Viewpoints: Seeking Facts On Repeal And What Comes Next; Health Savings Accounts’ Problems

Boston Globe: Repealing The Affordable Care Act — Fact Vs. Fiction
As the new administration and Republican allies in Congress plan their agenda for 2017, repeal of the Affordable Care Act is front and center. Senate Republicans last week put out a policy statement reiterating their plans to roll back the law and claimed — in part based on our research — that this would have only modest effects on the number of Americans without health insurance. Simply put, this is wrong and a misleading characterization of our work and that of others who have studied the ACA’s impact. (Jonathan Gruber and Benjamin Sommers, 12/8)

Forbes: Republicans Are In A Nasty Obamacare Trap
Republicans have been predicting (sometimes even gleefully) that Obamacare will end in a death spiral. As it turns out, the election of Donald Trump makes that unhappy ending more likely. But here is the irony: If Obamacare does crash and burn, Trump and the Republicans are likely to get the full blame for any suffering and misery that follows. (John C. Goodman, 12/7)

Weekly Standard: After Repeal
It’s the opportunity Republicans have been awaiting for six years, which invites the obvious question: Are they going to screw it up? In January, a united Republican Congress and Republican White House will finally have the ability to dispose of Obamacare, the unpopular and destructive health-insurance law. After running four straight national elections against the jammed-through, unconstitutional, failing, expensive, and disastrous Patient Protection and Affordable Care Act, the GOP finally has the power to do something about it. (Michael Warren, 12/8)

Health Affairs: Five Reasons The ACA Won’t Be Repealed
Since November 8, a chill has descended among individuals nationwide who are involved with or otherwise care about health care. Like sheep herded to their fate, there has been a resignation that the Affordable Care Act (ACA) will be repealed, taking with it coverage for over 23 million people, strong protections for consumers, and innovations in care delivery. But, if you take a closer look, the repeal and replace “two step” is fraught with difficulty, bolder than the ACA itself, and far from certain to succeed. So I think we all need to take a deep breath and refocus on what’s inside the sandwich we are about to be served, and resolve intentionally whether or not we’re going to eat it. (Billy Wynne, 12/7)

Stat: Donald Trump's Health Policies Could Turn My Patients Into 'Forgotten Ones'
Throughout his campaign, Trump vociferously championed “the forgotten ones.” All Americans, and especially health care providers, need to hold him to his word and make sure he acts as the president for everyone. But by overthrowing or radically altering the ACA, Trump will be creating a new legion of “forgotten ones.” With respect to health care access and coverage, “forgotten ones” aren’t necessarily minorities. Instead, they are individuals who will be affected by altering the ACA, including many working-class white Americans who voted for Trump. (Melissa Simon, 12/8)

Modern Healthcare: CBO Offers Republicans Ideas On Cutting The Deficit Beyond Repeal Of The ACA
Repealing all insurance coverage provisions of the Affordable Care Act without replacing them would reduce the federal budget deficit by $1.2 billion between 2017 and 2026, according a new Congressional Budget Office compendium of possible cost-saving moves across the entire U.S. government budget. Along with the cost-savings, repeal of the ACA would increase the number of uninsured Americans from about 23 million to 51 million, and lead to skimpier benefits in the individual insurance market and more denial of coverage to people with pre-existing medical conditions, the CBO projects. (Harris Meyer, 12/8)

Health Affairs: Trump Plan To Increase Health Savings Accounts Should Ensure That They Do Not Only Benefit The Wealthy And Healthy
One of the reforms proposed as part of the Trump health platform is to “allow individuals to use Health Savings Accounts (HSAs).” This increased emphasis on HSAs is a clarion call for more understanding about how to make HSAs work so that they are equitable, effective, and efficient. Although HSAs are conceptually appealing and can play an important role in health reforms, current evidence suggests that they primarily benefit the wealthy, the healthy, and the educated. (Kathryn Phillips, 12/8)

The New England Journal of Medicine: The Future Of Health Care Reform — Section 1332 Waivers And State-Led Reform
Actually repealing and replacing the entire ACA would be a complicated process, even with Republican majorities in both chambers. Gridlock over what a replacement plan would look like and procedural rules may limit what President-elect Donald Trump and Congress can achieve. Already, Republicans and interest groups have expressed concern about the effects of repealing the law in its entirety. The most likely effort will include congressional Republicans passing reconciliation legislation that will repeal a portion of reform while bypassing the threat of a filibuster. This approach, which was vetoed in 2015 by President Barack Obama, would leave some aspects of the ACA intact. One such component is state innovation waivers (Section 1332 waivers), which the Trump administration could use to strengthen state-led reforms or to further undercut the remnants of the ACA. (Phillip M. Singer, 12/7)

