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Wednesday, Nov 12 2014

Full Issue

Viewpoints: Hatch Says GOP Is Ready To 'Repeal And Replace'; Brill Finds Opponents' Court Arguments 'Absurd'

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

A number of liberal pundits working off of White House talking points became heavily invested in the argument that the election was not about Obamacare. They seemed to believe if the election was about something else, Obamacare wouldn鈥檛 be repudiated or the GOP would lack a mandate to get rid of it. This was, to put it mildly, silly and desperate. (Jennifer Rubin, 11/11)

Voters last week flatly rejected the Obama administration's policies and created a new opportunity to improve American health care by electing a Republican Congress that is firmly committed to repealing and replacing Obamacare. With a flawed website launch, failed state exchanges, burdensome mandates, mass cancellations of coverage and countless other broken promises paid for by Medicare cuts and a trillion dollar tax hike, it's no wonder so few Democratic candidates campaigned on the merits of Obamacare. (Sen. Orrin Hatch, R-Utah, 11/11)

Getting Obamacare up and running has been like trying to build a house while gangs were throwing rocks at the carpenters and inept plumbers were bungling the pipes. Between relentless attacks and self-inflicted mistakes, what would have been a tough job under good conditions has flirted with disaster. And yet, at least for now, the law survives. Millions more people have health coverage than a year ago, including many who previously couldn't afford it or qualify. (11/11)

In completing a book on the saga of Obamacare, due out in about seven weeks, I thought the argument in King v. Burwell by the Obamacare opponents was so absurd that I didn鈥檛 spend much time on it. But what I did find out is that no legislator or staff member on either side of the aisle that I spoke with ever thought that the subsidies would not go to the states using the federal exchange, and that the confusion and inconsistency in the wording was the result of some last-minute cutting and pasting of a phrase from a prior draft. Put simply, from what I can tell, the Obamacare opponents鈥 current argument that the sentence they have homed in on was put there to penalize states that did not set up their own exchanges is not something that was on the minds 鈥 or that emerged in the conversations, memos or drafts 鈥 of anyone involved in the negotiating, writing and passing of Obamacare. (Steven Brill, 11/11)

It's possible that the congressional Democrats who drafted Obamacare five years ago purposely sabotaged their signature accomplishment, failed to tell anyone and are now lying about it. More likely, they just made a mistake -- and the states can easily address it. ... Until last week, refusing to build a state exchange was an easy way for state Republicans to demonstrate opposition to Obamacare without actually incurring any cost to their constituents. That calculus has now changed. If the court rules that subsidies are illegal in states that use the federal exchange, insurance will become unaffordable for the almost 5 million people who now get those subsidies. (11/11)

More than 168,000 people in Illinois get a federal subsidy on their health insurance through the Affordable Care Act, better known as Obamacare. Beginning Friday and continuing through Feb. 15, thousands more people are likely to sign up for Obamacare, also finding it affordable because of the subsidy. For the sake of all these financially strapped people, the Illinois General Assembly should move quickly to make sure those tax considerations continue even if the U.S. Supreme Court next year rules against Obamacare鈥檚 current system of subsidies. (11/10)

The U.S. Court of Appeals for the Sixth Circuit last week essentially forced the Supreme Court to decide whether there's a constitutional right to same-sex marriage, by refusing to recognize such a right itself. The next day, the court agreed to hear a potentially fatal legal challenge to the Affordable Care Act. Taken together, these two cases transform the current Supreme Court term into a blockbuster -- and the linkage relationship between them will be all-important. ... if the Roberts Court (without Roberts鈥檚 vote) announces a fundamental constitutional right to marry, its liberal legacy will be so prominent that [Chief Justice John] Roberts may have reason that he can kill Obamacare without tarnishing the court鈥檚 reputation too much. (Noah Feldman, 11/11)

On Tuesday, Harvard law professor Noah Feldman speculated in a blog post about a possible 鈥渓inkage鈥 between the pending ACA case and a likely same-sex marriage case this Term. Not that he asserts any linkage in the facts, legal issues, or background principles, which would be a fascinating read. ... the conjecture in his BloombergView post is unpersuasive on its own terms and reflects a dismaying trend in constitutional-law writing: a hyper-legal-realism that is neither legal nor very real. (Dale Carpenter, 11/12)

If even a conservative Republican such as [Ohio Gov. John] Kasich (and [Kentucky Sen. Mitch] McConnell, for that matter) can see value in expanding Medicaid, why are the Republicans in the Virginia General Assembly so adamant against it? Have they simply backed themselves into an ideological corner they can鈥檛 get out of? Political analyst Mark Rozell at George Mason University says yeah, that鈥檚 pretty much it: 鈥淜asich and some of the other GOP governors are pragmatists who happen to be conservatives. The legislators here who oppose taking the federal money are ideologues who happen to hold elective positions." ... Used to be, Republicans were considered the party of business. And you can鈥檛 get more businesslike than the Virginia Hospital and Healthcare Association (or the state Chamber of Commerce, for that matter). Both groups are pushing for Medicaid expansion, citing the kind of bottom-line figures that Republicans used to crave. GOP legislators appear unwilling even to listen to big voices in the business community. (11/9)

One health insurance-related mistake that I鈥檝e seen many people make this year is to fail to realize that they have some control over the size of Affordable Care Act subsidies that they can receive for purchasing health insurance on the new exchanges. Assuming you meet the other requirements for eligibility (e.g., not having 鈥渁ffordable鈥 coverage through your employer), your 鈥渉ousehold income鈥 is what determines the size of the subsidies that you can receive. (Piper, 11/12)

Now declared Ebola-free, Craig Spencer left New York City鈥檚 Bellevue Hospital on Tuesday. How will he be received by a wary public? After returning from treating Ebola patients in West Africa last month, Dr. Spencer traveled around town in an Uber cab, went bowling and rode the subway hours before being diagnosed with the virus. He thus earned widespread condemnation in the media, charged with 鈥渟elfishness,鈥 鈥渟olipsism鈥 and worse. ... Maybe it鈥檚 time to reconsider. (David Feith, 11/11)

The most positive aspect of health care reform is the widespread recognition of the complexity of the primary care of patients with chronic multiple comorbid illnesses. This includes the way in which frontline clinicians prioritize care needs in the context of numerous competing risks and value judgments, as well as the management of complex care transitions and the coordination of teams deployed to reflect the integration of all necessary care components. Mental health services, in this case to address dementia and depression in old age, must become a much higher priority in the health care system of the future. (Dr. Constantine G. Lyketsos, 11/11)

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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