Daily Health Policy Report

Thursday, October 24, 2013

Last updated: Thu, Oct 24

KHN Original Reporting & Guest Opinion

Administration News

Capitol Hill Watch

Health Reform

State Watch

Weekend Reading

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Consumers Who Sign Up For Health Coverage By March 31 Will Avoid Penalties Under New Obama Administration Plan

Kaiser Health News staff writer Mary Agnes Carey reports: "The Obama administration said Wednesday that it would delay imposing penalties for six weeks on some consumers who might have been caught in a sticky timing problem for enrolling in coverage through the health law’s new insurance marketplaces. Those marketplaces, also known as exchanges, have come under intense scrutiny since opening on Oct. 1 because the technology has malfunctioned. But the White House is not linking this change of policy to website problems" (Carey, 10/23). Read the story.

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Are Federal Call Centers Up To The Task Of Enrolling Millions In Health Plans?

Kaiser Health News staff writer Phil Galewitz reports: "An elderly man calls to ask if the land he owns will count as income to qualify for health coverage through Medicaid. A legal immigrant asks if she can sign up for a health plan through the state’s online insurance marketplace. A broker wants help to become certified to start selling coverage. It’s 10 a.m. Monday inside the call center of Connecticut’s new insurance exchange established under the federal health law. On the 21st floor of the downtown Prudential Building, about 25 operators in blue shaded cubicles are talking on telephone headsets while a dozen more callers wait on hold" (Galewitz, 10/24). Read the story.

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Health Law Brings Changes In How Therapists Do Business

Kaiser Health News staff writer Sarah Varney, working in collaboration with NPR, reports: "In the corporate world of American health care, with its consolidating hospital chains and doctors’ groups, psychologists and other mental health therapists are still mostly Mom-and-Pop shops; they’ve built solo practices, hanging their own shingles, not unlike Lucy in the Peanuts gang: 'Psychiatric Help 5¢, The Doctor Is In.' But that business model is shifting from solo practices toward large medical groups, say mental health experts" (Varney, 10/24). Read the story.

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Capsules: Study: Low-Income Californians Want Better Information; Navigators Tread Water As Website Problems Continue; A View From The States: Health Care Continues Stumbling Startup

Now on Kaiser Health News’ blog, Ankita Rao reports on the quality of health care information that low-income Californians seek: "For many low-income Californians, enrolling in health insurance is just one hurdle to overcome in getting the care they want. A new report says better communication with doctors and obtaining clearer information is also high on their wish lists" (Rao, 10/23).

Also on Capsules, Jenny Gold writes about how "navigators" are handling health care website problems: "Navigators in states relying on the flawed federal exchange healthcare.gov are focusing on bolstering excitement and education about the law as they wait for fixes to the website" (Gold, 10/24).

Also on the blog, an update of how states are dealing with the early troubles of their health exchanges: "States are making some progress getting customers signed up for health insurance. But it isn’t pretty. Here is a roundup of dispatches from KHN’s radio partners at NPR member stations" (10/24). Check out what else is on the blog.

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Political Cartoon: 'Sacked?'

Kaiser Health News provides a fresh take on health policy developments with "Sacked?" by Gary Varvel.

Here's today's health policy haiku:


Feds have exchange mess.
Exchange the developers?
That might resolve it.
-Beau Carter

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

White House To Give Consumers Extra Time To Buy Coverage Before Facing Penalty

The Wednesday announcement gave people an extra six weeks -- until March 31 -- to comply with the health law's requirement that they enroll in a health plan. 

The New York Times: White House To Tweak Tax-Penalty Deadline
The Obama administration said Wednesday that people who obtained health insurance by March 31 would not face any tax penalties for being uninsured in the first three months of 2014. Under President Obama’s health care law, most Americans will be required to have insurance next year, and they may be subject to tax penalties if they go without coverage (Pear, 10/23).

The Washington Post: Americans Will Have An Extra Six Weeks To Buy Health Coverage Before Facing Penalty
The Obama administration said Wednesday night that it will give Americans who buy health insurance through the new online marketplaces an extra six weeks to obtain coverage before they incur a penalty. The announcement means that those who buy coverage through the exchange will have until March 31 to sign up for a plan, according to an official with the Department of Health and Human Services (Somashekhar, Goldstein and Eilperin, 10/23).

Kaiser Health News: Obama Administration Plans To Delay Penalties For Consumers Who Sign Up For Insurance By March 31
The Obama administration said Wednesday that it would delay imposing penalties for six weeks on some consumers who might have been caught in a sticky timing problem for enrolling in coverage through the health law’s new insurance marketplaces. Those marketplaces, also known as exchanges, have come under intense scrutiny since opening on Oct. 1 because the technology has malfunctioned. But the White House is not linking this change of policy to website problems (Carey, 10/23).

The Wall Street Journal's Washington Wire: Officials Affirm March 31 Is Deadline For Health Enrollment
Americans won’t face a health-insurance penalty so long as they sign up for coverage by March 31, 2014, the Obama administration said late Wednesday, offering what amounted to a six-week extension on the deadline. The Affordable Care Act’s most prominent feature is the “individual mandate,” the requirement that most Americans carry coverage or pay a tax penalty, starting on Jan. 1, 2014 (Radnofksy, 10/23).

Politico: White House May 'Align' Obamacare Signup Dates
The Obama administration is working to push back a deadline to prevent people who buy insurance during Obamacare’s open enrollment from being hit by the law’s individual mandate penalty, a Health and Human Services official said Wednesday. Right now people must to sign up by Feb. 15 if they want to avoid paying the penalty — even though there are six weeks left in the enrollment season (Chaney, 10/24).

CNN: White House Moves To Clarify Obamacare Deadline
Some believed that in order to avoid a penalty, one needed to buy insurance by February 15 because a plan bought after that date would not begin until April 1, one day after the March 31 deadline. According to the White House, that March 31 deadline comes from language in the Affordable Care Act that says if one has access to affordable coverage but chooses to be uninsured for three consecutive months in a calendar year, one would face a penalty (10/23).

NPR: Why Postponing Insurance Mandate Is No Easy Fix For Obamacare
The Obama administration has entered full damage-control mode over the balky website intended to enroll people in new health plans under the Affordable Care Act. Senior officials met Wednesday morning with Democrats on Capitol Hill, and in the afternoon insurance CEOs got an audience at the White House. Tomorrow some of the private contractors responsible for building the website, HealthCare.gov, will testify at a House committee hearing (Rovner, 10/23).

