Daily Health Policy Report

Thursday, January 2, 2014

Last updated: Thu, Jan 2

KHN Original Reporting & Guest Opinion

Health Reform

Administration News

Medicare

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

The Health Law Takes Effect: A Consumer's Guide

Kaiser Health News staff writer Mary Agnes Carey reports: "Starting Jan. 1, central provisions of the Affordable Care Act kick in, allowing many uninsured Americans to afford health insurance. But the landmark law still faces heavy opposition from Republicans and from a public that remains skeptical the law can improve health care coverage while lowering its cost. The law has already altered the health care industry and established a number of consumer benefits. It will have sweeping ramifications for consumers, state officials, employers and health care providers, including hospitals and doctors. … Here's a primer on where the law might affect you" (Carey, 1/1). Read the story.

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Insuring Your Health: Despite Health Law's Protections, Many Consumers May Be 'Underinsured'

Kaiser Health News consumer columnist Michelle Andrews writes: "People with chronic conditions will be better protected from crippling medical bills starting in January as the health law's coverage requirements and spending limits take effect. But a recent analysis by Avalere Health found that many may still find themselves 'underinsured,' spending more than 10 percent of their income on medical care, not including premiums, even if they qualify for cost-sharing subsidies on the health insurance marketplaces" (Andrews, 12/31/13). Read the column.

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One Texan Weighs Obamacare Options: High Deductible Vs. 'Huge Fear'

KUHF's Carrie Feibel, working in partnership with Kaiser Health News and NPR, reports: "Boudreaux, 43, lives just outside of Houston and works as a psychiatric social worker on a freelance basis, with no benefits. This year Boudreaux estimates she spent about $1,500 on medical care, including a trip to the ER for a cut finger. She also takes a few prescription medications and occasionally sees a psychiatrist and a nutritionist. She can’t get insurance through her partner, because her partner’s employer doesn’t offer benefits to same-sex couples. And, Boudreaux has been skipping mammograms and other check-ups for a few years. 'It's worrisome,' she says. 'It's like gambling. Gambling with my health, and it is very frustrating'" (Feibel, 12/26/31). Read the story

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Capsules: Iowa Opens The Doors To Medicaid Coverage, On Its Own Terms; Finding Health Insurance For 71 Cents Per Month

Now on Kaiser Health News' blog, Iowa Public Radio’s Clay Masters reports on Iowa’s version of Medicaid expansion: “When the federal Affordable Care Act called for states to expand Medicaid programs to cover people like Gross, Iowa Republican Gov. Terry Branstad refused. He said he feared the federal government wouldn’t come through on its promise to fund the expansion to include childless adults. Iowa was one of many states that initially refused all or part of the federal funds offered. … Eventually Branstad said ‘yes,’ but only if Iowa could take the money on its own terms. The state legislature, which is evenly split between Republicans and Democrats, came up with an alternative: Federal expansion dollars would pay for managed care policies that poor people would select on the HealthCare.gov site” (Masters, 1/1). 

Also on the blog, Mississippi Public Broadcasting’s Jeffrey Hess reports on how the federal health exchange is working for his state’s residents: “If you’re looking for evidence that healthcare.gov, the federal health insurance marketplace, is working much better these days, you might want to ask Arlene Wilson. The 56 year old is a chef with a popular pizza shop in Jackson, Mississippi. Wilson says that “most jobs don’t offer” health insurance. Because “most of us live paycheck to paycheck,” she says she’s been unable to afford insurance for the past eight years. But the health law was designed to help people like Wilson and her co-workers (Hess, 1/2). Check out what else is on the blog

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Political Cartoon: 'Baby Steps?'

Kaiser Health News provides a fresh take on health policy developments with "Baby Steps?" by Larry Wright.

And here's today's health policy haiku:

HEALTH LAW MOMENTS OF TRUTH

You're seeing the doc?
Today? Let's see how it works...
It is a big test.
-Anonymous

 If you have a health policy haiku to share, please send it to us at http://www.kaiserhealthnews.org/ContactUs.aspx and let us know if you want to include your name. Keep in mind that we give extra points if you link back to a KHN original story.

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Health Reform

After Bumpy Launch, Consumers Start Using Health Law Coverage

Nearly four years after passage of the health law, its major provisions finally took effect Jan. 1, and millions of Americans are about to see how it really works. Media outlets offer tip sheets to consumers and report on the challenges that lie ahead.

Kaiser Health News: The Health Law Takes Effect: A Consumer's Guide
Starting Jan. 1, central provisions of the Affordable Care Act kick in, allowing many uninsured Americans to afford health insurance. But the landmark law still faces heavy opposition from Republicans and from a public that remains skeptical the law can improve health care coverage while lowering its cost. The law has already altered the health care industry and established a number of consumer benefits. It will have sweeping ramifications for consumers, state officials, employers and health care providers, including hospitals and doctors (Carey, 1/1). 

The New York Times: Consumers Start Using Coverage Under Health Law
Consumers around the country began using coverage provided by the new health care law on Wednesday, the same day that Medicaid expanded to hundreds of thousands of people in about half the states. Many provisions of the 2010 health care law offering new benefits and protections to consumers, including those with pre-existing conditions, also took effect. Hospitals said they were getting ready for an influx of newly insured patients, but many health care providers said the pace was slower than usual because of the New Year’s holiday. In a typical report, Clay Holtzman, a spokesman for Swedish Medical Center in Seattle, said the system’s hospitals were not seeing an immediate surge (Pear and Goodnough, 1/2).

