Daily Health Policy Report

Friday, October 18, 2013

Last updated: Fri, Oct 18

KHN Original Reporting & Guest Opinion

Capitol Hill Watch

Health Reform

Health Care Marketplace

State Watch

Health Policy Research

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Tough Medicare Decisions Await Bipartisan Budget Panel

Kaiser Health News staff writer Mary Agnes Carey reports: "The deal President Barack Obama, Republican and Democratic lawmakers reached to reopen the federal government and raise the debt ceiling includes a bipartisan panel charged with producing a long-term budget agreement. … Both parties have agreed on some Medicare changes, including asking wealthier beneficiaries to pay more for their coverage. They disagree on others, such as increasing the Medicare eligibility age. Democrats won’t agree to any major overhaul of Medicare unless Republicans agree to raise taxes, which they have rejected" (Carey, 10/17). Read the story.

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What’s The Deadline For Buying Health Insurance In Order To Avoid A Penalty?

Kaiser Health News consumer columnist Michelle Andrews offers this answer to a reader’s question: “The simple answer is March 31, but unfortunately it’s not that straightforward. Starting in January, most people will need to have health insurance. If they don’t, they’ll owe a penalty amounting to $95 or 1 percent of the family income, whichever is greater. This fee will be collected when they file their federal income taxes. But the rules allow people to have a short gap in coverage of less than three consecutive months before they get dinged with the penalty" (Andrews, 10/18). Read the answer.

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Capsules: After 63 Tries, Reporter Creates Account On Federal Exchange

Now on Kaiser Health News' blog, Phil Galewitz reports: "After 17 days and 63 attempts, I finally made it. I was able to create an account on the federal health insurance exchange at www.healthcare.gov – a task which has frustrated millions of Americans" (Galewitz, 10/17). Check out what else is on the blog.

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Political Cartoon: 'Great Minds?'

Kaiser Health News provides a fresh take on health policy developments with "Great Minds?" by Chip Bok.

Here's today's health policy haiku:


After sturm and drang,
we're left with new normal: So
few days til next fight.

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

As Budget Talks Resume, Parties May Face Tough Decisions On Medicare, Other Entitlements

With the ink hardly dry on the deal providing short-term funding to reopen the government and to raise the debt ceiling, negotiators dived into the next round of fiscal talks. Media reports cast doubt on the possibility of a grand bargain, while Medpage Today suggests the latest deal muddled the prospects for an SGR fix.

The New York Times: Two Parties Start Work To Avoid Repeat Crisis
By definition, common ground suggests no grand bargain, which would require a much more difficult trade-off where they fundamentally differ — higher tax revenues that Republicans oppose, in exchange for reductions in Medicare, Medicaid and Social Security that Democrats vow they will not entertain without curbs on tax breaks for wealthy individuals and corporations (Weisman and Calmes, 10/17).

The Washington Post: President, Congress Leave One Crisis Behind But Face Long Road To Budget Deal
The Democrats' budget would restore funding to federal agencies by replacing deep automatic cuts known as the sequester, in part with a large infusion of new tax revenue from the rich. The Ryan budget would not raise taxes and would balance in 10 years, but only by canceling the benefits of the Affordable Care Act while keeping its tax hikes and Medicare cuts. Ryan would also cut spending by domestic agencies to levels so low that even some House Republicans balked at approving funding bills based on his framework. … Rather than trying to hash out a full budget blueprint, many lawmakers and independent analysts expect the conference committee to focus on the most urgent issue facing Congress: funding federal agencies through fiscal 2014. … To avoid increasing deficits, they proposed adopting a range of proposals from Obama’s most recent budget request, such as raising Medicare premiums for high-income seniors and requiring federal workers to contribute more to their retirement (Montgomery and Goldfarb, 10/17).

Kaiser Health News: Tough Medicare Decisions Await Bipartisan Budget Panel
The deal President Barack Obama, Republican and Democratic lawmakers reached to reopen the federal government and raise the debt ceiling includes a bipartisan panel charged with producing a long-term budget agreement. … Both parties have agreed on some Medicare changes, including asking wealthier beneficiaries to pay more for their coverage. They disagree on others, such as increasing the Medicare eligibility age. Democrats won’t agree to any major overhaul of Medicare unless Republicans agree to raise taxes, which they have rejected (Carey, 10/17).

Medpage Today: Budget Deal Muddles SGR Fix
As the dust settled following yesterday's last-minute budget deal to avert a federal government's default, a frightening fact emerged for the nation's doctors. It might be tougher to delay for yet another year the planned cuts physicians face under Medicare's sustainable growth rate (SGR) formula. Physicians face a 24.4% cut for Medicare payments in 2014 unless Congress acts to avert it. Hear me out. With the federal government funded till Jan. 15 and no natural bill to attach a one-year SGR patch to, what mechanism is left for Congress to take action? (Pittman, 10/17).

The Wall Street Journal’s Washington Wire: Unions Warn Lawmakers On Budget Cuts
With the federal government back in operation, union officials wasted no time stating their demands for future congressional budget talks: no cuts to Social Security, Medicare or Medicaid benefits and repeal the across-the-board budget cuts known as sequestration (Trottman, 10/17).

