Viewpoints: Rethinking what health insurance should cover; Sen. Johnson suing over congressional health plan; Medicaid's unsung success

Jan 7 2014

Los Angeles Times: It's Time To Rethink Health Insurance
The proper role of health insurance should be to finance necessary and expensive medical services without the patient incurring devastating financial consequences. Over the last decade, however, Americans have come to expect their health insurance to subsidize the consumption of all medical care. ... This shift in expectation has meant that health insurance stands out as entirely different from all other types of insurance. Ask yourself: Would you use automobile insurance to buy gasoline? Would you use homeowner insurance to finance painting your house? This wrongheaded view has played an important role in contributing to rapidly rising health care costs (George P. Shultz, Scott W. Atlas and John F. Cogan, 1/5).

Los Angeles Times: The Quasi-Final 2013 Tally For The ACA: More Than 9 Million Insured
Enrollment figures for insurance under the Affordable Care Act are all over the place, largely because the act has so many moving parts: the individual insurance exchanges (federal and state), Medicaid (in expansion states and otherwise), children enrolled in their parents' employer-sponsored plans. Keeping track of the numbers requires an obsession. So be thankful that one Charles Gaba has taken on the responsibility. Gaba's conclusion is that the ACA has brought insurance in one form or another to more than 9 million Americans, possibly 9.5 million (Michael Hiltzik, 1/3). 

The Wall Street Journal: Obamacare Is Redistribution, Not Reform
Every piece in Obamacare is being postponed or rewritten. The individual mandate is becoming a comatose letter if not a dead one. In the latest doomed innovation from the White House, insurers are being sandbagged by a new requirement to sell to older, sicker customers policies designed and priced for a healthier, under-30 crowd. Obamacare's authors are being mugged by reality in real time, before our eyes. This is the most propitious development for health care reform in decades (Holman W. Jenkins, Jr., 1/3).

The New York Times: An Error Message For The Poor 
More than two million people have signed up for health insurance coverage under the Affordable Care Act, a tribute to the effectiveness of the "tech surge" the Obama administration deployed to overcome the highly publicized problems with healthcare.gov that emerged in October. ... Sadly, food stamp and Medicaid recipients can only look on in envy. ... students of anti-poverty programs remember a litany of automation and contracting meltdowns -- some of them prolonged, even epic. ... [A]ttention, oversight and willingness to act decisively to remedy fiascoes seem to depend on the wealth and clout of those who are affected (David A. Super, 1/3).

The Wall Street Journal: I'm Suing Over Obamacare Exemptions For Congress
On Monday, Jan. 6, I am filing suit in the U.S. District Court for the Eastern District of Wisconsin to make Congress live by the letter of the health care law it imposed on the rest of America. By arranging for me and other members of Congress and their staffs to receive benefits intentionally ruled out by the Patient Protection and Affordable Care Act, the administration has exceeded its legal authority (Sen. Ron Johnson, R-Wis., 1/5). 

The Wall Street Journal: Little Sisters Of The Government
[The Little Sisters of the Poor] belong to a special type of insurance collective known as a church plan, also run by a Christian order. This plan will itself also qualify for the accommodation, in the same way as a Christian soup kitchen.The Administration never envisioned that a religiously affiliated organization would contract with a religiously affiliated insurer, probably because there are so few church plans. ... This case is simply a raw assertion of state power directing the religious to follow orders (1/3).

Bloomberg: How Obama Can Get His Groove Back
Even with no real scandal and only one demonstrable policy blunder, the health-care rollout, President Barack Obama had a miserable 2013 as his public standing plummeted. History suggests it is tough for a second-term president to rebound. ... The president and Democrats are paying a huge price for the dreadful rollout of the Affordable Care Act and HealthCare.gov. The goal of 7 million enrollees by April 1 is beyond reach. There must, however, be a substantial number -- say 5 million, with a quarter of those young people -- to keep the support of the insurance industry and prevent an explosion in premiums. Obama had to enlist an expert to fix the website. The critical question in 2014 will be whether a chief executive is tapped to run the entire program (Albert R. Hunt, 1/5).

