Viewpoints: 'Death Throes' Of Health Law Opponents; Ryan's Plan On Entitlements May Offer Way Out Of Budget Crisis

WBUR Cognoscenti blog: Obamacare 101: Promise, Pitfalls And Predictions
Politically, the biggest challenges facing the ACA are behind us. By my count, the law has already survived three near-death experiences: the Democrats' loss of a filibuster-proof Senate majority with the election of Scott Brown in Jan. 2010, the Supreme Court's June 2012 decision upholding (with one exception) the law's constitutionality, and President Obama's re-election last Nov. Much of what we see going on in Washington now is the death throes of the opposition, especially now that Americans are beginning to sign up for coverage (John McDonough, 10/9).

The New York Times' Taking Note: A New Danger For Democrats: Boehner's Delegation
Speaker John Boehner isn't taking the House Tea Party coalition with him to the White House on Thursday. Though President Obama invited the entire Republican caucus to discuss the budget crisis, Mr. Boehner is only bringing 17 others along. … But the delegation — which Mr. Boehner provocatively called a group of "negotiators" — includes Paul Ryan, the budget chairman, and several other leaders who have been far more interested in extracting a budget deal out of the shakedown than an end to health care reform. And that poses a novel set of dangers for Democrats who may be tempted by some of the new negotiating ploys that these leaders are trying out (David Firestone, 10/9).

The Washington Post: Obamacare Saved My Family From Financial Ruin
House Speaker John Boehner and his tea party friends shut down the U.S. government because of people like me. I am the mother of an insurance hog, someone who could have blown through his lifetime limit of health coverage by the time he was 14. My son has managed to survive despite seemingly insurmountable challenges, and he wears his preexisting condition like a Super Bowl ring (Janine Urbaniak Reid, 10/9).

The Washington Post: Paul Ryan Hints At A Way To End The Political Paralysis
The House Republicans, egged on by a couple of bomb-throwing senators, are responsible for the stalemate. Having essentially won the budget battle, when Democratic senators agreed to keep the government operating at GOP-preferred spending levels, they came up with additional demands that they knew could not be met: defunding, then delaying, the Affordable Care Act. As long as their strategy was nihilism, Mr. Obama was quite right to say that negotiation would be pointless. Now Mr. Ryan, the chairman of the House Budget Committee and a former vice presidential candidate, has offered a different approach, although he doesn't explicitly label it that way. In an op-ed in the Wall Street Journal on Wednesday, Mr. Ryan proposes negotiations not over Obamacare but about "common-sense reforms of the country’s entitlement programs and tax code" (10/9).

Politico: Train Wreck: The Obamacare Rollout 
Nancy Pelosi infamously said that we had to pass the law to find out what’s in it. But the then-House speaker erroneously assumed, evidently, that people would be able to get onto the government-run exchanges created by the law. So far the law's implementation has been as ugly as its passage. Judging by the haphazard rollout — incomprehensible error messages have been the norm, and the federal website has had to be taken offline several times — you'd guess that this was a back-burner project for the Obama administration, or the start-date for the exchanges had been sprung on it a few weeks ago. Of course, it is the president's most cherished initiative, and his team has had more than three years to get the exchanges up and running (Rich Lowry, 10/10).

Houston Chronicle: Gov. Perry's Political Health Care Circus Will Cost Texans Billions
The only questions left to answer are whether states such as Texas will create barriers to implementing these good changes and whether they'll expand Medicaid to cover, in our case, about 1.3 million to 1.7 million more uninsured citizens. The federal government would pick up nearly all of the costs of the expansion. So far, the tragic answers are "yes" to barriers and "no" to more people being covered. Gov. Rick Perry and others have made a political circus out of health care in Texas by turning their backs on billions of your tax dollars that now won't come back to Texas for your benefit (State Sen. Kirk Watson, 10/8).

Houston Chronicle: Congress Doesn't Need Health Subsidies
Those following the debate in Congress over President Barack Obama's health care reform law are by now well-versed in the arguments over health care exchanges, the rising costs of premiums and deep cuts to Medicare. I represent a diverse House district with different perspectives and understand that there will be differences of opinion over our nation's health care system But one aspect of the health care law seems to unite just about all my constituents: how it applies to members of Congress, the president and his appointees (Rep. Michael McCaul, R-Texas, 10/9).

Houston Chronicle: Affordable Care Act Brings Health Benefits To Texans
Yet opponents of the law drown out this positive news with shrill distortions. The latest myth rattling around is that Congress and their staff are exempted from the Affordable Care Act. That is not true. Members and their staff will be moved from their current coverage and required to seek insurance in the marketplace; their employer, the federal government, will continue to contribute to the premiums -just like everyone else in the private sector with employer-sponsored premiums (Rep. Joaquín Castro, D-Texas, 10/9).

The Washington Times: The Obamacare 'Myth' Becomes All Too Real
On health care, the president's pile of broken promises keeps getting a little higher. Consider this gem from Aug. 20, 2009: "Let's be clear about the fact that nobody has proposed anything close to a government takeover of health care." Well, yes, somebody did. President Obama is now well on his way to orchestrating the federal government’s "takeover" of Americans' health care (Robert E. Moffit, 10/9).

Jackson Clarion-Ledger: Mississippi's Medicaid Opt-Out Creates A Gap For Working People
There's nothing new about spreading the cost of health care or any other risk among a lot of people. That's what insurance does. The big difference is having government and tax funds in the picture. Too many wrongly think Obamacare is a handout. There's great concern that giving people access to health insurance is a disincentive, but think about that (Charlie Mitchell, 10/9).

