Daily Health Policy Report

Wednesday, October 23, 2013

Last updated: Wed, Oct 23

KHN Original Reporting & Guest Opinion

Administration News

Health Reform

Capitol Hill Watch

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Online Insurance Brokers Stymied Selling Obamacare Policies

Reporting for Kaiser Health News, in partnership with NPR, Eric Whitney reports: "Consumers aren't the only ones frustrated by problems with the online health insurance exchanges being run by the feds. Private companies that sell health insurance on the Internet are also in a bind. Websites like eHealthInsurance.com that were planning to start selling new, subsidized Obamacare policies on Oct. 1 still can't offer them to customers" (Whitney, 10/22). Read the story.

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Oregon Experiment Puts Therapists On Primary Care Teams

Oregon Public Broadcasting’s Kristian Foden-Vencil, working in partnership with Kaiser Health News and NPR, reports: "The state of Oregon is trying some experiments to bring different kinds of medical professionals under the same roof. ... [A]nd the hope is it will provide better patient care, eventually at less cost to the state. This can make sense in a primary care setting, where doctors often have to deal with stomach aches and migraines that end up stemming from mental, rather than physical, problems" (Foden-Vencil, 10/22). Read the story.

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Capsules: In Some States, Most Early Marketplace Enrollees Qualify For Medicaid

Now on Kaiser Health News’ blog, Phil Galewitz reports: "Many of the uninsured are poor, and applicants don’t have to pay anything to sign up for Medicaid. Shoppers applying for private health coverage through the marketplace have to pay their first monthly premium before they are fully enrolled. Their first payment must be made by Dec. 15 for coverage to take effect Jan. 1. Most are expected to be eligible for some tax credits, up front, to help pay the monthly premiums" (Galewitz, 10/22). Check out what else is on the blog.

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Political Cartoon: 'Bad News Bears?'

Kaiser Health News provides a fresh take on health policy developments with "Bad News Bears?" by Jen Sorensen.

Here's today's health policy haiku:


Who ya gonna call?
Why, the glitch buster, of course.
He will make it work.

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

Defending Health Exchange's Rollout Puts Sebelius In Hot Seat

Health and Human Services Secretary Kathleen Sebelius is being called to Capitol Hill by Republican lawmakers who want her to explain what went wrong with the Oct. 1 unveiling of healthcare.gov. She is also facing calls for her resignation. Still, according to Politico, her job is safe.  

The New York Times: Sebelius Thrust Into Firestorm On Exchanges
Republicans insist the buck stops with the secretary. But although Ms. Sebelius runs the Department of Health and Human Services, the agency directly responsible for the health care law, there are questions about how deeply she was involved in the development of the troubled Web site (Stolberg, 10/22).

Politico: Upton Previews Sebelius 'Grilling'
The chairman of the House committee that plans to take testimony from Obamacare tech contractors Thursday previewed his questions today in an interview with a local radio station. "When did they know that it was going to be so poorly run? What answers do they have? Did they alert the administration that there were troubles early on?” said House Energy and Commerce Committee Chairman Fred Upton (R-Mich.) on Detroit’s WJR Radio. "There's going to be a ton of questions for them, and we’ll see how they respond" (Cheney, 10/22).

Politico: Marilyn Tavenner To Testify On Hill Next Week
The Obamacare grilling on Capitol Hill will continue. Marilyn Tavenner, administrator of the Centers for Medicare & Medicaid Services, will testify in front of the House Ways and Means Committee on Tuesday, Oct. 29, on implementation of the health law, POLITICO has learned (Haberkorn, 10/22).

Politico: Kathleen Sebelius: ACA Delay Wasn't An Option
Health and Human Services Secretary Kathleen Sebelius said delaying the launch of the insurance exchanges was "not really an option" — even though those building the federal website knew about major problems days in advance. "There are people in this country who have waited decades for affordable health coverage, people who are so eager for this to happen," Sebelius told CNN’s Sanjay Gupta on Tuesday night. "Waiting is not really an option" (Cunningham, 10/22).

The Wall Street Journal's Washington Wire: Sebelius: 'We Didn't Have Five Years' to Keep Testing Site
Health and Human Services Secretary Kathleen Sebelius said Tuesday that under ideal circumstances, the administration would have had more time to develop and test the online health-insurance marketplace that has been tripped up by technical troubles (Nelson, 10/22).

CNN: Sebelius: Obamacare Website Problems Blindsided The President
Kathleen Sebelius said President Barack Obama didn't hear that there may be problems with the signup portal for his signature healthcare law until it went live on October 1. That's when the site nosedived into a technical abyss. In an exclusive interview with CNN's Dr. Sanjay Gupta, the Health and Human Services secretary admitted that her department and the White House are displeased with the technically botched rollout. "No one could be more frustrated than I am and the president," she said (Botelho and Yan, 10/23).

The Hill: Sebelius: Obama Didn’t Know About Website Problems Beforehand
Kathleen Sebelius said Tuesday that President Obama had no prior knowledge of the problems that HealthCare.Gov would face upon its rollout. Speaking on CNN’s AC360, Sebelius was pressed on when the president learned about the technical issues surrounding the ObamaCare website. The Health and Human Services secretary said it “became clear" to the president "in the first couple of days,” but that Obama didn't know about the problems until after the Oct. 1 rollout (Easley, 10/22).

Politico: Why Kathleen Sebelius Is Safe
Kathleen Sebelius may be irreplaceable — in that she cannot be replaced. Not because President Barack Obama wouldn’t be able to find someone else to do the job, or that anyone’s too pleased with the launch of the Obamacare website. But the White House and Democrats on the Hill know a potential confirmation fight would be so torturous and difficult that they’re better off sticking with the Health and Human Services secretary they’ve got, despite all that’s gone wrong on her watch (Dovere, 10/23).

