�鶹Ů��

Medicare and Medicaid, the two mainstays of government health insurance, turn 50 this month, having made it possible for most Americans in poverty and old age to get medical care. While the Affordable Care Act fills the gap for people who don’t qualify for help from those two programs, there are important improvements still needed in both Medicare and Medicaid. (7/3)

[Chief Justice John] Roberts’s ruling advanced a crucial conservative objective, that of clawing back power from the executive branch and independent agencies that increasingly operate essentially free from congressional control and generally obedient to presidents. If conservatives cannot achieve their objectives, including ACA repeal, through the legislative branch, conservatism’s future is too bleak to be much diminished by anything courts do. If, however, conservatives can advance their agenda through Congress, they will benefit from Roberts’s ACA opinion, which buttresses legislative supremacy. (George F. Will, 7/3)

The urge to merge is sweeping managed health care. Aetna announced Friday a $37 billion deal to acquire Humana. Anthem and Cigna are in merger talks and could be next. The national for-profit insurers are on an anxious mission to consolidate. These combinations will sharply reduce competition and consumer choice, as five big insurers shrink, probably, to three. This trend is a direct consequence of ObamaCare, reflecting the naïveté of its architects and the fulfillment of their myopic vision. (Scott Gottlieb, 7/5)

In the past three months, the health-care industry has added 135,000 jobs. Between January 2001 and December 2004, the net job creation was ... negative-78,000. So not a super high bar, to be fair. (Using that standard, you could also say that the horse-drawn carriage industry created more jobs in the past three months than the entire U.S. economy between 2001 and 2004.) But the broader point, that the health-care industry is going gangbusters, is also true. And it's been true since President Obama took office. Over the 78 months of Obama's presidency, the industry has lost jobs in only three — all between May and December 2013. Otherwise: Up, up, up. (Philip Bump, 7/2)

The most noteworthy part of President Barack Obama's speech Wednesday was the note he wrote in black ink on a hallway wall to the students of Taylor Stratton Elementary: Dream big dreams. Otherwise the president's Affordable Care Act speech at the Madison elementary school was a tame Q&A session for about 160 people who were either supporters or too corporate to heckle. If the speech had to have a title it could have been: coverage costs and the costs of coverage. (Holly Fletcher, 7/2)

Let me start by saying this is not a political screed against Obamacare; I’m thrilled that some 18 million Americans now have health insurance who didn’t before the law took effect, lowering the percentage of uninsured adults from 18% in 2013 to 11.9% today. But I’m growing concerned that for some people — especially older, middle- and lower-income adults — the Affordable Care Act is becoming The Unaffordable Care Act. (Richard Eisenberg, 7/5)

Providers, insurers, and governments, among others, have sharply changed direction in order to comply with the Affordable Care Act (ACA). They’re experimenting with new health-care delivery and payment models and exploring new opportunities for information technology. All of this action, aimed at providing access to high-quality affordable care to Americans everywhere, has inspired robust debate. But one sector of our society is still lagging behind. Higher education has yet to transform to meet the needs of health-care reform. That’s a problem. As health-care changes, so must higher education. (Rainu Kaushal, 7/2)

And as we’ve seen in the past couple of days, one of the biggest pieces of unfinished business the administration confronts is the incomplete expansion of Medicaid. The question is whether Obama can make any progress toward fixing this problem. On Wednesday, Obama went to Tennessee to tout the success of the ACA and encourage the state to expand Medicaid, and though the visit was described as a “victory lap,” Tennessee shows just how deep the challenge on Medicaid is. (Paul Waldman, 7/3)

If the uncertain legal future of the Affordable Care Act seemed reason enough to keep stalling on Medicaid expansion in Kansas during the legislative session, that excuse is gone. The tax credit subsidies in states that use the federally run online exchange prevailed in last week’s 6-3 decision at the U.S. Supreme Court, leaving intact the ACA coverage of nearly 70,000 Kansans among millions of Americans. With that chaos averted, state leaders are free to judge the proposed expansion of Medicaid on its own merits, which are compelling. (7/2)

According to a recent study, Alaska is either in a recession or on the brink of one. It’s time for nonpartisan solutions, not time to play Russian roulette with the economy. Alaska will lose 4,000 jobs across the economy by September. Blocking a vote on a Medicaid expansion bill that’s passed in Democratic and Republican states and would create 4,000 Alaska jobs isn’t smart politics. The public supports it across party lines. (State Rep. Les Gara, 7/4)

The Supreme Court’s recent decision to ignore the letter of the law and uphold the Obama Administration’s unconstitutional rewrite of Obamacare undermines the American people’s trust and confidence in our nation’s highest court. Justice Scalia summed up the Court’s actions rightly when he called them “absurd” and opined that “words no longer have meaning” under the Court’s ruling in King v. Burwell. (Rep. Brian Babin, R-Texas, 6/3)

