Viewpoints: Cantor was no RINO; battles over Medicaid in Va. and Ind.; reforms moving for VA

Richmond Times-Dispatch: Stunning Upset
Ideas have consequences. Elections sure do, too. David Brat's victory over Eric Cantor is stunning, to state the glaringly obvious. ... Brat's victory also moves the Virginia GOP even further to the right. No one ever could have mistaken Cantor -; who organized 50 votes to repeal Obamacare -; for a RINO, let alone a limousine liberal. But for many GOP diehards, he was insufficiently confrontational (6/11).

The Washington Post: Virginia's Low-Income Population Needs Obstruction On Health Coverage To End
For months now, Gov. Terry McAuliffe (D) has been battling Republicans over whether Virginia should take $2 billion per year of federal money to expand Medicaid within the state, covering some 400,000 people. Amid this deadlock, Phillip Puckett (D-Russell), a state senator, suddenly resigned on Monday, shifting power in the Senate from the Democrats to the Republicans. The newly configured Senate now appears ready to pass a state budget without Medicaid expansion in it, possibly jamming the governor with a spending plan that does not include his top priority. Mr. McAuliffe could try to amend the bill and send it back to the legislature, but it's also very possible that the governor will be thwarted in delivering on his push to expand Medicaid in this legislative round (6/11). 

The Fiscal Times: The Pol Who Sold Out 400K Uninsured Constituents
When they went to bed on Saturday night, the 400,000 Virginians currently without health insurance stood at least a fighting chance of getting coverage through an expansion of the state's Medicaid program. They woke up Sunday to rumors, quickly confirmed, that that chance had virtually disappeared. ... Sen. Phillip P. Puckett, a Democrat representing a poverty-stricken district in the southwestern part of the state suddenly announced his resignation. ... It was a mortal blow to the Democrats' control of the Senate. The district Puckett used to represent contains part of Wise County, where poor residents wait anxiously to get free medical care from a mobile clinic that visits once a year (Rob Garver, 6/10).

The Wall Street Journal: The Short Unhappy Life Of ObamaCare
President Obama claims the debate over the Affordable Care Act is "over," but in coming weeks and months expect it to intensify. Health-insurance companies will soon begin releasing preliminary rate estimates for next year's plans. Industry experts say consumers should once again brace for significantly higher premiums. Fearing the political fallout before November's elections, the administration last month quietly increased by billions of dollars the "risk corridor" funds that insurance companies can use to staunch their losses (Stephen T. Parente, 6/10).

USA Today: For Obama, Inaction Speaks Louder Than Words
Now new revelations about the handling of Obamacare subsidies and health care for our nation's veterans paint a startling picture of incompetence at the highest level of our government. President Obama must act now to correct these deficiencies before the faith of the American people in our federal government -; already at record lows -; is further undermined. Since its enactment, Obamacare has lurched from crisis to crisis, the result of fundamental flaws in rushed legislation with no bipartisan support and without proper consideration or necessary amendments. Based on new information that has come to light, Obamacare's broken subsidy provision may end up being among the most costly of these flaws (Sen. Rob Portman, R-Ohio, 6/10).

The New York Times' The Conscience Of A Liberal: The Pundits And The President
Obama's signature initiative, health reform, made a stunning comeback from a rocky start and will almost surely be irreversible by the time he leaves office. He's taken the most important step on environmental policy since the Clean Air Act. … If the point of being president is to do things with lasting effect, Obama has delivered. So why the bashing? Part of the answer, I think, is that these are the wrong achievements. He was supposed to be serious in the approved way, slashing entitlements to deal with the fiscal crisis. The fact that there wasn't actually a fiscal crisis, and that anyone who really cares about the long run should worry a lot more about carbon emissions than about the Medicare age, doesn't change the bias; strong presidents are supposed to use that strength on behalf of the elite's pet obsessions, not other stuff (Paul Krugman, 6/10).

