Daily Health Policy Report

Monday, October 21, 2013

Last updated: Mon, Oct 21

KHN Original Reporting & Guest Opinion

Health Reform

Administration News

Capitol Hill Watch

Health Spending And Fiscal Battles

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Thousands Of Consumers Get Insurance Cancellation Notices Due To Health Law Changes

Kaiser Health News writers Anna Gorman and Julie Appleby report: "Health plans are sending hundreds of thousands of cancellation letters to people who buy their own coverage, frustrating some consumers who want to keep what they have and forcing others to buy more costly policies" (Gorman and Appleby, 10/21). Read the story.

This Story: Print | Link to | Top

A Tale Of Two State Exchanges

The Seattle Times' Amy Snow Landa, working in partnership with Kaiser Health News, reports: "To get a glimpse of how the two-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. … Compare that to Oregon, where state officials acknowledge not a single resident has been able to enroll through the website of that state's exchange, called Cover Oregon, because the site still is not fully functioning" (Landa, 10/18). Read the story.

This Story: Print | Link to | Top

Affordable Care Act Brings More Money, More Stress To Illinois Clinics

The Chicago Tribune, working in partnership with Kaiser Health News, reports: "As political debate continues to rage over President Barack Obama's signature health careoverhaul, the law already is reshaping health care in the most troubled communities in Chicago and its suburbs. Since 2010, Illinois health clinics have received more than $50 million in development grants under the Affordable Care Act to build new facilities, expand operations, modernize equipment and improve the overall quality of care for the state's poor and uninsured" (Hood, 10/18). Read the story.

This Story: Print | Link to | Top

Texas Doctors, Hospitals Don't Know If They're In Or Out Of Obamacare Plans

The Texas Tribune's Becca Aaronson, working in partnership with Kaiser Health News, reports: "As consumers weigh coverage options available in the newly launched federal health insurance marketplace, three of the largest medical associations in Texas have raised concerns about the uncertainty of provider networks offered by health plans in the marketplace" (Aaronson, 10/21). Read the story.

This Story: Print | Link to | Top

Political Cartoon: 'Call Of Duty?'

Kaiser Health News provides a fresh take on health policy developments with "Call Of Duty?: by Joe Heller.

Here's today's health policy haiku: 

DEPLOYING HEALTH EXCHANGE REINFORCEMENTS

Surge? Again, the buzz...
This time it's about techies.
Can they make it work?
-Anonymous

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

This Story: Print | Link to | Top

Health Reform

'Tech Surge' Mounted To Fix Healthcare.gov

The Obama administration promised Sunday to enlist experts both inside and outside the government to solve the problems that have crippled healthcare.gov and caused consumers frustration as they attempt to shop for coverage. But some federal contractors worry the system may be weeks away from operating smoothly.

The New York Times: Contractors See Weeks Of Work On Health Site
Federal contractors have identified most of the main problems crippling President Obama's online health insurance marketplace, but the administration has been slow to issue orders for fixing those flaws, and some contractors worry that the system may be weeks away from operating smoothly, people close to the project say (LaFraniere, Austen and Pear, 10/20).

The Washington Post: HealthCare.gov's Glitches Prompt Obama To Call In More Computer Experts
The Obama administration said Sunday that it has enlisted additional computer experts from across the government and from private companies to help rewrite computer code and make other improvements to the online health insurance marketplace, which has been plagued by technical defects that have stymied many consumers since it opened nearly three weeks ago. This expanded team has come up with new ways of monitoring which parts of the federal Web site, HealthCare.gov, are having problems and has been taking the site offline for rigorous overnight tests, according to a Department of Health and Human Services spokesman (Goldstein, 10/20).

The Wall Street Journal's Washington Wire: 'Tech Surge' Planned To Fix Obamacare Exchanges
The Department of Health and Human Services said Sunday it was bringing in outside help to resolve some of the technical woes that have beset the federally run insurance exchanges, which the agency acknowledged "has not lived up to the expectations of the American people" (Radnofsky, 10/20).

Politico: Tech 'Surge' To Tackle Obamacare Websites
The Health and Human Services statement didn't explain everything that's wrong, or give technical details about the repairs underway. It outlined some steps being taken to fix the site, including updates with "new code that includes bug fixes." The department also says it's installing monitors to catch parts of the website that are proving the most troublesome for consumers. And it also said it had seen some improvements in wait times and consumer access to the website, the online portal to health insurance exchanges or marketplaces the federal government is running in 36 states (Millman, 10/20).

Politico: HHS Makes Changes To Obamacare Home Page
Health and Human Services officials announced Sunday that consumer-friendly changes have been made to the homepage of the troubled Obamacare enrollment website. The changes to the homepage aim to relieve some user frustration — but it isn't a wider fix to the buggy and crash-plagued signup system (Kenen, 10/20).

