Viewpoints: Decoupling jobs and insurance; overblown fear: Medicaid willl take my house

Feb 14 2014

The New York Times: Work And Health Insurance: Is There An Alternative?
Three blog posts and a column should probably suffice to cover the debate over Obamacare and work incentives, but I don't want to let the topic drop without first stepping back and talking about the actual health policy disagreement here. My column and posts last week criticized what struck me as a kind of insouciance from liberals about this issue, shading into a post-work utopianism that doesn't wrestle with what, in practice, the decline of work is actually likely to mean for issues of class, mobility, and social equality. But it's also important to recognize that for many liberal writers, the controlling assumption here is not anti-work or pro-work. It's just pro-universal health care as a basic standard for a decent society, with the consequences taken as they come (Ross Douthat, 2/12).

Los Angeles Times: Today's Overblown Obamacare Fear: Will Medicaid Take My House?
The word is beginning to percolate through public discourse as the Affordable Care Act takes hold: If you're in the cohort receiving your healthcare through Medicaid, the government can seize your house later to pay for your bills. Is that really true? In technical terms and under limited circumstances, yes. But in real terms, that concern is vastly overblown, and certainly not a reason to shun the Medicaid option if it's offered to you. For the vast majority of enrollees, it won't be happening. So let's distinguish facts from fears (Michael Hiltzik, 2/12). 

The Wall Street Journal: Behind The White House's Health Law Dodges
Earlier this week, Mr. Obama demonstrated his imperial flexibility again, delaying another important provision of the Affordable Care Act. For firms with 50-99 employees, the president waived until 2016 the requirement they provide health insurance or pay a fine. Also, companies with 100 or more workers can avoid most of the law's penalties if they provide coverage to at least 75 percent of their workforce. The House Energy and Commerce Committee says this is Mr. Obama's 22nd delay or modification of his signature law (Karl Rove, 2/12).

Politico: The Whatever President
We were told that President Obama would wield his executive power this year to defy Congress. Instead, he is defying his own health care law. ... The first delay was bad enough, but the latest move is more brazen. It creates a distinction between employers with fewer and more than 100 employees that doesn't exist in the law, and delays the mandate for another year for businesses with 50-99 employees. At the same time, it changes the obligation on employers with more than 100 employees. These aren't waivers or delays, but detailed revisions at variance with the law as passed by a duly elected Congress of the United States. Last year, the Treasury Department justified the delay as "transition relief," a euphemism right up there with "shared responsibility payments," the administration's favored term for fines on employers (Rich Lowry, 2/12). 

USA Today: Healthcare.gov Is Improving: Opposing View
HealthCare.gov continues to perform well under strong demand, and it has had more than 3.4 million site visits this month alone. The traffic shows there continues to be strong demand for affordable medical coverage. Consumers are shopping, applying and enrolling online every day. This Saturday is the final day to enroll in Marketplace coverage that begins on March 1 (CMS Administrator Marilyn Tavenner, 2/12).

USA Today: Obamacare Errors Weaken Support: Our View
Nearly four years after the Affordable Care Act was signed into law, you'd think most of the kinks would have been worked out. And, of course, you'd be completely wrong. True, the website that could sign up only six customers on Oct. 1, the day it debuted, is working better. The administration said Wednesday that 1.9 million people have signed up in the federal marketplace. But vital parts of the portal still haven't even been built. One critical omission is the part that processes the appeals of people who end up with the wrong health insurance coverage or no coverage at all (2/12).

The Washington Post: The Fault Lies Not In Obamacare, But In Obama
Four months after the botched rollout of Obamacare, things are starting to look up a little for the president and his troubled program: Some three million Americans have selected a plan through the state or federal exchanges, and numbers in December were seven times that of October and November combined. And yet reviews of the Affordable Care Act in the wake of its disastrous opening days remain stubbornly negative. While much of the attention has focused on technological and bureaucratic failures, or recently the delayed requirements, the Web site's botched launch also illustrates the key weaknesses of this president's leadership style (Drew Westen, 2/12). 

New Hampshire Union Leader: Medicaid Expansion Is Bad Medicine For New Hampshire
The recently announced deal in the New Hampshire Senate of a "framework" to expand Medicaid is a bad deal for our state's future. The fundamental problem is not just that the plan implements a key component of Obamacare here, but it continues to build on a profoundly flawed Medicaid program desperately in need of reform (John Stephen, 2/12). 