National Review: The Politics Of Federalizing Medicaid Dual Eligibles
Though I assume the architects of the health law thought deeply about the politics of Medicaid expansion, one wonders if advocates of coverage expansion made a mistake. Rather than convincing states to expand eligibility by promising to meet the cost of new beneficiaries, Congress might have proposed fully federalizing the costs associated with the dual eligible population. This would obviously have benefited some states (like North Dakota) much more than others (like Arizona), yet it would relieve all states of a fast-growing burden. And by consolidating responsibility for the dual eligible population, one assumes that the Medicare program could achieve efficiencies by eliminating the buck-passing dynamic, in which one system attempts to shunt off costs to another (10/9).

The Seattle Times: EU Ambassador Surprised By Shutdown Over Obamacare
On Tuesday, our editorial board met with Joao Vale de Almeida, the first European Union Ambassador to the United States. On tour to promote U.S.-European relations, he expressed surprise House Republican leaders are holding a vote on a federal budget hostage unless Obamacare is repealed. "People in Europe sometimes have trouble understanding your health care debate particularly after legislation was passed," de Almeida says. "(President Barack Obama) was reelected and the Supreme Court ruled. In Europe, health care is much less controversial and ideological, so it’s unlikely to risk the functioning of the government" (Tan, 10/9).

JAMA: The Affordable Care Act After Week 1: What We Know And What We Don't Yet Know
It is now common knowledge that the new health insurance marketplaces (also known as "exchanges") created under the Affordable Care Act (ACA) got off to a rocky start last week. Indeed, it's possible that more Americans now know about the technical glitches experienced by the exchanges than even knew open enrollment was beginning October 1 (Larry Levitt, 10/9).

The San Francisco Chronicle: Tales Of Obamacare Love And Betrayal
In response to my Tuesday column about Obamacare, a Santa Cruz man who describes himself as a "staunch" Obama supporter tells me he feels "betrayed." Anthem sent him a notice that his private plan, which also covers his spouse, ends Jan. 1. But he is eligible for a comparable Affordable Care Act plan. Alas, the premiums will rise from $766 to $1,251 per month.  He was angry before because he wanted a European-style single payer system, but he wrote, "Honestly I gave this little thought because I knew I could keep what I had, but as it turns out, this apparently is not possible" (Debra J. Saunders, 10/10).

Health Policy Solutions (a Colo. news service): On The Health Exchange Rollout, Take The Long View
The new health insurance marketplaces, or exchanges, opened a week ago. Even though we are only a few days into a six-month enrollment period, pundits on all sides have used the rollout to forecast the success or failure of the new health care law. When reading the instant-analysis accounts, it’s best keep in mind that there is a great deal more to the health care reform law than the new marketplaces. And the success of these marketplaces will be clear only after they have been in business a whole lot longer than a week. The current open-enrollment period continues until the end of March 2014, and that gives the federal and state exchange websites time to correct problems that are inevitable with such large and complex IT systems (Bob Semro, 10/9).

And on other issues --

Los Angeles Times: New California Abortion Law: More Dangerous Than Skydiving
At a time when so many states are chipping away at reproductive rights, making it nearly impossible for women to exercise their constitutional right to terminate a pregnancy, how refreshing to see California standing up for women's rights. On Wednesday, Gov. Jerry Brown signed a bill into law that gives some medical professionals who are not doctors the right to perform early abortions. The bill, introduced by Democratic Assemblywoman Toni Atkins of San Diego, followed a years-long pilot program involving more than 11,000 women who underwent first-trimester abortions. Half of the procedures were done by physicians, the other half by nurse practitioners, certified nurse midwives and physician assistants (Robin Abcarian, 10/9).

Los Angeles Times: In Medicine, More Care May Not Be Better
The dull whir of the computer running in the background seemed to have gotten louder as the patient fell quiet. She was a young woman, a primary-care patient of mine, seeking a referral to yet another gastroenterologist. Her abdominal pain had already been checked out by two of the city's most renowned gastroenterologists with invasive testing, CAT scans and endoscopic procedures. But she wasn't satisfied with her diagnosis — irritable bowel syndrome — or the recommended treatment and wanted a third opinion. I tried to reason with her but failed to convince her otherwise. Even when I acquiesced and gave her the referral, she walked out visibly unhappy. I sat there listening to the whirring, feeling disappointed (Haider Javed Warraich, 10/10).

New England Journal of Medicine: Professionalism and Caring for Medicaid Patients — The 5% Commitment?
Medicaid is an important federal–state partnership that provides health insurance for more than one fifth of the U.S. population — 73 million low-income people in 2012. The Affordable Care Act will expand Medicaid coverage to millions more. But 30% of office-based physicians do not accept new Medicaid patients, and in some specialties, the rate of nonacceptance is much higher — for example, 40% in orthopedics, 44% in general internal medicine, 45% in dermatology, and 56% in psychiatry. Physicians practicing in higher-income areas are less likely to accept new Medicaid patients (Dr. Lawrence P. Casalino, 10/9).  

Health Policy Solutions (a Colo. news service): A Path To Pay For Integrated Health Care
Patients’ mental and physical health problems are interwoven, especially for the chronically ill. The vast majority of patients with chronic diseases such as diabetes, congestive heart failure, asthma, lung disease and others have co-occurring mental health and/or substance use issues. And there is significant evidence that integrating primary and behavioral health care leads to improved outcomes and reduced costs of care. Yet few payers, either public or private, pay for integrated care. Why is that, and what can be done to change it? (Edie Sonn, 10/9).

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