USA Today: HHS 'Committed To Doing Better' On Insurance Exchanges
Signaling a shift in tone in acknowledging problems with the launch of the Affordable Care Act website, the government posted a blog Sunday taking responsibility for issues millions of Americans have had trying to sign up for health insurance (Kennedy, 10/20).

NBC News: Damage Control: Administration Pledges Obamacare Enrollment Fixes
As the Obama administration scrambles to rectify the rocky rollout of the online health care marketplace, the Health Department said Sunday that it has enlisted the "best and brightest" to help fix the website's torrent of technical glitches and bugs as the president prepares to address the problems at the White House on Monday. "Our team is bringing in some of the best and brightest from both inside and outside government to scrub in with the team and help improve HealthCare.gov," the Department of Health and Human Services said in a blog post published Sunday. The blog post also says technology officials have been working "around the clock" to ensure that individuals can create accounts and apply for health care coverage without any digital roadblocks (Welker and Arkin, 10/20).

CBS News: Outside Help Called In To Fix Obamacare Website
The Obama administration has called in additional help from inside and outside the government to fix glitches that have plagued the Obamacare website. Critics say the issues reveal that Obamacare is a bad idea, while the White House says half a million people have successfully enrolled (Pegues, 10/20).

Bloomberg: Obamacare Hustles To End Delays As Deadline Talk Grows
The Obama administration said it has reached out to the "best and brightest" from inside and outside of government to get its health-insurance exchange up to speed, even as it faces another missed deadline for the rollout. The promised debut this week of a Spanish-language version of its website is uncertain after an administration spokeswoman said no date had yet been set for it (Wayne, Armstrong and Nussbaum, 10/21).

The Fiscal Times: Can An Army Of Private Programmers Fix Obamacare?
The Congressional Budget Office established two simple benchmarks for Obamacare to meet in its projections last February: 1) 7 million Americans would receive private insurance through the exchanges; and 2) 8 million more Americans would enroll in Medicaid and the Children’s Health Insurance Program. That means 15 million Americans total would have health insurance coverage. The administration is currently on pace to get a fraction of those projections. Millward Brown estimates that just 36,000 Americans bought insurance through Obamacare during the first five days of the online exchanges. Just 2 percent of the 9.47 million unique visitors to the federal exchange during that period even began the application process. (Boak and Ehley, 10/21).

Fox News: ObamaCare Site Glitches Run Risk Of Turning Off Millenials
The prolonged glitches with the ObamaCare website are frustrating many of the president’s most high-valued customers -- the young, tech-savvy generation that helped him win two terms and whose participation is critical to the success of the health care exchanges (10/19).

The Kansas City Star: Glitches Persist In Health Insurance Marketplace Mandated By Obamacare
Would-be health insurance buyers and the merely curious continue to be frustrated by the rocky rollout of the federal Health Insurance Marketplace. Nearly three weeks into the planned launch of this centerpiece of the Affordable Care Act, Kansas City area residents, as well as millions nationally, are unable to get enough policy details to make purchase decisions (Stafford, 10/21).

The Fiscal Times: Obamacare Tech Fail May Do What The GOP Couldn't
The myriad of obstacles raise questions as to whether the White House will be forced to push back deadlines and even postpone the tax penalty for Americans who forgo health coverage. “There are so many key technical problems you can’t sum them up,” said Robert Laszewski, president of Health Policy and Strategy Associates, a policy and marketplace consulting firm. “I mean, it’s [Internet] architectural problems at the front end, it’s coding problems in terms of the inefficiency in the way the system works and wastes people’s time, and it’s screens that freeze. And then connections between insurance companies simply aren’t working” (Pianin, 10/21).

This Story: Print | Link to | Top

Health Exchanges By The (Application) Numbers

The Obama administration reports that about 476,000 applications have been filed through federal and state health insurance online marketplaces but has not released how many people have actually enrolled in coverage.

The Associated Press/Washington Post: About 476,000 Applications Filed Through Obamacare Health Exchanges, Officials Say
Administration officials say about 476,000 health insurance applications have been filed through federal and state exchanges, the most detailed measure yet of the problem-plagued rollout of President Obama’s signature legislation. However, the officials continue to refuse to say how many people have actually enrolled in the insurance markets. Without enrollment figures, it’s unclear whether the program is on track to reach the 7 million people projecting by the Congressional Budget Office to gain coverage during the six-month sign-up period (Pace, 10/19).

NPR: Enrollments For The Health Care Exchanges Trickle In, Slowly
The Obama administration's hopes ran high that millions would flock to enroll for health insurance on state and federal exchanges established under the Affordable Care Act. Those exchanges went online Oct 1. The administration projected that half a million individuals or families would enroll within 30 days, according to the Associated Press. But three weeks in, the data suggest the actual number of enrollments is lagging far behind that number (Noguchi, 10/21).

