Daily Health Policy Report

Tuesday, October 22, 2013

Last updated: Tue, Oct 22

KHN Original Reporting & Guest Opinion

Administration News

Health Reform

Capitol Hill Watch

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

How Long Does Obama Have To Fix Healthcare.gov?

Kaiser Health News staff writer Julie Appleby reports: "They've got a few weeks. But if federal officials can’t get the new online insurance marketplace running smoothly by mid-November, the problems plaguing the three-week-old website could become a far bigger threat to the success of the health law, hampering enrollment and fueling opponents’ calls to delay implementation, say analysts" (Appleby, 10/21). Read the story.

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Insuring Your Health: Readers Ask About HSAs, Infertility Treatment, And The Consequences Of Not Buying Insurance

Kaiser Health News consumer columnist Michelle Andrews answers various reader questions (Andrews, 10/22). Read the column.

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New Health Policies Will Expose Many Missourians To Higher Premiums, More Risk

The St. Louis Dispatch’s Jim Doyle and Tara Kulash, working in partnership with Kaiser Health News, report: "Thanks to government subsidies, many St. Louis-area residents will be able to afford health insurance for the first time, beginning in 2014. But the insurance they’ll be able to buy will offer a limited range of options" (Doyle and Kulash, 10/22). Read the story.

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Obama Seeks To Reassure Consumers Frustrated With Healthcare.gov (Video)

Kaiser Health News has video clips of the President Barack Obama as he discussed the rollout of the federal health law in a White House speech Monday. In the excerpt, he discusses the technical problems with the federal health insurance marketplace website and what his administration is doing to help consumers get enrolled in an insurance plan (10/21). Watch the video or read the transcript.

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Capsules: Updates: The Latest On The Health Law’s Insurance Exchanges

Now on Kaiser Health News' blog, watch video of KHN’s Jenny Gold on C-SPAN’s Washington Journal Monday giving an update on the health law’s insurance exchanges and previewing President Obama’s comments on the exchange’s rollout (10/21). Watch the video or check out what else is on the blog.

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Political Cartoon: 'Tech Talk?'

Kaiser Health News provides a fresh take on health policy developments with "Tech Talk?" by Mike Smith.

Here's today's health policy haiku:


Done by Thanksgiving...
Pros say that's the target date
or mandate's at risk.

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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Administration News

Obama Admits Healthcare.gov Problems, But Says Health Law Is Bigger Than The Website

In a Rose Garden speech, President Barack Obama said there was "no excuse" for the bungled rollout of the online health insurance marketplaces and promised that the difficulties would be ironed out.

The New York Times: Obama Admits Web Site Flaws On Health Law
President Obama offered an impassioned defense of the Affordable Care Act on Monday, acknowledging the technical failures of the HealthCare.gov Web site, but providing little new information about the problems with the online portal or the efforts by government contractors to fix it (Shear and Pear, 10/21).

Los Angeles Times: Obama Promises To Iron Out Glitches On Healthcare Website
With the shutdown and debt limit crisis past, Washington's attention has turned to persistent problems with the website, which processes enrollments for insurance under the Affordable Care Act. But the site — healthcare.gov — has been plagued since it opened Oct. 1 by glitches that threaten to overshadow Obama's signature domestic accomplishment. The president relaunched his campaign to sell the law as Republicans announced plans for hearings on the balky website. A Gallup poll last week found that 7 out of 10 uninsured Americans were "not too familiar" or "not familiar at all" with the online marketplaces (Parsons, Levey and Terhune, 10/21).

McClatchy: Obama Says 'No Excuse' For Website Foul-Ups, Vows To Fix Them
The president’s Rose Garden appearance seemed at times like a campaign rally. More than 100 supporters were seated in the audience, applauding regularly as he spent the bulk of his 25-minute speech touting some of the benefits of the law: free preventive care, cheaper medicine for seniors and insurance for those who have pre-existing medical conditions. "Let me remind everybody that the Affordable Care Act is not just a website," he said. "It’s much more." Republicans criticized the White House event. "If the president is frustrated by the mounting failures of his health care law, it wasn’t apparent today," said House Speaker John Boehner, R-Ohio. “Americans are looking for accountability, but what the president offered today was little more than self-congratulation” (Kumar and Pugh, 10/21).

The Fiscal Times: Obama Turns to High Pressure Sales to Save Obamacare
Obama told health care advocates gathered in the White House Rose Garden that government officials and Internet technology experts in the country were working overtime to try to fix the problems. But he gave no clear time line for ending the humiliating program crisis that has garnered about a half-million applications since the Oct. 1 launch, but only a minimal number of actual enrollments. While the site is being fixed Americans can apply by phone or in person, Obama said (Pianin, 10/21).

Politico: The Obamacare Bunker Mentality
President Barack Obama likes to say his team is the most transparent administration in history — but on the Obamacare website debacle, it’s been more like they’ve been holed up in the bunker. That’s why there’s growing pressure for the administration to come out from underneath the covers, and start releasing more details on what, exactly, is wrong with the Healthcare.gov site and how soon it might be fixed (Nather, 10/22).

The Wall Street Journal: Obama Admits Health Website Flaws
Mr. Obama promised that the website crucial to the success of the health law is "going to get fixed." His comments came as Republican lawmakers began trying to assign blame to the Obama administration. In a letter released Monday, a House committee chairman said the top contractor developing the website cited a Department of Health and Human Services agency as making 11th-hour decisions that led to some of its biggest problems (Radnofsky, Schatz and Weaver, 10/21).

