Viewpoints: Obama’s Signal To The Justices; Are Dems To Blame?; Reflecting On The ADA

The Wall Street Journal: ObamaCare Omen?
Does the White House think it is going to lose this year’s big ObamaCare subsidy case at the Supreme Court? We’re beginning to wonder given President Obama’s increasing show of pique when he talks about the law. On Monday in Austria, Mr. Obama responded to a question about the looming decision in King v. Burwell by treating the Supreme Court like first-year law students for even considering the case. (6/9)

The New York Times: Saving Affordable Health Insurance
The Affordable Care Act, which has helped millions of people get health care, is now fully woven into the nation’s social fabric. As President Obama said Tuesday, there is something “deeply cynical about the ceaseless, endless, partisan attempts” to roll back the progress already made. His remarks at a forum of the Catholic Health Association come only weeks before the Supreme Court is expected to issue a ruling that could, if the administration loses, eliminate federal tax subsidies in 34 states that have made it possible for millions of Americans to buy health insurance. Mr. Obama was right when he said on Monday that the court probably shouldn’t have even taken the case. Unfortunately it did, and no one can predict how the deeply divided court will rule. (6/10)

The Huffington Post: SCOTUS Optimism
June marks the end of the Supreme Court's yearly session, and it is when all the biggest decisions get handed down. This year, there are many important decisions we'll be hearing about all month long, but the biggest two (or the two with the biggest political overtones, at any rate) will likely be held back until the very end of the month. They are Obergefell v. Hodges and King v. Burwell. The first will settle once and for all the question of marriage equality for same-sex couples, and the second will determine whether millions of Americans will lose their health insurance subsidies or not. (Chris Weigant, 6/8)

The Washington Post's Plum Line: Obama: Health Law Has Now Been ‘Woven Into The Fabric Of America’
In a speech today before the Catholic Health Association in Washington, President Obama didn’t directly mention the Supreme Court case that could gut subsidies for millions of people in three dozen states on the federal exchange. But he telegraphed the political argument he and Democrats will make in the aftermath of such a Court ruling. (Greg Sargent, 6/9)

The Washington Post: Obama To Supreme Court: You Wouldn’t Dare Kill Obamacare
President Obama uttered more than 3,600 words on the stage of Washington’s Marriott Wardman Park ballroom on Tuesday, but his message could be summed up in three: You wouldn’t dare. He was speaking not to the hundreds of hospital administrators assembled for the Catholic Health Association’s conference but to five men not in the room: the conservative justices of the Supreme Court, who in the next 21 days will declare whether they are invalidating the most far-reaching legislation in at least a generation because of one vague clause tucked in its 2,000 pages. (Dana Milbank, 6/9)

Politico: Reward Physicians For Keeping Patients Healthy
When President Barack Obama signed the Patient Protection and Affordable Care Act five years ago, he did so without knowing whether the law would eventually prove effective. Fortunately, in large part, it has, and those who doubted the ACA — myself included — were reminded of its success when the Department of Health and Human Services recently reported that 16.4 million previously uninsured Americans have gained insurance under it. This includes 14.1 million adults and 2.3 million young adults. In short, there’s much to celebrate, and we should make a point to shine a spotlight on what’s working — and what isn’t. (Howard Dean, 6/9)

Orlando Sentinel: Florida's Health-Care Hypocrisy Carries Big Cost
Florida's health-care debate is over. But our problems remain. In fact, they're growing. As many as 800,000 uninsured Floridians will continue to go without coverage. The state budget is a mess — with as much as $400 million of your tax dollars now being siphoned away from schools, roads and other needs to plug holes created by the rejected federal money. Businesses could face millions in fines because the federally provided health care now won't be available for their employees. Hospitals could lose $200 million. The state will lose out on tens of thousands of jobs. And on and on — all because members of the Florida House claimed they were outraged at the idea of costly entitlements, especially for "able-bodied" adults. (Scott Maxwell, 6/9)

New Hampshire Union Leader: Only Democrats Are To Blame For Obamacare Mess
If the Supreme Court were to decide not to allow retroactive legislating and uphold Obamacare as written, terrible things would happen to America. We might, for instance, find out what health insurance in fabricated, state-run “marketplaces” actually costs. The Kaiser Family Foundation estimates that the 37 states that have declined to set up exchanges would see an average spike of 287 percent should the King v. Burwell decision not go the Obama administration’s way. It would be 650 percent in Mississippi — an amount that only proves that exchanges have not made insurance markets more competitive or more affordable as promised. Actually, the cost of insurance in federally run exchanges is already 287 percent higher. The difference is picked up by taxpayers. And you know who’s to blame for that, right? (David Harsanyi, 6/8)

