Daily Health Policy Report

Wednesday, October 16, 2013

Last updated: Wed, Oct 16

KHN Original Reporting & Guest Opinion

Capitol Hill Watch

Health Reform

Administration News


State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

9 Things Millenials Need To Know About Obamacare (But Likely Don't)

Kaiser Health News staff writers Ankita Rao and Marissa Evans report: "Despite being tapped into social media networks and watching The Daily Show, only 10 percent of young Americans say they are very familiar with the Affordable Care Act. Here’s what you need to know" (Rao and Evans, 10/16). Read the story.

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Advocates Target Latinos in ACA Enrollment Outreach

The Texas Tribune's Becca Aaronson, working in partnership with Kaiser Health News, reports: "Though they make up roughly a third of the state’s population, Latinos account for nearly two-thirds of the more than 6 million Texans without health insurance. As a result, proponents of the Affordable Care Act in Texas are specifically targeting Latinos in their efforts to enroll people in a federal insurance marketplace aimed at helping the uninsured find coverage" (Aaronson, 10/15). Read the story.

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Capsules: Report: 5.2 Million Adults Will Fall Into ACA Coverage Gap Next Year; Rocky Opening Leaves Health Law's New Co-Ops Jittery

Now on Kaiser Health News' blog, Phil Galewitz reports on the health law's coverage gap: "About 5.2 million poor, uninsured adults will fall into the 'coverage gap,' created by 26 states choosing not to expand Medicaid under the federal health law next year, according to a study released today by the Kaiser Family Foundation" (Galewitz, 10/16).

Also on the blog, Jay Hancock reports on co-op jitters: "Nothing is more important for a startup burning through cash than winning customers and revenue. So problems with the Affordable Care Act's online marketplaces, also known as exchanges, aren't just an inconvenience for the likes of Evergreen Health Co-op. They're a threat" (Hancock, 10/15). Check out what else is on the blog.

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FAQ: What Is The ACA's 'Reinsurance Tax?'

Kaiser Health News staff writer Mary Agnes Carey reports: "Here are some frequently asked questions about the health law’s temporary 'reinsurance tax' and how it would work" (Carey, 10/15). Read the story.

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Political Cartoon: 'Nuclear Reaction?'

Kaiser Health News provides a fresh take on health policy developments with "Nuclear Reaction?" by Nate Beeler.

Here's today's health policy haiku:


Reinsurance? Who
remembered that? That is the
wacky D.C. world!

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

Tuesday Came And Went -- Still No Agreement To Reopen The Gov't, Raise The Debt Ceiling

Differences among House GOP lawmakers are a key factor in this ongoing Capitol Hill drama, as some members continue to push to delay and derail parts of the health law. The current proposal emerging from the Senate includes changes to the overhaul, but most say these provisions would not significantly alter the measure.

The New York Times: Debt Talks In Disarray As House Balks
A day that was supposed to bring Washington to the edge of resolving the fiscal showdown instead seemed to bring chaos and retrenching. And a bitter fight that had begun over stripping money from the president's signature health care law had essentially descended in the House into one over whether lawmakers and their staff members would pay the full cost of their health insurance premiums, unlike most workers at American companies, and how to restrict the administration from using flexibility to extend the debt limit beyond a fixed deadline. Even so, the House speaker, John A. Boehner, Republican of Ohio, and his leadership team failed in repeated, daylong attempts to bring their troops behind any bill that would reopen the government and extend the Treasury's debt limit on terms significantly reduced from their original push against funding for the health care law (Weisman, 10/15).

The New York Times: With G.O.P. Badly Divided, Boehner Is Left 'Herding Cats'
It was yet another moment of decision for Mr. Boehner, who finally finds himself at the crossroads he has been marching toward for weeks: an imminent financial default on the one hand, and on the other an unyielding conservative rank and file that persists with the futile effort to take down President Obama's health care law even if they also take down the speaker in the process. While his colleagues sang about how what once was lost had now been found, Mr. Boehner did not tell them a more dispiriting truth: With less than 48 hours left before the nation is set to exhaust its authority to borrow money, he and his lieutenants were running out of ideas — a fact made starkly evident by the mad and fruitless scramble on Tuesday to come up with a measure that could win enough support from his members. Around 7 p.m., he sent the House home and canceled all votes for the day (Parker and Peters, 10/15).

The Wall Street Journal: House GOP Abandons Its Proposal
For all the drama, the House legislation looked much like the Senate plan and, like the Senate proposal, was only a short-term fix. The House bill would have raised the debt limit through Feb. 7 and ended the 15-day government shutdown by funding federal agencies through Dec. 15. Conservatives objected both to the Senate bill and Mr. Boehner's alternative because they gave Republicans too little of what they had been demanding—major changes in the 2010 health-care law and measures to reduce the deficit (Hook, Cui and Peterson, 10/15).

