Daily Health Policy Report

Tuesday, October 1, 2013

Last updated: Tue, Oct 1

KHN Original Reporting & Guest Opinion

Capitol Hill Watch

Health Reform

Administration News

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Obamacare Marketplaces Open, Despite Glitches And Shutdown

Kaiser Health News staff writers Jay Hancock and Ankita Rao report: "After three years of political strife that intensified into a government shutdown on the eve of implementation, the engineers of the Affordable Care Act slipped the keystone of the law into place Tuesday, offering health coverage to uninsured millions with no certainty how the public will respond. Starting Tuesday, uninsured people can buy subsidized policies in government-operated marketplaces designed to overcome high prices, exceptions for preexisting illness, benefit caps and other decades-old obstacles that dominated the individual insurance market" (Hancock and Rao, 10/1). Read the story and check back for updates throughout the day on KHN's live blog.

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Millions Previously Denied Insurance Coverage Because Of Health Problems Look To Online Marketplaces

Kaiser Health News staff writer Phil Galewitz, working in collaboration with McClatchy, reports: "Denise Marshall of Sonoma, Calif., was diagnosed with non-Hodgkin lymphoma in 2011 and a year later, lost her toy company job along with her health insurance benefits. The good news is that her disease was caught early and she is now in remission. The bad news was her cancer diagnosis made it impossible to buy coverage because insurers thought she was too high a health risk. Marshall, 55, is one of millions of Americans with pre-existing health conditions who have been shut out from buying coverage on the individual insurance market. But under the Affordable Care Act., starting Jan. 1 insurers can no longer reject people, charge them more or restrict their benefits because of their health status" (Galewitz, 9/30). Read the story.

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Start Your Exchange Shopping Early, But Don't Rush To Buy

Kaiser Health News consumer columnist Michelle Andrews reports: "In recent months, all eyes have been focused on today, the day health insurance marketplaces open for business. While the date is a milestone in the implementation of the health law, other dates are likely more critical for consumers planning to shop for health insurance on their state marketplace" (Andrews, 9/30). Read the story.

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Capsules: Marketplace Shoppers Must Pay 1st Premium By Dec. 15; Answers To Your Online Health Insurance Exchanges Questions

Now on Kaiser Health News' blog, Phil Galewitz reports on when the first premium payments will be due for new coverage purchased on the exchange: "When consumers start shopping for coverage through new federally run health insurance exchanges on Tuesday, they will be asked dozens of questions before they are shown what health plans are available and how much they cost. Then, to finalize their enrollment, they must contact the private insurer and pay their first monthly premium. If enrollees don’t pay their insurer by Dec. 15, they will not have coverage that takes effect Jan. 1, federal health officials said Monday. If they miss that first deadline, however, open enrollment runs through March 2014" (Galewitz, 9/30).

Also on the blog, you can watch Galewitz Monday on C-SPAN’s Washington Journal taking questions about tomorrow's launch of the health law'’ online health insurance exchanges (9/30). Check out what else is on the blog.

If you have more questions, Kaiser Health News provides a resource page designed to help you navigate your way around what the new health law will mean for you, your family and what health care -- and insurance -- will cost you. Check it out.

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Options For Young Adults: Stay On The Folks' Plan, Move To The Marketplace Or Go Without

Reporting for Kaiser Health News, in collaboration with NBC News, Michelle Andrews writes: "In 2014, options for young adults, many of whom either aren't offered health insurance at their jobs or can't afford it, will expand again with the opening of the state health insurance marketplaces and the expansion of the Medicaid program to low-income adults in many states. Here's what to look for" (Andrews, 10/1). Read the story.

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Political Cartoon: 'Exchange You Can Believe In?'

Kaiser Health News provides a fresh take on health policy developments with "Exchange You Can Believe In?" by Rick McKee.

Here's today's health policy haiku:


Government shuts down
And yet... Is this really true? 
Exchanges still launch.

Plus here's a bonus haiku:


Obamacare prep:
Six loads of laundry, no starch
Send kid to neighbor
-Joanne Kenen

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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Capitol Hill Watch

Impasse Over Health Law Leads To Federal Government Shutdown

The long-running battle to defund or derail the health law came to a head Monday when Congress failed to approve a short-term spending measure to continue funding the government. For an entrenched group of House Republicans, Obamacare is the sticking point. But a new round of polls finds public opinion doesn't support their strategy.    

Los Angeles Times: Government Shutdown: House Seeks Conference With Senate
An hour after the federal government began shutting down, House Republicans approved a last-ditch effort early Tuesday seeking to set up a committee with the Senate to resolve their monumental differences over Obamacare. … Although Democratic leaders said they would be willing to work with the House to resolve the differences, they said they would only agree to form a committee after the House approved a government funding bill that was not linked to stopping the president’s health care law (Mascaro and Memoli, 9/30).

The New York Times: Government Shutting Down In Impasse
A flurry of last-minute moves by the House, Senate and White House late Monday failed to break a bitter budget standoff over President Obama’s health care law, setting in motion the first government shutdown in nearly two decades. … In the hours leading up to the deadline, House Republican leaders won approval, in a vote of 228 to 201, of a new plan to tie further government spending to a one-year delay in a requirement that individuals buy health insurance. The House proposal would deny federal subsidies to members of Congress, Capitol Hill staff, executive branch political appointees, White House staff, and the president and vice president, who would be forced to buy their health coverage on the Affordable Care Act’s new insurance exchanges. But 57 minutes later, and with almost no debate, the Senate killed the House health care provisions and sent the stopgap spending bill right back, free of policy prescriptions (Weisman and Peters, 9/30).

Los Angeles Times: With Congress At Impasse, Government Starts Shutting Down
The official word to shut down came from the White House just before midnight Monday. Hours earlier, the Senate, by a 54-46 party-line vote, killed a House measure that would have funded government agencies for six weeks but delayed key parts of Obamacare for a year. It was the second such vote that the Senate took during a day in which the two chambers exchanged volleys of legislation with little expectation that any of it would become law (Mascaro and Memoli, 9/30).

The Wall Street Journal: Government Shuts Down As Congress Misses Deadline
On Capitol Hill, a day of rapid-fire legislative maneuvering between Senate Democrats and House Republicans over the terms of a short-term spending bill collapsed late Monday. House Republicans said they planned to appoint a set of negotiators to work out a budget resolution with a small group with senators. But the GOP move came with no concessions on the party's central demand—that Democrats agree to scale back the new federal health law—and it brought lawmakers no closer to reaching a budget deal (Hook and Peterson, 10/1).

The Associated Press/Washington Post: Long-Running Feud Over Obama Health Care Law Plunges Nation Into Government Shutdown
The health care law itself was unaffected as enrollment opened Tuesday for millions of people shopping for medical insurance (Taylor, 10/1).

Los Angeles Times: Government Shutdown: Obama Calls House GOP Irresponsible
Speaking for several minutes without taking questions, the president outlined the functions that would continue in a shutdown – including Social Security, Medicare, national security and public safety – and those that would be curtailed, including national parks, NASA, federal lending programs and recovery efforts helping victims of Superstorm Sandy. Obama said the impact would be a setback to a recovering economy. … The president also noted that, despite Republican efforts to kill his healthcare law, the online insurance marketplaces will roll out Tuesday as scheduled. "The Affordable Care Act is moving forward. That funding is already in place. You can't shut it down," he said (Hennessey, 9/30).

