Daily Health Policy Report

Wednesday, October 2, 2013

Last updated: Wed, Oct 2

KHN Original Reporting & Guest Opinion

Health Reform

Administration News

Capitol Hill Watch

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Obamacare Marketplaces Open, Despite Technical Glitches And Government Shutdown

Kaiser Health News staff writers Jay Hancock, Phil Galewitz and Ankita Rao report: "Online marketplaces at the heart of the health law opened for business Tuesday, often haltingly, as a government shutdown loomed over a milestone in President Barack Obama’s signature domestic accomplishment" (Hancock, Galewitz and Rao, 10/1). Read the story.

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Obamacare Day One: A Tale Of Two States

Kaiser Health News staff writers Jenny Gold and Sarah Varney, working in collaboration with NPR, report: "'Keep calm and go live.' Those were the words on the backs of the t-shirts worn by workers at a bustling state health insurance call center in Rancho Cordova, California yesterday. But if the t-shirts urged calm, the mood was ecstatic and emotional among the architects and key backers who gathered to flip the switch on the Golden State’s new insurance marketplace" (Gold and Varney, 10/2). Read the story.

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Language, Knowledge Are Barriers For Immigrants Seeking Insurance In California

Kaiser Health News staff writer Anna Gorman reports: "Carrying Spanish-language brochures, outreach worker Sandra Pena walked around a crowded health clinic here early Tuesday morning. 'Have you heard of the program Obamacare?” Pena asked a group of patients. A few nodded. Others stared blankly. As enrollment began around the nation, the scene at this Wesley Health Center underscored one of the major challenges facing officials – overcoming the lack of awareness'" (Gorman, 10/1). Read the story.

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Three Things To Know Before Buying A Health Plan -- And Where To Find Them

Kaiser Health News staff writer Julie Appleby reports: "Consumers shopping for coverage in new online markets for health insurance will be able to see what plans are offered in their area, how much they will cost per month, what their annual deductibles  are and whether their families might qualify for federal subsidies or Medicaid. But they should consider at least three other factors before making their decisions, which may take a little effort to ferret out" (Appleby, 10/1). Read the story.

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Seven Things To Know About Signing Up For Obamacare

Kaiser Health News staff writer Phil Galewitz, working in collaboration with Cosmopolitan, reports: "If you've been unable to get insurance either because of a pre-existing illness or high costs, the Affordable Care Act opens up new options. Here are seven things you need to know" (Galewitz, 10/1). Read the story.

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Capsules: HHS Releases List Of Premium Rates For 36 States; Live Blog: Exchanges Launch, Government Shuts Down

Now on Kaiser Health News' blog, Jordan Rau posts the list from the Department of Health and Human Services of premium rates in 36 states: "The Department of Health and Human Services has posted premiums for more than 78,000 plans on its website. The data lists each plan by insurer and the plan name and the monthly premium rate for a child, a 27-year-old,a family with 30-year-old parents and two kids, a single-parent family with two 30-year-olds, and a 40-year-old couple without children" (Rau, 10/1).

Also on Capsules, yesterday was Oct. 1, which means that the online insurance marketplaces created by the Affordable Care Act launched. But it also means that the start of the new federal fiscal year was marked by a government shutdown. Kaiser Health News helped make sense of the day's developments on this live blog (Stapleton, 10/1). Check out what else is on Capsules.

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Political Cartoon: 'Red Letter Day?'

Kaiser Health News provides a fresh take on health policy developments with "Red Letter Day?" by Darrin Bell.

Here's today's health policy haiku:


What's the exchange rate?
The answer has to do with
site visits, not cash.

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

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Health Reform

Despite Snags, Online Insurance Marketplaces Open For Business

The technical glitches were complicated by the millions of people who visited the online health exchanges on Tuesday, their first day of operations. For instance, Health and Human Services officials reported that 2.8 million unique visitors had been to the federal website.

The New York Times: Opening Rush To Insurance Markets Runs Into Snags
Millions of Americans visited new online health insurance exchanges as enrollment opened on Tuesday, suggesting a broad national appetite for the affordable coverage that President Obama has promised with his health care law. But many people quickly encountered technological problems that prevented them from getting rates, comparing health plans or signing up (Goodnough, Pear and Perez-Pena, 10/1).

Kaiser Health News: Obamacare Marketplaces Open, Despite Technical Glitches And Government Shutdown
Online marketplaces at the heart of the health law opened for business Tuesday, often haltingly, as a government shutdown loomed over a milestone in President Barack Obama's signature domestic accomplishment (Hancock, Galewitz and Rao, 10/1).

The Washington Post: Obamacare Site Goes Live, With Some Glitches
Millions of Americans flooded government Web sites Tuesday to get a long-awaited look at insurance options available under the health law, but the high traffic contributed to widespread computer problems on what President Obama hailed as a historic day. HealthCare.gov, the federal Web marketplace serving more than 30 states, was jammed for most of the day, with people encountering error messages that froze their applications. In the states operating their own marketplaces, the experience was spotty. Maryland's site, Maryland Health Connection, was down for the morning and sluggish into the evening. Lesser problems were reported in Colorado, Washington, Hawaii and elsewhere (Somashekhar, Kliff and Svrluga, 10/1).

Los Angeles Times: Glitches, Delays Mar Rollout Of Online Health Insurance Marketplaces
New online insurance marketplaces created by President Obama's healthcare law got off to a bumpy start Tuesday, as a rush of consumers and a host of technical glitches slowed enrollment on the first day uninsured Americans could sign up for coverage. Several states running their own marketplaces — including Hawaii, Maryland, Minnesota and Washington — were forced to delay the rollout of their websites, even as other states reported that shoppers were signing up (Levey, 10/1).

Politico: Obamacare: Hurry Up And Wait
By mid-afternoon, the Department of Health and Human Services reported that 2.8 million unique visitors had been to the Website, though there were no statistics available for how many were actually able to enroll. Some users experienced long waiting periods, and others ran into impediments that likely had little to do with the volume of traffic. For example, the drop-down boxes on the federal Website weren't working for much of the day, preventing users from answering security questions and establishing accounts. But HHS, which cited figures of 81,000 consumers calling the department's toll-free number to sign up and another 60,000 requesting help through online chats, celebrated the fact that the health insurance marketplaces at the heart of Obamacare were in fact open for business Tuesday (Allen, 10/1).

The Associated Press: A Bumpy First Day For New Insurance Marketplaces
For millions of Americans trying to log in, the online insurance marketplaces created by the new health care law began with a stalled website, an error message or a menu that didn’t work. But the debut of the new insurance marketplaces might have been a victim of the law's own success. The initial sign-up day appeared to draw heavy interest that suggested pent-up demand for just the kind of coverage now being offered (Johnson, 10/2).

The Wall Street Journal: Health Exchanges Open, With Glitches
The health-insurance marketplaces at the center of President Barack Obama's health law saw a surge of consumer interest Tuesday that surprised even many of the law's backers. But the debut proved patchy, with few applicants actually able to buy coverage on clogged websites that were bedeviled with technological problems (Weaver, Martin and Radnofsky, 10/1).

The New York Times: As Insurance Marketplaces Make Debut, Questions Remain
Most predictions have been for a trickle of new customers at first, with polls showing that many Americans remain uncertain about the purpose of the exchanges and unconvinced that the law will help them. The exchanges are online markets where people can shop for health plans and see if they qualify for federal subsidies. Despite months of feverish preparation, few officials are sure the exchanges have overcome a range of problems that have plagued the system in many states, including with Spanish-language versions, subsidy calculators and programs to enroll small businesses (Perez-Pena, 10/1).