Los Angeles Times: Boehner's Push For House Budget Compromise Falters
Shortly after House leaders officially called off a vote on their most recent plan, spokesmen for Reid and McConnell said Senate talks were resuming. They had paused for the day to allow Boehner (R-Ohio) a chance to get a bill through the House. … Senate aides said the agreement would extend the Treasury's authority to borrow money through Feb. 7 and end the government shutdown, providing federal agencies with funds through Jan. 15. … The plan would make no significant changes in President Obama's healthcare law. Democrats were expected to drop a proposal to repeal a new tax on insurance plans that is opposed by some unions. The agreement also would direct officials to confirm that people receiving insurance subsidies under the law were eligible for them, something Democrats say the law already requires (Memoli, Mascaro and Bennett, 10/15).

The Wall Street Journal: Republicans Insistent About Tweaking Health-Care Law
Some of the changes in the health-care law Republicans have sought in budget negotiations affect provisions so obscure few have heard of them, while others would hit more high-profile parts of the legislation. What the changes all have in common is that they are relatively small, particularly when compared with opponents' original hopes: to use the budget debate as a lever to strip funds from implementation of the law, or delay for a year its signature provision that most individuals carry insurance or pay a penalty. Those efforts have fallen short (Radnofsky, 10/15).

CNN: Proposed Budget Deal Barely Dents Obamacare
Although the terms of a deal that would end a two-week partial shutdown of federal offices and raise the government's legal borrowing limit weren't final Tuesday, Democratic sources told CNN one possible change being weighed by Senate leaders could delay a fee on employers, unions and other health-plan sponsors that compensate insurance companies for taking on high-risk customers in the first year of the program set up under the Affordable Care Act. Another could strengthen verification measures for people seeking federal subsidies to help them purchase health insurance required by the law. Both of those are far short of the target set by conservative Republicans in the House of Representatives, who hoped to wipe out funding for Obamacare, as the program has become known. "This doesn't, frankly, do a whole lot to Obamacare," said Lawrence Jacobs, director of the University of Minnesota's Center for the Study of Politics and Governance (Smith, 10/16).

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Congressional Health Coverage At Center Of House GOP Concerns

Conservatives argue that federal contributions to their health insurance, which the health law requires them to purchase in the new online marketplaces, is an unfair subsidy. But Democrats say the government is just providing the same support that it has in the past and is in line with what other big employers give workers.

The New York Times: Conservatives Look To End Health Contributions For Congress Members And Staff
A group of House Republican conservatives met midday on Tuesday to discuss an acceptable alternative to a House proposal to reopen the government that was abandoned earlier in the day for lack of support. What many seek is a provision that would eliminate government contributions to the health plans for members of Congress and their staff members — as well as for the president, vice president and members of the cabinet — who would obtain their insurance through the exchanges established by the Affordable Care Act (Steinhauer, 10/15).

USA Today: Congressional Health Care Bogs Down Shutdown Talks
Congress' own health insurance could be one of the last obstacles to reaching a deal to reopen the government and avoid default. House Republicans floated a bill Tuesday that would have ended the 16-day federal government shutdown and raised the debt limit, but it also would have eliminated the employer contribution for health care for all members of Congress, their staffs, the president, the vice president, and all their political appointees (Korte, 10/15).

Fox News: Sen. Vitter: Democrats 'Determined' To Protect The Political Elite From ObamaCare Costs
GOP Sen. David Vitter says the White House and Democratic leaders are determined to protect the political elite from ObamaCare costs, telling Fox News' Greta Van Susteren that's the reason he and GOP Rep. Ron deSantis' amendments that would end subsidies for lawmakers under the health law have been opposed. Vitter, who is mounting a campaign to get rid of the subsidies in the Senate, said on "On the Record" he believes Senate Majority Leader Harry Reid would resist and try to squash his amendment if it was attached to a budget deal. "President Obama went so far as to issue a personal veto about this language today," Vitter said (10/15).

Politico Pro: How Much Would Lawmakers Pay For Insurance Next Year?
House Republicans are suggesting lawmakers — and possibly their staff — shouldn't get government contributions to their health insurance. It's part of the House GOP plan, which is still in flux, to end the government shutdown and raise the debt limit. And it's a vote that could hit lawmakers directly in the pocketbooks. If the federal contribution is eliminated, lawmakers will have to pay the entire tab. If they keep the contribution that most federal workers get, they would pay only about one-quarter of that amount (Haberkorn, 10/15).

Politico: Obama Vows Veto Over Vitter Measure
President Barack Obama told House Democratic leaders Tuesday that he would veto debt-ceiling legislation if it includes a provision pushed by Sen. David Vitter (R-La.) and House GOP leaders that would cut health subsidies for congressional and senior executive branch officials, according to sources familiar with the discussion at a private White House meeting (Allen, 10/15).

