KHN Morning Briefing

Summaries of health policy coverage from major news organizations

Viewpoints: ‘Pent-Up Demand’ For Health Care; Too Early For That White House Victory Lap; The Fight Over Medicare Advantage

The New York Times: Measuring The Success Of Health Reform
More than seven million people have signed up for insurance on the new federal and state health exchanges, President Obama said this week. Millions more could be added to that total once insurers tally up the people who bought policies directly from them and when those who tried to apply on balky websites are able to complete the process. This is a remarkable turnaround that seemed unlikely after the health care exchanges operated by the federal government and by several states got off to a horrendous start in October and continued to suffer intermittent difficulties as late as Monday, the last official day for enrolling for coverage in 2014. The figures provide stark evidence of the pent-up demand for health insurance and the willingness of people to comply with a law that has been vilified by conservatives as a disaster for millions of Americans (4/2). 

Louisville Courier-Journal: Health Law Heading For Success
The stunning success announced Tuesday will do little to stop critics, chiefly in the Republican Party and its offshoot tea party, who have made the law also known as Obamacare a focal point of relentless political attack. In fact, the public should brace for a new onslaught of attacks as false as they are virulent —fueled by torrents of SuperPAC cash and special interest money as we enter the election season. But the public should consider some really good questions President Obama posed in remarks Tuesday as he announced the results of enrollment for health coverage by the March 31 deadline. "Why are folks working so hard for people not to have health insurance?" he asked. "Why are they so mad about the idea of folks having health insurance?" (4/3).

Time: Obamacare: Mend it, Don't End it
Indeed, there is one political thing that we know for sure: the Republicans have lost this debate substantively. The law won’t be repealed. "There is no off switch," says Professor John DiIulio of the University of Pennsylvania, who is studying the system from the bottom up in 35 states. "There are financial obligations to the people who have signed up [and receive subsidies from the government]. There are 50 different stories here. The program is different in every state. That makes it difficult to formulate a national policy response," whether it be repeal or sweeping reform. Which doesn't mean the Affordable Care Act doesn't need reform. It is a slovenly piece of legislation that will need constant modification and in some cases structural overhaul (Joe Klein, 4/3).

The Washington Post: The GOP Must Admit It Was Wrong On Obamacare
Is there any accountability in American politics for being completely wrong? Is there any cost to those who say things that turn out not to be true and then, when their fabrications or false predictions are exposed, calmly move on to concocting new claims as if they had never made the old ones? (E.J. Dionne Jr., 4/2).

The Fiscal Times: The Coming Obamacare Shock For 170 Million Americans
The public has hardly been in a celebratory or a laughing mood. Polls show that the American public remains as opposed to the ACA as ever, with 55 percent of Quinnipiac respondents disapproving of the law. Only 39 percent approve of Obama's handling of health care policy, which has until recently been a Democratic Party strength. For that matter, Obama only gets a 40 percent approval rating on the economy and jobs, to which House Minority Leader Nancy Pelosi wants the debate to turn now that the Obamacare debate "is over."  Pelosi and Obama may want to be careful with that wish casting, because the two debates are now closely related (Edward Morrissey, 4/3).

The Fiscal Times: Obamacare Got To 7 Million. Here's Its Next Big Test
Now that Obamacare enrollment has closed — with some 7.1 million enrollees, as the president crowed Tuesday — the next big test for the reform will be whether its spurs competition among health insurers to lower costs. While competition may thrive in the largest states, it may not hold true in mid-sized and smaller states, where only a handful of insurers dominate the new health care exchanges. Some radical changes may be necessary if competition is to play a role in reducing overall health spending (John F. Wasik, 4/2).

CNN: Too Early To Run Obamacare Victory Lap
Now that it's implemented, public opinion of the [health care] law is going to be tied to its success or failure. And the first year enrollment figures are only one small indicator. In other words, the Obama administration's celebration might be legitimate, but it could be premature as the long-term viability of the Affordable Care Act unfolds (Leigh Ann Caldwell, 4/2).

Huffington Post: A Tale Of Two Siblings, The ACA, And The Supreme Court
Yet there is a part of the law that is not at all working as originally envisioned, because the Supreme Court dramatically altered the structure of the ACA when it ruled that the expansion of Medicaid should be voluntary for states. Since then, political and fiscal considerations have led almost half of governors and state legislatures to choose not to expand Medicaid. The result is an insurance system that makes very little sense: An estimated 4.8 million poor Americans in states not expanding Medicaid will fall in a coverage gap this year and get no help paying for insurance, while 10.1 million people in those states who earn more than they do can get tax credits to help pay for coverage (Drew Altman, 4/1).