Bloomberg: Obama Says Health Care Law More Important Than Website
President Barack Obama said flaws in the government’s online insurance exchanges don’t indicate a broader failure of the program, as his spokesman suggested the administration is considering adjusting deadlines under the law. Obama said the website that is central to getting as many as 7 million uninsured Americans covered under the 2010 health-care law hasn’t met expectations (Talev and Wayne, 10/21).

The Washington Post: White House Won’t Say Whether Web Site Glitches Will Delay Mandate
White House press secretary Jay Carney was bombarded with questions Monday about whether the glitches will lead the Obama administration to withdraw penalties for people who don't comply with the requirement that they carry insurance. "Americans who have access to affordable insurance would need to have insurance by March 31," Carney said. "People who do not have access to affordable care due to a state not expanding Medicaid, for example, or due to other factors will not be penalized." Reporters pressed Carney on whether having trouble with the Affordable Care Act Web site also qualified as another exemption (Blake, 10/21).

The Associated Press: Obama Says 'No Excuse For Health Care Signup Problems'
President Barack Obama on Monday offered "no excuses" — and little explanation — for the computer bugs still frustrating Americans who are trying to enroll online for insurance plans at the center of his health care law. But software developers tasked with building the site said they saw signs a year ago that the debut could fail (Gillum, 10/22).

Los Angeles Times: Obama: Fighting For A Better Perception Of Healthcare Law
President Obama held a Rose Garden event Monday morning with two goals: to convey a sense of urgency about fixing the problems that have confounded those trying to sign up for insurance using the program’s online insurance site, and to split the divergent group of Americans who oppose Obamacare right now. Two polls released Monday showed how, at this point, opponents of the healthcare law have benefited from opposites attracting (Deckler, 10/21).

The Fiscal Times: Obamacare Poll Shows Devastating Consumer Response
The Gallup Organization has released a devastating new poll about Obamacare, upending the argument from Democrats that the health insurance program is generating a lot of interest. A shocking 71 percent of uninsured Americans claim to be “unfamiliar” with the online exchanges launched this month to substantial fanfare. That figure is roughly the same as September, when 72 percent said they had little understanding of the site and the program. This finding suggests that these Americans are not as thrilled about the options of buying insurance coverage as the administration and its allies would suggest because of the alleged 19 million visits to the online exchanges (Boak, 10/21).

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Health Reform

Finger Pointing Surrounds Health Care Website Woes

News outlets examine some of the technology issues, as well as political dynamics, that contributed to the launch difficulties.

NPR: How Politics Set The Stage For The Obamacare Website Meltdown
Since the Affordable Care Act's health care exchanges launched to a long series of error messages Oct. 1, most of the 'what went wrong' fingers have been pointing at software developers. But some say there's more to it than that – that politics has played a role as well (Rovner, 10/21).

The Washington Post: Health Insurance Exchange Launched Despite Signs Of Serious Problems
Days before the launch of President Obama’s online health insurance marketplace, government officials and contractors tested a key part of the Web site to see whether it could handle tens of thousands of consumers at the same time. It crashed after a simulation in which just a few hundred people tried to log on simultaneously. Despite the failed test, federal health officials plowed ahead (Sun and Wilson, 10/21).

The Associated Press: Insiders Who Worked On US Health Website Describe High Stress, Complaints About Major Problems
Crammed into conference rooms with pizza for dinner, some programmers building the Obama administration's showcase health insurance website were growing increasingly stressed. Some worked past 10 p.m., energy drinks in hand. Others rewrote computer code over and over to meet what they considered last-minute requests for changes from the government or other contractors. As questions mount over the website's failure, insider interviews and a review of technical specifications by The Associated Press found a mind-numbingly complex system put together by harried programmers who pushed out a final product that congressional investigators said was tested by the government and not private developers with more expertise (Gillum and Pace, 10/22).

USA Today: Geographic Issues Plague Federal Health Site
The federal government's new Web portal for health insurance lags the rest of the health care industry in performance, and the problems could have been prevented with adequate pre-testing, according to a new analysis by Compuware APM, which monitors and manages the performance of websites and other Internet-based assets (O'Donnell, 10/21).

The New York Times: Awareness Grows Of Online Insurance Exchanges, And Their Problems, Survey Finds
Public awareness of the new health insurance exchanges has risen substantially in the weeks since they opened, but only a small percentage of consumers have visited the sites. Most of those already have insurance and are simply trying to learn more about the program, according to a survey released on Monday by the Pew Research Center (Bornemeier, 10/21).

Politico: Even Obamacare Successes Have Hit Some Roadblocks
Most of the people representing Obamacare success stories who flanked President Barack Obama during his Monday Rose Garden speech haven't gotten past the HealthCare.gov glitches. They're still exploring their options (Haberkorn, 10/22).

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Vows To Fix Insurance Website, But No Details Offered

The Obama administration has been tight-lipped about the cause of the website problems, who has signed on to fix them and what their timetable might be. News outlets report on ideas advanced by technology experts and explore the practical and political ramifications of delayed enrollment.  