Politico: For Obamacare, It's Finally Showtime
Obamacare just got real. Sure, there were some new rules and benefits over the last few years, but that was just a warmup. Starting today, all of the big pieces of the Affordable Care Act — the biggest domestic achievement of Barack Obama’s presidency and one of the most far-reaching changes in American social policy in decades — go into effect. And Americans will start to see, for better or worse, how the law really works. ... Obamacare supporters and the president and his team can bask for just a moment in the glow of their long-sought goal finally becoming law — but only for a moment. The ACA’s Perils of Pauline debut is going to continue. Here are the obstacles ahead this year (Nather, 1/1). 

The Wall Street Journal: Health Law's Uneasy Launch
Nearly four years after President Barack Obama signed his health initiative into law, the Affordable Care Act is officially reshaping America's $2.75 trillion health-care system. A survivor of bare-knuckle political fights, a U.S. Supreme Court challenge and a technologically disastrous rollout, the law now faces a fundamental test: Can its mix of government subsidies and market-based competition extend health insurance to millions of people whose medical conditions, income level or personal choice left them without it? (Weaver, 1/1). 

Politico: White House Expects Day 1 Obamacare Snags
The health coverage under Obamacare finally begins New Year’s Day and the Obama administration knows that it may not all go smoothly. More than 2.1 million people have signed up through the state and federal exchanges, and Obama administration officials acknowledged that some of them may not actually have their new health plan finalized Jan. 1, because of all the tech problems that plagued HealthCare.gov during the last three months (Norman, 1/2). 

Los Angeles Times: White House Issues New Tip Sheet For Obamacare Consumers
The Obama administration is releasing a new tip sheet for Americans who have signed up for coverage under the president’s healthcare law and is urging consumers to be careful before they start using their new insurance Wednesday. … Since Oct. 1, approximately 2.1 million people have enrolled in a private health plan through new marketplaces created by the Affordable Care Act, the administration announced Tuesday. About an additional 4 million low-income Americans have qualified for Medicaid or the Children's Health Insurance Program (Levey, 12/29/31). 

Politico: Key Obamacare Changes Come With The New Year 
Coverage begins on Jan. 1 for people who selected plans through new federal and state exchanges before the Dec. 24 deadline. Others have until March 31 to sign up. Many Americans can receive federal subsidies to help pay for insurance. Several million low-income people also qualified for Medicaid, which 26 states are expanding under the health law that President Barack Obama signed nearly four years ago. But there’s a ton of fine print taking effect, too, nitty-gritty details that are critical to making the health law work as intended. Here’s a look at some of the other Obamacare elements taking effect Jan. 1 (Cheney, 12/31/13).

USA Today: Health Care Changes To Watch For 2014
Beyond the law's new requirements, analysts and industry officials say they anticipate a series of related changes to affect health care in 2014, including: Private exchanges. ... Employer mandate. ... Pricing transparency. ... New rules and higher enrollments. ... Electronic records. ... Shrinking networks. ... States will drive change. Medicaid, which is run by the states, will have the most impact on local price structures (Kennedy, 1/1).

The Associated Press: New Year May Mean New Challenges, Too, For Health Care Law
This could be the year that things finally turn around for President Barack Obama's health care law. Yet it could start with another round of glitches that vex consumers and leave Republicans crowing, "We told you so." The law's major benefits take effect with the new year, along with an unpopular insurance mandate and the risk of more nerve-racking coverage disruptions (1/1).

The New York Times: Millions Gaining Health Coverage Under Law 
The decisively new moment in the effort to overhaul the country’s health care system will test the law’s central premise: that extending coverage to far more Americans will improve the nation’s health and help many avoid crippling medical bills. Starting Wednesday, health insurance companies can no longer deny coverage to people with pre-existing conditions and cannot charge higher premiums to women than to men for the same coverage. In most cases, insurers must provide a standard set of benefits prescribed by federal law and regulations (Pear and Goodnough, 12/31/13).

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Detailing The Numbers: Parsing The Latest HHS Tally Of New Enrollees

According to reports, 2.1 million people have signed up for new insurance coverage, and 3.9 million have been found eligible for Medicaid. Who are these people and what do the numbers mean? 

The Washington Post: Obamacare’s 2013 Tally: Six Million Signed Up For Coverage
Health and Human Services Secretary Kathleen Sebelius told reporters that 2.1 million have signed up for coverage through Dec. 28. That includes the 1.1 million that the White House had announced this past Sunday, who had enrolled through Dec. 24 on HealthCare.gov. There are also 3.9 million people who have been found eligible for Medicaid (Kliff, 12/31/13).

The Wall Street Journal: Health-Plan Enrollment Surpasses 2.1 Million
Nationwide enrollment in private health plans under the Affordable Care Act has topped 2.1 million, the Obama administration said Tuesday as it prepared to tackle potential new problems when coverage takes effect New Year's Day. The enrollment figure as of Dec. 28, announced by Health and Human Services Secretary Kathleen Sebelius, encompasses the federal health-insurance exchange serving 36 states and those who enrolled through exchanges in the 14 states that are running their own marketplaces. ... Uninsured people have until March 31 to sign up for coverage or run the risk of being required to pay a 2014 penalty (Schatz, 12/31/13). 

Reuters: Over 2.1 Million Have Signed Up For Obamacare: Officials
More than 2.1 million people have enrolled in private health insurance plans through new federal and state websites since they were launched in October as part of President Barack Obama's healthcare overhaul, U.S. officials said on Tuesday. While short of the 3.3 million enrollees that the Obama administration was hoping for by now, the number signing up for insurance is a dramatic improvement from the early weeks of the program, when barely 150,000 got coverage because of a series of technical problems with the federal website HealthCare.gov (Cornwell, 12/31/13).