The Wall Street Journal: Government Shutdown Is Defining Moment For Boehner
Since January, Mr. Boehner has strained to steer clear of either a shutdown or a debt-ceiling crisis for which his party might be blamed, from reshuffling the legislative calendar to scheduling more than 40 votes to repeal or rework the health law, a move designed to give his members ample opportunity to voice their displeasure with the law. In the end, the impasse resulted as much from the internal dynamics of Mr. Boehner's GOP caucus as it did from the partisan divisions in the country as a whole and the chasm between Democrats and Republicans about basic tax-and-spending policies. After months of jockeying, Mr. Boehner heeded the calls from his most conservative colleagues by refusing to give in on requesting health-law changes (O’Connor, 10/1).

Fox News: Congress Misses Deadline, Sending Government Into Partial Shutdown
Lawmakers missed the deadline after being unable to resolve their stand-off over Obamacare, despite a volley of 11th-hour counterproposals from the House. Each time, Senate Democrats refused to consider any changes to Obamacare as part of the budget bill. House Republicans, for their part, refused to back off their demand that the budget bill include some measures to rein in the health care law – a large part of which, the so-called insurance “exchanges,” goes into effect on Tuesday. As House Republicans endorsed one more counterproposal in the early morning hours, lawmakers spent the final minutes before midnight trying to assign blame to the other side of the aisle. Republicans are no doubt wary of the blowback their party felt during the Clinton-era shutdown, while Democrats were almost eager to pile the blame on the GOP (10/1).

PBS NewsHour: GOP Rep. Says Delaying Health Reform Is a 'Fairness Issue'
Rep. Marsha Blackburn, R-Tenn., says House Republicans are doing their duty to "soften the blow" of health care reform by insisting that a federal spending bill include a provision on the Affordable Care Act. Gwen Ifill talked to Blackburn from Capitol Hill before votes began in the House about the fight over the budget (Ifill, 9/30).

From the world of public opinion -

Bloomberg: Americans By 72% Oppose Shutdown Tied To Health Care Cuts
In a rejection of congressional Republicans’ strategy, Americans overwhelmingly oppose undermining President Barack Obama’s health-care law by shutting down the federal government or resisting an increase in the nation’s debt limit, according to a poll released today. By 72 percent to 22 percent, Americans oppose Congress "shutting down major activities of the federal government" as a way to stop the Affordable Care Act from going into effect, the national survey from Quinnipiac University found (Giroux, 10/1).

McClatchy: Poll: Americans Oppose Shutdown
Americans overwhelmingly make it clear: They oppose the federal government shutdown. A new Quinnipiac poll released Tuesday found people were against the shutdown, 72-22 percent. They also were heavily against blocking a debt limit increase--the next likely congressional fight--as a way to stop the Affordable Care Act (Lightman, 10/1).

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As Part Of Capitol Hill Debate, GOP Seeks To Charge Congressional Employees More For Insurance

Even as House Republicans sought to eliminate federal subsidies for congressional workers, the Office of Personnel Management described how staffers would have to get insurance through small-business insurance exchanges.

The Associated Press: GOP Demanded Lawmakers Pay More For Health Care
About 18,000 people -- including members of Congress, all their aides, presidential appointees and even the president and vice president -- would lose the employer-provided health insurance under a condition that Republicans proposed for averting a government shutdown. The Democratic-controlled Senate rejected the measure Monday night, an hour after the House passed it (Kellman, 10/1).

The Wall Street Journal: One GOP Demand On Health Law Hits Lawmakers' Coverage
[It] exposes lawmakers, their aides and White House staff to the law in a way designed to maximize the pain. The proposal, similar to one backed in the Senate by Sen. David Vitter of Louisiana, would limit federal health care contributions to lawmakers, staff and to some White House officials, making their coverage more expensive (Peterson, 9/30).

The New York Times: House To Add Measure Cutting Health Subsidy For Congress
Conservative activists have framed the language as ensuring that Congress and the White House live under the same strictures as ordinary Americans under the health care law. In fact, the language would put poorly paid junior staff members at a disadvantage. Most people purchasing coverage on the exchanges will be subsidized by generous tax credits. Most Americans will still get their insurance from their employers who will remain subsidized by a tax deduction for the cost of that care (Weisman, 9/30).

Also in play during the continuing congressional debate --

NPR: How A Tax On Medical Devices United Political Rivals
As the federal government lurches toward a shutdown, there's one thing a lot of people in Congress actually agree on. A 2.3 percent excise tax on medical devices that took effect at the beginning of 2013 should be undone, they say. House Republicans included a provision to do that in a funding bill passed over the weekend that also sought a one-year delay in the implementation of the Affordable Care Act (Hensley, 9/30).

Meanwhile --

CQ HealthBeat: Final OPM Rule: Members, Staff Must Get Health Benefits From D.C. Small-Business Exchange
Congressional lawmakers and staff members they designate must go to the small-business insurance exchange for the District of Columbia to get their 2014 health benefits from the federal government, according to a final rule the Office of Personnel Management released Monday. The regulation makes clear that employer-sponsored coverage for members of Congress and their designated staff will continue under the health care law, contrary to assertions by congressional Republicans and other critics of the law that the overhaul ends such benefits (Reichard, 9/30).

The Washington Post: Administration Moves To Limit, But Not End, Health Insurance Subsidy For Congress
Members of Congress and Capitol Hill workers, like almost all other federal employees, currently are eligible for the Federal Employees Health Benefits Program, in which the government pays about 70 percent of the total premium cost on average. However, under the ACA, House and Senate members and certain personal staff -- although not other Hill employees -- instead will have to get their insurance through the ACA's marketplace effective with the 2014 calendar year (Yoder, 9/30). 

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Health Reform

It's Oct. 1 -- Health Exchanges Go Live ... Glitches And All

Despite three-and-a-half years of political intrigue and hijinx culminating with a government shutdown, this key health law provision is rolling out. Administration officials expected some glitches, but are confident in the marketplaces' ultimate success. However, if the exchanges are to achieve their intended goal, people will have to sign up.   

The Wall Street Journal: Muted Rollout For Much-Changed Health-Care Law
It's Oct. 1 and the Affordable Care Act is finally getting its rollout, but President Barack Obama's health-care law looks a lot different from the one he signed 31/2 years ago. Thanks to a Supreme Court ruling, about half the states aren't participating in a Medicaid expansion that was a core part of the legislation. The federal government is running the bulk of new marketplaces for health insurance, not the states as originally envisioned. And some of the key provisions are delayed, including one that makes larger businesses pay a fine if they don't offer coverage (Radnofsky, 9/30).

Los Angeles Times: Full Steam Ahead For Obama Healthcare Law
Three and a half years after President Obama signed his landmark healthcare law, his administration made its final preparations Monday to begin enrolling millions of Americans in health insurance amid persistent anxiety over possible technical problems and intense opposition from Republican critics. Administration officials emphasized that a government shutdown would not prevent the federal website for enrolling in health coverage — http://www.healthcare.gov — from going live at 8 a.m Eastern time Tuesday, allowing consumers to begin signing up for plans (Levey, 9/30).