Kaiser Health News: How Long Does Obama Have To Fix Healthcare.gov?
They've got a few weeks. But if federal officials can’t get the new online insurance marketplace running smoothly by mid-November, the problems plaguing the three-week-old website could become a far bigger threat to the success of the health law, hampering enrollment and fueling opponents’ calls to delay implementation, say analysts (Appleby, 10/21).

Bloomberg: Obamacare Crashes Months In Coming Not Easily Repaired
The frantic weeks before the start of Obamacare were marked by a chaotic effort in which officials failed to complete exhaustive testing of the program’s website in a push to begin signups by Oct. 1, according to people involved in the rollout. The federal Healthcare.gov site -- which has been plagued by software bugs -- went live without attempts to replicate a customer’s complete experience, said a person familiar with the project who asked not to be identified to discuss what happened (Dorning, Wayne and Miller, 10/22).

Fox News: ObamaCare Website Fix-It Team Faces Massive Undertaking, Warning Signs Detailed
The overhaul of the broken ObamaCare website could be a massive undertaking, with one specialist reportedly saying 5 million lines of code may have to be rewritten and indications that the newly hired tech team may need weeks to repair the system. The details come amid reports that, in advance of the Oct. 1 launch of HealthCare.gov, several issues had raised red flags among the very people charged with putting the website together. The administration is now in a scramble to fix the problems that have prevented many from signing up for health insurance online. President Obama on Monday directed the public to apply over the phone or by mail -- but at the same time, the White House did not rule out delaying the health law's 2014 requirement on individuals to buy insurance (10/22).

NBC News: Better Use The Phone: Why Obamacare Website Is Such A Fail[ure]
The Obama administration has been tight-lipped on just what the problems are with the website, which was originally billed as something resembling Travelocity for health insurance — a place online where people could go to compare one plan to another and get a price. But experts point out that HealthCare.gov was never that simple. While most in the industry are confident that Obama can keep his promise to eventually fix the site, they say there are multiple places where things may have gone wrong. “Buying a health plan is a lot more complicated than buying a flight," says Brandon Cruz, president of GoHealth, a private health insurance marketplace. “When you’re buying a health plan, you need to know all the doctors in the network, what you deductible will be, what your co-insurance will be. And the terminology is so foreign” (Fox, 10/21).

NPR: The HealthCare.gov 'Tech Surge' Is Racing Against The Clock
A "tech surge" is underway to help clean up the code of the error-plagued HealthCare.gov site. The Obama administration says this surge is made up of engineers from inside and outside government, but beyond saying that Presidential Innovation Fellows are involved, officials haven't specified who's making up those teams and what exactly they're doing to fix the systemic issues with the site. Either way, tech industry leaders say the tech system — responsible for helping people in 36 states get health coverage — may have such deep flaws that it could take several months to fix them (Hu, 10/21).

Politico: ACA Team: Best, Brightest — And A Mystery
The “best and the brightest” also appear to be the cloaked and elusive. President Barack Obama insists he’s culled the country’s tech elite to help repair the mangled Healthcare.gov website. But the administration hasn’t made its smart new crew public, and any of the tech companies or federal contractors involved remain tight-lipped. The silence may stem from a tangle of obstructions and fears — from the complex legal requirements for federal procurement contracts to the increasingly volatile politics associated with Obamacare.“Experts from some of America’s best private sector tech companies” have volunteered to help, Obama said from the Rose Garden on Monday. “They want it to work. They are reaching out.” But it’s not even clear to some in Silicon Valley how tech could save it (Meyers and Romm, 10/21).

CBS News: What's Being Done To Fix Obamacare Site Bugs?
The Obama administration is relying on the nation's insurance industry to help fix healthcare.gov. But insurance firms have complained the administration did not reveal the full design of the site until the day of launch -- when it was too late to suggest changes (Andrews, 10/21).

Politico: Ezekiel Emanuel Wants Obamacare Website Briefings
Former White House health care adviser Ezekiel Emanuel said Monday that the administration should be giving “wonky” daily briefings on what is wrong with the health care exchange website — and how they’re going to fix it. “I think they need to have daily briefings and they need to give us milestones over the next four weeks as to what we should look for for improvement. Reassurance verbally is not worth much at this point,” Emanuel said on MSNBC’s “Morning Joe.” The former adviser to the Office of Management and Budget, who left the administration in 2011, said the briefings should be detailed (Kopan, 10/21).

ABC News: How Steve Jobs Would Fix Obamacare
With a product desperately in need of improving, it's no wonder that Obama has Steve Jobs on the brain. Jobs, the founder of Apple and the man behind the iPod and iPhone, was known to be a brilliant innovator, not because he invented new things, but because he improved on existing technologies. "Consider that just a couple of weeks ago, Apple rolled out a new mobile operating system. And within days, they found a glitch, so they fixed it. I don't remember anybody suggesting Apple should stop selling iPhones or iPads -- or threatening to shut down the company if they didn't," Obama recently told reporters. "That's not how we do things in America. We don't actively root for failure. We get to work, we make things happen, we make them better, we keep going." Obama's not the only one evoking Apple and Jobs to make a point about Obamacare. Conservatives have also used Jobs, who died in 2011 ... as evidence that the government should never have gotten involved in selling insurance and building websites (Goldman, 10/21).

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Ohio Board OKs Medicaid Expansion, Lawsuits Loom

The state Controlling Board agreed Monday to Republican Gov. John Kasich's proposal to accept federal money to expand Medicaid to more than 275,000 Ohioans. Conservatives, however, are planning lawsuits over Kasich's circumvention of state lawmakers.

