KHN Morning Briefing

Summaries of health policy coverage from major news organizations

Viewpoints: Debate Rolls On About Enrollment Numbers; Ryan’s Plan ‘Squeezes Seniors’

The Washington Post: Obamacare Hits Its Target In Final Days
You can forgive a little football-spiking, even if Obamacare is far from the end zone. The White House this week announced that the number of people who enrolled in new individual health-care insurance plans under the Affordable Care Act topped 7 million and could still rise. According to figures collected by’s Charles Gaba, an additional group of around the same number found coverage from two federal health programs, Medicaid and CHIP. Several million more Americans under the age of 26 have been able to stay on their parents' plans. Not all of those people were uninsured to begin with; some had to move off old plans, and that policy shakeup hasn't always been easy. But this week's news is among the first of what we hope will be many signs that the health-care law is working toward its primary goal: enrolling many Americans into decent, comprehensive plans in sustainable marketplaces (4/3). 

The Wall Street Journal: A Catastrophe Like No Other
As I say, put aside the argument, step back and view the thing at a distance. Support it or not, you cannot look at ObamaCare and call it anything but a huge, historic mess. It is also utterly unique in the annals of American lawmaking and government administration. Its biggest proponent in Congress, the Democratic speaker of the House, literally said—blithely, mindlessly, but in a way forthcomingly—that we have to pass the bill to find out what's in it. It is a cliché to note this. But really, Nancy Pelosi's statement was a historic admission that she was fighting hard for something she herself didn't understand, but she had every confidence regulators and bureaucratic interpreters would tell her in time what she'd done. This is how we make laws now (Peggy Noonan, 4/3). 

The New York Times: Rube Goldberg Survives
Holy seven million, Batman! The Affordable Care Act, a k a Obamacare, has made a stunning comeback from its shambolic start. As the March 31 deadline for 2014 coverage approached, there was a surge in applications at the "exchanges" — the special insurance marketplaces the law set up. And the original target of seven million signups, widely dismissed as unattainable, has been surpassed (Paul Krugman, 4/3). 

Los Angeles Times: A Look At How Many Obamacare Enrollees Were Uninsured: 5.4 Million
As we observed earlier this week, one of the obsessions of opponents of the Affordable Care Act is the question of how many enrollees in Obamacare health plans already had insurance. The goal is to knock down the latest enrollment numbers by suggesting that most of the 7.1 million people enrolled through the individual insurance exchanges just moved from one insurance plan to another in a waste of time and effort. The real figure probably won't be known for weeks, even months. But researchers at the Urban Institute's Health Policy Center have weighed in with their own estimate. They're figuring that the ACA has reduced the number of uninsured Americans by 5.4 million from the first quarter of 2013 through early March this year (Michael Hiltzik, 4/3). 

News@JAMA: Access To Care And Ongoing Battles Over Scope Of Practice
More than 7 million Americans have signed up for private health insurance under The Affordable Care Act (ACA), and millions more gained coverage under the ACA’s expansion of Medicaid. This is a great achievement, but will they have access to care? (Diana Mason, 4/3).

Los Angeles Times: Subject To Debate: Do The Obamacare Delays Break The Law?
No one would claim that implementation of the Affordable Care Act has been especially smooth. The technical problems of the federal enrollment website,, last October and November, were only part of it: The administration has repeatedly postponed deadlines for a raft of major mandates in the law, including requirements that employers provide health coverage for their workers and that insurers bring substandard health plans into compliance. With every delay comes a chorus from Obamacare opponents that the president is acting "illegally." The New England Journal of Medicine has now weighed in with analyses by legal experts on both sides of the issue. Their discussion should clear the air (Michael Hiltzik, 4/3). 

The New England Journal of Medicine: Obama's ACA Delays — Breaking The Law Or Making It Work?
As the Obama administration has over the past several months postponed implementation of various parts of the Affordable Care Act (ACA), the President's political opponents have charged that his decisions are "blatantly illegal" .... Indeed, even ACA supporters may wonder whether there might be something to it, given the number of missed deadlines and the fact that implementation of some provisions has been delayed more than once. How should the administration's actions be understood? (Timothy Stoltzfus Jost and Simon Lazarus, 4/2).