The New England Journal of Medicine: Beyond Repeal -- A Republican Proposal For Health Care Reform
By voting repeatedly to repeal the Affordable Care Act (ACA) over the past 4 years, Republicans have risked being identified as a party without a positive health policy agenda. On January 27, 2014, however, three Republican senators -- Orrin Hatch (UT), Tom Coburn (OK), and Richard Burr (NC) -- unveiled a proposal that would not only repeal the ACA, but also replace it with comprehensive legislation based on Republican health policy principles. ... Senators Hatch, Coburn, and Burr are to be commended, however, for moving beyond simply demanding repeal and putting out a proposal, the effects of which can now be debated (Timothy Stoltzfus Jost, 2/12).

The New England Journal of Medicine: PCORI At 3 Years -; Progress, Lessons, And Plans
[The Patient-Centered Outcomes Research Institute (PCORI)] board of governors has adopted three strategic goals to meet its mandate under the Affordable Care Act. These goals are to increase the quantity, quality, and timeliness of usable, trustworthy comparative research information; to accelerate the implementation and use of research evidence; and to exert influence on research funded by others to make it more patient-centered and useful. ... Over the next 3 years, PCORI will commit as much as $1.5 billion to research projects (Dr. Joseph V. Selby and Steven H. Lipstein, 2/12). 

And on other issues --

The New York Times: We Need Proof On Marijuana
Dozens of other anecdotes of miraculous responses to marijuana treatments in children with severe epilepsy are rife on Facebook and other social media, and these reports have aroused outsize hopes and urgent demands. Based on such reports, patients and parents are finding official and backdoor ways to give marijuana to their children. But scientific studies have yet to bear out the hopes of these desperate families. The truth is we lack evidence not only for the efficacy of marijuana, but also for its safety. This concern is especially relevant in children, for whom there is good evidence that marijuana use can increase the risk of serious psychiatric disorders and long-term cognitive problems (Drs. Orrin Devinsky and Daniel Friedman, 2/12).

Los Angeles Times: A No-Drama Debt-Limit Vote By The House GOP
Many House Republicans voted against raising the debt limit in the apparent hope that the public won't hold them accountable for the continuing deficits. If they're really serious about the growing debt, though, they'll get working on bills to solve the main source of the government's long-term fiscal problems: the rising cost of healthcare entitlements, such as Medicare and Medicaid. So far, they've addressed those issues only with rhetoric, not legislation (2/12). 

The Washington Post: The Global AIDS Response Can Help In Fighting Hepatitis C
A decade after the global AIDS response began in earnest, it's worth asking whether the lessons learned will be sustained over time and used to avoid past mistakes when tackling new challenges. One such challenge is chronic hepatitis C infection, which afflicts an estimated 170 million people worldwide. Since its discovery 25 years ago, hepatitis C has become the leading indication for liver transplant in the United States and a common cause of liver failure around the world. For some, however, it is about to become eminently curable (Dr. Paul Farmer, 2/12). 

The Wall Street Journal: Why 'Metrics' Overload Is Bad Medicine
"Quality" has been the buzzword in health care for a decade, but the worthy goal is driving health-care providers to distraction. All stakeholders -- insurers, patients, hospital administrators and government watchdogs -- are demanding metrics to ensure that money is spent wisely. ... Primary-care providers like me are bearing the brunt of these often misguided efforts. As front-line providers responsible for a patient's health, we have had every aspect of our professional lives invaded by the quality police (Dr. Victoria McEvoy, 2/12). 

Bloomberg: Too Many Mammograms
A 25-year study of 90,000 women has found that mammograms do nothing to lower the death rate from breast cancer. That's pretty strong evidence, to say the least. And it's only the latest from many studies over the last several years indicating that mammography often doesn't help prevent advanced cancer. Yet women -- and, even more crucially, their doctors -- remain unwilling to give up annual mammograms (2/12).

The New England Journal of Medicine: "Misfearing" -- Culture, Identity, And Our Perceptions Of Health Risks
During my cardiology fellowship, I worked at a women's cardiovascular clinic where we asked every new patient the same question: "What do you think is the number-one killer of women?" ... Ms. S., a middle-aged woman with high blood pressure and hyperlipidemia, answered in a way that sticks with me: "I know the right answer is heart disease," she said, eyeing me as if facing an irresistible temptation, "but I'm still going to say 'breast cancer.'" If helping women understand their cardiovascular risk were about right answers, I would simply have reiterated the facts about heart disease. ...  Her sense of risk was clearly less about fact than about feeling. Would more facts really address those feelings? (Dr. Lisa Rosenbaum, 2/13).