Daily Health Policy Report

Friday, October 25, 2013

Last updated: Fri, Oct 25

KHN Original Reporting & Guest Opinion

Capitol Hill Watch

Health Reform

Administration News

Health Spending And Fiscal Battles

Health Care Marketplace

Public Health & Education

State Watch

Health Policy Research

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Health On The Hill: Lawmakers Challenge Healthcare.gov Contractors On Website Problems

Kaiser Health News staff writer Mary Agnes Carey and Politico Pro's Jennifer Haberkorn discuss recent events on Capitol Hill. For more than four hours in a hearing Thursday, House Energy and Commerce Committee members grilled contractors who helped build the health law's problem-plagued online insurance marketplace (10/24). Read the transcript or listen to the conversation.

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A Reader Asks: I Don’t Have Children, So Why Do I Have To Buy Pediatric Dental Insurance?

Kaiser Health News consumer columnist Michelle Andrews answers a question about pediatric dental insurance (10/25). Read the exchange.

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Capsules: Administration Says 700,000 Have Applied For Coverage; Medical Schools See Record Numbers Of Enrollees

Now on Kaiser Health News’ blog, Phil Galewitz reports on administration estimates about how many people have sought insurance coverage: "The Obama administration said Thursday that 700,000 people have completed applications for coverage in the health law’s new marketplaces — a key step before people can begin shopping for insurance plans" (Galewitz, 10/24).

Also on Capsules, Ankita Rao reports that medical schools are experiencing a record level of enrollees: "About 20,000 students enrolled in medical school in 2013, around 2.8 percent more than the year before, according to the data distributed by the Association of American Medical Colleges on Thursday. First-time applications were also up by almost 6 percent" (Rao, 10/24). Check out what else is on the blog.

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Political Cartoon: 'Force Refresh?'

Kaiser Health News provides a fresh take on health policy developments with "Force Refresh?" by Darrin Bell.

Here's today's health policy haiku:

CONGRESSIONAL HEARINGS 101

With stony faces
Members want to pin the blame
Witnesses dodge it
-Anonymous

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

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Capitol Hill Watch

Capitol Hill Testimony: Testing Started Too Late, Was Limited

During Thursday's House Energy and Commerce Committee hearing, contractors who work on healthcare.gov told the panel that "end-to-end" testing that should have been done months before the online insurance marketplace's launch actually began just weeks in advance. In addition, a last-minute administration decision to require users to sign in before shopping for insurance caused the system to bottleneck.

The Washington Post: Full Testing Of Healthcare.gov Began Too Late, Contractors Say
Private contractors in charge of building the federal online health insurance marketplace testified Thursday that the administration went ahead with the Oct. 1 launch of HealthCare.gov despite insufficient testing. In their first public remarks since the debut of the problem-ridden insurance exchange, executives of the main IT companies told members of the House Energy and Commerce Committee that full tests of the Web site that should have been carried out months in advance, but began just two weeks before its rollout (Somashekhar and Goldstein, 10/24).

The New York Times: Contractors Describe Limited Testing of Insurance Web Site
Federal officials did not fully test the online health insurance marketplace until two weeks before it opened to the public on Oct. 1, contractors told Congress on Thursday. While individual components of the system were tested earlier, they said, the government did not conduct "end-to-end-testing" of the system until late September (Pear, 10/24).

Los Angeles Times: Health Website Contractors Acknowledge Late Changes, Limited Tests
Developers of the troubled Obamacare website confirmed Thursday that a last-minute decision requiring users to sign up before shopping for insurance caused the system to bottleneck and acknowledged they did not conduct an "end to end" test until just before this month's botched rollout. The federal contractors sought to shift responsibility for the more than $400-million project to the Obama administration, providing fuel for Republicans who want to kill the Affordable Care Act (Mascaro and Hennessey, 10/24).

The Wall Street Journal: Botched Launch Of Health Site Blamed On Poor Coordination
No one in the government made sure the many complex parts of the federal health-insurance website worked together properly, and testing of the complete site didn't take place until two weeks before its Oct. 1 launch, contractors said at the first congressional hearings into the matter. The website's botched launch has become the biggest threat to the success of President Barack Obama's health law, just days after Democrats beat back a Republican bid to defund it. More Democrats said Thursday that penalties on those who lack health insurance—a linchpin of the law—should be delayed because of the difficulties many people have had in navigating the site (Schatz, 10/25).

