Viewpoints: Sebelius' 'ethical line'; As tricky phase of health law approaches, concerns about exchanges opening on time

May 21 2013

The Washington Post: Kathleen Sebelius Dances On An Ethical Line
One of the biggest questions hanging over the health-care system is how many young Americans will sign up for coverage once the Affordable Care Act begins to phase in this October. If too few buy insurance on the markets that the government is creating, insurance companies would be stuck covering primarily the old and the sick. They would have to pay out more per customer. Their customers, in turn, would have to pay more to those companies for coverage. The stakes for the Health and Human Services Department, which is overseeing the transition, are tremendous. But they are not high enough to justify HHS Secretary Kathleen Sebelius dancing around serious ethical lines (5/18). 

The Washington Post: Obamacare's Tricky Next Phase
Thought you had seen the last of the fighting over the Affordable Care Act, also known as Obamacare? Since its passage in 2010, after all, it has survived Supreme Court review, innumerable challenges from House Republicans and Mitt Romney's unsuccessful campaign to evict its author from the White House. Nonetheless, with the heart of the reform set to take effect next year, its most contentious days may lie ahead (5/19).

The Wall Street Journal: Navigating The ObamaCare Maze
On Oct. 1, millions of Americans are supposed to be able to go online and acquire health insurance on electronic exchanges in the states where they live. But here is a question that is being increasingly asked by people in the insurance industry: What happens if the exchanges aren't ready on time? (John C. Goodman, 5/19).

The Washington Post: Is The Health Care Spending Slowdown For Real?
We all know that Stein's Law will someday apply to health-care spending, which has risen from 5 percent of the economy (gross domestic product) in 1960 to almost 18 percent now. What we don't know is how and when its share of the economy will stabilize. Will this result from spending controls imposed by Washington; or from delivery-system "reforms" that spontaneously cut "waste"; or from rationing, which limits spending by denying people treatment; or by some combination of these? As for when, could it be now? (Robert J. Samuelson, 5/19).

Tampa Bay Times: Paying For Benefits, Getting None
Economists like myself are accustomed to seeing politicians act in ways that don't make economic sense. That being said, the decisions many are making about health care policy are truly dumbfounding. Florida recently failed to pass a budget that included the expansion of Medicaid that is part of the Affordable Care Act (Obamacare) and will be implemented on Jan. 1, 2014. In so doing, Florida joins 24 other states that are "opting out" of expanding Medicaid. Not surprisingly, most of the South is in that group. The economic consequences of opting out are likely to be large (Alan Green, 5/19).

Austin American Statesman: A Texas Solution For The Affordable Care Act
Because the governor is hesitant to expand Medicaid, the legislature will probably adjourn without taking full advantage of the dollars available to Texas to cover the uninsured through the Affordable Care Act. Fortunately there is more than one way to skin a cat, which in this case means a way to pull down all the dollars in the affordable care act through a market solution rather than by expanding traditional Medicaid, and it can be done before the legislature meets again in 2015 (Anne Dunkelberg, 5/19).

Bloomberg: Oregon's Radical Health Overhaul Blazes New Trail
The past few years have seen two remarkable health-care experiments in the Beaver State. One is the Oregon Health Insurance Experiment, the first randomized, controlled trial comparing Medicaid -- or any kind of health insurance -- with being uninsured. The other is (Gov. John) Kitzhaber's effort to rebuild the state's Medicaid program around community health rather than individual fee-for-service treatments. The health-insurance experiment has gotten all the attention. But it's the Medicaid reforms that really matter (Ezra Klein, 5/17).

Oregonian: Getting More Doctors, Nurses Into Rural Oregon Should Win Legislature's Support
Oregonians living in rural settings can have a hard time finding adequate and prompt medical care. It's either far away, too expensive or both. Finding an available doctor or a trained nurse practitioner close to home in Grant or Tillamook counties, to name just two of more than a dozen Oregon counties rated by the U.S. government as medically underserved, could be more of a trial than the runaway fever in need of attention (5/19).

Arizona Republic: Refusing Medicaid Expansion Means Abandoning Neighbors 
But when (Timothy Leffler) lost his position at the Arizona State University School of Music because of state budget cuts, he faced dire circumstances. Leffler has type 2 diabetes. As a single adult without children, he narrowly qualified for Arizona Health Care Cost Containment System coverage just before the state froze enrollment. Soon after, he was diagnosed with severe hereditary neuropathy, which started in his feet and moved to his hands and arms. It's a very painful disease with no cure. He will need medication for the rest of his life. And he will be one of 60,000 Arizonans to lose such coverage on Dec. 31, if the state Legislature refuses Medicaid restoration (John Linder and Martha Seaman, 5/19).

Star Tribune: Minnesota Program Cuts Costs For Poor -- Compassionately
Ezekiel Allen's weary voice and his long list of medical challenges -- schizophrenia, a back injury, bipolar condition, high blood pressure, brain polyps, dental troubles, migraine headaches -- make him sound far older than his 45 years. Homeless for a number of years, Allen didn't see a doctor regularly for far too long. When the pain of his conditions became overwhelming, the Minneapolis man would get medical care from one of the costliest venues -; an emergency room (5/19). 

The New York Times: Angelina Jolie's Disclosure
Very few women fall into such a high-risk category. But for those who do, the test may be lifesaving. ... The health care reform law requires private insurers to cover genetic counseling and, if appropriate, BRCA testing, without a co-payment, in recently issued policies. ... Generally, neither private nor public insurance will cover the tests for women whose family history does not suggest increased risk, and that makes good sense (5/17).

Los Angeles Times: Health Care For Angelina Jolie -- And Everyone Else
We applaud Times columnist Robin Abcarian for shining the light on the inequities in our healthcare system in response to Angelina Jolie's recent announcement about her prophylactic mastectomy. When Jolie made her medical decision, she had at her disposal the resources to pay for the procedures and the best doctors; not everyone has the same ability. At the Cancer Legal Resource Center (CLRC), our attorneys hear from individuals who experience great difficulty undergoing the same procedures as Jolie because they fear discrimination based on the results of genetic tests, and because their insurance won't cover the care they need (Anya Prince and Jen Flory, 5/18). 

Los Angeles Times: A Birth Control Double Standard
In the uproar about making the morning-after contraceptive known as Plan B available to our daughters, there has been no similar outcry about condoms and our sons. Anyone of any age can walk into a drugstore -- as well as most grocery and big-box stores -- and buy condoms. If you want to remain anonymous, you can pay cash; no ID is required. If you're too embarrassed to face the checkout clerk, use the self-check aisle or, for $17.97, get a box of 100 -- flavored or with "added sensations," even -- delivered to your door in a plain brown box (Meg White Clayton, 5/20).

Des Moines Register: Dental Board's Actions Protect Dentists, Not The Public
Some licensing boards are obviously important to protect public safety by ensuring workers have certain minimum education and training. Yet the licensing boards, often composed largely of industry insiders, may limit competition. ... Among the most egregious examples of this: In 2009, the Legislature approved an amendment to Iowa law that ensured only dentists can provide teeth-whitening services. ... That's right. You can whiten your own teeth with a mouth tray and gel purchased at a drugstore. You can go online and buy exactly the same products dentists use in their offices. And if you lived in most other states, you could set up a business offering this cosmetic procedure to the public -- and many people have. But not in Iowa  (5/19).