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Capitol Hill Watch

Hearing On Healthcare.gov Billed As Oversight, Likely To Focus On Blame

Among those who will appear before the congressional panel will be Cheryl Campbell, senior vice president of CGI Federal Inc. She will likely be asked about the company's involvement in the bungled rollout of the online enrollment process.

Politico: Obamacare Hearings: Oversight Or Heckling?
There's congressional oversight that answers everyone’s most urgent questions -- and then there's just heckling from the partisan peanut gallery. Over the next few weeks, Republicans are going to have to decide which path they’re going to take as they open hearings into the broken Obamacare website (Nather, 10/24).

The New York Times: Contractors Assign Blame, But Admit No Faults Of Their Own, In Health Site
Contractors that built President Obama's health insurance marketplace point fingers at one another and at the government, but each insists that it is not responsible for the problems that infuriated millions of Americans trying to buy insurance on the Web site, according to testimony prepared for a Congressional hearing on Thursday (Pear, 10/23).

The Wall Street Journal: Executive To Defend Firm's Role In Health Site
An executive from the top contractor involved in designing the federal website consumers can use to sign up for health insurance is set to testify Thursday in Congress about the problems that have stymied the site. Cheryl Campbell, senior vice president of CGI Federal Inc., the U.S. unit of Canadian company CGI Group Inc., is expected to be asked about the firm's role in an enrollment process riddled with glitches that risk jeopardizing President Barack Obama's signature law (Nagesh, 10/23).

USA Today: Hot Seat For Health Care Exchange Website Builders
High demand for health insurance coupled with confusion between contractors led to many of the problems that have plagued the HealthCare.gov website meant to allow uninsured Americans to buy insurance through the Affordable Care Act, an official with the top contractor will say in prepared testimony to a House panel Thursday. Cheryl Campbell, senior vice president of CGI Federal, said in advance testimony for her scheduled Thursday appearance before the House Energy and Commerce Committee that another contractor was responsible for the technology that allowed users to create new accounts and which caused the initial bottleneck issues on the site (Kennedy, 10/24).

Fox News: Contractor Behind HealthCare.gov To Testify Extra Testing Could Not Have Saved Site
A top executive with CGI Federal, one of the contractors paid millions to create the ObamaCare website, says "no amount of testing" could have prevented the site's problem-plagued start. Senior Vice President Cheryl Campbell’s remarks are part of prepared testimony she will give before a Republican-led House hearing Thursday on the insurance-marketplace site. They also appear to challenge new claims by the administration that a lack of adequate testing was part of the problem (10/24).

The Wall Street Journal: Contractors Point Fingers Over Health-Law Website
A new round of finger-pointing will kick off Thursday morning when a House committee grills four contractors involved in the development of HealthCare.gov, the troubled site where uninsured consumers are supposed to sign up for health insurance. CGI Federal, the lead contractor for HealthCare.gov, said the federal agency in charge of the project was "the ultimate responsible party for the end-to-end performance of the overall" health exchange, according to testimony released Wednesday by the House Energy and Commerce Committee (Schatz, 10/24).

Politico: Contractors To Explain Rough Rollout
Key Obamacare contractors testify before Congress on Thursday to explain the disastrous rollout of HealthCare.gov. It will be a much different scene from their previous trip to the Hill a little more than a month ago. Just three weeks before the health care law's troubled launch, four contractors assured a House panel that everything was on track for the Oct. 1 launch. According to written testimony posted Wednesday night, none of them are taking the blame for the website mess ahead of an expected grilling from the House Energy and Commerce Committee (Millman, 10/24).

The Associated Press: Website Contractors Blame Obama Administration
The principal contractors responsible for the federal government's trouble-plagued health insurance website say the Obama administration shares responsibility for the snags that have crippled the system. Executives of CGI Federal, which built the federal HealthCare.gov website serving 36 states, and QSSI, which designed the part that verifies applicants' income and other personal details, are testifying Thursday before the House Energy and Commerce Committee (Alonso-Zaldivar and Ohlemacher, 10/24).

NBC News: 5 Key Questions Await Developers Of Healthcare.Gov
It's against this tumultuous backdrop that officials of two of the main contractors hired to build the website -- CGI Federal, the lead firm on healthcare.gov with $300 million in contracts, and software maker QSSI -- will testify on Thursday. The executives can expect a rough reception, both from opponents of the law, who may try to get them to blame the website's woes on the complex law, and its defenders, who will likely try to deflect the blame onto the private firms. Here are five key questions the execs are likely to be grilled on, and some of the key issues they will have to explain (Aegerter, 10/24).

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Hill Panel Seeks To Put Price Tag On Website, But Some Estimates May Be Too High

A tally from the House Committee on Oversight and Government Reform suggests HHS spent between $400 million and $600 million to build the troubled website, but The Washington Post Fact Checker and a government watchdog group say the true cost may be much lower.

The Wall Street Journal's Washington Wire: Troubled Health Site Cost At Least $400 Million
How much did it cost to put together the problem-plagued Healthcare.gov website? The House Committee on Oversight and Government Reform said Wednesday that by its latest tally, the Department of Health and Human Services had awarded between $400 million and $600 million in contracts to develop the federal health insurance exchange and related data services (Radnofsky, 10/23).

The Washington Post's The Fact Checker: How Much Did Healthcare.gov Cost?
How much did the troubled HealthCare.gov actually cost? It may be much less than you've heard. Given the vagaries of the federal contracting system, this is not an easy question to answer. But that has not stopped some people from speculating that the total is $500 million or more. That may be a reasonable figure, but the more we looked into this, the more it seemed a bit high (Kessler, 10/24).

Sunlight Foundation Blog: How Much Did Healthcare.gov Actually Cost?
The new health care exchange site has been the topic of several news stories these past few weeks. Many of them are quoting vastly different numbers for how much it cost to build. You'd think that sites like USASpending.gov or the Federal IT Dashboard would be able to give us some idea. But in reality, that's just not how federal spending is reported (Devine, 10/22).

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Dems Grow Frustrated With Obamacare Website, Impact On Broader Law

Even some Obama allies are calling for major changes -- as well as someone's firing -- after the technically flawed rollout of the health law's online insurance marketplace. Democrats are also worried about what the problems could do to support for the broader law, and some are even calling for a delay to a mandate that Americans buy insurance.