Politico: Contractors Grilled On The Hill
Top Obamacare contractors said Thursday they never recommended that the Obama administration delay the Oct. 1 launch of HealthCare.gov — even though some of them harbored doubts about a website that would crash shortly after it went live. Republicans pressed four contractors appearing before the House Energy and Commerce Committee on why they had told Congress in September that Obamacare’s online enrollment system was on track, only to go off the rails in October (Haberkorn and Millman, 10/24).

The Associated Press/Washington Post: Contractors: Obama Admin. Left Little Time For Testing Health Care Site And Made Late Changes
Who’s to blame? The first congressional hearing into what went wrong dug into issues of website architecture and testing protocols — but also re-stoked the partisan battle over President Barack Obama’s signature expansion of health coverage for millions of uninsured Americans. Republicans who’ve been trying to kill the program the past three years sounded outraged that it is being poorly carried out, while Democrats jeered them as political hypocrites (10/24).

Politico: Obamacare Website Hearing Takeaways: Missing Word Was 'Sorry'
So now we know the contractors’ side of the Obamacare website debacle: They did a great job, the bad decisions weren’t their fault, and they’re fixing it. Thursday’s standing-room-only hearing on the snakebit federal Obamacare enrollment website, HealthCare.gov, saw a parade of witnesses who weren’t about to take responsibility for the disaster. We just do what the client asks, they said — and in this case, the client was the Obama administration (Nather, 10/24).

Kaiser Health News: Health On The Hill: Lawmakers Challenge Healthcare.gov Contractors On Website Problems
Kaiser Health News staff writer Mary Agnes Carey and Politico Pro's Jennifer Haberkorn discuss recent events on Capitol Hill. For more than four hours in a hearing Thursday, House Energy and Commerce Committee members grilled contractors who helped build the health law's problem-plagued online insurance marketplace (10/24).

Reuters: Contractors Describe Scant Pre-Launch Testing Of U.S. Healthcare Site
The Obama administration launched its troubled healthcare insurance website after only a minimum of crucial system-wide testing, despite contractors warning officials repeatedly about performance risks, a congressional panel heard on Thursday (Morgan and Cornwell, 10/25).

PBS NewsHour: HealthCare.Gov Contractors Testify They Warned Of Glitch Risks Before Launch
The contractors behind the development of HealthCare.gov testified before a House committee that they warned officials the insurance exchange site was not properly tested before it went live. Meanwhile the White House announced that insurance seekers will now have until March 31 to sign up for coverage (Sreenivasan, 10/24).

McClatchy: Contractors Say Late Changes, Lack Of Testing Doomed Health Care Website Launch
Private contractors working on the troubled federal health insurance marketplace told a congressional committee Thursday that they needed several months, but only had two weeks, before the launch date to fully test what could be the most complex government IT system in U.S. history. The task was further complicated by the Obama administration’s late decision to require users to create personal accounts before they could browse and compare health plans on the marketplace portal, the Healthcare.gov website (Pugh, 10/24).

Fox News: Contractors Point Fingers Over ObamaCare Botch, Blame Gov't For Poor Testing
The finger-pointing was in full swing Thursday at a tense Capitol Hill hearing where the contractors behind the botched ObamaCare website defended their work and claimed the government failed to properly test the system before launch. ... Lawmakers cast doubt on attempts by contractors, who were paid millions, to claim they were not responsible for many of the site's problems. Top contractor CGI Federal revealed it was paid $290 million in taxpayer funds. But CGI Federal and other contractors repeatedly claimed that overall "end-to-end" testing was the responsibility of an agency within the Department of Health and Human Services, as was the decision to go live on Oct. 1 (10/24).

The Washington Post's Post Politics: Pallone: House Health-Care Hearing A 'Monkey Court'
Rep. Frank Pallone (D-N.J.) derided today's House Energy and Commerce Committee hearing as a "monkey court," accusing Republicans of exhibiting false concern during testimony and chastising them for raising security concerns that he said were specious. “You are trying to scare people so they won’t apply,” he said, adding that he believes the Republicans’ true purpose is to undermine people’s trust in the new health-care law so that it has to be delayed or repealed. His outburst came after two Republicans alleged that the federal marketplace does not adequately protect people’s medical privacy (Somashekhar and Eilperin, 10/24).

