Viewpoints: Obama's budget punts on entitlements; Medicaid debate rankles states

Mar 6 2014

The Washington Post: Obama Budget Avoids Needed Entitlement And Tax Reform
There is a lesson in this unexpected juxtaposition nevertheless: No nation can safely base its tax and spending plans on inflexible commitments. Political life, both domestic and international, is too unpredictable. Yet U.S. government spending is mostly on autopilot. The government is scheduled to lay out $3.8 trillion this fiscal year -; 70 percent of which will go to mandatory-spending programs, chiefly Social Security, Medicare, Medicaid and interest on the federal debt. Mr. Obama's plan for fiscal 2015 does not change this; it would increase overall spending slightly, paying for it with selected tax increases, while shifting money among priorities here and there. But these tweaks would take place within the same 30 percent of discretionary spending that the current budget contains (3/4).

The Washington Post: A Budget Without Vision
Gone was the proposal from a previous Obama budget to restrain the growth of Social Security costs. Missing was any major proposal to fix the huge long-term deficits in Medicare. Included: $1 trillion in tax increases on business and the wealthy over 10 years, and a wish list of government initiatives, with names such as "Opportunity, Growth, and Security Initiative," "ConnectEDucatos" and "Climate Resilience Fund" (Dana Milbank, 3/4).

In commentary on the Medicaid expansion debates in the states-

Bangor Daily News: LePage's Medicaid Expansion Rhetoric Is Straight Out Of '1984'
The Maine Department of Health and Human Services is apparently employing the concept of doublethink as it continues its attack against Medicaid expansion, resorting to distortion of facts to serve an ideological purpose. On Friday, the department, which has staunchly opposed expansion under Gov. Paul LePage, questioned the preliminary analysis of the nonpartisan Office of Fiscal and Program Review, which found expanding Maine's health insurance program to 70,000 low-income people would cost the state $ 683,520 over three years (3/4).

Foster's Daily Democrat: Why I Will Always Fight For Life-Saving Health Care
I have championed legislation, LD 1578, to help 70,000 Mainers, including nearly 3,000 veterans, get health care. ... In recent weeks, opponents of our compromise proposal have resorted to desperate attacks on my ethics, alleging that I will see personal financial gain from more Mainers getting health care because I work for a behavioral health organization when the Legislature is not in session. ... As Speaker of the Maine House, I urge lawmakers to debate the merits of the issues not launch desperate or unfounded personal attacks on your opponent's ethics. We see enough of that in Washington (Speaker of the Maine House Mark Eves, 3/4).

Portland Press Herald: Changes To Plan Don't Redeem MaineCare Expansion's Flaws, Republican Legislator Says
I don't blame many people for thinking that expanding Medicaid in Maine under Obamacare sounds like a great idea at first glance. Free money from the federal government? More people covered by free health insurance? Where do we sign up? However, when you examine the fine print, as well as Maine's past experiences with welfare expansion, you quickly begin to have second thoughts. Medicaid expansion entails putting 70,000 or more able-bodied adults on medical welfare at a massive cost to the state (Republican Rep. Deborah Sanderson, 3/3).

Bangor Daily News: Help Us Serve Low-Income Patients In Maine By Expanding Medicaid
Recently, as leaders from the federally qualified health centers of Washington County, we spent a day in the Hall of Flags at the State House in Augusta to showcase the resources, initiatives and services we provide to our communities. ... we stressed how an additional $300 million in federal funds to the state of Maine would ease the hard times for many people. With those funds, Maine will provide health care service to an additional 70,000 people while thoughtfully looking at ways to reduce costs. ... Sadly, Maine is one of 25 states that have not chosen to accept the federal funds, and it's hurting poor parents and other adults who otherwise remain ineligible (Lee Umphrey and Holly Gartmayer-DeYoung, 3/4). 

Miami Herald: Lawmakers Would Be Negligent In Declining Federal Help
It's this simple: The Florida Legislature cannot afford to decline federal dollars for healthcare. A state with an estimated 3.3 million uninsured -; even in a post-Affordable Care Act world -; can't continue to play political games and forgo $51.3 billion in federal funds (Fabiola Santiago, 3/4).

Roanoke Times: Make Health Care A Priority In Va.
Under full Medicaid expansion, or even the Republican Senate compromise I spoke in favor of on the House floor, we will shift the overwhelming majority of indigent care costs away from the commonwealth. This would save Virginia $1.1 billion. Some Virginia legislators would rather mask the issue by funding our health care priorities through cuts in core government functions such as education, law enforcement and economic development. However, the expansion of health care to all Virginians is the fiscally responsible option for the commonwealth. Not making health care coverage available to everyone hurts society in many ways, as we inevitably pay for all health care costs in one way or another (Democratic State Del. Sam Rasoul, 3/5).

And on other health issues-

The New York Times: Some Progress On Eating And Health
For those concerned about eating and health, the glass was more than half full last week; some activists were actually exuberant. First, there was evidence that obesity rates among pre-school children had fallen significantly. Then Michelle Obama announced plans to further reduce junk food marketing in public schools. Finally, she unveiled the Food and Drug Administration's proposed revision of the nutrition label that appears on (literally, incredibly) something like 700,000 packaged foods (many of which only pretend to be foods); the new label will include a line for "added sugars" and makes other important changes, too (Mark Bittman, 3/4).

Los Angeles Times: Fecal Transplants: A Therapy Whose Time Has Come
Clostridium difficile is a dangerous infection that, as its name implies, is not always easy to treat successfully with antibiotics. In many cases, the infection is actually triggered by antibiotic use during hospitalization; the medications kill beneficial bacteria that keep C. difficile in check. Now, some doctors are treating the infection with a procedure called fecal transplant, an unappealing but extremely effective approach that involves transferring filtered stool from a healthy donor to a patient afflicted with the disease, to reintroduce the helpful gut bacteria (3/5).

JAMA Internal Medicine: Comparing Diabetes Medications: Where Do We Set the Bar?
More than 25 million Americans have type 2 diabetes mellitus and face decisions about which medications to use to lower glucose levels. These decisions are increasingly complex (now involving 12 different classes of glucose-lowering agents) and increasingly costly (resulting in over $18 billion in annual expenditures). Yet, despite the enormous health and economic implications of these decisions, there are few comparative effectiveness outcomes studies to guide clinical practice (Drs. Kasia J. Lipska and Harlan M. Krumholz, 3/3).

JAMA Neurology: Medicare Coverage of Investigational Devices: The Troubled Path Forward For Deep Brain Stimulation
Medicare coverage plays an important role in innovative device-based therapy in a market with increasing medical device costs and scarce financial resources. In January 2014, the Centers for Medicare and Medicaid Services (CMS) implemented changes to coverage policies for items and services associated with investigational device exemption (IDE) studies.1 Medicare's changes centralize coverage decisions and establish 10 new ethical and scientific criteria for coverage determination. Despite revision, current policies risk curbing the advancement of an innovative treatment known as deep brain stimulation (DBS) (P. Justin Rossi, Dr. Andre Machado and Dr. Michael S. Okun, 3/3).