The Wall Street Journal: Health-Law Glitches Lead To Frustration, Resolve To Keep Trying
Americans who flocked Tuesday to shop for health insurance on the online marketplaces created under the federal health law were largely frustrated in their attempts. But many were undeterred and said they would be back. Kevin Burke, a 44-year-old New Jersey entrepreneur, logged onto an exchange website eager to find a plan for himself, his wife and two children that would be less expensive than the one they have now with Aetna Inc. … But high traffic and glitches on the website made it impossible to find what he needed, said Mr. Burke, who is starting an online business. "It's a total mess. I can't get any information. I'm no more knowledgeable now than I was yesterday," he said. Still, he said, "I'm going to keep trying" (Needleman and McWhirter, 10/1).

Politico: Obamacare's Day 2 Message: Forget Washington
If there's one message coming out of the White House about the Obamacare sign-up period, it's this: Forget Washington. While the nation's capital remains in shutdown mode, lost in a seemingly hopeless partisan clash over whether the rest of the government's operations and its creditworthiness should be held captive to the health care law, the administration's six-month window to "enroll America" enters Day Two on Wednesday (Allen, 10/2).

CQ HealthBeat: 'Focus And Fix' Must Be The Mantra At CMS, Say Brooking Analysts Who Set Up Part D
Coping with the glitches that crop up during the first open enrollment of the health care law exchanges is going to be a matter of focusing and fixing them — something the staff at the Centers for Medicare and Medicaid Services has the experience and determination to do, say top Bush administration officials who implemented the Medicare drug benefit (Reichard, 10/1).

NPR: Tech Problems Plague First Day Of Health Exchange Rollout
Many Americans got "please wait" messages Tuesday when they tried to start shopping for health coverage on the federal government's new health insurance website, healthcare.gov. A series of technological glitches, delays and crashes kept people from getting to several of the 16 state exchanges, too (Hu, 10/2).

Reuters: Web Traffic, Glitches Slow Obamacare Exchanges Launch
Technical glitches and heavy internet traffic slowed Tuesday's launch of new online insurance exchanges at the heart of President Barack Obama's healthcare reform, showcasing the challenge of covering millions of uninsured Americans. The opening itself represented a victory for Obama's signature domestic policy achievement after years of attack from Republican foes and delays in building the technology infrastructure to support sites in 50 U.S. states (Morgan and Humer, 10/1).

Reuters: 'The System Is Down': Obamacare Glitches Go Public, Reasons Unclear
Blank boxes where security questions are supposed to appear. Pleas to "be patient." Error messages galore. Notices that "the system is busy right now." Web pages timing out before they load. Garbled lines of text riddled with stray question marks. Technology experts and government officials were stumped about the reasons for the computer glitches plaguing the Obama administration's launch of new health insurance exchanges (Begley and Humer, 10/1).

PBS NewsHour: Opening Day Of Insurance Exchanges Overwhelmed By Online Rush
Americans eager to explore or sign up on the new online insurance exchanges were confronted with technical glitches due to the rush of traffic on the website. Judy Woodruff talks to Julie Rovner of NPR and Louise Radnofsky of The Wall Street Journal about who was shopping for health care coverage on day one of the program (Woodruff, 10/1).

McClatchy: On Opening Day For Obamacare, A Rocky Start
The problems didn’t come as a surprise. Health and Human Services Secretary Kathleen Sebelius warned on Monday that technical issues would arise in the marketplace rollouts. But the extent of the problems caught many by surprise and left agency officials forced to play defense. "This work represents more than three years of policy and operations coming together. This has never been done before and this is a historic moment," Chiquita Brooks-LaSure, deputy director of the federal Center for Consumer Information and Insurance Oversight, said in the telephone briefing. "If you look at what we have just experienced in the last 15 hours, the first that we have actually been open, we have seen more simultaneous users to our website than we have ever seen on Medicare.gov. We think that's a tremendous beginning to this program and we are off to a good start" (Pugh, 10/1).

Meanwhile, with the launch came more information about the plans that will be available -

Kaiser Health News: Capsules: HHS Releases List Of Premium Rates For 36 States
The Department of Health and Human Services has posted premiums for more than 78,000 plans on its website. The data lists each plan by insurer and the plan name and the monthly premium rate for a child, a 27-year-old,a family with 30-year-old parents and two kids, a single-parent family with two 30-year-olds, and a 40-year-old couple without children (Rau, 10/1).

The Associated Press: Florida's Cheapest Plan Under Health Overhaul Less Than $100 A Month For 27-year-old
The most expensive health insurance premiums for individuals in Florida in the new government-run online marketplace are in the Florida Keys, and the cheapest premiums are for a bare-bones plan offered in Broward County, according to federal data released late Tuesday (Schneider and Kennedy, 10/2).

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Traffic Reports: High Volume Causes Health Insurance Shoppers To Face Delays

Across the country, states reported computer problems and long wait times as consumers tried to check out the new insurance options available through the health law's online insurance marketplaces. At the same time, though, many states reported tallies of applications and hits that exceeded expectations.

Politico: Glitches And Recoveries: State Exchanges Run The Gamut
Despite the early troubles, a few states were quick to report the number of enrollment and consumer interactions throughout the day, showing consumers had been waiting for the rollout. Kentucky’s state-run exchange, known as Kynect, reported processing more than 1,000 applications by morning. Connecticut’s exchange, Access Health CT, said 18,000 people logged into its site, and dozens signed up on the first day. But right up to launch day, some insurers continued to report problems with the federal computer system’s ability to accurately produce plan premiums and to match those premiums with the subsidy a consumer might be eligible for. That’s essential. It’s what determines the price someone would pay for a particular plan (Millman and Norman, 10/2).

Los Angeles Times: Demand Is Strong As Obamacare Enrollment Starts In California
Kicking off a historic health care expansion, California's new insurance market stumbled out of the gate with computer glitches, long hold times and an online enrollment delay for small businesses. Still, many consumers rushed to get coverage Tuesday when enrollment opened nationwide as part of President Obama's Affordable Care Act. It was a rocky start for many government-run insurance exchanges across the country as computers froze and online enrollment was postponed for several hours. In California, officials nonetheless took heart at the stronger-than-expected response: about 5 million online hits and more than 17,000 calls (Terhune, Mason and Reston, 10/1).

The Sacramento Bee: Californians Fight Tech Troubles To Buy Health Insurance
Covered California Executive Director Peter Lee, whose state was the first to establish an exchange, characterized the commencement of the program as a historic marker for the nation that signals health care as a right, not a privilege. At a launch event in Rancho Cordova, with a countdown clock and celebratory music, Lee described the nascent health program as nimble, innovative, self-sustaining and reflective of the state’s diversity. “This is a day when for millions, dreams come true,” Lee said. “This is a day when people finally will have access to quality, affordable health care that cannot be denied and cannot be taken away.” Access wasn’t easy for everyone on Tuesday. A landing page on the Covered California website took several minutes to load. Clicking through to the next step brought additional delays (Cadelago, 10/1).

The New York Times: New York State Health Dept. Has Heavy Traffic On First Day
Like those in several other states, the Web site for New York State’s health exchange – nystateofhealth.ny.gov – was having difficulty Tuesday, the first day of enrollment, because of a crush of traffic. Visitors were walked through the familiar first steps of any online enrollment: Provide your name, your e-mail and a password, and retype some scrambled characters from the image provided (Hartocollis and Kaminer, 10/1).