Reuters: Official Who Made Big Healthcare Website Decision A Frequent White House Visitor
The government official identified as being responsible for a last-minute decision that helped jam up the Obamacare health insurance website has been a frequent presence at the White House, according to visitor logs. Henry Chao, deputy chief information officer at the Centers for Medicare and Medicaid Services (CMS), was named Thursday in congressional testimony as the one who ordered the lead contractor to make consumers register before browsing for price information, a step avoided by popular online shopping sites such as Amazon.com (Debenedetti and Cornwell, 10/24).

Medpage Today: Healthcare.gov Builders: Jan. 1 Coverage Doable
The contractors who built the federal government's online health insurance marketplace told Congress on Thursday that problems with the troubled website will be ironed out in time to allow uninsured people to enroll for coverage that starts Jan. 1. Furthermore, they believed the website was ready to go live on Oct. 1 -- despite the issues encountered later that day -- and didn't recommend delaying the launch ofHealthcare.gov, four contractors told the House Energy and Commerce Committee (Pittman, 10/24).

In related news -

Bloomberg: CGI Group Seen Rebounding From Obamacare Website Failure
CGI Group Inc. (GIB/A) Chief Executive Officer Michael Roach told investors at a conference two weeks before the debut of the Obamacare website that the contract marked the start of a “long-term relationship” and a “significant growth opportunity.” Instead, Canada’s biggest technology company is now a visible face for software snags on the U.S. government site for the 2010 Patient Protection and Affordable Care Act (Tomesco, 10/25).

ProPublica: Healthcare.gov's Users Speak Out: 'Clean This Mess Up'
Over the weekend, the U.S. Department of Health and Human Services began unveiling its effort to fix Healthcare.gov, the home for the federal insurance marketplace. Part of that was a blog post soliciting comments from folks who have tried the site (Ornstein, 10/24).

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GOP Leaders Seek More Information About Federal Health Exchange Rollout

House Oversight Committee Chairman Darrell Issa, R-Calif., and others are threatening to issue subpeonas to federal contractors that worked on healthcare.gov, as well as Health and Human Services Secretary Kathleen Sebelius, if inquiries are not answered.

Fox News: GOP Lawmakers Threaten Subpoena Over ObamaCare Rollout Information
House Oversight Committee Chairman Darrell Issa, R-Calif., and other GOP committee leaders sent letters to 11 of the largest recipients of contracts to design and implement HealthCare.gov seeking an explanation of the contracts awarded, communications between the companies and the White House and a detailed list of all meetings related to the launch of ObamaCare.The lawmakers said the committee would consider using "compulsory process" if the companies did not respond to the request for information by 5 p.m. on Friday. "It is crucial that you provide information quickly because of the serious concerns about data security related to the lack of testing," the lawmakers wrote, referring to reports that the federal health care website went through little, if any, testing (10/25).

CNN: Issa Threatens Possible Subpoena For Obamacare Info
House Oversight Committee Chairman Darrell Issa is raising the threat of a possible subpoena if Health Secretary Kathleen Sebelius doesn't respond to his panel's questions and requests for documents about problems with the Obamacare website. Committee aides say Sebelius has failed to respond to a previous request and he's now giving her until Monday to comply or possibly face "compulsory" action (10/24).

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Democrats' Once United Front Fraying As Some Urge Delay In The Individual Mandate

Sen. Kay Hagan, D-N.C., and Sen. Richard Blementhal, D-Conn., are the latest to joing the ranks of those who are urging this delay and who are criticizing the launch of healthcare.gov.  

The Wall Street Journal's Washington Wire: More Democrats Seek Delay In Health-Law Penalty
More Democrats called for a delay in a core element of the federal health law, with two senators blasting the Obama administration’s rollout of a health-insurance website and its response to public criticism. Sen. Kay Hagan (D., N.C.), who is up for re-election in 2014, said in a Thursday statement that the $95 penalty on individuals who fail to enroll in a health insurance plan should be waived for two months. That penalty starts at $95 for 2014 tax returns. A few hours earlier, Sen. Richard Blumenthal (D., Conn.) said in a television interview that the U.S. needs to consider delaying the penalty, which as at the heart of the 2010 law designed to prod Americans without health insurance into buying coverage (Hughes, 10/24).