Bloomberg: Obamacare Rallies From Botched Debut As 2 Million Enroll
About 2.1 million people will have medical coverage today through Obamacare after a late surge in enrollment helped regain ground lost to the botched debut of insurance exchanges created by the U.S. health-care overhaul.  More than 1.6 million Americans signed up through state and federal exchanges in December alone, according to calculations from data released yesterday by the U.S. Department of Health and Human Services (Wayne, 1/1).

ABC News: A Torturous Obamacare Odyssey Ends in Victory
For Ted and Maxine Baumgartner of Ft. Wayne, Ind., their first day as owners of a 2014 Obamacare insurance policy  can be summed up in one word: relief. The couple's months-long odyssey to buy coverage for Maxine through HealthCare.gov was a torturous experience that encapsulates everything that went wrong with the rollout. It also shows how persistence can ultimately pay off. Baumgartner, 62, is among an estimated 2 million Americans who've selected health plans through the Obamacare insurance exchanges since October and will start 2014 with protection from a potential medical and financial nightmare (Dwyer, 1/1).

NBC  News: Insured, Finally: Families Put Obamacare To The Real Test
For the 2.1 million people who've signed up for health insurance under the new federal and state exchanges, Jan. 1 is when the rubber meets the road. Health and Human Services Secretary Kathleen Sebelius called it "an exciting new day in health care" as latest enrollment figures were released Tuesday. But for people like the Schulz family of Phoenix, Ariz., Rita Rizzo and Lou Vincent of Akron, Ohio, and Joyce Moore of Zionsville, Pa., it's the first test of whether Obamacare will really work. They all say they're relieved and excited to finally have new access to health care, and they hope that the rocky rollout of the exchanges under the Affordable Care Act will actually give way to the smooth delivery of vital medical services (Aleccia, 1/2).

Fox News: Sebelius: No More ObamaCare Delays
Health and Human Services Secretary Kathleen Sebelius, on the eve of the ObamaCare launch, told Fox News she doesn't anticipate any more delays for the health care law. The secretary voiced confidence in the law as her department announced what it claimed was a "surge" in enrollment. The Centers for Medicare and Medicaid Services said Tuesday that more than 2.1 million people have enrolled through the federal- and state-run marketplaces.  "I'm thrilled that we're going to have millions of people for the first time that have health security, and it should be a great New Year for lots of families across America," Sebelius told Fox News in an exclusive interview, as she left a downtown D.C. restaurant Tuesday afternoon (12/31). 

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Winners And Losers: Some Will See Big Benefits, Others May Take Hits

USA Today reports midsize businesses may be the ones having the hardest time absorbing health care costs, while other groups -- for instance, newly released prisoners -- could finally be eligible for health coverage.   

The Washington Post: Beneath Health Law's Botched Rollout Is Basic Benefit For Millions Of Americans 
Adam Peterson’s life is about to change. For the first time in years, he is planning to do things he could not have imagined. He intends to have surgery to remove his gallbladder, an operation he needs to avoid another trip to the emergency room. ... Peterson is among the millions of uninsured Americans who are benefiting from the Affordable Care Act ... These beneficiaries have not been oblivious to the problems of the new insurance exchanges ... . [Yet] as New Year’s Day approaches, and with it, health insurance, their frustration is trumped by gratitude (Sun and Goldstein, 12/28/13).

USA Today: Health Law May Hit Midsize Businesses Hardest
The new year will bring tough new health care decisions for many businesses, especially those that are too small to easily absorb new costs and too big to think about dropping coverage, experts say. These midsize businesses, particularly those with 50 to 200 workers, are having the toughest time affording escalating health care costs, says Nancy Taylor, a health care lawyer with Greenberg Traurig (O’Donnell, 12/31/13).

Marketplace: In Prison You Get Health Care. When You're Released...
People in prison are sick. A recent report found the nation spends more than $6.5 billion every year on healthcare services for the men and women who are incarcerated. But right now, much of that care stops as prisoners are released. And many prison officials believe that’s part of the reason why so many former inmates keep coming back. The Affordable Care Act could interrupt this cycle beginning in January as several hundred thousand former inmates become eligible for healthcare (Gorenstein, 12/30/13).

The California Health Report: Parolees, Corrections To Benefit From ACA
Recent parolees, a population in dire in need of improved medical care, could be among those poised to benefit most from the Affordable Care Act come Jan. 1. The full implications of how the law will affect this population are still hazy, as officials across all fields of corrections prepare for the changes. It is clear, however, that parolees are among those with a high rate of health concerns and are likely to fall into the categories qualifying for assistance under the new law. Roughly 1,000 inmates are released from California prisons each month. Many return to their communities and struggle to access health care or coverage for it (Wyman, 12/24/13).

Earlier, related KHN coverage: Medicaid Expansion To Cover Many Former Prisoners (Gugliotta, 12/4/13).

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Evaluating The Rollout In The States

Media outlets track how the health law is being implemented in Texas, Iowa, Mississippi, Florida, Wisconsin, Connecticut, Massachusetts, Illinois and Minnesota. 

Kaiser Health News: One Texan Weighs Obamacare Options: High Deductible Vs. 'Huge Fear'
Boudreaux, 43, lives just outside of Houston and works as a psychiatric social worker on a freelance basis, with no benefits. [In 2013,] Boudreaux estimates she spent about $1,500 on medical care, including a trip to the ER for a cut finger. She also takes a few prescription medications and occasionally sees a psychiatrist and a nutritionist. She can’t get insurance through her partner, because her partner’s employer doesn’t offer benefits to same-sex couples. And, Boudreaux has been skipping mammograms and other check-ups for a few years. 'It's worrisome,' she says. "It's like gambling. Gambling with my health, and it is very frustrating" (Feibel, 12/26/31). 