Bloomberg: Let's Celebrate Medicaid's Success
But the fact remains that Medicaid enrolled well over twice as many people as signed up for private insurance through the exchanges. It's "the biggest ACA success story that has not yet been told," says Ron Pollack, head of Families USA, a nonpartisan health-care advocacy group (Ezra Klein, 1/3).

New Hampshire Union Leader: Expand Medicaid? Why Would NH Do That?
Medicaid is a boondoggle. There are far better ways to insure low-income people than by enrolling them in Medicaid. The one and only reason the left so passionately advocates expansion is to sweep more people into government-provided health insurance. People who are more dependent upon the government are therefore more dependent upon the party of government -- the Democrats. This is what Medicaid expansion is all about (1/4).

New Hampshire Union Leader: A 2014 Agenda For New Hampshire
Without question, the single most important thing we must accomplish as soon as possible is expanding access to health care to 58,000 men, women and children across our state. ... With nearly all of the northeastern states engaging in Medicaid expansion, we put our state at a competitive disadvantage (and a loss of $500,000 per day) by refusing to participate in the program. On Wednesday, one of our first orders of business will be to amend a related retained bill to include Medicaid expansion (New Hampshire House Speaker Terie Norelli, 1/4).  

Health Policy Solutions (a Colo. news service): Driving Into Obamacare's Future Using The Rear-View Mirror
I view the website rollout and the paucity of recent enrollments with a jaundiced eye. After all, it took Amazon, Google, Facebook and Twitter five years before they got their mojo. Obamacare, in the end, has the penalties and subsidies to drive demand. By 2017, enrollment will meet expectations and the wrinkles will be ironed out of the system. The insurance companies and federal government will use their deep pockets to make it happen. The news media have temporarily found a perverse form of currency in the problems. While advertisers like the attention of all the eyeballs and ears, the talking heads have missed the big picture (Francis Miller, 1/3).

And on other issues --

The New York Times' Opinionator: Can Upward Mobility Cost You Your Health?
Even in an age of soaring inequality, we like to think that people can still make it big here if they work hard and stay out of trouble. The socioeconomic reality of most of the last four decades -- stagnant wages, soaring income and wealth inequality, and reduced equality of opportunity -- have dented, but not destroyed, the appeal of the American dream. Those who do climb the ladder, against the odds, often pay a little-known price: Success at school and in the workplace can exact a toll on the body that may have long-term repercussions for health (Gregory E. Miller, Edith Chen and Gene H. Brody, 1/4).

CNN: Is Lung Cancer Screening Right For You
This week, the U.S. Preventive Service Task Force issued its long-awaited guideline on lung cancer screening. They recommend annual screening for lung cancer with low-dose computed tomography (CT) in adults ages 55 to 80 who are at high risk for lung cancer ... The Affordable Care Act mandates that health insurance cover screenings the task force deems useful. ... Many health care centers will have to work to ensure they have the appropriate equipment and skills to provide screening. Just as with the introduction of mammography for breast cancer screening, it may take years for these skills to be available throughout the country (Dr. Otis Brawley, 1/3).

The Boston Globe: Boston Must Rein In Retiree Health Plans
While the problems of Detroit have highlighted the large deficits in municipal pension plans, less attention has been given to the even larger unfunded obligations of cities to pay the health care benefits of their retired employees -- called retiree health care plans, or RH plans. Most recently, in 2011 Boston reported an unfunded deficit of $3 billion for its RH plan (Robert Pozen, 1/5).  

WBUR: A Phrase To Renounce For 2014: 'The Mentally Ill'
I wince every time I read it. So does the president-elect of the American Psychiatric Association, Dr. Paul Summergrad, he says. I saw it most recently in The New York Times, in the headline pictured above and a recent masthead editorial: "Equal Coverage For The Mentally Ill." It's all over, from The Boston Globe -- "New Era for the Mentally Ill" -- to The Wall Street Journal -- "Crime and The Mentally Ill." Just about any media outlet you care to name. What's so bad about "the mentally ill"? Isn't it reasonable shorthand in the usual headline space crunch? (Carey Goldberg, 1/3).