KHN Morning Briefing

Summaries of health policy coverage from major news organizations

Viewpoints: A ‘Misguided’ Debate; Trying To Figure Out Who’s Uninsured; The Safety Net For The Middle Class

The Washington Post: Obamacare Has Spawned A Misguided Debate
Supporters of Obamacare are celebrating that the law is not an unmitigated disaster, just a mitigated one. As enrollment closed (for most) on March 31, the system passed 7 million exchange sign-ups. What some are taking as a triumph of governmental competence was actually an emergency rescue by private-sector volunteers after a laughable failure of government to construct and run its own system. This has hardly been a confidence-builder when it comes to public faith in bureaucracy. But never mind (Michael Gerson, 4/7).

The Wall Street Journal: Off The ObamaCare Deep End
It doesn't take much for some conservatives to shout "betrayal" these days, but the latest example is especially obtuse. House GOP leaders are rushing to quell a micro-rebellion on the right for having repaired a small corner of ObamaCare's economic damage. It's going to be a long three years until there is a new President if harm reduction now constitutes health-care treason (4/7).

Bloomberg: Obamacare Isn't Failing. Now What?
Some Republicans, however, think proposing their own health-care ideas is a mistake because it distracts from the case against Obamacare. And even those who think it's important to advance alternatives are divided on a key question: How important is it that a replacement plan increase coverage? More people would have coverage under Jindal's plan than under the pre-Obamacare system. But compared to Obamacare, people would lose coverage. Does that matter? (Ramesh Ponnuru, 4/7).

Bloomberg: So Who Are The 'Uninsured,' Anyway?
Supporters of the Affordable Care Act are basically counting on its beneficiaries to make it impossible to repeal. That makes it important to know exactly how many of those beneficiaries there are. As I've written before, it's hard to know yet -- Medicaid signups will continue for the rest of the year, and while we know how many people selected a policy on the exchanges, we don't know how many of them have paid. But one number should be pretty easy to figure out: how many young people have gained insurance through their parents' policies, thanks to the Obamacare provision that allows them to stay on those policies until they are 26. And yet, that's not very easy to figure out (Megan McArdle, 4/7).

Bloomberg: It's A Fact: More People Have Health Insurance
That Gallup poll previewed in a Los Angeles Times story at the end of last month was finally published today. As expected, it finds that the percentage of Americans without insurance has plunged. As I've said before, be very careful about these polling results. This series shows the percentage of uninsured in the first quarter of 2014 at a little less than 16 percent, a drop of more than 1.5 percentage points from the end of 2013. Yet, earlier last year, Gallup also had an unexplained spike to 18 percent. My best guess is that the 2013 spike was just noise in the polling data. This drop is larger, but I wouldn't get too attached to Gallup's exact numbers or to the size of the reduction (Jonathan Bernstein, 4/7).

The New Republic: Another Day, Another Sign That Obamacare Is Working
These tracking surveys on the uninsured are far from precise. Among other things, people answering these surveys aren't always sure of their own insurance status. Nobody should treat them as gospel. But Gallup also found the most dramatic change in insurance status among low-income and minority populations, which would be consistent with implementation of a law that has its most dramatic impact on people with the least money. It's also consistent with three other pieces of information (Jonathan Cohn, 4/7).

Bloomberg: Obamacare Needs To Start Clipping Drug Coupons
Unlike coupons for, say, breakfast cereal, coupons for pricey drugs are a bit of a racket. It works like this: Your doctor says you need a drug to, say, treat your depression. Perhaps you've heard about a particular brand-name antidepressant and ask for it; your doctor says a generic version has just been approved but agrees to prescribe the brand you want. ... Your doctor, however, isn't paying the cost of the drug; your insurance company is. Insurers could simply refuse to cover brand-name drugs, but then who would buy their policies? Instead, companies discourage higher-priced medicines by charging you a higher copayment. Drugmakers know this, and they offer some patients coupons offsetting that copayment. You stick with the brand-name drug; the drugmaker gets more revenue; and your insurance company is hit with a much higher cost (4/7).