The Wall Street Journal: New York Health Insurance Exchange Launches
Thousands of New Yorkers struggled Tuesday as they sought to use a balky new website that hosts the state's new health-insurance exchange, but officials pledged to fix the bugs and took heart that the site received unexpectedly high traffic on its first day. … The state's online marketplace, which opened for business as enrollment for insurance under the federal Affordable Care Act began around the U.S., was receiving upgrades to handle more traffic late Tuesday, Ms. Frescatore said. The website recorded more than 10 million hits, while about 9,000 people were able to shop. The site counts every hit, regardless of whether someone was able to get onto the site, a spokesman said (Dawsey, 10/1).

Pioneer Press: Minnesota’s Online Health Exchange Goes Live; Other States Having Problems
Minnesota successfully launched its online link to the federal Affordable Care Act on Tuesday afternoon, with initial numbers suggesting sizable interest in coverage that's available through the new health insurance exchange marketplace. Earlier in the day, the federal government and more than a dozen other states also launched new websites, with some shutting down for periods as they struggled to handle an influx of traffic (Snowbeck, 10/1).

Minnesota Public Radio: With A Few Glitches, MNsure Goes Live
The Minnesota system isn't without problems. MNsure officials say none of the network of groups chosen to help consumers will be certified to provide help until Wednesday at the earliest. Alycia Riedl, president of the MN Association of Health Underwriters, said members of her group have serious concerns about being able to help people use MNsure in the way they're used to - over the phone. Many brokers who have completed the MNsure training have yet to receive certification from MNsure to help consumers. Even when they are, it will be difficult for brokers to help clients unless they do it in person, Riedl said. That's because a quirk in the MNsure system won't allow a broker to set up an account for a client over the phone. "The MNsure website for individual consumers does not have functionality for an assister to help someone set up an account, guide them through the system, seeing what they see, helping them when they need it," Riedl said (Richert, 10/1).

The Star Tribune: MNsure Health Insurance Exchange Gets Off To A Halting Start
Within the first hour, more than 500 accounts were created, but MNsure officials couldn’t say whether anyone bought policies. A server that helped consumers set up accounts went down early on, which spawned griping on social media from some frustrated users. But MNsure executive director April Todd-Malmlov, who made the final keystrokes to launch the exchange, said it mostly handled the volume, which registered as many as 3,000 people at one time (Crosby and Olson, 10/2).

The Oregonian: Cover Oregon: New Health Exchange Swamped By 80,000 Online Visitors
More than 80,000 people visited Cover Oregon Tuesday as the new health exchange opened its online doors for consumers to comparison shop among insurance plans. But technical problems gummed up operations for many users seeking to enroll under new provisions of the 2010 Patient Protection and Affordable Care Act. And for now, state employees, not the automated website, will check eligibility for new income-based tax credits and other government assistance."This is day one," said Liz Baxter, chair of the Cover Oregon board of directors. "It is the beginning of a new venture. It is not the end point” (Budnick, 10/1).

The Arizona Republic: Health Markets Swamped On Day 1
Workers at Meritus, a newly created health-insurance cooperative, answered a study stream of calls and inquiries from potential customers. Like Blue Cross Blue Shield, Meritus also had trouble connecting with the federal marketplace, but the company worked to get information for its customers. Meritus CEO Kathleen Oestreich said one customer sought answers on behalf of his wife, who was on hold waiting for federal marketplace operators to answer her questions. Meritus sales representatives were able to relay information the couple needed via instant messaging. “We are trying to be a source of help for people with hands-on customer service and answering questions,” Oestreich said (Alltucker and Reinhart, 10/1).

The CT Mirror: Connecticut's Uninsured Begin Shopping For Obamacare Coverage
Access Health’s call center took 1,930 calls Tuesday. And 167 applications were processed -- 83 for private health insurance for customers who will get federal subsidies to lower their premium costs, and 84 for Medicaid coverage. The day wasn’t without glitches, although officials said they didn’t go beyond what was expected. Many people reported problems accessing the Access Health website early in the day. And Elly Banos, who tried to sign up during an afternoon enrollment fair hosted by Community Health Center Inc., hit a roadblock when she tried to create an account on the Access Health website. Instead of letting her proceed, the system froze, a problem that plagued the others trying to sign up at the enrollment fair. Still, Banos was heartened that she’d gotten started toward getting coverage. “At least I got my foot in the door,” she said (Becker, 10/1).

North Carolina Health News: Obamacare Rollout Bumpy, Busy In N.C.
More than three-and-a-half years after being passed into law, the Affordable Care Act finally allows consumers to sign up for health insurance (Hoban, 10/2).

The Denver Post: Colorado’s New Obamacare Exchange Web Site Experiences High Volume
Affordable Care Act reforms in Colorado hit a speed bump just hours after launch Tuesday, with a primary website telling consumers they couldn't create accounts because of overwhelming volume. Connect for Health Colorado officials said the glitch was fixed within hours and added they had anticipated worse computer problems than those that surfaced (Booth, 10/1).

Philly.com: Health Insurance Exchanges Open, Users Can’t Get In
As the much-anticipated new online insurance exchanges opened Tuesday, many users have had to wait longer than expected to sign up for health care due to heavy traffic on the federal website…For the other states that are running their own exchanges – such as Rhode Island, California and New Mexico – their websites experienced delays as well (Mennen, 10/1).

The Baltimore Sun: Maryland Health Insurance Exchange Stumbles Out Of The Gate
Bill Kammerzell of Annapolis hoped to enroll in an insurance plan under health reform first thing Tuesday morning but the state's website crashed. The state marketplace where the uninsured could start buying health plans began having problems immediately after its scheduled 8 a.m. launch. Delays continued all day with people still unable to get onto the site by early evening (Walker and Dance, 10/1).

The New York Times: Health Insurers Report High Volume Of Queries On Health Care Coverage
"We are up and running," said one health insurance company official on Tuesday, even as the Web sites for many of the state marketplaces, and for www.healthcare.gov, the source of information about the health plans being run by the federal government, seemed plagued by technical problems. Blue Cross Blue Shield of North Carolina reported that it was experiencing higher volumes of calls and online queries regarding coverage than usual, as well as more visits to its retail stores (Abelson, 10/1).

In related news -

The Wall Street Journal: Massachusetts Officials Try To Keep New Rules From Curbing Enrollment
As open enrollment for the U.S. health law kicks off nationwide, the state that helped inspire the law is trying to avoid a potential pitfall: watching its own coverage numbers slip. Massachusetts, where a 2006 law created a marketplace where uninsured people could shop for coverage, sometimes with state subsidies, estimates 97% of its 6.6 million residents have insurance. But because of different federal rules, roughly 150,000 people who got coverage through the state's exchange marketplace will have to re-enroll to avoid losing coverage next year, state officials said. Until now, their coverage automatically carried over (Kamp, 10/1).

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Figuring Out How To Shop Around On Health Exchanges

News outlets report on the efforts by states, navigators, organizations and others to help uninsured people find their way through the challenges of applying for health insurance on the new online marketplaces. In places ranging from Florida, Ohio and California to Pennsylvania, New York and Minnesota, there was a buzz surrounding outreach efforts, and sometimes frustration on the part of consumers attempting to find out about coverage.