Kaiser Health News: Capsules: Iowa Opens The Doors To Medicaid Coverage, On Its Own Terms
When the federal Affordable Care Act called for states to expand Medicaid programs to cover people like Gross, Iowa Republican Gov. Terry Branstad refused. He said he feared the federal government wouldn’t come through on its promise to fund the expansion to include childless adults. Iowa was one of many states that initially refused all or part of the federal funds offered. … Eventually Branstad said ‘yes,’ but only if Iowa could take the money on its own terms. The state legislature, which is evenly split between Republicans and Democrats, came up with an alternative: Federal expansion dollars would pay for managed care policies that poor people would select on the HealthCare.gov site (Masters, 1/1). 

Kaiser Health News: Capsules: Finding Health Insurance For 71 Cents Per Month
If you’re looking for evidence that healthcare.gov, the federal health insurance marketplace, is working much better these days, you might want to ask Arlene Wilson. The 56-year-old is a chef with a popular pizza shop in Jackson, Mississippi. Wilson says that “most jobs don’t offer” health insurance. Because “most of us live paycheck to paycheck,” she says she’s been unable to afford insurance for the past eight years. But the health law was designed to help people like Wilson and her co-workers (Hess, 1/2).

Health News Florida: New Insurance Era Begins
Thousands of previously uninsured Floridians woke up Wednesday morning with peace of mind for the first time in years: They had a health insurance card, or at least the promise that one is in the mail (Gentry, 1/2).

The Milwaukee Journal Sentinel: Obamacare Exchanges Identify 32,000 People Eligible For Badgercare Plus
The federal health care law has already identified tens of thousands of Wisconsin residents eligible for state BadgerCare Plus health care, with some potentially receiving coverage as early as Wednesday as key parts of Obamacare take effect. In a letter Monday to federal officials, state Medicaid director Brett Davis said the Wisconsin Department of Health Services wrote last week to these 32,000 people identified so far as being eligible to receive BadgerCare. This first wave of applicants for state coverage — a 4% bump to the BadgerCare program and a sharp increase over referral figures from the end of November — gives a new look at the effects the federal law will have for both the uninsured and taxpayers in the state (Stein, 12/31). 

The CT Mirror: 6 Questions About Obamacare In Conn. For 2014
Many of the major provisions of the federal health law known as Obamacare take effect today. Insurance companies will no longer be able to deny anyone coverage because of a pre-existing condition. Nearly everyone in the country will be required to have health insurance (although if you don’t have it today, you still have time to buy a plan before the penalty kicks in). And there are new requirements for what insurance plans must cover. But many of the implications of those and other changes the law requires won’t be clear overnight. Here are some of the key things to watch (Becker, 1/1).

WBUR: Come On, Massachusetts, Get This Pregnant Woman Covered
Jessica Stanford of Sharon, Mass., is 40 and newly pregnant. She’d really like to see a doctor soon because she’s had several miscarriages and developed gestational diabetes during her last pregnancy. But she doesn’t have health insurance and is worried about racking up medical bills. Stanford applied for subsidized coverage in early December. She keeps calling the Connector to find out about her enrollment status. One customer rep told Stanford she could take her application number to a doctor’s office for proof that the state will cover her, at least temporarily, but Stanford wants something more certain (Bebinger, 1/1).

The Chicago Sun-Times: Affordable Care Act: Hope, Uncertainty For Residents Who Need Coverage
Illinois residents have had different experiences with President Barack Obama’s health care law: Some expect to benefit, others are disappointed and some aren’t sure yet, as the earliest health insurance coverage starts Wednesday. On Tuesday, the federal government said 3.9 million Americans had enrolled in Medicaid and another 2.1 million had selected a private plan through the Affordable Care Act. Many of the people who qualified for Medicaid, thanks to the broader expansion of Medicaid made possible by the Affordable Care Act, said they had been uninsured before the change. The state expects about 190,000 low-income people to successfully enroll in Medicaid, of the people who have applied so far. It remains to be seen whether these people will have difficulty finding doctors willing to take Medicaid, as Illinois is notoriously slow to pay for its notoriously low portion of Medicaid (Thomas, 12/31).

MinnPost: MNsure Navigator: ‘Doing Group Enrollment Events Has Really Worked Well’
Rebecca Lozano is a certified MNsure navigator and the outreach program manager of Portico Healthnet, an organization that has assisted people with finding health coverage for nearly two decades, mainly focusing on public programs (Nord, 1/1). 

Minnesota Public Radio: Health Care Overhaul Has Some Clinics Preparing For Rush Of New Patients
Community health centers are hiring more people to prepare for an influx of new patients who are now covered because of the federal health care law. The law expanded Medicaid and provided some people with premium discounts through the state's new online insurance marketplace, MNsure. As a result, community health centers expect to see a 12 to 15 percent rise in the number of patients this year (Stawicki, 1/1).

Minnesota Public Radio: 7 Things To Know About MNsure And The Affordable Care Act In 2014
Jan. 1 marks the start of the New Year, but it's also an important date for the Affordable Care Act. Starting Wednesday, nearly all provisions of the biggest change to the U.S. health insurance system since the establishment of Medicare and Medicaid in 1965 take effect. Here are some of the law's biggest changes (Richert, 12/31/13).