Los Angeles Times: Obama Allies Join In Criticism Of Health Care Website
The rocky rollout of the Affordable Care Act again came under sharp criticism Wednesday, three weeks into the launch, but this time some of the loudest voices were among top Democrats, including President Obama's closest allies. Democrats on Capitol Hill said they were unhappy with the performance of the Obamacare website, which has been plagued with problems since its debut Oct. 1. Even the president's longtime campaign guru, David Axelrod, was critical of the administration's handling of the issue (Mascaro and Parsons, 10/23).

The Associated Press/Washington Post: Frustrated Dems Lament Damage Glitchy 'Obamacare' Website Has Inflicted On Broader Law
Frustrated Democrats lamented Wednesday that persistent problems with new health care exchanges have inflicted damage on the public's perception of the already unpopular "Obamacare" -- with some lawmakers insisting President Barack Obama should ensure those responsible lose their jobs. Emerging from a closed-door briefing with health officials from the Obama administration, House Democrats appeared to have at least as many questions as answers about how and when the beleaguered website will be fixed. Although they resolved not to let setbacks with one aspect of the health law outshine the parts that are working, they griped that the shoddy website had given Republicans an opening to do just that (10/23).

Politico: Hill Democrats Frustrated By Obamacare Rollout
House Democrats voiced growing frustration and anger with the broken Obamacare enrollment site on Wednesday as administration officials tried to reassure them that HealthCare.gov will be repaired. Democrats, who labored to get the Affordable Care Act through Congress in the first year of the Obama presidency, said they wanted the administration to share details of what's wrong and when it will be fixed (Haberkorn and Allen, 10/23).

The Associated Press/Washington Post: Some Dems Say Obama Should Fire Those Responsible For Problems With HealthCare.gov Website
The principal contractors responsible for the federal government's trouble-plagued health insurance website say the Obama administration shares responsibility for the snags that have crippled the system. Executives of CGI Federal, which built the federal HealthCare.gov website serving 36 states, and QSSI, which designed the part that verifies applicants' income and other personal details, are testifying Thursday before the House Energy and Commerce Committee (10/24).

Fox News: Dems Join Call To Delay Obamacare Mandate Amid Website Failures
Several Democratic senators are calling on the Obama administration to delay enforcement of the health care law's individual mandate, joining their Republican colleagues in saying it would be unfair to penalize Americans for failing to buy insurance when the primary sign-up website doesn't work. The Democratic dominoes began to fall quickly Wednesday, after Sen. Jeanne Shaheen, D-N.H., circulated a letter urging President Obama to extend enrollment beyond March 31, 2014 (10/24).

The Wall Street Journal: Democratic Unease Grows On Health Law
The hard line Democrats have drawn against delaying a core element of the federal health law has begun to crack, as problems with the new federal insurance website prompted calls for President Barack Obama to delay penalties on people who don't carry health coverage (Hughes and Nelson, 10/23).

Politico: Red State Democrats Propose Changes To Obamacare
The Obama administration's day ended much as it began, with Democrats frustrated over Obamacare's rollout. After the administration briefed House Democrats on the myriad remaining issues with HealthCare.gov, red and swing-state Democratic senators began to call for further changes to Obamacare (Everett and Kim, 10/24).

McClatchy: Democrats Call For Changes To Obama’s Health Care Law
Republicans have always been harsh critics of Obamacare. Now President Barack Obama's signature health care law is taking heat from Democrats, too. More than three weeks after the problem-plagued rollout of the federal marketplace where consumers can sign up for health insurance, support for major provisions of the Affordable Care Act is weakening among some Democrats, who want to see someone fired over the botched debut (Pugh and Lightman, 10/23).

The Associated Press: Shaheen Asks For Extension For Health Enrollment
As website glitches make it difficult for consumers to sign up for health insurance under the new federal health care overhaul law, New Hampshire Sen. Jeanne Shaheen is requesting for an extension on the open-enrollment period beyond March 31, 2014. In a letter to President Barack Obama, Shaheen suggested the extension to provide greater flexibility for people seeking access to health insurance (Fram and Alonso-Zaldivar, 10/24).

The Associated Press/Washington Post: Obama Administration Spells Out Those Health Care Site Problems -- And Its Efforts To Fix Them
On the defensive, the Obama administration acknowledged Wednesday its problem-plagued health insurance website didn't get enough testing before going live. It said technicians were deep into the job of fixing major computer snags but provided no timetable. Democratic unhappiness with the situation began growing louder -- including one call for President Barack Obama to "man up" and fire someone -- as the president's allies began to fret about the political fallout. Democrats had hoped to run for re-election touting the benefits of the health care law for millions of uninsured Americans, but the computer problems are keeping many people from signing up (10/23).

Reuters: More Democrats Voice Obamacare Concerns As Website Blame Goes Around
The contractors for the government's troubled healthcare website sought to deflect blame on Wednesday as more Democrats voiced concerns about the implementation of President Barack Obama's signature domestic policy. Administration officials, in damage-control mode for nearly a week, held a closed-door briefing for Democrats in the U.S. House of Representatives and a private session with insurance company executives, who said they would assist in efforts to fix the Healthcare.gov website (Morgan and Felsenthal, 10/23).

Meanwhile, on the bright side for Democrats -

The Washington Post's Post Politics: Democrats Rally Around Health-Care Law After Shutdown
Despite a series of problems with the Web site for President Obama's new health care exchanges, support for the law is up slightly. A new Gallup poll shows support has increased four points since August, thanks to a rise in support from Democrats (Blake, 10/23).

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GOP Reconsidering Strategy On Health Law Fight

House Republicans are seeking to shift public attention from a government shutdown over the health law to problems in the marketplace website with hearings on the issue. But GOP Senate and House leaders do not seem to have a consensus on tactics for their overall efforts on the law.

The New York Times: Republicans, Sensing Weakness In Health Law Rollout, Switch Tactics
Emboldened by the intense public criticism surrounding the rollout of the online insurance exchange, Republicans in Congress are refocusing their efforts from denying funds for the health care law to investigating it (Steinhauer and Pear, 10/23).

Politico: GOP Reconsiders Obamacare Tactics
The stiffest test facing congressional GOP leaders is how to avoid another Obamacare-induced fiscal crisis, which top Republicans say would put their House majority in jeopardy and further deplete the party's uphill chances of capturing control of the Senate. ... Senate Minority Leader Mitch McConnell (R-Ky.), whose grip on most Senate Republicans is strong, isn’t mincing words: He says the defund Obamacare movement that led to a government shutdown and near default on U.S. debt was a "tactical error" and "not a smart play." ... But McConnell's bluster is tempered by House Speaker John Boehner. Given the unruly dozens in his House Republican Conference, Boehner has to let the specter of another shutdown and deficit crisis linger (Sherman and Raju, 10/23).