Bloomberg: Would The Poor Prefer Cash Instead Of Medicaid?
Medicaid is the nation's largest means-tested transfer program, and even conservatives generally acknowledge that it makes its recipients better off. ... What, in other words, is the value of the transfer to the people who are getting health care through Medicaid? In a new paper, Amy Finkelstein, Nathaniel Hendren and Erzo F.P. Luttmer note that the Congressional Budget Office values the transfer at the amount of money the government is spending on Medicaid. ... they looked at data from the Oregon Medicaid Study to try to get a more nuanced assessment of the actual value to the people the benefit is supposed to be for. Here's what they came up with: "Our baseline estimates of the welfare benefit to recipients from Medicaid per dollar of government spending range from about $0.2 to $0.4, depending on the framework, with a relatively robust lower bound of about $0.15." (Megan McArdle, 6/10)

Bloomberg: The Vanishing U.S. Abortion Clinic
Abortion clinics are closing in the U.S. at a record pace. In four states — Mississippi, North Dakota, South Dakota and Wyoming — just one remains. American women were having fewer abortions before clinic closings accelerated in the last couple of years. So no one can be sure how much the push to restrict clinics is connected to falling abortion rates. But the new strategy adopted by abortion opponents, and the court battles it has set off, may define how far abortion rights can be limited without being overturned. (Esmé E. Deprez, 6/9)

Orlando Sentinel: Stop Pricing Health Care By Blank Check: My Word
Aside from health care, there is no other product sold where you must first incur the obligation to pay before you learn the price. The system is rigged to prevent price competition. Your cost may be many times higher than your neighbor's cost for the same service at the same hospital, lab or physician. Billing is determined by how much can be extracted from each patient case by case. Sky-high hospital, physician and lab bills necessarily result in unaffordable insurance premiums. To cure our health-cost misery, the analysis must reach beyond Obamacare and other reform of the health-insurance system to the underlying charges. (Steven I. Weissman, 6/10)

The New York Times' The Opinionator: Death Without Dignity
The California Senate’s passage of the End of Life Option Act last week, which would allow terminally ill people to choose to end their lives, filled me with both joy and sadness. The bill — which needs the approval of the State Assembly and Gov. Jerry Brown to become law — would have made all the difference when I tried to help my friend Robin kill herself five years ago. (Annabelle Gurwitch, 6/10)

JAMA Forum: The “Doc Fix” Is Over, But Unresolved Concerns Linger
Although Washington and the physician community were expressing euphoria over the end of the SGR, these unresolved issues are concerning. But moving away from a billing system that reimburses for microunits of service and that indiscriminately increases or decreases unit reimbursement across all physicians irrespective of their own behavior is worth some downside risk. Physician groups and others are rightly raising concerns about the process that will be used to determine which alternative delivery systems warrant bonus payments, as well as the metrics that will determine bonuses and penalties for those remaining in a fee-for-service payment system. What is useful to remember is that the payment under the SGR and until MIPS debuts in 2019 implicitly assumes that there are no variations in quality, efficiency, or value in the clinical care provided by physicians—or at least none worth paying for. These assumptions are surely wrong. (Gail Wilensky, 6/9)

USA Today: 4 Lessons From Ebola Wars: Our View
Last year's Ebola outbreak, the worst in history, claimed more than 11,000 lives and tested the world's ability to contain a killer in some of West Africa's most impoverished countries. While the virus has slowed to a trickle of new cases — 25 in Guinea and Sierra Leone in the last week of May, and none in Liberia — few people would credit quick action or smart preparation. (6/9)

The Chicago Sun-Times: Lock Fewer People Up To Improve Illinois Inmate Health Care
Stories of incompetent health care inside Illinois prisons have been legion for many years, and nearly all have been met with derisiveness by the Department of Corrections. Presented with the choice of believing prisoners or their overseers, state officials sided with the bureaucrats and declined to act. That may be about to change.The barbaric state of medical care in state prisons was documented recently by a team of doctors acting as court-appointed experts, and the team’s blistering 405-page report leaves the state with but two choices: either spend more money on medical care of 49,000 inmates or deliver better medical care to a much smaller prison population. (David M. Shapiro, 6/9)

