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This week’s study of Oregon Medicaid recipients has quickly become a Rorschach test for how partisans and health policy wonks view the health care law.

To recap, that study compared the health care of the winners and losers of a lottery held by Oregon in 2008 to decide who could enroll in the limited spots in the state’s Medicaid program. The study’s nuanced results were reflected in the varied headlines in news stories. The Associated Press declared “Depression rates for uninsured dropped with Medicaid coverage” while Bloomberg News announced that “Medicaid coverage may not improve the health of poor in U.S.”

Bloggers took the discrepancies and ran with them.

The liberal Daily Kos, like many supporters of the health law, focuses on the finding that people with Medicaid were less likely to have crippling medical bills:

That’s the point of health insurance: You get it for the peace of mind of knowing that catastrophic illness won’t ruin you physically and financially. That shouldn’t be reserved just for people lucky enough to a) have job-related health benefits, b) have enough money to buy their own insurance.

The libertarian Cato Institute’s Michael Cannon says the study‘s lack of definitive proof of improved health should give governors more reason to turn down the law’s Medicaid expansion:

The Obama administration has been trying to convince states to throw more than a trillion additional taxpayer dollars at Medicaid by participating in the expansion, when the best-designed research available cannot find any evidence that it improves the physical health of enrollees. The [researchers] even studied the most vulnerable part of the Medicaid-expansion population – those below 100 percent of the federal poverty level – yet still found no improvements in physical health.

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Obama speaks during a town hall meeting on health care in 2009 (Photo by Alex Wong/Getty Images)

The health policy world has moved on from what happens IF the health law survives to what happens NEXT now that its future appears secure.

Bloggers are focusing on how the law will be implemented, what the role of states may be, how patient care will be affected and how the work left to be done will shake out. Here’s a sampling:

Health Affairs’ Blog has three pieces on how the law moves forward: The first from Christine Vestal and Michael Ollove, of Stateline, examines two key decisions facing each state: whether to join the Medicaid expansion and whether to create their own health insurance exchange. “Most Democratic-led states are expected to fully participate in both, although some may seek flexibility. But among the 30 states that will be run by GOP governors starting next year, it is unclear how many will opt in. Many predict that the federal government’s offer of covering the full cost of the Medicaid expansion for the first three years, and 90 percent after that, will be too rich for states to refuse” (11/8).

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Last night’s vice presidential debate provided contentious contrast on the issues of abortion and Medicare between Vice President Joe Biden and the Republican nominee, Rep. Paul Ryan. The candidates sparred over the role their faith plays in their positions on abortion and laid out their tickets’ visions for Medicare reform.

Here’s a sample of how some bloggers around the nation are seeing the debate:

At ThinkProgress, Alyssa Rosenberg provided questions that she was waiting for moderator Martha Raddatz to ask the candidates: “If you believe abortion should be illegal except in cases of rape, incest, or where the life or health of the mother is at risk, how would you enforce a ban on abortions performed for other reasons? What sentences would doctors who performed abortions or women who solicited them have to serve if found guilty of violating the ban? How would you fund enforcement mechanisms?” (10/12).

Irin Carmon at Salon says the way Raddatz framed the abortion question favored Ryan:  “She chose to frame the late-breaking, much-yearned for question about ‘social issues’ in just the way Republicans prefer: in terms of religion. … Everyone at Salon’s debate-watching party groaned, and with good reason. Please, let’s hear more from two religiously observant white men about their personal experiences with women’s reproductive freedom and access! It’s not that religion, or men, have no place in the debate over abortion rights; it’s that her question left women out of the equation from the start” (10/11).

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This week, the Congressional Budget Office updated its numbers on the cost of the health law, the Affordable Care Act. The verdict? Now that the Supreme Court has overturned part of the Medicaid expansion – thereby allowing states to opt out of this portion of the overhaul without penalty, the law’s cost will likely be around $84 billion lower over 11 years than previously estimated.