The Wall Street Journal's Washington Wire: Boehner Goes Back On Offense Over Health Care
House Speaker John Boehner (R., Ohio), seeking to move past a failed political strategy that shuttered large parts of the government and sank the party's approval ratings, on Wednesday went back on offense, targeting budget deficits and the new health-care law as problems Republicans could address (Hughes, 10/23).

CNN: GOP: Website Woes Create Fresh Opening To Go After Obamacare
With fresh data and the acknowledgment from President Barack Obama that the web portal to enroll in new health care plans isn't working, Speaker John Boehner and other GOP leaders told House Republicans on Wednesday the website's bumpy rollout gives them an opening to seize public attention. But according to several GOP sources present at the weekly GOP meeting, leaders said they expected the administration would fix those so-called technical "glitches" soon, so House Republicans need to cast the debate more broadly and hone in on the real-world impact that the law is having on Americans (Walsh, 10/23).

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Health Reform

Insurers Huddle At The White House; Talk Health Exchange Technical Difficulties

About a dozen CEOs from major insurance companies met with administration officials to address the online marketplace's flaws, especially those related to generating the enrollment files that the insurers receive.  

Politico: White House, Insurance Industry Tackle Obamacare Tech Problems
Top White House and HHS officials met with CEOs of about a dozen major insurance companies Wednesday to address the flawed Obamacare enrollment system, particularly the problems in generating accurate enrollment files that are sent to the insurers selling health plans through the new exchanges. They also discussed the problems arising as people try to bypass the federal website and enroll directly with the insurers (Kenen, 10/23).

Los Angeles Times: WellPoint CEO Upbeat On Exchanges, Talks Obamacare At White House
Insurance giant WellPoint Inc., a key player in the rollout of the Affordable Care Act, said it remains optimistic about the healthcare expansion despite the rocky start of a federal insurance exchange. WellPoint's chief executive, Joseph Swedish, and other industry executives are meeting Wednesday with White House officials about continuing problems with the 36-state federal insurance marketplace and its troubled healthcare.gov website (Terhune, 10/23).

And, in Illinois, a similar meeting was held -

The Associated Press: Insurance Brokers Air Frustrations With Health Care Website
Insurance brokers in Illinois vented their frustrations Wednesday with the troubled rollout of President Barack Obama's health care law and the crippled federal website, HealthCare.gov. Dozens attended a meeting with Gov. Pat Quinn's aide Max Fletcher, a policy analyst for the Illinois Health Insurance Marketplace. Fletcher said Illinois officials also are frustrated but have no control over the federal website and don't know when it will be fixed (10/23).

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A Closer Look At HHS Sec. Sebelius' Health Law Role

Health and Human Services Secretary Kathleen Sebelius' role in the problems the health law's insurance marketplace is having, and the subsequent calls for her ouster, are examined. Sebelius' absence would mean a key post in implementing Obamacare would be vacant.

NBC News: Safe For Now? Why Sebelius Is Unlikely To Be Axed After Obamacare Mess
Critics calling for the ouster of Kathleen Sebelius after Obamacare’s clumsy online rollout are unlikely to get their wish any time soon. If she were sacked, it would leave a crucial cabinet position vacant -- and Republicans could use a confirmation fight to re-argue the merits of Obamacare. And many GOP leaders are already calling for her resignation after technical glitches made initial online registration nearly impossible for millions of Americans. Another factor: Losing the Health and Human Services secretary would leave the agency without a leader when it is under intense pressure to fix flaws in the Healthcare.gov website before Dec. 15 -- the last day for Americans to enroll for coverage that begins on the first of the year (Dann, 10/24).

CNN: Sebelius: Veteran Of Health Care Wars
Navigating the political waters in her own family, says one ally, likely prepared Kathleen Sebelius well for the partisan cauldron she's now enduring in Washington over the rocky rollout of the Obamacare website. The embattled Health and Human Services Secretary was the daughter of a Democratic governor of Ohio, then became the daughter-in-law of a Republican Congressman from Kansas. Her husband is a federal magistrate (Todd, 10/23).

Bloomberg: Sebelius Saleswoman Role Left Gap In Obamacare Oversight
In the months before the Obamacare health insurance website debuted, Kathleen Sebelius gave few hints that anything might be wrong. A June version of the site carrying educational material was easy to navigate, and an early September demonstration of the enrollment function appeared to work well, said a person with knowledge of the situation (Wayne, 10/24).

The Kansas City Star: Kansas' Kathleen Sebelius Is At The Center Of Obamacare Rollout
Finally, Republicans and Democrats agree: Kathleen Sebelius now faces the biggest crisis of her 27 years in politics. Three weeks after the Health and Human Services secretary launched the campaign to sign up millions of Americans for health insurance, the ongoing technical meltdown connected with that effort has prompted increasingly loud demands for her resignation -- or firing (Helling, 10/23).

The New York Times: Sebelius Finds A Friendly Crowd in Boston
For Kathleen Sebelius, the Obama administration official who has become the focus of bipartisan anger over the bungled rollout of the online health insurance exchanges, a night out in Boston appeared to be a much-needed respite from scrutiny and criticism (Bidgood, 10/23).

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Will Obamacare Website Be Able To Transfer Medicaid Enrollment Data?

Politico raises questions about whether the transfer of Medicaid enrollment data to 36 states participating in the federal exchange will go smoothly Nov. 1 when it's slated to begin. The Los Angeles Times looks at how Ohio Gov. John Kasich's decision to pursue Medicaid expansion in defiance of the right wing of his party may affect his political future.

Politico: Medicaid Could Be The Next Headache For Obamacare
A new phase of the Obamacare launch is coming, this one involving Medicaid. And it could be déjà vu all over again. On Nov. 1, the health law’s malfunctioning enrollment system is supposed to send reams of data to states so they can begin placing thousands of people into Medicaid. But state officials say that transfer system has barely been tested and could be vulnerable to technical failures like those that have crippled the broader Obamacare sign-up process (Cheney, 10/24).