The New York Times: For Many, Personal Service Is More Helpful Than Web Site
By 10:30 a.m. Eastern time, Mr. Flynn said he had tried to enter preliminary login information on (healthcare.gov) but was unable to submit it, apparently because of the volume of requests that the site was receiving from around the country. But working with Kyle Rouse, a "navigator" with the Health Federation of Philadelphia who was tasked with helping consumers, Mr. Flynn discovered that he would face maximum out-of-pocket expenses of $6,250 if he enrolled in a "bronze" level plan in the new marketplace. That would be significantly lower than the $10,000 he currently faces, in the first sign that the marketplace could offer him a better deal than the old system (Hudle, 10/1).

NPR: In Florida, Insurer And Nonprofits Work On Enrollment
Florida Gov. Rick Scott and other Republican leaders have worked to block the Affordable Care Act since it was first proposed. As Tuesday's opening of enrollment approached, Florida's Health Department said it wouldn't allow navigators and others to use its offices to educate and counsel people on the new law (Allen, 10/1).

The Washington Post: Computer Glitches Prevent Health Insurance Enrollment For D.C. Family
After going six months without health insurance, Mohammad Goni walked into Mary’s Center in Petworth ready to enroll his family for benefits on the opening day of health insurance exchanges under Obamacare. Goni took the day off from his work as a pizza cook, prepared to fill out applications and navigate bureaucracy at the federally funded health center with his wife, Razia, and their 10-month-old and 21-month-old children in tow (Bui, 10/1).

The Washington Post: As Obamacare Starts, Patients In Maryland Community Clinics Are Eager To Sign Up
The day Maryland’s health insurance exchange opened for business was Rebecca Wener’s first day of work. She sat down next to Maria Martinez on Tuesday in the waiting room of a Silver Spring clinic and started gently asking questions in Spanish. Do you have health insurance? Wener asked. No, replied Martinez, 44, of Rockville. She works two part-time jobs — in customer service at Balducci’s, a gourmet food store, and cleaning houses. Do you know that many new options are available to you under health reform? No, Martinez said. She knew that a law had been passed and that everyone had to have insurance, but not much more than that (Sun, 10/1).

The New York Times: Health Care Coverage Business Is Bustling At New York City Hospital
Ms. Munoz, a community relations manager, was helping to staff an informational booth outside the hospital on Tuesday as part of Montefiore’s extensive efforts at helping patients and other community members enroll in insurance under the new health care law (Thomas, 10/1).

The New York Times: In Ohio, Little Help For Consumers In Navigating Enrollment
The federally run health insurance exchange opened in Ohio on Tuesday, but the state had no certified "navigators" to help consumers find insurance plans on the first day of the Affordable Care Act marketplace. In addition to federal authorization and training, navigators here must also get approved by the Ohio Department of Insurance, the state regulatory agency that is monitoring the exchange. Chris Brock, a spokesman for the state insurance agency, confirmed Tuesday morning that none of the state’s navigator grant recipients, which received a total of more than $3 million to implement outreach programs and assist people through the sign up process, had been authorized by the state to fully begin their work (Yaccino, 10/1).

Los Angeles Time: Team Takes Health Care Plan To Ethnic Areas
As political forces collide in the nation's capital over the Affordable Health Care Act, a small army of workers fans across Southern California, going door-to-door and store-to-store in communities where some residents are so isolated that they know little about the healthcare reform or even how to plan for its arrival (Do, 10/1).

Los Angeles Times: Health Providers Fielding Few Questions On First Day For Obamacare
For all the fuss over Obamacare -- the president's plan to extend health coverage to about 30 million Americans -- Southern California health providers were fielding only a smattering of questions on Tuesday, the first day of enrollment. Officials at Covered California, the agency overseeing the state's health insurance exchange, have a goal of signing up more than 2 million people through next year, the most of any state (White, 10/1).

Los Angeles Times: In California, Some With Big Needs Have High Hopes For Obamacare
Health care coverage is an issue that weighs heavily on Alfred Luevano's family. Luevano, 35, of Boyle Heights came to the Healthcare Partners Medical Clinic on Atlantic Boulevard in Monterey Park for a medical checkup, but also wanted answers about Obamacare. The federal healthcare overhaul, after years of debate, officially opened enrollment on Tuesday in state health insurance exchanges, with California looking to play a lead role (White, 10/1).

The New York Times: Employees Without Health Care Coverage Looking To Exchanges
Ms. Graham was among a group of curious people at the Aurora Public Library, outside Denver, who stopped by a table set up by the Aurora Mental Health Center. It had stationed experts — known as "navigators" — there to tell people about the new health care coverage options available under the law. Ms. Graham said she had never heard anything about the exchange before walking into the library on Tuesday and she planned on checking with her employer to see if she was eligible (Frosch, 10/1).

Kaiser Health News: Obamacare Day One: A Tale Of Two States
"Keep calm and go live." Those were the words on the backs of the t-shirts worn by workers at a bustling state health insurance call center in Rancho Cordova, California yesterday. But if the t-shirts urged calm, the mood was ecstatic and emotional among the architects and key backers who gathered to flip the switch on the Golden State’s new insurance marketplace (Gold and Varney, 10/2).

Politico: Virginia Health Fair Unfazed By Obamacare Problems
The glitches and computer problems on Day One of Obamacare signup didn’t faze Gaylene Kanoyton. She anticipated them — so much so that she had already planned a second enrollment fair for Saturday in this Virginia town. “I expected it today,” Kanoyton said of the glitches. “I think it was more important that people actually come out and see what the process is, talk to someone face to face about the facts and see what their options are.” Kanoyton of Healthcare Marketing Outreach organized the signup event at a community sports center here. Certified application counselors like Sylvia Whitaker had hoped to get people enrolled in health coverage. Instead counselors sent people home clutching colorful bags loaded with health care information — and assurances that the health insurance exchange website will work, eventually (Cunningham, 10/1).

Kaiser Health News: Language, Knowledge Are Barriers For Immigrants Seeking Insurance In California
Carrying Spanish-language brochures, outreach worker Sandra Pena walked around a crowded health clinic here early Tuesday morning. 'Have you heard of the program Obamacare?' Pena asked a group of patients. A few nodded. Others stared blankly. As enrollment began around the nation, the scene at this Wesley Health Center underscored one of the major challenges facing officials – overcoming the lack of awareness (Gorman, 10/1).

The Milwaukee Journal Sentinel: Glitches, Shutdown Complicate Obamacare Exchange In State
The lack of information about the problems frustrated organizations that plan to help people through the complex process of signing up for coverage. "We have gotten zero communication from (Centers for Medicare and Medicaid Services)," said Sarah Bailey, a spokeswoman for Progressive Community Health Centers in Milwaukee of the federal agency overseeing the launch. Progressive, which operates two clinics in Milwaukee, had 27 patients scheduled to meet with three application counselors. An additional 24 people also asked for help. "We were not able to help anyone," Bailey said. The community health center has appointments scheduled for Wednesday and for the next several weeks. "We could be having these issues tomorrow," Bailey said, "and we don't know how to gauge that” (Boulton and Stein, 10/1).

Miami Herald: Obamacare Insurance Exchange Off To Rocky Start
George Sauvigné, a 61-year-old real estate agent from Miami Shores, waited almost three years for Tuesday to arrive — the day when government officials would unveil the centerpiece of the healthcare reform law known as the Affordable Care Act: online exchanges offering subsidized health insurance plans in every state (Armas, Green and Chang, 10/1).

The Baltimore Sun: Obamacare Rolls Out Anyway – Even In Western Maryland
It's a beautiful thing: Thousands of people in Western Maryland — that cradle of rural conservatism and fed-up secessionists who want to declare their independence as the country's 51st state — are now eligible for affordable health insurance under Obamacare. And 100 trained and certified Obamacare specialists are standing by at numerous locations in the five Western Maryland counties to help them enroll (Rodricks, 10/2).

