Viewpoints: Executive Orders, Obamacare Replacements And Cold, Hard Facts; Medicare’s Challenges In Health Law Debate

The Wall Street Journal: The ObamaCare Holdouts
Republicans are getting battered at town halls on ObamaCare, with constituents — or least protestors — yelling about the benefits they’ll lose if the entitlement is repealed. But maybe the better measure of public sentiment is the choices that the people who are subject to ObamaCare have made in practice. (2/23)

The New England Journal Of Medicine: Trump’s Executive Order On Health Care — Can It Undermine The ACA If Congress Fails To Act?
Within hours after taking the oath of office, President Donald Trump executed his first official act: an executive order redeeming his campaign pledge to, on “day one,” begin repeal of the Affordable Care Act (ACA). The New York Times characterized his action as itself “scaling back Obamacare,” and the Washington Post said the order “could effectively gut [the ACA’s] individual mandate” to obtain health insurance coverage. But consumer advocate Ron Pollack dismissed Trump’s action as “much ado about very little.” To put these divergent assessments into perspective, it’s important to examine the actual executive order, recognize the departures from the Obama administration that it contemplates, and assess the scope and significance of changes the administration can lawfully make by executive order or other administrative actions. (Timothy Stoltzfus Jost and Simon Lazarus, 2/22)

Vox: John Boehner Told Republicans Some Inconvenient Truths On Obamacare
Didn’t Boehner hold repeal vote after repeal vote? Didn’t he win back the House in 2010, and hold it thereafter, promising to repeal Obamacare? Didn’t he participate in the government shutdown over Obamacare in 2013? He did. But to interpret Boehner generously, Obamacare is in a very different place now than it was in 2010, 2012, or even 2013. It’s delivering benefits to about 30 million people. Dozens of states have built budgets around Medicaid dollars flowing in from the federal government. Health systems nationwide have reorganized themselves around its provisions. (Ezra Klein, 2/23)

RealClear Health: Repeal & Replace: Missing The Medicare Forest For The Obamacare Trees
The Trump Administration has promised to deliver to the American people a healthcare plan that is, in President Trump’s own words, “much less expensive and far better” than Obamacare. But While Obamacare is expected to spend over $900 billion from 2018 to 2027, focusing solely on the Obama administration’s signature achievement ignores bigger fiscal challenges; Namely, the Medicare program. (Yevgeniy Feyman, 2/24)

Tribune News Service/Lincoln (Neb.) Journal-Star: A Simple Solution On Health Care
But the largest contributing factor to the voter anger directed at Republican senators and representatives didn’t require sly scheming — because it is very real, and even frightening to many voters. They are frightened about what they are NOT hearing from Trump and most Republicans in Congress about what will happen when they succeed in repealing President Obama’s Affordable Care Act. Republicans haven’t shown voters how they will replace it or sufficiently addressed what its elimination might mean to middle class folks who voted for Trump as an act of blind trust. (Martin Schram, 2/24)

Topeka Capital Journal: Medicaid Expansion Lives In Kansas
Considering how much disagreement there is on the economic and practical dimensions of Medicaid expansion – as well as the massive impact it has on the people of Kansas – didn’t it deserve a full debate in the Legislature? To Ward, Rep. Susan Concannon (a Beloit Republican who introduced the Medicaid amendment to HB 2044) and the legislators who voted in favor of expansion: Thank you for representing the interests of your fellow Kansans. While we’re not saying legislators should vote for a bill simply because it’s popular, they do have a responsibility to take their constituents’ concerns seriously and give critical issues their full attention. The lawmakers who tried to kill the Medicaid expansion bill in committee did the opposite. (2/23)