The New York Times: Medicaid Expansion Is Set for Ohioans
As a Republican chairman of the House Budget Committee in the 1990s, John R. Kasich wielded a ferocious budget ax. On Monday, as Ohio's governor, Mr. Kasich defied his party's majorities in the state legislature to push through a multibillion dollar expansion of Medicaid under President Obama's health care law (Gabriel, 10/21).

The Washington Post: Ohio Will Expand Medicaid After Months-Long Battle Between Governor And Legislature
Ohio agreed Monday to offer Medicaid to about 300,000 more low-income people, a major victory for Gov. John Kasich over fellow Republicans who control the state legislature and oppose the expansion. After nine months of battling with the state GOP's conservative wing, Kasich resorted to an uncommon maneuver in which he turned to a relatively obscure state board with power over certain budget decisions. The board voted to accept $2.55 billion in federal money to cover the cost of expanding Medicaid in Ohio through July 2015 (Goldstein, 10/21).

The Wall Street Journal: Ohio's Governor Pushes Through Medicaid Expansion
Mr. Kasich this year proposed adding an estimated 275,000 residents to the Medicaid rolls under the provision, in which the federal government would pay 100% of coverage costs through 2016. But the proposal didn't win support from Republican leaders in the legislature, where the party controls both chambers. Those Republicans have said they are concerned about the rising costs of the government health-care program (Peters and Radnofsky, 10/21).

Politico: Ohio OKs Obamacare Medicaid Expansion
An obscure Ohio board has approved Obamacare's Medicaid expansion, but a likely legal fight by furious conservatives is looming. The decision, 5-2, by the state Controlling Board to back expansion at the urging of Republican Gov. John Kasich would accept billions of federal dollars to extend coverage to an estimated 300,000 poor Ohioans. Kasich pursued a vote of the board after efforts to win over his Republican-led Legislature failed to gain traction (Cheney, 10/21).

Reuters: Ohio Panel OK's Medicaid Expansion In Win For Obamacare
An Ohio legislative panel on Monday voted in favor of the state expanding its Medicaid program for the poor in a victory for President Barack Obama's signature federal health reform law. The decision permits Governor John Kasich, a Republican who otherwise opposes the reform law known as the Affordable Care Act, to bypass the state's Republican-dominated legislature to expand Medicaid, a move strongly opposed by many Ohio conservatives (Palmer, 10/21).

The Hill: Ohio To Expand Medicaid Under ObamaCare
Ohio became the 25th state to approve Obamacare's Medicaid expansion Monday after a little-known legislative panel voted 5-2 in favor of the policy. The move ends months of debate that saw Republican Gov. John Kasich circumvent the state's GOP legislature and gain a way forward through the bipartisan Controlling Board (Viebeck, 10/21).

Modern Healthcare: Ohio's Plan To Expand Medicaid Advances
An Ohio legislative panel on Monday approved Republican Gov. John Kasich's plan to expand the state's Medicaid program under the Patient Protection and Affordable Care Act. It is expected to provide health coverage for more than 275,000 low-income Ohio residents (Johnson, 10/21).

Cleveland Plain Dealer: Controlling Board Gives OK To Use Of Federal Money To Pay For Medicaid Expansion In Ohio
The state Controlling Board on Monday approved a spending request from Gov. John Kasich’s administration that clears the way for the state to expand Medicaid to cover Ohio’s working poor. ... The vote means that the state can start offering Medicaid health care insurance to people earning up to 138 percent of the federal poverty level beginning Jan. 1, 2014. The net change would be the addition of 275,000 uninsured Ohioans to the Medicaid program, [the state's director of Medicaid John] McCarthy said. The administration estimates that at least half of those people hold jobs that don't provide health plans. About 26,000 are veterans (Higgs, 10/22).

Cleveland Plain Dealer: Medicaid Expansion OK Marks A Long-Awaited Victory For Supporters, Grounds For A Fight Among Critics
Crucial support for expansion came from the business community, including traditionally GOP-friendly groups such as the Ohio Chamber of Commerce. The Chamber of Commerce's Keith Lake said in a statement that expansion would help protect employers from the ACA's penalties and could create thousands of jobs, particularly in the health-care industry. "The question of whether or not to expand Medicaid is a complex one. However, doing so is ultimately the right decision," Lake said. Hospitals also aggressively pushed for the measure, worried that, among other things, that without Medicaid expansion, they would be left on the hook as federal aid for uninsured patients is decreased (Pelzer, 10/21).

The Columbus Dispatch: Vote Expands Medicaid; Opponents Vow To Sue
After months of debates, delays and political hand-wringing, Ohio will expand Medicaid to cover 275,000 low-income residents. But as soon as today, a conservative organization, possibly joined by House Republicans, may file a lawsuit to invalidate the vote yesterday by the seven-member Controlling Board, which approved by a 5-2 bipartisan vote a request to accept $2.56 billion in federal money for the expansion through June 2015 (10/21).

In other Medicaid news --

The New York Times' Economix Blog: Medicaid And The Incentive To Work
The Affordable Care Act is -- to state the obvious -- aimed at bolstering insurance coverage in the United States. But the law is so big that it will necessarily have widespread economic ramifications, economists think, including an effect on the labor market. For instance, the Congressional Budget Office has surmised that the law may lead more workers to choose early retirement, since they would not fear losing their insurance coverage if they did so. It might also lead certain employers to hire more part-time workers, to avoid the so-called "employer mandate" (Lowry, 10/21).

