KHN Morning Briefing

Summaries of health policy coverage from major news organizations.

Viewpoints: Halbig Decision Is ‘Ominous,’ ‘Major Victory For The Rule Of Law,’ ‘Far From Last Word’

The New York Times: An Ominous Health Care Ruling
Millions of low- and moderate-income people who signed up for health insurance with the help of federal tax-credit subsidies could find themselves without coverage or facing big premium bills if a destructive decision handed down by a federal appeals court in Washington on Tuesday is not reversed. It would be a crippling blow to the ability of the Affordable Care Act to reduce the ranks of the uninsured with grievous consequences for vulnerable customers (7/22). 

The Wall Street Journal: Upholding ObamaCare – As Written 
In Halbig v. Burwell, the D.C. Circuit Court of Appeals held that the Administration violated the Affordable Care Act by expanding subsidies to the 36 insurance exchanges run by the federal government. The plain statutory language of ObamaCare repeatedly stipulates that these credits shall flow only through "an Exchange established by the State." The 2-1 panel majority thus did not "strike down" part of ObamaCare, as liberals and the media claim. Using straightforward textual construction, the court upheld the law the President signed but it vacated the illegitimate federal-exchange subsidies he tried to sneak in via regulation (7/22).

Los Angeles Times: Administration Can’t Afford To Lose On Obamacare Subsidies
A federal appeals court in the District of Columbia shocked supporters of the 2010 healthcare law Tuesday by ruling that millions of Americans would no longer be eligible for health insurance subsidies. Shortly thereafter, a panel at the U.S. 4th Circuit Court of Appeals in Richmond, Va., came to the opposite conclusion on a similar lawsuit, upholding the subsidies. The full D.C. Circuit should follow the 4th Circuit's lead and reject the first panel's ruling, which wildly misconstrues Congress' intent (7/22). 

The Washington Post: D.C. Circuit Court Ruling On Obamacare Was Wrong – But The 4th Circuit Got It Right
First blame Congress. Generally a useful rule these days, it certainly holds when considering Tuesday’s worrying, though possibly temporary, setback for the Affordable Care Act in the U.S. Court of Appeals for the District of Columbia Circuit. Blame Democrats who pressed through a bill containing contradictory language. Blame Republicans who, in their drive for full repeal, have declined to fix the ambiguities and unintended consequences that turn up in any sizeable piece of legislation (7/22). 

USA Today: Ruling Ignores Congress’ Intent: Our View 
Obamacare supporters should hope the law has nine lives, because it may have used up another one Tuesday. A panel from the second most powerful court in the country ruled, in effect, that nearly 5 million people who got their health insurance through the federal insurance exchanges this year weren't entitled to subsidies. Obamacare's subsidies are what make coverage affordable for many of the people the law requires to buy health insurance — hence the law's name: the Affordable Care Act. Taking those subsidies away could make insurance too expensive for millions of low- and middle-income people, crippling a crucial part of the law (7/22). 

USA Today: A Victory For The Rule Of Law: Opposing View 
The D.C. Circuit's decision Tuesday morning in Halbig v. Burwell is a major victory for the rule of law. And correspondingly, the Fourth Circuit's contrary ruling hours later, in King v. Burwell, is a loss. Under the Constitution, Congress is responsible for making the law while the president must faithfully execute it. With a statute as complex as the Affordable Care Act, it's tempting for the administration to bend it for policy reasons. But, as the D.C. Circuit ruled, this is flatly illegal (Sam Kazman, 7/22). 

The Washington Post: Why Obamacare Probably Isn’t Doomed
The Affordable Care Act took a potentially serious hit today when the D.C. Circuit Court of Appeals struck down a rule that extended the law’s health-care subsidies to residents of the three-dozen states where the federal government runs a health insurance exchange. But the fact that another court of appeals upheld the same rule on the same day shows that the legal issue is very thorny and will very likely be ultimately resolved by the Supreme Court. And the administration probably will come out ahead in the end (Tom Goldstein, 7/22). 

The New York Times’ The Upshot: Rulings On Health Law Are Far From Last Word 
An appellate court ruling issued Tuesday would be very bad news for the Affordable Care Act if it became the law of the land. But it’s still a long way from a settled issue, as a second appellate decision, issued a few hours later, highlighted (Margo Sanger-Katz, 7/22).

