Viewpoints: Battle for Medicaid; GOP's report on enrollment off base; need for kidney donations

May 6 2014

Los Angeles Times: Medicaid Expansion Is The Final Battle In War Over Obamacare
The final battle of the war over the Affordable Care Act is being waged today over expanding Medicaid. ... The refusal of more than half the states to cover so many of their neediest citizens -; the number who have fallen into the "coverage gap" is estimated at 5 million -; amazes and frustrates health experts. That's especially so because the federal government covers 100% of the cost of expansion through 2016. After that, the federal share will slowly decline to 90% in 2020 and beyond (Michael Hiltzik, 5/4).

The Wall Street Journal: Standing To Sue Obama
The legal left and media are always last to know, but there are the makings of a correction in how the courts police conflicts between the political branches. President Obama's serial executive power abuses-;on health care, immigration, marijuana and much else-;may be inspiring a healthy rejoinder. Under the Constitution, Congress is supposed to create and amend laws and the President to faithfully execute them, but Mr. Obama has grabbed inherent Article I powers by suspending or rewriting statutes he opposes. The President has usurped Congress with impunity because he assumes no one has the legal standing to challenge him (5/4). 

The Wall Street Journal: What People Don't Realize About The Affordable Care Act
The Affordable Care Act enrollment numbers released this week illustrate how much more complex the health-care law is than the political debate about it. Many in politics view the ACA through a left or right perspective that sees it only as good or bad. But consider that the law is engineered for variation; it is the exact opposite of a Starbucks or McDonald's, where you get the same product no matter where you live or what your income is (Drew Altman, 5/2).

The New York Times: Inventing A Failure
Last week, House Republicans released a deliberately misleading report on the status of health reform, crudely rigging the numbers to sustain the illusion of failure in the face of unexpected success. Are you shocked? You aren't, but you should be. Mainstream politicians didn't always try to advance their agenda through lies, damned lies and -; in this case -; bogus statistics. And the fact that this has become standard operating procedure for a major party bodes ill for America's future (Paul Krugman, 5/4).

The Dallas Morning News: How Has The Massachusetts Health Insurance Law Worked Out?
At Boston Medical Center, the emergency room sees more than 356 of the poorest and most disadvantaged on an average day. Many don't need to be here. They now have Medicaid or health insurance, and their pains, flu and stomach upsets could easily be tended at a doctor's office or outpatient clinic -; and at far less cost. "We're still seeing a very high volume," said Dr. Andy Ulrich, vice chairman of the emergency department. "You can't go to your primary care doctor at 8 p.m. or when you get off work." Eight years ago, as Massachusetts enacted the nation's first sweeping health insurance law, legislators expected newly insured patients to stop using the emergency room as their gateway to medical help. That did not happen. Massachusetts now has the nation's lowest rate of uninsured -; 3.1 percent -; and the most expensive health care (Jim Landers, 5/3).

Richmond Times-Dispatch: Beg, Borrow & Steal
The latest twist in the long-running debate over Medicaid expansion in Virginia concerns debt. Republicans say expansion "relies on borrowed federal money." Democrats call that rubbish. After all, they say, Medicaid expansion is part of Obamacare, and Virginians are paying Obamacare taxes, so expansion is paid for. Besides, when you borrow money you have to pay it back, and it's not as if Washington is going to send Virginia a bill. That's cute -; but wrong. In fact, it's wrong in every conceivable way (5/4).

San Jose Mercury News: Impoverished Thinking About Health Care And Poverty
Two weeks ago, my friend finally saw a doctor for diagnosis and treatment of her fever and shortness of breath. Concerned she had pneumonia, I'd been prodding her for days to seek medical attention. But she was uninsured, impoverished and unwilling to accept my help. She instead planned to "hold out" until obtaining health insurance through her state's insurance exchange program that operated in concert with the Affordable Care Act. Although given no guarantee that her application was accepted, she expected to receive coverage by May. Unfortunately, her illness didn't wait that long (Dr. Kate Scannell, 5/2).

Health News Colorado: Survival Skills Needed For Health Care Exchanges When Money Runs Out
We are now at a crossroads in the implementation of Obamacare. The exchange can either continue to promote a fantasy version of what recently happened or it can double down and make real, substantive changes. The recently published feel-good statistics suggest the focus is on pay raises and bonuses for the staff. If the legislative oversight committee and the board buy it lock, stock and barrel, little change will be forthcoming (Francis M. Miller, 5/2). 