California Healthline: California May Learn From Other States In Move Toward Streamlined Enrollment
California is in the process of streamlining the eligibility and enrollment system for Medi-Cal, the state's Medicaid program. In July, Gov. Jerry Brown (D) signed into law two bills -- ABX1-1, by Assembly member John Pérez (D-Los Angeles), and SBX1-1, by Sen. Ed Hernandez (D-West Covina) -- that included provisions making it easier for California to use income data from existing state assistance programs to determine Medi-Cal eligibility. As California works to set up its new system, officials could take lessons from other states' experiences (Blasi, 10/21).

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Despite Glitch-Ridden Rollout, Health Insurers Not Panicking Yet

Media outlets document the pace of enrollment through health insurance marketplaces in Kansas, Missouri, Wisconsin, Wyoming, Minnesota and Washington state.

The St. Louis Dispatch/Kaiser Health News: New Health Policies Will Expose Many To Higher Premiums, More Risk
Thanks to government subsidies, many St. Louis-area residents will be able to afford health insurance for the first time, beginning in 2014. But the insurance they’ll be able to buy will offer a limited range of options (Doyle and Kulash, 10/22).

The Milwaukee Journal Sentinel: Obamacare Rollout 'Frustrating,' But Insurers Not Panicking Yet
Insurers in Wisconsin are being either patient or silent about the problems that have rendered the new federal health insurance marketplace largely inoperable. "It's not the point in time where we need to hit the panic button," said Marty Anderson, director of marketing for consumer products at Security Health Plan in Marshfield. Three weeks after its launch in Wisconsin and other states, the federal marketplace for all practical purposes isn't working, and some experts estimate the problems could take weeks or even months to fix. "It's very frustrating," said Tanya Hudson, a benefits coordinator at Milwaukee Health Services, a community health center (Boulton, 10/21).

The Associated Press: National Health Insurance Site Sputters In Wyoming
Only a handful of Wyoming residents have managed to enroll so far for health care coverage through the troubled federal insurance exchange network that kicked off three weeks ago. WINHealth and Blue Cross Blue Shield of Wyoming are the only two insurance companies offering Wyoming coverage through the new federal health care exchange (Neary, 10/21).

St. Louis Beacon: Scholars Pinpoint Gaps In Consumer Knowledge Of Health Insurance Jargon
Thinking of buying insurance through the exchange? While you wait for programmers to fix the glitch-ridden sign-up system, grab a crib sheet and learn the terms that can help you make good decisions about coverage. Pay close attention to words like PPO, POS, deductible, co-payment, drug formulary, and many more (Joiner, 10/21).

The Seattle Times: Washington Healthplanfinder: More Than 35,000 Have Enrolled In 3 Weeks
Three weeks after its launch, Washington’s online insurance marketplace continues to set a strong pace for enrollment. To date, more than 35,500 Washington residents have enrolled in coverage through the state’s online insurance marketplace, Healthplanfinder, according to data released Monday by the Washington Health Benefit Exchange. That figure is up about 10,500 from the week before (Landa, 10/21).

Kansas Health Institute: Fixes To Kansas Insurance Marketplace Produce Trickle Of Activity
The technical problems that have plagued the federal online health insurance marketplace since its launch three weeks ago are slowly being resolved, at least in Kansas, according to those who are helping people navigate the new system or are using it to sell health plans (McLean, 10/21).

Minnesota Public Radio: MNsure Unaffected By Federal Exchange Problems
The problems that have plagued the federal insurance marketplace in the last two weeks have not affected the system in Minnesota, MNsure Executive Director April Todd-Malmlov said Monday. President Barack Obama took to the White House lawn today to lament the technological problems that have prevented people from enrolling in plans offered through the federal exchanges. Todd-Malmlov said Minneosta's online insurance marketplace operates separately from the federal exchange. "We don't have any interaction with that at all, and that's what the president was talking about," she said (Richert, 10/21).

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Judge Expected To Rule On Federal Exchange Subsidies Today

Politico: Judge To Rule On Lawsuit Challenging Obamacare Subsidies
A District of Columbia federal judge says he’ll rule Tuesday on a lawsuit over whether Americans enrolling in federally run exchanges as part of the health care law can collect insurance subsidies after he directed pointed questions to the Obama administration in a three-hour hearing Monday. The case is one of two prominent attempts to stop premium subsidies from being awarded in states where the federal government is running the new health exchange. The seven businesses and self-employed individuals bringing the case say the Affordable Care Act allows insurance subsidies in the state-run exchanges, but not the federal ones (Cunningham, 10/22).

Earlier, related KHN analysis: Health Exchanges And The Litigation Landscape (Stuart Taylor, 11/29/12).

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Fact Checking DeMint On Medicare/Obamacare Comparison And President On Premium Cost

The Washington Post's Fact Checker examined several claims about Obamacare.

The Washington Post: Jim DeMint's Claims About Medicare Cost Estimates From 1965
In making the case that the cost of the health-care law was sure to grow, [Jim DeMint, president of the Heritage Foundation] cited some figures about Medicare that struck us as a bit fishy. ... There's no question that any new social program often has unintended costs. ... DeMint's figures are ridiculously overstated. He preferred to use trumped-up stats rather than refer to the concrete examples (Kessler, 10/22).

