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Thursday, Feb 16 2017

Full Issue

Viewpoints: Will The IRS Do In Obamacare Or Is The Sweeping Health Law Here To Stay Despite Attack?

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

The burgeoning crisis over President Trump鈥檚 and former national security adviser Michael Flynn鈥檚 connections to Russia makes the already difficult task of repealing and replacing the Affordable Care Act even more confounding for Republicans, who won the White House and both houses of Congress based on unrealistic expectations about an as-yet-unidentified replacement plan. (Jennifer Rubin, 2/15)

The last 24 hours have been one long string of bad news for Obamacare. Tuesday, the insurer Humana announced that it would be pulling out of the exchanges for next year. Then聽we found out that the IRS had responded to Trump鈥檚 executive order on Obamacare by quietly rolling back a new rule planned for this year, which would have required filers to indicate whether they had maintained coverage in 2016 or to pay a penalty. And on Wednesday, word came that Mark Bertolini, the CEO of Aetna, had told a Wall Street Journal conference that Obamacare was in a death spiral. This stands in pretty stark contrast to claims by Andy Slavitt, who ran the Center for Medicare and Medicaid Services under President Barack Obama, that things were shaping up splendidly for 2018, so long as Republicans didn鈥檛 screw anything up. (Megan McArdle, 2/15)

The Internal Revenue Service has become the first agency to follow President Trump鈥檚 directive to start undermining the Affordable Care Act.聽In a quiet rule change, but an important one, the IRS has told tax preparers and software firms that it won鈥檛 automatically reject tax returns that fail to聽state whether the tax filer had health insurance during the year. That effectively loosens enforcement of the ACA鈥檚 individual mandate. It appears to be a direct response to Trump鈥檚 Jan. 20 executive order聽requiring federal agencies 鈥渕inimize ... the economic and regulatory burdens of the Act.鈥 (Michael Hiltzik, 2/15)

If you want to keep your health insurance status a secret from the I.R.S., the Trump administration just made it a little easier. The policy change, confirmed by the I.R.S. on Wednesday after elements were reported by the libertarian magazine Reason, does not do away with the Affordable Care Act鈥檚 requirement that all Americans who can afford it obtain health insurance or pay a fine. But it might make it a little harder for the I.R.S. to figure out who is breaking the rules. (Margot Sanger-Katz, 2/15)

Now that Tom Price has been confirmed as Secretary of Health and Human Services, it's time to examine what he has in store for Medicare. He backs "premium support," which is the GOP's backdoor plan to privatize the system. Although GOP leaders such as House Speaker Paul Ryan have said that privatization is the only way to save Medicare -- it's not -- there are some dangerous drawbacks for retirees. (John Wasik, 2/15)

One reason health insurance premiums exploded under the Affordable Care Act is the law鈥檚 requirement that health insurers accept anyone who applied for individual coverage, known as guaranteed issue. The provision destroys an insurance market because it allows people to wait until a medical incident has occurred to get coverage. (Merrill Matthews and Mark Litow, 2/16)

The election of President Donald Trump and a Republican-controlled US Congress may once again thrust medical liability reform into the health care debate. One likely policy solution to be advocated for is to place a cap on noneconomic damages that plaintiffs can recover through lawsuits. This policy proposal is part of the GOP鈥檚 A Better Way health care platform and has been part of previous Republican proposals to limit medical malpractice torts despite concerns that federal medical liability reform, by preempting state laws, may potentially weaken successful state regulation in some cases. (Anand Parekh and G. William Hoagland, 2/15)

If the U.S. Supreme Court were to reverse Roe v. Wade, individual states could still permit abortion. But, in theory, the Supreme Court could go further, and rule that laws permitting abortion violate the equal protection rights of unborn fetuses. That may seem far-fetched -- but in his book on assisted suicide and euthanasia, Judge Neil Gorsuch lays out an argument that could easily be used to this end. (Noah Feldman, 2/16)

In 1948 the World Health Organization officially defined health as a 鈥渟tate of complete physical, mental and social well-being and not merely the absence of disease or infirmity.鈥 The definition has remained unchanged for more than 60 years. When it was adopted, tools to measure health did not exist. Indeed, it was decades before a comprehensive set of tools to measure physical, mental, and social well-being were developed. (Robert H. Brook, 2/14)

For all their dysfunction, the Republican Senate and House have managed to act with lightning speed in striking down a sensible Obama administration rule designed to stop people with severe mental problems from buying guns. President Trump, who championed the National Rifle Association agenda as a candidate, is expected to sign the regressive measure. This, despite the Republican mantra that tighter control of mentally troubled individuals 鈥 not stronger gun control 鈥 is the better way to deal with the mass shootings and gun carnage that regularly afflict the nation. (2/15)

One promising idea in a state efficiency study was having school districts join a statewide health insurance plan. But as a new audit found, such a move is complicated and would not save as much money as previously suggested. What鈥檚 more, a big share of the potential savings would be cost shifts to schoolteachers, especially in Wichita. In fact, 40 percent of the projected savings would come from shifting costs to teachers and other district employees. And of the $25 million in net cost shifts statewide, nearly $24 million would come from Wichita school district employees. (2/16)

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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