Morning in America did nothing to boost insurance — in fact, the share of Americans with private coverage declined, and because Medicaid din’t grow the overall rate of uninsurance rose from 12 percent in 1980 to 15.6 percent in 1989. In other words, nothing in the economic record — not even the record of the great conservative hero — suggests that you can grow your way into universal health coverage. (Paul Krugman, 7/4)

Don’t like same-sex marriage, contraception, HIV testing or even child labor laws? Never you worry: Just say that a higher power has exempted you, even if your exemption means trampling on other people’s rights. ... Last year’s Hobby Lobby ruling allowed companies to exempt themselves from an Obamacare requirement that insurance plans cover birth control, and now congressional Republicans want to expand that exemption. A frightening section of a House appropriations bill would let any employer or insurance company deny health-care coverage for any service that they have a “moral or religious objection” to, even if that service is required by law. This could include mental health screenings and vaccinations, in addition to contraception and abortion. (Catherine Rampell, 7/2)

According to an account in the New York Times, the [U.S. Chamber of Commerce], which describes itself as representing the interests of more than 3 million businesses, is quietly supporting efforts around the world to resist tighter controls on tobacco use. The Times published e-mails and documents showing how the chamber has lobbied to curtail anti-smoking measures outside the United States. How does advancing a product that kills people prematurely serve the interests of businesses? The chamber ought to be the first organization to grasp that smoking puts a terrible burden on societies, draining their public health and medical resources and stealing away lives that could be productive for years to come. (7/4)

The U.S. government has fallen shamefully short of honoring its commitment to veterans in recent years. One reform measure after another has failed to resolve chronic problems with health care provided by the Department of Veterans Affairs. On Capitol Hill, a new attempt is in the works — this time focusing on workforce shortages and leadership vacuums, including in Missouri. The Delivering Opportunities for Care and Services (DOCS) for Veterans Act seeks, among other things, to bolster recruitment efforts through salary increases and tuition loan assistance. It also would expand partnerships with existing agencies to establish more mental health residency programs, particularly in rural and underserved areas. (6/2)

For years, research on prostate cancer has sought an approach to screening that is more individualized than a one-size-fits-all measurement of the level of prostate-specific antigen in a man’s blood. These efforts are now paying off. That’s why it’s time to re-evaluate the nation’s current approach to prostate cancer. Even though we anticipate 221,000 new diagnoses this year, and 28,000 deaths, recommendations drafted in 2010 and finalized in 2012 strongly discourage PSA screening men without symptoms for this disease. (Deepak A. Kapoor, 7/5)

Scientists have made enormous gains in reducing deaths from coronary heart disease, the leading cause of heart attacks, but it is astonishing how much they still don’t know. That leaves patients and their doctors uncertain about the best way to fight a disease that is still the leading cause of death for both men and women in the United States. ... The most surprising gaps in knowledge involve two of the most common treatments: when to use stents — small wire cages — to prop open coronary arteries and how far to drive down blood pressure. (7/3)

The Food and Drug Administration recently moved to eliminate trans fats from the American diet, and food activists and the public-health lobby are claiming a historic victory. Yet this is a rare case of the Obama Administration regulating from behind. Markets had as much to do with the fall of trans fats as government did with their rise. (7/5)

Existing antibiotics underpin much of modern medicine but are rapidly losing their ability to treat many deadly infections, according to the Centers for Disease Control and Prevention. Yet even as more strains of drug-resistant bacteria emerge, the introduction of new antibiotics has slowed down. Congress should enact a proposed new regulatory pathway that will help spur the investment that can bring new lifesaving treatments to the public. ... To revitalize the search for lifesaving antibiotics, the Food and Drug Administration needs a new way to approve them. Legislation proposed in both the House and the Senate would create a new regulatory pathway that would enable the FDA to approve drugs specifically for patients whose serious infections can’t be treated with existing drugs, and for whom there are few or no other treatment options. (Jonathan Leff and Allan Coukell, 7/2)

Jaws dropped earlier this year when Gov. Jerry Brown told the Legislature that he wanted to set aside $300 million for two years' worth of specialty drugs for Medi-Cal users, state prisoners and others covered by state health programs. Even with a general fund of more than $110 billion, $300 million is nothing to sneeze at. This week, a new study suggested that Brown may have been low-balling the cost of those new drugs. By a lot. (Jon Healey, 7/2)

[Calif. Gov. Jerry Brown] did something last week that more governors should, signing legislation that compels almost all schoolchildren in California to be vaccinated. While the state had been fairly liberal in granting exemptions to parents who cited strongly held personal beliefs, the new law insists that there be a sound medical reason for opting out. Some children with compromised immune systems, for example, simply cannot be given the shots. I imagine that [Robert Kennedy Jr.] was displeased. I’ll confine myself to imagining, because I’m not about to hop on the phone with him again. He’d just subject me to the scaremongering he practiced in his campaign against the California law. (Frank Bruni, 7/4)