Los Angeles Times: In Ohio, Obamacare Fight Renewed As GOP Governor And Activists Tussle
It is the center of the political universe in presidential contests. And now the war over the nation’s new healthcare program has come to Ohio as well, with potential repercussions for the short- and long-term future of the state’s governor, John Kasich (Decker, 10/23).

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States Report Vastly Differently Obamacare Enrollment Experiences

Navigators in states relying on the federal website to enroll people in coverage are focused on education while they wait for fixes, while officials in states like New York and Washington with functional websites are reporting high demand and enrollment. Meanwhile, consumer advocates express skepticism about directing people in federal exchange states to call centers as a way to enroll. 

Kaiser Health News: Are Federal Call Centers Up To The Task Of Enrolling Millions In Health Plans?
Centers like these were touted by President Barack Obama this week as one of several alternatives for consumers having trouble shopping and enrolling in plans through healthcare.gov, the bug-ridden website run by the federal government for residents of 36 states ... But consumer advocates say the centers were never meant to be an alternative to the insurance exchange website. They were conceived of as a supplement – a way to offer some consumers more help to understand their options (Galewitz, 10/24).

Kaiser Health News: Capsules: Navigators Tread Water As Website Problems Continue
Navigators in states relying on the flawed federal exchange healthcare.gov are focusing on bolstering excitement and education about the law as they wait for fixes to the website (Gold, 10/24).

Kaiser Health News: Capsules: A View From The States: Health Care Continues Stumbling Startup
States are making some progress getting customers signed up for health insurance. But it isn’t pretty. Here is a roundup of dispatches from KHN’s radio partners at NPR member stations (10/24).

The Associated Press: SD Officials: Few Details On Health Care Enrollees
South Dakota insurance regulators said Tuesday they don't know a lot about the people signing up for health insurance under the new health care law because the online market is run by the federal government. Members of the Legislature's Government Operations and Audit Committee asked state insurance officials about the characteristics of the more than two dozen South Dakotans who have signed up for insurance since the online health exchange started operating Oct. 1 (10/23).

The Associated Press: 174,000 Have Applied For Coverage In NY Through Health Care Exchange
New York's health insurance marketplace reported Wednesday having received 174,000 completed applications for new coverage starting next year, accounting for a large share of initial signups nationally under the Affordable Care Act. About 500,000 applications have been filed through federal and state marketplaces, also known as exchanges, since they launched three weeks ago with systems plagued by technical problems, Obama administration officials have said (Virtanen, 10/23).

The Seattle Times: Health Exchange Indundated With Calls, Plans To Double Staff
Faced with many more calls to its toll-free hotline than expected, the Washington Health Benefit Exchange plans to dramatically scale up resources for its customer-service center in Spokane. Calls have been pouring in to the call center from residents around the state seeking to enroll in coverage through the online insurance marketplace, called Washington Healthplanfinder, which opened Oct. 1 (Landa, 10/23).

Bloomberg: Tale Of Two Obamacares As Some States Bypass U.S. Site
Don’t tell Elisabeth Benjamin it’s tough to sign up for Obamacare. For two weeks, she has been enrolling uninsured people from her New York City office through an online marketplace created by the law. Most recently, she helped a Bronx home-health worker in her 30s get health coverage for $70 a month (Pettypiece, Klopott and Newkirk, 10/24).

Kansas Health Institute: The Kansas Insurance Marketplace That Might Have Been
Perhaps it is a case of could-have-been. Two years ago, Gov. Sam Brownback rejected a $31.5 million federal grant to set up a health insurance marketplace tailored for Kansas — defaulting instead to the federally run marketplace that was launched Oct. 1 but which continues to be beset by problems (Cauthon, 10/21).

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CBS Finds Misleading Prices On Federal Marketplace 'Shop And Browse' Feature

News outlets give deeper detail on the continuing problems with the federal government's online insurance system.

CBS News: Healthcare.gov Pricing Feature Can Be Off The Mark
CBS News has uncovered a serious pricing problem with Healthcare.gov. It stems from the Obama administration's efforts to improve its health care website. A new online feature can dramatically underestimate the cost of insurance. The administration announced it would provide a new "shop and browse" feature Sunday, but it's not giving consumers the real picture. In some cases, people could end up paying double of what they see on the website (Crawford, 10/23).

CBS News: How Is White House Dealing With Obamacare Website Fallout?
Top officials say President Obama was more concerned with the insurance product and finding insurance companies in all 50 states than with the functionality of the government website healthcare.gov (Garrett, 10/23).

CNN: Insurance Industry Aware Of Obamacare Website Problems Before Launch
The insurers are a key player in the implementation of the Affordable Care Act as they are selling policies that are purchased on the site, then processing consumers' enrollment files. Among the technical problems detected prior to October 1 were the "front-end issues," the source said, pointing to the trouble many consumers have had setting up accounts. But the problems go further (Acosta, 10/23).

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Health Law Opponents Queue Up New Ad Campaign

The new ads, from the conservative group Americans for Prosperity, target individual members of Congress.

The New York Times: Tea Party Group Begins Anti-Health Care Law Blitz In Four House Districts
Americans for Prosperity, the Tea Party group that has made rolling back the health care law one of its priorities, is starting a $2 million campaign of television, radio and Internet advertisements aimed at lawmakers facing tough re-election battles in four House swing districts (Stolberg, 10/23).

Los Angeles Times: Next Wave Of Obamacare War: Ads To Hold Lawmakers 'Accountable'
As it wages a state-by-state battle to limit the reach of the nation's healthcare law, the conservative group Americans for Prosperity is launching a $2-million ad buy to hold congressional lawmakers “accountable” for their votes on Obamacare. AFP is launching the first round of the new television ads Wednesday in Arizona, Colorado, Florida and California, where they are targeting Rep. Scott Peters of San Diego, a freshman Democrat (Reston, 10/23).

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Health Law Fails To Bring Competition To Rural Areas

The New York Times examines the effects of the law on prices of coverage in rural areas while KHN details how therapists may be forced to move away from their solo practices.

The New York Times: Health Law Fails To Keep Prices Low In Rural Areas
As technical failures bedevil the rollout of President Obama's health care law, evidence is emerging that one of the program's loftiest goals — to encourage competition among insurers in an effort to keep costs low — is falling short for many rural Americans (Abelson, Thomas and McGinty, 10/23).