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The White House Names Zients To Be Healthcare.gov Fixer

Jeffrey D. Zients, who previously served as the Office of Management and Budget chief performance officer, is already a tested administration troubleshooter. 

The New York Times: Sebelius Names Administration Veteran To Lead Tech Repair Efforts
The Obama administration did not look far for someone to lead the so-called tech surge to fix its troubled health insurance Web site: Jeffrey D. Zients, a management trouble-shooter already in line to take over as the chief White House economic adviser on Jan. 1, until then will manage the effort to resolve the technical failures (Calmes, 10/22).

Los Angeles Times: White House Brings In Help To Fix Healthcare Website
A familiar troubleshooter has been enlisted to try to fix the government's health insurance website, administration officials said Tuesday, as political pressure piled up over the centerpiece of President Obama's healthcare law. Jeffrey Zients, a former acting director at the Office of Management and Budget, will assist the Department of Health and Human Services with "short-term advice, assessments and recommendations," White House spokesman Jay Carney said. Zients has served as the chief performance officer at OMB, a job aimed at improving government technology and efficiency (Hennessey, 10/22).

The Associated Press/Washington Post: Who Ya Gonna Call? Obama Calls Trusted Fixer To Work On Health Care Site’s Embarrassing Woes
When a federal program that promised cash rebates to people who traded in their clunkers for more fuel-efficient vehicles was overrun by demand, President Barack Obama assigned Jeffrey Zients, his deputy budget director, to help eliminate the backlog. When the same thing happened with sign-ups for an updated version of the GI Bill, one designed to help the 9/11 generation of veterans get a college education, Obama again turned to Zients for help (10/22).

The Wall Street Journal: Obama Turns To Fix-It Aide For Health Site
The move—the first shakeup of top personnel since the troubled rollout Oct. 1 of the federal government's HealthCare.gov website—comes a day after President Barack Obama acknowledged the site's poor functioning and said "nobody's madder than me" about it. Mr. Zients, who previously served as acting director of the Office of Management and Budget, will face a steep challenge in fixing the federally run marketplace, which is designed to offer health-insurance choices to those who can't get coverage from their employer or a government program in 36 states that have declined to run their own exchanges. The government has addressed some problems, including a technical flaw that had blocked most people from viewing their options, but others have emerged (Nelson and Radnofsky, 10/22).

USA Today: Health Care Website Problems Jeopardize Obama's Legacy
As his administration scrambles to fix the online enrollment process under the Affordable Care Act, President Obama is facing a challenge that threatens to undercut the most significant legislative victory of his presidency. The difficulty of the situation, and the pressing need to find a solution, was underscored on Tuesday when the White House announced that Obama has tapped Jeffrey Zients, a former deputy White House budget director who has helped the president fix other troubled government programs, to lead the embattled Department of Health and Human Services' effort to repair the online exchange (Madhani, 10/22).

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Obama Administration To Loyalists: Help Boost The Health Law

From the White House to YouTube, the administration is hoping to rally the troops who have supported the health law in the past.

Politico: White House Works To Flip Obamacare Narrative
The Obama administration is scrambling on multiple fronts to salvage the Obamacare web site and change the negative narrative for the president’s signature health care law. On Wednesday the CEOs of several health insurance companies will head to the White House to meet with adviser Valerie Jarrett and chief of staff Denis McDonough, two industry sources said (Haberkorn and Meyers, 10/23).

The Associated Press: Obama Appeals To Allies to Stick With Health Law
The Obama administration is appealing to its allies in Congress, on Wall Street and across the country to stick with President Barack Obama’s health care law even as embarrassing problems with the flagship website continue to mount. ... While the website has become an easily maligned symbol of a law that Republicans despise, Obama said it's important Americans realize that "Obamacare," with its various patient protections, is much more. "That's why I need your help," Obama told OFA's supporters. The group has been organizing a multitude of events and social media campaigns around the health care law's implementation. OFA said those efforts will continue, but the group isn't adjusting its strategy in response to the website's issues (Lederman, 10/23).

Los Angeles Times: Obama Calls On His Supporters To Join 'Team Obamacare'
Could the activists of the 2012 presidential campaign come to Obamacare's rescue? With the website for the nation’s new healthcare program mired in structural problems that could take weeks — if not months — to fix, President Obama appealed to his supporters in a video Tuesday to join "Team Obamacare" and help counter the law's critics (Reston, 10/22).

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Health Reform

Health Exchange Status Update: Two Key Fixes Will Take Longer Than Expected

Making the necessary repairs will likely take more talent and more offline time for the online marketplace. Meanwhile, a survey conducted by CBS found that very few Americans think the federal online insurance marketplace's launch has gone well.

The Washington Post: Two Key Parts Of Online Health Insurance Exchange Will Take Longer To Fix Than Expected
The Obama administration acknowledged Tuesday that two key parts of its online health insurance marketplace will take longer than expected to fix, even as it brought back a former senior White House official to help diagnose and correct the website's flaws. A senior health official said that the insurance exchange, HealthCare.gov, is still unable to perform one of its basic functions: making it easy for low-income Americans to enroll in Medicaid electronically. Days before the exchange opened three weeks ago, the administration said that feature was not ready but would be available by Nov. 1, at the latest (Eilperin and Goldstein, 10/22).

Bloomberg: Obamacare Site Needing Fresh Talent Added To Downtime
To repair its troubled health-care website, the Obama administration may need to add project workers with fresh talent, take portions of the system off line for days or weeks, and conduct more comprehensive tests to prevent crashes and delays, technology experts say (Wayne and Ricadela, 10/23).