Roll Call: Senate Staff Gets Guidance (For Now) On Obamacare Exchanges
Senate staffers were notified by the Disbursing Office on Tuesday that they will need to enter the D.C. health care exchange, regardless of their state of residency, and will lose their employer contribution if they do not enter the D.C. exchange, according to a memo obtained by CQ Roll Call (Shiner, 10/15).

The Hill: Grassley: End Health Contributions For Hill Staff
Sen. Charles Grassley (R-Iowa) said he never intended to make lawmakers and congressional aides cover the full cost of their healthcare plans, but that he believes it's the only fair thing to do. Grassley sponsored the provision in ObamaCare that requires members of Congress and their staffs to buy healthcare coverage through the law's insurance exchanges (Baker, 10/15).

The Washington Post’s Fact Checker: Did Obama Exempt 1,200 Groups, Including Congress, From Obamacare?
The waivers were granted to companies (such as McDonald's or other fast food chains) that provided inexpensive bare-bones health plans known as "mini-meds," in what the administration called "a bridge" to 2014, when the law would be fully implemented. That's because the law says that annual coverage limits can't be lower than $750,000 in 2013 — and there are no annual dollar limits starting in 2014. ... As for Congress being exempted, this is also incorrect. ... For lawmakers and their staffs, the loss of employer contributions would have amounted to an unintended pay cut of between $5,000 to $10,000. Under pressure from Congress, the Office of Personnel Management proposed a rule in August, which was finalized in September, saying the federal government could still contribute to health-care premiums (Kessler, 10/16).

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What's In? What's Out? Tracking The Health Law Changes And The Budget Talks

After playing a central role in the negotiations, two health law tax provisions -- one related to reinsurance and the other a levy on medical devices -- appear to be off the table as of Wednesday morning. News outlets explained both in stories filed Tuesday night.

Politico: Obscure Obamacare 'Reinsurance' Fee Takes On Big Role In Spending Deal Talks
The Senate’s proposal to end the shutdown and debt stalemate would delay private sector payments to the health care law’s temporary reinsurance program, which is meant to stabilize the new health insurance marketplaces that opened for enrollment Oct. 1. The House counter-proposal doesn’t have it, so its inclusion in any final deal is looking less likely (Millman, 10/15).

CQ HealthBeat: Reinsurance Fee Delay In, Then Out, Of Emerging Senate Deal
Negotiators appear to have removed a provision from the latest deal to lift the debt ceiling and reopen the federal government that would have delayed a fee designed to cushion insurers against early losses in the exchange markets. Lawmakers reportedly were looking at a one-year delay as a way to address union concerns about the impact of the health care law on the health plans they offer to their membership (Reichard, 10/15).

Kaiser Health News: FAQ: The Senate Is Looking At The ACA's 'Reinsurance Tax.' What Is That?
One provision of the Senate's emerging deal to reopen the federal government and extend the federal debt ceiling includes a one-year delay of a tax to help provide relief to insurers which cover large numbers of high-cost medical cases. Here are some frequently asked questions about the health law’s temporary 'reinsurance tax' and how it would work (Carey, 10/15).

Politico: Talking About The Medical Device Tax
The tax has been in and out and in and out of several offers from both Republicans and Democrats to smooth a deal to re-open government and lift the debt ceiling. As of late on Tuesday, it was cut from the latest House Republican offer. It also fell out of a Senate offer from earlier this week. But the repeal’s staying power in the debate highlights a typical Washington confluence of money and local politics (Bade and Dixon, 10/15).

Los Angeles Times: Medical Device Makers See An Opening In Budget Impasse
Leaders from the medical device industry listened when President Obama vowed in 2009 that there would be shared sacrifice and "no sacred cows" to help pay for his healthcare law. But unlike the pharmaceutical industry, insurers and others at that healthcare summit, the device makers never shook hands on a deal. Instead, after a 2.3 percent tax on their revenue was included in the 2010 Affordable Care Act, they started a drive to repeal it. Now, with Washington paralyzed in a government shutdown and a fight over the debt limit, the device makers have seized on the impasse as a chance for victory (Tanfani, 10/16).

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Health Reform

Federal Exchange: Expectations Were Rosy, But Consumer Frustration Taking Root

The Washington Post reports that visits to healthcare.gov dropped 88 percent between Oct. 1 and Oct. 13. In an interview, President Barack Obama said the glitches consumers have experienced must be addressed.

