Viewpoints: 'Reasonable' debate about health law's 'rate shock; 'absurdity' of Sebelius' account of fund raising; Obama killed the grand bargain

Jun 7 2013

The New Republic: Un-Rigging The Rate-Shock Debate
Many of us have been wondering whether it's possible to have an honest, reasonable debate about Obamacare. To my pleasant surprise, one may finally be starting. It's about the same subject that got me all worked up early this week: Whether Obamacare will cause "rate shock" among people buying insurance coverage on their own, through the new insurance exchanges. And if you pay attention to the right people, you'll discern a basic consensus about the facts. The consensus goes like this: Some people buying coverage on the exchanges will pay more for insurance than they do today. Some people will pay less. The benefits will be better and the policies will be more widely available, but those changes require their own trade-offs, like forcing some people to get more coverage than they want. The insurance offerings from California-;the announcement that set off this debate-;were better than most of us were expecting. But the numbers in other states could look a lot worse (Jonathan Cohen, 6/5). 

The Washington Post's The Plum Line: Obamacare And Collective Action
There's been a big debate going on over the last two weeks about the Affordable Care Act and "young healthies" -; people who don't really need much health insurance, and who (conservatives have discovered) may pay more when the ACA fully kicks in. As Jonathan Cohn and Sarah Kliff point out in detail, the point is severely overstated, because Obamacare won't just tend to raise premiums for those who don't use much insurance, but also gives subsidies for lots of people, so that the overall outcome for many is actually better than the old status quo (Jonathan Bernstein, 6/5).

The New York Times: The Split Between The States
Wisconsin and Minnesota are neighboring states with long traditions of caring for the least fortunate, but, at the moment, only one of them is concerned about the health of the poor and uninsured (6/5).

Los Angeles Times: Divvying Up California Healthcare Funds
The 2010 federal healthcare law will make health coverage available to millions of the uninsured, but it won't reach all of them. In California, county health officials and the Brown administration are now tussling over how much to spend on the remaining uninsured, and on county health programs in general. Gov. Jerry Brown wants to reclaim some of the state tax dollars that counties have been spending because there will be fewer uninsured to care for, and that's not unreasonable. But the state should be careful not to undermine the counties' efforts to protect public health, nor should it deny them the ability to care for more people in a more cost-effective way, if they choose (6/6).

Virginia Pilot: Expand Medicaid, Save Money, Lives
Virginia lawmakers established a commission this year to determine whether to expand Medicaid, a move that allowed General Assembly Republicans and Gov. Bob McDonnell to defer a decision until federal officials accept a series of cost-cutting reforms. The strategy is just as misguided as outright refusal. Virginia, previous analyses have shown, would get back nearly all of the tax dollars its residents pay over the next several years if the commonwealth expands Medicaid (6/6).

Sacramento Bee: Should State Close 'Loophole' In Health Care Law? Yes
Unfortunately, a small number of large corporations are skirting their responsibility to provide health care or pay a penalty by cutting hours and wages so low that workers end up on taxpayer-funded Medi-Cal. Why Medi-Cal? Because on Medi-Cal there is currently no penalty or cost to the employers. Due to this loophole in the ACA, these big companies can avoid paying their fair share, and taxpayers pick up the tab instead. This loophole will have devastating consequences on the state budget if it is not closed (Jimmy Gomez, 6/6). 

Sacramento Bee: Should State Close 'Loophole' In Health Care Law? No
While sponsors of Assembly Bill 880 suggest it would affect only a few large and profitable companies, the facts are quite different. This legislation would have a broad and devastating impact on organizations in nearly every industry in this state, including nonprofits such as the Community College Foundation. The Community College Foundation serves at-risk youths to improve communities through education. We can employ more than 500 tutors to work with thousands of K-12 youths who are one to three grade levels behind. ... Most of our good work for those most at risk could screech to a halt if AB 880 passes (Rick Fowler, 6/6).

Bloomberg: Sebelius' Absurd Excuses On Obamacare Fundraising
Kathleen Sebelius, secretary of the Department of Health and Human Services, told a House committee yesterday that she did nothing wrong by suggesting to companies she regulates that they support a group publicizing the Affordable Care Act. Let's consider the absurdity of that position by looking at the arguments behind it (Christopher Flavelle, 6/5).

National Review: How Obama Killed The Grand Bargain
Prospects for a "grand bargain" on the budget finally seem dead, and, we're told, the reason is the improved budget outlook. While it is certainly true that the Congressional Budget Office's latest projections of federal deficits over the coming decade are less dismal than they were previously, that's not the main reason Washington has lost interest in a bipartisan compromise on the budget. The chances of such a compromise have been low all year, and are due to the tactical choices made by the one person with the most to gain from a deal -; the president (James C. Capretta, 6/6).

Los Angeles Times: Get Rid Of Those Outdated HIV Laws
A bipartisan bill introduced in the House calls for a review of state laws that criminalize behavior by people with HIV, including many laws that seem anachronistic or inappropriate given what has been learned during the last three decades about the transmission and treatment of the virus that causes AIDS. The bill should be passed (6/6).

Roll Call: Cancer Patients Are Being Left Behind
Just when we all thought Congress was gridlocked beyond hope, it successfully pushed through a legislative change that would improve the daily lives of millions of Americans. It didn't improve funding for poor children whose programs had been cut by the federal sequester, and it didn't work to make changes that would safeguard public health or safety initiatives. Working together and reaching across the aisle, the members quickly and decisively made changes that ensured their flights to and from Washington, D.C., would not be delayed as a result of cuts from the sequester. If only cancer patients could be so fortunate (Nancy Davenport-Ennis, 6/5).

The New England Journal of Medicine: In Support of SUPPORT -; A View From The NIH
The Surfactant, Positive Pressure, and Oxygenation Randomized Trial (SUPPORT), carried out at more than 20 sites between 2004 and 2009, sought to identify, in infants born very prematurely at 24 to 27 weeks' gestation, the oxygen-saturation level within the range considered the standard of care that would minimize the risk of retinopathy of prematurity (ROP), a complication of oxygen therapy that can result in vision loss. ... The circumstances surrounding the SUPPORT study have unquestionably created controversy in the research community, but the situation has created an opportunity for a better understanding of the scientific and ethical issues that must be addressed when designing such studies in the future (Kathy L. Hudson, Drs. Alan E. Guttmacher and Francis S. Collins, 6/5).

The New England Journal of Medicine: How AIDS Invented Global Health
[T]he progress made in addressing this pandemic and its effects on science, medicine, and public health have been far-reaching. The changes wrought by HIV have not only affected the course of the epidemic: they have had powerful effects on research and science, clinical practices, and broader policy. AIDS has reshaped conventional wisdoms in public health, research practice, cultural attitudes, and social behaviors. Most notably, the AIDS epidemic has provided the foundation for a revolution that upended traditional approaches to "international health," replacing them with innovative global approaches to disease (Allan Brandt, 6/5).