Alaska Dispatch News: Medicaid Expansion Proves Good For Alaska
It's not often that government has a chance to help thousands of people and save money at the same time. Medicaid expansion was one of these opportunities. Expansion is a bright spot in a dismal Alaska economy. Over 25,000 people now have health coverage at no cost to the state of Alaska. Alaska health care providers have received over $288 million in revenues since it started in September 2015. Health care jobs are the fastest growing sector in our economy, in part due to Medicaid expansion. (Chris Ashenbrenner, 12/8)

The New England Journal of Medicine: Cost Containment And The Tale Of Care Coordination
Nobody likes waste or fragmentation. Evidence that both are hallmarks of the U.S. health care system has fueled debate over how to redesign payment and delivery systems to root out inefficiencies. In the face of broader imperatives of cost containment and quality improvement, a narrative has emerged from this debate that now dominates policy: care coordination not only improves outcomes but lowers costs, too. Though attractive, this notion is not evidence-based. (J. Michael McWilliams, 12/8)

Stat: Mr. Trump: Don't Become The First Anti-Vaccine President
Dear President-elect Trump, Your record as a businessman is something of an open book to the people you will lead come Inauguration Day. But with no track record in governance, the policies you plan to put into effect are something of a black box. One that concerns me is what you will do about vaccination, a proven public health success story that has saved millions of children’s lives worldwide. ... There are unsettling signs that you plan to de-emphasize support for autistic people and their families, and at the same time erode mandatory vaccination laws because you subscribe to the misguided theory that vaccines are responsible for triggering a global autism epidemic. (Steve Silberman, 12/8)

The Washington Post: The Big Problem With Donald Trump’s Big Idea For Stopping The Flow Of Illegal Drugs
When asked during his presidential campaign how he would stop America’s raging opioid overdose epidemic, Donald Trump said “cut off the source, build a wall.” No one disputes that many drugs enter the United States via the Mexican border. But does this imply that trying to seal off the border would reduce the nation’s drug problem? The influence of a public policy change, for example tightening or loosening border security, varies depending on the baseline from which one is starting. Compared to having no border security, the United States' current, moderate level of drug law interdiction at its borders clearly has an impact. (Keith Humphreys, 12/8)

Miami Herald: Opioids Are Killing Us; Fight It Like Zika
The Zika epidemic in Miami-Dade is pretty much over and done with, Gov. Rick Scott announced on Thursday. Now another scourge with a higher human toll is showing up on our radar — an epidemic of opioid overdoses. As we close out 2016, things will likely only get worse in 2017 with this crisis. The county must brace itself. Law enforcement must attack. Social-service agencies must prepare. (12/8)

The New England Journal of Medicine: The Rising Price Of Naloxone — Risks To Efforts To Stem Overdose Deaths
Given the attention focused on naloxone [to help reverse opioid overdoses] and the initiatives broadening recommendations for its use, one would expect rapid increases in utilization. But between 2009 and 2015, the annual number of naloxone prescriptions increased only from 2.8 million to 3.2 million; while retail-prescription numbers were unchanged, the proportion attributed to clinics and EMS providers has grown from 14% to 29%. The relatively slow adoption of naloxone may be due in large part to stigmatization and lack of familiarity with the treatment among clinicians and opioid users. Another reason, however, may be its rising cost, which is probably enabled by the small number of manufacturers producing it. (Ravi Gupta, Nilay D. Shah and Joseph S. Ross, 12/8)

Los Angeles Times: What's The Prescription For A Hateful Patient? Connecticut Doctor Asks
I have been appalled by the swastikas, homophobic propaganda and lynching references mushrooming across the country, but the danger felt theoretical until recently, when I became a victim of hate speech from a patient. My patient's kidneys were failing and we needed to know why. After wheeling, dealing and pleading, my intern and I persuaded the MRI techs to do one last scan before they went home for the weekend. My heart beating triumphantly, I raced to update the patient. To be honest, I was dreading the conversation as he was a certified curmudgeon, but I felt relieved when I found him prattling pleasantly with some nurses. As I told him about the upcoming scan, he exploded. (Pranay Sinha, 12/8)

Miami Herald: Hype, Hope And The Truth About Alzheimer’s Disease
The good news about Alzheimer’s disease is that the rate of dementia in the United States appears to be declining. We hope this is a product of healthier lifestyles among baby boomers and portends a better future for many of us. The bad news is that another major experimental treatment for Alzheimer’s disease failed to show benefit — in line with 99 percent of all similar clinical trials in the past 15 years. Stuck in between these news items is yet another “miracle brain tonic” being hawked on social media, with the “last three trucks leaving the warehouse” so better order it fast. Given all these stories, what is one to actually believe about the current status of this late-life scourge? (Marc E. Agronin, 12/8)