The Associated Press/Washington Post: Before Glitches Arose, Internal Admin. Projections Called For Robust Health Care Signups
The Obama administration's internal projections called for strong enrollment in the states in the first year of new health insurance markets, according to unpublished estimates obtained by The Associated Press. Whether those expectations will bear out is unclear. Technology glitches have frustrated many consumers trying to sign up for coverage online, and efforts to upgrade and repair healthcare.gov are ongoing (10/15).

The Washington Post: Visits To Federal Health-Care Web Site Off 88%
The number of visitors to the federal government's HealthCare.gov website dropped 88 percent between Oct. 1 and Oct. 13, according to a new analysis of America's online use, while less than half of 1 percent of the site's visitors successfully enrolled for health insurance the first week (Eilperin, 10/15).

CNN: Obama: Obamacare Website Glitches Are Unacceptable
Despite the consistent problems, the president touted the health care law, saying it enables those seeking coverage to purchase private insurance, compare the prices of different plans and receive a tax credit to make it affordable. "The product itself is actually really good but we have to make sure that the cash register works and that the lines aren't too long when people are checking in and checking out," Obama said. The president has insisted he will not negotiate over the law as part of discussions currently underway to reopen the government and increase the debt ceiling before the Thursday deadline. But in Tuesday's interview, the president also reiterated his willingness to improve parts of the law in the future as long as those who are now eligible for coverage are not turned away (Schwarz, 10/16).

Also in the news, more coverage of how online insurance brokers are on hold as federal officials work to sort out the difficulties involved with the insurance marketplace as well as the fits and starts related to co-ops and Medicaid -   

Politico: Web Brokers On Standby, Waiting To Sell Obamacare Plans
The Obama administration has enlisted a small army of online brokers to help sell new Obamacare health plans, but those sites have been sidelined in the health care law's first two weeks as the feds struggle to sort out their own glitch-filled website. The federal agency in charge of the exchanges signed agreements this summer with several e-brokers to sell health plans in the 36 states where the feds are running the new individual marketplaces. But the online brokers, eager to tap a new market of people who'll qualify for federal subsidies, learned shortly before the Oct. 1 launch that they wouldn't be able to offer exchange plans right away (Millman, 10/16).

Kaiser Health News: Capsules: Rocky Opening Leaves Health Law's New Co-Ops Jittery
Nothing is more important for a startup burning through cash than winning customers and revenue. So problems with the Affordable Care Act's online marketplaces, also known as exchanges, aren't just an inconvenience for the likes of Evergreen Health Co-op. They're a threat (Hancock, 10/15).

Modern Healthcare: Federal Exchange Won't Transfer Medicaid Applications Until November
Americans submitting their applications for Medicaid through the federal government's online insurance marketplace in 36 states may want to contact their state Medicaid agencies for faster results. The CMS said Tuesday the online marketplace, HealthCare.gov, will not begin transferring applications to state Medicaid programs until Nov. 1 (Johnson, 10/15).

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California Exchange Draws Strong Interest, While Hawaii's Finally Opens

Media outlets report on the progress of state-run exchanges, ranging from the nearly 100,000 application starts in California, to Hawaii's two weeks-delayed launch, to Oregon officials' concern about sites using sound-alike names.

Los Angeles Times: California Insurance Exchange Reports 94,500 Application Starts
After two weeks of open enrollment, Californians have started nearly 95,000 applications for health insurance through the state's new exchange. Covered California, the state marketplace, announced the latest figures Tuesday and it said consumer interest in the federal healthcare law remains strong (Terhune, 10/15).

The Associated Press: Hawaii Insurance Marketplace Launches With Plans
Hawaii's health insurance marketplace under President Barack Obama's federal health care overhaul began offering plans for sale on Tuesday, more than two weeks after the start of open enrollment. Hawaii Health Connector Executive Director Coral Andrews said at a news conference that consumers can now review and buy plans offered on the exchange's website (Garcia, 10/15).

The Oregonian: Cover Oregon; Insurance Agents Set Up Sound-Alike Sites, But Some Raise Concerns
Insurance agents are taking advantage of internet searches for the state's new health marketplace, even using sound-alike website names like Cover Oregon Plan, Cover Oregon Now and Oregon Health Exchange. But consumers need to make sure their agent is certified, and should know that only the state's official website --coveroregon.com -- can offer tax credits and other savings, says Cover Oregon spokesman Michael Cox. So far, officials have contacted three websites about potentially misleading language on their sites, two of them sites with similar names to Cover Oregon or its earlier name, the Oregon Health Insurance Exchange (Budnick, 10/15).

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5.2M Won't Get Coverage In States Rejecting Medicaid Expansion

A new report projects that 5.2 million adults will not get health coverage next year because their states aren't expanding Medicaid under the health law. In Wisconsin, expanding the program becomes an issue in the gubernatorial race, while in North Carolina, county commissioners ask state officials to reconsider their decision not to expand, and in Virginia, supporters of expansion outnumber opponents in a hearing.