Politico: Mitch McConnell Defends Deal, Slams Obamacare Tactics
Using a football analogy, McConnell said he got the ball on his own two-yard-line with a “shaky” offensive line and had to cut a last-ditch deal with Senate Majority Leader Harry Reid to end the crisis, no matter how unappealing to many in his party. Despite acting as a chief deal-maker in recent years during government crises, it was unclear the role McConnell would play until the final days of the bitter fight (Raju, 10/17).

The New York Times: From The Right, Despair, Anger And Disillusion
Many conservatives described a dispiriting gap between conservative ideals, which they believe inspire widespread agreement, and conservative tactics, which do not. The failure to stop the health care plan left Republicans like Ms. Naples pessimistic and disillusioned. "I’m just totally blown away by everything," she said. "I don’t know what’s right and what’s wrong anymore." Still, for many Wednesday night’s vote had to play out as it did, because there was no other alternative (Robertson, 10/17).

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Health Law Is Back In The Hot Seat

Now that lawmakers have an extension on pressing budget issues, they are refocusing attention on the health law's "rocky rollout." For instance, GOP leaders are pressing administration officials for answers about what's gone wrong with the federal online health insurance marketplace.

The Wall Street Journal: Attention Likely To Shift To Health Law
The end of Washington's budget showdown is likely to shift attention back to President Barack Obama's health law and its rocky rollout, news of which was sometimes submerged in the past 16 days of struggle. Both the government shutdown and the opening of new online health-insurance exchanges happened on the same day, Oct. 1. Republicans tried to defund Mr. Obama's law as part of a deal to reopen the government, but the law emerged virtually unscathed. The greater damage to the law, it turns out, has been self-inflicted: Officials and contractors charged with getting the federally run exchange up and running instead produced a problem-plagued website that has blocked many people from shopping for coverage. Even when people do sign up, private insurers have warned that the information they are getting about the enrollees may be flawed (Radnofsky and Weaver, 10/17).

Reuters: Republicans Press U.S. Officials Over Obamacare Snags
Republicans in Congress chastised President Barack Obama's top health adviser on Thursday for declining to testify before an oversight panel about problems in rolling out the president's signature healthcare program known as Obamacare. Less than a day after Congress ended a 16-day partial government shutdown precipitated by Republican demands to delay or defund Obamacare, they sent a letter to Health and Human Services Secretary Kathleen Sebelius demanding she make officials available for the October 24 hearing (Morgan, 10/17).

CNN: Congressional Fight Over Obamacare Turns To Website Woes
The deal ending the shutdown may not have put a dent in Obamacare, but the battle over implementing the health coverage law is not over. One venue that Republicans are turning to for leverage, starting next week: oversight hearings, beginning with some tough questions about why the rollout of the website for enrolling in health care exchanges is having so many problems. "The American people deserve to know what caused this mess," said Rep. Fred Upton, R-Michigan, chairman of the House Energy and Commerce Committee. "Delays and technical failures have reached epidemic proportions” (McConnell and Todd, 10/18).

Fox News: House Panel Questions Firms Paid $$ For Troubled Obamacare Website
A House committee is probing the widespread technical problems with the launch of the ObamaCare website, including the contractors that were paid hundreds of millions of dollars to create it. The House Energy and Commerce Committee announced Thursday they have scheduled a hearing on the issue for Oct. 24, and have asked Health and Human Services Secretary Kathleen Sebelius to attend. Committee member Rep. Leonard Lance, R-N.J., told Fox News' Greta Van Susteren Thursday night he wants Sebelius to testify at the hearing but she has not so far responded "favorably" to the proposition (10/18).

NPR: Despite Being Friends, Sen. Roberts Tries To Oust Sebelius
While Republicans failed to undo any part of Obamacare before reopening the government and lifting the debt ceiling, their detest for the program is unchanged. One manifestation is a quiet movement to oust Health and Human Service Secretary Kathleen Sebelius (Gonyea, 10/18).

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Health Reform

Tech Experts Say Total Overhaul Of Healthcare.Gov May Be Needed

Beyond consumers' problems using the federal website, insurers are getting flawed enrollment data from the few who manage to sign up for plans, the Wall Street Journal reports. Meanwhile, White House press secretary Jay Carney said that President Barack Obama was seeking "accountability" from those working to fix the glitches as tech experts suggest the site might have to be redesigned.

CNN: Logging Into Healthcare.gov Tough For Some Early Registrants
The Obamacare website, which launched October 1, deleted some users' passwords, according to multiple call center representatives for the site. Five call center agents told CNN on Wednesday that because of an upgrade to the beleaguered website, many passwords were deleted if they were created in the first week or so after the launch. More recently created user names and passwords don't seem to have the same problems (Cohen, 10/17).

The Wall Street Journal: Health Website Woes Widen As Insurers Get Wrong Data
Insurers say the federal health-care marketplace is generating flawed data that is straining their ability to handle even the trickle of enrollees who have gotten through so far, in a sign that technological problems extend further than the website traffic and software issues already identified (Weaver and Radnofsky, 10/17).