The Richmond Times Dispatch: No Easy Fix For Health Insurance Website, Experts Say
David Evans believes drastic change would probably be the best way to solve problems with the federal government’s health insurance website. "Probably the right solution would be to scrap what has been done so far and start from scratch,” said Evans, a professor of computer science at the University of Virginia. "But it’s difficult to throw away hundreds of millions of dollars' worth of work. … It's hard for the federal government to operate like a startup company" (Hallman and Blackwell, 10/23).

Politico: Poll: 12% Say Obamacare Rollout 'Going Well'
Following the troubled rollout of the website behind Obamacare, very few Americans said the launch is going well, according to a new poll out Tuesday. Only 12 percent said the enrollment process on Healthcare.gov is going well, the CBS survey shows. Almost half of Americans say it isn't and 38 percent say they can’t evaluate (McCalmont, 10/22).

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Calif. Marketplace Under Fire For Not Providing Quality Ratings For Plans

News outlets look at a variety of issues that the state-run exchanges are facing.

Los Angeles Times: Lack Of Quality Ratings On Covered California Site Is Criticized
California's insurance exchange came under fire for its plan to withhold quality ratings of health plans until late 2015 while thousands of consumers shop for coverage under the federal healthcare law. The state exchange, Covered California, said Tuesday that it had reliable ratings on only four of the 12 participating health insurers primarily because their networks of doctors and hospitals have changed so much for new policies available next year (Terhune, 10/22).

Los Angeles Times: Selling Healthcare: Colorado Uses Beer Kegs, Golf Clubs And Bros
Most of the sales pitches being made for the new national healthcare plan have been along the lines of California’s earnest effort, using pictures of cherubic children in toy cars with taglines like "Preexisting conditions won't stop your kids anymore." Not so everywhere. In Colorado, the sales job is the province of, among others, "Rob, Zach and Sam, bros for life." They star in social media ads for Colorado's healthcare plan with the presumed detritus of bro life: beer kegs, those ubiquitous red beer cups, errant golf clubs (Decker, 10/22).

The CT Mirror: Obama Misspeaks About Connecticut Health Exchange
Obama was right in that nearly a third of the applicants in Connecticut's exchange who registered from the first day the exchange was open, Oct. 1, through Oct 15 (29 percent) were younger than 35. But more than 65 percent of those young applicants were signed up in Connecticut's Medicaid program and the Children's Health Insurance Program, another government-run health care plan for low-income families included in the state's HUSKY program. They did not "get a good deal at low cost" from private insurers in the exchange or help the exchange's  private insurers with their risk pools. In fact, according to information provided by Access Health CT at a board meeting last week, the age group with the most applicants during the first two weeks of operation were aged 55-64, the least desirable demographic for insurers (Radelat and Becker, 10/22).

The CT Mirror: Obamacare Challenge: Convincing The Uninsured Insurance Is Worth The Price
At Access Health CT, the state's health insurance exchange, the most common feedback in the early days of enrollment was, "It's too expensive. I can't afford it," chief operating officer Peter Van Loon said. "Price is the big one, and people don't like the price, which is kind of what we expected," Van Loon told a committee of the exchange's board earlier this month. Will those unhappy about the prices decide to seek exemptions or pay the penalty? Or will they ultimately decide having insurance is worth it and buy into the system? (Becker, 10/22).

Health Policy Solutions (a Colo. news service): Congressman Fights Sky-High Rates As Ski Town Signups Stall
Health insurance rates are so high in Colorado's mountain resort areas that U.S. Rep. Jared Polis plans to seek waivers from the federal government so people who skip buying insurance in 2014 won't face financial penalties. "We will be encouraging a waiver. It will be difficult for Summit County residents to become insured. For the vast majority, it's too high a price to pay," said Polis, D-Boulder. Health coverage guides working to enroll Summit County residents in new health plans through Colorado’s health exchange have been deeply disappointed. They have not enrolled a single new client since Colorado’s health exchange launched on Oct. 1 (Kerwin McCrimmon, 10/23).

Minnesota Public Radio: Dayton Talks MNsure, Mining And Light Rail Before Heading To Mayo
DFL Gov. Mark Dayton said the rollout of Minnesota's new health insurance exchange was not perfect, but given the complexity and scope of the project, Dayton said he believes it performed "phenomenally well." He said as of Monday, more than 18,000 people had created MNsure accounts, but it's too soon to say whether the program is a success. "It’s going to be a year before we really have a sense of the scope of public participation," he said (Pugmire, 10/22).

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Ohio Opponents Of Medicaid Expansion File Lawsuit

A group of six Ohio lawmakers, along with two anti-abortion groups, brought suit Tuesday, challenging a legislative board's move to approve that state's expansion of Medicaid under the health law. Other media outlets look at the estimated 5 million Americans who will go without insurance because their states are not expanding the federal-state program for the poor. 

The Associated Press: Ohio Opponents Of Medicaid Expansion File Lawsuit
Two anti-abortion groups and six Republican lawmakers in Ohio sued the state Tuesday over a move by a legislative board to fund an expansion of the Medicaid health program. Gov. John Kasich's administration brought the funding request to the state's Controlling Board, bypassing the full Legislature (Sanner, 10/22).

Bloomberg: Ohio Medicaid Expansion Challenged In Lawsuit
Ohio Governor John Kasich's plan to expand Medicaid under President Barack Obama’s health-care overhaul, approved yesterday by a state legislative panel, was challenged in a lawsuit brought by a group of Ohio lawmakers. Six Republican state representatives, joined by anti-abortion organizations based in Cleveland and Cincinnati, filed the complaint challenging the panel's action today at the state's Supreme Court in Columbus (Harris, 10/22).

NPR: States' Refusal To Expand Medicaid May Leave Millions Uninsured
President Obama Tuesday appointed one of his top management gurus, Jeffrey Zeints, to head the team working to fix what ails Healthcare.gov, the troubled website that's supposed to allow residents of 36 states enroll in coverage under the Affordable Care Act. But even if the team gets the website working as it should, millions of Americans may still log on to discover that they aren't eligible for any health coverage at all. And that won't be due to any technical glitch. It's because their state has decided not to expand its Medicaid program (Rovner, 10/23).

