KHN Morning Briefing

Summaries of health policy coverage from major news organizations

Viewpoints: GOP’s ‘Political Sideshow;’ Boehner Says House Must Defend The Constitution; Jonathan Gruber On Center Stage About Subsidies

USA Today: GOP Lawsuit Looks Like Political Sideshow: Our View
This week, before the House leaves for its August recess, the GOP majority is expected to approve a lawsuit against Obama. Speaker John Boehner, R-Ohio, says it will accuse the president of unconstitutionally abusing his executive power by delaying the Obamacare requirement that larger companies provide health insurance or pay a fine — the so-called employer mandate. ... A fair-minded look at the suit's merits suggests it's really more of a political grudge match, one in which the GOP is seeking an outcome it hasn't been able to achieve at the polls or through the legislative process (7/27). 

USA Today: Boehner: We're Defending The Constitution
President Obama has overstepped his constitutional authority — and it is the responsibility of the House of Representatives to defend the Constitution. ... On the advice of legal experts, the House action will focus on his decision to extend — twice — the deadline to institute the employer mandate in his health care law. We believe this targeted lawsuit offers the best chance of success. ... I oppose the employer mandate in the president's health care law. The House of Representatives has voted to delay or eliminate it (and we will do so again if we prevail in court). But it is the letter of the law that was passed by Congress and signed by President Obama. He simply cannot unilaterally rewrite it (Speaker John Boehner, R-Ohio, 7/27). 

The New York Times: The Fight Over 'Impeachment Lite'
Rather than getting on with the country's business and focusing solely on can't-wait issues before they jet out of town this weekend — like the unfinished bill to fix veterans' health care and the stalled bill to deal with the humanitarian crisis of Central American children arriving at the border — House Republicans are gearing up for a grand maneuver: an apparently unprecedented move by the House to sue the president over his use of executive orders. Talk about misplaced priorities (Charles M. Blow, 7/27). 

Bloomberg: Killing Obamacare Even if It Hurts
I don’t think Republicans believe that damaging Obamacare so that it provides middle-class subsidies in some (mostly blue) states while providing none at all in other (mostly red) states is actually a better policy outcome than the status quo. They just hope that it will weaken the law sufficiently to lead somehow to its collapse and eventual repeal. That's clearly the motivation behind House Speaker John Boehner's proposed lawsuit against President Barack Obama for deferring the law's employer mandate. And we’ve seen the same agenda in other instances as well, including the advertising campaign, sponsored by conservative groups, to convince young people that they are better off without health insurance. It's hard to believe that Republicans think that adding to the numbers of uninsured Americans is actually a desirable policy goal. Yet Republicans are willing to encourage such negative outcomes if that increases the chances of scuttling the law (Jonathan Bernstein, 7/25).

The Wall Street Journal: Obamacare’s Insider Testimony
As Jonathan Gruber will tell you, the MIT economist helped to write ObamaCare and remains one of its fiercest defenders. So it's no surprise that on Friday the Web was full of chatter that Mr. Gruber had at least twice made public assertions that support the latest legal challenge to the health law. The D.C. Circuit Court of Appeals ruled last week in Halbig v. Burwell that the plain language of ObamaCare says that subsidies for health insurance can only be delivered through state, not federal, exchanges. The Administration claims this ignores the clear intent of the law, but someone didn't tell Mr. Gruber (7/27). 

The New Republic: Jonathan Gruber: 'It Was Just A Mistake'
Did the people who designed Obamacare intend to deprive millions of people of health insurance, just because officials in their states decided not to operate their own insurance marketplaces? A lawsuit making its way through the federal judiciary, and perhaps on its way to the Supreme Court, claims the answer is yes. ... now there’s a video from 2012 in which one of the law’s best known advocates and architects—MIT economist Jonathan Gruber—makes the same basic argument that the lawsuit does. Among those who say they are surprised by the statement is Gruber himself, whom I was able to reach by phone. "I honestly don't remember why I said that," he said, attempting to reconstruct what he might have been thinking at the time. "I was speaking off-the-cuff. It was just a mistake" (Jonathan Cohn, 7/25).

Bloomberg: Obamacare's Smoking Gun Fires Again
I believe that Gruber sincerely does not remember making these remarks. Memory is fallible; at some point, Gruber probably changed his mind and forgot that he had ever believed otherwise. ... But though I do not fault his honesty, I also think that in January 2012, Gruber did believe that premium tax credits would only be available on state-created exchanges, and that this would give states a strong incentive to create exchanges. We can draw two conclusions from this: First, the reading of the law by Halbig's plaintiffs is clearly not ridiculous or dishonest; if it is a mistake, it is a mistake that one of the law's chief architects could make. And second, we should be very skeptical of people who are now telling us, four years later, what the legislative intent was. Memory really is extraordinarily unreliable, and as we see here, it's very easy to forget what you believed even a couple of years ago (Megan McArdle, 7/25).