The Texas Tribune: Marketplace Launches With High Expectations, Hiccups
Down in South Texas, health care providers are reporting an unusual problem with the federal marketplace: Many patients don’t have email addresses and, therefore, can’t sign up online. The Brownsville Community Health Center had 50 people show up on Tuesday ready to sign up for health coverage — many even brought pay stubs and income documentation — but not a single one of them had an email address (Aaronson, 10/1).

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Small Insurers Play Larger Role In Health Exchanges

Media outlets examine the rise of small insurers in the new online health insurance marketplaces, the expected increases in physician demand and the importance of enrolling young people to balance the costs of caring for those who are older and sicker.

Marketplace: The Rise Of The Small Insurer
L.A. Care is a health plan provider located on the 10th floor of a high rise in downtown Los Angeles. It only offers plans to low-income individuals through Medicare and Medicaid. But starting today, anyone can buy private insurance form L.A Care. They expect to sign up 20,000 new customers in the first month. And that's just in L.A. County. Howard Kahn, the CEO of L.A. Care expects an increase in annual revenue of $60-80 million from new customers. Nationwide, 7 million people are expected purchase health insurance through the state exchanges. And dozens of small companies are offering plans. More than a quarter of insurers are new to the private insurance market. So why would some of the nation's largest companies decide not to compete for these new customers? "The fear is that you will only get sick people," says Kahn. "And that doesn't work. The problem with the current market is they only let healthy people in. ... You want a blend" (Weinberg, 10/1).

CBS News: Obamacare Marketplaces Raise Data Security Concerns
As more health-related data is digitized, "the privacy violations are going to be incalculable," Jim Pyles, an expert in health law who co-founded the law firm Powers Pyles Sutter & Verville, told CBSNews.com. Health data breaches are far from just an Obamacare issue. Doctors, health administrators and their business associates already regularly handle personal information, like a patient's address, date of birth, Social Security number, prescription information and medical history. Since 2009 -- when the Health and Human Services Department started requiring reporting on data breaches -- about 27 million people have been impacted by major breaches of unencrypted health data (Condon, 10/2).

The Baltimore Sun: Getting Young People To Embrace Health Reform
Young people often criticized as whiny, entitled and irresponsible, may now have the most clout in one of the biggest overhauls of the country's health system ever. Enrollment in President Barack Obama's landmark health reform plan began this week and particular interest is being paid to the country's 19 million uninsured young people, who range in age 18 to 34 and are viewed as key to the legislation's success (Walker, 10/2).

The Fiscal Times: Why Divorce Attorneys Will Love Obamacare
Someone in the White House thinks marriage is a bad idea. Earlier this year, TFT showed that a high-earning couple, each with incomes of $400,000, would save about $27,000 annually if they divorced and filed their taxes separately. Now we learn that the Affordable Care Act, a.k.a. Obamacare, is dangling a similar fate in front of middle income earners (Leo, 10/2).

The Hill: Delay Of ObamaCare's Employer Mandate Draws Legal Challenge
The Obama administration broke the law when officials decided to delay a crucial provision of the president's signature healthcare law, according to a lawsuit filed Tuesday in federal court. The lawsuit, filed by the conservative group Judicial Watch on behalf of an orthodontist from Florida, seeks to block a one-year delay of the Affordable Care Act's (ACA) employer mandate (Goad, 10/1).

Fox News: Physicians Prepare To Deal With Increased Demand, Strain On Practices Under ObamaCare
As enrollment in ObamaCare begins, physicians throughout the country are preparing to deal with an influx of newly insured patients – as well as the increased financial demands this will place on their practices. While it will take a few years for doctors to fully determine how they will be affected by ObamaCare, some physicians are already anticipating the need to make major changes to the way they run their practices (Woerner, 10/1).

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Gov't Shutdown Takes Focus Off GOP's Obamacare Opportunity

Some say Republicans missed a political opportunity Tuesday to point at the difficulties Obamacare's new online exchanges were having because news of the government's shutdown dominated headlines. In the meantime, Ohio has become a political battleground for fights over the health law as the state is home to both Republican House Speaker John Boehner -- who is central to repeal efforts -- and Gov. John Kasich, whose support for the law's Medicaid expansion has him split from other conservatives.

Bloomberg: Obamacare Demand Signals Potential Success For Exchanges
Obamacare's opening day drew millions of consumers to the law's core insurance exchanges, offering supporters and investors confidence that if the websites can stay up and running, customers will follow. In New York, officials said their exchange had 2.5 million visitors in its first half hour. California reported as many as 16,000 hits a second. And U.S. officials recorded 2.8 million visitors to the federal website, healthcare.gov, even as it fought technical problems much of the day (Nussbaum, 10/2).

Politico: GOP Goes Off-Message On Obamacare
The Obamacare train wreck happened Tuesday -- and Republicans were chasing a different train. By walking into a government shutdown that's dominating the news coverage, some Republicans are realizing they blew their chance to shine a spotlight on all the website crashes and breakdowns that plagued the first day of Obamacare signup. There was plenty of material for the Republicans to work with. The federal health insurance exchange website gave users error messages, drop-down menus failed, and the system went down for a while on Tuesday morning. State exchange websites got snarled by heavy traffic and spat out error messages, too (Nather, 10/1).

The Associated Press/Washington Post: Leaders In Republican States Sit Idly As Residents Start Using New Health Insurance Exchanges
After three years of bashing President Barack Obama's health care overhaul, Republican governors were surprisingly mute on the first day consumers could shop for insurance policies through online marketplaces. But in the 36 mostly Republican states that left the operation of their exchanges to the federal government, consumer interest Tuesday was high, while Democrats and advocacy groups took the lead in promoting the latest provision of the law (10/2).

Politico Pro: Houston Clinic Struggles Through Obamacare Website Glitches
State Sen. Rodney Ellis, a Democrat from Houston who is a strong supporter of the law, pleaded with the public to have patience with the glitches. Speaking at a press conference with other Houston officials to mark the first day of enrollment Tuesday, he added that problems and political fights over big laws are normal. "If you went back and researched when Medicaid and Medicare both went into effect and the big political fights -- each one barely made it," he said. "There are always glitches starting up any program." When asked how long it should take for the federal government to get the sites up and running smoothly, he said only that it would take a "reasonable" amount of time (Haberkorn, 10/1). 

Politico Pro: Ohio: 'Ground Zero' For Nation's Obamacare Debate
Backers of Obamacare here are enraged that the national efforts to undermine the health law are being fueled by their own representatives -- from House Speaker John Boehner to prominent conservative Rep. Jim Jordan. "Ohio becomes ground zero in this battle because of Speaker Boehner and Congressman Jordan," said John O’Grady, the commissioner of Franklin County, which includes Columbus. "The speaker and the House of Representatives need to do what is in the best interest of the citizens of their districts, the people that they represent." But even a bullish pro-Obamacare event Tuesday morning veered slightly off plan when an enrollment demonstration had to be shelved due to the malfunctioning federal website (Cheney, 10/1).

Politico Pro: Launch Day In Ohio Underscores The Medicaid Gap
The last time there was a government shutdown, Ohio Gov. John Kasich, a Republican, was chair of the House Budget Committee. This time, he’s the governor of a swing state and he’s standing opposite Washington Republicans on one central issue: Obamacare’s massive Medicaid expansion. Kasich has aggressively pursued Medicaid expansion since early this year, and a top health aide told Politico that today's opening of Obamacare insurance exchanges exposes a coverage gap that leaves out the poor and adds fuel to the governor's case for expansion. The poorest don't qualify for subsidies in the new insurance exchanges -- and in states that don't expand, they don’t get Medicaid either (Cheney, 10/1).