The Hill: Facts Show Faults Of Health Law
Now, in a breathtakingly deceptive declaration, the administration is touting the fact that with approximately 7 million people supposedly signed up, ObamaCare is a success. Of course, this entirely glosses over the millions of people who are in healthcare limbo as they try to figure out what their coverage is, who will provide it and at what cost. Most important, it is now rather obvious that ObamaCare is not going to insure a very large share of the previously-uninsured population. The defects of the law do not begin and end with the taking away of insurance plans from people who were previously happy with those plans. ObamaCare will also cost an extraordinary amount of money because of the new federal subsidies and mandates both in the exchanges and in the states' Medicaid programs (Judd Gregg, 4/7).

Denver Post: Obamacare Not Helping Mountain Dwellers
While many of us still think the Affordable Care Act is a terrible law, it's not because of any of the unsubstantiated inanities about how it will destroy the economy and bankrupt ordinary Americans, but because it doesn't go far enough in terms of truly socializing medicine and holding down costs like we see in Canada, Japan and England. In the mountains, we face another problem with the new health-care system: premiums under Obamacare that are hundreds of dollars more than the rest of the state (Steve Lipsher, 4/7).

Fox News: ObamaCare Is Destroying My Medical Practice
The Obama administration has been boasting about its great enrollment numbers for ObamaCare, claiming that 7.1 million people have signed up for plans through the new insurance marketplaces. But, in reality, medicine has gotten harder and harder to practice since ObamaCare became the law of the land. As a doctor who treats many patients on a daily basis, I’ve seen firsthand how difficult it can be to maneuver the new health care landscape and get patients the help they need (Dr. Manny Alvarez, 4/7).

Journal of the American Medical Association: The Changing Landscape Of Medicaid
The opportunity for each state to create an exchange was seen as a form of "conservative means to liberal ends," allowing the country to move closer to universal coverage through a state-level market-based mechanism favored by conservative policy experts. Similarly, many commentators and scholars suggested that the Medicaid expansion would be so beneficial that every state would ultimately comply. ... Yet by January 2014 only 15 states and the District of Columbia had chosen to fully comply with the ACA by creating a state-based exchange and expanding Medicaid, whereas 23 states took neither of these steps. ... These decisions have followed partisan patterns (David K. Jones, Phillip M. Singer and Dr. John Z. Ayanian, 4/6).

On other health issues -

The Washington Post: The Safety Net Catches The Middle Class More Than The Poor
Liberals are shocked (shocked!) that Rep. Paul Ryan (R-Wis.) and his co-partisans would consider cutting Medicaid, food stamps, Pell grants and other programs that serve the neediest Americans. They have accused Ryan of trying to balance the budget on the backs of the poor. But long before Ryan unveiled his "Path to Prosperity," politicians of both parties had been redistributing government spending away from the truly destitute and toward everyone else (Catherine Rampell, 4/7).

Modern Healthcare: Time For A New Test On Hospitals' Tax Exemptions
As of last year, not-for-profit hospitals are required under the Patient Protection and Affordable Care Act to meet new tax-exemption reporting requirements on their policies and practices in four areas: community health needs assessment; patient financial assistance; billing and collections; and emergency-care pricing. Unfortunately, this is the wrong way for tax-exempt hospitals to demonstrate their performance in providing special benefits to their communities. First, these four areas are far from the only important community-benefit considerations for a hospital's board and management. ... Second, and more important, the current reporting requirements represent a form of micromanagement by the federal government, focusing on process rather than results (Bruce McPherson, 4/5).

Georgia Health News: The Personal Side: Looking Into Getting Older
While recently sharing a seafood dinner, three of my old high school friends and I also shared an inventory of our medical conditions. "Old" is a relative term. We’re in our early 60s. And our annual reunion is a golf vacation in Florida, so we’re mobile enough to get around the links (and send too many Titleists splashing into lagoons). After some initial chitchat, our dinner conversation eventually got around to health (Andy Miller, 4/7).

WBUR: Project Louise: Music Makes The Heart Beat Faster
So it turns out this kid thing really works. I did not do great workouts on all three days that I promised to exercise, but I did get myself moving. Even better, having made this promise caused me to think about taking care of myself for my kids’ sake every single day. Being here for my children turns out to be a really great motivator. And – who knew? – my kids are helping with Project Louise in other ways, too. The 5-year-old got me running around outside on Sunday; it didn’t even feel like a workout, but it was. (That’s my new goal: workouts that feel more like "playouts.") And the 16-year-old has given me another boost: music to listen to while I walk or bike (Louise Kennedy, 4/7).

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