The Wall Street Journal’s Washington Wire: The Stakes Beyond The Halbig Lawsuit
A lot of attention is being paid to the dueling decisions in two U.S. appeals courts about whether the U.S. government can provide tax credits to people in federal- as well as state-run insurance exchanges. In human terms, the stakes are high: Millions of moderate-income people will not be able to afford health coverage without a subsidy, and a court ruling could gut coverage expansion in the 36 states with federally run insurance exchanges, unless states decide to set up their own exchanges. ... Amid the reaction, little attention has been paid to whether Americans will perceive Halbig as a legitimate legal question or as more inside-Washington politics (Drew Altman, 7/25). 

The Wall Street Journal's Washington Wire: Obamacare Challenges: Where The Conventional Wisdom Falls Short
Since the U.S. Court of Appeals for the D.C. Circuit struck down an Internal Revenue Service regulation implementing Obamacare, some observers have predicted that the IRS rule would ultimately be upheld. The regulation extends federal subsidies to individuals purchasing insurance from federal exchanges and not just state-run exchanges, as the Affordable Care Act specifies. But when it comes to legal challenges regarding the health-care law, the conventional wisdom has sometimes been wrong (Chris Jacobs, 7/25). 

The Chicago Sun-Times: Obamacare’s Never-Ending Story
Obamacare appears headed for another rendezvous with the U.S. Supreme Court. The justices bent over backward, well mainly Chief Justice John Roberts did, to save the Affordable Care Act two years ago. Will similar legal gymnastics be found to rescue President Barack Obama and Democrats from the clear text of the law this time? At issue is explicit language saying that subsidies to purchase health insurance should go only to Americans who buy coverage through "an Exchange established by the State." There’s reason to believe that the law was written this way to compel states to establish exchanges so their citizens would get subsidies. But the law proved so unpopular that 36 states did not set up marketplaces (Steve Huntley, 7/25).

Los Angeles Times: College Campuses Are Fertile Ground For Promoting Obamacare
Much has been made of the need to enroll "young invincibles" under the Affordable Care Act. These are young adults who, according to many, are often uninsured because they think they don't need insurance. They are also critically important to the success of the ACA. Without their participation, state and national insurance pools in the new marketplaces such as Covered California will be older, sicker and costlier. Insurance premiums will be higher (Walter A. Zelman, 7/27). 

In other health care issues -

The Wall Street Journal: Let Patients Decide How Much Risk They'll Take
Earlier this month, at a private conference for the CEOs of his portfolio companies, venture capitalist Vinod Khosla interviewed Google co-founders Sergey Brin and Larry Page, asking them if the company might jump into health care. "It's just a painful business to be in," Mr. Brin replied, later noting that "the regulatory burden in the U.S. is so high that I think it would dissuade a lot of entrepreneurs." Mr. Brin is right. As a neurosurgeon-scientist and entrepreneur who co-founded a bioelectronic medicine company that deploys implantable technology to supplant drugs, I wish he were wrong. But rampant misalignment of incentives is hampering technology in the U.S. health industry (Kevin J. Tracey, 7/27). 

Marketplace: We Really Are Living In The (Medical) Future
We live in the future. That's not my phrase; it is my daughter Madeleine's invention. True, the monorails remain few and far between, but every once in a while I get a reminder that some of what was once science fiction is no longer fiction. Recently, I got to spend a bit of time with a physicist and physician who says she is trying to do for medicine what Google did for information technology. Her idea is democratize healthcare so that the big stuff doesn't always have to go through professional gatekeepers (David Brancaccio, 7/28).

The Boston Globe: Farewell To The Routine Pelvic Exam?
While the American College of Obstetricians and Gynecologists still endorses routine exams, the American College of Physicians, which includes internists like me, does not. Citing 60 years of data from several sources, the ACP last month recommended that doctors stop performing routine annual pelvic exams on women who are not pregnant, not due for a Pap test (which is no longer recommended annually for most women), and who have no history or symptoms of pelvic disorders. The ACP concluded that the low chance of detecting an asymptomatic gynecologic condition — including ovarian cancer, for which no effective screening test exists — doesn’t justify the pain, fear, anxiety, and embarrassment that a high percentage of women report after having a pelvic exam. I’ve been trying to figure out why the ACP’s announcement left me feeling a little sad (Suzanne Koven, 7/27).

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