Kaiser Health News: Capsules: Report: 5.2 Million Adults Will Fall Into ACA Coverage Gap Next Year 
About 5.2 million poor, uninsured adults will fall into the 'coverage gap,' created by 26 states choosing not to expand Medicaid under the federal health law next year, according to a study released today by the Kaiser Family Foundation (Galewitz, 10/16).

The Milwaukee Journal Sentinel: Mary Burke Says Scott Walker, Legislature Erred On BadgerCare Move
Democratic candidate for [Wisconsin] governor Mary Burke said the state should provide BadgerCare Plus health care coverage to people making up to 138 percent of the poverty level under Obamacare, sharply differing from Republican Gov. Scott Walker's plan. Such an approach would draw an additional $119 million to the state in federal aid over the next two years. Walker rejected that money because he said he did not trust Congress to meet its obligation to provide funding it has already promised over the long term. Burke, a former Trek Bicycle executive, made the comments Tuesday in an interview with The Associated Press. Republicans who control the Legislature approved a plan by Walker this summer that cuts the income threshold for BadgerCare from 200 percent of the poverty level to 100 percent of the poverty level (Marley, 10/15).

The Associated Press: Burke Says Walker Should Have Taken Medicaid Money
Democratic candidate Mary Burke criticized Gov. Scott Walker on Tuesday for turning down $119 million from the federal government to expand Medicaid coverage for Wisconsin residents just above the poverty line. Burke launched her run for governor last week but hasn't spoken in much detail about her campaign platform. In an interview with The Associated Press, Burke said the Republican Walker was wrong not to accept the $119 million in federal money over the next two years to pay for state Medicaid coverage for people earning up to 138 percent of poverty. Instead, Walker lowered BadgerCare Medicaid eligibility from 200 percent to 100 percent of poverty. The move is expected to result in about 92,000 people losing BadgerCare coverage in January (Bauer, 10/15).

In the meantime, the expansion also makes news in Washington, Ohio and North Carolina --

Spokesman Review: Washington Medicaid Increases Dental Coverage For Adults
A quarter-million adults in Washington will gain dental coverage over the next two years as the state expands its Medicaid rolls under the Affordable Care Act and re-establishes programs dropped in budget cutbacks. Starting Jan. 1, current Medicaid recipients who lost coverage after successive rounds of budget cuts in 2009 and 2011 will have it restored, and those added to the health care program under an agreement between the state and federal government will also be eligible for dental coverage, state officials said (Camden, 10/16).

Columbus Dispatch: Kasich’s Medicaid Expansion Expected To Pass Controlling Board
Though no Republican on the board has announced that he will vote for it, Senate President Keith Faber said yesterday he expects Gov. John Kasich to win Controlling Board approval to spend what is needed to expand Medicaid (Siegel, 10/16).

Charlotte Observer: Commissioners To Legislature: Reconsider Your Rejection Of Expanding Medicaid Coverage
Mecklenburg County commissioners passed a resolution Tuesday urging state lawmakers to reconsider turning down billions in federal money that would expand Medicaid coverage to 500,000 uninsured North Carolinians. The resolution, approved 6-3 along party lines, urges Gov. Pat McCrory to call the General Assembly into a special session to reverse its previous decision and expand the state’s Medicaid coverage as part of the Affordable Care Act (Perlmutt, 10/15).

And in Virginia, supporters outnumbered opponents at a hearing on whether the state should expand Medicaid --

Richmond Times-Dispatch: More Than 100 Sound Off On State Medicaid Plans 
With Virginians expected to pay an additional $26 billion in taxes in the next 10 years under the Affordable Care Act, Shinholser wants the state to accept more than $23 billion in federal funds to expand Medicaid and help pay for the drug and alcohol recovery programs his foundation runs. Virginians are expected to receive an additional $6 billion in federal subsidies for insurance sold on the electronic marketplace that will begin operating fully on Jan. 1. ... supporters outnumbered opponents by about 3-to-1 at the hearing, as well as in more than 1,400 online comments received by the commission, according to counts by health insurance and hospital advocates who favor expansion. The gulf between supporters and opponents also was wide on whether expanding Medicaid would help the estimated 400,000 uninsured Virginians (Martz, 10/16).

Fredericksburg Free Lance-Star: Both Sides Speak Out At Medicaid Expansion Hearing
Opponents and proponents of Medicaid eligibility expansion packed a General Assembly committee room Tuesday for the only public hearing planned by the legislative panel that will decide whether Virginia expands the program. ... Dave Schwartz, the Virginia director of Americans for Prosperity -- a national group that has intensely worked against the expansion -- said 1 in 4 doctors don't accept Medicaid, and that expansion would do nothing to help people if they can't see doctors. "Everyone needs coverage. Coverage means nothing if you don't have care," Schwartz said. "I don't know anybody that wants to be part of this program." Dr. Chris Lillis, a Fredericksburg doctor, is on the side of expansion and came to Richmond to say so to the commission members. "This is an historic opportunity to eliminate the problem of the uninsured," he said before the meeting began (Davis, 10/15).

