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Tuesday, Feb 10 2015

Full Issue

Viewpoints: Entitlement Debate Fades; GOP's Va. Medicaid Fight Maligned; Fear Of Measles

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

Two words seem to be slipping from the Washington vernacular: entitlement reform. There was a time, not long ago, when both parties were at least paying lip service to the idea that the Social Security and Medicare entitlement programs鈥攖heir long-term solvency in peril, their contributions to long-term deficits and debt daunting -- needed to be adjusted before they either broke the bank or failed future retirees. Now a combination of factors has blunted the reform drive. (Gerald F. Seib, 2/9)

The budget proposes additional increases to Medicare means-testing: reducing federal Part B and Part D subsidies to higher-income households. It also would increase the Medicare Part B deductible, introduce a Part B surcharge for beneficiaries who purchase rich supplemental Medigap coverage, and introduce home health co-payments. The latter three changes would apply only to new beneficiaries鈥攁nd all the changes would take effect in 2019, more than a year after President Obama leaves office. (Chris Jacobs, 2/9)

On Sunday, The Post published the editorial 鈥溾楳assive resistance,鈥 again,鈥 equating House of Delegates Speaker Bill Howell (R-Stafford) to white supremacist Harry F. Byrd. ... Massive resistance was aimed at denying ALL African American children equal educational opportunity. It grew from opposition to obeying the Supreme Court and U.S. Constitution. The fight over Medicaid expansion, on the other hand, is an issue created by the Supreme Court鈥檚 decision to uphold Obamacare. The justices simultaneously gave each state the option to refuse to participate in any future expansion of the Medicaid program. (Norman Leahy and Paul Goldman, 2/9)

In 2013, the Illinois General Assembly and Gov. Pat Quinn wisely made a decision to expand Medicaid under the Affordable Care Act and, thus, help low-income Illinoisans get and stay healthy. But Wednesday鈥檚 Tribune editorial called the expansion law a 鈥渄ebacle鈥 and a 鈥渇ailure.鈥 In fact, the expansion is an enormously positive achievement. It is true that consultants hired by the state five years ago 鈥済uesstimated鈥 that 342,000 adults would become eligible for the expansion. The enrollment figure now stands at 541,000. The higher enrollment demonstrates how difficult it has been to count low-income adults, even though they were cared for at various times in emergency rooms, homeless shelters, mental health clinics, social-service agencies and jails. (Julie Hamos, 2/9)

Congressional Republican leaders are hoping their new Obamacare repeal-and-replace proposal will convince Chief Justice John Roberts and his conservative colleagues on the U.S. Supreme Court that it's safe to strike down the premium subsidies at the heart of the healthcare reform law. ... Some conservatives argue that the new plan proposed by Sen. Richard Burr (R-N.C.), Sen. Orrin Hatch (R-Utah) and Rep. Fred Upton (R-Mich.) will cover more people than the Affordable Care Act for less money. That's impossible to prove or disprove now because the proposal can't be scored by the Congressional Budget Office until it's put into legislative form, and that's not likely to happen any time soon. (Harris Meyer, 2/9)

Measles is back. Last year, about 650 cases were reported in the United States 鈥 the largest outbreak in almost 20 years. This year, more than a hundred have already been reported. Parents have chosen not to vaccinate their children because they can; 19 states have philosophical exemptions to vaccination, and 47 have religious exemptions. The other reason is that parents are not scared of the disease. But I鈥檓 scared. I lived through the 1991 Philadelphia measles epidemic. Between October 1990 and June 1991, more than 1,400 people living in Philadelphia were infected with measles, and nine children died. (Paul A. Offit, 2/10)

The fear of the spread of measles is now swamping the fear of vaccines. Sadly, but predictably, the fear of disease is provoking an overreaction to risk, precisely what the anti-vaccine community is accused of. There are calls in California to completely eliminate personal-belief and religious exemptions for mandatory childhood vaccination. That call, though understandable, is a step too far. (David Ropeik, 2/9)

The phone call came two billing cycles after Ben and I had increased his session frequency to twice a week. A woman identifying herself as 鈥渁n independently licensed care advocate鈥 with a large insurance company left a message asking me to call back. My neck tightened. No psychologist wants to hear from an insurer. Like some ne鈥檈r-do-well relative, insurers call only when they want money 鈥 or rather, when they want to keep money they鈥檇 once promised to disburse. ... The peer reviewer, when I spoke with him by phone, seemed less interested in hearing about Ben than in finding a sanctioned justification for cutting off reimbursement. Denial of treatment is allowed under a handful of conditions, and the reviewer moved down a list of them .... Finally, the reviewer implied that it was Ben himself who was the problem. (Darcy Lockman, 2/10)

A new Gallup poll finds that only about one in three Americans is satisfied with U.S. abortion policies 鈥 the lowest share since 2001. What's more, among the Americans who are dissatisfied with our abortion laws, twice as many (24%) want stricter rather than less strict (12%) laws. In such an environment, one might expect abortion-rights advocates to be looking for ways to find common ground with their anti-abortion adversaries. (Gary Bauer, 2/9)

The World Health Organization鈥檚 anemic performance in handling the Ebola outbreaks in West Africa may yield one positive outcome: sweeping, and long overdue, institutional reforms to improve its ability to respond more quickly to the next outbreak of a lethal infectious disease. Scrambling to answer growing criticism, the W.H.O.鈥檚 executive board recently endorsed changes to enhance the agency鈥檚 rapid response capabilities. (2/10)

Pediatric mental disorders affect 1 in 5 children, and most serious mental disorders begin early in life, approximately 50% by age 14 years and 75% by age 24 years. The Surgeon General鈥檚 report on mental health called national attention to the public health relevance of pediatric mental disorders, citing encouraging news of an increasing number of evidence-based treatments, as well as the discouraging news that most youth struggling with mental disorders receive no mental health services and that even when services are accessed, they are often inadequate in quality and/or quantity. More than a decade later, still less than half of young people with a mental disorder obtain treatment. (John V. Campo, Jeffrey A. Bridge and Cynthia A. Fontanella, 2/9)

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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