USA Today: Tech Experts: Health Exchange Site Needs Total Overhaul
The federal health care exchange was built using 10-year-old technology that may require constant fixes and updates for the next six months and the eventual overhaul of the entire system, technology experts told USA TODAY (Kennedy, 10/17).

Politico: Fed IT With Obamacare Not Deepest Pool
The lineup in the federal IT game doesn’t read like a list of tech-company all-stars — but the same names keep popping up on the roster when it comes to jobs like the ones at the heart of the troubled Obamacare rollout. The need for an experienced hand — combined with the rules necessary to protect the public interest — ensures a club-like environment for the companies vying for those contracts. The federal procurement machinery makes for a smaller bench of players. Forty-seven information technology companies have won contracts from Health and Human Services or the Treasury Department to manage, support or service the implementation of the Affordable Care Act, according to a Sunlight foundation analysis. Nearly all of them have a long and deep relationship with the federal government (Boliek, 10/17).

The Hill: Carney: Obama 'Not Happy' With ACA Rollout
White House press secretary Jay Carney said Thursday that President Obama was seeking "accountability" from federal employees working to fix glitches with the ObamaCare website designed to let uninsured Americans purchase coverage. Carney sidestepped questions about whether the administration would seek to recover any of the millions of dollars paid to contractors responsible for building the healthcare.gov website, which has been plagued by technical errors since its launch earlier this month (Sink, 10/17).

Politico: W.H. Obamacare Not Just A Website
President Barack Obama’s signature health care law is more than just a balky website and is proceeding with some success, White House press secretary Jay Carney said Thursday. "It’s important to remember the website alone is not the Affordable Care Act," Carney said. Obama, Carney said, is not happy about what the White House has termed "glitches" in healthcare.gov that have prevented an unknown number of people from registering for new health care plans. Carney said Obama didn’t include a discussion of the health care law during his Thursday speech about the end of the government shutdown and debt limit crisis because those remarks were about what Congress ought to do and healthcare implementation is an administration priority (Epstein, 10/17).

Philly.com: Sebelius Admits: Health Exchange Launch 'Rockier Than We Would Have Liked'
U.S. Health and Human Services Secretary Kathleen Sebelius admitted Wednesday that the troubled launch of the federal government's new health insurance exchange hasn't gone as planned. However, she said technicians were working to fix the glitches that have plagued the HealthCare.gov website, and improvements should be evident shortly to consumers, the Cincinnati Enquirer reported Wednesday (Pallarito, 10/17).

Reuters: 'Obamacare' Helpers Frustrated As Tech Problems Stall Enrollment
Community organizations and non-profit groups that were supposed to help millions of Americans sign up for "Obamacare" are trying to manage mounting frustration with a federal website hobbled by technical problems. Dozens of these groups, known as "navigators," received federal grants to guide consumers through the government's Healthcare.gov website serving 36 states, which is meant to help the uninsured determine their eligibility for tax credits toward buying private coverage under President Barack Obama's healthcare reform law, known as Obamacare (Skinner, 10/17).

Kaiser Health News: After 63 Tries, Reporter Creates Account On Federal Exchange
After 17 days and 63 attempts, I finally made it. I was able to create an account on the federal health insurance exchange at www.healthcare.gov – a task which has frustrated millions of Americans (Galewitz, 10/17).

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State Exchanges Report Sign-Up Successes

Although Healthcare.gov may be barely limping along, some state health insurance exchanges are completing applications and signing up thousands. News outlets also offer other developments related to the marketplaces in Kentucky, Connecticut, Oregon, California, Minnesota, Georgia and Maryland.

The Washington Post’s Wonk Blog: The Obama Administration Projected 500,000 Obamacare Sign-Ups This Month. Can That Still Happen?
We don't know, at this point, how many people have signed up for health insurance through HealthCare.gov. Because the site has been very difficult to use, the assumption is not many. One outside estimate pegs the number around 36,000. That's for 34 states that tend to have the highest uninsured rates. That's not so great. But that's not the story in Washington, where more than 25,000 applications for private insurance have been completed, and another 20,000 or so for Medicaid. And it’s not the case in New York, which has had 40,000 such applications come in. In Kentucky, Washington, Minnesota and a handful of other states running their own marketplaces, they've seen thousands signing up this month (Kliff, 10/17).

Modern Healthcare: Kentucky's Exchange Doing Well Despite Using Same Contractor As The Feds
Some observers have blamed the federal government's prime contractor, CGI Federal, for the severe glitches that have blocked many Americans from signing up for health coverage through the new federal online health plan marketplace. Several state-run insurance exchanges are using the same technology vendor in a supporting role that the federal government has used with such problematic results for the federal online marketplace, but with quite different results (Conn, 10/17).

The Associated Press: Conn. Health Exchange Attracting Older Enrollees
Connecticut’s new online insurance marketplace is getting a better picture of who is signing up for health coverage -- mostly middle-aged and older adults. In the most detailed briefing since enrollment began Oct. 1, Access Health CT’s Peter Van Loon expressed some concern that older people "have jumped on this in a big way," acknowledging that the marketplace has always wanted a mixed sampling of ages so the risk pool is balanced (Haigh, 10/18).