Kaiser Health News: Capsules: In Some States, Most Early Marketplace Enrollees Qualify For Medicaid
Many of the uninsured are poor, and applicants don't have to pay anything to sign up for Medicaid. Shoppers applying for private health coverage through the marketplace have to pay their first monthly premium before they are fully enrolled. Their first payment must be made by Dec. 15 for coverage to take effect Jan. 1. Most are expected to be eligible for some tax credits, up front, to help pay the monthly premiums (Galewitz, 10/22).

St. Louis Beacon: Medicaid Coverage Gap Will Affect More Than 5 Million Americans, Including 193,000 In Missouri
By Missouri's refusal to expand its Medicaid program, more than 193,000 adults in the state will find themselves stuck in a coverage gap, come Jan. 1. These are uninsured adults who make too much money to qualify for Medicaid but too little to be eligible for the government subsidies that discount the price of private health insurance (Joiner, 10/22).

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Judge Allows Obamacare Subsidies Lawsuit To Proceed, But Stops Short Of Imposing Injunction

A federal judge Tuesday allowed a legal challenge against the health law's insurance price subsidies to go forward, but stopped short of imposing an injunction that would have halted the subsidies until the legal matter is resolved. At issue is a challenge to how the Obama administration determines who gets what subsidies and the related tax penalties.

The New York Times: Judge Allows Legal Challenge Of Law To Continue
A federal judge cleared the way on Tuesday for consumers to challenge President Obama’s health care law on the grounds that the federal government cannot legally provide subsidies to people who buy insurance through the exchange run by it. The judge, Paul L. Friedman, of Federal District Court here, said that four individuals could pursue their lawsuit challenging the Obama administration's interpretation of a provision of the law that defines who is eligible for subsidies (Pear, 10/22).

The Wall Street Journal: Judge Allows Suit Challenging Health-Law Subsidies
The mixed ruling means the Obama administration will have to mount a full defense of the law's subsidy provisions in a Washington, D.C., federal court. Challengers had sought a preliminary injunction to block subsidies immediately for those who buy health insurance through federally run online exchanges. Such an injunction could have dealt a considerable blow to the administration at a sensitive time, as U.S. officials continue to fight technical difficulties with a federally run website (Kendall, 10/22).

Politico: Challenge To Affordable Care Act Subsidies Advances
D.C. District Judge Paul Friedman has allowed a case challenging the federal government's authority to give out premium subsidies on the federal exchanges to go ahead but has denied a request for a preliminary injunction to block the subsidies from flowing. Friedman denied on standing grounds the government's motion to dismiss the case, saying that four individual plaintiffs in Halbig v. Sebelius have standing to sue over the IRS rule allowing insurance subsidies to be awarded (Cunningham, 10/23).

Reuters: Judge Declines To Halt 'Obamacare' Insurance Subsidies
Foes of President Barack Obama's healthcare law lost a bid on Tuesday to put an immediate stop to a key part of the law -- the insurance subsidies in the 34 U.S. states that declined to establish their own online marketplaces. At a court hearing, U.S. District Judge Paul Friedman in Washington, D.C., declined to grant a preliminary injunction sought by a group of individuals and small businesses that in a lawsuit call the subsidies unlawful (Ingram and Drawbaugh, 10/22).

CNN: Fed Judge Allows Case Challenging ObamaCare Penalties To Continue 
A federal judge on Tuesday allowed a case to go forward challenging the constitutionality of imposing tax penalties under ObamaCare on those who fail to buy health insurance. Judge Paul Friedman denied a Justice Department request to have the case dismissed, in making the ruling in the U.S. District Court for the District of Columbia. Separately, the judge denied a request by the plaintiffs to get a preliminary injunction to stop subsidies through the Obamacare insurance exchanges in 34 states. Friedman said the plaintiffs had not proven "irreparable harm" by either taking the insurance with the subsidy or paying the penalty (10/22).

Fox News: Jay Sekulow: ObamaCare Lawsuits Could Reach Supreme Court 
A federal judge's decision to allow a case to go forward that challenges the constitutionality of Obamacare's tax penalties could signal trouble for the President's signature law, Jay Sekulow, chief legal counsel of the American Center for Law and Justice and the attorney at the center of the case, told Megyn Kelly Tuesday. "What's at stake is the IRS taking on a broader scope of what it's allowed to regulate or impose," Sekulow said on "The Kelly File" (10/23).

In news regarding other pending legal challenges --

The Associated Press: Hobby Lobby Asks Supreme Court To Rule On Health Care Law
Lawyers for Hobby Lobby asked the U.S. Supreme Court on Monday to take up the company's lawsuit against the federal health care law's requirement that coverage include access to the morning-after pill. Lawyers for the Oklahoma City-based craft store chain and its sister company, Mardel Christian bookstore, asked the U.S. Supreme Court to take up the case because of what they say are conflicting decisions by other courts regarding religious freedom (10/22).

Meanwhile, legal experts are eyeing the web site problems as another potential point for lawsuits --

Politico: Obamacare Site  Could Mean Legal Fights
If the Obamacare enrollment website seems like a tangled mess, just wait for the lawsuits. The potential for a morass of litigation over who’s responsible for the problems that have plagued the rollout of President Barack Obama’s signature health care law is significant, government procurement experts say (Gerstein, 10/23).

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Little Evidence Obamacare Is Costing Full-Time Jobs

Reuters and The Wall Street Journal challenge the notion, based on recent jobs data, that the health law is causing an erosion of full-time work. Other media outlets look at the endangered status of new insurance co-ops funded by the law, the high price of many prescription drugs and concerns about the people enrolled in high-risk insurance pools that will close at the end of the year.