The Washington Post: President Obama's Claim That 6 Of 10 Uninsured Will Pay Less Than $100 A Month In Premiums
Whether health insurance premiums go up or go down is a central part of the debate over the Affordable Care Act, a.k.a. Obamacare. The research and policy arm of the Department of Health and Human Services released a report last month asserting premiums before tax credits were 16 percent lower than projected — a claim immediately challenged by skeptics of the law as a "load of spin." So what about the study referenced by the president? The study, titled "Fifty-Six Percent of the Uninsured could pay $100 or less per month for Coverage in 2014," turns out to also be an in-house study produced by HHS — a fact that the president failed to mention. Moreover, it really is not based on an examination of premiums at all, but household composition and income data (Kessler, 10/22).

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Capitol Hill Watch

Sebelius To Testify On Healthcare.gov Problems

Health and Human Services Secretary Kathleen Sebelius is expected to answer lawmakers' questions about the troubled rollout of the health law's exchange website as early as next week. Her staff had declined a request to have her testify Thursday citing scheduling conflicts.

Politico: Kathleen Sebelius Offers To Testify On Obamacare
HHS Secretary Kathleen Sebelius is expected to testify before Congress about the rocky Obamacare rollout a week from Wednesday, House Republicans announced late Monday, just hours after House Speaker John Boehner slammed the White House for skipping an earlier hearing scheduled for this Thursday. A few hours after Sebelius signaled she was willing to testify before the House Energy and Commerce Committee at a "mutually agreeable date," the committee announced she was "expected" on Wednesday, Oct. 30. Her testimony would come a few days after the lead contractors working on the balky Obamacare enrollment system — CGI and QSSI — testify before the same committee (Cheney, 10/21).

The Washington Post: Sebelius Negotiating With House Republicans, But Won't Testify Thursday
Health and Human Services Kathleen Sebelius is negotiating with House Republicans over when she will appear before the House Energy and Commerce Committee to answer questions about the troubled rollout of enrollment for the new federal health-insurance exchange, according to agency spokeswoman Joanne Peters, but has not agreed to appear at a hearing scheduled on Thursday (Eilperin, 10/21).

The Wall Street Journal's Washington Wire: Sebelius To Testify On Rocky Health Care Rollout
The Department of Health and Human Services said Monday that Secretary Kathleen Sebelius will testify before Congress on the law’s rocky rollout "as early as next week." Ms. Sebelius's staff had declined a request for her to testify at a House Energy and Commerce Committee hearing this Thursday, citing a schedule conflict. That decision was criticized last week by lawmakers who then called on the department to send other officials "voluntarily" (Radnofsky, 10/21).

Politico: 5 Obamacare Questions Kathleen Sebelius Won't Answer
The reality is that no matter how long Sebelius sits and takes the heat, there are some questions she can't or won't answer (Norman and Millman, 10/22).

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State Watch

In Calif.: Hospital Laptop Thefts, KP Joins Heart Attack Transfer Network

A collection of health care news stories from California.

Los Angeles Times: Laptop Thefts Compromise 729,000 Hospital Patient Files
Thieves steal two laptops containing patient data from an administration building of San Gabriel Valley-based AHMC Healthcare. The hospital group is uncertain if the data were accessed or used. ... The laptops were stolen Oct. 12 and contain data from patients treated at [six]AHMC hospitals (Winton, 10/21).

Los Angeles Times: Kaiser To Join L.A. County Transfer Network For Heart Attack Care
Amid concern among some experts that the healthcare giant had been slow to act, Kaiser Permanente has announced it will join a Los Angeles County patient transfer network that quickly gets victims of severe heart attacks to specially equipped hospitals to reduce chances of serious complications or death (Brown, 10/21).

California Healthline: L.A. County Officials Predict Substance Misuse Care Will Expand Under ACA
Some experts in Los Angeles County, which is in the middle of a five-year strategic plan to deal with substance abuse, predict that substance abuse treatment will be the region's single biggest increase service demands under the Affordable Care Act. ... The division expects a significant proportion of the region's population with substance abuse problems to be eligible for subsidized coverage, said Wayne Sugita, SAPC's deputy director (Stephens, 10/21).

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Editorials and Opinions

Viewpoints: 'Unforced Error' On Marketplace Website Raises Questions About Administration's Handling Of Health Issues; Obama's 'Desperate Sales Pitch;' GOP's Faux Concerns For Exchanges

USA Today: Healthcare.Gov Feeds Doubts About Rollout: Our View
Anyone who supports the plan to cover Americans who couldn't get health insurance has to hope the administration quickly gets it right. But you can't help but wonder: Where was all this frantic effort in the three-and-a-half years from the time Obama signed the health law to the day the exchanges opened on Oct. 1? Because that might have helped avoid the unforced error that is raising doubts about the administration's ability to manage other pieces of the complex law (10/21).