Kaiser Health News: Health Law Brings Changes In How Therapists Do Business
In the corporate world of American health care, with its consolidating hospital chains and doctors' groups, psychologists and other mental health therapists are still mostly Mom-and-Pop shops; they've built solo practices, hanging their own shingles, not unlike Lucy in the Peanuts gang: "Psychiatric Help 5¢, The Doctor Is In." But that business model is shifting from solo practices toward large medical groups, say mental health experts (Varney, 10/24). 

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State Watch

State Highlights: Va. Gov. Candidates Differ On Mental Health System

A selection of health policy stories from Virginia, California, Colorado, Missouri, Pennsylvania, Kansas and Texas.

Stateline: 'Habilitation' Is Among New Obamacare Benefits
Thanks to the Affordable Care Act (ACA), habilitation services will now be widely covered for the first time in private insurance plans. Rehabilitative and habilitative services are among the 10 "essential benefits" that must be provided by all plans sold on all the state and federally run health insurance exchanges. Starting in 2014, all individual and small group health policies sold outside the exchanges also will have to cover habilitative services. But as is the case with some of the other "essential benefits," the federal health law mandates coverage of habilitation services without spelling out exactly what that means (Ollove, 10/24).

The Washington Post: Virginia's Mental Health System Needs More Money; Candidates Differ On How To Provide It
When people talk about improving Virginia's mental health system, they inevitably return to one word: money. Money for treatment centers and hospital beds, money for staff, money for youth programs, money for housing. Money that has been cut significantly in recent years. The major-party candidates for governor of Virginia agree that mental health systems need more resources. But their approaches differ greatly, based in part on how they view the Medicaid expansion of the new health care law in Virginia (Jackman, 10/23).

California Healthline: State Agency’s Penalty Check Payout For Late Hearings Climbs Above $2.7 Million
The Department of Social Services has issued more than $2.7 million in penalty checks to Californians who successfully appealed their eligibility status for the Community Based Adult Services program, which was created and is overseen by the Department of Health Care Services. In July, Capitol Desk reported the state had paid more than $1.1 million in penalties to 670 CBAS recipients. DHCS officials yesterday said another $1.6 million in penalties will be paid to 145 successful eligibility appellants. For those new recipients, that's an average of more than $11,000 per penalty check (Gorn, 10/23).

Health Policy Solutions (a Colo. news service): Online Tax Credit System To Go Live Nov. 4
Managers at Connect for Health Colorado initially delayed the online feature until the end of October and in order to secure subsidies, customers have had to call clogged phone lines. Now, a spokesman said in a written response to questions that customers wanting to use the exchange website to cut their health insurance costs will have to wait until Nov. 4, the new target date for Colorado to have an online subsidy application (Kerwin McCrimmon, 10/23).

Kaiser Health News: Capsules: Study: Low-Income Californians Want Better Information
For many low-income Californians, enrolling in health insurance is just one hurdle to overcome in getting the care they want. A new report says better communication with doctors and obtaining clearer information is also high on their wish lists (Rao, 10/23).

St. Louis Beacon: ConnectCare Patients Transition To Specialty Care At New Locations
Joyce Simms has been a St. Louis ConnectCare patient in the pulmonology program for four years.  Because she has asthma, she sees her pulmonologist, Dr. Barbara Lutey, as often as every three months…Health care providers throughout St. Louis and St. Louis County have been scrambling to come up with places to treat more than 2,000 ConnectCare specialty-care patients (Davidson, 10/23).

The Philadelphia Inquirer: Children’s Hospital Of Phila. Funds Gene-Therapy Company
Children's Hospital of Philadelphia has invested $50 million in a new biotech start-up that seeks to be the nation's first commercial provider of gene therapy, company officials announced Tuesday. Spark Therapeutics will assume control over two clinical trials that originated at the prominent teaching hospital -- one in which patients with a rare form of blindness already have regained some vision, the other an early-stage effort to treat hemophilia B (Avril, 10/23).

Kansas Health Institute: Outlook Mixed For Parent Companies Of KanCare MCOs
The parent companies of Kansas’ three main Medicaid managed care organizations posted mixed earnings reports this week and provided stock analysts with differing forecasts.  Centene, the St. Louis-based company that does business in Kansas as the Sunflower State Health Plan, reported third quarter earnings of $49.4 million on revenue of $2.7 billion (McLean, 10/23).

The Texas Tribune: Final Arguments Made In Case On Abortion Regulation
With days remaining until new abortion regulations take effect in Texas, attorneys for abortion providers and the state of Texas presented their final arguments Wednesday on whether those restrictions meet constitutional muster (Aaronson, 10/23).

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Weekend Reading

Longer Looks: Website Problems 'Could Be Worse;' Why Poor People Take More Health Risks

Every week reporter Ankita Rao selects interesting reading from around the Web.

Computerworld: Healthcare.gov Website 'Didn't Have A Chance In Hell' 
[President Barack Obama's] advisors shouldn't be surprised -- the success rate for large, multi-million dollar commercial and government IT projects is very low. The Standish Group, which has a database of some 50,000 development projects, looked at the outcomes of multimillion dollar development projects and ran the numbers for Computerworld. Of 3,555 projects from 2003 to 2012 that had labor costs of at least $10 million, only 6.4% were successful. The Standish data showed that 52% of the large projects were "challenged," meaning they were over budget, behind schedule or didn't meet user expectations. The remaining 41.4% were failures -- they were either abandoned or started anew from scratch (Patrick Thibodeau, 10/21).

The New Yorker: Healthcare.gov: It Could Be Worse 
For large software projects, failure is generally determined early in the process, because failures almost exclusively have to do with planning: the failure to create a workable plan, to stick to it, or both. Healthcare.gov reportedly involved over fifty-five contractors, managed by a human-services agency that lacked deep experience in software engineering or project management. ... I signed up for an account on Healthcare.gov last week. It wasn’t the smoothest process, but I was able to create an account. Some parts are slow; sometimes you have to reload a page to make progress. But it’s starting to work. It will be fixed, because it has to be. And now that the launch and inevitable crash has finally happened, in a way the worst is over. Real-world traffic is providing programmers all the debugging data that they could ever want (Rusty Foster, 10/21).

Slate: Don't Jump!
Shortly after 1 p.m. on March 8, San Francisco officials pulled the fully clothed body of a 56-year-old white man from the waves off secluded Marshall’s Beach, just south of the Golden Gate Bridge. … As surely as a leap from the Golden Gate Bridge kills—98 percent of jumpers die—barriers on suicide hot spots can save lives. The evidence showing that bridge barriers work is "overwhelming," says Paula Clayton, professor of psychiatry at the University of New Mexico School of Medicine and former medical director of the American Foundation for Suicide Prevention. Most people die the first time they try to kill themselves. The easiest way to prevent suicide is by restricting access to methods with a high risk of death, Clayton says—such as jumping from a bridge (Liza Gross, 10/15).

