JAMA Forum: States and Health Care Reform—Laboratory, Stepping Stone, or Stumbling Block?

Mark D. Smith, JD

Mark D. Smith, JD

“All politics is local” is a maxim coined by Thomas “Tip” O’Neill, former Speaker of the US House of Representatives, and most people probably think that’s a good thing and a key feature of our democracy. And, of course, most people know that “all health care is local.” So even though the fate of the Patient Protection and Affordable Care Act (ACA) is being debated on a national stage today, the future of health reform is likely to take on a local flavor, no matter who prevails on November 6.

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JAMA Forum: To Serve Patients Better and Lower Costs of Care, Respect End-of-Life Wishes

Mark D. Smith, JD

Mark D. Smith, JD

The election debate has focused on warring narratives about whose approach to reforming Medicare is more harmful, as Democrats and Republicans promote competing solutions to lower Medicare spending. But outside of Washington, there is general agreement on one way to serve patients better and lower the costs of care: respect patients’ end-of-life wishes. Continue reading

JAMA Forum: How Can Medicaid Succeed After Absorbing Millions of New Enrollees?

Mark D. Smith, JD

Mark D. Smith, JD

The term “Obamacare,” once derisive, has now been embraced by the President, and the Affordable Care Act (ACA) is likely to be an important issue in the upcoming election. Since the Supreme Court ruling surprised nearly everyone and struck down some provisions related to the Medicaid expansion, several Republican governors have vowed to reject the expansion in their states, and debate about the value of Medicaid has intensified. Continue reading

JAMA Forum: The Supreme Court’s Medicaid Surprise

Mark D. Smith, JD

Mark D. Smith, JD

Most of the considerable speculation about how the US Supreme Court would rule on the Affordable Care Act (ACA) focused on the fate of the individual mandate, which requires individuals to purchase health insurance or pay a penalty. Few predicted the Court would strike down provisions of the law that dealt with the expansion of Medicaid. Now, instead of the blogosphere ruminating over the prospect of adverse selection in insurance markets without a mandate (meaning many healthy individuals would not purchase insurance until they get sick), the prime topic of discussion is the prospect of states turning down “free” federal money for the expansion of Medicaid that is part of the ACA.

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