The Star Tribune: MNsure: As Clock Strikes 12, Some Are Insured, Others Are In Limbo
Wednesday marks a “new day” for thousands of Minnesotans who acquired health insurance through MNsure — whether they know it or not. While many Minnesotans are enjoying the certainty of coverage they obtained through the state’s online insurance exchange for 2014, others reached the stroke of midnight Tuesday night with no clue whether their enrollments had been completed or whether they have medical benefits today. As of late last week, more than 50,000 people had completed applications to buy private health plans on MNsure but had not completed enrollment — leaving their status in health insurance limbo (Olson, 1/1).

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With Implementation Of Health Law, Medicaid Expands To Broader Role

The Washington Post examines how the health overhaul moves many middle-class Americans into the program that has long been viewed as insurance for the poor. Meanwhile, Virginia Republicans downplay the issue in a recent survey.

The Washington Post: With New Year, Medicaid Takes On A Broader Health Care Role
Medicaid embarks on a massive transformation Wednesday — from a safety-net program for the most vulnerable to a broad-based one that finds itself at the front lines of the continuing political and ideological battle over the Affordable Care Act. Already the nation's largest health care program, Medicaid is being expanded and reshaped by the law to cover a wider array of people. Among them will be many who consider themselves middle class (Somashekhar and Tumulty, 12/31/13).

The Richmond Times-Dispatch: GOP Issues Survey Does Not Mention Medicaid Expansion
A year-end survey issued by the Republican Party of Virginia asks respondents to list the potential Democratic policy under new Gov. Terry McAuliffe that worries them the most. It does not mention Medicaid expansion. The survey from state GOP Chairman Pat Mullins first asks respondents what issue the GOP should focus on this year, listing tax relief, transportation, deficit reduction and national defense (Cain, 1/1). 

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2014's Health Law Tactics:GOP Midterm Hopes, Democrats Re-Selling Law

The health law will be a major factor in 2014's midterm elections, with Republicans -- including some candidates who are doctors -- hoping to use its rocky rollout to their advantage in holding the House and re-taking the Senate. In the meantime, the White House and President Barack Obama look to use feel-good health care stories, celebrities and even moms to sell the overhaul.

The Wall Street Journal: Republicans Pin Hopes On Midterm Elections
Mr. Obama's fading popularity and the rocky debut of his sweeping health care law have given Republicans a big jolt of optimism that they can build on their 31-seat House majority and retake the Senate (King, 1/1). 

ABC News: 2014 Could Be Kind Or Cruel To Democrats And Republicans
New years offer good opportunities for fresh starts. And after a rough -- and unproductive -- 2013, both Democrats and Republicans desperately need 2014 to be the dawn of a new era. With a midterm election on the horizon, control of Congress is at stake in 2014. The next year could also present opportunities for prospective presidential candidates to distinguish themselves in Washington or against Washington. The implementation of President Obama's health care law begins in earnest in 2014 and several issues, including the debt limit and immigration reform, will demand Washington's attention (Phillip, 1/2).

The Boston Globe: Physician-Candidates Running Against Health Care Law
One candidate's website shows her wearing blue scrubs as she reviews X-rays. Another shows a candidate with a stethoscope over his white coat. A third displays a photo of the doctor’s bag he uses for house calls. There is no mistaking what these candidates for Congress are trying to convey: Trust me. I’m a doctor (Bierman, 1/2). 

The Washington Post: Obama's OFA Begins Effort To Showcase Personal Health Care Testimonials
With millions of Americans starting to receive health insurance coverage under the Affordable Care Act on Wednesday, President Obama's political organization is starting a new campaign to highlight the personal stories of people benefiting under the new law (Rucker, 1/1). 

CBS News: White House Solicits Feel-Good Obamacare Stories
Now that the Obamacare marketplaces are open for business, the Obama administration is aiming to improve perceptions about the controversial law with its success stories. A new page on WhiteHouse.gov allows visitors to submit their own Obamacare stories, along with their name, email address and zip code. "Whether you've got new insurance that started on January 1, know someone who does, or simply want to help get the word out about the importance of getting covered, we want to hear from you," the site reads (Condon, 1/1).

The Associated Press: Racy Ads, Celebrity Endorsements, Pressure From Mom: Efforts To Sign Up Uninsured Youth Increasing
The so-called "young invincibles" are so important to the success of the Affordable Care Act that supporters and detractors are spending millions to reach them with racy ads, social media campaigns and celebrity endorsements. The president is even (gasp) asking their mothers to help convince them to sign up for insurance (1/1).

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Temporary Halt To Obamacare Birth Control Rule From Justice Sotomayor

The Supreme Court justice's ruling affects a number of faith-based groups. She asked for an administration response by tomorrow.

Los Angeles Times: Justice Sotomayor Grants Temporary Obamacare Exemption To Nuns
Supreme Court Justice Sonia Sotomayor granted a temporary exemption late Tuesday to a small group of Catholic nuns that shields it from having to comply with a part of President Obama's healthcare law that requires it to provide contraceptive coverage in its insurance plans. She acted on an emergency appeal from lawyers for the group who said the nuns faced "draconian fines" beginning on New Year's Day if they failed to comply with the law widely known as Obamacare (Savage and Reston, 12/31/13).

The Associated Press: Justice Delays Health Law’s Birth Control Mandate
Her decision, which came after federal court filings by Catholic-affiliated groups from around the nation in hopes of delaying the requirements, throws a part of the president's signature law into temporary disarray. At least one federal appeals court agreed with Sotomayor, issuing its own stay against part of the Affordable Care Act, also known as Obamacare. ... Sotomayor acted on a request from an organization of Catholic nuns in Denver, the Little Sisters of the Poor Home for the Aged (Holland, 1/1).

