�鶹Ů��

In the fetid swamp that is America's healthcare coverage system, there has been one consistent ray of light: medical coverage for children. Credit for that belongs to the federal Children's Health Insurance Program, or CHIP, which was established in 1997 as an add-on to Medicaid with special rules and funding. Since its enactment, the uninsured rate for children under 18 has been cut in half, from 14% in 1997 to 7% in 2012. Now that progress is under threat. CHIP funding is scheduled to expire on Sept. 31. Congressional action is required to extend it. If your guess is that the Republican Congressional majority is plotting to cut the program back--if it extends funding at all--you guessed right. (Michael Hiltzik, 3/11)

A great deal is at stake here. If the plaintiffs win, individuals in 34 states—the states that have opted not to operate a state insurance exchange—will still be subject to Obamacare’s individual mandate, but they won’t qualify for federal tax subsidies. As a result, their insurance will cost more out-of-pocket. Moreover, because individuals in these 34 states won’t get tax subsidies, employers in these states won’t be subject to the employer mandate, so they won’t have to offer health insurance and can’t be taxed for failing to do so. And yet, those states would be able to continue registering their profound opposition to the entirety of the Obamacare regulatory scheme, thereby undermining its legitimacy. Given these consequences, supporters of Obamacare are pulling out all the stops to prevent a plaintiffs’ victory. (David Rivkin and Elizabeth Price Foley, 3/11)

The game of chicken, which was popularized in the 1950s movie Rebel Without a Cause, has many variants, but the basic design goes like this: players involved in a conflict of some sort try not to yield in the hope that the other player will yield first. But the worst and potentially catastrophic outcome is when no one yields. After hearing oral arguments last week, the US Supreme Court (aka SCOTUS) is deliberating in King v Burwell, a case that has the potential to unleash a massive game of chicken around the Affordable Care Act (ACA). (Larry Levitt, 3/11)

Republican heavyweight Jeb Bush, who's likely to run for president in 2016, offered his ideas this past weekend on how to repeal and replace the Affordable Care Act. But in a speech mostly devoid of details, his most concrete proposal could well worsen one of the biggest consumer problems under the ACA – high out-of-pocket costs. (Harris Meyer, 3/11)

When is this country going to wake up — really wake up — to the catastrophe that prescription opioid painkillers have caused since they came into widespread use in the early 1990s? (Charles Lane, 3/11)

One loudly trumpeted tool to create value in Medicare is the Accountable Care Organization (ACO). Unfortunately, ACOs are underwhelming and soon likely to fall off the radar screen. The ACO model never fooled the Congressional Budget Office (CBO), which estimated that in 2010 they would only save $4.9 billion through 2019 – just 11% of the total cuts to Medicare incorporated within Obamacare. ACOs are complicated contracts whereby the government and provider organizations agree to share the gains that provider organization wrings out of Medicare costs. Although we only have two years of Medicare ACO experience, their supporters are already starting to panic that ACOs are “at risk,” according to the title of a recent paper by scholars from Dartmouth College, Dartmouth-Hitchcock Health, and the Campaign to Fix The Debt. Total savings for Medicare ACOs last year were $417 million, less than 1% of Medicare spending. (John R. Graham, 3/11)

A perennial congressional battle over Medicare is about to erupt. And the result is likely to be a steep increase in the program’s long-term costs—with older Americans eventually paying many of those bills. (Philip Moeller, 3/11)

What this chart [of Congressional Budget Office historical detail] tells you right away: 1. The “nation of takers” stuff is deeply misleading. Until the economic crisis, income security had no trend at all. The only way to make it seem as if means-tested programs were exploding is to include Medicaid, which has gone up in part because of rising costs, in part because of a major expansion to cover children (all those 11-year-old bums on welfare, you know). (Paul Krugman, 3/11)

Let the finger-pointing begin! Prime Healthcare Services dropped its bid to rescue the six Daughters of Charity Health System hospitals in California this week, citing the lengthy mandates Atty. Gen. Kamala Harris placed on Prime in approving the deal. "The conditions placed on the sale by the California attorney general are so burdensome and restrictive that it would be impossible for Prime Healthcare -- or any buyer -- to make the changes needed to operate and save these hospitals,” Prime's founder and chairman, Dr. Prem Reddy, stated Tuesday. Harris responded by accusing Prime of acquiescing to the conditions during negotiations with her office, then turning around and rejecting them. (3/10)