NBC News: Glitches Or Not, Some Are Just Happy To See Health Exchanges Go Live
The debate over the Affordable Care Act may have (nearly) shut down federal government spending, but the new health-insurance websites are scheduled to be up and running as planned Tuesday morning. However, "as planned" doesn’t mean enrollment will go smoothly. Maryland's site for enrolling people crashed early Tuesday morning. "Please visit the site again at 12 noon," the site advised. Supporters and opponents alike of the health-care reform law, known widely as Obamacare, say to expect more ups and downs during the enrollment process. ...  Supporters and opponents alike of the health-care reform law, known widely as Obamacare, say to expect ups and downs during the enrollment process. There have already been some, from a computer jam in Washington, D.C.'s exchange to a delay in the plan for small business enrollment. It’s one of the reasons the federal government has set a six-month enrollment period. It isn’t going to be easy (Fox, 10/1).

The Associated Press: Health Insurance Marketplaces Open For Coverage, But Their Success Remains Far From Assured
The online insurance marketplaces at the heart of President Barack Obama’s health care overhaul are showing signs of trouble handling the volume of consumers on the first day of a six-month open enrollment period.For nearly every state using the federal exchange, users on Tuesday reached a page with a notification to please wait or a message that said: “The System is down at the moment (10/1).

The Associated Press: Under Fire, 'Obamacare' Going Live – With Glitches
Contentious from its conception, President Obama’s health care law has survived the Supreme Court, a battle for the White House and rounds of budget brinkmanship. Now comes the ultimate test: the verdict of the American people. A government shutdown could dampen the rollout today as insurance markets open across the country. But it won’t stop the main components of "Obamacare" from going live as scheduled, glitches and all (Alonso-Zaldivar, 10/1).

The Washington Post: As Government Shuts Down, Obamacare Moves Forward
The day has arrived when millions of uninsured Americans have their first chance to sign up for what the administration says will be high-quality, affordable health coverage. That achievement is something presidents of both parties sought unsuccessfully for more than 60 years. The coming months and years will show whether the new health-care law, commonly known as Obamacare, lives up to its aspirations. Those who sign up now, for instance, will not begin to receive benefits until January (Tumulty, 10/1).

The Wall Street Journal: Health Exchanges Open For Business
New marketplaces meant to steer millions of uninsured Americans to health insurance under President Barack Obama's signature health-care law open for business today. After a weeks long scramble by state and federal officials to iron out technical wrinkles and position thousands of outreach workers, the marketplaces are set to launch, warts and all, giving the public a first taste of the health law's core provisions (Weaver, 10/1).

Politico: Obama: Expect Months Of 'Glitches'
President Barack Obama on Monday said he "absolutely" expects glitches and problems with Obamacare as enrollment kicks off Tuesday. But even with the inevitable complications and issues that accompany the new health insurance exchanges, the president told NPR News he is "confident" the law will offer "the prospect that any American out there who does not currently have health insurance can get high-quality health insurance" (Weinger, 10/1).

The Wall Street Journal's Washington Wire: Agencies Set To Implement Health Law, Shutdown Or No
A Department of Health and Human Services memo says staffers helping to get the Affordable Care Act off the ground won't be furloughed along with other federal workers. That includes employees who are helping with "coordination between Medicaid and the Marketplace, as well as insurance rate reviews," according to the memo. Although Congress is fighting about funding for the law known as Obamacare, a government shutdown wouldn't actually stop the law from being implemented Tuesday. That's because the principal funding for the Affordable Care Act comes from mandatory spending rather than a short-term extension to discretionary spending that Congress is considering now (Schatz, 9/30).

Reuters: Obamacare Launch Poised To Reach Millions Despite Shutdown Drama
Millions of Americans will learn on Tuesday what President Barack Obama's landmark healthcare law actually means for them, as the administration opens new insurance marketplaces in 50 states despite the government shutdown. The launch marks a milestone for Obama's signature domestic policy achievement, which aims to provide subsidized healthcare to millions of the uninsured, the most ambitious U.S. social program since Medicare was introduced in the 1960s (Morgan, 10/1).

The Boston Globe: Tarnished By Shutdown Battle, Health Law Moves Ahead
Americans lacking health insurance will be able to sign up for coverage beginning Tuesday, federal officials say, despite Tea Party Republicans' efforts to torpedo President Obama's health care law or cripple its implementation. But the debut of the health insurance marketplaces — a critical component of the law that mandates most Americans obtain insurance by January — has been tarnished, politically and practically, by the threat of a government shutdown. Consumer advocates and health policy experts say recent talk of a shutdown has stirred up even more consumer confusion over an already controversial law. They fear that the added uncertainty will deter people from signing up for health insurance (Jan, 10/1).

Bloomberg: Obamacare Markets Debut As Early Hurdles May Slow Signups
The three-year effort to open the Obamacare health-insurance exchanges culminates today, beset by logistical delays and efforts by Republicans to shut down the U.S. government in protest. Even states that have cooperated with the rollout, designed to enroll the uninsured in health plans, are downplaying the debut of the marketplaces to avoid having the websites and call centers overwhelmed (Wayne and Nussbaum, 10/1).

Fox News: Age Of Obamacare Begins: Launch To Test Claims Of Law’s Supporters, Foes
The sales pitches for and against ObamaCare have all been made. It’s now up to Americans to judge whether the law works as advertised, as the so-called insurance "exchanges" launch Tuesday. Against the backdrop of the aggressive congressional showdown over ObamaCare -- and partial shutdown of the federal government -- Tuesday is the day that Americans can finally log on to the insurance-purchasing websites to take a test drive and decide for themselves (10/1).

CBS News: Obamacare Kicks Off: What's Happening, What's Not
Many Obamacare changes have already gone into effect, while other major reforms remain on the horizon. In the past three years, the Obama administration and Congress have modified the law, scrapping some major parts and delaying others. Republicans, meanwhile, have remained focused on dismantling the law in any way possible. With so many moving parts, it's worth reviewing what happens on Oct. 1 and what doesn't (Condon, 10/1).

Kaiser Health News also provides a resource page designed to help you navigate your way around what the new health law will mean for you, your family and what health care -- and insurance -- will cost you.

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50 States, 50 Views Of Health Exchanges

Media outlets across the country spotlight the opening of federal and state-run websites that are designed to be a portal into new insurance marketplaces where those without group coverage can compare and purchase plans. The Milwaukee Journal Sentinel describes a fund created by the University of Wisconsin Hospital and Clinics to pay the premiums of those who would have been eligible for expanded Medicaid had the state opted into that health law program. The Texas Tribune spotlights potential problems as a result of state restrictions on the navigators who are supposed to act as consumer guides.

The New York Times: Online Map Helps New Yorkers Understand Federal Health Law Benefits
More than one million New Yorkers are expected to gain coverage under the federal health care law, according to estimates from the New York State Health Foundation. On Monday, the foundation unveiled an online map, where people will be able to view estimates by region of how many people are expected to be covered under Medicaid and how many will get private insurance – as well as how many are likely to remain uninsured (Abelson, 9/30).

The Associated Press: Kansas Braces For Opening Of Health Care Exchanges
Kansas' health care exchange is set to go online Tuesday, but even the biggest proponents of the federal health care law that created the marketplace suggest that consumers might want to wait until any glitches have been fixed before they buy coverage. Republican Gov. Sam Brownback and the GOP leaders of the Legislature have resisted implementing the Affordable Care Act since its passage three years ago, arguing that it represents a costly expansion of government and limiting the state's involvement in establishing and promoting its centerpiece, the health care exchange (Hegeman, 10/1).