The New York Times: Health Law Challenge Opens Up New Front
In temporarily blocking enforcement of the part of President Obama’s health care law that requires many employers to provide health insurance coverage for birth control or face penalties, Justice Sonia Sotomayor on Tuesday opened a second front in Supreme Court challenges to the provision. The initial front opened in November, when the justices agreed to hear a pair of cases from for-profit companies challenging that provision. Now Justice Sotomayor has ordered the Obama administration to file a brief by Friday morning responding to a different kind of challenge, this one from groups affiliated with religious organizations (Liptak, 1/1).

Politico: W.H. Stands By Birth-Control Rule
"We defer to the Department of Justice on litigation matters, but remain confident that our final rules strike the balance of providing women with free contraceptive coverage while preventing non-profit religious employers with religious objections to contraceptive coverage from having to contract, arrange, pay, or refer for such coverage,” a White House official said (Allen, 1/2).

The Washington Post: Supreme Court Temporarily Allows Religious Groups Not To Cover Birth Control
The ruling applied not only to the Little Sisters of the Poor, a nonprofit group that provides services to low-income elderly people, but also to more than 200 other faith-based groups that use insurance offered by the Christian Brothers Employee Benefit Trust, which adheres to Catholic principles. Most nonprofit groups that challenged the mandate had received temporary reprieves. The injunction could expire as soon as Friday, which is when Sotomayor has asked for a response from the federal government (Somashekhar, Barnes and Boorstein, 1/1).

Bloomberg: Obama Contraception Rules Halted Catholic Groups’ Suit
The U.S. Court of Appeals in Washington, in a 2-1 ruling, yesterday granted a request by the Roman Catholic Archbishop of Washington and the Catholic University of America among other plaintiffs for an order barring the federal government from imposing the contraceptive services requirement on them while they appeal a lower-court ruling they lost (Pettersson, 1/1).

The Baltimore Sun: Little Sisters Hopeful After Supreme Court Stays Obamacare Birth Control Mandate
[T]he Little Sisters of the Poor, an international order with its U.S. headquarters in Catonsville [Md.], say that step alone would amount to participating in a practice that violates Catholic teaching, and they cannot comply "in any way." The Little Sisters, who employ hundreds of workers at 30 homes for the elderly across the United States, would have faced substantial IRS fines beginning Wednesday (Brown, 1/1).

Kaiser Health News on Wednesday tracked additional headlines and coverage of this development (1/1).

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Administration News

Second Administration Official Resigns After Troubled Healthcare.gov Rollout

Michelle Snyder oversaw technology experts who helped build healthcare.gov and is the second administration official to leave after problems with the website where Americans can buy health insurance.

The New York Times: Second Official to Leave After Health Site Trouble
The No. 2 official at the Centers for Medicare and Medicaid Services, who supervised the troubled rollout of President Obama's health care law, is retiring, administration officials said Monday. Michelle Snyder oversaw the technology experts who built the Healthcare.gov website. The official, Michelle Snyder, is the agency's chief operating officer. She is the second administration official to depart since problems at the website, healthcare.gov, frustrated millions of people trying to buy insurance and caused political embarrassment to President Obama (Pear, 12/30/13).

Reuters: Official Who Oversaw Building Of Obamacare Website Retires
Snyder, a career bureaucrat, was identified by U.S. Health and Human Services Secretary Kathleen Sebelius at a hearing in October as the CMS official who decided to have the federal government fulfill the key role of system integrator for healthCare.gov. But Sebelius also told lawmakers: "Michelle Snyder is not responsible for the debacle. Hold me accountable for the debacle. I'm responsible." ... Snyder has not taken a public role in defending the administration's work on Healthcare.gov or its effort (Cornwell, 12/30/13).

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Medicare

Medicare Shapes What Others Pay For Health Care

Because of Medicare's huge scale, the prices it pays for procedures often shape what others pay for similar care, economist are finding. In the meantime, the program continues to look for ways to prevent inappropriate prescribing by its doctors.

The Washington Post: Medicare Pricing Drives Health-Care Costs 
Medicare may be best known for paying the medical bills for millions of people 65 and older, but recent studies show it plays another gargantuan role in American health care: It helps determine prices for everyone. For virtually every procedure and service -- from routine colonoscopies to brain surgery and hospice care -- Medicare comes up with a dollar figure that the government considers a fair price. But economists are finding that, largely because of the program's vast scale, Medicare prices substantially shape what all Americans pay for health care (Whoriskey and Keating, 12/31/13).

ProPublica: Medicare Moves To Tighten Oversight Of Prescribers
Ten years after Medicare’s vaunted prescription drug program was signed into law, the Obama administration and Congress are re-evaluating whether it does enough to stop inappropriate prescribing and fraud by physicians (12/31/13).

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State Watch

State Roundup: 'Hope' For Texas' Mental Health System

A selection of health policy news from Oregon, Texas, Maryland, California, Georgia and Wisconsin.

The Texas Tribune: New Year Brings Cautious Hope For Mental Health Care
Texas has lagged far behind virtually every other state when it comes to investment in mental health care. But after lawmakers allocated record levels of funding to mental health services during the 2013 legislative session, and with the beginning of expanded mental health care coverage under the Affordable Care Act, advocates say they see new cause for optimism — and still more room for improvement (Walters, 1/2). 

The Associated Press: Down-Home Health Care On The Farm
For years, [Wisconsin dairy farmer Kevn Ainsworth] has received basic care from a unique community program that sends a nurse to farms to check farmers' blood pressure, cholesterol and blood sugar levels and screen them for health risks. ... Agriculture and health care advocacy groups had hoped the new federal health care law would improve farmers' situation by allowing them to buy affordable policies that cover preventive care and have lower deductibles. No savings are to be had, say farmers ... That's why Wisconsin's Rural Health Initiative remains valuable (Johnson, 1/1).

