�鶹Ů��

Legislators in Arkansas, New Hampshire, South Dakota and elsewhere have spent the past three months considering whether they should expand Medicaid under the terms of the Affordable Care Act, or renew their previous commitment to do so. But new projections by the Congressional Budget Office (CBO) and Joint Committee on Taxation (JCT) indicate the federal government’s cost of Medicaid expansion over the next decade will be significantly higher than originally expected. This raises serious questions about the program’s financial viability. (Justin Haskins, 4/7)

Even before Obamacare became the law of the land, the U.S. health-care system was undergoing a dramatic transformation. Millions of people were shifting from generous health-insurance plans to consumer-directed ones that pair low monthly premiums with high out-of-pocket costs. This shift has been encouraged by employers eager to reduce the cost of employee benefits. It has also been encouraged by market enthusiasts who contend that the U.S. health-care system needs to be more like the traditional consumer economy. (Peter Ubel, 4/8)

When it announced its record-setting $160-billion merger with Allergan, the maker of Botox, last November, the giant drug company Pfizer tried valiantly to pretend that the deal wasn't mostly about cutting its tax bill. "We are doing this because of the strategic importance of the franchises, the revenue growth we believe we can get within the U.S. and internationally, and the importance to combine the research approaches," Pfizer CEO Ian Read told investment analysts on Nov. 23, after the merger was announced. He also said, a bit lamely: "I want to stress that we are not doing this transaction simply as a tax transaction." (Michael Hiltzik, 4/6)

Donald J. Trump wants to build a bricks-and-mortar wall to keep immigrants out of the United States. President Obama wants to build a virtual wall to keep companies from leaving. Neither is likely to work. On Monday, the Treasury Department issued new regulations in an attempt to limit “inversions” — in which American companies are acquired by foreign companies, legally lowering the tax burden of American companies. Speaking at the White House, Mr. Obama said, “We shouldn’t make it legal to engage in transactions just to avoid taxes.” (Diana Furchtogott-Roth, 4/7)

The signs directing people to a big nonprofit gala at a downtown hotel last week were oddly neutral. Stylized placards with a pretty bluebonnet motif announced “2016 annual awards luncheon.” They didn’t say what luncheon. Times being what they are, it was understandable. It wasn’t a secret that this was the big spring fundraiser for Planned Parenthood of Greater Texas, but it wasn’t overtly publicized, either. (Jacquielynn Floyd, 4/7)

Thirty years ago Paul Simon immortalized one of the first animal-human transplants with the lyrics, “These are the days of miracle and wonder.… Medicine is magical and magical is art. Thinking of the boy in the bubble and the baby with the baboon heart.” Today we face the possibility of babies getting organs grown in human/nonhuman chimeras — beasts that are pigs except for a single human organ. To the uninitiated, this may sound more like the dark arts than modern medicine, but pursuing careful research and potential clinical use of these chimeras is both proper and important. Every day about 30 Americans die because they can't get an organ transplant. Upward of 120,000 Americans are on transplant waiting lists. We are, medically, on the cusp of being able to save these lives in new ways: repairing failing organs with new genes or stem cells, building mechanical organs and growing replacement organs. (Henry T. Greely, 4/7)