Reuters: Nearly Half Million Apply For U.S. Health Insurance Despite Flaws: Officials
Roughly half a million Americans have applied for health insurance through new federal- and state-run exchanges under President Barack Obama's signature healthcare law, an administration official said on Saturday. That figure comes as problems with the federal marketplace's entry portal serving 36 states, the website Healthcare.gov, have thwarted consumers from shopping for federally subsidized health coverage and drawn derision from Republicans, who oppose the law, popularly known as Obamacare (Mason, 10/20).

This Story: Print | Link to | Top

GOP Sees New Political Battleground Because Of Bumpy Rollout

Though the health law came through the most recent budget battle unscathed, its opponents view the problems with the website as a potential opportunity -- both in terms of the fight to derail the law and as an election issue for the upcoming campaign cycle.  

The Associated Press/Washington Post: Rollout Problems Hand GOP A New Line Of Attack On Obama's Health Care Law
"Obamacare" escaped unharmed from the government shutdown Republicans hoped would stop it, but just as quickly they have opened a new line of attack — one handed to them by the administration itself. While Congress was arguing, President Barack Obama's plan to expand coverage for the uninsured suffered a self-inflicted wound. A computer system seemingly designed by gremlins gummed up the first open enrollment season. After nearly three weeks, it's still not fixed (Cassata, 10/21).

Politico: Dems Caught In Obamacare Uproar
It's not the GOP that President Barack Obama has to worry about in defending his botched health care rollout, it’s fellow Democrats. They voted for the law, sang its praises for three-plus years and still believe in the promise of health care reform. But now they face a conundrum: stay in lock step with Obama and risk their credibility as advocates for the law's benefits or publicly criticize the administration for its recent problems — especially a failure to more quickly acknowledge, and rectify, the major malfunction of its Internet marketplace (Allen and Haberkorn, 10/21).

Politico: Obamacare Wins? See You In 2014
President Barack Obama's signature health care law is now turning into a 2014 election issue, rather than the disastrous defunding fight that led the government to close for three weeks. With the shutdown out of the way, the health care law's problems will take center stage in a way that they didn’t while Republicans were stepping on their own message (Nather, 10/18).

CBS News: Obamacare's Rocky Start: Hiccup Or Sure Sign Of Failure?
The circus that attended the shutdown prevented the public and the media from focusing more completely on the website problems that stymied thousands who tried to explore the online insurance marketplace on healthcare.gov. Stories about privacy concerns and technological glitches that might have led evening newscasts, for example, were pushed to the back-burner by the fiscal food fight. But now, with the budget war abated, at least temporarily, Obamacare's clumsy debut is again front-and-center on the political stage. And for Democrats, that could be a big problem (Miller, 10/21).

The Associated Press: Politicians Offer Their Opinions On Rocky Rollout Of Obama’s Health Care Law
The new online health insurance markets, the portals to coverage for most of the nation's nearly 50 million uninsured people, have gotten off to a rocky start since their Oct. 1 launch. The law was also central to the budget fight that led to a 16-day partial government shutdown. Politicians had these comments on the Sunday talk shows about the state of President Barack Obama's health care law (10/20).

The Texas Tribune: Addressing Medical Group, Cruz Talks Obamacare Fight
Speaking at the Texas Medical Association's fall conference Saturday, U.S. Sen. Ted Cruz reiterated that he would do anything he could to defund the Affordable Care Act and emphasized the importance of grassroots advocacy…As a voice for the Tea Party in the U.S. Senate, Cruz has spent weeks rousing grassroots advocates for the fight to defund the Affordable Care Act, commonly called Obamacare (Aaronson, 10/19).

This Story: Print | Link to | Top

Medicaid Expansion: Ohio Board To Decide On Governor's Proposal Today

Republican Gov. John Kasich is seeking to expand Medicaid without the legislature's approval, a move that could prompt a lawsuit. Elsewhere, the Obamacare's Medicaid "gap" is examined and health policy experts say they expect more states will end up expanding the program.

PoliticoPro: State Week: Ohio Medicaid Decision Looming
Today's the big day for the Medicaid expansion in Ohio, when a state spending board is expected to vote on Republican Gov. John Kasich’s request to expand without the Legislature's support. The request would allow Ohio to tap into about $2.5 billion in federal funds for the expansion over the next two years. If a majority of the seven-member Controlling Board approve the request, expansion opponents have already indicated they could sue Kasich for subverting the legislature's will (Millman, 10/21).

Politico: Medicaid Gap Leaves Obamacare Haves And Have-Nots
April Gomez-Rodriguez hopes Obamacare changes her life. Daniel Hughes says it's like the health law never happened. The difference between them: one state border. ... Gomez-Rodriguez, 32, who works with kids at a behavioral health center, lives in New Mexico, where Gov. Susana Martinez was among the first in the GOP to embrace the Medicaid expansion under the Affordable Care Act. On Jan. 1, Gomez-Rodriguez and her husband will have health coverage for the first time in years. Hughes, 40, who works in home repair, lives in Texas, where Gov. Rick Perry’s staunch opposition to Medicaid expansion and other key elements of Obamacare shut him out (Haberkorn, 10/20).

