Viewpoints: 'Implosion' of the ACA; Administration 'spin machine'; Republicans on 'search-and-destroy' mission

The Wall Street Journal: Big Government Implodes 
July 3 was the quiet afternoon that a deputy assistant Treasury secretary for tax policy announced in a blog post that the Affordable Care Act's employer mandate would be delayed one year. Something about the "complexity of the requirements." ... Even if you are a liberal and support the goals of the Affordable Care Act, there has to be an emerging sense that maybe the law's theorists missed a signal from life outside the castle walls. While they troweled brick after brick into a 2,000-page law, the rest of the world was reshaping itself into smaller, more nimble units whose defining metaphor is the 140-character Twitter message (Daniel Henninger, 7/10). 

The Wall Street Journal: The ObamaCare Spin Machine Revs Up 
Meanwhile, the temporary reprieve from the employer mandate will not stop many businesses from preparing their people for when the company stops providing insurance. They'll also continue limiting more part-time employees to fewer than 30 hours a week, in order to avoid being snared by this provision in the law. To offset this development, the administration desperately wants to sign up as many people for health policies as possible, hoping the newly insured will be grateful voters on Nov. 4, 2014 (Karl Rove, 7/10). 

The Washington Post: Republicans' Obamacare Search-And-Destroy Mission 
Last week, the administration announced it was delaying by a year the implementation of one of Obamacare's provisions, the requirement that large employers provide health insurance. You'd think the opposition party, which has spent four years denouncing the health-care reforms, would be delighted by the reprieve. But on Wednesday, Republicans on the House Ways and Means Committee held a hearing to condemn the administration -; for incomplete enforcement of the law they hate (Dana Milbank, 7/10).

MinnPost: Obamacare And The Myth Of Rate Shock
Arguments about health-insurance rate shocks when the Affordable Care Act (Obamacare) kicks in willfully disregard key facts behind the policy. Claims regarding rate shock are based on the premise that the cheap plans on the market today are no longer going to be available, and the new plans will be incredibly expensive (Kevin George, 7/11).

Health Policy Solutions (a Colo. news service): The Role Of The Employer Mandate In The Affordable Care Act
So, perhaps the question about the delay is less important than whether the employer responsibility provision is the best approach to meet the law's objectives. Employer reporting could be less onerous. The law could be modified to base the penalty on the percentage of payroll that a business spends on health care instead of a threshold based on full-time employees. That kind of discussion would require both sides to recognize the benefit of working together to improve the law for both employers and employees. Given the politically polarized Congress, that seems unlikely (Bob Serno, 7/10).

New England Journal Of Medicine: Bundle With Care – Rethinking Medicare Incentives For Post-Acute Care Services
Although health policy experts disagree on many issues, they largely agree on the shortcomings of fee-for-service payment. The inefficiency of a payment method that rewards increases in service volume, regardless of health benefit, has become practically indefensible. But replacing discrete payments for each service with bundled payment for a set of services does not simply promote efficiency; it also potentially promotes skimping on care or avoidance of costly patients (Judith Feder, 7/10).

Health Policy Solutions (a Colo. news service): Finding Systems Of Care That Drive Value
We are all health care consumers, whether paying directly or indirectly for coverage or care. In the past, many people were unaware of specific health care costs because there was little cost-sharing involved, and price transparency in health care has been limited. Yet as patients pay higher out-of-pocket costs, they are taking a closer look at doctor and hospital bills – and rightly so. The recent spotlight on facility fees for physicians employed by health systems illustrates one aspect of health care sticker shock (Eric Worthan, 7/10).

The Star Ledger: The A.P. Is Missing The Real Story Concerning Obamacare And Smoking 
The Associated Press has an article on a glitch in Obamacare that will make it impossible to impose a proposed 50 percent hike in premiums on smokers. The article is fine as far as it goes, but the writer misses a key point: Even without the glitch, most smokers will be exempt from the individual mandate to purchase insurance (Paul Mulshine, 7/11).

The New York Times: What's Wrong With a 20-Week Abortion Ban?
The way the Catholic Association mentions "late-term" abortions, you might think the only women who had them were lazy and callous, just waiting around until the last second for no good reason. But as Cecile Richards, the head of Planned Parenthood, told me in an email, nearly 99 percent of abortions occur before 21 weeks; abortions later on often involve rare, severe fetal abnormalities and real threats to a woman's health. In many cases, women are facing the need to terminate a desired pregnancy, not an unwanted one (Andrew Rosenthal, 7/10).

Baltimore Sun: A Better MCAT May Not Produce Better Doctors
What does it take to become a good doctor? In the midst of a period of health care reform and primary care shortages, how we do to encourage talented students who want to give back to the community to go into medicine? (Diane Kuhn, 7/10).

Medpage Today: 7 Golden Rules For EHR Implementation
Eligible physicians are dropping out of the HITECH incentive program. Why? Often, it's because a practice implements an EHR and then tries to mimic all their old paper processes and workflows. That can get them through the vendor's initial implementation, but it is not sustainable for the long term. Workflows and operational processes must be modified to optimize the new tool. Technology changes what is feasible, and to adapt, we need to change what we do every day (Rosemarie Nelson, 7/10).

Des Moines Register: Iowa View: Wellmark Cash Pile Raises Questions
Wellmark Blue Cross and Blue Shield recently announced it will not increase rates for individuals and small businesses who agree to renew their business prior to Jan. 1, 2014. On the surface, this decision is welcome, short-term relief for the working families and small businesses that have been tightly squeezed by Wellmark's recent string of double-digit rate increases (Matt McCoy, 7/10).

The Lund Report: Oregon Plan to Cut Diabetes Testing By 95%
Ask anyone with diabetes. Testing blood sugar levels is a pain. It takes time, fingers become sore and the levels change during the day based on diet, exercise and other factors. They tolerate that because it is important. Managing blood sugar levels is critical to managing diabetes (Judy Fry and Denise Cedar 7/10).

Des Moines Register: The Register's Editorial: Change Surplus Law If Wellmark is Troubling
Wellmark Blue Cross and Blue Shield provides health insurance to about 2 million Iowans, two-thirds of the state's population. Iowans can have confidence that the vast majority of their premiums are used to cover the cost of prescription drugs, hospital care, visits to physician offices and other health services for policyholders. But Iowans might be surprised to learn how the state's largest health insurance company uses some of the money that doesn't directly pay for health care (7/10).