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Monday, Feb 9 2015

Full Issue

Viewpoints: Jindal-Ponnuru Debate GOP's Health Plan; Va.'s 'Massive Resistance' On Medicaid

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

[W]e favor eliminating Obamacare, capping the tax break for employer-provided coverage, and providing everyone who doesn't have such coverage with a tax credit that could be used to buy insurance that (at least) covers catastrophic health expenses. Louisiana Governor Bobby Jindal disagrees, favoring an alternative that would result in millions of people losing their coverage and deriding the higher-coverage proposals of other conservatives as "Obamacare Lite." In response to my criticism of his idea, Jindal argues that his plan would have the advantage of lowering insurance premiums, and that the disadvantage I mention -- it would result in millions of people losing their health insurance -- is a "feature" rather than a "bug." (Ramesh Ponnuru, 2/6)

In critiquing my proposal, Ponnuru falls into the typical trap of the left -- to evaluate a health plan primarily, if not exclusively, by how many people it provides with insurance cards, regardless of whether those cards translate into affordable deductibles or access to doctors. I fundamentally disagree with that premise. The American people are worried first and foremost about the rising cost of health coverage -- it's what makes their health care unaffordable, and Obamacare unsustainable. (La. Gov. Bobby Jindal, 2/6)

Sixty years after Virginia waged a campaign of 鈥渕assive resistance鈥 against integrating its public schools, the state is once again insisting on a policy that targets its least advantaged citizens. Even as one Republican-led state after another moves to tap available federal funds for extending health coverage to needy citizens under Medicaid, Virginia stands pat. ... Yet Republicans in Richmond, standing on the 鈥減rinciple鈥 that Virginians bear no responsibility for their least fortunate neighbors, will not budge. (2/7)

Baton Rouge, La., is about to lose one of its crucial hospital emegency rooms, and the reason is clear: The administration of Gov. Bobby Jindal has refused to expand Medicaid under the Affordable Care Act, and won't put up any other money to keep the facility open. (Michael Hiltzik, 2/6)

Just when you thought there was some hope for the nearly 4 million people Republican leaders are denying access to health coverage across the country, the 鈥渉ell no鈥 caucus struck back. Conservative Indiana Gov. Mike Pence (R) concluded negotiations with the Obama administration last week to expand Medicaid in his state. 鈥淚ndiana Medicaid Expansion May Tempt Other GOP-Led States,鈥 declared one headline. 鈥淲ill Mike Pence tip the GOP scales on Medicaid expansion?鈥 asked another. Not in Tennessee, where the state legislature on Wednesday repudiated an expansion plan that its GOP governor, Bill Haslam. (Stephen Stromberg, 2/6)

The central debate that is emerging in Republican circles is between those who support a means-tested approach to subsidizing health insurance, and those who support a uniform subsidy that is the same regardless of one鈥檚 income. This may seem like a technical and obscure debate, but it is critical to the future of Republican health reform. Plans like Burr-Hatch-Upton and my own take into account the fact that we already massively subsidize health coverage for upper-income folks, through the employer tax exclusion and Medicare. They try to balance that out by offering comparable help to the uninsured, and limiting the tax break for high earners. ... An alternative approach鈥攅mbraced by groups like the 2017 Project鈥攑refers a uniform tax credit that would be the same for the poor and the rich. (Avik Roy, 2/5)

A New York Times article last weekend explained how the administration has moved to lessen the impact of Obamacare鈥檚 individual mandate 鈥渢o avoid a political firestorm.鈥 But there is a cost to taking political cover: President Barack Obama鈥檚 executive actions to blunt the mandate鈥檚 impact on the public will give future administrations an opportunity further to undermine the mandate and, with it, much of the health-care law. (Chris Jacobs, 2/7)

Opposing Obamacare in the abstract is easy enough, but it becomes more challenging when you present a specific alternative, because such cheaper alternatives inevitably cover fewer people and make consumers pay more for benefits. This explains why the House, in passing its 56th attempt at some form of Obamacare repeal this week, included no specific alternative but rather a suggestion that committees get together and come up with some ideas. (Dana Milbank, 2/6)

