Viewpoints: Contraception At The Court Again; Cadillac Tax And Wages; Drugs And Mortality

The New York Times: The Fallacy Of The Latest Contraception Case
Now that the Supreme Court has agreed to hear the latest challenge to the Affordable Care Act’s guarantee of insurance coverage for birth control, it is worth reiterating what the conflict at the core of these cases is really about. The plaintiff employers — including several religious schools and an order of Catholic nuns that provides services to the elderly poor — refuse to provide coverage for certain contraceptives, which they believe (contrary to scientific consensus) induce abortions. The government has already agreed that these employers are not required to provide such coverage. ... This should not be a difficult case. In a secular society, religious freedom demands respect and accommodation, not a veto over government action that benefits others who believe differently. (11/6)

Bloomberg: A Birth-Control Morality Play Comes To Supreme Court
My own intuition is that the Obama administration chose this fight, and should have avoided it by quietly making an exception for religious nonprofits with doctrinal objections. For one thing, contraception is an inexpensive routine purchase that is exactly the sort of thing that insurance shouldn’t cover (for the same reason your car insurance doesn’t cover routine service: you’d just end up pre-paying the service in the form of higher insurance premiums). For another, the number of people employed by these groups is small. Picking this fight was not worth amping up the culture wars. America doesn’t need more things to have bitter partisan battles over. We’ve already got a years-long backlog to get through. (Megan McArdle, 11/6)

The New York Times: Obamacare Not As Egalitarian As It Appears
The Affordable Care Act has generated an enormous amount of partisan rancor, but with more access to data, it is worth taking stock of how it has actually been working. We can safely say that the policy is costing less than anticipated, perhaps 20 percent less, according to a Congressional Budget Office estimate, and that it has reduced the number of Americans without insurance. But the numbers also suggest that by some measures, the Affordable Care Act has had only a limited impact on economic inequality. (Tyler Cowen, 11/6)

The Wall Street Journal: Medicaid Expansion Is Proving To Be A Bad Bargain For States
Conservative lawmakers in our home states of Utah and Florida recently defeated a combined three proposals to expand Medicaid under ObamaCare. They were absolutely right to do so, as the fiscal messes in states that did expand Medicaid demonstrate. ... Florida and Utah taxpayers will thank their legislators in the years to come. Consider the experience of the states that did expand Medicaid. “At least 14 states have seen new enrollments exceed their original projections, causing at least seven to increase their cost estimates for 2017,” the Associated Press reported in July. ... This has blown holes in state budgets. (Evelyn Everton and Chris Hudson, 11/6)

Modern Healthcare: A Green Light For Attacking Obamacare
Last week's election results in Kentucky and Virginia dashed any hope that attacks on Obamacare might finally be losing their political currency. Healthcare providers and payers should brace themselves for a full year of well-funded assaults on the law. (Merrill Goozner, 11/7)

Louisville Courier-Journal: Bevin’s Big Test: Medicaid Expansion
At his first press conference since his election, [Kentucky Gov.-elect Matt] Bevin said he wants to design a plan that would require participants to pay premiums or co-pays and that his plan would not re-enroll people up to 138 percent of the poverty rate. He added that his goal “isn’t an attempt to cut people off. It is an attempt to have people take responsibility.” If his goal isn’t to cut people off, the key will be to find price points that people can afford. It’s tough for a family of four to live on $33,000 without having to pay for insurance or medical care, and even the slightest increase could mean they are priced out of the market. (Joseph Gerth, 11/7)

The Denver Post: ColoradoCare Is Health Care For Everyone
One year from this week, Colorado voters will make a fundamental choice about health care in our state. We can stick with the status quo — the Affordable Care Act, which leaves hundreds of thousands with no health insurance — or we can switch to a new health plan, designed in Colorado, that will cover everybody and cut costs sharply for almost every family and business in the state. This new plan has been named ColoradoCare, precisely because it is not Obamacare. It's a system of universal coverage proposed by state Sen. Irene Aguilar, a Denver physician, along with health policy experts around the state. When Aguilar's plan came up in the legislature, the private insurance companies crushed it. They fear (and they're right) that competition from ColoradoCare will force them to cut their soaring premiums. (T.R. Reid, 11/6)

Forbes: Will The Obamacare Cadillac Tax Increase Worker Wages?
Asking whether the Obamacare Cadillac tax will increase worker wages might seem nonsensical on its face. But wait until you hear the answer: yes AND no. Don’t worry: Schrodinger’s cat hasn’t wandered into the thicket of health policy (nor am I channeling my inner two-handed economist). It’s a trick question: the answer depends on whether employers respond to the Cadillac tax by trimming health benefits to avoid the tax, or instead simply keep their health benefits as is and pass the tax onto their employees. For employers who trim health benefits I have a high degree of confidence that on average, worker wages will rise. For employers who absorb the Cadillac tax increase, average worker wages will fall. (Chris Conover, 11/6)