USA Today: White House: Health Law's More Than A Website
On Oct. 1, the Affordable Care Act's Marketplace -- a new way to apply for, browse and buy affordable health insurance plans -- opened for business. One way to buy these plans in many states is a new website, HealthCare.gov. As you've probably heard, it's not working as well as it's supposed to just yet. As President Obama said Monday, that's inexcusable. And he's fully focused on fixing the problem as soon as possible. But it's important to remember that the Affordable Care Act is much more than a website. Most Americans already have health insurance and won't need the Marketplace at all. Because of this law, they already have an array of new benefits and protections: Young people can stay on their parents' plans, seniors have new discounts on their prescriptions, and preventive care, such as mammograms and birth control, are free (Chris Jennings, 10/21).

Bloomberg: The President’s Anger Doesn't Fix Obamacare
In remarks this morning in the White House Rose Garden, President Barack Obama said HealthCare.gov, the website that is supposed to be the conduit through which people buy insurance under the new health-care law, "hasn't worked as smoothly as it was supposed to." That's a little like saying a plane that crashed into a mountain, caught fire and exploded didn't land as smoothly as it was supposed to. Three weeks into the most flagrant debacle of his presidency, Obama didn't say what went wrong, why or who was to blame. He offered no details about what the administration is doing to fix it ("We've got people working overtime"), or how long it will take. And he expressed no contrition, saying only that "Nobody's madder than me" (10/21).

The Washington Post: A Prescription For Fixing Obamacare Glitches
The first step in dealing with a problem is to admit that you have one. By that standard, President Obama began Monday to resolve the embarrassing computer malfunctions that marred the opening phase of the Affordable Care Act. The administration has been tardy in dealing with a brewing crisis that could undermine confidence in the program (10/21).

The Wall Street Journal: 1-800-ObamaCare-Denial
'More than a website" is the latest defense of the Affordable Care Act's painful rollout, and liberals are partly right. ObamaCare has larger ambitions than the basket case called Healthcare.gov and the 36 federally run insurance exchanges. But building the website was supposed to be the easy part. The health law's fiasco of a debut doesn't inspire confidence in those other ambitions, such as re-engineering how U.S. medicine is provided, but it does help explain the modern liberal project (10/21).

The Wall Street Journal: Vaporcare
"The Affordable Care Act is not just a website," President Obama said at the Rose Garden today. "It's much more." It's like a chamois, it's like a towel, it's like a sponge. Another way of putting it is that ObamaCare isn't just a technical failure. And it isn't just an economically unsustainable scheme. Now it's a rhetorical disaster too. Even by the standards of Obama speeches it was terrible. It was so bad, it was the ObamaCare website of political oratory (James Taranto, 10/21).

The New York Times: The Health Site's Chaotic Debut
President Obama rightly acknowledged on Monday that there is "no excuse" for the horrendously botched opening of the federal Web site consumers are supposed to use to sign up for health insurance policies under the Affordable Care Act. Unless the problems can be fixed soon, they threaten to undermine the ability of the health care exchanges to help enroll some seven million uninsured Americans in 2014 (10/21).

Los Angeles Times: President Obama Angry About ACA Glitches; Unbowed About Benefits
If anyone expected President Obama to be cowed, apologetic or remorseful Monday when he answered a barrage of criticism about the roll-out of the Affordable Care Act's website -- which even he  admitted "stank" -- they must have been very disappointed (Robin Abcarian, 10/21).

The Washington Post: Obamacare Needs A Doctor
For liberals, it is a cruel twist of history that Harry Truman's dream of universal health coverage, carried forward by generations of committed Democrats, should fall to the Obama administration for its fulfillment. Barack Obama seems to have adopted this cause in January 2007 as a last minute speech insert. "We needed something to say," one adviser told Politico. "I can't tell you how little thought was given to that thought other than it sounded good." Eventually, the Affordable Care Act was passed by a partisan vote, draining the law of legitimacy outside the Democratic Party. Over the next three years, Obama proved incapable of explaining Obamacare's virtues and its popularity fell. Then its implementation was entrusted to a Cabinet secretary, Kathleen Sebelius, who gratuitously alienated religious groups and massively bungled the law's rollout (Michael Gerson, 10/21). 

The Washington Post: In Obamacare Speech, Obama Makes A Desperate Sales Pitch
Not since the Ginsu knife cut through an aluminum can and still sliced a tomato has America seen a pitch quite like the one President Obama delivered in the Rose Garden on Monday. "The product is good. The health insurance that's being provided is good. It's high quality, and it's affordable," the president announced. "People can save money -- significant money -- by getting insurance that's being provided through these marketplaces" (Dana Milbank, 10/21). 

The New York Times’ Taking Note: Some Republicans Change Course On Health Care
Reince Priebus, the chairman of the Republican National Committee, never misses a chance to accuse President Obama of being a terrible leader. So it was inevitable that he would pronounce Mr. Obama’s Rose Garden speech today about problems with the federal health insurance Web site a sign of a "fundamental breakdown in leadership." But some Republicans are actually getting weary of their party's approach to the Affordable Care Act. Jeb Bush, the former governor of Florida, continued his pre-Presidential campaign by arguing that the G.O.P. made a huge mistake when it shut down the government in an attempt to dismantle the health law (Andrew Rosenthal, 10/21).

Bloomberg: Is Obamacare In A Death Spiral?
Another week has passed, which apparently means that it's time for another terrifying article from Sharon LaFraniere, Ian Austen and Robert Pear on the federal health care exchanges. … Time to panic? No. But it's time to prepare to panic. It sounds like the earliest anyone is projecting fixes is sometime in the middle of November (Megan McArdle, 10/21).