The score from the CBO had bloggers writing about what fate inclusion of the new numbers hold for coverage for the poor in America, and sounding off about a new study in the New England Journal of Medicine that found expanding Medicaid saved lives in three states.

Matt Salo, at the Health Affairs Blog, writes that the finding from the CBO might not be the last word from federal policymakers on the subject: “Ultimately state-level dynamics, such as the nuances of individual Medicaid programs, the Medicaid-Exchange interactions, and state fiscal conditions, combined with the Administration’s decisions about the optional aspects of the expansion will require policymakers to repeatedly revisit these estimates. … The ACA offers states many incentives.  Nonetheless, the reality is that for some states, the Medicaid expansion may not necessarily or immediately be a “no-brainer” as some have suggested. … While numerous entities are tracking state officials’ public statements about the Medicaid expansion, it is likely the decisions will shift dramatically over time for both policy and political reasons” (7/25).

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Although the Supreme Court’s validation of the health law’s individual mandate dominated the reports on the decision, the court’s ruling on the Medicaid expansion could have just as broad an impact. The court said that if state leaders decide to forgo the infusion of federal money to extend Medicaid – a joint federal-state financed program – to more people, their existing federal Medicaid dollars cannot be withheld as a penalty. Under the plan, the federal government initially would pay 100 percent of the cost for those new participants but that would fall to 90 percent in 2020.

Photo by Marxchivist via Flickr

Already, Republicans in four battleground states are considering rejecting the Medicaid expansion dollars: Florida, Ohio, Pennsylvania and Colorado. Additionally, governors in Kansas, Nebraska and South Carolina said they would have trouble coming up with even 10 percent of the total cost to put more people on the Medicaid rolls.

Bloggers are breaking down what implications the moves could have for health care coverage in America:

Kevin Russell, at SCOTUSblog, explains the justices’ bottom line: “(1) Congress acted constitutionally in offering states funds to expand coverage to millions of new individuals; (2) So states can agree to expand coverage in exchange for those new funds; (3) If the state accepts the expansion funds, it must obey by the new rules and expand coverage; (4) but a state can refuse to participate in the expansion without losing all of its Medicaid funds. Instead the state will have the option of continue the its current, unexpanded plan as is” (6/28).

Michael Cannon writes in the CATO@Liberty blog that the ruling severely limits the Medicaid expansion. The ruling effectively gives “states the green light to refuse to expand their Medicaid programs” helping to put the law in “a very precarious position,” Cannon writes (6/29).

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Nearly any comment from a sitting president can elicit negative feedback from opponents. But when a president takes on the Supreme Court — and raises questions about the proper role of the judiciary vis-a-vis Congress – the response can be swift and loud.

(Photo by Jessica Marcy/KHN)

That’s the case this week as the blogosphere reacts to President Barack Obama’s comments that he is confident the Supreme Court will uphold the health reform law and warning the court not to engage in “judicial activism.”

Here’s a sample:

At Reason, Steve Chapman writes that punishing judges for exercising their duties would call into question the entire constitutional system: “In any event, Obama’s criticism could well have come from a hard-line conservative with a crabbed view of the role of the judiciary. … Conservatives, of course, exhibit a strange new respect for judicial review, which they have often reviled for letting unelected elitists ride roughshod over prevailing public opinion. But that’s no excuse for Obama to suggest that the court would be acting illegitimately in striking down his health care plan.”

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This week, the Supreme Court heard oral arguments on the 2010 health law, in what court watchers are calling the biggest case at the high court in decades. Here’s a rundown from the social media-sphere of what happened in those three days.

Day 1: Can We Even Argue About The Health Care Law?
Mon., March 26

The first day began with an examination of whether the Anti-Injunction Act, which bars lawsuits seeking to prevent a tax, would prevent a review of the health law’s individual mandate at this time. This would push the consideration of the health law challenges to 2015, when the first penalties would be imposed.