On other health issues -

The New York Times: Why People Don't Donate Their Kidneys
The national transplant list just passed a morbid milestone: More than 100,000 people now wait for kidneys. We are at this point largely because even though demand is growing, donations from living and deceased donors have remained flat, between 16,500 and 17,000 annually, for the past decade. ... The problem lies in the requirement that all organs be given altruistically (as a friend did for me in donating her right kidney eight years ago). Federal law is widely interpreted as forbidding donors to receive anything of tangible value in return for their lifesaving deeds (Sally Satel, 5/3).

Los Angeles Times: L.A.'s Jails: Where Not To Treat The Mentally Ill
Los Angeles County supervisors talked for years about how it might make more sense to provide lower-cost healthcare at outpatient clinics instead of sending ambulatory patients to costlier beds at county hospitals. They talked -; but did nothing until the mid-1990s, when soaring hospital costs pushed the county close to bankruptcy. The Clinton administration bailed L.A. out, in the process requiring more clinics and fewer hospital admissions. The result was better and more appropriate patient care, smarter spending and, not inconsequentially, fiscal solvency. So if it took near-bankruptcy for the county to finally wise up on healthcare, what is it going to take to get the supervisors to finally move mentally ill offenders from costly and dangerous jail beds to more appropriate, more effective and less expensive community-based treatment? (5/4).

The New York Times: Finally, Some Optimism About Obesity
Earlier this year, we got what seemed like the first good news on obesity rates: A study in JAMA found that there had been a 43 percent drop in the obesity rates of 2- to 5-year-old children in the last decade. But then, last month, that news was contradicted by researchers at the University of North Carolina who used the same data to find that obesity rates had remained flat after all. ... if we compare the fight against obesity to the last public health challenge of similar size -; the fight against smoking -; it turns out that we are being much more aggressive today (Ezekiel J. Emanuel and Andrew P. Steinmetz, 5/4). 

The New York Times: Are Pap Smears On The Way Out?
Women who want to be screened for cervical cancer have just received a new option -; and a new quandary. The venerable Pap smear, which has been the only screening tool to look for cancer in asymptomatic women for many decades, now has a rival, a genetic test that looks for the viruses implicated in causing cervical cancer. Adding a new option seems a positive development. Yet some critics have opposed using the new test as a primary screening tool lest it displace the Pap test, which has been credited with cutting the incidence and death rate from cervical cancer sharply in recent decades (5/4). 

Los Angeles Times: L.A. County Needs To Construct Mental Health Programs, Not Jails
For decades, the county has spent untold amounts of public money to warehouse people with mental illnesses in the Los Angeles County jail. This costly and ineffective approach has resulted in sky-high recidivism rates and increased crime. Now, the Los Angeles County Board of Supervisors is considering a proposal to spend as much as $2.3 billion on a massive jail expansion, with a significant portion of that money going to facilities for mentally ill inmates, who currently make up nearly 20% of the jail population (Terry Smerling, 5/4). 

USA Today: Budget Squeeze Jeopardizes Search For Cures: Our View
Xiao-Wei Chen is the sort of scientist you'd want to see stay in the United States. Francis Collins, director of the National Institutes of Health, calls him "one of the smartest kids that's come along in a long time." But after 12 years at the University of Michigan, most recently conducting research into how cellular secretions regulate cholesterol, he's returning to China. Some of the reasons why are ominous for U.S. biomedical research. Chen's work ranked him at the very top of a group of scientists being evaluated for research work at NIH, but a budget-caused hiring freeze meant no positions were available. At the same time, Peking University offered him a tenure-track position, funding for his research, good lab space and students to help with his work (5/4). USA Today also provides comments representing an opposing view. 

WBUR: Mass. Medical Society Chief: Medicare 'Data Dump' Unfair To Docs
Transparency in health care is a worthy goal, but, like any major undertaking, the success of the effort depends on how it's done. When the Centers for Medicare and Medicaid Services released its list of $64 billion in Medicare payments to individual physicians in 2012, it fell short of its goal in helping consumers understand how care is delivered through Medicare. Provided without context and with little explanation, the payment data had the unintended consequences of creating confusion and misperceptions among patients (Dr. Ronald Dunlap, 5/2).

WBUR: Midnight Friends: How Wired Patients Are Transforming Chronic Illness
Over the years, I've watched my cousin Deborah Haber struggle with several chronic, painful medical conditions, including fibromyalgia and a rare incurable disorder called Ehlers-Danlos Syndrome, a connective tissue disease that causes profuse sweating, a high heart rate and insomnia, among its many symptoms. Largely housebound, and managing the life of her 11-year-old daughter, Deborah faces social isolation and persistent pain. But along the way, my cousin has discovered a lifeline that's lifted her outlook and improved her health. It combines the best qualities of a mother, best friend, therapist and trusted doctor to help her cope: it's social media (Nell Lake, 5/2).