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Tuesday, Aug 25 2015

Full Issue

Viewpoints: Barring Abortions For Down Syndrome; GOP's Replacement Options

A selection of opinions on health care from around the country.

It is tempting to dismiss the latest anti-choice salvo from Ohio lawmakers, which would criminalize abortions based on a fetal diagnosis of Down syndrome, as a blatantly unconstitutional ploy that would never be enforced. That would be a mistake. The bill stands a disturbingly good chance of approval this fall by the state鈥檚 Republican-controlled legislature, which has been passing abortion restrictions as quickly as it can write them in the four-plus years since Gov. John Kasich, a Republican who is also running for president, took office. (8/25)

Ohio is considering legislation that would ban abortion, even before viability, if the reason for the termination is that the fetus has Down syndrome. On the surface, the law seems blatantly unconstitutional: The U.S. Supreme Court has affirmed a woman鈥檚 basic right to be free of any 鈥渦ndue burden鈥 on terminating her pregnancy before viability. ... Yet on closer examination, the legal issue is more complicated. Seven states have laws banning abortion aimed at selecting the sex of a child. These laws are arguably constitutional, and haven鈥檛 been struck down by the courts. The argument in favor of those laws is that the state has a compelling interest in combating sex discrimination. It seems possible that countering discrimination against those with Down syndrome is a compelling interest on par with combating discrimination against women. (Noah Feldman, 8/24)

Trying to repeal Obamacare has long been a popular (if futile) Republican pastime. Now replacing Obamacare is catching on, at least among Republican presidential candidates. This would count as progress, except that none of their proposals quite meets the definition of "replacement." (8/24)

Taking on the Affordable Care Act is de rigeur for Republican candidates, but Republican voters are not of one mind about Obamacare鈥揳nd the different positions candidates take may not have much effect on their primary prospects. Republican presidential candidates Scott Walker, Bobby Jindal, and Marco Rubio have put forth plans to replace the ACA. But the proposals are not detailed enough to analyze their likely impact. (Sen. Rubio鈥檚 approach, for example, was laid out in an op-ed.) We can, however, analyze the political strategy here. (Drew Altman, 8/25)

The long term prospects of many of these Obama initiatives will depend on whether the next president will build on them or instead will try to roll them back. ... Clinton has vowed to build on Obamacare鈥檚 coverage expansion; the 2016 GOP candidates are all vowing to repeal it, and those who are purporting to offer their own plans would, at a minimum, roll that coverage achievement back. (Greg Sargent, 8/24)

A person鈥檚 health care spending tends to be high in the last year of life 鈥 but not as high as conventional health economics suggests. The biggest spending comes from years of custodial, disability care endured in nursing homes and hospitals 鈥 mostly by women who don鈥檛 have long-term care insurance. A paper released this summer by a team writing for the National Bureau of Economic Research found spending concentrated among a small cohort of elderly Americans, who tend to stay at the high end for three years or more. (Jim Landers, 8/24)

Consumers are trying to figure out how they鈥檒l absorb the double-digit increases in health insurance premiums that many insurers have announced for next year. American employers, meanwhile, are worried about what will happen to health costs several years out, in 2018. That鈥檚 because 2018 is when one of Obamacare鈥檚 most onerous taxes takes effect 鈥 the 鈥淐adillac鈥 tax. The levy will apply to employer-provided insurance plans deemed too costly by the federal government. (Sally Pipes, 8/24)

The [Utah] state Legislature is still looking for ways to expand Medicaid under President Obama鈥檚 Affordable Care Act. After years of 鈥渟tudying the issue,鈥 legislators quickly learned what experts have been telling them for months 鈥 that such a plan is plainly unaffordable for Utah taxpayers. Such a discovery has made the state government look desperately for alternative ways to make expansion work. To pay for this boondoggle, lawmakers want to extract much of the $78 million needed to expand Obamacare from our health care providers. Put another way, they want a 鈥渄octors鈥 tax.鈥 (Evelyn Everton, 8/25)

On the 50th anniversary of Medicaid, it鈥檚 time to ensure the oral health of all Americans. ... Despite the great strides made to provide coverage to those who need it most, 83 million Americans still face obstacles in receiving dental care each year. As more Americans become eligible for Medicaid 鈥 average enrollment is projected to increase by 3 percent annually over the next 10 years 鈥 the number of those who face barriers in receiving dental care will continue to rise unless state and federal leaders act now. (Steve Pollock, 8/24)

This is part of the Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.
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