Viewpoints: Enrollment 'plummeting'?; Arkansas' 'boondoggle'; move Medicare to Obamacare exchanges

Aug 15 2014

Los Angeles Times: Latest Obamacare Freakout: Enrollment "Plummeting" (Spoiler: Not So)
In the latest leg of their endless journey to find bad news about the Affordable Care Act, conservative analysts and websites have seized on some ambiguous figures to declare that enrollment is "plummeting," "shrinking," "sinking rapidly"--choose your headline. The most charitable interpretation of this claim is that it's based on extreme cherry-picking. The most accurate interpretation is that it's wrong (Michael Hiltzik, 8/13). 

The Wall Street Journal: How Obamacare Is Doing Better But Feeling Worse
The Affordable Care Act is like a patient who is feeling worse when key clinical indicators say he is doing better. Obamacare recovered from its Web site fiasco last October and went on to exceed enrollment projections in March. Despite predictions of "rate shock," early indications are that premiums in the new insurance marketplaces are increasing modestly in most states that have made 2015 information public and more slowly than the non-group market has grown in the past. ... Still, opinion about the ACA has not moved significantly in any direction since 2010, when the law passed, and remains decidedly more negative than positive (Drew Altman, 8/13).

The Washington Post: Where Obamacare Is Going
The liberal attraction to making government the sole source of health-care insurance has not abated even as the deficiencies in ObamaCare, a halfway move toward the single-payer model, have become increasingly evident. The question is whether growing signs of single-payer trouble overseas will be enough to discourage this country's flirtation with socialized medicine (Scott W. Atlas, 8/14). 

Forbes: Arkansas Private Option's Latest Boondoggle: "Health Independence Accounts" Increase Dependence and Increase Costs
Arkansas' "Private Option" ObamaCare Medicaid expansion has been "bumpy." Costs have run over budget every single month. Arkansas officials have signaled that they now are seeking a bailout from federal taxpayers. The Medicaid director who spearheaded the program abruptly resigned to "pursue other opportunities." The program's chief architect, a three-term Republican state legislator, lost his primary election to a political newcomer. And the Private Option is already prioritizing coverage for able-bodied adults over care for truly needy patients .... Could things really get worse for the Private Option and its supporters? You bet (Jonathan Ingram, Nic Horton and Josh Archambault, 8/12).

Politico: Don't Repeal Obamacare, Transcend It
Conservatives don't have to repeal Obamacare in order to advance their principles. Indeed, it's actually possible to take advantage of one of the law's core provisions-;its tax credits for the purchase of private coverage-;to reform America's entire health-entitlement behemoth, and to finally put the country on a fiscally stable trajectory. Rep. Paul Ryan's proposal to reform Medicare-;giving future retirees "premium support" subsidies to shop for private health insurance-;is, in fact, quite similar to Obamacare's usage of "premium assistance" tax credits to offer coverage to the uninsured. So what if we used Obamacare to reform Medicaid and Medicare, by gradually migrating future retirees and Medicaid recipients onto a reformed version of Obamacare's exchanges? (Avik Roy, 8/13).

The Tennessean: Congress Should Re-Fund CoverKids
Can Congress set aside a few of its differences over the nation's health care system and continue a popular program that is working to make children healthier? It should. In October, federal funding for the Children's Health Insurance Program (CHIP), called CoverKids here in Tennessee, will expire. The expiration could take insurance coverage away from about 68,000 children in the state, and about 8 million across the country (8/12).

Bloomberg: The Best Doctors Money Can Buy?
Here's a deal you might be interested in. You get $10 billion a year of taxpayers' money to do something you may well have done anyway. You don't need to say what you spend it on, or why. You can use it wisely or wastefully; the money keeps coming regardless. That's the nice arrangement the federal government grants U.S. hospitals when it comes to training doctors. ... But this way of directing the cash has unfortunate consequences, as a recent report from the Institute of Medicine, an independent research group in Washington, explains. Payments to hospitals are all but guaranteed, "regardless of program performance, efficiency, or quality of training." There's no attention to the right mix of specialties, which means a shortage of primary-care physicians. Nobody in a position of authority is even asking what kinds of doctors the country needs (8/13).

The Wall Street Journal: Legal Pot Is A Public Health Menace
The great irony, or misfortune, of the national debate over marijuana is that while almost all the science and research is going in one direction-;pointing out the dangers of marijuana use-;public opinion seems to be going in favor of broad legalization. For example, last week a new study in the journal Current Addiction Reports found that regular pot use (defined as once a week) among teenagers and young adults led to cognitive decline, poor attention and memory, and decreased IQ (William J. Bennett and Robert A. White, 8/13). 

JAMA Surgery: Team-Based Surgical Care: An Important Role For Academic Health Centers
It is an inescapable fact that the expectations for the delivery of high-value, safe, and effective patient care in the hospital setting have changed dramatically over the last few years, and nowhere is this evolution more evident than in acute surgical care. ... Unfortunately the capacity for collaborative care is often constrained by the current rigid hierarchy of health care occupations and the silo divisions of labor. Traditional surgical care has routinely been taught and delivered within that vertically oriented authority gradient. How often has a senior surgeon expounded with great seriousness that the "surgeon is captain of the ship"? (Drs. Peter W. Dillon and Harold L. Paz, 8/13).

The New England Journal Of Medicine: Adverse Effects Of Prohibiting Narrow Provider Networks
Faced with ACA-based limitations on their ability to trim benefits and increase cost-sharing levels, many exchange insurers have opted to control costs by offering plans with narrow provider networks. ... I would argue that CMS and state insurance commissioners should not force insurers to contract with providers or otherwise interfere in plan–provider negotiations. In addition to increasing insurance premiums, network-adequacy regulations risk politicizing insurers' decisions about provider networks -; and a provider's success shouldn't depend on its influence with key legislators or regulators. ... CMS would be wise to limit its role to ensuring that plans make their provider lists readily accessible to consumers before they choose a plan. Plans could control costs while diminishing consumer concerns about limited choice by making greater use of tiered networks (David H. Howard, 8/14).

The New England Journal Of Medicine: When Religious Freedom Clashes With Access To Care
The Obama administration's attempts to compromise on the contraceptives-coverage mandate ultimately backfired, since its efforts were used to demonstrate that applying the mandate even to secular employers was not necessarily the only way to achieve the government's interests. In the future, regulators may be less willing to seek compromise lest their efforts be similarly used against them -; and it is bad news for all of us if health policy can be made only through polarization and rancor rather than compromise (I. Glenn Cohen, Holly Fernandez Lynch and Gregory D. Curfman, 8/14).

The New England Journal Of Medicine: Is It Time For A Tobacco-Free Military?
Secretary of the Navy Ray Mabus recently announced that he wanted to end tobacco sales on all Navy installations. Secretary of Defense Chuck Hagel, citing both financial costs and tobacco's harmful effects on readiness, added that military tobacco policy in general should be reviewed, including the possibility of ending tobacco sales and establishing smoke-free military installations. ... despite the underlying expectations for superlative fitness -; and despite the availability of state-of-the-art tobacco-cessation programs -; many military personnel still use tobacco, and its use remains accepted, accommodated, and promoted in the armed forces. Why? (Elizabeth A. Smith, Sara A. Jahnke, Walker S.C. Poston, Larry N. Williams, Christopher K. Haddock, Steven A. Schroeder and Ruth E. Malone, 8/14).