Politico: Democrats' United Front Cracks
The great Democratic unity of 2013 held for five-and-a-half days. For weeks leading up to the shutdown -- and over the 16 days it dragged on -- President Barack Obama did the unthinkable: he held every Democrat in the House and Senate together. There weren't any defectors. There wasn't even anyone running to reporters to question his strategy. The man who'd disappointed them so many times was suddenly exciting them, with his newly apparent backbone and successful resistance to Republicans. They were rushing to do whatever they could to stand by him, next to him, with him (Dovere, 10/25).

Meanwhile, senators are now facing the choice of whether their staff members should obtain health insurance through the new online insurance marketplaces --

Politico: Senate Leaders Consider Health Exchanges
Senate leaders are beginning to make the tough choice about whether to put their staffers on Obamacare's health insurance exchanges. Three members of Senate leadership all plan to place their aides on the health exchanges, they confirmed to Politico. They are: Sen. John Thune (R-S.D.), the No. 3 in GOP leadership; Sen. John Barrasso (R-Wyo.), the No. 4 among Senate Republicans; and Sen. Patty Murray (D-Wash.), No. 4 in Senate Democratic leadership and the Senate Budget Committee chairwoman (Everett, 10/24).

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Health Reform

Nearly 700,000 Applications Completed Through Online Marketplaces

The Obama administration said Thursday that 700,000 people have completed applications for coverage in the health law’s new marketplaces — a key step before people can begin shopping for insurance plans. The update came as officials responded to complaints about the numerous glitches consumers are encountering as they try to shop for health insurance.

Los Angeles Times: Nearly 700,000 Applications Completed At Heatlhcare.Gov, Officials Say
Nearly 700,000 applications for health insurance coverage under the Affordable Care Act have been completed, administration officials said Thursday, although they would not release data on how many people successfully enrolled in insurance plans despite problems with the online marketplace. The updated figure comes as administration officials tried to respond to complaints and finger-pointing from the contractors who built the troubled website, www.healthcare.gov (Hennessey, 10/24).

The Wall Street Journal's Washington Wire: Health-Insurance Applications Near 700,000
Nearly 700,000 Americans have completed applications for health insurance using federal and state insurance marketplaces, an Obama administration spokeswoman said Thursday, trying to parry characterizations of the health-law rollout as a failure and a disaster. Thursday was the first of what the administration says will be daily briefings by the Centers for Medicare and Medicaid Services, or CMS, the agency in charge of the problem-plagued HealthCare.gov website (Dooren, 10/24).

Reuters: Obamacare Applications Near 700,000
About 700,000 applications have been submitted for U.S. healthcare coverage being offered through new exchanges created by President Barack Obama's healthcare law, a U.S. official said on Thursday. The U.S. Centers for Medicare and Medicaid Services released the number during an update for journalists about the healthcare marketplace, which has had a rocky rollout since enrollment in the new plans began on Oct 1 (10/24).

Kaiser Health News: Capsules: Administration Says 700,000 Have Applied For Coverage
The Obama administration said Thursday that 700,000 people have completed applications for coverage in the health law’s new marketplaces — a key step before people can begin shopping for insurance plans (Galewitz, 10/24).

The Washington Post: State Insurance Boards Frustrated With Obamacare Technical Glitches
Commissioners responsible for overseeing insurance industries in states relying on the federal government to run health-care exchanges are hearing from consumers who can’t log into Web sites, and some aren’t hearing back when they call Washington for answers. At the same time, the Department of Health and Human Services says its Web site, HealthCare.gov, is working better every day. More than 700,000 applications have been completed, many through the Web site, according to a department spokeswoman (Wilson, 10/25).

Meanwhile, in related news -

The New York Times: In White House Pitches, Rosy View Of Health Care Site
Just days before HealthCare.gov went live with disastrous results, top White House officials were excitedly briefing lawmakers, reporters, Capitol Hill staff members and Washington pundits on their expectations for the government’s new health care Web site. … In fact, the rosy presentations set President Obama up for even more criticism when the portal was swamped by millions of people who quickly found out they could not log on. The technical problems that emerged have raised questions — still not entirely answered — about how much the president’s aides knew, or should have known, about the site’s troubles (Shear and Stolberg, 10/24).