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Health Law Politics Are Far From Over

The Washington Post reports that the political winds in individual states will impact the health law's chances for success or failure -- maybe even more than the current technical challenges that have been a hallmark of its roll out.

The Washington Post: Health-Care Law's Fate Could Hinge On Political Climate In Individual States
The greatest threats to the ultimate success of the new health-care law come not from the technical problems that have plagued its rollout, but from a hostile political climate in many individual states and from potentially serious weaknesses in its design. Those are the conclusions of a cautionary report just published by the Brookings Institution's new Center for Effective Public Management (Tumulty, 10/15).

Also in the news, KHN details the things millenials need to know about the overhaul and HealthyCal reports that mobile health clinics have a lot to benefit.

Kaiser Health News: 9 Things Millenials Need To Know About Obamacare (But Likely Don't)
Despite being tapped into social media networks and watching The Daily Show, only 10 percent of young Americans say they are very familiar with the Affordable Care Act. Here’s what you need to know" (Rao and Evans, 10/16).

Healthy Cal: Mobile Health Clinics Hopeful About ACA
Managers who run mobile health clinics are hopeful that the new health care law will benefit them – not put them out of business. For decades, mobile health care vans have primarily served the uninsured – making a dent in a substantial problem. The U.S. has 55 million uninsured nonelderly residents, according a May 2013 report by the Congressional Budget Office. The Affordable Care Act (ACA) will require most of them to get insurance or pay a fine, starting in January. The CBO estimates that 14 million people will enroll in a health plan in 2014. The question is, will that help or hurt the mobile clinics? (Potter, 10/15).

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Administration News

Sebelius Gets 'Full Confidence' From Obama Despite Shaky Exchange Rollout

Amid a Republicans chorus calling for her to be fired, Health and Human Services Secretary Kathleen Sebelius got the "full confidence" of President Barack Obama Tuesday.

Politico: Obama Has 'Full Confidence' In Sebelius
President Obama has "full confidence" in Health and Human Services Secretary Kathleen Sebelius despite the bumpy rollout of HealthCare.gov, the White House said Tuesday. "The secretary does have the full confidence of the president," press secretary Jay Carney told reporters, responding to a question about the "Fire Sebelius" movement that's cropped up among Republicans (Epstein, 10/15).

Reuters: Obama Backs Health Secretary Sebelius Despite 'Obamacare' Woes
President Barack Obama has "full confidence" in Health and Human Services Secretary Kathleen Sebelius despite the troubled launch of the U.S. government website for signing up for his signature health care insurance program, the White House said on Tuesday. Americans trying to shop for health insurance at healthcare.gov under Obama's health care law have been frustrated by error messages, long waits and system failures, with many failing to make it through the system despite repeated tries (Rampton, 10/15).

CBS News: Former WH Official, Republicans Slam HHS For Flawed Obamacare Rollout
In the wake of the botched rollout of the online Obamacare marketplace, some Republicans are saying it's time for Health and Human Services Secretary Kathleen Sebelius to go. At least one former Obama administration official agrees that someone, if not Sebelius, should get fired for the problems with HealthCare.gov. Health and Human Services spent almost $394 million over three years in contracts, according to one government report, to build the online marketplace (referred to as an exchange) on which consumers in 36 states can shop for private insurance. A couple congressional Republicans have also called for Sebelius' replacement. "For the sake of the American health care system, as well as jobs and the economy, Obamacare should be repealed," Rep. John Fleming, R-La., said in a statement Monday. "In the meantime, someone must be held accountable for wasting taxpayer dollars on a rollout that was more than three years in the making” (Condon, 10/15).

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Where Seniors Live Affects Their Health Care And The Medications They Get

The Associated Press examines how geography can make a key difference in the treatments that Medicare beneficiaries receive. Other outlets look at the annual open enrollment period for Medicare prescription drug plans. USA Today reports that thousands who rely on nursing home trust funds have had their savings mismanaged or stolen.

The Associated Press: Study: Where Seniors Live Affects What Medications Prescribed, Whether They're The Best Kind
Where seniors live makes a difference not only in how much health care they receive but also the medications they're prescribed — as some miss out on key treatments while others get risky ones, new research shows. More than 1 in 4 patients on Medicare's prescription drug plan filled at least one prescription for medications long deemed high-risk for seniors, according to the study released Tuesday by the Dartmouth Atlas Project (Neergaard, 10/15).

