summaries of health policy coverage from major news organizations

Viewpoints: Blum’s Departure Is A Serious Loss; GOP Fighting Medicaid Expansion With New Tactic

Bloomberg: The Health-Care Job That Really Matters
The official who matters most when it comes to controlling U.S. health-care spending has just resigned, leaving behind a program with serious fiscal problems that badly needs further reform. No, not Kathleen Sebelius -- and the program isn't the Affordable Care Act. The official is Jonathan Blum, and the program in question is Medicare, which next year will replace defense as the largest federal expenditure after Social Security. Blum had started to get Medicare costs under better control, but there's a lot more work to do and there'll be plenty of resistance along the way (4/23).

Reuters: Why The Obamacare Fight Never Ends
With 8 million people signed up for Obamacare — and perhaps as many as 14 million covered by the law — repealing Obamacare looks like a lost cause. "This thing is working," the president announced. The fact that Obamacare is working should shut down the debate. But that's not happening. Why not? Six reasons (Bill Schneider, 4/24). 

The New York Times' Taking Note: The Real Reason Red States Won't Expand Medicaid
By now it's pretty clear that the states refusing to expand health coverage under Medicaid aren't really worried about the expense. They're motivated entirely by ideological stubbornness — "for no other reason than political spite," as President Obama said last week (David Firestone, 4/23). 

MSNBC: Medicaid Expansion Starts To Look Even Better
Here’s the deal: in some states, it's up to the governor’s office to decide whether or not to embrace Medicaid expansion. For opponents of health care, this works out fine, just so long as there’s a far-right governor who’s prepared to ignore all of the evidence and obvious benefits. But what if that governor loses? In Georgia and Kansas, there are far-right incumbent governors who are favored to win re-election, but polls suggest their races will at least be competitive. It’s no longer ridiculous to think voters in either state – or perhaps both – could elect a Democratic governor who would, of course, do the smart thing when it came to Medicaid expansion. The mere possibility has led legislators in Georgia and Kansas to push changes to state law, moving authority over the decision from the governor’s office to the legislature, just to make sure state finances, state hospitals, and the state’s struggling families will suffer now and in the future, regardless of who wins the gubernatorial races (Steve Benen, 4/23).

National Review: Conservatives And The Medicaid Expansion
But a group of states with significant Republican control, such as Michigan, Arkansas, Iowa, and, most recently, New Hampshire, are trying to chart a middle way by using seemingly conservative means to expand their states' Medicaid programs. Obamacare’s Medicaid expansion provides an opportunity for Republicans to reform the welfare state by applying conservative ideas and principles, and some GOP-led states are trying to seize this opportunity. Despite their best efforts, though, these states are hamstrung by federal regulations and control of Medicaid. The Obama administration is limiting their ability to innovate and their capacity to stake out a fundamentally different vision of welfare in the United States from the one implied in Obamacare (Andrew Evans, 4/24).

The Wall Street Journal: The Other Stealthy ObamaCare Menace
The Affordable Care Act's Independent Payment Advisory Board has been so heavily criticized for being an unaccountable body with the power to effectively ration Medicare services that many congressional Democrats no longer support it. IPAB's bureaucratic cousin—the Center for Medicare and Medicaid Innovation—deserves the same treatment (Lanhee J. Chen and James C. Capretta, 4/23). 

news@JAMA:  What Do We Know About The Affordable Care Act?
Now that the 2014 enrollment period has (finally) ended for signing up for a plan in the Affordable Care Act’s (ACA’s) health insurance exchanges, many of us policy analysts and political observers are trying to figure out what we know about the ACA’s early effects and what else we need to know to begin a reasonable assessment of the law. ... Beyond the total number, however, we know almost nothing about those who’ve enrolled, not even the most basic demographic data. This lack of information is frustrating and has led many to wonder why the administration has only chosen to dribble out favorable information while refusing to make basic facts easily available (Gail Wilensky, 4/23).

Fox News: A Doctor, Not A Bureaucrat, Should Be In Charge Of Health And Human Services
"The torch has been passed to a new generation of Americans," Jack Kennedy famously said in his 1961 inaugural address, a phrase once swollen with optimism and American pride. It may be tempting for President Obama to use this same expression now to describe Health and Human Services Secretary (Baby Boomer) [Kathleen] Sebelius handing off the HHS secretarial torch to her apparent (Generation X) replacement, Sylvia Burwell, but such a sentiment would be false optimism. It is time for a physician or an expert in health care to administer Health and Human Services, not another numbers-massaging manager, no matter how able (Dr. Marc Siegel, 4/23). 

The Fiscal Times: How To Play The Obamacare Data Game
The need for statistical data is certainly no myth. The only rational way to understand and measure complicated systems is from metrics that produce hard data. That need exists in complex systems in small applications such as data and call centers, which I managed for years, to large government bureaucracies, and especially in risk-pool management as conducted by insurers in every application. The key is to know the scope and the limits of those measurements and to understand their meaning to the whole of the operation. Otherwise, it's too easy to see just the statistics that suit one's own purposes, or to deliberately cherry-pick them to advance one's own agenda. Nowhere has this been impulse been more often displayed than with the Obama administration and Obamacare (Edward Morrissey, 4/24).

The Fiscal Times: How Medicare Data Could Revolutionize Health Care
The release this month of a mountain of data on physician payments by the Centers for Medicare and Medicaid Services (CMS) might be remembered by future historians as a major turning point in the quest to battle overpriced medical care. As a result of a court ruling, the government on April 8 made public some $77 billion in payments to nearly one million providers during 2012. In a month or so, data will be released on hospitals and clinics. An injunction making the information private since 1979 was challenged by the Dow Jones Co., publisher of The Wall Street Journal. While increasing transparency in public health care services is generally a win for patients and taxpayers alike, the numbers are meaningless without pragmatic analysis (John F. Wasik, 4/23).

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