Medpage Today: More States Expected To Expand Medicaid
For the 26 states that haven't expanded their Medicaid programs thus far, the question going forward isn't whether they will expand but how, state health policy experts said here Friday. A smattering of politics, uncertainty, and budgetary concerns have prevented most states from accepting federal funds to cover individuals making essentially up to 138 percent of the federal poverty level, as the Affordable Care Act provides. But slowly more states will buy into Medicaid expansion -- although many will do so through alternative expansion programs, such as using public dollars to purchase private insurance, predicted Genevieve Kenney, PhD, co-director of the Health Policy Center at the Urban Institute in Washington (Pittman, 10/20).

Doctors in South Dakota are urging lawmakers there to expand the program as well --

The Associated Press: South Dakota Doctors Urge State To Expand Medicaid Program
Fearing a long-term rise in private insurance premiums, South Dakota doctors are renewing pressure on Gov. Dennis Daugaard to expand the state's Medicaid program under President Barack Obama's health care overhaul. Dr. Daniel Heinemann, president of the South Dakota State Medical Association, told a group of 50 physicians in Rapid City that failure to expand Medicaid could have an effect on all South Dakotans (10/20).

This Story: Print | Link to | Top

Cancellation Notices, Uncertainty Over Doctors In New Plans Spur Concerns

News outlets report on a range of policy issues related to the health law's implementation.  

Kaiser Health News: Thousands Of Consumers Get Insurance Cancellation Notices Due To Health Law Changes
Health plans are sending hundreds of thousands of cancellation letters to people who buy their own coverage, frustrating some consumers who want to keep what they have and forcing others to buy more costly policies (Gorman and Appleby, 10/21).

The Texas Tribune: Uncertainty In Marketplace Health Plans Concerns Doctors
As consumers weigh coverage options available in the newly launched federal health insurance marketplace, three of the largest medical associations in Texas have raised concerns about the uncertainty of provider networks offered by health plans in the marketplace (Aaronson, 10/18).

Los Angeles Times: Insurer Health Net Overhauls Its Operations Preparing For Obamacare
Health Net Inc. sees a big opportunity in Obamacare. Although some insurers have taken a cautious approach to the Affordable Care Act, the Woodland Hills managed care company is actively seeking to cover thousands of previously uninsured people under the new healthcare system (Pfeifer, 10/20).

In addition, fresh legal tests to the health law will be heard this week --

The Wall Street Journal: Health Law Faces New Legal Challenges
The health law championed by President Barack Obama survived one major legal challenge in last year's Supreme Court ruling, but it will face fresh legal tests starting this week. Federal judges in Washington, D.C., and Virginia will consider whether the text of the statute prevents the administration from offering subsidized health insurance to millions of low- and middle-income Americans (Palazzolo, 10/20).

This Story: Print | Link to | Top

States Shaking Health Law Tree To Deal With What Falls Out

States are grappling with the realities of the health law: Illinois is using social media to field consumer worries over the rollout of the law even as the law brings more money -- and more stress -- to the state. In the meantime, the differences between exchange launches in Washington state and Oregon are examined.

The Associated Press/Washington Post: Social Media Team In Illinois Tends To Consumer Frustrations With Federal Health Care Website
Inside a command center at a Chicago marketing agency, a small team of social media experts hunkers down to monitor online chatter about President Barack Obama’s health care law, answer questions on Facebook from discouraged consumers and post information and advice on Twitter. They are holding down the fort for a $33 million ad campaign planned for Get Covered Illinois, the new health insurance marketplace that's a cornerstone of the law, also known as "Obamacare," in what is arguably the biggest social media campaign rolled out by the state of Illinois (10/18).

The Chicago Tribune/Kaiser Health News: Affordable Care Act Brings More Money, More Stress To Illinois
As political debate continues to rage over President Barack Obama's signature health care overhaul, the law already is reshaping health care in the most troubled communities in Chicago and its suburbs. Since 2010, Illinois health clinics have received more than $50 million in development grants under the Affordable Care Act to build new facilities, expand operations, modernize equipment and improve the overall quality of care for the state's poor and uninsured (Hood, 10/18).

The Seattle Times/Kaiser Health News: A Tale Of Two State Exchanges
To get a glimpse of how the two-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. … Compare that to Oregon, where state officials acknowledge not a single resident has been able to enroll through the website of that state's exchange, called Cover Oregon, because the site still is not fully functioning (Landa, 10/18). 

This Story: Print | Link to | Top

Va. AG: Health Law Rollout A 'National Embarrassment'

Virginia Attorney General Ken Cuccinelli, who is also a candidate for governor, blasted the rollout of the health law in the GOP's weekly address this weekend. Cuccinelli called the implementation of the law a "national embarrassment." 