And a close look at public opinion of the health law reveals people actually view it less negatively than often reported --

The New York Times: Closer Look At Polls Finds Views Of Health Law A Bit Less Negative
On opening day of the new federal and state health insurance exchanges, a deeper look at how Americans view the Affordable Care Act shows that public opinion is not as negative as has been reported. Although much polling has shown that more Americans disapprove of the 2010 health care law than approve, recent polling has shown that a slice of those who disapprove are critical of the law because it does not go far enough in changing the nation’s health care system (Kopicki, 10/1).

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New Ads, New Conservative Appeals For Obamacare Repeal

A conservative group and the National Republican Congressional Committee are aiming new ads at Democrats and Obamacare, urging the law's repeal via radio and other avenues. 

The Associated Press/Washington Post: Conservative Group Airing Ads Urging Democrats To Defund Obama's Health Care Law
A conservative group is airing television and radio ads urging Democrats to eliminate funding for President Barack Obama's health care law to resolve a government shutdown. The Senate Conservatives Fund accuses Senate Majority Leader Harry Reid of Nevada and fellow Democrats of "forcing a government shutdown" in order to allow the so-called Obamacare system to move forward. The ad buy is expected to be about $500,000 per week (10/1).

Politico: NRCC Targets Democrats On Obamacare
Under withering assault from the White House and congressional Democrats for their role in the government shutdown, House Republicans are hitting back. The National Republican Congressional Committee on Wednesday will begin airing 60-second radio ads hammering vulnerable House Democrats for refusing to defund Obamacare. It represents an effort to frame the shutdown narrative around the health care law, which polling shows remains unpopular among vast swaths of the public. Individual health care marketplaces began opening on Tuesday (Isenstadt, 10/1).

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Administration News

Obama Admonishes Republicans On 'Ideological Crusade'

Surrounded by beneficiaries of the federal health law, President Barack Obama blamed Republicans for the government shutdown, noting the law's insurance marketplaces had opened for business even as most of the federal government had shut down.

The New York Times: Obama Urges Republicans To Drop Health Law Fight
Flanked by new beneficiaries of his health law, President Obama on Tuesday publicly admonished Republicans in the House to "reopen the government" rather than continue to block federal spending to battle the three-year-old Affordable Care Act (Calmes, 10/1).

The Associated Press/Washington Post: Obama Blames Shutdown On House GOP's 'Ideological Crusade' Against Health Care Law
President Barack Obama says House Republicans have shut down the federal government over an "ideological crusade" against his health care law. Obama is speaking in the Rose Garden on the first day of the government shutdown. He says the longer the shutdown continues, the worse the impact will be (10/1).

Los Angeles Times: Obama: Amid Shutdown, Obamacare Is 'Open For Business'
President Obama on Tuesday blamed Republicans for the government shutdown, noting the "irony" that the health care program they were trying to kill is "open for business." "This shutdown isn't about spending or deficit or budgets," Obama said. "This shutdown is about rolling back our efforts to provide health insurance to folks who don’t have it. This, more than anything else, seems to be what the Republican Party stands for these days." The president's remarks came shortly after noon EDT in the Rose Garden, as the White House went into a partial shutdown along with the rest of the federal government (Parsons and Hennessey, 10/1).

Reuters: Obama Spotlights Health Care Launch As Republicans Try To Block It
President Barack Obama spotlighted the opening day of sign-up for his landmark health care program on Tuesday, noting that it is taking place although Republicans in the U.S. Congress have shut down the government because they oppose the law (Felsenthal, 10/1).

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Capitol Hill Watch

Neither Side Budging On Health Law As Gov’t Shutdown Continues

Neither Republicans nor Democrats appear ready to budge in the short-term to end a government shutdown and their impasse over funding for the health law. House Republicans are looking to pressure moderate Democrats in the Senate by sending the upper chamber a series of bills aimed at funding popular government services, but Republicans are beginning to feel the pressure building over who will get the blame for the shutdown.

The Wall Street Journal: Capital Digs In For Long Haul
President Barack Obama pointed the finger at House Republicans for their efforts to scale back or dismantle the 2010 health law, the Affordable Care Act. "They've shut down the government over an ideological crusade to deny affordable health insurance to millions of Americans," Mr. Obama said from the White House Rose Garden. House Speaker John Boehner (R., Ohio) pinned the blame on his adversaries, saying, "Senate Democrats today slammed the door on reopening the federal government by refusing to talk." House Republicans launched a new strategy aimed at increasing pressure on Senate Democrats to negotiate with them, only to see it fail in their own chamber Tuesday night. GOP leaders brought forward a series of short-term bills to finance small parts of the government, including veterans services and national parks, through Dec. 15 (Hook, Peterson and Lee, 10/1).

The Washington Post: Washington Braces For Prolonged Government Shutdown
Washington began bracing for a prolonged government shutdown on Tuesday, with House Republicans continuing to demand that the nation’s new health-care law be delayed or repealed and President Obama and the Democrats refusing to give in. There were signs on Capitol Hill that Republicans -- knowing that blame almost certainly will fall most heavily on them -- are beginning to look for ways to lift some of the pressure (Tumulty and Montgomery, 10/1).

Los Angeles Times: Republican Moderates Hold Key To Ending Government Shutdown
In the current battle, conservative Republicans have forced votes on issues they hoped would cause Democratic senators from Republican-majority states to break with Senate Majority Leader Harry Reid (D-Nevada). Democrats have hoped to divide suburban moderates such as Meehan from hard-line conservatives, who have repeatedly tried to tie money for government agencies to measures aimed at delaying or dismantling President Obama's health care law (Memoli and Mascaro, 10/1).

The New York Times: Conservatives Choose Between Budget And Health Law
Congressional Republicans have insisted on defunding, delaying or repealing the Affordable Care Act as a condition of keeping the government running. Congressional Democrats have refused to negotiate over the health care law, and much of the federal government has shut down (Lowery, 10/1).

Politico: House Conservatives Still Fighting On Obamacare
They've tried to defund, delay and eliminate portions of the president's health care law, and they're still not wavering. Instead, they are demanding that Senate Democrats and Majority Leader Harry Reid (D-Nev.) come to the negotiating table. But at the first post-shutdown meeting of House Republicans on Tuesday, conservatives ignored questions about a realistic way out of the current standoff (Gibson, 10/2).

The Wall Street Journal: Deep Divide Over Health Law Persists
Lurking behind the first government shutdown in 17 years are two starkly different views of how Americans see the health care law championed by President Barack Obama. In making the budget fight all about the law, popularly known as Obamacare, Republicans point to a program they say is broadly and consistently unpopular. Democrats see a program that Americans aren't quite sold on yet but believe should be given time to work -- and they note the health law is actually less unpopular now than the Medicare prescription-drug benefit was before it went into effect. Complicating the debate, recent polls provide ammunition to both sides. Surveys reveal an American people clearly ill at ease over the law, but also uncertain over its provisions and ambivalent about its eventual impact (King, 10/1).