The Washington Post: Yet Another Inconvenient Truth For Its Opponents: Obamacare Is Not ‘Killing Jobs’
Within last week’s strong jobs report was yet another good month for the health-care sector, which added 45,000 jobs. The growth of jobs in this sector is a long-term trend, driven in no small part by our aging demographics. Even when we were hemorrhaging jobs in the depths of the last recession, health care was an outlier, never experiencing even one negative month of job growth during the downturn. (Jared Bernstein and Ben Spielberg, 11/9)

Bloomberg: Diseases Are Bad. That's Good Politics.
Did you catch that line from Mike Huckabee during the last Republican presidential debate in which he calls for a declaration of war on four major diseases? "I really believe that the next president ought to declare a war on cancer, heart disease, diabetes and Alzheimer’s," he said, "because those are the four things that are causing the greatest level of cost.” ... A "cures caucus" is building within Republican ranks. ... It seems some Republicans are betraying conservative dogma -- perhaps most emphatically pushed by Cruz -- that says government agencies are inept and federal spending inane. But the cures caucus makes eminent sense. (Paula Dwyer, 11/8)

The New York Times: I Am Paying For Your Expensive Medicine
You may not know it, but you could be on the hook to pay at least $124 this year for a drug you probably don’t take. The drug is a new class of cholesterol-lowering agents called PCSK9 inhibitors. ... According to a recent article in The New England Journal of Medicine by Kevin A. Schulman and his colleagues at Duke, even if the price came down to about $11,000 per patient per year, and only 1.1 million of the roughly 23 million middle-age Americans with high cholesterol actually took these drugs, the bill would be so high that for a typical insurance plan, “annual insurance premiums would increase by $124 for every person” in the insurance plan. (Ezekiel J. Emanuel, 11/7)

The New York Times: The Dying Of The Whites
Starting around the turn of the millennium, the United States experienced the most alarming change in mortality rates since the AIDS epidemic. This shift was caused, not by some dreadful new disease, but by drugs and alcohol and suicide — and it was concentrated among less-educated, late-middle-aged whites. We had hints that something like this was happening. We knew suicide was increasing among the middle-aged, that white women without a high school degree were struggling with health issues, that opiate addiction was a plague in working-class communities. But we didn’t know it was all bad enough to send white death rates modestly upward in the richest nation in the world. (Ross Douthat, 11/7)

The New York Times: How Doctors Helped Drive The Addiction Crisis
Driving this opioid epidemic, in large part, is a disturbing change in the attitude within the medical profession about the use of these drugs to treat pain. Traditionally, opioid analgesics were largely used to treat pain stemming from terminal diseases like cancer, or for short-term uses, such as recovering from surgery. But starting in the 1990s, there has been a vast expansion in the long-term use of opioid painkillers to treat chronic nonmalignant medical conditions, like low-back pain, sciatica and various musculoskeletal problems. To no small degree, this change in clinical practice was encouraged through aggressive marketing by drug companies. (Richard A. Friedman, 11/7)

The Wall Street Journal: Healing The Brains Of American GIs
When Arnold Fisher mustered out of the U.S. Army in 1954 after a stint in Korea, he left as a corporal. But he didn’t leave the service. ... Now he is in his ninth decade, and this Veterans Day will find the Fisher Brothers’ senior partner aiming much higher than skyscrapers. Today his obsession is the human brain—specifically, how Americans can help our warriors who return from the battlefield with injuries few understand. (William McGurn, 11/6)

The New York Times: Arbitrating Disputes, Denying Justice
In recent years, America’s corporations have created a private system for handling disputes that benefits them greatly while denying consumers their day in court. ... Even more disturbing, the shift away from the civil justice system has gone beyond disputes about money. Nursing homes, obstetrics practices and private schools increasingly use forced-arbitration clauses to shield themselves from being taken to court over alleged discrimination, elder abuse, fraud, hate crimes, medical malpractice and wrongful death. For the most part, Congress has looked the other way. (11/7)

news@JAMA: The “Dickey Amendments” 20 Years Later
The 104th US Congress marked an important period in the legislative legacy of then-Rep Jay Woodson Dickey, Jr, (R, Ariz). Only 2 years into his 8-year congressional tenure, Rep Dickey spearheaded the 1996 enactment of 2 far-reaching amendments. In so doing, Rep Dickey assured the prohibition of public funding of gun violence research and human embryo research by the Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH), respectively. The lasting impact of the 2 amendments can hardly be overstated. Both remain in effect. Now, in an interview 20 years later with the Huffington Post, the retired 75-year-old congressman expressed his regrets over the curbing of gun violence research. Similar sentiments have been expressed earlier in a 2012 op-ed with the Washington Post. No such qualms have been publicly articulated relevant to the generation-long funding freeze of human embryo research. (Eli Y. Adashi and I. Glenn Cohen,, 11/6)