The New Republic: How Republicans Became Accidental Champions Of Obamacare
Yes, it is awfully rich that Republicans and conservative commentators, after doing their utmost to undermine the Affordable Care Act these past few years, are now carping about the serious flaws in the Web sites set up to process applications for health insurance coverage. While the administration bears responsibility for the technological problems, there is no question that odds for success would have been greater if it had not been denied the funding it needed to set up such a complex new system, if it had not had to handle the new insurance exchanges in so many states that refused to build their own, and if it had not had to delay stages of the exchange construction to avoid political opposition (Alec MacGillis, 10/22).

The Denver Post: Health Exchange Website Tests Administration's Credibility
President Obama was right Monday when he said "we did not wage this long and contentious battle [over the Affordable Care Act] just around a website. That's not what this was about." No, it was not. But the credibility of his administration does in fact now rest in part on whether the federally designed site used in 36 states to search and sign up for health insurance can be fixed in reasonably short order (10/21).

Fox News: I Was An ObamaCare Guinea Pig
I signed up. I saved. And so will millions of Americans. Honestly, I couldn't wait to sign up for ObamaCare -- not because I talk about it on television, but because I'm tired of being ripped off by my insurance company. I live in New York State -- which for several decades has had the highest individual insurance premiums in the nation. Three years ago when I was shopping for insurance, there weren't that many options to choose from. And the plan I ended up with is expensive and, to put it bluntly, crappy (Sally Kohn, 10/21).

The Milwaukee Journal Sentinel: Frustrated? Fix Obamacare Website's Problems
Obama did say "there's no excuse for the problems" and promised they will be fixed. He also pointed out that Obamacare is much more than a website and that applicants could still sign up via telephone or through the old-fashioned way, through a paper application. On that he's right: Despite the website's initial problems, the Affordable Care Act is still a huge step forward in health care insurance reform. But to realize its promise, people have to sign up, and if the website's problems continue, many could be discouraged from doing so. The president's words Monday at his Obamacare pep rally were heartening, but they won't mean much if the problems don't get fixed soon and if frustration over the system continues to grow (10/21).

The Boston Globe: A Better Way To Tackle Health Law
Instead of pointing out the very real and serious flaws in the new health care law, [politicians opposing the health law] repeat hyperbolic dubious claims: That the act is in the "realm of socialism." (Representative Steve King of Iowa.) That "individual liberty is gone." (Representative Louie Gohmert of Texas.) That Obamacare "is going to destroy America and everything in America." (Representative Paul Broun of Georgia.) Wouldn't it be better if, instead of mimicking a doomsday cult, these Obamacare opponents would highlight actual problems that really do exist? (Farah Stockman, 10/22). 

Los Angeles Times: How Obamacare Reduces Premiums For Some Without Subsidies
The launch of Covered California, the state's marketplace for health insurance, has prompted a new line of argument over the 2010 health care law among readers of The Times. Some supporters of the law say they've found lower prices for insurance through the new state exchanges; others (some of whom say their premiums are skyrocketing) insist that's impossible (Jon Healey, 10/21). 

Bloomberg: Saving Obamacare Without Congress
The failures of HealthCare.gov have reignited the question of whether and how the federal government should delay the penalty for not buying insurance. Here’s half an answer: If the administration of President Barack Obama opts for delay, a provision of the Affordable Care Act gives it the legal authority to do so, without turning to Congress (Nicholas Bagley & Austin Frakt, 10/21).

USA Today: Reform Medicare By Raising Eligibility Age
While all of the health policy attention has been focused on the Affordable Care Act's website problems, a long-term issue is being ignored -- the sustainability of the Medicare program. Baby Boomers might be slowing down, but as they age, the behind-the-scenes debate to reform Medicare is getting more vigorous. Some suggest that the glut of beneficiaries born 1946-64 -- what demographers call the "pig in the python" -- will pass and we can merely nip and tuck at the program's rising costs. In fact, the huge demographic bulge is being followed down the snake's gullet by something even larger: increasing life expectancy (Denis Cortese and Robert Smoldt, 10/21).

Los Angeles Times: Your Prescription History Is Their Business
Think you can keep a medical condition secret from life insurers by paying cash for prescription meds? Think again. A for-profit service called ScriptCheck exists to rat you out regardless of how diligent you are in trying to keep a sensitive matter under wraps. ScriptCheck, offered by ExamOne, a subsidiary of Quest Diagnostics, is yet another example of data mining -- using sophisticated programs to scour databases in search of people's personal information and then selling that info to interested parties (David Lazarus, 10/21).

CBS News: Obamacare Site: It Never Should Have Been This Bad
What caused the website problems? From the looks of it, long-standing architectural and design mistakes, a lack of an adequate testing, a wildly inadequate rollout strategy, political infighting, and the need to create the systems for 36 states that could not or would not build their own. When the massive problems appeared as the website opened, the administration blamed the results on higher-than-anticipated traffic, spinning that as a sign that the law was badly needed. The traffic excuse is not entirely unreasonable. Because so many states had opted out of building their own exchanges, the federal government had to pick up the slack. Few major transaction websites like an Amazon.com or Walmart.com go from nothing to massive popularity overnight (Erik Sherman, 10/21).

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The Kaiser Daily Health Policy Report is published by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation. (c) 2014 Kaiser Health News. All rights reserved.