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It was hardly surprising that a president who expects so little from Congress devoted some of his speech to celebrating the things that he has accomplished against considerable odds. With Congress’s help, he rescued the automobile companies, jump-started the renewable energy industry, imposed new rules on financial institutions and, most dramatically, engineered a major overhaul of the health care system. ... His task will be to defend these initiatives from almost certain congressional attack, wielding his veto pen, or threatening to wield it, much as President Bill Clinton found himself doing after Newt Gingrich and his Republican majority took over the House in 1995. (1/20)

While Medicare and Social Security dominate discussion about entitlement reform, too little attention is paid to the dire financial straits of the Social Security Disability Insurance trust fund. Without legislative action, SSDI benefits will be cut nearly 20% by the end of 2016. Congress likely will pass a short-term measure to shore up the trust fund and enable it to pay full benefits. But to survive long term, the program needs far-reaching reform. (Lanhee J. Chen, 1/20)

During the past half century, the supply of inpatient psychiatric beds in the United States has largely vanished. In 1955, 560 000 patients were cared for in state psychiatric facilities; today there are fewer than one-tenth that number: 45 000. Given the doubling of the US population, this represents a 95% decline, bringing the per capita public psychiatric bed count to about the same as it was in 1850—14 per 100 000 people. A much smaller number of private psychiatric beds has fluctuated since the 1970s in response to policy and regulatory shifts that create varying financial incentives. As a result, few high-quality, accessible long-term care options are available for a significant segment of the approximately 10 million US residents with serious mental illness. (Dominic A. Sisti, Andrea G. Segal and Ezekiel J. Emanuel, 1/20)

Death and taxes might be life’s only certainties, but birth and deductibles are poised to become their equivalent in the private US health system. Childbirth is the most frequent reason for hospitalization in the United States, and high-deductible health plans (HDHPs)—combined with their high out-of-pocket cost “bronze” counterparts in state health exchanges—will soon become the most common insurance arrangements for expectant mothers. Although the Affordable Care Act (ACA) mandates that health insurers cover birth hospitalizations, it does not limit cost sharing except through relatively high annual out-of-pocket maximums. Thus, childbirth-related cost sharing may increase markedly for US families in the coming years. (J. Frank Wharam, Amy J. Graves and Katy B. Kozhimannil, 1/20)

Governor Corbett will leave office today. Unfortunately for working Pennsylvanians, his vision for health care – more bureaucracy, higher costs, more complexity and fewer benefits – will remain. That is, unless incoming Governor Wolf sets about immediately to reverse course on Corbett’s direction. (Antoinette Kraus, 1/20)

Republican legislators think that changing Medicaid’s oversight structure will fix problems in predicting costs for the federal/state health care program. That’s not necessarily so, given how the rolls change depending upon eligibility, population and economic conditions. ... Advocates for the poor are rightly suspicious of Republicans who now talk of setting up an independent board to run Medicaid. After all, GOP lawmakers and Gov. Pat McCrory have balked at expanding Medicaid. (1/20)

The Affordable Care Act has fostered major enhancements in our health care system and improved the lives of millions of people who are newly insured and getting care. Community-based health centers played a major role in that progress by expanding services and providing free or affordable care to many more people, thanks to increased federal funding. (H. Duane Taylor, 1/20)

Top healthcare executives who gathered in San Francisco this past week at the J.P. Morgan Healthcare Conference widely agreed that the healthcare reform law's coverage expansion and other provisions are not in jeopardy at the hands of congressional Republicans or the Supreme Court. Really? (Harris Meyer, 1/17)

In just 15 years, one in every four Coloradans will be 60 or older. This unprecedented demographic shift has important implications for all. Addressing it begins with good planning. Medicaid is a critical safety net for tens of thousands of Coloradans, including thousands of seniors. But, especially with seniors, it often is not the most cost-effective option for those in need of some assistance. (Ed Shackelford, 1/20)

“All new patients have an x-ray before seeing the doctor.” As a physician, I found this sentence baffling—I had been taught that the physician’s role is to first see a patient, take a detailed history, perform an examination, and consider the differential diagnoses. Only then could I consider the investigations required to get closer to a diagnosis and determine a treatment plan. As a patient, however, my experience was different. (Dr. Sunita Sah, 1/19)