The New England Journal Of Medicine: Protecting The Tired, The Poor, The Huddled Masses
During Donald Trump’s presidential campaign and transition period, I worried that the climate of xenophobia and the widespread misunderstanding of the immigrants and refugees already in our country would dissuade others from seeking asylum here. ... as a person who believes that health is a human right and that ensuring basic human rights promotes health, I remain terrified for the world’s well-being. The suspension of the U.S. Refugee Admissions Program for 120 days was poorly planned and discriminatory, and it has only intensified the fear and anxiety of people who are fleeing terror, bombings, domestic abuse, and other types of persecution because of their religion, sexual orientation, or ethnic background. ... Moreover, many U.S. clinicians have noted that their patients who are already here are refraining from seeking the medical care they need or using other vital public services for fear of being incarcerated and deported. (Katherine Peeler, 2/22)

The Washington Post: Sean Spicer Seemed To Tie Marijuana Use To Opioids. The Evidence Isn’t On His Side.
The epidemic of opioid addiction in the United States has been well documented. A staggering 33,000 people died in 2015 from overdosing on prescription painkillers, heroin or similar drugs, on par with the number killed by firearms and in car accidents. The epidemic is growing, but its general causes are not in dispute. Nearly all research on the issue shows that excessive and improper prescriptions are what’s causing more people to become addicted. But White House press secretary Sean Spicer on Thursday appeared to link the surge in opioid abuse to another factor: recreational marijuana use. (Derek Hawkins, 2/24)

Milwaukee Journal Sentinel: Try Something New To Deal With Drug Crisis
In 2016, Milwaukee County saw a record high in deaths from drug overdoses, when at least 340 people died. Many of the drugs involved in this crisis such as oxytocin, vicodin and oxycodone are at first prescribed legally to treat physical pain. When users become addicted and lose avenues to these prescribed drugs, they often turn to illegal drugs. Bravo to Gov. Scott Walker, who has called for a special session of the Legislature to address this crisis. (Jerry Schultz, 2/23)

Stat: The Power — And The Fear — Of Knowing Your Cancer Genome
When it comes to cancer, all knowledge is power — even when that knowledge is scary. Knowing as much as you can about cancer lets you and your health care team act decisively in devising your treatment strategy. Even more important, it lets you act specifically in selecting treatments or clinical trials that might be best in treating your disease. ... For me, learning everything about my disease has been essential to discovering how to attack and treat my cancer and, I believe, why I went into a surprising but welcome long-lasting remission. (Kathy Giusti, 2/23)

The New England Journal Of Medicine: The Perils Of Trumping Science In Global Health — The Mexico City Policy And Beyond
During his first week in office, President Donald Trump reinstated an executive order banning U.S. aid to any international organization that supports abortion-related activities, including counseling or referrals. The so-called Mexico City Policy — colloquially referred to as the “global gag rule” on women’s reproductive health — is allegedly intended to reduce the number of abortions around the world, in accordance with an antiabortion agenda. Scientific evidence suggests, however, that the policy achieves the opposite: it significantly increases abortion rates. The policy defunds — and in so doing, incapacitates — organizations that would otherwise provide education and contraceptive services to reduce the frequency of unintended pregnancies and the need for abortions. (Nathan C. Lo and Michele Barry, 2/22)

Seattle Times: Ethics And Trust Paramount In Physician, Patient Relationship
dramatic and complex changes in the health-care environment have placed a strain on medical professionalism and on physicians’ ability to exercise independent clinical judgment. We must ensure that doctors’ professionalism and independent judgment remain protected, even in our quest to have a healthy bottom line. (Jennifer Lawrence Hanscom, 2/22)

The New England Journal Of Medicine: Recreational Cannabis — Minimizing The Health Risks From Legalization
The cannabis-policy landscape is undergoing dramatic change. Although many jurisdictions have removed criminal penalties for possessing small amounts of cannabis and more than half of U.S. states allow physicians to recommend it to patients, legalizing the supply and possession of cannabis for nonmedical purposes is a very different public policy. Since the November 2016 election, 20% of the U.S. population lives in states that have passed ballot initiatives to allow companies to sell cannabis for any reason and adults 21 or older to purchase it. Although other states may move toward legalization, uncertainty abounds because of the federal prohibition on cannabis. The Obama administration tolerated these state laws; it’s unclear what the Trump administration will do. (Beau Kilmer, 2/22)