The Wall Street Journal: Part-Time Work Still Up, But Health Law Isn't The Cause
Millions of Americans remained stuck in part-time jobs in September, but there's little evidence to support claims that the federal health care law is to blame. Part-time employment rose during the recession and remains far above historical norms. Critics of the 2010 Affordable Care Act have suggested the trend could be due to its provision that requires many companies to offer health insurance to full-time employees beginning in 2015. That rule, critics argue, provides companies with an incentive to hire part-timers -- and some employers have said they are already shifting to part-timers. But recent jobs data provide little evidence that's happening(Casselman, 10/22).

Reuters: Analysis: Little Evidence Yet That Obamacare Costing Full-Time Jobs
There is little evidence that employers are sacrificing full-time jobs by hiring more part-timers or reducing existing employee hours because of the costs of providing health coverage under Obamacare. Conservative Republicans have pointed to the high level of part-time employment as evidence businesses are cutting hours for staff in response to the new healthcare law, which will require them to offer health insurance to full-time workers. ... But there is little discernible impact in the employment figures released in recent months, including the September numbers out on Tuesday (Lange, 10/22).

The Washington Post: Health Co-Ops, Created To Foster Competition And Lower Insurance Costs, Are In Danger
When the new health-care law was being cobbled together, Congress decided to establish a network of nonprofit insurance companies aimed at bringing competition to the marketplace, long dominated by major insurers. But these co-ops, started as a great hope for lowering insurance costs, are already in danger (Merkon, 10/22).

The New York Times: As Drug Costs Rise, Bending the Law Is One Remedy
The high price of many prescription drugs in the United States has left millions of Americans telling white lies and committing fraud and other crimes to get their medicines. In response to a New York Times article about the costs, hundreds of readers shared their strategies, like having a physician prescribe twice the needed dose and cutting pills in half, or "borrowing" medicines from a friend or relative with better insurance coverage. But an increasingly popular -- though generally illegal -- route is buying the drugs from overseas (Rosenthal, 10/22).

Kaiser Health News: Online Insurance Brokers Stymied Selling Obamacare Policies
Consumers aren't the only ones frustrated by problems with the online health insurance exchanges being run by the feds. Private companies that sell health insurance on the Internet are also in a bind. Websites like eHealthInsurance.com that were planning to start selling new, subsidized Obamacare policies on Oct. 1 still can't offer them to customers (Whitney, 10/22).

Politico: With High-Risk Pools Closing, Some Could Be In Limbo
The heads of state-run high-risk insurance pools are worried that Obamacare's troublesome launch could cause tens of thousands of people with pre-existing conditions -- the very people supposed to be protected by the law -- to become uninsured Jan. 1. At least a third of 35 state-run high-risk pools for people whose medical conditions made it nearly impossible for them to find coverage will close at the end of the year, and a large swath is expected to shop for subsidized coverage on new health insurance exchanges. Temporary federal-run high-risk pools covering about 105,000 people will also shut down at the end of the year, leaving those enrollees to seek out new coverage (Millman, 10/22).

The Hill: Obamacare To Raise Premiums Dramatically For Some Young Women
Many younger women who purchase coverage individually will see triple-digit increases in their health care premiums under ObamaCare, according to an analysis released Wednesday. The conservative American Action Forum (AAF) found that on average, a 30-year-old woman who does not smoke and buys health insurance on the individual market will see her cheapest available premium increase 193 percent (Viebeck, 10/23).

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Capitol Hill Watch

Democratic And Republican Lawmakers Alike Are Anxious For Health Law Briefings

As a senior White House official heads to Capitol Hill to brief House Democrats on the health law's implementation -- especially the troubled rollout of healthcare.gov, Republicans want the same opportunity.

The Washington Post: Senior HHS Official To Brief Democratic Lawmakers Wednesday On Obamacare
Mike Hash, who directs the Office of Health reform at the Department of Health and Human Services, will brief House Democrats Wednesday about implementation of the Affordable Care Act. The closed-door session, which will start at 8:50 a.m., marks the first time the administration will have briefed members of Congress on the online enrollment system since its troubled rollout on Oct. 1 (Eilperin, 10/22).

Politico: House GOP Want Obamacare Briefing 
House Democrats are set to be briefed on Obamacare implementation on Wednesday morning, but Republicans say they haven't been offered the same opportunity and are asking for a similar meeting in the days to come (Epstein, 10/22).

McClatchy: Republicans Want Equal Briefing On Embattled Health Care Law
House Republicans are asking for an invite of their own to a health care law briefing that the White House has arranged for House Democrats. The Washington Post reports that Mike Hash, who directs the Office of Health reform at the Department of Health and Human Services, will brief House Democrats Wednesday. "The closed-door session, which will start at 8:50 a.m., marks the first time the administration will have briefed members of Congress on the online enrollment system since its troubled rollout on Oct. 1," the Post says (Clark, 10/22).

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Sen. Rubio Readies Bill To Delay Insurance Mandate Penalty

Sen. Marco Rubio is proposing a bill that would delay imposing penalties on people who don't have health insurance until six months after the Government Accountability Office has certified the federal website is functional. Sen. Jeanne Shaheen, a New Hampshire Democrat, is calling on President Obama to extended open enrollment beyond March 31, 2014 and to waive penalties for those who are unable to sign up because of technical problems.

The Associated Press/Washington Post: Rubio Introducing Bill To Delay Health Care Penalty Amid Sign-Up Difficulties
Sen. Marco Rubio says he'll introduce legislation to delay the penalty that can be assessed on individuals who don't buy insurance under the government's new health care law. The Florida Republican says people should not be punished for not buying the insurance when major technical problems have plagued the online sign-up process. Uninsured Americans have until about mid-February to sign up for coverage if they are to meet the law's requirement that they be insured by the end of March. If they don't, they will face a penalty (10/22).