Los Angeles Times:  Rich Brain, Poor Brain
Study after study has suggested that poor people are more likely than wealthy people to behave in ways that are imprudent and counterproductive. ... including more risk-taking (not using seat belts, for example), worse adherence to protocols (such as failing to complete a full course of a medicine) and poorer financial management (impulse buying, for example, or buying on credit, which adds considerably to an item's cost) Why is this? ... When asked to think about a minor repair, the rich and the poor performed equally well on the cognitive tests (arguing against the notion that the poor make poorer decisions because they aren't as smart). But when the repair was described as costly, performance crashed dramatically in the poor but not the rich. In other words, having to reflect on tight finances increased cognitive load for poor people  (Robert Sapolsky, 10/18).

The New York Times: Fear Vs. Radiation: The Mismatch 
It has been more than two and a half years since the Fukushima nuclear disaster began to unfold, and still the world watches events closely, fearfully. The drumbeat of danger seems never ending: Earlier this month, to take just one example, international news reports spread word that six workers at the plant had been accidentally doused with radioactive water. Yet leading health scientists say the radiation from Fukushima has been relatively harmless, which is similar to results found after studying the health effects of Chernobyl. With all that evidence, why does our fear of all things nuclear persist? And what peril does that fear itself pose for society? (David Ropeik, 10/21).

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Editorials and Opinions

Viewpoints: Republicans' New-Found Interest In The Workings Of The Health Website; Fixing The Problem Crucial To Obama's Presidency

The New York Times: Web Sites And Grave Sites
Republicans are apoplectic about Healthcare.gov, the official Web site for the Affordable Care Act. They are trying desperately to change the subject from their disastrous government shutdown by ranting about the failures of a government Web site that cost a tiny fraction of what was lost as a result of the shutdown. Republicans are pretending that they care about the problems encountered in signing up for a system that many of them are bent on destroying (Charles M. Blow, 10/23).

Los Angeles Times: Why The Website Meltdown Won't Crash Obamacare
The crash of the Obamacare federal website, which is preventing many people in three dozen states from signing up for health insurance, has turned the outright hate some conservatives have for the program all of a sudden into sympathy and solicitude (Michael Hiltzik, 10/23).

Politico: Heckuva Job, Sebelius
Little did they know it, but Republicans fighting to defund or delay Obamacare had an ally in spirit in Health and Human Services Secretary Kathleen Sebelius. Her explanation for why the Obamacare website doesn't work is that she couldn't possibly have been expected to make it work in the mere 3½ years since the law passed. She told The Wall Street Journal the website ideally needed five years of construction and one year of testing and instead had only two years of construction and almost no testing (Rich Lowry, 10/23).

Bloomberg: Obama's Presidency Depends On 'Just A Website'
The flip side of the conservative desire to believe Obamacare's problems are much worse than they actually are is the liberal desire to believe they're much less severe than they actually are. One refrain that's become particularly popular, perhaps because President Barack Obama uses it, is "Obamacare is more than just a website." This has the advantage of being true: The Patient Protection and Affordable Care Act is a vast and complex effort that includes drastic changes to how health care is delivered, a huge expansion of Medicaid (welcome, Ohio!), and an array of regulations meant to protect consumers from the worst predations of insurers. But Obamacare’s website is much more crucial to the law's success than the website for your average government program (Ezra Klein, 10/23).

Roll Call: Sebelius' Tenure As Obamacare Overseer Hangs With Vulnerable Democrats
Will the star witness who isn't there become the sacrificial secretary? ... It will be little surprise if the corporate executives, taking advantage of her absence as a rebuttal witness, push as much blame as possible for the online morass toward their government customers. What will be more newsworthy is if the wall of Democratic support for Sebelius starts to crumble (David Hawkings, 10/23).

The Fiscal Times: Obama And Sebelius: The Dog Ate My Homework
In short, the ACA was the Obama administration's own bid to prove that activist, large-scale government was superior in innovation and competency. Instead, it has become a signature example of the lack of accountability, incompetence, and rank dishonesty that activist, large-scale government creates and protects.  And that was just on performance.  Despite the 42 months lead time and the outlay of $400 million, the web portal failed immediately, and two successive weekends of repair couldn't make it work.  When the media demanded to know what happened, the White House responded with a battalion of Ida Knows (Edward Morrissey, 10/24).

The Washington Post: Don't Give Up On The Uninsured
Obamacare is working. True, that sentence comes with a large asterisk. It is working in states that have followed the essential design of the Affordable Care Act, particularly in Kentucky, Connecticut, Washington and California. The law was written with states' rights and state responsibilities in mind. States that created their own health-care exchanges — and especially those that did this while also expanding Medicaid coverage — are providing insurance to tens of thousands of happy customers, in many cases for the first time (E.J. Dionne Jr., 10/23).

The Washington Post: Obamacare Backfires – On Everyone
The Affordable Care Act ("Obamacare") turns out to represent dreadful miscalculations by both the president and his Republican adversaries. Doubtlessly, Barack Obama imagined that achieving something close to "universal" health insurance would guarantee his legacy. It would make him the liberal heir to Franklin Roosevelt and Lyndon Johnson. Forget it. Even if Obamacare worked flawlessly — that's now a joke — it's too small to rank with the New Deal or the Great Society. Meanwhile, Republicans say Obamacare threatens liberty and would lead to a federal "takeover" of health care. This fiction, pursued fanatically with policies risking anarchy, has earned the GOP a deserved public backlash (Robert J. Samuelson, 10/23).

The Wall Street Journal: Has He Got A Health-Care Deal For You
He sounded every bit the pitchman—repeating a 1-800 number, promising that "call centers are available" and reassuring viewers "you can get your questions answered by real people, 24 hours a day." And boy was he selling: "The product is good. . . . It's high quality and it's affordable. People can save money, significant money . . . . And we know the demand is there. People are rushing to see what's available" (Karl Rove, 10/23). 

