KHN Morning Briefing

Summaries of health policy coverage from major news organizations.

Viewpoints: George Will Assails ‘Illegal’ Delay Of Employer Mandate; Cohn Reminds Conservatives That Subsidies Will Be Important

The Washington Post: Obama's Unconstitutional Steps Worse Than Nixon's
Barack Obama's increasingly grandiose claims for presidential power are inversely proportional to his shriveling presidency. Desperation fuels arrogance as, barely 200 days into the 1,462 days of his second term, his pantry of excuses for failure is bare, his domestic agenda is nonexistent and his foreign policy of empty rhetorical deadlines and redlines is floundering. And at last week's news conference he offered inconvenience as a justification for illegality. Explaining his decision to unilaterally rewrite the Affordable Care Act (ACA), he said: "I didn't simply choose to" ignore the statutory requirement for beginning in 2014 the employer mandate to provide employees with health care. No, "this was in consultation with businesses" (George Will, 8/14).

The Fiscal Times: Did Obama Flout The Law By Delaying Obamacare?
The Obama administration suffered a telling and potentially far-reaching defeat in the D.C. Circuit Court of Appeals this week on the need for the executive branch to abide by statutory law. While the issue at the center of the case involved an old and somewhat arcane controversy over nuclear waste, the implications may well alter the political calculus on immigration, drug policy and especially the rollout of Obamacare (Edward Morrissey, 8/15).

Atlanta Journal-Constitution: ObamaCare With A Human Face, And A Human Story
With all the controversy about ObamaCare, it's important to remember why the legislation was passed in the first place. Health-insurance premiums were soaring. People who had pre-existing conditions could not get coverage, particularly if you were buying insurance individually or through a small business. Health-caused bankruptcies were soaring (Jay Bookman, 8/14).

National Review Online: What Obama Can't Admit
President Barack Obama continues to insist that under the law, as he said in his pre-vacation press conference, people are going to be able to "sign up for affordable quality health insurance at a significantly cheaper rate than what they can get right now on the individual market." This has been his sales pitch for his health-care law from the beginning, and it's never been true. But admitting that Obamacare will mean higher rates for many people is too painful a concession to make, so the president simply doesn't make it, despite all the evidence contradicting his rote assurances of lower premiums (Rich Lowry, 8/13).

The New Republic: The Big Savings Obamacare Critics Miss
Obamacare provides offers tax credits to offset the cost of insurance. If your income is less than four times the poverty line, and if you're buying through one of the new insurance exchanges, then the tax credit will operate like a discount. The less money you have, the bigger the discount. Nowadays, most Obamacare critics acknowledge that the subsidies exist. But they tend to dismiss them as trivial. "Some low-income people will get subsidies," Rich Lowry of the National Review wrote on Monday. "But that doesn’t change the essential facts." Actually, it does change the essential facts—by quite a lot (Jonathan Cohn, 8/14).

The New York Times: Taking Note: Mitch McConnell Tries Leadership, Then Backs Away
Yesterday Mitch McConnell, the Senate minority leader, appeared to attempt to act like a leader by throwing cold water on the government shutdown plan, which many Republicans have endorsed as a way to stop the implementation of the Affordable Care Act. … After sounding sensible for a second, Mr. McConnell told The Washington Post’s Greg Sargent that he did not mean to "take sides in the dispute over whether to stage a shutdown confrontation. He was merely stating a fact — that even if the government is shut down, it won't stop the funding of Obamacare." To recap: Mr. McConnell knows the shutdown won't work as intended, but he's not willing to actually come down against it (Juliet Lapidos, 8/14).

The Wall Street Journal: Government Shutdown Blame Game
Republican senators like Ted Cruz of Texas and Mike Lee of Utah are urging the GOP to reject any government spending plan that includes funding for ObamaCare, which could lead to a government shutdown when the current spending bill expires on Sept. 30. If that happens, will voters blame Republicans? A new poll commissioned by Heritage Action for America, which supports defunding the health-care law, suggests that Republican lawmakers shouldn't worry because there would be little political downside to a shutdown. ... Of course, the government did shut down partially in November 1995, when we also had a Democratic president and a Republican-controlled House. A Gallup poll taken the day after the shutdown showed that by almost 2-to-1, Americans blamed Republican leaders (49%) instead of President Clinton (26%). Republicans must decide whether past is prologue (Jason L. Riley, 8/14). 

JAMA: First, Do No (Financial) Harm
"First, do no harm" is a well-established mantra of the medical profession, but it may need to be reconceptualized in an era of unsustainable health care spending. Medical bills are now a leading cause of financial harm and physicians decide what goes on the bill. The possible consequential harm is substantial, often leading to lost homes and depleted savings (Drs. Christopher Moriates, Neel T. Shah and Vineet M. Arora, 8/14).

JAMA: The Critical Role Of Caregivers In Achieving Patient-Centered Care
Achieving high-quality, cost-effective medical care remains an elusive goal of the US health care system, but there is widespread agreement that patient-centered care will be a key ingredient. Yet for frail elders and patients with advanced illness, many of whom have multiple chronic diseases, patient-centered care is impossible without caregiver involvement. ... For caregivers to make patient-centered care a reality for frail elders and those with advanced illness, they will need unprecedented education and assistance. In addition to supporting policies designed to reimburse caregivers for some of their services—proposals unlikely to be enacted, given the current political climate—the medical establishment needs to incorporate caregivers at every step of patient care (Dr. Muriel R. Gillick, 8/14).

The New York Times: Opinionator: Beautiful Pathologies
At our medical school, we have something called the organ transplant observation program, which allows students to shadow the doctors who transfer functional organs from deceased or living donors into the bodies of dying patients. ... The program is wildly popular and often a highlight of the medical school experience. This year, over half of my class signed up as soon as the forms went online. ... In medicine, a lot of our training depends on the misfortune of others. Without sick people, we cannot learn to diagnose and treat. But we sometimes forget to manage our enthusiasm for the science of disease and, in doing so, ignore the human suffering that comes with the experience of disease (Nathaniel P. Morris, 8/14). 

National Review Online: After Newtown
Following [the shooting deaths at] Newtown, Obama promised to make "access to mental health care as easy as access to guns." Obama's first step was to set up a task force under Vice President Biden to make recommendations. Biden, in turn, asked the lead government agency on mental-health services for direction. That agency, the Substance Abuse and Mental Health Services Administration (SAMHSA), is a $3.1 billion component of the Department of Health and Human Services. SAMHSA's official mission is to reduce "the impact of substance abuse and mental illness on America's communities." The only problem is that SAMHSA knows nothing about severe mental illness and, indeed, is not even certain that it believes such illnesses exist. That was the beginning of President Obama's problems (E. Fuller Torrey & D. J. Jaffe, 8/15).

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