The Associated Press: Advocate: W. Va. Misses Out On Health Care Ad Money
An advocacy group that's worked for months to spread the word about a new health insurance marketplace born of the Affordable Care Act says West Virginia has passed up millions of dollars in federal advertising money that could have helped. In July, the Associated Press found West Virginia was spending more per capita than any other state to promote awareness of the law and the new health care exchanges, with $17.1 million. That amounts to $9.23 per resident and was 11th among the states in total spending (Smith, 10/1).

The Associated Press: Illinois Unveils Health Marketplace Ads
Illinois officials plan to launch a long-delayed, $33 million advertising campaign to inform residents about a new health insurance marketplace Tuesday, the ads first appearing on the same day the marketplace goes live with details of benefits available under President Barack Obama's health care law. The Get Covered Illinois ad campaign will start slowly with full-color newspaper ads in 50 cities, said Kelly Sullivan, chief marketing and communication officer for the marketplace. She provided copies of the ads to The Associated Press (9/30).

The Associated Press: Health Exchange, Medicaid Enrollment Set To Start
New Mexicans can begin taking advantage of key portions of a federal health care law on Tuesday as the state launches a new marketplace for buying health insurance and the government-funded Medicaid program starts enrolling more low-income adults. Under federal law, individuals and small businesses can start shopping Tuesday for health insurance from private insurers through newly created health insurance exchanges. Insurance coverage will start in January (Massey, 9/30).

The Associated Press: Health Insurance Exchange Goes Live In Tennessee
Tennesseans can now sign up for health insurance under the federally run online marketplace. The state's average premiums in the exchange rank among the cheapest of the 36 states that have deferred to the federal government to run their exchanges (10/1).

Miami Herald: Health Insurance Marketplace Key To Reform Opens Tuesday
The Affordable Care Act’s insurance exchanges open Tuesday amid fierce political pushback, recent delays of important provisions and a whole lot of confusion among the public. The online exchanges — also known as marketplaces — are the centerpiece of healthcare reform, and they will give consumers unprecedented power to examine an extensive menu of health plans and to compare prices and benefits side by side (Chang, 9/30).

MinnPost: MNsure Health Exchange Scheduled To Go Live Tuesday Afternoon
MNsure, the state’s health insurance exchange, is scheduled to go live Tuesday afternoon after several last-minute test and security checks, officials said Monday. The exchange will make Obamacare’s initial deadline, they said, though it will come online later in the day than originally planned (Nord, 10/1).

Marketplace: Health Exchanges Go Live, But Will The Young And Healthy Sign Up?
It’s October 1, this morning the new Affordable Care Act health exchanges go live. Beginning at 8 o’clock Tuesday morning consumers around the country can start to shop for insurance online at healthcare.gov. The success of Obamacare, in part, rests on the ability to attract young, healthy inexpensive people to the insurance market. They’re called ‘young invincibles’ (Gorenstein, 10/1).

Minnesota Public Radio: Minnesota’s Health Insurance Marketplace Opens For Business Today
Minnesota's health insurance exchange, MNsure, launches today along with similar programs across the country. But that doesn't mean you have to rush to a computer to sign up if you are uninsured. President Obama and health insurance experts are calling it a soft launch as glitches and other problems are sorted out. The insurance plans won't go into effect until Jan. 1 (10/1).

Minnesota Public Radio: MNsure: Who Is It For? Not Everyone
As health insurance marketplaces go online in every state today as part of the Affordable Care Act, surveys indicate that confusion abounds over how the so-called exchanges will work and who should use them. The president's health care overhaul relies heavily on the exchanges, like MNsure in Minnesota, to expand access to insurance. But MNsure isn't for everyone. "MNsure will be very helpful for people who don't have health insurance today," said Minnesota Human Services Commissioner Lucinda Jesson. "It will also be a real option for people who are buying insurance on the individual market, especially for people who have pre-existing conditions and may not have access to affordable insurance before” (Stawicki, 10/1).

The Star Tribune: MNsure Health Insurance Exchange Opening Awaits Final Test
Minnesota’s new health insurance exchange won’t go live until sometime Tuesday afternoon, as testing of the complex system continues into launch day. After a series of glitches attracted criticism in recent weeks, officials of the MNsure exchange insisted Monday that the afternoon opening does not reflect a delay. Executive director April Todd-Malmlov said at a late afternoon news conference that the exchange’s connection with a federal hub needs a “final check” and that it would take “a little bit of time” to make sure everything is secure (Crosby, 10/1).

The Baltimore Sun: Maryland Prepares For Opening Day Of Health Insurance Exchanges
The state marketplace where the uninsured can buy health plans beginning Tuesday is ready for business, but state health officials are prepared for glitches in the system. Maryland Health Connection, which operates much like a travel or other online shopping website, opens at 8 a.m. and will allow people to search 45 plans offered by six insurers (Walker, 9/30).

The Arizona Republic: Health Exchange Sign-Ups Now Open
Nearly 1 million uninsured Arizonans today can begin shopping for health insurance through the new federal marketplace established under the nation’s health-care law. But despite years of planning, health experts predict some consumers may experience temporary setbacks when applying for coverage today through the new government-run website, healthcare.gov. One problem: People who may be eligible for Medicaid won’t have their applications immediately processed due to a computer glitch. Federal and state health officials expect the problem will be fixed by November, long before any coverage kicks in under the Affordable Care Act (Alltucker, 9/30).

The Milwaukee Journal Sentinel: Chris Abele Considers Dropping Health Coverage In Favor Of Exchanges
Milwaukee County would end health insurance coverage for some or all of its 4,400 employees and instead provide a subsidy toward individual coverage purchased through the new federal exchanges, under an idea floated in County Executive Chris Abele's 2014 budget. The shift could save the county at least $10 million a year, according to an estimate included in Abele's budget, which must be approved by the County Board. But that estimate is based on hypothetical figures, not the actual cost of health plans that will be available in the Milwaukee marketplace (Schultze and Boulton, 9/30).

The Milwaukee Journal Sentinel: UW Hospital And Clinics Donates $2 Million To Defray Obamacare Premium Costs
University of Wisconsin Hospital and Clinics is contributing $2 million to United Way of Dane County to create a program that will pay for the cost of insurance premiums for plans bought on the marketplace set up through the Affordable Care Act. The program, HealthConnect, will help about 7,300 adults in Dane County who have household incomes between 100% and 133% of the federal poverty threshold — or $11,490 to $15,281 a year for one person (Boulton, 9/30).

The CT Mirror: Obamacare Insurance Enrollment Begins As Officials Warn Of Potential Glitches
Rather than touting the upcoming changes on the eve of opening, Access Health officials took a more cautious approach. In a press release issued Monday evening, they focused largely on the likelihood of errors occuring once customers begin using the system, in spite of what the statement called “rigorous testing” prior to launching. “We know there will be defects that we will continue to uncover as we roll out this system to residents,” Access Health CEO Kevin Counihan said in the release (Becker, 10/1).

PBS NewsHour: California Reaches Out to Educate Latino Community on New Insurance Exchange
On the eve of open enrollment for insurance exchanges as part of the Affordable Care Act, the state of California is making a big push among Latinos, who make up a third of the uninsured nationwide. Kwame Holman reports on the $60 million effort to educate and enroll Californians in the new health care program (Woodruff, 9/30).