The Seattle Times: Obamacare: 'Great Start' Here, While Oregon Lags
To get a glimpse of how the 2-week-old health-insurance exchanges are faring under the Affordable Care Act, there may not be a better place to look than the Pacific Northwest and its striking contrasts. On the one hand, the Washington state-run exchange, called Washington Healthplanfinder, is widely perceived to be off to a strong start (Landa, 10/17).

The Oregonian: Cover Oregon: Health Exchange Workers Will Review Eligibility Manually Until Online Enrollment Is Fixed
On Tuesday, Cover Oregon staff began processing eligibility applications manually as a first step prior to helping people get enrolled in either a government program or the commercial insurance of their choice. The applications are a backup plan to what was intended to be the exchange's online enrollment function. Applications will now be considered by Cover Oregon employees, rather than its website, to determine if people qualify for the Oregon Health Plan, tax credits to reduce premiums, or other government assistance. The decision to have workers, not the website, process applications underlines that a fix to the website's enrollment problems may not be imminent (Budnick, 10/17).

California Healthline: Campaign Launched To Enroll Children, Families In Covered California
The Children's Partnership launched a statewide drive Wednesday to reach uninsured children and their families through schools, after-school programs and child care centers to provide information on the health care options available in Covered California and Medi-Cal under the Affordable Care Act." … The campaign is geared to let schools, after-school programs and child-care centers know that there is information and help available for them to work with students, families and even employees to let them know about health care options (Norberg, 10/17).

Minnesota Public Radio: Five MNsure Promises: Has The Agency Delivered?
State officials have said it will make shopping for health insurance easier, and for some people, provide less expensive insurance options. When the state's $100 million online insurance marketplace finally launched earlier this month, consumers found that while it shares some of the same components as those well-known websites, it lacks important features -- even though it was more than two years in the making. MPR News went back into the archives to find five of the biggest promises MNsure officials made about the future site before its launch -- and gauged whether they've delivered on them (Richert, 10/17).

The Star Tribune: MNsure Announces Recipients Of $4 Million In Grants
Officials with the state’s online health insurance exchange on Wednesday announced the final list of recipients for $4 million in federal outreach grants, ending a process that spawned a contentious public hearing before legislators and drew questions from Gov. Mark Dayton over its lack of inclusion of certain groups, including those who serve African-Americans and those with mental health concerns. In a meeting with the MNsure board, Executive Director April Todd-Malmlov defended the sweep of the recipients, saying the organizations have adequate reach across the state and across various hard-to-reach populations. About 55 percent of grantees serve minorities and immigrants -- with six groups serving African-Americans, six serving Hispanics, five working with American Indians, and four each working with Asian and/or Hmong populations and new immigrants (Crosby, 10/17).

Georgia Health News: Exchange Enrollment In Georgia Still Unknown
Technical problems have continued to block and frustrate consumers trying to enroll online on healthcare.gov. That’s the government portal, created by the Affordable Care Act, that offers coverage for people who are uninsured or have individual health policies. It took until Wednesday, in fact, before community health centers in Georgia were finally able to get their first consumer signed up for coverage via the website. The successful online enrollment, at a health center in Warrenton, took two hours, Cathy Bowden, information management coordinator for the Georgia Association for Primary Health Care, told GHN on Thursday. The community health centers have 14 people licensed as navigators across the state, with another 17 hoping to gain licensure soon (Miller, 10/17).

The Washington Post: Gansler's New Running Mate Knocks Brown For Problems With Maryland's Health Exchange
Health care is among the issues on which Brown has played a leading role in the administration of Gov. Martin O’Malley (D). Until recently, Maryland had been held up as a model for its implementation of the Affordable Care Act. But the Web site for Maryland's health exchange was plagued by glitches when it debuted this month, hindering the ability of people to sign up for coverage as part of Obama’s signature initiative (Wagner, 10/17).

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Medicaid 'Coverage Gap' Causing Anxiety In Non-Expansion States

In states that decide not to expand Medicaid under the health law, more than 5 million people may be left without coverage. Oregon's expansion has already lowered the number of people there without coverage. Exchange issues are also examined in Maryland, Florida, Ohio and Alabama.

Bloomberg: Push Against Obamacare Leaves 5 Million Without Coverage
Alabama, Louisiana, Mississippi and South Carolina will be particularly hard-hit, as those southern states will fail to provide coverage to at least one-third of uninsured adults, according to a report from the Kaiser Commission on Medicaid and the Uninsured. ... Once the [Supreme] court struck down the mandate to expand Medicaid, poor workers in states that elected not to broaden their programs had nowhere to turn, the commission said in its report. They don’t earn enough to get the tax credits and they aren’t poor enough to qualify for Medicaid under the current eligibility level (Cortez, 10/18).

The Oregonian: Oregon Cuts Tally Of People Lacking Health Insurance By 10 Percent In Two Weeks 
Though Oregon's health insurance exchange is not yet up and running, the number of uninsured is already dropping thanks to new fast-track enrollment for the Oregon Health Plan. The low-income, Medicaid-funded program has already signed up 56,000 new people, cutting the state's number of uninsured by 10 percent, according to Oregon Health Authority officials. Though the new exchange called Cover Oregon was originally intended to be used for Oregon Health Plan enrollment, the online marketplace doesn't work yet. Instead, new Oregon Health Plan members are being enrolled using a fast-track process that was approved by the federal government in August (Budnick, 10/17).