In the meantime, some health care services are shuttered as a result of the shutdown --

Medpage Today: Shutdown Halts Some Health Care Operations
Several medical groups decried the effect Tuesday's shutdown will have on research programs, funding to children's hospitals, and some public health activities. Even though many activities of the Department Health and Human Services (HHS) don't rely on annual funding from Congress or are deemed essential to public safety, many health programs will be limited or temporarily shuttered during the government shutdown. The CDC will continue "minimal support" on public health activities such as outbreak investigations, processing of lab samples, and maintaining a 24/7 operations center, according to a contingency staffing plan released by HHS Monday. It will be unable to support its annual seasonal influenza program and outbreak detection and linking (Pittman, 10/1).

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State Watch

State Highlights: As Nation Implements Health Law, Mass. Eyes Lowering Costs

A selection of health policy stories from California and Massachusetts.

Los Angeles Times: L.A. Sues To Block Measure To Create L.A. Health Department
Los Angeles County filed suit Tuesday to remove from the ballot a measure that would strip the city of Los Angeles from the county health department's jurisdiction and require the city to create its own department. The suit argues that the ballot measure, set to appear before voters in June, is invalid because it seeks to take away administrative decision-making authority that is the purview of the county and the city, and that it is preempted by state law (Mehta, 10/1).

WBUR: As Nation Braces For Obamacare, Mass. Tackles Health Costs
In the midst of all this Obamacare angst and government shutdown, our fair state this week kicks off the Oscars of health wonkdom, aka, the Massachusetts Health Policy Commission’s Annual Health Care Cost Trends Hearing. It's a time for state health care officials and bureaucrats to conduct a little reality check with insurers, hospitals, businesses and consumers to ensure that everyone's making a good-faith effort to hold down medical costs. Stuart Altman, economist and professor of National Health Policy at Brandeis University and chair of the board of the Massachusetts Health Policy Commission, says the role of the commission is to keep all of the players involved in the health system accountable and sharply focused on driving down costs while improving quality (Zimmerman, 10/1).

California Healthline: Tech Leaders Target The Underserved
At Monday's opening session of the annual Health 2.0 Conference -- a health information technology meeting held this year in Santa Clara -- experts in the field said technology can be used to address some of the health disparities in California and to reach the state's underserved populations. "There are strong predictors of limited access to health care," said Urmimala Sarkar, a UC-San Francisco resident physician and researcher, "and those are exactly the same factors that produce health disparities." Lower income, geographic isolation, cultural differences and language barriers all contribute both to a decline in the quality of health care and access to it, she said (10/1).

Healthy Cal: A Long Road to Restoring Medi-Cal Dental Benefits
While Denti-Cal reinstatement is good news for patients, community clinics and federally funded health centers, there is a long road to restoring dental care to low-income people. One of those is the Aug. 14 announcement by the California Department of Health Care Services (DHCS) that it will begin implementing a provision of AB 97, passed in 2011, requiring a 10 percent reduction in Medi-Cal provider payments. The California Medical Association (CMA) and others filed a lawsuit to stop the cuts and a district court ruled in favor of CMA. But the 9th Circuit Court of Appeals reversed that. Dental providers will see those cuts start on Sept. 5 of this year. And the cuts will be retroactive to June 1, 2011. These cuts may make it difficult to find a dentist that accepts Medi-Cal, especially when 1.4 million more people will qualify for the coverage starting in January, when health care reforms kick in (Graebner, 10/1).

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Editorials and Opinions

Opinions On Shutdown: Boehner Says Dems Have 'Slammed The Door;' GOP Effort To Derail Law Takes Democracy 'Hostage'

The impasse in Washington sparked many opinions.

USA Today: John Boehner: Obama Owns This Shutdown Now
The president isn't telling the whole story when it comes to the government shutdown. The fact is that Washington Democrats have slammed the door on reopening the government by refusing to engage in bipartisan talks. And, as stories across the country highlight the devastating impact of Obamacare on families and small businesses, they continue to reject our calls for fairness for all Americans (House Speaker John Boehner, R-Ohio, 10/2).

USA Today: The Shutdown Party: Our View
This shutdown, the first in 17 years, isn't the result of two parties acting equally irresponsibly. It is the product of an increasingly radicalized Republican Party, controlled by a disaffected base that demands legislative hostage-taking in an effort to get what it has not been able to attain by the usual means: winning elections. ... More immediately, the party needs to get out of the hole it is digging for itself and the nation. That will require Boehner to allow the House to vote on a bill to fund the government without any Obamacare amendments. Such a measure would likely pass with votes from Democrats and pragmatic Republicans, ending the shutdown and leaving Obamacare to succeed or fail on its own (10/1).  

The New York Times: John Boehner's Shutdown
By Tuesday morning, the leadership failure of Speaker John Boehner was complete. In encouraging the impossible quest of House Republicans to dismantle health care reform, he pushed the country into a government shutdown that will now begin to take a grievous economic toll. ... He stood in the well of the House and repeated the tired falsehood that the Affordable Care Act was killing jobs. He came up with a series of increasingly ridiculous demands: defund the health law, delay it for a year, stop its requirement that employers pay for contraception, block the medical device tax, delay the individual mandate for a year, strip Congressional employees of their health subsidies. All were instantly rejected by the Senate (10/1).

The New York Times: Our Democracy Is At Stake
This time is different. What is at stake in this government shutdown forced by a radical Tea Party minority is nothing less than the principle upon which our democracy is based: majority rule. President Obama must not give in to this hostage taking — not just because Obamacare is at stake, but because the future of how we govern ourselves is at stake (Thomas Friedman, 10/1).

Bloomberg: The Republicans' Ideological Shutdown
Republicans lost the legislative battle against Obamacare in Congress in 2010, then lost the political battle when President Barack Obama was re-elected in 2012 (along with a Democratic majority in the Senate). Like Medicare and Social Security before it, Obamacare is offensive to some conservatives on principle and to others on political grounds. The law’s conservative origins aside, that’s hardly surprising: Obamacare intrudes on the health-care and insurance markets and creates new bureaucracies to boot. If successful, it may also, as some Republicans fear, create new Democratic voters. Yet Republicans have never grappled honestly with the law, resorting to hyperbolic denunciations without ever offering a viable alternative for public consideration. When the House majority leader calls a law to extend health insurance an "atrocity," it’s hard to ignore the signs of panic (10/1).

The Wall Street Journal: A GOP Shutdown Strategy
Our advice is to give up on the impossible task of defunding or delaying ObamaCare at the current moment and focus instead on a quick if smaller policy victory. The House has already voted for three specific policies that might be achievable if they became the GOP's main political focus. The biggest potential victory would be a delay in the individual mandate to buy insurance, matching Mr. Obama's own unilateral delay of the business mandate to provide insurance to employees. The White House would resist, but Senate Democrats would have to explain why they favor business over individuals (10/1).

The Wall Street Journal: Behind The Noise, Entitlement Reform
It would be nice if today's fight were genuinely about the future, about long-term spending. Oh wait, that's exactly what the ObamaCare fight is about. By trying to stop a brand new entitlement before it gets started, in a country already palpably and indisputably committed to more entitlement spending than it wants to pay for, those radical House Republicans aren't trying to chop current spending amid a sluggish recovery (however much one begins to doubt that pump-priming from Washington is the solution the economy needs)(Holman W. Jenkins Jr., 10/1).

The Wall Street Journal: Budget Brawl
GOP leaders haven't given up hope for a quick resolution that will allow them to quickly re-open federal agencies and save face. The top plan to move forward is to pass the continuing resolution with only one condition: eliminate the Washington exemption that allows Congress and their staffers to opt out of ObamaCare. This is the so-called Vitter amendment, named after Louisiana Senator David Vitter. Many Republicans like this fallback plan because it would be extremely difficult for Senate Democrats to turn down (Stephen Moore, 10/1).