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Progress Reports From Online Insurance Marketplaces Across The Country

In Texas, brokers, physicians and insurers express exasperation with the bug-ridden federal exchange website, while media reports from Maryland, Minnesota and Oregon document the challenges faced by those state-based exchanges. In California, community groups mobilize to educate people about their new insurance options.

The Washington Post: Maryland Shelves Educational Workshops For Small-Business Health Insurance Exchange
It isn't just the federal health insurance exchange that is running into problems. Some of the state-run exchanges are facing their own setbacks — including the one in Maryland. State health officials, who already missed the federal government's deadline to launch an insurance exchange for small businesses, have quietly nixed plans to hold informational sessions this month to educate employers about their soon-to-open insurance marketplace (Harrison, 10/24).

Dallas Morning News: Health Care Law's Commercial Allies In Texas Frustrated By Balky Rollout
Texas brokers, physicians and health insurers are exasperated with the federal government's online marketplace, but they say the site must be fixed because the Affordable Care Act is here to stay. Many people shopping for themselves or for small companies have called insurance brokers for help in accessing HealthCare.gov. Brokers were eager to oblige but soon found themselves stymied. "I've seen absolutely no improvement in the weeks that we've been trying to work through this," said Carolyn Goodwin, a broker who heads the Goodwin Benefits Group in Dallas. "But we have it, and we have to live with it. I'm hoping against hope they will find a way to fix this. I'm just not confident that they can" (Landers, 10/24).

The Oregonian: Cover Oregon: Some Significant Progress Fixing Health Exchange But Still No Enrollment
Officials for Oregon's health insurance exchange on Thursday reported some progress, but acknowledged a major fix to the problem-plagued site may not happen this month as hoped. The website still has not enrolled anyone. Earlier this month officials at Cover Oregon said they expected the site to let insurance agents and certified application assisters to enroll people by Halloween. Spokesman Michael Cox said that timeline is now a goal, rather than an expectation. "We're not going to rush out a system that we are not satisfied with” (Budnick, 10/24).

Minnesota Public Radio: Credit Report Lock May Hinder Ability To Sign Up For MNsure
People who have locked their credit reports may have trouble creating an account on the state's new insurance marketplace, MNsure officials said today. To buy a plan on MNsure, consumers must prove they are who they say they are. To verify an applicant's information, MNsure uses a federal service that relies on information provided by the credit bureau Experian. People who block access to their credit reports to prevent identity theft also block MNsure (Richert, 10/24).

MinnPost: MNsure Gets $41 Million Federal Grant For Improvements And Operations
MNsure received $41 million in expected aid to fund its operations through 2014 from the U.S. Department of Human Services, the state's health exchange announced on Thursday. The newest grant, which the exchange applied for in August, brings the total amount of federal awards to roughly $150 million for Minnesota’s fledgling insurance marketplace (Nord, 10/24).

Minnesota Public Radio: $41M Grant To Help Fund MNsure Operations
Minnesota's new online insurance marketplace has received $41 million in additional federal funds to fund operations through next year. MNsure will use the new grant from the U.S. Department of Health and Human Services for general operations, to support IT and related systems and security training. It also will allow MNsure to study quality rating systems and fund consumer satisfaction surveys through 2014 (Stawicki, 10/24).

The Star Tribune: MNsure Gets More Federal Funding
The state has received a $41 million grant from the federal government to further the ongoing implementation of its health insurance exchange site, known as MNsure. With this latest infusion from the feds, Minnesota has received about $155 million to hire staff and vendors and build the website, MNsure officials said Thursday. Minnesota is one of 13 states and the District of Columbia that built their own insurance exchange websites, which launched in October for consumers and small businesses to shop among a variety of health insurance plans (Crosby, 10/24).