A Tax or a Penalty, or Both? nyti.ms/Hc1NXL

— NYTimes Lede Blog (@thelede) March 26, 2012

RT @philgalewitz: Justice Ginsburg has best argument shooting down anti injunction act. Saying law was meant to impact gov’t revenue.

— Kaiser Health News (@KHNews) March 26, 2012

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The blogosphere is tickled pink with the abundance of analysis and commentary on the decision last week by Susan G. Komen for the Cure Foundation to cut off funding to Planned Parenthood for, among other things, giving low-income women breast exams. After a major outcry, Komen announced Friday that it was reversing that decision, but bloggers are still actively discussing the ramifications of the week.

At The Washington Post’s Wonkblog, Sarah Kliff reacts to criticism from some quarters that the press did not treat both nonprofit organizations equally. “As Lena Sun and I reported in yesterday’s Washington Post, Planned Parenthood had a very aggressive media strategy: Within a day of the Komen decision, the organization blasted out the news it had raised $400,000 from 6,000 online donors. … Throughout the past week, I’ve repeatedly called and e-mailed Komen requesting comparable data. So far, nothing. … The lessened coverage of supporters of Komen’s initial decision to defund Planned Parenthood could simply be a product of the fact that most Americans supported it. Or, as [Ross] Douthat suggests, it might represent the media ignoring a lot of people. As a reporter covering this story, it’s been incredibly difficult to figure out which explanation is right when Komen declines to discuss the impact this past week has had on its organization” (2/6).

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Should doctors think about cost when they’re helping you make your health care decisions?

Yesterday on the main KHN site we had a round robin of experts talking about the American College of Physicians’ latest update of its ethics manual. The manual encourages doctors to be “parsimonious” in doling out health care — that is, if you see our handy definition, “having an extreme reluctance to spend money.”

The term, which has actually been part of the ethics manual since 1998, has recently been the source of controversy. Some say docs shouldn’t consider cost when caring for patients and call the idea ”rationing” — that minefield of a phrase — while others say doctors have an increasingly important role to help the U.S. control its health costs.

After we talked to experts for the round robin, I also sauntered around the Internet looking for blog posts on the subject. Here’s a sampling:

Aaron Carroll, at The Incidental Economist, in the second of two postings: “I think it’s fine for patients to see that some treatments may be a waste of money, and they might want to save that money. But I’m not sure that I think it’s as great an idea for doctors to consider “health care resources” in the same way. I’m just not as comfortable with that. At least, not when we’re talking “ethics.” Is a physician who advocates for a treatment that’s not cost-effective acting unethically? Again, I don’t think that’s what the ACP intended” (1/5).

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Yesterday, Sen. Ron Wyden, D-Ore., and Rep. Paul Ryan, R-Wis., rocked the health policy world with a new, bipartisan plan to reform Medicare. The two lawmakers propose to change the program for the elderly and disabled by giving beneficiaries a fixed amount to use on health insurance coverage. The plan would preserve traditional Medicare for those that prefer it, but would also open the program to private insurance providers who would be required to offer coverage at levels equal to the federal program.

Photos by Alex Wong/Getty Images, Jessica Marcy/KHN

The blogosphere was ablaze with comments on what the plan means for Medicare, for beneficiaries and for the 2012 political season.

At his Wonkblog, Ezra Klein writes that Ryan and Wyden want to bring health care reform concepts to Medicare: “The Ryden plan is part of an ongoing attempt by the Republican Party to carve out a more politically sustainable position on Medicare reform. Conservative activists might like Ryan’s original plan, but voters don’t. Wonks might admire its boldness, but they admit that its numbers don’t add up. … [T]he competition is driven by tying the subsidy to the second-least expensive plan in the market. That way, the system gives beneficiaries a financial incentive to choose the cheaper plan. That is exactly — exactly! — how the Affordable Care Act works” (12/15).

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