Politico: Marco Rubio Bill Would Delay Obamacare 
Rubio also hit the Obama administration for a lack of transparency on Obamacare, saying the White House is withholding information so people won't see the "ugly things" of the law (McCalmont, 10/22).

CBS News: Marco Rubio: Postponing Obamacare Mandate A "Prudent Approach"
Sen. Marco Rubio, R-Fla., says he will introduce a bill to postpone the Affordable Care Act individual insurance mandate until HealthCare.gov is fixed. He called effort to postpone the Obamacare measure a "prudent approach." On "CBS This Morning," he said, "It's unfair to punish people for not purchasing a product that they can't purchase right now because of the technology that's in place, the website they're supposed to buy it on -- by the president's own admission -- is not working (Cochran. 10/22).

The Wall Street Journal's Washington Wire: Democratic Senator Suggests Extending Health Deadlines
Sen. Jeanne Shaheen, a Democrat from New Hampshire, on Tuesday told the White House that individuals shouldn't face penalties for failing to buy health insurance if technical problems with the new federal health-care website prevent them from signing up for an insurance plan (Hughes, 10/22).

CNN: Democratic Senator Asks Obama To Delay Obamacare Deadline 
New Hampshire Sen. Jeanne Shaheen joins the growing ranks of Republicans asking the President to extend open enrollment under Obamacare. The only difference is that she is a Democrat. "As website glitches persist, we are losing valuable time to educate and enroll people in insurance plans," writes Shaheen. "I also fear that people that have tried, and failed, to enroll online may become frustrated and not return to the website to try again at a later date. ... Allowing extra time for consumers is critically important so they have the opportunity to become familiar with the website, survey their options and enroll” (Finnegan, 10/22).

Politico: Shaheen Calls For Open Enrollment Extension
Democratic Sen. Jeanne Shaheen is calling on the White House to extend Obamacare's open enrollment period amid continued frustration with the troubled Healthcare.gov. "The difficulty that people in New Hampshire and in other states that are relying on the federally facilitated marketplaces are experiencing is incredibly frustrating and disappointing," Shaheen wrote in a letter to President Barack Obama. "For over three years, we have been waiting for the creation of the health insurance exchanges, which now in their fourth week of existence, are riddled with problems." She is also asking the administration to clarify whether Americans will get fined for not getting insurance when the site is not working properly (Haberkorn, 10/22).

In other Capitol Hill news --

Politico: Hill Staffers A Potential Boon For DC Exchange
District of Columbia insurance officials who have long worried about how many people would sign up for health coverage get a surprise bonus next month: a slew of Congress members and staffers. Three weeks from now, about 15,000 Hill aides and their bosses will be eligible to sign up through the small-business or SHOP exchange offered by the D.C. Health Link. Not all will enroll — some are on a spouse's plan or have Medicare. But those who do will most likely be disproportionately young and healthy, reflecting the Capitol Hill workforce — exactly the kind of customers the insurance pool wants and needs (Cunningham, 10/23).

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State Watch

State Highlights: Cuccinelli Blasts Health Law, Sebelius To Gain Ground In Va. Governor's Race

A selection of health policy stories from Virginia, New York, California, Oregon, Michigan, Texas and Georgia.

The Washington Post: Cuccinelli Teams With Paul Ryan To Rip New Health Care Law
Virginia's Republican candidate for governor, Ken Cuccinelli II, sought to make up lost ground in his campaign on Tuesday by again spotlighting the bug-filled launch of Obamacare and teaming with a nationally known conservative. This time it was Rep. Paul Ryan (R-Wis.), who shared a telephone press conference with Cuccinelli to bash the Affordable Care Act and warn that Terry McAuliffe (D) has bet his agenda on expanding Medicaid in Virginia under the federal health-care law (Kunkle, 10/23).

The Richmond Times Dispatch: Cuccinelli Calls For Obama To Fire Sebelius Over Health Care Rollout
Republican gubernatorial candidate Ken Cuccinelli also called for Congress to back legislation delaying the individual mandate provision of the law by one year. Exemptions have already been provided to large employers affected by the act. “President Obama put Kathleen Sebelius in charge of implementing a bad policy that is already having disastrous consequences as it intrudes upon our fundamental liberties and significantly exacerbates the uncertainty already felt by job creators in Virginia and around the country,” Cuccinelli said in a copy of prepared remarks distributed to reporters (Nolan, 10/22).

The Associated Press/Wall Street Journal: Poll: NY Residents Divided Over Health Care Law
A new poll has found more New York state residents who favor moving ahead with the new health care law than those who want to repeal it. A Siena poll released Tuesday found 43 percent of respondents saying they want to see the law go forward. Another 32 percent say the law should be put on hold until it's workable and affordable and 22 percent want it repealed (10/23).

California Health Report: Cuts To Medi-Cal Threaten Access to Care
Medi-Cal, the Medicaid program for 8.5 million impoverished Californians, will greatly expand with the implementation of the Affordable Care Act next year. But even as the state Department of Health Care Services prepares to accept an estimated 1.1 million newly-eligible people into the program, California is reducing its payments to many doctors and pharmacies by at least 10 percent. That’s bringing warnings it may be increasingly difficult to find health-care providers willing to serve Medi-Cal patients (Richard, 10/23).

Los Angeles Times: L.A. Leaders Fight Ballot Measure To Create City Health Agency
City Hall and Los Angeles County elected leaders are warning that if voters pass a June ballot measure that forces the city to create its own health department, it will increase costs and erode essential services now provided by the county. But the officials find themselves in a quandary: Although they vehemently oppose the measure, state law blocks them from publicly financing an opposition campaign (Mehta, 10/22).