The Washington Post: Parting Companies And Their Employee Health Care
Hobby Lobby's case is that the Affordable Care Act confronts it with an impossible choice: paying for contraceptives that its owners' faith prohibits as abortifacients ... or dropping coverage. ... No doubt Hobby Lobby provides this insurance out of a sincere intent to fulfill [its religious duty to provide care for employees]. But I’ll bet the federal tax exemption for employer-paid health insurance plays a role, too.
Given that it benefits from this feature of the Internal Revenue Code, Hobby Lobby’s insistence on delivering health insurance to employees in precisely the manner its company conscience dictates strikes me as not only a matter of principle but also a subtle manifestation of the great American entitlement mentality (Charles Lane, 4/2). 

Bloomberg: Understanding Health-Care Spending's Ugly Spike
I’ll point you to a new piece of data that came in last week: In the fourth quarter of 2013, health-care spending seems to have grown at the fastest pace in a decade .... The timing doesn't jibe well with the theory that health-care spending is rising because of Obamacare. It's much more consistent with the theory that the slowdown was driven by the recession, or a temporary innovation hiatus, or a combination of both. This is hardly the last word, of course. But as it stands, the data suggest two things: We need to revisit our theories of why cost growth has slowed over the last few years, and we need to prepare for what this trend might do to our budget if it continues (Megan McArdle, 4/2).

Forbes: The Real Value Of ObamaCare Has Nothing To Do With Enrollment
The noisy debate over how many people have gotten health insurance under the Affordable Care Act misses the point. Yes, reducing the number of uninsured was one goal of the ACA. But only one. The law’s most enduring legacy will come from its historical—but largely unnoticed—changes in the way health care is delivered. Unlike the insurance expansion, which largely excludes Medicare, many of those delivery reforms affect seniors and younger people with disabilities. In some cases, they are remaking the care people get through Medicare. In others, they change the way care is delivered through Medicaid, which is critical for many receiving long-term services and supports (Howard Gleckman, 4/2). 

On other health issues -

USA Today: Trim Medicare Advantage Subsidies: Our View
Here we go again. Insurance companies and members of Congress are trying to scare seniors with dire warnings that new spending cuts will hurt the popular Medicare Advantage program, forcing beneficiaries to pay more for less. The final numbers are due from the Obama administration on April 7. Our advice: Take the warnings with a big grain of salt. Many of these same folks said many of these same, scary things back when health reform was being debated in 2009, insisting that cuts to Medicare Advantage in Obamacare would devastate the program (4/2). 

USA Today: Don't Harm Seniors: Opposing View
History often repeats itself, and that reality is a daunting one for seniors in Medicare Advantage. While some have argued that cuts to the popular program would do nothing to jeopardize seniors' health benefits, precedent tells us this isn't true. In 1997, Congress passed substantial cuts to Medicare Advantage, then known as Medicare+Choice. As a result, between 1999 and 2003, nearly 2.4 million seniors lost their health care coverage. That's a dangerous precedent (Karen Ignagni, 4/2). 

The New York Times' The Opinionator: An Illness, Inherited?
I spent many months, as a fetus, in a mental institution, listening to the world shuffling outside. I don't know what meds were administered to me in that developing stage. I lived in the belly of a woman I would never know. But my relationship with something dubiously entitled mental health was already established. I grew up in public care, in a series of foster placements, children's homes, adoptions, hostels; by the time I was 16 I had moved around 30 times. I had no memory of ever meeting anyone I was related to or even seeing a photograph of them. All I knew, thanks to a social worker, was that one parent had at one point been given a diagnosis of schizophrenia (Jenni Fagan, 4/2). 

USA Today: Health App Users Beware
Patients in my clinic increasingly use health apps on their mobile devices. Many of these apps track health metrics, such as weight or calories eaten, while others go a step further and help patients make sense of their symptoms or suggest diagnoses. By 2015, an estimated 500 million people worldwide will use a health app, turning the industry into a $26 billion business by 2017. Despite the promise of these apps, I'm not ready to recommend them to my patients. The sheer number of health apps is staggering, with more than 40,000 apps categorized as "health and fitness" or "medical" in Apple's app store alone (Kevin Pho, 4/2). 

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