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Thursday, Mar 19 2015

Full Issue

Viewpoints: House Budget Promises; Shifting Medicare Costs; Abortion Restrictions

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

Describing its proposed budget resolution for fiscal 2016, the House Budget Committee declares, "This budget repeals Obamacare in its entirety -- including all of the tax increases, regulations, subsidies and mandates." It adds that the resolution also repeals the more than $700 billion in Medicare reductions made by the healthcare law, along with the expansion in Medicare. Only it does none of those things. (Jon Healey, 3/18)

That isn鈥檛 to say the budget is free of gimmickry or outlandish projections (we鈥檒l get to that in a moment). But let鈥檚 look at some of the rather notable things it would do. ... Turn Medicare into a voucher program. ... Roll back the Affordable Care Act鈥檚 expansion of Medicaid and lay the groundwork for further cuts. ... Repeal the rest of the ACA. ... Sure, the White House is going to criticize it, because the Democrats鈥 priorities are very different. Now we can have a debate. Should we turn Medicare into a voucher program? Should we toss millions of people off Medicaid and take away the subsidies that allow millions more to afford insurance? Should we cut food stamps and education grants? What are the alternatives? (Paul Waldman, 3/18)

One ramification of the proposed $137 billion increase in deficit spending: Seniors would fund a significant portion. As CBO noted in its 2009 score of an earlier, unsuccessful SGR repeal bill: 鈥淏eneficiaries enrolled in Part B of Medicare pay premiums that offset about 25 percent of the costs of those benefits. ... Therefore, about one-quarter of the increase in Medicare spending would be offset by changes in those premium receipts.鈥 The House Republican leadership is well aware of the premium effects of an unpaid-for SGR repeal. When then-Speaker Pelosi brought an unpaid-for SGR repeal bill to the House floor in November 2009, then-Minority Leader Boehner called it an 鈥渁bsolute train wreck,鈥 because it 鈥渇orces seniors to pay higher premiums.鈥(Chris Jacobs, 3/18)

The proposed bipartisan House deal to repeal and replace Medicare's hated sustainable growth-rate physician payment system offers Republicans a chance to make two significant benefit changes they've long sought. Now it remains to be seen if they can accept and lock in that victory. It also raises the question of what Democrats, if they help enact the SGR bill, would have left to offer when Republicans come back the next time 鈥 probably quite soon 鈥 with more and bigger demands to revamp and reduce spending on Medicare. (Harris Meyer, 3/18)

Medicare Advantage (MA) is a $150-billion-plus-a-year program that pays insurance companies to enroll elderly and disabled clients in managed-care plans 鈥 unlike traditional Medicare, which reimburses health-care providers directly on a fee-for-service basis. About 16 million people participate in MA, roughly a third of the Medicare-eligible population. MA plans absorb a similar share of Medicare鈥檚 $450鈥塨illion annual outlays. Intended as a more efficient alternative, MA has never quite lived up to this promise 鈥 at least not in any generally agreed-upon sense. (Charles Lane, 3/18)

The number of people who say they have been helped by the law (19%) is also about the same as the number who say they have been hurt by it (22%). Most people鈥57%鈥搒ay that they have not been affected. Opinion has been little influenced by the King v. Burwell case recently argued before the Supreme Court; the poll found that the public has not been following the King case much at all. Just over half (53%) of the public say they have heard nothing about the case, and 25% say they have heard a little, while about two in 10 say they have heard at least something about the case. (Drew Altman, 3/19)

Other than hard-core partisan Republicans, no one would blame Obama if her insurance disappeared under President Scott Walker and a Republican Congress. Indeed, the dynamic would flip: Republicans would suddenly be blamed for every health-care policy problem, whether it was caused by repeal or not. Even a successful replacement plan wouldn鈥檛 shield Republicans from blame -- all legislation requires trade-offs, and most of the time the losers care more than the winners. But passing a successful replacement for Obamacare would be extraordinarily difficult. (Jonathan Bernstein, 3/18)

State legislatures across the country continue to concoct new ways to restrict a woman's constitutional right to a legal abortion. Already this year, four states, including New York, have introduced legislation that would force women to wait for periods of 24 to 72 hours between receiving state-mandated abortion counseling and undergoing the procedure. Among the 26 states that already have such waiting periods, four have introduced bills to make them longer. (3/18)

California Attorney General Kamala Harris is running for Senate, and some liberals call her a future President. So it鈥檚 worth putting on the record how she blew up a deal by Prime Healthcare Services to rescue a group of struggling Catholic hospitals so she could curry favor with the Service Employees International Union (SEIU). (3/18)

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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