California Healthline: Let The Exchange Begin
State health officials will appear at events all over the state [Tuesday] to mark the official launch of California's new health benefit exchange. Covered California’s enrollment and eligibility website goes live Tuesday. Community groups also are holding events across the state this week to drum up interest and awareness in the exchange. A health fair is scheduled Wednesday in Salinas (Monterey County), for instance, and the California Primary Care Association Wednesday is hosting an outreach and enrollment Educational Expo in Sacramento. The Service Employees International Union has posted an online Spanish-language video series to help educate Latinos about the exchange. The first video is up, and is available in English, as well (Gorn, 9/30).

The Associated Press: Michigan To Release Cost Of Health Insurance Plans
Michigan's uninsured residents will soon learn the cost of health insurance plans being offered on a new marketplace created under the federal health care overhaul. Officials today will release premium information for 73 Michigan health plans approved by the federal and state governments. The release coincides with the first day of a six-month enrollment window (10/1).

The Texas Tribune: Some Fear Impact Of State Rules On Health Navigators
The day before the launch of the federal health insurance marketplace, Democratic lawmakers alleged that Gov. Rick Perry ordered restrictive new rules on so-called navigators trained to help Texans find coverage to intentionally impede implementation of Obamacare (Aaronson, 9/30).

Dallas Morning News: Obamacare Supporters Want Texas To Delay Rules For Insurance Helpers
Advocates for the poor and Democratic lawmakers urged the state Monday not to issue rules on health “navigators” unless federal safeguards fail to protect Texas consumers. Senate Democratic leader Kirk Watson of Austin said it would be premature for the Texas Department of Insurance to weigh in. A state health insurance marketplace opens Tuesday, as provided under the federal health care overhaul. The federal government is running the online marketplace, after Texas declined to do so. Navigators are employees of nonprofit groups that obtained federal grants. They will counsel people who want to explore their coverage options (Garrett, 9/30).

St. Louis Post-Dispatch: As Insurance Marketplace Opens, Focus Is On Recruiting Young Adults
Sher-rÈ Bird, 30, doesn’t see much point in buying health insurance…Her attitude foretells the challenge faced by the national campaign that kicks off today to get the uninsured to use new online marketplaces to buy health plans (Young, 10/1).

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HHS Warns Of Early Hiccups As It Premieres Insurance Website

HHS Secretary Kathleen Sebelius is asking the public and press to be patient as the law unfolds.

The Washington Post: White House Shows Off Web Site to Buy Health Insurance Under Obamacare
The Obama administration on Monday showed off the federal Web site, Healthcare.gov, where millions of Americans starting Tuesday will be able to buy coverage under President Obama's health-care law, promising it will be open for business despite congressional battling and widespread reports of computer problems. People seeking to buy health insurance on the federal marketplace will be able to enter personal information, including their incomes and Social Security numbers; learn how much government assistance they might qualify for, if any; search for plans by price and coverage level; and then purchase a plan directly from the insurance company (Somashekhar and Sun, 9/30).

USA Today: HHS Puts Final Touches On Exchange Sites Before Launch
Starting at 8 a.m., visitors to healthcare.gov, the federal government's health care website, will be able to navigate how to shop for and buy health insurance as part of the law, [HHS Secretary Kathleen] Sebelius said. … The stakes for the health exchanges are high, and there have been some stumbles on the way. In July, the administration acceded to the wishes of business groups and delayed the requirement that employers with more than 50 workers provide health insurance to their employee or pay a fine. Businesses had complained the tax and insurance requirements were too complicated and difficult to implement in time for the Jan. 1. deadline (Kennedy, 10/1).

The Associated Press: Consumers Will Need Personal Details, Financial Info, Basic Insurance Knowledge To Get Covered
Getting covered under President Barack Obama's health care law might take you more than one sitting. In a media preview, it felt like a cross between doing your taxes and making an important purchase that requires research. "Nothing like this has ever existed before," said Health and Human Services Secretary Kathleen Sebelius (Alonso-Zaldivar, 10/1).

Kaiser Health News: Capsules: Marketplace Shoppers Must Pay 1st Premium By Dec. 15
When consumers start shopping for coverage through new federally run health insurance exchanges on Tuesday, they will be asked dozens of questions before they are shown what health plans are available and how much they cost. Then, to finalize their enrollment, they must contact the private insurer and pay their first monthly premium. If enrollees don’t pay their insurer by Dec. 15, they will not have coverage that takes effect Jan. 1, federal health officials said Monday. If they miss that first deadline, however, open enrollment runs through March 2014 (Galewitz, 9/30).

CQ HealthBeat: HHS Officials Envision Glitches Without Rollout But Say The Law Will Vastly Improve Benefits
Health and Human Services Secretary Kathleen Sebelius reiterated Monday that the rollout of the health exchanges on Tuesday will have snafus, but she said that the agency will work quickly to fix them and that consumers' experience will improve over time. Behind the scenes, insurance industry sources said technical glitches, including back-office problems in completing enrollment transactions and in providing accurate rate information, continue to be common (Adams, 9/30).

Politico: Sebelius: Be Patient With Obamacare
On the eve of Obamacare's launch --and an increasingly likely government shutdown -- HHS Secretary Kathleen Sebelius is pleading for patience with the rollout of the massive new entitlement program. Sebelius again stressed that Tuesday, the first day people can sign up online for Obamacare coverage, is just the start of a six-month open enrollment period representing a massive change to the health insurance landscape. "Oct. 1 is not the end of anything. This is the beginning," Sebelius said in a Monday afternoon meeting with more than two-dozen health reporters at HHS headquarters (Millman, 9/30).

Meanwhile, a new poll is out that some health law advocates might view as an encouraging sign --

Politico: Poll: Most Will Get Health Insurance
Asked whether they plan to get insurance when the requirement takes effect or pay the fine for not doing so, 65 percent of uninsured Americans said they would get health insurance, according to a Gallup poll out Monday. Twenty-five percent said they would pay the fine. Gallup also asked about the whether those individuals planned to use the exchange markets that launch Tuesday to buy their insurance. Almost half, 48 percent, said they planned to use the exchanges, 36 said they did not and 17 percent weren't sure (Kopan, 9/30).

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Your Guides To Buying Insurance On The Health Insurance Exchanges

While Americans who get health insurance through their jobs won't need to go there, news outlets have information for consumers who may want to purchase insurance through the new exchanges.

Kaiser Health News: Insuring Your Health: Start Your Exchange Shopping Early, But Don't Rush To Buy
In recent months, all eyes have been focused on today, the day health insurance marketplaces open for business. While the date is a milestone in the implementation of the health law, other dates are likely more critical for consumers planning to shop for health insurance on their state marketplace (Andrews, 9/30).

Kaiser Health News: Options For Young Adults: Stay On The Folks' Plan, Move To The Marketplace Or Go Without
In 2014, options for young adults, many of whom either aren't offered health insurance at their jobs or can't afford it, will expand again with the opening of the state health insurance marketplaces and the expansion of the Medicaid program to low-income adults in many states. Here's what to look for (Andrews, 10/1).

PBS NewsHour: Your Cheat Sheet To The Health Care Law's New Marketplaces
It's time to hit the market, America. On Tuesday, the Affordable Care Act's health insurance exchanges, or "marketplaces," open for business. ... And what that means for millions of uninsured Americans is they'll need to start shopping or prepare to face a fine. But many are still left with some very basic questions. Primarily: What are the exchanges and how do they work? If you're among the confused, the PBS NewsHour has you covered. Here's your guide (Kane, 9/30).

