Viewpoints: Problems in training docs; impact of HHS' territory decision; what Halbig decision might mean

Jul 22 2014

The Wall Street Journal: Territories Free Of ObamaCare
Last week's burst of world disorder was ideal for a news dump, and the White House didn't disappoint: On no legal basis, all 4.5 million residents of the five U.S. territories were quietly released from ObamaCare. Where does everybody else apply? The original House and Senate bills that became the Affordable Care Act included funding for insurance exchanges in these territories, as President Obama promised when as a Senator he campaigned in Puerto Rico, the Virgin Islands and other 2008 Democratic primaries. But the $14.5 billion in subsidies for the territories were dumped in 2010 as ballast when Democrats needed to claim the law reduced the deficit (7/20).

The New York Times: Bottlenecks In Training Doctors
The new head of the Department of Veterans Affairs, Sloan Gibson, told a Senate committee last week that he needed $17.6 billion over the next three years to hire some 1,500 doctors, 8,500 nurses and other clinicians to reduce the unconscionably long waiting times that many veterans now endure before they are able to see a doctor. That news was bad enough, but the department's problems are emblematic of an even deeper problem: a nationwide shortage of doctors, especially primary care doctors, and other health care professionals, that will only get worse in coming years (1/19).

Boston Globe: A Death Blow For Obamacare?
The moment the Affordable Care Act was enacted in 2010, it became a litigation magnet. ... [A] new round of litigation attacks the health insurance exchanges at the heart of Obamacare. ... So, when this case ultimately reaches the court, the ACA's fate would again rest in the hands of Roberts, just as it did in 2012. If Roberts is true to his pragmatic judicial philosophy, he should find the challengers' reading unconvincing. ... The huge uncertainty is whether he would do so again or would conclude that, because Congress created the present problem by its careless drafting, it's up to Congress to fix it. Because Congress isn't likely to come to the rescue, the health care of millions of Americans hangs in the balance (Laurence H. Tribe, 7/18). 

The Wall Street Journal's Washington Wire: How Obamacare's Progress Makes Expanding Coverage Harder
The Affordable Care Act's success meeting its initial enrollment goals and the repair of HealthCare.gov seem to have calmed the political waters for Obamacare. But the job of enrolling the uninsured gets harder, not easier, because the remaining uninsured will generally be tougher to reach (Drew Altman, 7/21).

Los Angeles Times: Report Shows The High Stakes Of Latest Legal Battle Over Obamacare
While the House GOP positions itself to sue the Obama administration for not implementing a mandate in the 2010 Affordable Care Act quickly enough, a D.C. Circuit Court of Appeals panel is mulling whether the administration implemented a second provision too broadly. At issue in the appeal is the tax credits the law provides to help low- and moderate-income Americans buy health insurance policies through the new state exchanges. The Internal Revenue Service held that these subsidies would be available nationwide, but the plaintiffs in the case, Halbig vs. Burwell, contend that the law makes them available only in states that operate their own exchanges (Jon Healey, 7/19).

The Washington Post: Virginia's GOP Hurts The Poor And The Budget By Refusing Medicaid Expansion
Virginia's refusal to opt into expanded Medicaid since Jan. 1 has cost the state at least $693 million in federal funding. Democrats say it's an even $1 billion. ... The decision to leave those dollars on the table -; an amount that increases by at least $3.46 million per day -; is the doing of Republicans in the General Assembly. ... The point is purely ideological and partisan: to hand a defeat to President Obama and Democratic Gov. Terry McAuliffe. Richmond's Republicans have achieved that goal. In the process, they have also handed a defeat to Virginians (7/19).

The Washington Post: At A Huge Free Medical Clinic In Southwest Virginia, Misery That Shouldn't Exist 
A gravel parking lot deep in the green hills of Virginia coal country was packed to capacity by 4 a.m. Friday. More than 1,500 people with canes, wheelchairs, oxygen tanks, bleeding gums, black lungs and other ills had come to the Wise County Fairgrounds, camping in tents, sleeping in pickup truck beds or scrunched up in their cars, hoping to see a doctor. ... The tents, the livestock corral, the desperate, broken bodies. It is shameful that Virginia has allowed partisanship and politics to stand in the way of caring for its people (Petula Dvorak, 7/18).

The San Francisco Chronicle: Housing As Health Care
With the rollout of the Affordable Care Act in California, we have an unprecedented opportunity to provide the one proven treatment to improve the health and well-being of people living with mental illness, substance abuse, chronic medical problems and homelessness: housing. In San Francisco, the health care system that will partner with high-tech know-how and philanthropy to embrace this will not only deliver on our social responsibility to serve the urban poor, but will leave public funding on the table for other essential governmental functions (Dr. Joshua Bamberger 7/18).