The Washington Post: Why The D.C. Circuit Was Wrong To Eviscerate Obamacare
The country was almost out of this Obamacare mess. After years of political strife and Obama administration management failures, after an exacting legal review that included two high-profile Supreme Court cases, after broken Web sites were improved, after some people lost plans the liked, after others gained plans they would never have been able to afford, after millions of people enrolled, and after the rate of uninsured Americans dropped, the Affordable Care Act finally seemed to be finding its footing, and there were indications that the nation would finally move on (Stephen Stromberg, 7/22). 

Forbes: Halbig Court Opinion: A Victory For The Rule Of Law, But Merely A Speed Bump For Obamacare
If the IRS had never written its rule expanding the spending authority of the federal exchange, Obamacare wouldn’t have collapsed. Why? Because, over time, every state would have taken the “free” federal cash. ... The original Medicaid program, passed in 1965, was optional for the states. Most states signed up within a few years, but there were one or two holdouts. Arizona, the last holdout, set up its Medicaid program in 1982. The point is: every state now participates in Medicaid (Avik Roy, 7/23).

The Wall Street Journal: Reining In ObamaCare – And The President
A three-judge panel of the U.S. Court of Appeals for the D.C. Circuit -- a tribunal second only to the Supreme Court -- ruled on Tuesday that the Obama administration broke the law. The panel found that President Obama spent billions of taxpayer dollars he had no authority to spend, and subjected millions of employers and individuals to taxes he had no authority to impose. The ruling came in Halbig v. Burwell , one of four lawsuits aimed at stopping those unlawful taxes and expenditures. It is a decision likely to have far-reaching repercussions for the health-care law (Jonathan H. Adler and Michael F. Cannon, 7/22). 

The Wall Street Journal: Aid Veterans Affairs By Nixing Budget Gimmickry 
The worst scandal in decades at the Department of Veterans Affairs doesn't only involve unethical staffers cooking the books on waiting times, inexcusable as that is. Woefully inadequate VA funding and budget gimmicks by multiple Congresses and administrations created the long waiting lists in the first place (Garry Augustine, 7/22).

Journal of the American Medical Association: New Expensive Treatments for Hepatitis C Infection 
Perhaps surprisingly, most media coverage of this important development in HCV treatment has not focused on the cure rates but, rather, on cost. The price of sofosbuvir is essentially $1000 per pill, or $84 000 for a standard 12-week course. The fact that pricing in the United Kingdom for a similar regimen is $54 000, and perhaps as low as $900 in Egypt and other developing countries, indicates that the pricing in the United States is a purely financial decision by Gilead and has outraged many. Indeed, some pharmacy benefit managers are calling on their clients to boycott these products until alternatives are available late in 2014. But is the pricing unfair? (Troyen Brennan and William Shrank, 7/22).

Los Angeles Times: How To Escape The Medical Care Debt Trap
An analysis this year by NerdWallet Health found that about 60% of all bankruptcies are health related. And a comprehensive study by Harvard researchers who examined a large sample of 2007 bankruptcy filings found that, "using a conservative definition, 62.1% of all bankruptcies … were medical." That research, published in the American Journal of Medicine, found that most of these "medical debtors were well educated, owned homes and had middle-class occupations" (Steve Trumble, 7/22).

The New York Times: A Dearth In Innovation For Key Drugs
There is clearly something wrong with pharmaceutical innovation. Antibiotic-resistant infections sicken more than two million Americans every year and kill at least 23,000. The World Health Organization has warned that a “post-antibiotic era” may be upon us, when “common infections and minor injuries can kill.” Even the world’s tycoons consider the proliferation of antibiotic-resistant bacteria one of the crucial global risks of our times, according to a survey by the World Economic Forum (Eduardo Porter, 7/22). 

Los Angeles Times: Can Laura’s Law Really Help The Mentally Ill? Researcher Tom Burn’s Surprising Conclusion.
Laura's Law has been an option for counties in California since 2003, but only in recent weeks have three of the most populous ones — Los Angeles, Orange and San Francisco — voted to implement it. The law — like another one in New York, Kendra's Law — allows families or officials to ask the courts to order outpatient treatment for the seriously mentally ill (Patt Morrison, 7/22). 

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.