Miami Herald: After Saying No To Feds On Medicaid Expansion, Florida May Ask For More Money
Months after Florida lawmakers rejected $51 billion from the federal government to expand Medicaid, state officials are prepared to request billions in new federal aid for a different program to improve care for the poor, uninsured and under-insured. But this cash grab, for whatever reason, has yet to ignite a political furor. ... State officials want to grow Florida's Low Income Pool (LIP) program from $1 billion a year to possibly $3 billion a year (Mitchell, 10/17).

Columbus Dispatch: House Republicans May Sue Over Kasich's Medicaid Expansion
House Republicans are preparing to potentially sue GOP Gov. John Kasich over taking Medicaid expansion to the state Controlling Board, and they would base their lawsuit on the arguments laid out in a formal protest they filed yesterday. Thirty-nine GOP representatives signed a letter in protest of Kasich’s plan to ask the seven-member legislative-spending oversight panel on Monday to approve $2.56 billion in federal money over two years to cover about 275,000 more poor Ohioans under Medicaid (Siegel and Vardon, 10/17).

Al.com/Birmingham News: Medicaid Expansion Rejection Leaves Alabama's Largest City With "Patchwork" Safety Net Under Obamacare
Alabama's rejection of Medicaid expansion under Obamacare leaves Birmingham's low-income and uninsured adults with a weak safety net, according to a study out today. Little insurance regulation, a dominant insurer in Blue Cross and Blue Shield of Alabama and a dominating provider in the University of Alabama at Birmingham are all factors in the city's future under the Affordable Care Act, the study said (Oliver, 10/17).

In Wyoming, officials consider managed care as a way to cut costs in the Medicaid system - 

Casper Star-Tribune: Wyoming Eyes More Medicaid Changes
More changes may be in store for Wyoming Medicaid as lawmakers look to cut costs in one of the state’s most expensive programs. The state Department of Health is already redesigning its Medicaid eligibility system, as well as a program that pays for disability services. Now it’s exploring what could be the biggest modification yet: altering how it manages health care for the roughly 90,000 poor and medically needy people who use Medicaid annually (Wolfson, 10/17).

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GOP Loses A Battle Over Obamacare But Continues War

Media outlets report that conservatives aren't done fighting the health care law. Obamacare was always going to be a major issue in the 2014 midterm elections, and the disastrous launch of the online health insurance marketplaces is likely to play into conservative arguments that the Democrats overreached.

NPR: How The GOP's Shutdown Over Obamacare Fell Short
Remember how that fight over the budget was all about Obamacare? Seems like ancient history now, but House Republicans ostensibly shut down the government 17 days ago, demanding first a defunding, and, when that failed, a year's delay in the health law. When it became clear that President Obama and Senate Democrats weren't going to yield to demands to stop or slow implementation of the administration's signature legislative achievement, Republicans looked for smaller changes (Rovner, 10/17).

The Washington Post: Conservative Republicans Aren’t Done Fighting The New Health-Care Law
Fresh off an unsuccessful attempt to block the president’s sweeping Affordable Care Act, several conservative Republicans announced Thursday that they have decided on their next political target: the Affordable Care Act. The temporary resolution of the budget battle is likely to intensify, rather than lessen, public scrutiny of the health-care law, commonly known as Obamacare. Chronic problems with the online enrollment system — which have diminished but not disappeared since its Oct. 1 launch — were largely overshadowed by the 16-day fiscal standoff in Washington (Eilperin, 10/17).

Politico: Obamacare Wins? See You In 2014
Obamacare was always going to be a major issue in the mid-term elections, since so many of its major pieces — the new health coverage, the online marketplaces where the coverage is available, the expansion of Medicaid, and the hated individual mandate — become real in January. But now, Democrats will also have to talk about a federal health insurance website that barely anyone can use. Even White House spokesman Jay Carney was reduced to arguing Thursday that Obamacare isn’t just a website — after Obama has been saying it would be as easy as shopping for flat-screen TVs online. That’s why, even though Republicans have been damaged in the short term by the Obamacare fight they picked, there’s no reason to believe the Obama administration and Democrats will have an easy time in the months ahead, according to health care analysts and political strategists from both parties (Nather, 10/17).

Politico: Democratic Pollster: GOP Suffers From ACA Talk
Republicans’ high-stakes wagers over Obamacare are dramatically hurting them in the eyes of the public — that’s the message from Democrats just a day after the government shutdown ended with no major concessions on the health law. “Each time Republicans ratchet up their efforts to delay or defund the ACA instead of focusing on what should be their No. 1 priority — strengthening our economic recovery and creating jobs — they suffer,” Obama campaign pollster Joel Benenson wrote Thursday in a memo obtained by POLITICO. Approval of congressional Republicans is drastically low, Benenson says. An ABC/Washington Post poll conducted last week found that only 21 percent of people approve of Republicans on the Hill. A Pew poll last week found a 20 percent approval rating, the lowest ever recorded, according to Benenson (Haberkorn, 10/17).