The New York Times: Busy Doctors, Wasteful Spending
Of all the ways to limit health care costs, perhaps none is as popular as cutting payments to doctors. In recent years payment cuts have resulted in a sharp downturn in revenue for many hospitals and private practices. ... Health care costs must be contained, but cutting payments to doctors is a self-defeating strategy. Policy makers need to focus on the drivers of waste. And one of the most potent is when doctors reflexively call other doctors for help (Dr. Sandeep Jauhar, 7/20). 

The Des Moines Register: Federal Report Finds Medicaid Is A Real Money-Saver On Drugs
A [GAO] report issued on June 30 evaluated federal spending on prescription drugs by government health care programs. ... Medicaid paid the lowest average net price for a sampling of 78 brand-name and generic drugs. ... While health care providers and pharmacies may complain about Medicaid's low reimbursement rates, the flip side of paying less for services and drugs is obvious: It saves tax money (7/18).

The New York Times: The Future of Robot Caregivers
Each time I make a house call, I stay much longer than I should. I can't leave because my patient is holding my hand, or because ... she just has to show me one thing, but getting to that thing requires that she rise unsteadily from her chair, negotiate her walker through the narrow hallway, and find whatever it is in the dim light of her bedroom. I can, and do, write prescriptions for her many medical problems, but I have little to offer for the two conditions that dominate her days: loneliness and disability. ... What she needs is a robot caregiver (Dr. Louise Aronson, 7/19). 

The New York Times: Dislocation, Italian Style
"Scusi," I said, calling a nurse in the same tone of casual deference used to summon a waiter, trying to ignore the pain that was blaring like a siren in my mind. It was a glorious day in Milan, [but] I found myself staring at the emergency room ceiling in the Ospedale Gaetano Pini, ... The first time I dislocated my artificial hip, in Pittsburgh, where I live, the hospital staff had propelled me from E.R. to O.R. with an all-hands-on-deck sense of urgency. Now I'd done it again. But the attendants in Milan seemed to be in no hurry (Holly Brubach, 7/19). 

The Washington Post: Should 'Mercedes Mom' Have Sold The Car Before Applying For Government Assistance? A couple of weeks ago, a young woman wrote about the shame she felt after driving a Mercedes to the local church to apply for government assistance. ... [Darlena Cunha's] family had fallen on hard times and she needed financial help to purchase a special baby formula for her new born twins. Although she and her husband had recently earned enough to purchase a $240,000 home, the financial crisis of 2008 caused the value of their home to plummet to $150,000 and, even worse, led to the loss of her husband's job. Their combined income fell from $120,000 to just $25,000, making them potentially eligible for Medicaid and assistance through the federal Women, Infants, and Children (WIC) program (Joann Weiner, 7/19).

Minneapolis Star Tribune: At 65, The Icing On The Cake? Medigap
I turn 65 in August. ... My next birthday not only is a reminder of advancing decrepitude, it's a chance to close a sale. ... After 30 years of writing about economics, I anticipated no problem in shopping for the right "Medigap" plan ... How could I have been so naive? The task of picking a Medigap policy is on par with trying to assemble an Ikea bookshelf without instructions -; and in the dark (Mike Meyers, 7/18).

The Washington Post: Who Had The Worst Week In Washington? The FDA And The CDC, For Freaking Us All Out.
[T]he FDA discovered smallpox, the virus behind dengue fever, a bacteria that causes spotted fever, and something called Q fever (sounds horrible) just sitting in a cold-storage room -; okay, they were in vials, but still -; at the National Institutes of Health in Maryland. "The reasons why these samples went unnoticed for this long is something that we're actively trying to understand," said Peter Marks, the deputy director of the Center for Biologics Evaluation and Research. Um, no duh. ... These are the people -; and the organizations -; we entrust with handling the deadliest viruses in the world because they're supposedly so careful and diligent about how they do their jobs. Or not (Chris Cillizza, 7/18).

Los Angeles Times: Conflicts Of Interest Pervasive On California Stem Cell Board
There's no good time for a public agency to be embroiled in a conflict-of-interest scandal, but this is an especially delicate time for California's stem cell agency. The California Institute for Regenerative Medicine, as the program is known formally, is on track to finish doling out its $3 billion in funding from the state's voters as soon as 2017. Its original sponsor, Northern California real estate developer Robert Klein II, has been quoted talking about another $5-billion infusion, perhaps via the 2016 ballot (Michael Hiltzik, 7/18).