ABC News: 10 Things to Know About Health Insurance Today
Starting today, you can shop for health coverage through national and state-administered insurance exchanges. Not sure what this means for you and your family? We have answers. Here are 10 things you need to know about the insurance exchange program. If you have more questions, ask them in our comments section. And if you've already shopped, tell us what you think about the plans (Moisse, 10/1).

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Obamacare Winners And Losers

NPR looks at what the federal government can learn from Massachusetts as health insurance exchanges roll out. Other media outlets check in with insurers, Wall Street traders, health care stakeholders and those who had previously been denied coverage in the individual insurance market.

NPR: Lessons For The Obamacare Rollout, Courtesy Of Massachusetts
Today marks a milestone on the nation's long march toward universal health coverage -- the launch of online marketplaces, called exchanges, designed to help people find health insurance they can afford (Knox, 10/1).

The Wall Street Journal: Health Care Overhaul Pushes Small Firms To Lock In Lower Rates
With major provisions of the federal health overhaul set to take effect Jan. 1, many U.S. insurers are prodding small-business customers to renew their current coverage early, to lock in lower rates. "With all of the changes coming up in 2014, we want to provide you with options that allow you to make the right decision for you and your employees," said a recent letter from one major insurer, Blue Shield of California, which has made the pitch to all of its small-business customers, who can keep their 2013 rates if they act to renew existing plans by Oct. 14 (Simon, 9/30).

The Hill: Wall Street Traders Seek Jackpot With Obamacare Bets
For investors, the basic calculus is this: The more people who enroll in the new insurance exchanges, the better it is for the hospitals, medical companies and insurers who will gain new customers (Bogardus, 10/1).

Modern Healthcare: Blues Wins First Federal Contract To Offer Multistate Plans On Insurance Exchanges
The Blue Cross and Blue Shield Association is the first insurer to receive a federal contract to offer individual insurance coverage options across a majority of state insurance exchanges in 2014, as part of a program to boost competition and consumer choice under the Patient Protection and Affordable Care Act. In a Monday announcement, the U.S. Office of Personnel Management, which will administer the multistate plan program, said the Blues will offer more than 150 plan options in 30 states as well as in the District of Columbia (McKinney, 9/30).

Kaiser Health News: Millions Previously Denied Insurance Coverage Because Of Health Problems Look To Online Marketplaces
Denise Marshall of Sonoma, Calif., was diagnosed with non-Hodgkin lymphoma in 2011 and a year later, lost her toy company job along with her health insurance benefits. The good news is that her disease was caught early and she is now in remission. The bad news was her cancer diagnosis made it impossible to buy coverage because insurers thought she was too high a health risk. Marshall, 55, is one of millions of Americans with pre-existing health conditions who have been shut out from buying coverage on the individual insurance market. But under the Affordable Care Act., starting Jan. 1 insurers can no longer reject people, charge them more or restrict their benefits because of their health status (Galewitz, 9/30).

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Chief's Personality Affects How Insurance Exchanges Will Work

The New York Times profiles Gary Cohen -- the head of the consumer office overseeing health reform. And doctors and other stakeholders weigh in on how the health law will unfold.

The New York Times: Federal Official at Center Of The Health Care Tumult Has Gone Against The Grain
The federal official in charge of health insurance shopping malls, which open Tuesday under President Obama's health care law, has been challenging conventional wisdom since he came to Washington from California three and a half years ago. The official, Gary M. Cohen, is at the center of the furor over the health care law. As director of the Center for Consumer Information and Insurance Oversight, he enforces the provisions of the Affordable Care Act that affect insurance companies. He supervises the new insurance marketplaces, or exchanges, including more than 30 that will be run by the federal government (Pear, 9/30).

NPR: A Doctor's 9 Predictions About The 'Obamacare Era'
Out here in Oklahoma we're grappling with implementation of the Affordable Care Act. ... Medicine has entered the era of big data. You'll be nudged regularly by your doctor, other health care providers or so-called medical homes to obtain recommended tests like mammograms, colonoscopies and vaccinations. ...  If you take a medication or have a particular condition, you'll get offers and ads tailored to you as a potential buyer of related goods and services (Schumann, 9/30).

Politico: Stakeholders Will Be Spending Big On 2014 ACA Ads
If you think you’re seeing a lot of Obamacare ads right now, just wait until 2014. No other piece of legislation has engendered such massive ad efforts as the Affordable Care Act, say marketing experts. They expect television ad spending to double in the next year and a half as people start to enroll for coverage and the health law remains a top political issue in House, Senate and gubernatorial races in 2014 (Cunningham, 10/1).

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Administration News

For President Obama: A Day Combining Shutdown And The Exchanges' Launch

The president is promoting the health law by meeting with people who will be helped by it. 

Reuters: Obama Spotlights Healthcare Launch As Republicans Try To Block It
President Barack Obama is due to lead officials spotlighting the opening day sign-up on Tuesday for his landmark healthcare program even as staunch Republican opposition to the plan shut down government operations. Obama is scheduled to meet and pose for pictures in the Oval Office with a group of people who stand to benefit from the healthcare law's provisions, while an interview with Vice President Joe Biden promoting the plan will air on 450 college radio stations in critical states, the administration said (Felsenthal, 10/1).

USA Today: Obama: A Shutdown, A Health Care Law
And, throughout the day, White House senior adviser Valerie Jarrett and other administration officials will be interviewed on African-American radio shows. The White House list includes the Tom Joyner Morning Show, the Al Sharpton Show, the Yolanda Adams Morning Show, Sway on Sirius HM, the Russ Parr Morning Show, Rickey Smiley Morning Show, and the Joe Madison Show (Jackson, 10/1).

Meanwhile, Obama discussed the current impasse with Congress and the health law's implementation during an NPR interview -

NPR: Obama: 'Perpetual Cycle Of Brinksmanship ... Has To End'
During a wide-ranging interview with Morning Edition's Steve Inskeep, President Obama assumed an indomitable posture as he talked about his negotiations with House Republicans. He said he will not negotiate with Republicans when it comes to a cornerstone of his health care law, and he will not negotiate when it comes to another congressional battle to raise the debt ceiling in a little more than two weeks. ... Steve, let's be clear: We're not going to delay the Affordable Care Act. There are millions of Americans right now who do not have health insurance. And they are finally, after decades, going to be in a position where they can get affordable health care, just like everybody else. And that means that their families, their kids, themselves, they've got the basic security that you and I enjoy.And the notion that we would even delay them getting that kind of peace of mind, potentially going to a doctor to get treated for illnesses that they currently have, simply because the Republicans have decided ideologically that they're opposed to the Affordable Care Act, is not something that we're going to be discussing (Peralta, 10/1).

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State Watch

State Highlights: NYC's Plan To Get Bids For Worker Coverage Meets Roadblock; Iowa Waits For Medicaid Expansion Waiver, Readies Enrollment

A selection of health policy stories from New York, Iowa, California and New Hampshire.