The Washington Post: Shutdown Crisis Ignores The Real Problems
That the fixation with Obamacare has now led to a government "shutdown" is bad policy and politics. For all its flaws, Obamacare was duly passed by Congress, upheld by the Supreme Court and (indirectly) affirmed by the 2012 election. Government cannot function if determined minorities threaten to stop many of its operations every time they lose a major vote. ... And, paradoxically, Obamacare's public image might actually benefit. Without a shutdown, Obamacare's critics could blame its start-up problems on the program's inherent flaws. Now, its defenders will claim that the program is being sabotaged by Republicans (Robert J. Samuelson, 10/1).

The Washington Post: House Republicans Are Failing Americans In Their Effort To Kill Obamacare
On many of the issues stalemating Washington, we find plenty of blame to go around. We've criticized President Obama's reluctance to pursue entitlement reform. The last time the country reached the debt ceiling, we urged both sides to compromise on revenue and spending in the interest of long-term fiscal soundness. This time, fiscal responsibility isn't even a topic. Instead, Republicans have shut much of the government in what they had to know was a doomed effort to derail the Affordable Care Act (10/1).

The Washington Post: Shutdown, Schmutdown
The shutdown, which I predict will be resolved relatively quickly to permit bragging rights for all, was really a prelude to the fight over the debt ceiling, which has to be raised by Oct. 17 or the U.S. government reneges on its debts. (Simple solution to the shutdown: The Senate repeals the medical-device tax in Obamacare; the House replaces lost revenue in a separate funding bill, not the continuing resolution; the president signs a clean resolution, federal employees return to work, and everybody says, "Yay.") (Kathleen Parker, 10/1).

The Washington Post: In D.C., Compromise Is A Dirty Word (And Should Be)
Democrats did offer to keep the government running for the next six weeks at current spending levels, which is a minor concession. But their refusal to consider any deal with Republicans that involves weakening Obamacare is good news, because doing so would make the already intolerable situation in Washington worse. Compromise is usually a happy notion, but in this instance it would invite more chaos. If Democrats agree to weaken health-care reform, they will have proved that all it takes to change an existing law is for a minority of lawmakers in one chamber to threaten a rebellion against their own party’s leadership (Dana Milbank, 10/1).

The Washington Post: Painted Into A Corner: What Now?
Meanwhile, the crowd that started this confrontation seems to have come full circle. If you can believe it, Sen. Mike Lee (R-Utah) now lectures Congress not to hold the government hostage. No, really: Lee, who has said he hopes the current shutdown will be short, said the House has tried three different approaches to funding the government — all of which changed or delayed the health care reform law — and the Senate rejected them, so it's time to try a new strategy. "In light of that, let's leave Obamacare for another day and not hold hostage the vast majority of government functions," Lee said (Jennifer Rubin, 10/1).

Los Angeles Times: Who Wants To Fix Obamacare?
The GOP's clear objective is to dismantle the act, not to improve it — and the single-minded focus on that goal is what has led to the partial government shutdown that began Tuesday. Democrats can hardly be blamed for refusing to bargain over how to sabotage the law before it fully takes effect (10/2).

Los Angeles Times: Government Shutdown: A Way Out For The GOP
[This] might be a good time for House Republicans to look for a dignified exit from the corner they've painted themselves into. Indeed, that's what an increasing number of relatively moderate conservatives in the GOP caucus have started saying. On Tuesday, Rep. Scott Rigell (R-Va.) broke with the leadership, saying he still wanted to repeal Obamacare but that it was time to reopen the government and move on. Before that, it was Rep. Devin Nunes (R-Tulare), who said his colleagues were behaving like "lemmings with suicide vests." ... Boehner's proposal that the House and Senate meet in a conference to iron out their differences might provide the pathway to an agreement (Doyle McManus, 10/2).

USA Today: When Shutdown Ends Is Up To You
The common assumptions heading into the federal government shutdown beginning early Tuesday was that 1) there would be a last-minute deal to prevent it from happening and that 2) if there were no deal, Washington would shut down for a very short time. The first of these assumptions has already proved to be wrong, and the second is about to be shown to be just as incorrect. Instead of hours off the grid, the federal government is likely to be shut for at least a week (Stan Collender, 10/1).

Detroit Free Press: Government Shutdown Is About More Than Health Care
The government shutdown is an annoying failure of democratic governance, wrought by a minority faction’s inability to accept reality. Health care reform was passed and signed like any other law. It has withstood 41 revotes initiated by the party that opposes it (Stephen Henderson, 10/1).

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Viewpoints: Obamacare Marketplaces' 'First-Day Jitters'; The Need For Healthy Young Adults To Enroll

Los Angeles Times: Obamacare Suffers First-Day Jitters As The GOP Pushes For Delay
The insurance-buying exchanges created by the 2010 health care law stumbled out of the gate Tuesday, or at least their websites did. In California, online sign-up pages loaded haltingly or not at all throughout the day. The problems weren't severe enough to stop determined applicants, as long as they didn't mind having their patience tested. But they were a sign that the system wasn't ready to handle the volume of inquiries it received on Day One (Jon Healey, 10/1).

Bloomberg: Will The 'Young Invincibles' Join Obamacare
It’s no exaggeration to say that if young people don't show up to the insurance exchanges in the next few months, the Affordable Care Act probably won't survive. Young, healthy people paying more than they have previously -- either because they are buying more expensive insurance or because they are buying insurance for the first time -- are the financing mechanism that makes Obamacare's insurance markets work. The administration estimates that a little over a third of the people on the exchanges need to be in the 18-to-35 range to hold premiums down to reasonable levels (Megan McArdle, 10/1).

Bloomberg: NRA Has Some Good Ideas For Stopping Massacres
Gun-control advocates think the only way to keep guns out of the hands of people who shouldn’t have them is to make it harder for everybody to get them. They should listen to some of the things National Rifle Association Executive Vice President Wayne LaPierre, their biggest nemesis, has been saying. ... Here’s what he said on NBC’s "Meet the Press" a week after a contractor -- who had a security clearance despite clear signs of mental distress -- shot and killed a dozen people at the Washington Navy Yard on Sept. 16: "We have a mental health system in this country that has completely and totally collapsed. We have no national database of these lunatics" (Craig R. Whitney, 10/1).

Los Angeles Times: Abortion And GOP Political Spouses
Anita Perry, wife of the super-duper pro-lifer Texas Gov. Rick Perry, who just signed into law very stringent abortion regulations, let it slip over the weekend that she regards abortion as "a woman’s right." ... Did Anita Perry truly let this comment slip? Or was it a calculated move to steal some Panhandle thunder from Wendy Davis, the Texas Democrat who filibustered to stop that abortion law, and walked her pink sneakers right into a national spotlight — and a possible run for governor? The list of Republican first spouses who have — sometimes softly and then more vocally, and rarely when their husbands are actually in power — opposed their husbands' anti-abortion policies is a substantial one (Patt Morrison, 10/1).

MinnPost: GOP 'Conscience Clause' Ignores Breadth Of Women’s Health Needs
At one point during the past few days, the Republican-controlled House of Representatives included a so-called "conscience clause" in its funding resolution to keep the federal government running. The clause would have given employers and insurers permission to opt out of providing any health-care services — most notably, prescription contraception coverage to women — that they personally object to for moral or religious reasons (Susan Perry, 10/1).

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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.