The Lund Report [an Oregon news service]: Patient Safety Commission Solicits Advice On Enacting Medical Error Law
The commission is tasked with putting into shape a resolution system for doctors, patients and hospitals by July 1. The confidential process, championed by Gov. Kitzhaber, aims to allow health care providers to come clean about errors while avoiding lawsuits (Gray, 1/1).

The San Jose Mercury News: California's Low Income Health Program Transfers More Than 630,000 To Medi-Cal
Acting under provisions of the new federal health care law, California's Department of Health Care Services on Tuesday said it transferred more than 630,000 Californians from the state's Low Income Health Program to Medi-Cal, the state's health program for the very poor. The new federal law, called the Affordable Care Act and also known as "Obamacare," offered states the ability to expand eligibility for Medicaid, the federal health program for the poor, which is called Medi-Cal in California. The LIHP was established in 2010 through a $10 billion federal grant to help states prepare for the Affordable Care Act (Seipel, 12/31/13). 

Georgia Health News: The Top 10 Health Stories In Georgia For 2013
Georgia health care had more than its share of drama and surprises in 2013. Some of the big stories were linked to the Affordable Care Act (ACA), also known as Obamacare. This far-reaching federal law, passed in early 2010, was still generating changes and attracting controversy as if it were brand new. But the ACA wasn’t the only hot topic in Georgia health. Issues ranged from drug scares to complex policy disputes and funding battles (Miller, 12/29/13). 

The Baltimore Sun: At Hopkins, Kidney Transplants Occur In Chain Reactions
When John Davis' kidney began failing in January, his girlfriend's mother decided to donate one of her kidneys to help save his life. That the two weren't actually a "match" -- meaning Davis' body would never accept her kidney -- didn't matter. In a groundbreaking program at Johns Hopkins Hospital that is as much about nationwide networking as it is medical innovation, kidney transplants are being arranged not through isolated pairings of patient and donor, but through longer and longer chains of individuals who don't even know each other (Rector and Cohn, 12/31/13).

NPR: 'Good Behavior' More Than A Game To Health Care Plan
Behaving well in elementary school could reduce smoking in later life. At least, that's what Trillium Community Health Plan hopes, and they are putting their money behind it. Danebo Elementary in Eugene, Ore., is one of 50 schools receiving money to teach classes while integrating something called the "Good Behavior Game." ... [The Coalition for Evidence Based Policy] found that by age 13, the game had reduced the number of kids who had started to smoke by 26 percent -- and reduced the number of kids who had started to take hard drugs by more than half (Foden-Vencil, 1/2). 

Los Angeles Times: Oregon Allows Mothers To Take Placentas Home From Hospital
New mothers will now be able to leave Oregon hospitals with two bundles of joy -- one in a car seat, the other in a cooler. The first, of course, is the baby. The second, thanks to one of the more curious laws that went into effect with the new year, is the placenta. Many cultures have long revered the meaty organ, whose chief duty is to provide nourishment and oxygen to the fetus (La Ganga, 12/31/13) 

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Editorials and Opinions

Viewpoints: Michael Moore Finds Health Law Affordability 'A Cruel Joke'; Can More Marketing Help Sell Insurance?

The New York Times: The Obamacare We Deserve 
Now that the individual mandate is officially here, let me begin with an admission: Obamacare is awful. That is the dirty little secret many liberals have avoided saying out loud for fear of aiding the president's enemies, at a time when the ideal of universal health care needed all the support it could get. ... For many people, the "affordable" part of the Affordable Care Act risks being a cruel joke. ... And yet -- I would be remiss if I didn't say this -- Obamacare is a godsend (Michael Moore, 12/31/13). 

The Washington Post's Plum Line: The 'Wingnut Hole' Measured: 5 Million Without Insurance Thanks To GOP Refusal
Because of the decision on Obamacare by the Supreme Court, which left the decision to expand Medicaid (a key part of Obamacare) up to the individual states, most Republican-controlled states refused said expansion, leaving substantial portions of the citizenry in the lurch. ... How many Americans will go without health insurance simply because the GOP dislikes the president? Well, happy 2014, dear readers: initial estimates are in, and we have 5 million lucky winners! (Ryan Cooper, 12/31/13).

The New Republic: We Don't Know If Obamacare Is Working Well. But We Know It's Working.
But nobody ever promised that Obamacare would solve all of the health care system's ills -- or that it would come without costs of its own. The goal has always been to make insurance more widely available, so that more people had access to care and protection from crippling medical bills, while beginning the difficult work of reengineering medical care to make it more efficient. The new enrollment numbers should give us new reason to think it will (Jonathan Cohn, 12/29/13).

Bloomberg: If 2013 Was Hard On Obamacare, Just Wait For 2014 
[P]eople shouldn't have been surprised that the law was so hard to implement and spawned so much bad press -- in fact, it was designed so that the law's more politically unpopular provisions would take effect only after the 2012 elections. ... Millions of Americans in the individual market being dropped from their existing plans is directly related to Obamacare's essential health benefits requirement, which mandates coverage across 10 categories and goes into effect in 2014 (Lanhee Chen, 12/30/13).

The New York Times: Obamacare Not A Total Disaster, Continued
Perceptions about health reform are in an interesting place. Just about everyone on the right is still living in October, the annus horribilis of Obamacare (yes, I know it was just a month, and I don't care), and is waiting to move in for the kill after the whole thing collapses. Meanwhile, a funny thing has been happening: enrollments surged this month, to such an extent that the original expectation of 7 million people signed up via the exchanges by the end of March no longer looks crazy (Paul Krugman, 12/30/13).

