Viewpoints: Indian health hit by budget cuts; Health care doesn't work like normal markets; Gov. Rick Scott paying a price for Medicaid expansion

The New York Times: The Sequester Hits The Reservation
The Congressional Republicans who brought us the mindless budget cuts known as the sequester have shown remarkable indifference to life-sustaining government services, American jobs and other programs. So what do they make of the country's commitments to American Indians, its longstanding obligations to tribal governments under the Constitution and treaties dating back centuries? Very little, it seems. The sequester will impose cuts of 5 percent across the Indian Health Service (3/20). 

Los Angeles Times: Health Care Reform And The Incentive To Keep Spending
Reforming the health care system is largely about fixing the incentives it provides for doctors, hospitals and patients to overspend. For example, the "fee for service" payment model that Medicare relies on encourages physicians to do as many things for a patient as they can bill for -- the more services provided, the higher the compensation. That's a model that profits from sickness, not health (Jon Healey, 3/20).

The Houston Chronicle: Health Care Is Not A Market
Here's a simple solution to our health care mess. Eliminate all the insurance companies, government subsidies, and other intermediaries and let people purchase medical services directly from a provider of their choice at the going market rate. Believe it or not, this is actually a popular concept on the Republican far right, and not just from Ron Paul. ... Republicans still struggle to promote a credible ownership culture largely because we refuse to wrestle honestly with the hard-cases; the situations in which market forces fail to allocate value effectively. Medical care is probably the most frustrating example since it stubbornly resists market solutions and affects everyone deeply. Health care is not a market (Chris Ladd, 3/21).

The Wall Street Journal: About That 'Scalpel'…
President Obama often claims he wants to cut the budget smartly, using a "scalpel" -- not a meat axe, machete, cleaver or chainsaw, to list a few of his favorite metaphors. He'll need a more inspired term to describe what he's now doing to Medicare Advantage, perhaps napalm or WMD. The Affordable Care Act drained $306 billion from this growing version of Medicare that 29 percent of seniors use to escape the traditional entitlement and obtain modern private insurance, but the Administration is imposing the cuts in ways that are even more harmful than the law requires. The post-election timing is no accident (3/20). 

USA Today: Republicans Bleed Slow-Moving ObamaCare
The House (continuing resolution to keep the government running) left out nearly a billion dollars in funding for insurance exchanges as well as funds for the IRS to prepare to enforce the law's tax rules. According to Rep. Nita Lowey, D-N.Y., this will delay "implementation of the Affordable Care Act. ... Without IT infrastructure to process enrollment and payments, verify eligibility and establish call centers, health insurance for millions of Americans would be delayed." Instead of repealing ObamaCare, an unlikely event with a Democratic Senate, Republicans aim to bleed it to death. The move fits with a pattern the GOP has followed since the law passed in 2010. Even as Republicans fail over and over again in high-profile efforts to simply destroy ObamaCare, they are succeeding with delaying tactics that may combine to turn the law's implementation into a fiasco (Kavon Nikrad, 3/20). 

Bloomberg: How Changes To Obamacare Can Cut The Deficit
Republicans in Washington have repeatedly called on President Barack Obama to make changes to the Affordable Care Act as a part of their efforts to deal with long-term budget deficits. Although complete repeal of the law is desirable, such an outcome is impossible in the near-term. This raises two questions: Should changes to the law be part of current budget negotiations? And, more important, what form should these changes take? The answer to the first question is yes (Lanhee Chen, 3/20). 

Bloomberg: Entice States To Expand Medicaid, Though Not At All Costs
Arkansas and a few other states are proposing to go a huge step further and use the federal Medicaid-expansion funds to give new enrollees "premium support" to buy individual policies on state insurance exchanges. Arkansas Governor Mike Beebe says this would satisfy Republican legislators' philosophical preference for private insurance over government programs. Presumably, it would give them a rhetorical path to accept billions of dollars in new federal Medicaid spending without seeming to compromise their anti-Obamacare principles. It's not clear, though, how the states could manage this in a way that would preserve the program's efficiency and taxpayer dollars. (Yes, Medicaid is efficient, delivering a high standard of care at rock-bottom cost.) Unless Arkansas and its counterparts include credible measures to ensure that private plans don't squeeze beneficiaries' health care, Sebelius should draw a line -- the tradeoff won't be worth it (3/20). 

Arizona Republic: Affordable Care Act Already Improving Ariz. Health Care
This week marks the third anniversary of the Affordable Care Act. For Arizonans, that means a health care system that is stronger than it was three years ago, and a future that looks even brighter. Arizonans who have health insurance now have more security thanks to new insurance-market reforms and consumer protections put into place by the law. Preventive services like mammograms and flu shots are newly available for free to 1.4 million people with private insurance plans. About 65,270 Arizona Medicare beneficiaries with the highest prescription drug costs have saved an average of $689 on their medications. And Arizonans are now protected from some of the worst insurance industry abuses, like lifetime coverage caps that could cut off benefits when people need them most (Sec. Kathleen Sebelius, 3/20).

The Wall Street Journal: Rick Scott's Slide
Two new polls show Florida Gov. Rick Scott skating on thin ice with approval ratings in the mid-30s. Suffice it to say the future doesn't look bright for the Republican. … Meanwhile, most of his reforms (e.g. requiring workers to contribute three percent of their salaries to their pensions) have been too timid to rally conservatives to his side. The legislature is now forging ahead with a more aggressive plan to shift new workers to defined contribution accounts. Republican legislative leaders have also rejected his plan to procure "free" federal money by expanding Medicaid. Notably, his waffling on the ObamaCare Medicaid expansion -- in an apparent effort to cozy up to Democrats -- didn't achieve his desired results (Allysia Finley, 3/20).

The New England Journal of Medicine: Budget Sequestration And The U.S. Health Sector
The inability of the Congress and President Barack Obama to agree by March 1 on a plan to reduce the budget deficit is triggering $85 billion in across-the-board cuts in most federal agencies and programs for the final 7 months of fiscal year 2013. These reductions will have adverse effects on many important governmental functions and activities affecting both the health sector and the health of Americans (John E. McDonough, 3/21).