The Associated Press/Wall Street Journal: NYC's Plan To Get Health Insurance Bids On Hold
New York City's plan to solicit bids for health insurance for hundreds of thousands of workers has been put on hold. A Manhattan judge on Monday granted a preliminary injunction preventing the City from issuing the bids. A group of unions sued the city Aug. 10, shortly after Mayor Michael Bloomberg said the city was planning to seek bids within days. Bloomberg said the request for proposals will look to save up to $400 million a year (10/1).

The Associated Press: Iowa To Move Forward With Low-Income Health Care
Iowa residents will be able to sign up for a new low-income health care program starting Tuesday, even though federal authorities have yet to approve the plan, Gov. Terry Branstad said Monday. The state has applied for a waiver enabling the state to receive more federal Medicaid money for the proposed Iowa Health and Wellness Plan, a new health insurance program which would cover up to 150,000 residents (9/30).

ProPublica: California Poised To Broaden Access To Abortions
When you read about abortion these days, the news is mostly about restrictions -- new state laws, regulations, and court challenges that aim (depending on your point of view) either to make the procedure safer for women or to put providers out of business. But California is going in the opposite direction, with two bills that could lead to the one of the biggest expansions of access to abortion in the United States since the FDA approved mifepristone, aka the abortion pill, in 2000 (Martin, 9/30).

Los Angeles Times: L.A. Sues To Block Vote That Could Force Separate Health Departments
The city of Los Angeles filed a lawsuit Monday to halt a ballot measure that would require the city to start its own health department separate from the county's. AIDS Healthcare Foundation, a major provider of HIV testing and treatment services for Los Angeles County's health department that also frequently butts heads with county leadership, led the charge to get the city measure on the June 2014 ballot (Sewell and Mehta, 9/30).

The Associated Press/Wall Street Journal: Dartmouth-Founded Health Collaborative Grows
Four more health systems have joined a data-sharing project at improving health care and lowering costs that was started by New Hampshire's Dartmouth-Hitchcock health system and other partners three years ago (9/30).

Medpage Today: Program Cuts Child Obesity In San Diego
An innovative public-private partnership in San Diego helped the county lower rates of childhood obesity and overweight by 3.7 percent over a 5-year span, organizers said here. After several years of working with schools and other community partners, the San Diego County Childhood Obesity Initiative lowered the percentage of overweight and obese fifth, seventh, and ninth graders from 35.83 percent in 2005 to 34.5 percent in 2010, according to data from the University of California, Los Angeles Center for Health Policy Research (Pittman, 9/30).

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Editorials and Opinions

Opinions On Shutdown: Using Obamacare Is A Sham Cause; GOP Isn't Crazy; What's The Endgame?

Los Angeles Times: The GOP's Shutdown Sham
House Republicans' irresponsible brinkmanship may finally lead to the government shutdown that some of its members have been coveting since they took control of that chamber in 2011. This time, though, the fight hasn't been a battle over spending on federal agencies. It's been a symbolic one over the 2010 Patient Protection and Affordable Care Act, a.k.a. Obamacare. And it's been a sham. The inconvenient truth for the GOP is that "defunding Obamacare," as the House tried to do, wouldn't stop most of the major provisions of the health care law, some of which have already gone into effect. That's because the new insurance rules, premium subsidies and many other features of the law don't rely on discretionary dollars; they're on fiscal autopilot (10/1).

The New York Times: Those Banana Republicans
They say that the definition of insanity is doing the same thing over and over again and expecting a different result. Why is it that the Republicans in Congress seem so determined to prove this maxim? Let's start with the Affordable Care Act, a k a Obamacare. The exchanges that are at the heart of Obamacare — making it possible for people who are currently uninsured to buy health care — open for business on Tuesday. Ever since the Republicans took control of the House, they have held vote after vote to roll back the law, even while ignoring important business like, say, fixing the Postal Service (Joe Nocera, 9/30).

The New York Times' Taking Note: Obama's Message To The Middle
It won't take more than 15 Republican defectors to stop Speaker John Boehner’s latest exercise in face-saving pride: a demand that the individual mandate of health care reform be delayed a year in exchange for keeping the government open. (He also wants to end insurance subsidies for members of Congress, their staffs, and political appointees around the executive branch.) Already, there are signs that some moderates, from the northeast and elsewhere, are disgusted with this intransigence and may vote against it tonight. "We have to end this process," Peter King, Republican of Long Island, told CQ Roll Call. "I don't want to facilitate a process that’s doomed." It is doomed, obviously (David Firestone, 9/30).

Los Angeles Times: Pingpong Over Obamacare, Government Shutdown Continues   
It's worth noting what's really going on here. Republicans don't have the votes to repeal the 2010 Patient Protection and Affordable Care Act (better known as Obamacare). Their best hopes had been to have the law thrown out by the courts (which failed when the Supreme Court ruled it constitutional in 2012) or to gain the power to change the law by taking control of the Senate or the White House in the 2010 and 2012 elections (which they didn't). That leaves them trying to extract concessions on the law by threatening not to pass other measures that Democrats badly want to pass (Jon Healey, 9/30).

Los Angeles Times: GOP Will Stop At Nothing To Deny Obama His Due On Healthcare Reform
This is crunch time. Republicans know that once people get a taste of the benefits they'll receive under the Affordable Care Act, there will be no turning back. So the GOP is working overtime to misinform, frighten and dupe people into keeping their distance. Think that's an exaggeration? Rep. Michele Bachmann (R-Minn.) said the Affordable Care Act must be repealed "before it literally kills women, kills children, kills senior citizens." Literally. Kills. Children (David Lazarus, 9/30). 

Los Angeles Times: Government Shutdown: Newt Gingrich Has Terrible Advice
[Former House Speaker Newt] Gingrich conveniently forgets that Democrats hold a majority in the Senate, and that senators have continued to block the Republican-dominated House's attempts to delay the implementation of Obamacare for a year, setting up a shutdown of many government functions and programs that could begin as early as Tuesday. As House of Republicans are on the verge of forcing the nation to relive its disastrous shutdown, Gingrich has conveniently developed a case of historical amnesia (Robin Abcarian, 9/30).

Bloomberg: The Republicans Fighting Obamacare Aren’t Crazy
But there’s nothing wrong with continuing to resist Obamacare even though it has been on the books for three years. What would be strange is if Republicans ended their opposition to it. The law was, after all, passed over almost-unanimous Republican objections. Other large government programs haven’t seen as sustained a campaign against them, but they had more bipartisan support at the outset. Obamacare was unpopular with the public when it passed, and it has only become more so. Republicans generally think it will have bad effects on the economy and on health care. And it isn’t yet entrenched. Why wouldn’t they keep opposing it? (Ramesh Ponnuru, 9/30).

Bloomberg: Don't Expect a Shutdown To Change Much
With a government shutdown upon us, it's worth pondering this drama's endgame. Does anyone seriously think Democrats in the Senate or the White House will abandon the president’s signature legislative accomplishment in order to appease a few dozen congressional Republicans with an appetite for hyperbole? Hands? Anyone? Didn’t think so. So, after some to-be-determined period of political squirming, Democrats and Republicans will reach a deal to fund the government at more or less current levels for either a shorter or a longer duration. The result will be a continuation of the current government by sequestration, itself a product of extreme dysfunction (9/30).

The Wall Street Journal: Peggy Noonan: Delay Obamacare For A Year (Video)
Declarations columnist Peggy Noonan explains why the president’s wisest move may be to compromise with Republicans (Noonan, 9/30).