Gov. Steve Bullock made waves last week with the unveiling of his 鈥淗ealthy Montana Plan,鈥 which would expand Medicaid under the Affordable Care Act. He and his allies are supporting the plan with claims that the expansion will be accomplished with 鈥渇ree money鈥 from the federal government and will provide high quality health care to 70,000 people. But Montanans should not be fooled. This is nothing more than ObamaCare by another name 鈥 and it will cost Montana taxpayers hundreds of millions of dollars and do little to improve the health conditions of the most vulnerable. (Zachary Lahn, 2/9)

Many Florida newspapers, including the Orlando Sentinel, have jumped on the bandwagon to promote Medicaid expansion in the state. Pressure to encourage the state Legislature and the governor to join this parade comes largely from a coalition of hospitals and businesses called A Healthy Florida Works. They argue this is good for the state's economy and for those Floridians who don't have health insurance. Responsible state legislators should be concerned about the costs of Medicaid expansion 鈥 and the quality of the health care their state residents would receive. (Robert S. Roberts, 2/8)

President Obama鈥檚 new budget contains a farsighted proposal that could ultimately transform the practice of American medicine. The proposal seeks to design treatments for the individual, which are sometimes called 鈥減ersonalized medicine鈥 or 鈥減recision medicine鈥 to distinguish them from the one-size-tries-to-fit-all approach. Despite the potential of the program, the president鈥檚 enthusiasm may have overtaken the science at times. (2/7)

We are gutting government. It is an extreme irony of the Obama presidency that a proud liberal 鈥 someone who believes in government鈥檚 constructive role 鈥 is presiding over the harshest squeeze on government since World War II. What鈥檚 happening is simple: Spending on the elderly and health care is slowly overwhelming the rest of the federal government. Spending on other vital activities (from defense to financial regulation) is being sacrificed to cover the growing costs of a graying nation. (Robert J. Samuelson, 2/8)

Total Medicare spending, however, is still growing as a share of the federal budget and will continue to do so as more baby boomers age into the system. The best way to slow this growth is not by putting the squeeze on Medicare beneficiaries, as well as drug companies, hospitals and other providers 鈥 as President Obama鈥檚 $4 trillion budget plan would do 鈥 or by creating new bureaucratic barriers to care, but by providing Medicare recipients with incentives to seek the best care for the best price. And you do that by allowing them to share in the gains from reducing costs. (John R. Graham, 2/6)

In the president鈥檚 budget released this week, the Obama administration proposed approximately $400 billion in health-care savings. While that sounds impressive, the number might actually be less鈥攆or one proposal relies on a board that does not yet exist and that the administration has made no effort to establish. (Chris Jacobs, 2/6)

Republicans and Democrats in Congress have found something meaningful they can agree about: strengthening the nation鈥檚 response to the tragic wave of veteran suicides. On Tuesday, by a 99-to-0 vote, the Senate approved a bill to improve suicide prevention and mental health treatment programs at the Department of Veterans Affairs. (2/9)

The nonpartisan Government Accountability Office this week released a scathing report on the lack of leadership in the Department of Health and Human Services for coordinating federal efforts related to serious mental illness. It described 112 separate programs in eight federal agencies with little coordination. 鈥淭he absence of high-level coordination,鈥 the GAO concluded, 鈥渉inders the federal government鈥檚 ability to develop an overarching perspective of its programs supporting and targeting individuals with serious mental illness.鈥 The report was especially critical of the lack of any formal evaluation mechanism for the majority of the programs, so there is no way to tell whether they are working. (E. Fuller Torrey and Doris A. Fuller, 2/6)

A new analysis from New York Attorney General Eric T. Schneiderman suggests that Americans are spending billions of dollars a year on ground up radish, rice mustard, primrose, alfalfa, spruce and houseplants. If this sounds like the most unappetizing plate at an avant-garde vegan restaurant, think again: It鈥檚 what the attorney general found when his office conducted DNA testing on six popular dietary supplements sold as house brands at four major retailers 鈥 GNC, Target, Wal-Mart and Walgreens. (2/7)

An investigation of herbal supplements by the New York State attorney general鈥檚 office carries a sobering message for the rest of the nation as well. The investigation looked at the store brands of well-known herbal products sold by four prominent national retailers: GNC, Target, Walgreens and Walmart. Among the popular products examined were ginkgo biloba, St. John鈥檚 wort and ginseng pills. Four out of five of the products tested did not include any of the herbs listed on their labels. Even worse, hidden ingredients and contaminants could be dangerous to people with allergies to those substances. (2/6)

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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