Bloomberg: Yes, Republicans Can Help Improve Obamacare
Why, four years after the Affordable Care Act was passed, are Republicans now offering alternatives? It may be thanks to enrollment on the new state and federal insurance exchanges, which has rooted the law more firmly into the U.S. health-care system: Now it's suddenly harder for opponents to denigrate it without suggesting what would be better. Whatever the reason, more proposals from conservatives are to be welcomed. This is not because they could be used to upend the law -- it makes no sense to start over from scratch -- but because they may contain strategies to improve on the ACA (4/3).

Bloomberg: Obamacare Lives After Dying 1,000 Deaths
It's certainly possible to continue to believe the law was a bad idea even if one has a reality-based understanding of what it actually is doing. But over and over again, leading Republican voices have chosen to use flat-out misinformation against ACA. The only thing I'd question about Ladd's analysis is that so much of the rhetoric bordering on conspiracy theory has come from the Republican-aligned media itself, not from the mass public. It's no wonder that those who get much of their news from those sources wind up believing things that just aren't so, including the idea of the law's coming demise (Jonathan Bernstein, 4/3).

Dallas Morning News: Medicaid's Cruel Realities For Hispanic Recipients
The White House recently began a Spanish-language media blitz encouraging people to sign up for the Affordable Care Act, which, for the lowest-income Americans, means Medicaid. Having a Medicaid card in your wallet is better for your health and well-being than having no coverage at all. But it's also worse for your health and well-being than just about any other form of health insurance in America. Despite its high costs, Medicaid yields low-quality health outcomes for the millions of low-income Americans who must rely on it (Robert Graboyes and Mario Villarreal, 4/1).

Springfield (Mo.) News-Leader: Failure To Expand Medicaid Costs Lives
Missouri has an opportunity to provide health coverage to low-wage working adults who earn up to $25,000 annually for a family of three. If our legislators do not act, these individuals will continue to fall into a gap and will have limited to no health coverage options. They make too much to qualify for Missouri Medicaid today and too little to qualify for the Obama health care exchange we hear about on TV and radio. Ironically, because our Medicaid eligibility levels are so low — among the lowest in the country — there is a disincentive for people to work more for fear they may lose health coverage (Charlie O’Reilly, 4/2).

On other health issues -

The Washington Post: More Work To Be Done On Mental Health In Va.
"The real work lies ahead" with reforming Virginia's mental health care system, State Sen. R. Creigh Deeds told a national audience this week. He's spot on. The General Assembly has taken some significant but still incomplete steps toward upgrading the state's system, whose serious shortcomings Deeds believes contributed to the suicide of his 24-year-old son Nov. 18 (Peter Galuszka, 4/3).

Reuters: Medicare Reform Redux: How Ryan's New Plan Squeezes Seniors
Imagine a Medicare reform plan that boosts your premiums 50 percent. If you like your doctor, you won't be able to keep her. The wealthy will subsidize healthcare for poor seniors. An Obamacare takeover of Medicare? Nope. It's the latest iteration of "premium support," the plan for Medicare unveiled this week by U.S. Representative Paul Ryan (R-Wisconsin). Ryan, who chairs the House Budget Committee, unveiled a deficit-reducing budget plan for fiscal 2015 that would give seniors vouchers to buy private insurance coverage in lieu of traditional Medicare. The plan also includes sharp cuts to Medicaid and food stamps, and repeal of the Affordable Care Act. With Democrats in control of the Senate and the White House, it has no chance of becoming law this year. But Ryan has proposed several Medicare premium support plans since 2010, so there can be no doubt this is where Republicans will take us if they gain control of Congress and the White House (Mark Miller, 4/3).

The New York Times: The Hospital-Dependent Patient 
Hospital-dependent patients are those who, a generation ago, were doomed to die. Now they are being saved. But they are not like the so-called hot spotters, a group of patients more commonly associated with frequent re-admissions who return to the hospital because of inadequate follow-up care, failure to take prescriptions correctly or difficult socioeconomic circumstances. Instead, hospital-dependent patients come back because they are so fragile, their grasp on health so tenuous, that they easily "decompensate," or deteriorate under stress, when not in the hospital. Medical advances can snatch them from the clutches of death, but not necessarily free them from dependence on near-constant high-tech monitoring and treatments (Dr. Pauline W. Chen, 4/3).

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