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In the American Health Care Act (AHCA), recently passed by the House of Representatives as a replacement for the Affordable Care Act (ACA), a key element is restructuring how Medicaid is financed. One effect of this legislation is focusing attention beyond how Medicaid’s financing is structured, to examine how well it has been performing as a public insurance program. (Gail Wilensky, 5/31)

In 2016, state tax revenues declined for the first time since the Great Depression. The decrease in this critical funding source, coupled with sharp increases in drug prices, and the addition of nearly 17 million new enrollees since 2013, has put enormous pressure on the nation’s largest healthcare program. There are currently 74.6 million people enrolled in Medicaid and CHIP (Children’s Health Insurance Program), the state-administered programs that provide healthcare to low-income individuals and families; and the downward revenue and upward cost trajectories have threatened the sustainability of these essential services. (Bill Lucia, 5/31)

Improving health takes time. Almost everyone has struggled to improve their health in one way or another – whether it’s trying to achieve a healthier weight, recover from a serious illness, reduce anxiety and stress, or overcome an addiction – and we don’t expect overnight results. But when we find something that truly helps, we know we ought to stick to it and see it through to real results. Expanding the Medicaid program in Kentucky to cover more low-income, and predominantly working, people is truly making a difference in our population’s health, and we ought to stick to it. (Ben Chandler, 5/31)

Leaders of North Carolina’s General Assembly can’t silence the truth by arresting the messengers and sending them off to jail. The legislators’ refusal to accept federal funds to expand Medicaid, denying health care coverage to half a million North Carolinians, should be of far more concern than the protesters who interrupted their comfort and convenience. The state budgets from both the Senate and House fail to take any significant action to extend health care to North Carolinians in need. Things aren’t much different in Washington where the “American Health Care Act,” the GOP-backed repeal and replacement for Obamacare will result in 23 million Americans losing health care coverage they have now. (5/31)

In its ongoing effort to dismantle everything about the Affordable Care Act that Americans like, the Trump administration is going after the ACA’s requirement that insurance plans include coverage for preventive health care with no cost-sharing, including birth control. While we knew this would be coming in some form, a draft of the regulation obtained by Vox shows that the administration may go farther than most people realized. (Paul Waldman, 5/31)

The American Health Care Act, the bill recently passed by the U.S. House, is a storm rolling in from Washington, D.C. Obscured by foggy notions of improved fiscal flexibility for states and broader insurance choices for individuals, the AHCA will in fact hamstring state budgets and wipe out coverage in ways that endanger the health of thousands of Iowans and the financial viability of the 118 community hospitals they count on. (Kirk Norris, 5/31)

The Founding Fathers purposely made it difficult for elected officials to enact sweeping legislation. Our Constitution’s separation of powers demands coordination and consensus to pass especially meaningful and impactful laws. For that reason, most of the significant pieces of legislation passed in the last 60 years, after lengthy debate, ultimately achieved bipartisan majorities on final passage. (Mike Mullins, 6/1)

President Trump’s proposed budget for fiscal 2018 is being condemned, right and left, for the cuts it imposes on various federal programs. Too little attention is being paid to the necessary economizing the Trump budget avoids — specifically, with regard to Medicare. (Charles Lane, 5/31)

With a week to sift through the Trump administration’s first full-fledged budget proposal, two inescapable realities have come into sharper focus: the enormous magnitude of the desired cuts in many domestic programs and an utter disdain for numerical integrity. First, no budget in my 40 years of following fiscal policy has attempted to reallocate outlays as radically as this budget does. Most of the commentary has focused on the cumulative spending changes over the next decade; look instead at the proposed outlays for 2027 to understand the full extent of the proposed shifts. (Steve Rattner, 5/31)