Fox News: Mocking Obamacare: Jon Stewart Leading The Media Charge
Naturally, the Obamacare debacle was ripe for mockery by the "Daily Show," which usually has more fun skewering the Republicans (and cable news networks). It's no secret that Stewart, who has interviewed President Obama, is more sympathetic to the liberal side, so this was telling—especially when he ridiculed the administration’s planned tech "surge" to the same strategy used to salvage the Iraq war. When your political program becomes a punchline, you've got problems (Howard Kurtz, 10/23).

The New York Times: Could Obamacare Discredit Neoliberalism?
As a kind of companion piece to my last post on the liberal and conservative visions for health insurance, I strongly recommend reading this post by Mike Konczal, which strikes a note that you can expect to hear sounded more often on the left if the Obamacare rollout continues to go badly. Contra conservatives suggesting that HealthCare.gov represents some kind of discrediting moment for liberalism, Konczal argues that the potential policy problems associated with a nonfunctional web portal really just point to the problems with neoliberalism — a much-debated term of art, but defined for his purposes as the post-1970s idea that social insurance should be "heavy on private provisioning and means-testing," that it should preserve as much "choice and competition" as possible, and that it should be delivered at the state level or through state-and-federal coordination rather than by the federal government alone (Ross Douthat, 10/23).

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. Now Mr. Kasich seems to view signing up for this part of Obamacare as an act of Christian charity and has literally all but claimed that God told him to do so (10/22).

Tampa Bay Times: A Medicaid Tale Of Two GOP Governors
This is a tale of two Republican governors who oppose the Affordable Care Act. ... Florida would receive $51 billion in federal money over 10 years to cover 1 million uninsured residents if the Legislature would vote to accept the Medicaid expansion money under the Affordable Care Act. ... Now low-income Floridians who would be covered by the expansion fall into a gap: They don't qualify for Medicaid, and they make too little money to qualify for subsidies to buy insurance in the new federal marketplace. So they will continue to show up in hospital emergency rooms for expensive charity care, and the costs are paid by taxpayers at public hospitals and by paying patients through higher insurance premiums. [Gov. Rick] Scott said Florida should take the Medicaid expansion money, but unlike [Ohio Gov. John] Kasich, he hasn't lifted a finger to force the issue (10/22).

Fox News: Obamacare And America's Journey Into The Third World
In Europe, national health care systems deliver coverage for everyone, at remarkably lower cost, and in countries with per capita income comparable to the United States, a lot better care. The United States spends 18 percent of GDP on health care; Germany and Holland spend about 12 with better results. One only need look behind the rollout of the federal health insurance exchanges to see why. President Obama sees every decision -- from the timing for sending his mother-in-law a birthday card to those required for the rollout of the exchange -- as a political calculation (Peter Morici, 10/23).

Health Policy Solutions (a Colo. news service): Making The Most Of Open Enrollment Season
In many cases, consumers who spend time reviewing their health plan options can find ways to save money on their health care costs, whether it's through selecting a plan that will cover more of their expected health costs for a major event in the coming year (such as having a baby or surgery), reviewing which doctors participate in the health plan's care provider network or evaluating prescription drug coverage. Unfortunately, just 14 percent of Americans understand basic health insurance concepts such as deductible, co-pay, co-insurance and out-of-pocket maximum, according to a recent study published in the Journal of Health Economics (Dr. Robert Beauchamp, 10/23).

Health Policy Solutions (a Colo. news service): Despite Good Intentions, Women Not Achieving Good Health
While 14 percent of Colorado women are in fair or poor health overall, around 40 percent are having days of poor mental or physical health every month. That’s a substantial portion of the population that is facing physical and mental health challenges, and a larger percentage than that of men reporting similar health challenges (Sarah Mapes, 10/23).

WBUR: The Last Bill JFK Signed – And The Mental Health Work Still Undone
The Community Mental Health Act reflected a bold new vision for the treatment of mental illness, but much remains to be done to fulfill that promise. While the legislation did usher in positive and hopeful changes for millions of people with serious illnesses such as schizophrenia, progress stalled because of funding challenges and continuing stigma. Only half of the proposed community mental health centers were ever built, and those were never fully funded. Drastic cuts were made to the remaining community mental health centers at the beginning of the Reagan administration (Vic DiGravio, 10/23).

Politico: Children Need Good Start In Life
America needs a grand bargain for babies. ... It's this simple: Our youngest children need to develop into healthy adults if America's economy is to have a healthy future. Our earliest life experiences shape the foundation of the brain architecture, which serves as the basis for all later learning and functioning. ... When babies and toddlers do not have engaging relationships with their parents and caregivers, it can rob them of the secure connections they need to thrive. When young children encounter adverse experiences, their early brain development can affect their health and ability to function as adults. These detrimental experiences can include poverty and its accompanying deprivations, depression, substance abuse and maltreatment. One in four babies in the United States starts life in poverty. Having this many babies who lack the ingredients to be mentally and emotionally healthy for school, work and life will be hugely detrimental to the future of this country if we don't prioritize putting our children on the right track (Denny Rehberg, 10/22).

The New England Journal of Medicine: Dead Man Walking
We met Tommy Davis in our hospital's clinic for indigent persons in March 2013 (the name and date have been changed to protect the patient's privacy). He and his wife had been chronically uninsured despite working full-time jobs and were now facing disastrous consequences. The week before this appointment, Mr. Davis had come to our emergency department with abdominal pain and obstipation. His examination, laboratory tests, and CT scan had cost him $10,000 (his entire life savings), and at evening's end he'd been sent home with a diagnosis of metastatic colon cancer. ... The year before, he'd had similar symptoms and visited a primary care physician, who had taken a cursory history, told Mr. Davis he'd need insurance to be adequately evaluated, and billed him $200 for the appointment. ... We find it terribly and tragically inhumane that Mr. Davis and tens of thousands of other citizens of this wealthy country will die this year for lack of insurance (Drs. Michael Stillman and Monalisa Tailor, 10/23).

The New England Journal of Medicine: Smoothing The Way To High Quality, Safety, And Economy
In recent years, health care institutions have awakened to the need to provide safe, high-quality care at lower cost. The Centers for Medicare and Medicaid Services is implementing multiple incentives and penalties intended to help realize this goal. ... We believe that greater attention to a frequently overlooked parameter in health service design — patient load and flow — would accelerate progress toward reliable, safe, efficient care. ... Direct and indirect savings from smoother patient flow could give Medicare a new lease on life, underwrite biomedical research, reduce the national debt, support schools, and serve many other private and public purposes (Eugene Litvak, and Dr. Harvey V. Fineberg, 10/23). 

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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.