Meanwhile, the Washington Post's fact checker examines some of Sen. Ted Cruz's arguments against the law --

The Washington Post’s The Fact Checker: Ted Cruz’s Claims On Obamacare Focus On Losers, Not Winners
In the wake of the defeat of his effort to derail the Affordable Care Act, a.k.a. Obamacare, Sen. Ted Cruz (R-Tex.) continues to make assertions about the law that have puzzled and concerned readers. But it’s hard to know where to begin, as he repeatedly uses language that sketches the law in apocalyptic terms, even though the law has barely begun to be implemented. So we will focus on a few key items (Kessler, 10/18).


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Health Care Marketplace

UnitedHealth Says Lower Medicare Advantage Payments Forced Smaller Profit

The news about UnitedHealth's profits forced the insurer's share prices lower.

Los Angeles Times: UnitedHealth's Shares Dip On Small Increase In Quarterly Profits
The Minnetonka, Minn., company said government funding cuts to Medicare Advantage plans were one drag during the quarter, but it said overall medical costs remained in check (Terhune, 10/17).

The Wall Street Journal: Tough Prognosis For Health Insurers
Health insurers got a first taste Thursday of the challenges awaiting them under the new federal health law, with UnitedHealth Group Inc. issuing a cautious outlook for 2014 due to funding cuts tied to the law. Under the health law, insurers like UnitedHealth and Humana Inc. will reap lower payments for additional services beyond the basic fee-for-service Medicare program (Martin, 10/17).

Reuters: UnitedHealth Sees Medicare Payment Shortfall, Shares Drop
UnitedHealth Group Inc on Thursday predicted a tough year in 2014 because of government funding cuts to its private Medicare business, dragging down its shares and those of its competitors. UnitedHealth Chief Executive Stephen Hemsley said that "underfunding" of Medicare Advantage plans for the elderly cannot be fully offset by the company's other healthcare business. UnitedHealth, the largest U.S. health insurer, has previously said that it plans to withdraw from some markets in 2014 because of these cuts (Humer, 10/17).

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HIPAA, Meant To Protect, Can Also Impede Information Sharing

The Wall Street Journal's Risk & Compliance Journal: HIPAA Impedes the Sharing of Medical Information
The Health Insurance Portability and Accountability Act was a well-intentioned law designed to protect patients from having their health information disseminated without their approval, but it also impedes the sharing of information among those with the same health afflictions (DiPietro, 10/17).

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State Watch

State Highlights: New Blue Cross Contracts For Pa. Health System

A selection of health policy stories from Indiana, New Hampshire, Pennsylvania and California.

The Associated Press: Report: 182,000 Low-Income Hoosiers Could Go Without Health Insurance
A new report that 182,000 low-income residents could go without health insurance is refocusing attention on whether Indiana will win an exception to expand Medicaid using the Healthy Indiana Plan. The Kaiser Family Foundation reported this week that 28 percent of the state's uninsured residents fall in that "gap" between Medicaid coverage and qualifying for subsidized insurance through the federal exchange. Nationally, the percentage is similar, but the number falling in that gap is more than 5 million (LoBianco, 10/17).

The Associated Press: Gaps Found In NH Insurance Enrollment Resources
As efforts get underway to insure New Hampshire residents under the new federal health care overhaul law, researchers say the demand for enrollment assistance likely exceeds available resources across much of the state's southern tier. The New Hampshire Health Plan, which currently runs the state's high-risk insurance pool, was approved this month to accept a $5 million federal grant for state-specific outreach and education about the law (Ramer, 10/17).

The Philadelphia Inquirer: Blue Cross, Jefferson Health Announce New Contracts
Independence Blue Cross and the Jefferson Health System on Thursday announced new two-year contracts for Thomas Jefferson University Hospitals and Main Line Health that include the potential for millions in incentive payments. The agreement with Jefferson means that IBC has 23 of 38 general adult hospitals in its network operating under incentive-laden contracts. Nearly $100 million in bonus payments from IBC are at stake for the hospitals and health systems next year (Brubaker, 10/18).

Los Angeles Times: A Journey From Mental Illness To Music And A Standing Ovation
With help from San Francisco’s Behavioral Health Court two years ago, [Kim] Knoble found herself not in prison -- where she was headed after committing a violent crime while off her medications -- but instead surrounded by a team of treatment specialists who have helped her thrive. The poised young woman, whose story was recently featured in The Times, told it in her own words Wednesday to an audience gathered at the St. Francis Yacht Club to celebrate the court’s 10-year anniversary (Romney, 10/17).

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Health Policy Research

Research Roundup: Less Savings Needed For Retirement Health Expenses

Each week, KHN compiles a selection of recently released health policy studies and briefs.

Employee Benefits Research Institute: Amount Of Savings Needed For Health Expenses For People Eligible For Medicare: More Rare Good News
Individuals should be concerned about saving for health insurance premiums and out-of-pocket expenses in retirement for a number of reasons. Medicare generally covers only about 60 percent of the cost of health care services for Medicare beneficiaries ages 65 and older, while out-of-pocket spending accounts for 12 percent. Furthermore, the percentage of private-sector establishments offering retiree health benefits has been falling, and where benefits are offered, they are becoming less generous. ... This report provides estimates for the savings needed to cover health insurance to supplement Medicare and out-ofpocket expenses for health care services in retirement. ... However, it should be noted that many individuals will need more than the amounts cited in this report because this analysis does not factor in the savings needed to cover long-term care expenses, nor does it take into account the fact that many individuals retire prior to becoming eligible for Medicare (Fronstin, Salisbury and VanDerhei, Oct. 2013).

