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There is considerable talk by pundits and members of Congress that the best weapon Republicans have to accomplish their agenda is something called “reconciliation.” ... The budget does not affect entitlement spending — unless, and here is the kicker, the budget includes “reconciliation” instructions. Those instructions specifically direct the committees with jurisdiction over entitlements such as Medicare, Medicaid, Social Security, farm subsidies, student loans and veterans benefits to change those programs to save a specific amount of money. This then triggers a crucial moment. Any of the changes to entitlements under reconciliation must meet something called the Byrd Rule. This requires (to simplify) that the primary result of the changes must be to reduce entitlement spending, not to change the policy purposes of the entitlement. (Judd Gregg, 1/5)

The problem with grandiose ultimatums — such as defunding ObamaCare or else — is not merely their predictable result of accomplishing zero. They also undermine the intelligent if undramatic tactics that, at the margins over time, can change how government works. Conservatives in the House are naturally frustrated by the lack of progress on larger tax and entitlement reform, but they’ve been too quick to elevate tactical disagreements into psychodramas. (1/5)

Congressional Republican leaders are eager to prove to themselves and the nation they can govern. Incoming Senate Majority Leader Mitch McConnell went so far as to tell The Post today that his goal is to make the GOP less “scary.” That’s nice. Pity the party’s obsession with the repeal of the Affordable Care Act (ACA) is going to make that as elusive a goal as McConnell’s other stated ambition. The Supreme Court is about to hear arguments in a case that seeks to void the federal health insurance subsidies of Obamacare, thereby gutting the law. (Jonathan Capehart, 1/5)

The key to which path the Affordable Care Act takes is how the Supreme Court rules in King v. Burwell, the case that concerns whether subsidies in the health law can be provided to millions of low- and middle-income enrollees in states with federally run insurance marketplaces. The effect on people as well as politics could be substantial. A decision for the plaintiffs would deny insurance subsidies for millions, threaten the viability of the marketplaces, and potentially throw the ACA back into the congressional arena (and onto front pages nationwide). Partisan debate about the health-care law could reignite nationwide. (Drew Altman, 1/6)

Jan. 1 was a red-letter day for America's provision of healthcare to its poorest residents -- and we do mean red. That was the expiration day of a two-year bump in Medicaid reimbursements for primary care physicians seeing Medicaid patients. The raise, which was part of the Affordable Care Act, temporarily raised Medicaid rates to the level of Medicare reimbursements; the expiration means a drop averaging nearly 43 percent nationwide, according to calculations by the Urban Institute. (Michael Hiltzik, 1/5)

If you thought it was getting increasingly difficult for Medicare and Medicaid patients to see a doctor, you’re right — and that problem may get even worse in 2015. Doctors who still accept Medicare patients could see an average reduction of 21.2 percent in Medicare reimbursement rates, according the Department of Health and Human Services. And a new Urban Institute study claims primary care physicians who still take Medicaid patients could see an average reduction of 42.8 percent. Think those pay cuts just might affect access to medical care? At issue is what the Affordable Care Act, or Obamacare, did and did not do. (Merrill Matthews, 1/5)

This tax-filing season brings the first enforcement of the Affordable Care Act’s individual mandate – the complexity of which could become a boon for tax-preparation firms. The instructions for completing the mandate exemption form run 12 pages, list 19 types of exemptions (with multiple codes), and include worksheets that may require individuals to go to their state exchange’s Web site to find the monthly premiums that will determine whether they had access to “affordable” coverage. (Chris Jacobs, 1/5)

"Deplorable, deeply regressive, a sign of the corporatization of the university." That's what Harvard Classics professor Richard F. Thomas calls the changes in Harvard's health plan, which have a large number of the faculty up in arms. Are Harvard professors being forced onto Medicaid? Has their employer denied coverage for cancer treatment? Do they need to sign a corporate loyalty oath in order to access health insurance? Not exactly. But copayments are being raised and deductibles altered, making their plan ... well, actually, their plan is still extraordinarily generous by any standard .... The deepest irony is, of course, that Harvard professors helped to design Obamacare. And Obamacare is the reason that these changes are probably necessary. (Megan McArdle, 1/5)

When hospital chains swallow physician practices, it’s time to beware of anti-competitive pricing. Charges at the doctor’s office can suddenly jump to the much higher charges of hospitals. (Jim Landers, 1/5)

Florida’s impoverished children need legislative champions on both sides of the aisle — again. Last week, a federal judge blasted the state of Florida for shortchanging poor and disabled children and the pediatricians who care for them by setting the state’s Medicaid budget at an abysmally and artificially low level for at least 10 years. As a result of the state’s dereliction, many pediatricians across the state dropped out of the program, meaning thousands of children are denied lower-cost preventive medical and dental care. (1/5)

One of the most difficult aspects to evaluate [when choosing a health plan] may be the adequacy of “provider networks” (ie, the specific people and institutions from whom enrollees can get care with full insurance coverage or the lowest copayments offered by their plan). Is there a reasonable choice among primary care clinicians, specialists, and hospitals? There is clearly a big difference to patients between having a “reasonable” number of physicians in the network and having their physician in the network. Compared with other aspects of the plans, the law offers relatively little on which consumers can rely. (Katherine Baicker and Helen Levy, 1/5)

Robert J. Beall, the president and chief executive of the Cystic Fibrosis Foundation, called his recent decision to sell the royalty rights to his organization’s research a “game changer.” Indeed: Deals like this, in which an investment company paid the foundation $3.3 billion for its future royalties from several cystic fibrosis drugs it helped finance, could revolutionize the way medical research is funded. Rather than the staid model of government-funded institutions handing out grants to academic research facilities, a new breed of “venture philanthropies” like the Cystic Fibrosis Foundation could corral private investment into developing lifesaving drugs quickly and cheaply. (Llewellyn Hinkes-Jones, 1/5)

Should the FDA regulate laboratory-developed diagnostic tests? — Yes. ... Laboratory-developed tests exist in a regulatory crevice. Because of its broad statutory authority over products “intended for use in the diagnosis of disease or other conditions,” the FDA considers laboratory-developed tests under its jurisdiction. Yet for many years, the FDA has taken the position that there were too few of these tests, and that they were of sufficiently low risk, to merit oversight. As a result, tests “designed, manufactured, and used within a single laboratory” are not subject to the standards for quality and validity applicable to other diagnostic tests, such as those made by medical device manufacturers. (Joshua Sharfstein, 1/5)

Should the FDA regulate laboratory-developed diagnostic tests? — No. ... In November 2014, the US Food and Drug Administration (FDA) revealed its intent to regulate thousands of medical diagnostic tests being performed in as many as 11 000 clinical laboratories throughout the United States, focusing especially on genomic medicine. Although the FDA is well intentioned, the current plan for regulation is unnecessary and, if carried out, could result in the closure of many laboratories, undermine innovation, and potentially limit patient choice. Moreover, the proposed regulation, if unchanged, is likely to lead to thousands of laboratory submissions to the FDA, for which its own staffing capacity is tenuous at best. (James P. Evans and Michael S. Watson, 1/5)