Viewpoints: Obama Must Address Health Law 'Train Wreck;' GOP Rebranding Effort Spurs Revolt; Will Health Law Help Or Hurt Democrats In Next Campaign?

Reuters: President Must Address Obamacare 'Train Wreck'
When even a key architect of Obamacare says the law's implementation will resemble a "train wreck," it is clear that its biggest remaining supporters need to finally level with the American people about what’s in store — starting with President Barack Obama. The president must step into the breach and explain to the public that skyrocketing premiums and a raft of new taxes, penalties and fees are coming their way (Sen. Mitch McConnell, R-Ky., 4/24).

The Washington Post: Fight Club On The Hill
Republican leaders had scheduled a vote in the chamber for Wednesday on a plan to help people with preexisting health problems get insurance — part of a broader scheme by Majority Leader Eric Cantor (Va.) to make Republicans appear to care about the little guy. But the conservatives lunching in the Rayburn House Office Building weren't biting. … In this case, Democrats opposed the bill because it proposed changes to Obamacare, which they considered an attempt to undermine the program. That meant the measure would pass only with near-unanimous Republican support, which seemed unlikely because conservative groups such as the Club for Growth and the Heritage Foundation spinoff Heritage Action opposed it, arguing that it wouldn't repeal Obamacare (Dana Milbank, 4/24). 

Bloomberg: Republicans Will Clobber Obamacare Until They Hug It
The Affordable Care Act is the law of the land, and the Obama administration is legally bound to implement it. Having denied the necessary funding to do so, Republicans now want to hinder the administration’s ability to transfer other funding, to ensure that Obamacare becomes the disaster Republicans have promised. The more horrendous the rollout, the more effectively Republicans can run against Obamacare in 2014. That might work: I wouldn’t be surprised to see Obamacare end up as a net negative for Democrats in the 2014 election -- much as Medicare Part D was for Republicans in 2006. But by the 2016 presidential election, it’s likely to be a law that Democrats brag about and Republicans scamper to get behind. And the final act of this depressing little political play will be Republicans embracing this policy that they did everything to destroy, and trying to build on it (Ezra Klein, 4/24).

JAMA Psychiatry: Two Steps Forward, One Step Back?
The Supreme Court ruling in the case of National Federation of Independent Business v Sebelius to uphold most of the significant pieces of the ACA, but permit states to opt out of the ACA's Medicaid expansions while still maintaining their current Medicaid funding, may have major consequences for Americans with mental disorders. ... Currently uninsured individuals in states that choose not to expand Medicaid who have income greater than 100% of the federal poverty line will receive subsidies to participate in the exchanges, while the population below the poverty line, which has disproportionately high levels of mental disorders, will likely remain uninsured. Therefore, people with mental disorders who live in states that do not participate in the Medicaid expansion may have much to lose compared with the residents of states that fully expand Medicaid (Ezra Golberstein and Susan H. Busch, 4/24).

Indianapolis Star: Why Indiana Shouldn't Fall For Obamacare's Medicaid Expansion
Ever since the Supreme Court let states opt out of the new health-care law's Medicaid expansion, supporters have been pressuring them to opt in. Before dissecting the supporters' unbelievable arguments, it's important to look at what they're asking states to expand. Medicaid already spends $460 billion annually, ostensibly on health care for the poor. A lot of that money never reaches the poor. Shady providers, drug dealers, organized criminals, states and even middle-class families all take a big slice. Medicaid fraud and abuse cost taxpayers maybe $100 billion annually. Meanwhile, many enrollees can't even find a doctor (Michael Cannon, 4/24).

The New England Journal of Medicine: The Medical Device Excise Tax — Over before It Begins?
The uncertainty surrounding the medical device excise tax raises unsettling questions about other future efforts to tackle rising health care costs in the context of the ACA's expansion of health insurance. The legislation to repeal the tax was sponsored and supported by Democrats who also initially supported the ACA, from states such as Minnesota that are home to large medical device companies. No player in the health care arena that is currently entrenched in the patchwork U.S. system is likely to volunteer to receive payment reductions, new levies, or fewer choices in order to fund expanded coverage and other initiatives included in the ACA. Losing the revenue that would have been provided by the medical device excise tax would not by itself cause the ACA to crumble, but it would send a powerful signal to other groups and their lobbyists about the law's vulnerability to piecemeal erosion (Dr. Daniel B. Kramer and Dr. Aaron S. Kesselheim, 4/25).

Los Angeles Times' Capitol Journal: Obamacare Fuels Turf War
Obamacare is supplying fresh ammunition for one of the oldest turf wars in Sacramento. It pits doctors — represented by the politically powerful California Medical Assn. — defending their turf against other medical providers. They're nurse practitioners, optometrists and pharmacists. In political speak, it's about "scope of practice" — the type of medical care non-doctors are allowed to provide. The war has been waged for many decades, at times also involving chiropractors, podiatrists and any number of medical professions trying to encroach on the docs' terrain (George Skelton, 4/24).

Journal of the American Medical Association: Are Health Insurers' Administrative Costs Too High Or Too Low?
There are few minutiae of health care economics that policy wonks love to fight about more than insurers' administrative costs. These are costs for things like management and marketing that are not directly related to care delivery. Are they too high or too low? To many, this would seem a strange question. Who wants to pay more in administrative costs? I'll get to that (Austin Frakt, 4/24).

JAMA Psychiatry: Public Safety, Mental Disorders, And Guns
Violence is a complex, multicausal phenomenon, and its prevention requires attention to the means used to perpetrate violence; in the United States of the 21st century, that means guns. Pointing the finger at people with mental illness as the cause of the problem of violence in this country is misleading, counterproductive, and just plain mean (Dr. Paul S. Appelbaum, 4/24).

Roll Call: Noseworthy: Not All Health Care Is Equal
In America, we've come to expect the best of everything. However, when it comes to health care, we pay more in this country than anywhere else in the world — yet the United States falls behind other countries on measures of health outcomes. Millions of Americans do not have or cannot afford the health care they need. We need to rethink how we pay for health care and develop differentiated payment models across the spectrum of primary, intermediate and complex care (John Noseworthy, 4/24).

Baltimore Sun: The Myths That Undermine Medicare And Social Security
The talk in Washington and among opinion leaders around the country's budget issues today centers on "balance" and "responsibility." Many conservatives declare that these terms mean that there should be no new revenue, only spending cuts to programs such as Social Security and Medicare. They also propose to reduce cost of living adjustments for all Social Security recipients, a group of Americans who have seen traditional pensions eliminated and savings devastated by the Great Recession — and who rely more and more on our Social Security system, into which they paid during their entire working lives (Frank Stell, 4/23).

Des Moines Register: 'Medical Repatriation' Is A Troubling Practice
Jacinto Cruz and Jose Rodriguez-Saldana were among those caught at the intersection of perhaps the two most dysfunctional systems in the United States, immigration and health care. The two had health insurance through their jobs at Iowa Select Farms, but neither had legal permission to live in the United States. Then they were badly injured in a car accident on the way home from a fishing trip in 2008. According to the Associated Press, Iowa Methodist Medical Center contemplated what to do with the men. Though their insurance paid more than $100,000 for their treatment, it was unclear whether it would cover needed, long-term care. Two rehabilitation centers refused to admit them. So the hospital put the comatose men on an airplane to a hospital in Mexico. Both survived, but they have debilitating injuries (4/24). 

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