Health Affairs: Biosimilars
The Affordable Care Act includes several provisions -- collectively referred to as the Biologics Price Competition and Innovation Act (BPCIA) -- which are designed to encourage competition in the market for biologic drugs. The term biologic refers to any therapeutic product derived from a biological source, including vaccines, antitoxins, blood products, proteins, and monoclonal antibodies. These drugs account for a substantial and an increasing share of the pharmaceutical market and a growing share of health systems costs. ... In February 2012 the FDA released draft guidance on this accelerated approval process, but to, date no biosimilar products have been reviewed or licensed in the United States. Numerous scientific, legal, and regulatory issues remain unresolved, and it is not yet clear how the biosimilar market will develop, nor if it will lead to substantially lower drug prices or better access to biologic drugs (Richardson, 10/10).

The Kaiser Family Foundation: Obamacare & You: If You Are A Woman . . .
As a woman, it is especially important for you to understand how the Affordable Care Act (ACA) will change healthcare in 2014. Your health care needs differ from men's and you are often the main healthcare decision maker for your family. Obamacare broadens the range of many services that are important to women that health plans now must cover, some without any co-pay. In addition, it expands access to coverage through Medicaid and the new state health marketplaces. Changes important to women include: no more pre-existing condition limits ..., equitable insurance pricing for men and women ... , preventive services ... , contraceptives (10/16).

The Urban Institute: Reaching And Enrolling The Uninsured: Early Efforts To Implement The Affordable Care Act
With open enrollment now underway, it appears that states and the federal government have taken many of the steps necessary to successfully promote insurance affordability programs, educate the public about new coverage options coming available under health care reform, and create new infrastructures for providing consumers with enrollment assistance. Following the playbook and lessons learned from previous expansions of coverage under Medicaid, CHIP, and other state coverage initiatives, policy-makers are launching multi-pronged campaigns that combine broad marketing with grass-roots outreach. Critically, they are equipping community-based outreach entities with the tools and training to also provide hands-on application assistance to consumers who need help navigating the enrollment process, typically building on existing networks of application assistors that have operated for years within Medicaid and CHIP programs. The most impressive efforts have involved diverse stakeholders from the beginning of the planning process, to gain their early input and buy-in, and to create long-term outreach partners that can help spread the word as expansions are implemented. What is striking, however, is that while state and federal policy-makers are both taking many of the right steps, they are doing so at very different levels of intensity. And these differences are likely to result in state-to-state variation in terms of the ultimate measure of success: consumer enrollment into coverage (Hill, Courtot and Wilkinson, 10/9).

JAMA Surgery: Relationship Between Asking An Older Adult About Falls And Surgical Outcomes
The purpose of this study was to evaluate the relationship of a history of falls to surgical outcomes in older adults undergoing major elective colorectal and cardiac operations. The specific aims were to compare outcomes of patients with and without a fall within the 6 months prior to their operation including 30-day morbidity, the need for discharge to an institutional care facility, and 30-day readmission. ... The main result was that having fallen in the 6 months prior to an operation was related to the occurrence of 1 or more postoperative complications, regardless of what procedure was performed. This finding is independent of advancing age in both groups. Having fallen was also associated with increased 30-day readmission and the need for discharge to an institutional care facility. In addition, a positive correlation between an increased number of falls and an increased number of complications existed for both the colorectal and cardiac groups. ... Given the high volume of surgical care provided for the elderly population, improving preoperative risk assessment for the older adult is becoming increasingly important. Incorporating geriatric-specific variables that reflect physiologic vulnerability of the older adult into large surgical outcomes data sets used to construct preoperative risk calculators has real potential to improve the accuracy of these tools at forecasting risk in older adults (Jones et al., 10/9).

AIDS And Behavior: Outcomes Of HIV-Infected Patients Receiving Care At Multiple Clinics
Receiving care at multiple clinics may compromise the therapeutic patient-provider alliance and adversely affect the treatment of people living with HIV. We evaluated 12,759 HIV-infected adults in Philadelphia, PA between 2008 and 2010 to determine the effects of using multiple clinics for primary HIV care. ... Overall, 986 patients (8%) received care at multiple clinics. The likelihood of attending multiple clinics was greater for younger patients, women, blacks, persons with public insurance, and for individuals in their first year of care. Adjusting for sociodemographic factors, patients receiving care at multiple clinics were less likely to use [antiretroviral therapy] ... and achieve HIV viral suppression ... than individuals using one clinic (Yehia, September 2013).

Here is a selection of news coverage of other recent research:

Medscape: Malpractice Premiums Drop For 6th Straight Year
Judging by 3 representative specialties, physicians in 2013 are once again experiencing relief on malpractice insurance premiums. Collective rates for obstetrician-gynecologists, internists, and general surgeons fell on average for the sixth straight year in 2013, according to an annual premium survey released this week by Medical Liability Monitor (MLM) (Loews, 10/10).