Kaiser Health News: Oregon Experiment Puts Therapists On Primary Care Teams
The state of Oregon is trying some experiments to bring different kinds of medical professionals under the same roof. Medicaid patients can see different kind of doctors in one visit, and the hope is it will provide better patient care, eventually at less cost to the state. This can make sense in a primary care setting, where doctors often have to deal with stomach aches and migraines that end up stemming from mental, rather than physical, problems (Foden-Vencil, 10/22).

The Associated Press: Retirees File Suit Against Health Care Plan Cuts
Attorneys for a committee representing retired Detroit municipal employees and other unions filed a lawsuit Tuesday in federal court to stop health care benefits cuts imposed by the city's state-appointed emergency manager and slated to go into effect Jan. 1. The suit in U.S. District Court in Detroit asks a judge to issue an injunction and seeks a jury trial (Williams, 10/22).

The Texas Tribune: Court Battle Continues Over TX Abortion Regulations
Abortion providers and state attorneys will present their final arguments Wednesday morning on whether the restrictions on the procedure in House Bill 2 are constitutional. … The plaintiff's final witness, Amy Hagstrom Miller, founder and CEO of Whole Woman's Health, countered the state's claim that providers could expand their ability to perform abortions by recruiting new doctors with active hospital admitting privileges (Aaronson, 10/22).

California Healthline: State Opens Adult Day Services Dialogue
Two state agencies -- the Department of Health Care Services and the Department of Aging -- tomorrow will convene the first stakeholder meeting in a new process designed to extend the CBAS program beyond the expiration date of the legal precedent that established it. The Darling v. Douglas settlement officially ends in August 2014. The state is exploring the idea of reworking its federal 1115 Medicaid waiver to include CBAS care as a Medi-Cal managed care benefit. That means altering the transitional terms and conditions created when the program changed from Adult Day Health Care to the CBAS program (Gorn, 10/22).

Georgia Health News: Hospitals, Nursing Homes Fear Provider Fee Cuts
As the fiscal standoff intensified last month, the Republican House leadership at one point pushed repealing such Medicaid provider assessments, including those for nursing homes, according to hospital industry officials. Other speculation has centered on the feds lowering the provider tax rates that a state can use to gain extra dollars for Medicaid. That’s why local hospital and nursing home groups, along with their national associations, have recently sounded alarms over possible federal attempts at changing these assessments (Miller, 10/22).

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Editorials and Opinions

Viewpoints: 'Elementary Errors' In Insurance Exchange; Problems Could Lead To Insurance Pool Imbalance; Recalcitrant Govs Could Have Made Obamacare Launch Better

The New York Times' Taking Note: Did Basic Errors Create The Health Insurance Mess?
Clearly, the government picked the wrong people to manage this project and it was a terrible decision to fragment it among so many contractors. Anyone who’s ever been involved in creating a new computer application knows that you don’t just assemble the thing and then see if it works. You’re supposed to test the components, obsessively, along the way (Andrew Rosenthal, 10/22).

The New York Times: How To Fix The Glitches
What went wrong? My diagnosis is that there were three big mistakes. First, the Obama administration acted too slowly. It waited too long to release specific regulations and guidance on how the exchange would work. It also waited too long to begin building the physical Web site (Dr. Ezekiel J. Emanuel, 10/22). 

Los Angeles Times: Saving Obamacare From The Website Disaster: A Smart Proposal
With dire reports of the Obamacare website's dysfunction rising by the hour--and the deadlines for signing up for insurance moving nearer by the day--the question on everyone's lips is: Has the time come to delay the individual mandate? Health economists Nicholas Bagley and Austin Frakt say no. But they do have a workable plan for saving Obamacare from the website's meltdown. Here's the best news: It doesn't require action by Congress (Michael Hiltzik, 10/22).

The Wall Street Journal: The ObamaCare Con Job
With enough time and unlimited resources, the government can invent the atom bomb or deliver men to the moon with 1960s technology. Fixing the exchange websites, though, won't fix the fact that ObamaCare depends on noneconomic enthusiasm to drive enlistment of people for whom ObamaCare is an objectively bad deal—the "marks" in grifter terminology. The mandate is too weak (Holman W. Jenkins Jr., 10/22). 

Bloomberg: Press 4 If You're Madder Than Obama About Obamacare
Please listen carefully as our menu options have changed. Press 1 if failure is not an option. President Barack Obama pressed the wrong button. He got the Affordable Care Act passed and then rested on his laurels. How sad to see our tech-savvy commander in chief, who blew billions on a website that is worse than any state’s DMV, direct frustrated consumers to a 1-800 number, like an infomercial host on late-night cable (Margaret Carlson, 10/22).

The Fiscal Times: How To Know If Obamacare Has Failed
Let's take the president at his word and assume the website problems get sorted out, and fairly soon. How will Americans know if Obamacare is a success or failure? Here are four benchmarks (John F. Wasik, 10/23).

The Seattle Times: No Excuses, Make Affordable Care Act Sign-Up Work
The successful launch of the Washington Health Benefit Exchange in Olympia stands in sharp contrast to the high-tech turmoil in the other Washington. ... The launch of our state’s system had the support of lawmakers and the governor. All that helps. But the Healthplanfinder website was also designed to be easy to use, with access and review like a familiar online-shopping experience.The federal system needs to be mindful of its customers and match consumer expectations (10/22).

The Milwaukee Journal Sentinel: Gov. Scott Walker's Obamacare Mistake 
Republican governors who oppose Obamacare, such as [Gov. Scott] Walker, didn't do their constituents any favors by shoving them onto the federal system (and then complaining loudly when it was overwhelmed). Wisconsin officials could have created a state exchange every bit as good as Kentucky's, where the governor says things are running smoothly. Instead, thanks in part to Walker's intransigence, Wisconsinites are stuck in the same line as the rest of the country. (10/22).