The Washington Post: Cuccinelli Aims Blast At Affordable Care Act In GOP's Weekly Address
Just days after a federal government shutdown triggered by a fight over President Obama's signature health-care law, Virginia Attorney General Ken Cuccinelli II delivered the weekly Republican address with a full-throated blast at the Affordable Care Act. Cuccinelli attacked the new law as the exemplar of big government and called its implementation "a national embarrassment" (Kunkle, 10/19).

The Associated Press/Washington Post: In Weekly Republican Address, Virginia AG Cuccinelli Speaks Out Against Health Care Overhaul
Virginia Attorney General Ken Cuccinelli is speaking out against the federal health care overhaul in the weekly Republican address. The Republican Virginia gubernatorial candidate delivered the address on Saturday that coincides with President Barack Obama's weekly radio and Internet address (10/20).

CBS News: Ken Cuccinelli: Obamacare Debut A "National Embarrassment"
Attorney General Ken Cuccinelli, the Republican nominee for governor in the commonwealth, warned that the law is already forcing employers in Virginia to drop health-care coverage of employees and their dependents, citing the University of Virginia, which "just announced that it will no longer be able to provide health-care coverage to many spouses of their thousands of employees," and the Fairfax County Water Authority, which blamed the law's taxes for a recent decision to stop providing health coverage to employees. "Everywhere you look, there's more evidence that Obamacare was fundamentally broken even before it started," Cuccinelli said. He also criticized the recent implementation of the law's insurance exchanges as a "national embarrassment" (Miller, 10/19).

This Story: Print | Link to | Top

Administration News

Obama To Acknowledge Troubled Rollout Of Healthcare.gov

President Barack Obama is expected to call the problems plaguing the insurance exchange's startup unacceptable and detail efforts to fix them in an address in the Rose Garden today.

The Associated Press/Washington Post: Obama To Address Health Care Problems; President Said To Find Glitches Unacceptable
President Barack Obama is expected to acknowledge that widespread problems with his health care law’s rollout are unacceptable, as the administration scrambles to fix the glitches. Obama was scheduled to speak Monday from the Rose Garden, his first health care-focused event since the cascade of computer problems became apparent. The troublesome rollout of the health care exchanges has been a glaring embarrassment for Obama's signature legislative achievement (10/21).

Politico: Obama To Speak About Obamacare Woes
He will be joined by people whom the White House described as already benefiting from the law, or helping with the outreach for people to understand and sign up for the new health coverage options. The White House has not announced how many people have enrolled in coverage, but some of the people attending the Monday event have done so (10/20).

Reuters: Obama To Call Healthcare Website Glitches 'Unacceptable' As Fix Sought
President Barack Obama will declare the glitches in a new healthcare website "unacceptable" on Monday and outline ways for consumers to sign up for insurance while his team scrambles to fix problems that have tainted the rollout of his signature healthcare law. Fresh from two weeks of budget battles that have consumed Washington, Obama will hold an event at 11:25 a.m. (1525 GMT) in the White House Rose Garden with consumers, small business owners, and pharmacists who have been affected by the new law (Mason and Mutikani).

The Associated Press/Washington Post: For President Obama, A Frustrating Rollout For His Signature Health Care Legislation
Last week, President Barack Obama gathered some of his top advisers in the Oval Office to discuss the problem-plagued rollout of his health care legislation. He told his team the administration had to own up to the fact that there were no excuses for not having the health care website ready to operate on Day One. The admonition from a frustrated president came amid the embarrassing start to sign-ups for the health care insurance exchanges. The president is expected to address the cascade of computer problems Monday during an event at the White House (10/20).

This Story: Print | Link to | Top

Capitol Hill Watch

GOP Leaders Want Answers To Questions About Website Difficulties

Health and Human Services Secretary Kathleen Sebelius is among the people some congressional Republicans want to testify about what some have termed the health exchanges' "failure to launch."

The Wall Street Journal: Health Law's Rocky Debut Puts Sebelius In Cross Hairs
Kathleen Sebelius keeps running into trouble, whether on the road, where she is out promoting the new health-care law, or back home, where she is struggling to resolve the technical woes that have hobbled its debut. Mrs. Sebelius, the nation's top health official, was in Tampa the other day to promote the "online shopping experience" of the federal website where uninsured Americans can now select coverage. Christopher Dawson, who sat to her left at the staged event, had tried for a week to enroll. Like others, he was foiled by "error" messages (Langley, 10/18).

CNN: McCain: Can't Go At Obamacare 'With A Meat Ax'
Responding to calls for the resignation of Health and Human Services Secretary Kathleen Sebelius, Senator John McCain said "let's have Congressional hearings" over Obamacare's failure to launch. He called the Affordable Care Act a "fiasco." Sebelius will not attend Congressional hearings scheduled to begin Thursday, but McCain said "let's find out who is responsible." "This is just the beginning of the problems associated with a massive restructuring of one-fifth of our economy," he said (10/20).