Kansas Health Institute: Medicare Part D Open Enrollment Starts Today
State officials are encouraging seniors to contact their area Senior Health Insurance Counseling for Kansas office if they need help enrolling or re-enrolling in the Medicare Part D prescription drug program. … In Kansas, seniors have access to 30 Medicare Part D plans. Subsidies are available for those with incomes below 150 percent of the federal poverty level, which is $1,436 a month for a one-person household or $1,939 a month for a two-person household (10/15).

NPR: Medicare Begins Open Enrollment, With An Online Caveat
The open enrollment for Medicare programs that began Tuesday will run into December. While the Medicare website doesn't have the problems found in the new federal health system's sites, the government shutdown means that information "may not be up to date," the site warns its users (Chappell, 10/15).

USA Today: Thefts From Nursing Home Trust Funds Target The Elderly
Thousands of residents in U.S. nursing homes and other long-term care institutions for the aged and disabled have had their personal savings raided or mismanaged after relying on the facilities to safeguard the money in special trust fund accounts, a USA TODAY investigation shows. These trust funds, which most long-term care providers are required to maintain for residents who request that the facility handle their money, are supposed to work like conventional bank accounts, with accrued interest, regular statements and reliable oversight. But USA TODAY found more than 1,500 recent cases in which nursing homes have been cited by state and federal regulators for mishandling the funds (Eisler, 10/16).

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State Watch

State Highlights: Calif. Gov. Vetoes 'Biosimilars' Bill

A selection of health policy stories from California.

California Healthline: Bill Regulating Biosimilar Drugs Vetoed
A bill that would have allowed "biosimilar" drugs to be substituted for biologic drugs was vetoed over the weekend by Gov. Jerry Brown (D), who said it was premature to pass the law until the Federal Drug Administration has worked out standards for the new drugs. SB 598, authored by Sen. Jerry Hill (D-San Mateo), would have allowed pharmacists to dispense biosimilar drugs as lower-cost replacements for biologics, a policy Brown said he supports (Norberg, 10/15).

California Healthline: Statewide Health Data Gateway Opens
Under the radar -- and all but forgotten in the combined cacophony of polarization in Washington, D.C., and the launch of the state's new benefit exchange -- a significant milestone was reached in California on Oct. 1. The Department of Public Health launched its Health Information Exchange Gateway, a single point of entry for submitting data for many state and public health programs. The gateway is an expansion -- a wider opening, to follow the metaphor -- of the department's Immunization Portal (Lauer, 10/15).

Los Angeles Times: LA County Health Workers Required To Get A Flu Shot Or Wear A Mask
Effective this influenza season, health care workers in Los Angeles County will be required to receive immunizations against influenza or wear a protective mask while in contact with patients. In an order issued by Public Health director Dr. Jonathan Fielding, the county mandated that all workers in hospitals, nursing facilities and intermediate care facilities who work in patient areas or have direct contact with patients receive an annual flu vaccination (Brown, 10/15).

Los Angeles Times: Doctor Arrested In Illegal Prescription Of Narcotics
A Southern California pain doctor who was featured in a 2012 Times investigative article on patient overdose deaths was arrested Tuesday on seven counts of illegally prescribing narcotics and other widely abused drugs. Dr. John Dimowo is charged with prescribing Vicodin, Norco, Adderall and Xanax to undercover agents who pretended to be patients but had no legitimate need for the drugs (Glover and Girion, 10/15).

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Editorials and Opinions

Viewpoints: Young People Could Spark Needed Entitlement Changes; Priebus Demands That Sebelius Go; GOP's 'Absurd Debate' On Hill Health Coverage

The New York Times: Sorry, Kids. We Ate It All.
Eventually this shutdown crisis will end. And eventually the two parties will make another stab at a deal on taxes, investments and entitlements. But there's one outcome from such negotiations that I can absolutely guarantee: Seniors, Wall Street and unions will all have their say and their interests protected. So the most likely result will be more tinkering around the edges, as our politicians run for the hills the minute someone accuses them of "fixing the deficit on the backs of the elderly" or creating "death panels" to sensibly allocate end-of-life health care. Could this time be different? Short of an economic meltdown, there is only one thing that might produce meaningful change: a mass movement for tax, spending and entitlement reform led by the cohort that is the least organized but will be the most affected if we don't think long term — today's young people (Thomas L. Friedman, 10/15). 

Los Angeles Times: Chipping Away At Obamacare: The Endgame In DC
The 2010 Patient Protection and Affordable Care Act, a.k.a. Obamacare, remains an issue in the endgame over ending the latest fiscal crisis in Washington -- just not a major one. But of course, the House and Senate disagree on what tweaks to make to the law that tea party-affiliated Republicans were so eager to defund (Jon Healey, 10/15). 