USA Today: Why Obamacare Surprise? 
Why are we being flooded with stories of people expressing surprise about the costs associated with Obamacare enrollment or purchasing individual plans that conform to the law's requirements? Don't tell me it's because you believed Obama when he made all those promises about blah, blah, blah. ... at least four years ago I started asking my doctors -- primary care and specialists -- what they thought Obama's vision of health care reform would lead to (Don Campbell, 12/25/13).

The Washington Post: The Obamacare Obama Gets
[T]he president signed up for Obamacare coverage he does not intend to use, skipped the disastrous Web site he forced millions of Americans to navigate, had someone else do the paperwork for him, chose the cheapest possible plan to avoid the premiums he is imposing on others and waited until the last possible moment to decide whether he wanted to cough up $400 a month as a symbolic show of solidarity. ... Will the president agree to give up his free military health care when his presidency is over? Will Obama live under Obamacare once he is a private citizen? If you believe he will, you probably still think you can keep your doctor (Marc Thiessen, 12/30/13). 

The Washington Post: Obamacare Needs More Enrollees To Work Well
It's still unclear how well the Affordable Care Act will function. But on Wednesday, the law started working for a good chunk of those it was designed to help. The formerly uninsured who signed up for health-care plans under its provisions are now able to use their new coverage. ... Consequently, the overriding task is to increase enrollment, particularly among target populations. That's not only for the well-being of those who will get coverage but also because insurers need enough healthy people paying into the system to offset the costs of the sick. They based their 2014 offerings and premiums on estimates of what that balance would look like; if the estimates fail to match reality, financing the system could be a challenge. Halfway through the open-enrollment period, it's past time for a sustained publicity blitz (1/1). 

Fox News: Marketing Is Causing Obamacare’s Problems
It is only when products flop do intelligent individuals realize the importance of marketing. The problem with many product failures is that decision makers often forget just what marketing is -- the art and science of satisfying customer needs. This means, no matter what others think,  marketing does not get people to buy what they do not want. And for this reason, the Affordable Care Act's (Obamacare) destiny can only be product failure because it does not satisfy the needs of most Americans (John Tantillo, 1/1).

The Dallas Morning News: Rick Perry: You Can't Dress Up The Failures Of Obamacare
The promise and potential I normally greet each New Year with is, this year, being tested by a great sense of peril as Americans face the full brunt of the disastrous impacts of Obamacare in 2014. The delays, deceit and debacles that marked Obamacare's rollout in 2013 show no signs of slowing in the new year. People all across the country have witnessed what a disaster this program has been from its earliest stages, ranging from the $600 million website debacle to the sad fact that President Barack Obama flat-out deceived the American people when he promised that those who like their coverage could keep it. To stem the bleeding, the administration is resorting to arbitrary delays for some Obamacare mandates, which only inject more confusion into the marketplace and with consumers (Texas Gov. Rick Perry, 1/1).

The Dallas Morning News: Kathleen Sebelius: Jan. 1 A Milestone For Better Health Care For Americans
As we wish our friends and family a happy, healthy New Year, these words have renewed meaning in 2014. Tomorrow, Jan. 1, will mark a new day in health care for millions of families and individuals throughout Texas. Starting tomorrow, it will be against the law for insurance companies to deny you coverage or charge you more because of a pre-existing medical condition like diabetes, high-blood pressure or asthma. And they will no longer be able to drop you from coverage just because you get sick or get into an accident (Health and Human Services Secretary Kathleen Sebelius, 12/31/13).

The New England Journal of Medicine: Physicians And The (Woman's) Body Politic
For two decades, legislatures have been encroaching on the realm of medicine. Heedless of medical ethics or evidence-based standards of care, they have been declaring medical "facts," specifying or forbidding medical procedures, and dictating to doctors what they must say to their patients. Roe v. Wade was not only about a woman's right to abortion. It was also about the right to her physician's medical judgment and best care, unconstrained by partisan strategies. It is not only women's bodies that are being held hostage to politics; it is also the hearts, minds, and professional pride of their physicians (R. Alta Charo, 1/1).

The New York Times: Room For Debate: Thinking Beyond The Pill
A recent Vanity Fair article exposed the risks of using NuvaRing, a relatively new form of contraception for women. More than 50 years after its introduction, the birth control pill -- and altering hormonal levels in general -- still seems to be the best contraceptive available. Has progress on developing new birth control methods stalled? What can be done to promote innovation? (1/1). 

The Wall Street Journal: Critics Of 'Me-Too Drugs' Need To Take A Chill Pill
It now takes 10-15 years for a pharmaceutical company to get a new drug approved, and on average the cost exceeds $1 billion. There is a lengthy process of laboratory, animal and clinical studies, and then regulatory review, to establish safety and effectiveness according to government standards. Arguably, that is more than enough (Henry I. Miller, 1/1). 

WBUR: Project Louise: Facing The Scale And Setting Goals
OK, so here is the truth I promised to share last week: I weigh 189 pounds. That's a pound more than I was figuring when I told you my BMI was 29.4. At this weight and my height (5 feet 7 inches), my BMI is 29.6. I guess I'm happy that I still haven’t quite tipped over into "obese" (BMI of 30 or more), but let's not quibble here, shall we? There’s no ducking it: I weigh more than I should, and more than I can admit without a deep sense of shame (Louise Kennedy, 12/30/13).

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EDITOR:
Stephanie Stapleton

ASSOCIATE EDITOR:
Andrew Villegas

WRITERS:
Marissa Evans
Lisa Gillespie
Shefali Luthra

The Kaiser Daily Health Policy Report is published by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation. (c) 2014 Kaiser Health News. All rights reserved.