Medscape: Higher Nurse Staffing Levels May Mean Fewer CMS Penalties
More nurses mean lower odds of hospital readmission, and that translates into cost savings for hospitals as well as better patient care, a new study suggests. Since October 1, 2012, as part of the Patient Protection and Affordable Care Act, the Centers for Medicare & Medicaid Services (CMS) has been reducing payments to hospitals that report excessive 30-day readmission rates among Medicare patients for acute myocardial infarction, heart failure, or pneumonia, note Matthew D. McHugh, RN, PhD, JD, MPH, from the School of Nursing and the Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, and coauthors (MacReady, 10/10).

Reuters: Medicare Choices Tricky Even For Med Students, Doctors
Even doctors in training have trouble sifting through insurance options to pick the cheapest available plan, a new study shows…An economist at Massachusetts Institute of Technology and director of the Health Care Program at the National Bureau of Economic Research, Gruber was not involved in the new report (Doyle, 10/15).

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Editorials and Opinions

Viewpoints: Health Marketplace Already Has Eligibility Verification; Entitlement Fight Lies Ahead

Los Angeles Times: Tea Partiers Shut Down The Government, And All They Get Is A T-Shirt?
If I were an entrepreneur in Washington, I'd be racing to print a bunch of T-shirts that said, "My tea party Republican shut down the government, and all I got was this lousy income verification mandate." ... Critics of the law have asserted that the new federal and state exchanges will issue subsidies on an "honor system," with no verification of eligibility. That would invite large-scale fraud if it were true -- but it isn't. The government's goal is to verify eligibility automatically by checking various federal and state databases to determine an applicant's immigration status and income (Jon Healey, 10/17).

The New York Times: Common Interests, Not Confrontation
What should not happen is a proposal made by Mitch McConnell, the Senate minority leader, on Thursday to trade long-term cuts in entitlement programs for short-term increases in domestic spending. As the majority leader, Harry Reid, quickly made clear, entitlement changes can't be discussed until Republicans accept the need for tax increases. But that doesn't rule out finding areas of common ground in hammering out a 2014 budget (10/17). 

The Wall Street Journal: 'How Business Is Done In This Town'
The obvious trade is a down payment on entitlement reform. House Budget Chairman Paul Ryan has proposals at the ready, some of them from Mr. Obama's own budget. They include means-testing benefits for the affluent, raising the retirement age for Medicare, improving the inflation index for calculating Social Security, and changing the incentives for first-dollar coverage on Medigap policies. Far more needs to be done to address America's long-term entitlement problem, but these reforms are better than nothing. If Mr. Obama won't go even this far and still insists on a tax increase, Republicans should tell him to live with the sequester and call again after the 2014 election (10/17).

Politico: The Defunding Debacle
Now, the same defunders who argued that Obamacare would be unrepealable beginning Oct. 1 with the opening of the exchanges are vowing to fight on against the health care law — as they should. It will be a long fight, requiring not just passion and principle but also a little strategic wisdom (Rich Lowry, 10/18).

The Wall Street Journal: The Charge Of The Defund Brigade
The rollout of the ObamaCare exchanges has been a failure. Not "glitchy." Not "troubled." Failure. Had the GOP not been mired in shutdown headlines, had it spent 24/7 highlighting the enrollment disasters, the flood of premium hikes and canceled policies, the layoffs and cut hours, Health and Human Services Secretary Kathleen Sebelius might at this moment be facing forced resignation. ... Defund ObamaCare was the wrong fight, at the wrong time, facing impossible odds, and conducted by generals who lacked an endgame. Being right isn't always enough (Kimberley A. Strassel, 10/17).

The Wall Street Journal: We Won't Back Down On ObamaCare
Now that the government shutdown has ended and the president has preserved ObamaCare for the time being, it's worth explaining why my organization, the Heritage Foundation, and other conservatives chose this moment to fight—and why we will continue to fight. The reason is simple: to protect the American people from the harmful effects of this law (Jim DeMint, 10/17).

Philadelphia Inquirer: Andre And 116,500 Others In The Region Are Caught In PA’s Coverage Gap
When it comes to health coverage, 116,500 low-income adults in southeastern Pennsylvania, the vast majority of them working, are betwixt and between. Andre Butler, a banquet server, is one such uninsured Philadelphian, caught in Pennsylvania’s coverage gap. ... As part of his Healthy PA plan, Governor Corbett has proposed a way to provide affordable coverage for people like Andre, through commercial insurance plans offered on the Health Insurance Marketplace in Pennsylvania. ... The hospital community urges Governor Corbett to move as quickly as possible to finalize his plan and expand coverage (Curt Schroder, 10/15).

And on another issue -

Los Angeles Times: Anthem Policy On Propofol For Colonoscopies May Be Shortsighted
There is perhaps no better metaphor for the painful relationship between patients and our for-profit healthcare system than the fact that Anthem Blue Cross thinks you don't need anesthesia for a colonoscopy. It's not "medically necessary," the insurer says. Anyone who has experienced this most invasive of medical procedures might think otherwise (David Lazarus, 10/17). 

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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.