The Sacramento Bee: Covered California Will Offer Quality Ratings For Health Plans
Consumers shopping for health care on California’s new exchange will see quality ratings for insurance plans as soon as next year. The direction by the Covered California board Thursday came after three large insurers criticized a staff recommendation to delay moving ahead until more information could be gathered about the current plans. Covered California Executive Director Peter V. Lee said the agency was concerned that offering ratings information for only a small percentage of the plans would be misinterpreted by consumers and dissuade people from enrolling (Cadelago, 10/24).

California Healthline: Cities, Counties Helping Covered California
In addition to paid help, the state's new health insurance exchange Covered California is receiving volunteer assistance from cities and counties in signing up Californians for health insurance. The Long Beach City Council last week authorized the city's health department to apply for status as a "certified enrollment entity." Staff members in the Long Beach Department of Health and Human Services will receive training to help enroll residents in health plans and serve as a community liaison between Long Beach organizations and small businesses and Covered California. … Although Covered California has funding for some community-based organizations seeking to become authorized enrollment entities, it does not offer funding for city or county governments (Lauer, 10/24).

The California Health Report: Community Members Mobilize for Volunteer ACA Outreach
More than 100 Santa Cruz County residents responded to a recent call to learn more about the Affordable Care Act (ACA) so they can in turn educate their friends, neighbors, co-workers and patrons about health care reform. Librarians, accountants, builders and non-profit staff members were among those who attended "Be a Champion for Expanded Coverage," an event sponsored by the Health Improvement Partnership (HIP) of Santa Cruz County at the Watsonville Civic Plaza. The volunteers plan to help solve one of the more vexing questions of reform: how to reach the many people who don't understand they are eligible for subsidies on the exchange or the expansion of Medi-Cal and then help them navigate the process of signing up for insurance (Graebner, 10/25).  

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Early State Enrollment Numbers Show Increased Medicaid Sign-Ups

Kentucky and New York release figures showing that a large majority of people signing up for coverage under the health law are qualifying for the federal-state program for low-income residents, often because they don't have to pay anything to immediately enroll. Meanwhile, Arkansas says more than 62,000 people have been approved for that state's innovative Medicaid program.

The Associated Press: More Than 26,000 Kentuckians Sign Up For Coverage
Three weeks into the federal health care overhaul, more than 26,000 Kentuckians have signed up for medical coverage, the vast majority of whom will become Medicaid recipients. Gov. Steve Beshear released updated enrollment numbers Thursday, showing that 21,342 people have been enrolled in Medicaid program and another 4,832 in private insurance plans since the Kentucky Health Benefit Exchange in just over three weeks. Coverage won't begin until Jan. 1 (Alford and Lovan, 10/25).

The Buffalo News: Many 'Obamacare' Enrollees In N.Y. Go To Medicaid
More than 37,000 New Yorkers have signed up for health insurance since enrollment under the Affordable Care Act began Oct. 1, but many of them are going into the state's Medicaid program rather than one of 16 private insurance carriers participating in the new federally mandated program. ... In the first three weeks of the "Obamacare" enrollment, 23,717 New Yorkers who went to a new state website to enroll for insurance ended up being steered to join Medicaid because their incomes were low enough to qualify. In all, 13,313 New Yorkers have enrolled for health coverage with one of the 16 private insurance carriers participating (Precious, 10/25).

The Associated Press: Ark. Signs 62K People Through New Medicaid Plan
State health officials said Thursday that more than 66,000 Arkansas residents applied for health insurance under the state's Medicaid expansion and slightly more than 62,000 of the applications were approved. Arkansas was granted a waiver from part of the federal health care law so that it could use Medicaid funds to subsidize private insurance for low-income residents, instead of expanding the public program (Bartels, 10/24).

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Clearer Obamacare Coverage Picture Developing For Specific Groups Of Americans

News outlets look at what the health law means for coverage: Insurers are dropping some plans, state denial of a Medicaid expansion is leaving some in a coverage gap, and farmers wait to see how the cost of their health insurance will change under the law.

CBS News: Arrival Of Obamacare Forcing Insurers To Drop Customers With Low Coverage
Natalie Willes is a sleep consultant who helps parents in Los Angeles train their newborns to sleep. She buys her own health insurance. "I was completely happy with the insurance I had before," Willes said. So she was surprised when she tried to renew her policy. What did she find out? "That my insurance was going to be completely different, and they were going to be replaced with 10 new plans that were going to fall under the regulations of the Affordable Care Act," she said (Evans, 10/24).

