Viewpoints: What’s Ahead For Medicare And Medicaid; State Innovations On Covering Uninsured Immigrants

The Wall Street Journal: Medicaid Explodes
On Donald Trump’s victory Republicans in Congress are primed for an ambitious agenda, and not a moment too soon. One immediate problem is ObamaCare’s expansion of Medicaid, which has seen enrollment at least twice as high as advertised. Most of the insurance coverage gains from the law come from opening Medicaid eligibility beyond its original goal of helping the poor and disabled to include prime-age, able-bodied, childless adults. (11/17)

The New York Times: The Medicare Killers
During the campaign, Donald Trump often promised to be a different kind of Republican, one who would represent the interests of working-class voters who depend on major government programs. “I’m not going to cut Social Security like every other Republican and I’m not going to cut Medicare or Medicaid,” he declared, under the headline “Why Donald Trump Won’t Touch Your Entitlements.” It was, of course, a lie. (Paul Krugman, 11/18)

Huffington Post: Not Just Obamacare: Medicaid, Medicare Also On GOP’s Chopping Block
Donald Trump and Republican leaders in Congress have made clear they are serious about repealing Obamacare, and doing so quickly. But don’t assume their dismantling of government health insurance programs will stop there. For about two decades now, Republicans have been talking about radically changing the government’s two largest health insurance programs, Medicaid and Medicare. (Jonathan Cohn and Jeffrey Young, 11/15)

The New England Journal Of Medicine: The End Of Obamacare
Donald Trump’s triumph in the 2016 presidential election marks the beginning of an uncertain and tumultuous chapter in U.S. health policy. In the election’s aftermath, the immediate question is this: Can Republicans make good on their pledge to repeal Obamacare? The Affordable Care Act (ACA) has persisted largely thanks to President Barack Obama’s protection. With Trump in the White House and Republicans maintaining House and Senate majorities, that protection is gone. (Jonathan Oberlander, 11/16)

The New England Journal Of Medicine: Maintaining Insurance Access Under Trump — A Strategy
Donald Trump’s election as President puts the future of the Affordable Care Act (ACA) in jeopardy. Full repeal is unlikely, given a probable filibuster by Senate Democrats, but major changes through the budget reconciliation process (which cannot be filibustered) are nearly certain. At the same time, eliminating insurance coverage for the millions of people now aided by the ACA carries its own political risks for the new administration. Complicating matters further is growing concern even among ACA supporters about the long-term viability of many of the insurance exchanges, through which more than 10 million people currently purchase private coverage (typically with federal subsidies). Several commercial insurers are either exiting or scaling back their participation in these marketplaces, and many smaller nonprofit insurers have shut their doors. One study predicts that 35% of U.S. communities will soon have only one available exchange insurance option. (Michael Sparer, 11/16)

Bloomberg: The Messy Politics Of Obamacare Repeal
Donald Trump and Republicans are about to encounter a political nightmare: unraveling Obamacare. Already there are tensions between Trump, who's been shaky on the specifics of the 2010 health-care law and says he wants to keep the popular parts, and congressional leaders like House Speaker Paul Ryan and conservative think tanks who ideologically, almost theologically, oppose anything associated with the Affordable Care Act. (Albert R. Hunt, 11/17)

The New England Journal Of Medicine: Covering Undocumented Immigrants — State Innovation In California
The proportion of undocumented immigrants in the United States who lack health insurance continues to be high — around 40%1 — even as the country’s overall uninsured rate has dropped to historic lows under the Affordable Care Act (ACA). Insuring undocumented immigrants would be an important step toward achieving universal coverage, but in an increasingly hostile national political climate, the likelihood of addressing this challenge at the federal level is low. Because the ACA continues a long-standing restriction on using federal funds to insure undocumented immigrants, covering this population will probably remain largely a state prerogative in terms of both policy and funding. (Rachel Fabi and Brendan Saloner, 11/16)

The New England Journal Of Medicine: Out-Of-Network Emergency-Physician Bills — An Unwelcome Surprise
Patients who seek care at in-network emergency departments may learn later that they owe thousands of dollars for a treating physician who isn't in their plan's network. But states could require hospitals to sell a bundled ED care package including physician services. (Zack Cooper and Fiona Scott Morton, 11/16)