Politico: Cruz: Sebelius 'Absolutely' Should Resign
Sen. Ted Cruz says Health and Human Services Secretary Kathleen Sebelius should resign due to the disappointing rollout of Obamacare. "Absolutely, she should resign. Why? Because the program she implanted, Obamacare, is a disaster. It's not working, it's hurting people all across the country," Cruz said in an interview that aired Sunday on CNN's "State of the Union." The freshman Republican senator from Texas went even further, attacking "grey beards" in his own party when asked whether Sebelius remaining in the administration would benefit GOP attack strategies (McCalmont, 10/20).

Fox News: Administration Responding To Pressure For Answers On Messy ObamaCare Site
On Sunday, Illinois Democratic Sen. Dick Durbin said Health and Human Services Secretary Kathleen Sebelius would testify before Congress about the site, amid a growing call for her to accept requests to speak on Capitol Hill. "Ultimately, Secretary Sebelius will testify," Durbin, the Senate's No. 2 Democrat, told "Fox News Sunday." The 918-word blog acknowledges the glitches have been "frustrating" for Americans and states roughly 500,000 applications for coverage have been submitted. It also states that healthcare.gov has had roughly 19 million unique visits, which "confirms that the American people are looking for quality, affordable health coverage, and want to find it online." Officials said in the post they have called in additional help to solve the problems (10/21).

CQ HealthBeat: Energy and Commerce Wants Sebelius At Implementation Hearing
The Energy and Commerce Committee wasted no time after the federal government opened Thursday to summon Obama administration officials to a hearing next week on what it calls the "implementation failures" of the health care law. And the panel issued a statement late in the day saying if Kathleen Sebelius had time for Jon Stewart she should make time for Congress (Bunis, 10/18).

This Story: Print | Link to | Top

Health Spending And Fiscal Battles

Dems, GOP Ready To Wage New Budget Fights, Even Inside Their Own Parties -- And Medicare Is In The Mix

Democrats and Republicans aren't just fighting each other, they're also dealing with intra-party squabbles over the latest plan to come together to find an accord to fix the nation's budget woes. The decisions are sure to involve Medicare as a 29-member panel has until Dec. 13 to reach an agreement to present.

Los Angeles Times: In New Budget Talks, Each Side Has A Motive To Reach A Deal
Interest in a big fix for the nation's budget has faded among Democrats because many no longer believe it is necessary or worth the political perils. … For Republicans, the idea of cutting expensive programs for retirees draws support from many party leaders, but divides the rank and file. The GOP has grown much more dependent on the votes of Americans older than 65 and on lower-income whites, groups that want to preserve Social Security and Medicare. Although the politics have shifted as the battered GOP struggles to regroup amid deep internal divisions, the nation's budget problems remain difficult and economically daunting: The country is on a budget trajectory that, while substantially improved from the recent recession, remains unsustainable (Mascaro, 10/19).

The Wall Street Journal: Budget Discord Simmers Among Democrats
But with eyes now turning toward a newly formed budget committee, some liberal lawmakers and groups are worried that Democrats will negotiate cuts to Social Security benefits and other entitlement programs. The president's budget blueprint, which was released in April, proposed slowing the growth of Social Security spending by using a new measure of inflation -- an idea that drew a rebuke from some lawmakers and liberal groups (Nicholas and Nelson, 10/20).

Medpage Today: Tough Medicare Decisions Await Budget Panel
Led by Senate Budget Committee Chairman Patty Murray, D-Wash., and House Budget Committee Chairman Paul Ryan, R-Wis., the 29-member panel has a Dec. 13 deadline to reach consensus, a timeframe that seems optimistic considering the bitter partisan showdown over the health law that resulted in a 16-day shutdown of the government and risked federal default. … In a joint statement, Murray and Ryan pledged to work together to find a way around the automatic spending cuts known as "sequestration" now governing federal spending. "We hope we can reduce the deficit in a smarter way. We hope to restore stability to the budget process and end the lurching from crisis to crisis," they said (10/20).

This Story: Print | Link to | Top

State Watch

State Highlights: Calif. Set To Get Health Law Long-Term Care Money

A selection of health policy stories from Massachusetts and California.

WBUR: What Makes Berwick Run: Spurned Medicare Chief Seeks To Lead Massachusetts
Dr. Don Berwick -- pediatrician, health care improvement guru, Anglophile, Obamacare booster -- has a really, really great bedside manner. He leans in; he listens. He's deeply thoughtful about seemingly intractable problems (Medicaid expansion, for instance, or the way doctors get paid) without being alarming. In short, he's the guy you want in the exam room when your kid falls off the jungle gym. And if you live in Massachusetts, he wants to be your governor. We spoke with Berwick mostly about health care on his way to more far-ranging interview on Radio Boston. In a 30-minute discussion, Berwick talked about the "majestic" Affordable Care Act and compared re-inventing health care to throwing a hat over a very tall wall and climbing over to retrieve it. Here, edited, is some of our (very long) interview (Zimmerman and Goldberg, 10/18).