The Philadelphia Daily News: School Nurses Vital To Education
Four years ago, a Philadelphia school nurse literally breathed life into the lungs of a child in respiratory and cardiac distress. She compressed her chest until medics arrived to take over. The child recovered at CHOP and went on to have a successful heart transplant. The front page story on Christmas Day told of the greatest gift her parents would ever receive - their little girl discharged with a brand new heart. That same week, 50 school nurses were laid off. By year's end the district was operating 100 nurses short. A model school health program, emulated nationally, has been limping along since then with nurses trying to serve as many as seven schools and 1,500 students each. Schools already trying to function with skeleton staffs under the district's "Doomsday Budget" saw nurses only one or two days a week. (Eileen Duffey, 6/9)

USA Today: 'Female Viagra' Rocks: Finally, Women Get Their Own Little Blue Pill
Is the female Viagra finally making its way to the market? An advisory committee to the Food and Drug Administration (FDA) voted 18-6 last week to recommend flibanserin for approval. But this 'pink pill' is not at all like the famous 'blue pill' Viagra, which works by increasing blood flow to the sex organs. Flibanserin, which will be marketed under the name Addyi, works directly on the chemicals of the brain, increasing dopamine and norepinephrine. (Marc Siegel, 6/9)

JAMA: The Americans With Disabilities Act At 25
Twenty-five years ago, on July 26, 1990, President George H. W. Bush signed the Americans with Disabilities Act (ADA), a historic moment when the polity gave voice to the nation’s highest ideals. The ADA enshrined in law a social promise of equality and inclusion into all facets of life, while offering an inspiring model that much of the world would come to embrace. As a civil rights law coming in the wake of racial and gender equality legislation, the ADA has had profound symbolic meaning and real-world effects. Its promise of full participation in life stood in marked contrast to the often-impenetrable social and physical barriers that individuals with disabilities faced regarding inclusion in the workplace and public spaces. (Lawrence O. Gostin, 6/9)

JAMA: The Promise Of The Americans With Disabilities Act For People With Mental Illness
When Congress enacts civil rights laws, like the Voting Rights Act enacted in 1965, it adopts principles that represent US ideals and our best selves. When it enacted the Americans with Disabilities Act (ADA) in 1990, among the principles it adopted was a commitment to include all individuals with mental illness, including serious mental illness, in the mainstream of society. After a civil rights law is passed, however, it can take decades before its tenets are fully reflected in everyday life; so it is with the ADA and individuals with psychiatric disabilities. Fulfilling the act’s commitment to inclusion will require fundamental changes in treatment and services. (Ira Burnim, 6/9)

JAMA: Why The Americans With Disabilities Act Matters For Genetics
The Americans with Disabilities Act (ADA) is arguably the most effective law in the United States protecting people from misuse of genetic information. ... The genome is frequently portrayed as particularly powerful in predicting health and disease, even going to the essence of what it means to be human. As a result, many people understandably fear that this type of information will be misused to deny them access to goods such as jobs and health insurance. Evidence, based largely on anecdotes and survey responses, suggests that these concerns lead some people to avoid useful genetic tests, raising concerns about whether the potential value of genomics research for human health will be fully realized. (Ellen Wright Clayton, 6/9)

JAMA: The ADA, Disability, And Identity
The Americans with Disabilities Act (ADA) celebrates its 25th anniversary this year. The civil rights approach to disability incorporated in the ADA challenges the all too prevalent views of US society that people with disabilities are to be the objects of pity, charity, and medical intervention. It also challenges the common view of what constitutes a disability. (Eve Hill and Daniel Goldstein, 6/9)

JAMA: The ADA and the Supreme Court: A Mixed Record
Two of the [Supreme] Court’s ADA cases have been extremely consequential for health policy. In Olmstead v LC (1999), the Court ruled that the unnecessary institutionalization of individuals with disabilities at least presumptively violates the statute. Disability rights advocates have dubbed Olmstead “the Brown v Board of Education of the disability rights movement,” and that decision has spurred a new wave of deinstitutionalization. ... The other Supreme Court ADA case with a direct effect on the medical profession was the Bragdon decision. The defendant in Bragdon, a dentist, refused to fill the tooth cavity of the plaintiff patient after the patient revealed that she had been infected with HIV. After determining that her HIV infection constituted a protected disability, the Court went on to address the defense that filling her cavity would pose a “direct threat” to the health and safety of the dentist, his staff, and his other patients. (Samuel R. Bagenstos, 6/9)