The Milwaukee Journal Sentinel: The Obamacare Rollout 'Glitch' Is Really A Disaster
Even Obama has called the rollout of the program — which passed Congress three years ago — "unacceptable." But Obamacare's supporters still say that this website fiasco shouldn't reflect poorly on other aspects of the program, which will aid people in getting health care. Apparently they believe that when literally the most important part of the program goes belly up, we should not look upon the remaining aspects of Obamacare with suspicion (Christian Schneider, 10/22).

The Wall Street Journal: ObamaCare 2016? Happy Yet?
Three years after the disastrous launch of the Affordable Care Act, most of the website troubles finally have been ironed out. People are now able to log on to the government's ACA website and to most of the state health-insurance exchanges. The public has grudgingly come to accept higher insurance premiums, new taxes and increases in part-time workers who were formerly full-time. But Americans are irate anyway—because now they're seeing the health-care law's destructive effect on the fundamental nature of the way their care is delivered (Bradley Allen, 10/22).

The New York Times' Economix: The Power Of The Individual Mandate
The Affordable Care Act has at least two provisions to make insurance cheaper to workers who have so far been uninsured, compared with what employer insurance would have cost them in previous years. ... The first provision is the "individual mandate penalty" for being uninsured, which will eventually reach the greater of 2.5 percent of husband-and-wife income, or $695 per uninsured family member (up to three, with uninsured children counting half, and the $695 indexed to inflation). ... The law’s premium assistance tax credits are another provision that makes insurance cheaper (Casey B. Mulligan, 10/23).

Los Angeles Times: Judge Allows Attack On Obamacare To Continue
[I]n addition to an attack on the employer mandate (which the administration has delayed until 2015), the case is a clever attempt to re-litigate the individual mandate. If the plaintiffs prevail, though, they wouldn't actually eliminate the requirement that adult Americans carry insurance. Instead, they would leave millions of lower-income Americans struggling to afford the coverage they have to buy -- and that they may need (Jon Healey, 10/22).

The Washington Post: Democrats Own Health Care
Fox News’s Sean Hannity, that paragon of journalistic integrity, hosted six "average Americans" on his show this month who were "feeling the pain" of Obamacare. One was Paul Cox, who runs a North Carolina construction business and complained that the new law prevented him from hiring full-time employees because he would have to provide health insurance to anybody working more than 30 hours a week. ... Salon's Eric Stern called Cox, and he found that Cox's business has only four employees — and therefore is not affected by the new requirement, which applies to businesses with 50 or more workers (Dana Milbank, 10/22).

USA Today: Technology Could Save Us From Obamacare
While we're a long way from the "autodocs" featured in some science fiction stories, the proliferation of devices that can do extensive blood tests and diagnostic workups doesn't seem that far away. Neither does the creation of freestanding gadgets that can diagnose things such as strep throat and other staples of doc-in-a-box or nurse-in-a-box practices now. While such devices will be expensive at first, they're likely to get steadily cheaper and more capable because, as electronic gadgets, they'll benefit from Moore's Law, the steady increase in computing power (Glenn Harlan Reynolds, 10/22). 

The New York Times' Evaluations: Why Not Medicaid For All?
My Sunday column on the potential consequences of Obamacare's botched rollout ended by sketching a scenario in which the program's Medicaid expansion is deemed a success while its reform of the individual market leads to much-higher-than-expected costs and much-lower-than-expected participation rates. ... This wouldn’t amount to the full-on push for single payer that some people expect from the left if Obamacare fails or gets repealed, but it would move the U.S. toward the closest thing to single payer that we’re ever likely to get  (Ross Douthat, 10/22). 

The Wall Street Journal: Medicaid And The Apostle Kasich
Believe it or not, there are still a few disciples with faith in an ObamaCare higher power, and one of them happens to run Ohio. Governor John Kasich is so fervent a believer that he is even abusing his executive power to join the Affordable Care Act's Medicaid expansion. Not to be sacrilegious, but the Republican used to know better  (10/22).

The New York Times' Economic Scene: New Front In The Fight With Infant Mortality 
Pregnant women, across the country and anywhere along the income spectrum, will for the first time [under the health law] have guaranteed access to health insurance offering a minimum standard of care that will help keep their babies alive. The benefit may seem narrow. But it offers the best opportunity in a generation to tackle one of the United States’ most notorious stigmas: an intractably high infant mortality rate that hardly fits one of the richest, most technologically advanced nations on earth (Eduardo Porter, 10/22). 

And on other issues --

Bloomberg: The Ozone Treaty That Banned Your Asthma Inhaler
The Food and Drug Administration has outlawed the only over-the-counter asthma medicine in the U.S. It has also banned a number of other asthma medicines that patients like and that doctors have prescribed for them. ... Why does it ban asthma medicines? The answer lies in the Montreal Protocol, a treaty the U.S. ratified in 1988. Strongly supported by President Ronald Reagan, the Montreal Protocol was designed to phase out chlorofluorocarbons and other substances that deplete the ozone layer (and thus increase the risk of skin cancer and cataracts) (Cass R. Sunstein, 10/22).

Journal of the American Medical Association: Eliminating Prevention Counseling To Improve HIV Screening
In an era of shrinking resources, clinicians and policymakers cannot ignore data that inform efficient clinical practice. Maximizing identification of individuals with undiagnosed HIV infection and reducing viral transmission will require consistent and extensive HIV testing with emphasis, for those identified with HIV infection, on linkage to care, treatment, and adherence. ... prevention counseling in conjunction with HIV testing is not effective and should not be included as a routine part of practice (Drs. Jason S. Haukoos and Mark W. Thrun, 10/22).

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Stephanie Stapleton

Andrew Villegas

Lisa Gillespie
Shefali Luthra

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