California Healthline: California One Of Two States Cashing In On New ACA Long-Term Care Funding
The Community First Choice Option, or CFCO, allows participating states to secure an increase of six percentage points in the federal share of the federal-state Medicaid funding partnership for home- and community-based attendant services to beneficiaries who otherwise would need institutional care. California was the first state to adopt CFCO last fall. Oregon followed suit a few months ago, and six other states have either submitted plans to participate or intend to submit plans by the end of fiscal year 2014 (Blasi, 10/18).

This Story: Print | Link to | Top

Editorials and Opinions

Viewpoints: HHS Officials Must Tell Congress, Citizens What Is Happening To Marketplaces; 'Rate Shock' Didn't Materialize; Problems With Medical Credit Cards

The Wall Street Journal: Sebelius On The Run
The Affordable Care Act's botched rollout has stunned its media cheering section, and it even seems to have surprised the law's architects. The problems run much deeper than even critics expected, and whatever federal officials, White House aides and outside contractors are doing to fix them isn't working. But who knows? ...  Health and Human Services Secretary Kathleen Sebelius is even refusing to testify before the House Energy and Commerce Committee in a hearing this coming Thursday. ... The department is also refusing to make available lower-level officials who might detail the source or sources of this debacle (10/18).

Los Angeles Times: No Way To Run A Health Exchange
The new federally run health insurance exchanges have stumbled badly in trying to sign up customers online, stymied by both design flaws and inept execution. If the website's problems aren't solved soon, they could inflict a greater toll on the Affordable Care Act than the law's opponents have. There's some consolation in the fact that shoppers can sign up over the phone or in person, and that they can enroll as late as mid-December and still have coverage on Jan. 1. But the failures are mind-boggling and inexcusable, especially considering how much time the government had to prepare (10/20).

The New York Times: Obamacare, Failing Ahead Of Schedule
Like the Bush administration in Iraq, the White House seems to have invaded the health insurance marketplace with woefully inadequate postinvasion planning, and let the occupation turn into a disaster of hack work and incompetence. ... But if the fix-it effort moves too slowly, it's possible to envision a worst-case scenario unfolding. If the Web site doesn't work soon, even liberals concede that the mandate would have to be delayed, because you can't very well fine people for failing to buy a product they can't access. And that combination — a hard-to-navigate online portal and no penalty for staying uninsured — could effectively discourage all but the most desperate customers from shopping, which in turn would create an unsustainably expensive insurance pool (Ross Douthat, 10/19). 

The Washington Post Wonkbook: One Nation, Two Health-Care Systems
In the last two weeks, Oregon has cut the ranks of its uninsured by 10 percent through Obamacare. They're not the only state seeing huge gains. California has signed up 600,000 low-income Golden Staters for the law's expanded Medicaid, and over 100,000 are in some stage of applying for insurance on the marketplaces. In Washington state, over 40,000 people have signed up for Obamacare. In New York, the numbers are even larger. Kentucky's online marketplace has been a model of glitch-free performance, with more than 10,000 signing up on the first day alone. It's increasingly possible that Obamacare, at least in its early years, will be a success in blue states (and red states run by Democrats, like Kentucky) even as it flails in red states (Ezra Klein and Evan Soltas, 10/18).

The New York Times: Driving A New Bargain On Obamacare
[W]ith all the conflict and vituperation over Obamacare, it sometimes seems that one of the few things Democrats and Republicans agree on is that the law is imperfect at best. And they also agree that it could be improved. Even if a bipartisan deal to create a better health care system seems far off today, it's not too soon to start imagining what a future bargain might look like (Tyler Cowen, 10/19).

The New York Times: Lousy Medicaid Arguments
In other words, the technical problems, while infuriating — heads should roll — will not, in the end, be the big story. The real threat remains the effort of conservative groups to sabotage reform, especially by blocking the expansion of Medicaid. This effort relies heavily on lobbying, lavishly bankrolled by the usual suspects, including the omnipresent Koch brothers. ... Before I get there, a word about something that, as far as we can tell, isn't happening. Remember "rate shock"? (Paul Krugman, 10/21).

Los Angeles Times: Is Obamacare Forcing Bonnie Doon Ice Cream Out Of Business?
Maybe you've heard about the beloved local ice cream company that's been forced to close its doors because of Obamacare? Earlier this week, Newt Gingrich shared the dreadful news with Sean Hannity on Hannity's radio show. It’s awful, just awful, the two men agreed, that small businesses are being driven under by the "job-killing" Affordable Care Act. It didn't take me long to identify the company: Bonnie Doon Ice Cream Corp., an Indiana ice cream maker. ... Or to figure out that the Affordable Care Act probably has nothing to do with the business's failure (Robin Abcarian, 10/18). 