USA Today: The Shutdown Party: Our View
This shutdown is not the result of the two parties acting equally irresponsibly. It is the product of an increasingly radicalized Republican Party, controlled by a deeply disaffected base that demands legislative hostage-taking in an effort to get what it has not been able to attain through the electoral process or the judiciary. Republicans in the House are making demands that are both preposterous and largely unrelated to budgetary matters. In return for keeping government running (and, even more ominously, for paying its bills), they want President Obama to undermine the health care law that he ran on in 2008 and 2012, and now considers his signature domestic accomplishment (10/1).

USA Today: Rep. Cathy McMorris Rodgers: It's Up To The Senate
We have arrived at the moment of a government shutdown because the Senate has refused to make the tough decisions. They've refused to accept anything other than a clean spending bill. They've refused to consider any reforms or changes to the status quo. And they've refused to listen to the millions of individuals who are struggling because the president is rationing costs and limiting access (Rep. Cathy McMorris Rodgers, R-Wash., 10/1).

The Washington Post: The Tea Party's Revolt Against Reality
During the Obama era, Republican ideological conflicts have intensified. The latest round began with a typical, largely healthy revolt against leaders such as House Speaker John Boehner and Senate Minority Leader Mitch McConnell, who were viewed as tired and uncreative (though easier to criticize than replace). The young guns — including Reps. Paul Ryan and Eric Cantor — would finally take on Medicare reform and push big questions about the role of government in American life. This involved political risk but had the virtue of intellectual seriousness. Tea-party populism, however, moved quickly beyond this point. We are no longer seeing a revolt against the Republican leadership, or even against the Republican "establishment"; this revolt is against anyone who accepts the constraints of political reality (Michael Gerson, 9/30).

The Washington Post: What The GOP Has Missed On Obamacare
Say what you want about Republicans' obsession with destroying Obamacare. One thing they can't be accused of is acting in calculated, partisan self-interest. If all the GOP cared about was hurting Democrats, Republicans might support the health-care law — because it threatens a core Democratic Party constituency: organized labor (Charles Lane, 9/30).

The Washington Post: Federal Workers Deserve Better Than Congress's Disregard
However the antics over a federal shutdown turn out, they have made depressingly clear why so many talented Americans disdain the idea of working for their government. Who would want to work for an employer so dismissive of its employees that it would heedlessly play games with their livelihoods? People in the employ of their country deserve better than the disregard — even contempt — demonstrated by Congress in its irresponsible brinkmanship. ... How rich is it that members of Congress — who have proved woefully inept at their job — would get paid but not the scientist at the National Institutes of Health working on cancer research; not the congressional staffer assisting constituents with problems; not the attorney with the Department of Housing and Urban Development cementing a deal to build housing for the low-income elderly; not the janitor sweeping out a restroom on the Mall? (9/30).

The Washington Post: Fox News Has Utterly Lost It On Obamacare
As uninsured Americans find themselves on the eve of getting brand-new options to secure health care, desperation at Fox News is surfacing. It has been fighting this law from the start, highlighting any bad news related to the Affordable Care Act and suppressing the good news. The tone has been uniform; the skepticism has spread across most time slots; and the inspiration comes from on high, as Fox News chief Roger Ailes has made public his disregard for Obamacare. Let the record show that Fox News, in its assault against Obamacare, has moved from attacking legislation to attacking Q and As (Eric Wemple, 9/30). 

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Viewpoints: Sen. Barrasso Warns Insurance Buyers To Beware; It Will Take Time To Assess Marketplaces

USA Today: Beware Obamacare
Today begins the first phase of Obamacare's big test. The Obama administration has spent months and millions of dollars promising people great benefits from the new government-run health insurance exchanges. Now Americans will see for themselves. ... Instead of lower health care costs and better access to care, here are four reasons for the buyer to beware (Sen. John Barrasso, 10/1).

Politico: No Quick Verdict On Obamacare
October 1 is a handy news hook for coverage of Obamacare as it moves from a political dogfight to a reality — a new phase for the law. But it is not a magic moment to make a judgment about the ACA. All sides will be spinning their version of the early implementation experience, but it will take longer to come to any kind of reasonable judgment about how the law is working and what its lessons are. And while the noise level will be highest in Washington, in the end it's the American people who will decide whether they like what they are getting from Obamacare or not (Drew Altman, 9/30).

The Washington Post: Everyone Should Hope Obamacare Works
The Affordable Care Act's market¬≠places open Tuesday, even though the federal government has shut down. A lot of people don't know what the opening means, let alone how the broader law is supposed to work. The political debate doesn't help: It has become increasingly distorted since the law passed three years ago, culminating in inflated Republican claims in recent days that the system will harm, rather than improve, health care for many Americans. That’s not only bad for President Obama’s signature policy achievement, it’s also bad for the health-care system (10/1).

USA Today: Mend Obamacare, Don't End It: Our View
From all indications, Tuesday's Obamacare rollout will be bumpy. ... Should the whole thing just be shut down or delayed for a year, which Republicans have been demanding as their price for averting a government shutdown Tuesday? Hardly. That reasoning skips over an inconvenient fact: No matter how rocky the start-up proves to be, it will be a step up because it will provide a new route to insurance for millions who until now had no option at all (9/30).

USA Today: Obamacare Not Ready For Prime Time: Opposing View
Despite the happy talk from President Obama about enrollment being as easy as online shopping, consumers are in for some big shocks. The first will be the daunting costs. Health insurance in the exchanges will be far from free. In most states, premiums will be higher than in the private market today, especially for the young people the administration most needs to enroll (Grace-Marie Turner, 9/30).

The Wall Street Journal: Obamacare's Technology Mess
President Obama is bracing Americans for inevitable problems as the Affordable Care Act rolls out this week, but what he calls "glitches" are hardly routine. Information technology is ObamaCare's Achilles' heel. The faulty IT will expose Americans to lost data, attempts to enroll online that fail and the risk of fraud (Scott Gottlieb and Michael Astrue, 9/30).

Medpage Today: Cost Savings Right Under Our Noses
As deliberations over how to make healthcare more cost-effective continue to play out in forums across the country -- from the U.S. Congress to state governments to health systems and hospitals -- it strikes me that we are paying insufficient attention to what should be an obvious consideration – the cost of supplies. Supplies run the gamut -- from operating tables, artificial knees, intravenous solutions, and wound dressings to bed linens, medication carts, cleaning supplies, and cafeteria food. By some estimates, the "supply chain" represents as much as 40 percent to 50 percent of a hospital's or health system's operating cost, amounts that are exceeded only by the cost of labor (Dr. David Nash, 9/30).

The Journal of the American Medical Association: The Elusive Path To Health Care Sustainability
Despite the recent slowdown in health care inflation, particularly in Medicare and Medicaid, increases in health care costs threaten to exceed the nation's capacity to pay. ... This national challenge calls for serious, bipartisan action. But amidst today's polarized policy-making environment, restoring financial sustainability to Medicare, Medicaid, and private health care continues to confound lawmakers, and the path toward a more sustainable, affordable, high-performing health system remains elusive. Still, despite the division and gridlock paralyzing the making of health care policy today, a consensus is emerging among health care experts and stakeholders regarding the next steps the nation must take toward health care sustainability (John C. Lewin, G. Lawrence Atkins and Larry McNeely, 9/30).

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Andrew Villegas

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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.