Los Angeles Times: I Had A Health Crisis In France. I’m Here To Tell You That ‘socialized Medicine’ Is Terrific
On Sunday, March 29, 2015, two days after my 54th birthday, I came very close to dying. I was sitting in an armchair in my Paris apartment, reading a newspaper, when I became dizzy. The next thing I knew, my heart was beating violently. When the paramedics arrived, it was racing at 240 beats per minute. I was taken to Lariboisière, a major hospital in the north of Paris. .. In the United States, opponents of the Affordable Care Act often raise the nightmarish specter of European “socialized medicine.” For what it’s worth, here is a brief account of my experience with a single-payer system in the face of a life-threatening crisis. (Jake Lamar, 11/18)

Des Moines Register: Branstad's Medicaid Is Not Working For Iowa
The U.S. health care system most of us are familiar with comprises three main parts: Patients who receive care, health professionals who provide it and insurers (including government programs) that pay for it. How is each of these faring under Gov. Terry Branstad’s privatization of Medicaid? A look at Iowa newspapers over only a few days this month reveals two of the three are not doing so well. (11/17)

Bloomberg: Valeant's Pharmacy Ties Get Even Murkier
It turns out that the relationship was much hazier than I thought. ... Today U.S. federal prosecutors brought criminal charges against former senior Valeant executive Gary Tanner and Philidor Chief Executive Officer Andrew Davenport, alleging that they built the Valeant/Philidor relationship, used it to enrich themselves, and concocted a whole mess of squiggles to conceal it from everyone else. (Matt Levine, 11/17)

The Washington Post: Those OR Horror Stories Are The Exception, Not The Rule
I work as a “device rep” in the operating room. The headline “Why is that salesman in the operating room for your knee replacement?” [Nov. 15] makes it seem as though someone is selling a device or procedure inside the operating room. All procedures must be presented to the hospital or facility. Then, medical and operating staff decide whether to use it based on efficacy and financial impact. In-service programs and operative training are offered to surgeons prior to use. (Michael Goldberg, 11/17)

Stat: To Be True Healers, Physicians Need To Learn More About Nutrition
Most primary care doctors find it relatively easy to talk with their patients about topics like depression or cancer. Yet many shy away from talking about nutrition, or find it difficult to do. Avoiding that conversation is costly. For someone with diabetes, it may mean the difference between losing a foot or keeping it. For someone with heart disease, that conversation could free them from workplace disability or empower them to work harder. For someone who is steadily gaining weight, it could save them from gastric bypass surgery or from a lifetime of medications to treat obesity and weight-related complications. (Agustina Saenz, 11/17)

USA Today: Police Not Adequately Trained On Mental Health
Since Deborah Danner was killed by law enforcement in her New York apartment on Oct. 18, police in the U.S. have killed at least 10 other people whose behavior may have been connected to a mental health issue. A recent report by the Ruderman Family Foundation estimated that up to half of the people killed by police in America are disabled in some way, and a good number of them suffer from some sort of mental illness. While the majority of these killings may be legally justified, this is still a tragic outcome that demands steps be taken to reduce the likelihood of these deadly encounters. (Alex S. Vitale and Owen West, 11/17)

Lexington Herald Leader: Clergy, Others Must Join City’s Fight Against Opioid Deaths
In Lexington, we are fortunate to have Ronnie Bastin, our public-safety commissioner, on the forefront of the fight against the heroin-overdose epidemic we are currently experiencing. As a pastor and chaplain, I have seen the devastating effects of heroin addiction up close. The pain, the brokenness and the heartache of the lives lost and those impacted is wreaking havoc on our community. (Jonathan Smith, 11/17)

The New England Journal Of Medicine: Rethinking The Ban — The U.S. Blood Supply And Men Who Have Sex With Men
After the magnitude of the June 12, 2016, massacre at the Pulse nightclub became clear, people throughout Orlando wanted to help in any way they could. Thousands volunteered to give blood; local restaurants offered free food and water to those waiting in hours-long blood-bank lines in the central Florida heat. Yet after this attack that specifically targeted the lesbian, gay, bisexual, and transgender (LGBT) community, one group was notably absent from these donation lines: men who have sex with men, who have been prohibited from donating blood in the United States since 1985. This prohibition was, of course, not the tragedy that day, but the added insult that gay and bisexual men were unable to offer this measure of help to their community was deeply felt. One week later, 24 U.S. senators wrote to Food and Drug Administration (FDA) Commissioner Robert Califf asking the agency to revisit this ban, and on July 28, 2016, the FDA announced a call for input about changes to this policy. (Chana A. Sacks, Robert H. Goldstein and Rochelle P. Walensky, 11/16)