The Fiscal Times: Obamacare Taught Millennials To Distrust Big Government
With government programs spreading like an algae bloom and threatening our solvency, some pushback from the next generation could head off fiscal Armageddon. Today's young people just need a little more convincing that the feds don't have all the answers. That's where the Obamacare roll-out may be helpful. It is horrific, and for the most mundane reason imaginable – bad software. For a millennial, that's like a Tesla being disabled by faulty tires. Software and coding are the bread and butter products of today.  Nothing could have cast a greater pall over President Obama's signature healthcare initiative than screwing up the programming. Why would those all-important young people have confidence in a program of marginal appeal when the administration flubs the basics? (Liz Peek, 10/16).

The Fiscal Times: My Obamacare Odyssey: New Week, Same (Rotten) Result
I've tried to remain patient and work through the myriad system crashes and cul-de-sacs. The government has admitted that it didn't have enough capacity to deal with tens of millions of people searching for policies. In a way, that's good for the future of the ACA, since it shows robust demand. But not being able to get into the HealthCare.gov system is both frustrating and politically volatile. The ACA will live or die based on whether Americans can eventually obtain affordable coverage that serves their needs (John F. Wasik, 10/16).

Politico: Opinion: It's Time To Fire Secretary Sebelius
The Obama administration continues making excuses for Health and Human Services Secretary Kathleen Sebelius and the people who spent hundreds of millions of taxpayer dollars on a site that does not work. How much more money will her department waste — and how much time will Americans waste on the website — before the administration admits they have a problem? In a business, someone would be held accountable for such a large-scale disaster. When pressed on her failures, Sebelius repeats her favorite line: "We had some early glitches." A glitch, says Merriam-Webster, is "temporary" and "minor." For two weeks, the Obamacare website has hardly functioned. That's not minor or temporary. That’s not a glitch; that’s a systemic failure (Reince Priebus, 10/15).

Bloomberg: Congress's Absurd Debate Over Its Obamacare 'Exemption'
Obamacare created state health-insurance exchanges expressly for people who don’t get coverage through their employers. At the insistence of Republican Senator Charles Grassley, it made one exception when the law was written: Members of Congress and their staffs would also have to use the exchanges. (The idea seems to have been to embarrass Democrats by forcing them to object to the idea. Instead, they embraced it.) That created a wrinkle: The law did not say whether the government, which pays the premiums for congressional staff, could keep paying them for exchange-based coverage. So when the Office of Personnel Management, which handles employee benefits for Congress, ruled that the government could continue paying the premiums for members and staff, it wasn’t creating an exemption; it was trying to make sense of one that Republicans had already made. Yet for Republicans, the idea that Congress would get special treatment, whatever the reason, was grounds for a new attack on Obamacare (10/15).

Cleveland Plain Dealer: In His Quest For Ohio Medicaid Expansion, Kasich Borrows An End-Run From Obama's Playbook
Obamacare is a nationwide program designed to increase government dependency to roughly 100 percent of the population. It's going to make health insurance more expensive everywhere. It's going to degrade medical care everywhere. It's going to be — already is — a bureaucratic nightmare everywhere. Sick people, young people and taxpaying people are going to get it in the neck. Everywhere. There's nothing hard about the math: The more recipients and bureaucrats added to a giveaway program, the more that program is going to cost. A bigger Medicaid is inescapably a more expensive Medicaid. Whether the state or the feds are collecting for it, the result for taxpayers everywhere is the same. And it's not a good result (Kevin O'Brien, 10/15).

On other topics --

The New York Times: Should You Eat Chicken?
In recent weeks, salmonella on chicken has officially sickened more than 300 people (the Centers for Disease Control says there are 25 illnesses for every one reported, so maybe 7,500) and hospitalized more than 40 percent of them, in part because antibiotics aren’t working. Industry's reaction has been predictably disappointing: the chicken from the processors in question — Foster Farms — is still being shipped into the market. Regulators’ responses have been limited: the same chicken in question is still being sold. Until the Food Safety and Inspection Service (F.S.I.S.) of the Department of Agriculture (U.S.D.A.) can get its act together and start assuring us (Mark Bittman. 10/15).

Journal of the American Medical Association: Should Health Care Systems Become Insurers?
Incentives under the Affordable Care Act (ACA) are spurring increasing numbers of health care systems to assume the risk of paying for patient care, blurring the boundaries between care delivery organizations and insurers. New arrangements such as bundled payments, value-based purchasing, and accountable care organizations (ACOs) transfer financial risk from payers to health care systems. The union of payer and care delivery functions may engender opportunities for health systems to invest in prevention and more comprehensive, coordinated, patient-centered care (Dr. Nirav R. Shah and Dr. Dave A. Chokshi, 10/16).

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Stephanie Stapleton

Andrew Villegas

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.