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Wednesday, May 27 2015

Full Issue

Viewpoints: Don't Trust Health Law Memories; Good Compromise In Fla.; Smoking And The Poor

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

Memory is so very terrible, and this [health] law is so very complex. Anyone who tells you that they have a full and accurate memory of the evolution of the various moving parts is lying -- at least to themselves. They are incapable of being accurate about what must have seemed like a minor point in a law that was drafted five years ago. That's why the Supreme Court largely ignores post-hoc statements, and we should too. ... In the absence of a clear record of legislative intent, which we don't have, we have to go back to where we should have been in the first place, the place from which the Supreme Court is going to rule: the text of the law. (Megan McArdle, 5/26)

If Congress did not mean to refer to state-established exchanges, why did it use the phrase 鈥渆stablished by the State鈥? According to story by Robert Pear in the New York Times 鈥渢he words were a product of shifting politics and a sloppy merging of different versions. Some described the words as 鈥榠nadvertent,鈥 鈥榠nartful鈥 or 鈥榓 drafting error.'鈥 In other words, by this account it was a mistake 鈥 and a mistake no one noticed until well after the bill鈥檚 passage. This may be how congressional staffers and legislators characterize the drafting process now, but that鈥檚 not what the federal government and its supporting amici told the Supreme Court. (Jonathan H. Adler, 5/26)

President Obama's second-term agenda, it seems, is in the hands of the courts. Same-sex marriage. Obamacare. Climate change. And now immigration. And in many cases, there is significant doubt about whether his signature initiatives will stand legal scrutiny. (Amber Phillips, 5/26)

I marked 34 years in newspaper journalism this month, and I鈥檝e never had a story grab public interest the way my recent post on Luis Lang did. The account of the uninsured Fort Mill, S.C., Republican seeking someone to pay for his sight-saving surgery pushed people鈥檚 buttons across the country. Even as he raised more than $25,000 from donors, readers lined up to scold him for seeking aid while living in a $300,000 home. People couldn鈥檛 wait to give him a virtual earful about smoking, neglecting the diabetes that put him at risk for blindness and blaming Obamacare for the Medicaid gap created by South Carolina lawmakers. (Ann Doss Helms, 5/25)

The Florida Senate has drawn a new road map for House Republicans to get to yes on accepting Medicaid expansion money. Tuesday's proposed revisions to a bipartisan proposal to use the federal money to help pay for private coverage for low-income Floridians answer their strongest objections and should lower the demagoguery in next week's special legislative session. House leaders ought to be able to claim credit for forcing the adjustments and join their Republican colleagues in the Senate to embrace a proposal that is fiscally responsible and lets everyone claim victory. (5/26)

Illinois Gov. Bruce Rauner wants to cut $735 million in Medicaid spending to Illinois hospitals, reductions that naturally will fall most heavily on hospitals that serve the poor in Chicago. The hospitals say Rauner鈥檚 cuts would force them to eliminate important services and, in some instances, even force hospitals to close. (Mark Brown, 5/22)

The income gap between smokers and nonsmokers has grown. And it's something companies may need to address directly in their efforts to help employees kick the habit. Over the past several decades, smoking rates have fallen sharply among high-income, highly educated Americans and not as much for less educated, low-income people. The result is that, in 2013, the smoking rate exceeded 20 percent for people with a high school degree or less while among those with a graduate degree it was just 5.6 percent. Among people living in poverty, smoking was almost twice as common (29 percent) as among those at or above the poverty line (16 percent). (Peter R. Orszag, 5/26)

Babies born too soon suffer fragile health and exact a high cost on our public health system. That's especially so for the babies born to Medicaid-eligible women and those who qualify for state-supported perinatal care. The estimated cost for a preterm birth in Harris County is $39,371. That's about 12 times more than the cost of a full-term birth that's covered by health insurance. If these statistics are not sobering enough, consider this: The care of a preterm infant generally does not stop when the baby leaves the hospital, but continues into childhood and beyond. (June Hanke, Catherine Clark Mosbacher and Luis Rustveld, 5/26)

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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