The Washington Post: Let's Get Rid Of (The Term) Entitlements
Let's drop the whole notion of "entitlement." Just eliminate it. Politicians, pundits and academics who talk about entitlements would then have to name the actual programs and argue their merits and demerits. ... Social Security, Medicare (health insurance for the elderly) and Medicaid (health insurance for the poor) aren't the only big entitlement programs. Here are 12 of the largest in 2012, ranked by the number of recipients, according to the Office of Management and Budget (Robert J. Samuelson, 10/20). 

The Wall Street Journal: The Tea Party And The Entitlement Fight
Not appreciated is the powerful new meme Mr. Obama has handed them, which will transform entitlement politics in our country. The new "conservative" position will be to defend Social Security and Medicare, those middle-class rewards for a life of hard work and tax-paying, against Mr. Obama's vast expansion of the means-tested welfare state for working-age Americans. This will discomfit traditional free marketers. They know Medicare and Social Security are generous in excess to the taxes that beneficiaries paid into them (Holman W. Jenkins Jr., 10/18). 

Bloomberg: Obama's 'Abuse of Power' Is Hardly Unprecedented
A leading Republican complaint during the partial government shutdown was that President Barack Obama had delayed implementation of the Affordable Care Act for businesses but not individuals. Many party strategists argued that its protest should have been focused on delaying rather than defunding the law. I am skeptical that this would have turned the political drama to Republican advantage. What is more intriguing to me as scholar is the charge that Obama, in giving businesses an extra year to prepare, defied the language of the statute and acted beyond the powers of the presidency (Stephen L. Carter, 10/20).

Bloomberg: Cruz Emerges Stronger From Republican Debacle
In the aftermath of the U.S. government shutdown and a close call with default, there is a political consensus among Democrats, many Republicans, establishment conservatives, business leaders and the inside-the-Beltway commentariat: Senator Ted Cruz of Texas and Tea Party members in the House have done grievous harm to themselves and their brand. ... That, however, isn't the way Deedee Vaughters and Bob Vander Plaats see things. "We're winning this argument and now have to go back at Obamacare and getting our fiscal house in order," says Vaughters, a Tea Party activist in Aiken, South Carolina. Vander Plaats, who heads an influential family-values group in Iowa, agrees: "Ted Cruz is a rock star sucking all the energy in the conservative movement. He's making all the right enemies with the Republican establishment, which is taking him to unprecedented heights" (Albert R. Hunt, 10/20).

Bloomberg: Let's Fight Obamacare By Getting Out Of The Way
But did Republican tactics permanently compromise their ability to capitalize on the deeply flawed rollout of Obamacare, and what many analysts (myself included) believe will be its deleterious impacts on the U.S. health-care system? Not necessarily. Republicans can still use Obamacare’s failings to their advantage, but it will require a disciplined, realistic approach. And it means recognizing the impossibility of large-scale changes to the law while Barack Obama is president (Lanhee Chen, 10/20).

National Review: Kasich Is Wrong About Reagan
Governor Kasich bases his argument [for expanding Medicaid in Ohio] that he is doing what [President Ronald] Reagan would have done on the fact that Reagan expanded Medicaid when he was president. ... Aside from offering a genuine choice to the states (as opposed to the economic coercion of Obamacare), this expansion had a factor missing from the current debate: abortion. In an era when there were perpetual fights over using public funds for abortion, the expansion assured that pregnant women would not be financially worse off carrying their children to term than they would be if they chose to have an abortion (Edwin Meese III & Robert Alt, 10/21).

And on another subject -

The New York Times: Alarming Abuses Of Medical Credit Cards
Patients around the nation are being victimized by medical credit cards that can lead to financial calamity. These cards, issued by specialty finance companies as well as commercial banks, carry exorbitant interest rates after an initial period of zero interest expires — with heavy penalties for late payments. They are often pushed on patients with modest incomes by health care providers who want to make sure that they get paid, even if some of their patients end up with huge credit card bills they can’t afford. Unless strong regulatory action is taken to curb the abuses, financial companies will continue to gouge consumers at their most vulnerable moments, when they are in pain and need medical attention (10/19).

Health Policy Solutions (a Colo. news service): Noise Over ACA Shouldn't Distract Seniors From Medicare Enrollment
If you are an American over 65, you may have questions about the new health care law, what it means for you and what you need to do. The short answer is that very little changes, and most seniors will not have to do anything. Some meaningful changes have already occurred, such as the shrinking of the prescription drug “donut hole,” but most of the major reforms in the Affordable Care Act, such as the new health insurance marketplaces and penalties for not having coverage, simply do not affect seniors (Bob Semro, 10/18).

This Story: Print | Link to | Top


EDITOR:
Stephanie Stapleton

ASSOCIATE EDITOR:
Andrew Villegas

WRITERS:
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.