The Hill: Two Sides Of The Medicaid Expansion Coin
Is it possible for more Republican-led state governments to expand their Medicaid programs without politically endorsing the extension of ObamaCare under the Affordable Care Act (ACA)? Indiana Gov. Mike Pence (R) says he can, but he hasn't convinced a number of conservative Republican critics. ... The overriding judgment call is whether Indiana is sending a signal of counterrevolutionary resolve, or disguised take-the-money-and-run capitulation, to the remaining states holding out against Medicaid expansion as part of broader efforts to overturn ObamaCare. The evidence for the former would be stronger if Indiana officials truly were still prepared to walk away from a bad waiver deal. But at this point, it appears that Pence and his state allies need even a watered down version of [Healthy Indiana Plan] 2.0 more than the Obama administration needs to add another red-state political trophy to its list of ACA-compliant jurisdictions (Tom Miller, 6/11).

Fort Wayne Journal Gazette: HIP Replacement: Pence Plan Needs To Be Ready To Go On Day 1
Later this month, the state will file its request for federal permission to substitute HIP 2.0 for an expansion of Medicaid. A meeting at Ivy Tech Monday was one of nine "conversations" state officials are having around the state. As Indiana Health Commissioner William VanNess and Indiana Medicaid Director Joe Moser fielded questions from about 50 participants, it became clear that the focus of concern was whether anyone has thought through how to get 2.0 off the ground. "We don't expect major challenges in implementation and enrollment," VanNess said. This was a tough audience, though; sprinkled with experienced health care workers and administrators, the questions they raised need to be seriously addressed (6/11).

And on other health issues -

The Washington Post: Congress Reforms Of VA System Could Be A Move In The Right Direction
For those of us who have been struck by the high rhetoric-to-fact ratio in the uproar over alleged misconduct at the Department of Veterans Affairs, Monday brought a needed infusion of hard data in the form of a department-wide audit. ... As the new department audit clearly demonstrates, the root cause of scheduling chicanery is not the inherent corruption of VA staff but the fact that there are too many veterans pursuing too few physicians, which, the audit said, made the 14-day goal "simply not attainable." ... "Privatization" is a dirty word to many VA supporters on the Hill and in the veterans' lobby. But if the Sanders- McCain bill's two-year experiment in letting vets seek care outside the system becomes law, and if it proves to be effective, Congress may well see the wisdom of this approach and want to continue and expand it (6/10). 

Bloomberg: Medicare Can Afford A Bit Of Fraud
Medicare fraud is not OK. You shouldn't do that, doctors, and if you are committing Medicare fraud, you should be very ashamed of yourself and stop. But that doesn't mean the folks who run Medicare should do everything in their power to stop you. Every organization should work hard to prevent malfeasance, but it should not go after every possible case of fraud ever. As the frauds get smaller or more sophisticated, the cost of preventing the fraud starts to exceed the cost of the fraud itself (Megan McArdle, 6/10).

Journal of the American Medical Association: Addressing The Burden Of Diabetes
If the current epidemic is not addressed, the US Centers for Disease Control and Prevention estimates that as many as 1 in 3 people in the United States could have diabetes by the year 2050. ... Addressing the epidemic of diabetes will involve reducing the effects of the disease on patient outcomes and quality of life, as well as lowering cost to the health care system. Ultimately, this will require new strategies to prevent the disease in those at risk and cure those who have already developed diabetes. More research is necessary to understand the pathogenesis of all forms of the disease to address the root causes. Until then, physicians, other health care professionals, and patients must focus on implementing evidence-based prevention and treatment approaches in determining how to best use the currently available tools (Dr. Elizabeth R. Seaquist, 6/10). 

Journal of the American Medical Association: Comparative Effectiveness Research And Outcomes Of Diabetes Treatment
Randomized clinical trials (RCTs) are the gold standard for advancing the science of medicine. However, many important clinical questions probably will never be answered by RCTs simply because many trials are extraordinarily expensive and RCTs might not always be appropriate for addressing some research questions. ... Comparative effectiveness research is creating new challenges as it generates much needed new evidence (Dr. Monika M. Safford, 6/10).