Health News Florida: Putting A Face On 'The Forgotten'
While most of the uninsured will be able to get subsidized health coverage Jan. 1 under the Affordable Care Act, the poorest adults under 65 will be out of luck in many states, including Florida. You could call them "The Forgotten."  Many are women in their 50s and 60s, too old to have children still at home so they can't qualify for Medicaid. But they're not yet 65 so they don't qualify for Medicare, either. (Gentry, 10/24).

North Carolina Health News: No Clear Answers For Farmers In Obamacare
Obama administration officials promised that rural residents, in particular, would see reductions in their health insurance rates. But North Carolina’s farmers are still waiting to see (Hoban, 10/23).

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Additional Regs Finalized For Health Law's Insurance Exchanges

Meanwhile, CBS News questions whether the White House delayed the release of other rules for several months before the election -- a step that could have caused delays for contractors, insurers and others.

The Hill: Feds Finalize ObamaCare Rules
The Obama administration has finalized additional regulations for new health insurance marketplaces under ObamaCare. The 236 pages of regulations released by the Centers for Medicare and Medicaid Services (CMS) on Thursday set out oversight and financial standards for the marketplaces, called exchanges (Hattem, 10/24).

CBS News: Did White House Delay Obamacare Rules Ahead Of Election?
A Health and Human Services official involved in the preparation of the Affordable Care Act says the administration stopped issuing proposed rules for several months before the 2012 general election, causing delays as contractors, states and insurance companies awaited guidance to move forward (Attkisson, 10/24).

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Administration News

Sebelius Pushes Back Against Calls For Resignation

As a congressional panel probes problems with the federal health care website, Health and Human Services Secretary Kathleen Sebelius visited an insurance call center in Phoenix, saying experts are working around the clock to fix the site. That message was repeated Thursday by officials from the Centers for Medicare & Medicaid Services during their first briefing on the repairs.

USA Today/The Arizona Republic: Sebelius Promises Fixes To Health Care Site
As a congressional panel probed her agency's oversight of the federal health care website, Health and Human Services Secretary Kathleen Sebelius said Thursday during a visit to Arizona that a team of government and private-sector technology experts are working around the clock to fix the problem-filled website. Following a tour of a Phoenix call center that handles enrollment and a community health center, Sebelius acknowledged that the website, Healthcare.gov, has not operated as seamlessly as she had hoped when it launched Oct. 1 (Alltucker, 10/25).

The Associated Press: Sebelius Visiting Phoenix Call Center Amid Ongoing Glitches In Health Care Enrollment
Health and Human Services Secretary Kathleen Sebelius is visiting Phoenix amid calls for her resignation after the clunky rollout of insurance exchanges under the new federal health care law. The former Kansas governor and the Obama administration’s point person on the health law’s implementation will tour an HHS call center on Thursday (10/24).

Politico: Kathleen Sebelius Hits Back At Critics
Health and Human Services Secretary Kathleen Sebelius took a swipe at those calling for her resignation over the troubled launch of the Obamacare enrollment site, saying she doesn’t work for them. “The majority of people calling for me to resign, I would say, are people who I don’t work for and do not want this program to work in the first place,” Sebelius said Thursday during a press availability, according to the Associated Press (McCalmont, 10/25).

CNN: Sebelius Pushes Back, Determined To Make Obamacare Website ‘Perfect’
Health Secretary Kathleen Sebelius is again pushing back against calls for her resignation over the rocky rollout of the Obamacare website, saying “we are determined to make it perfect.” While visiting a health insurance call center in Phoenix on Thursday, Sebelius stuck to the Obama administration’s line that the functionality of the online insurance marketplace Healthcare.gov is improving. "People are going through every day,” she said. “It's better today than it was on October 1, but it's a long way from perfect and we are determined to have it be perfect. But what we are is three weeks into a 26-week open-enrollment period, in football terminology early in the first quarter” (Aigner-Treworgy, 10/24).

Politico: CMS Obamacare Briefing Day One: It's Getting Better
The Obama administration’s tech "surge" to repair the Obamacare enrollment system may be more of a slow crawl — but a senior official said Thursday she’s confident the system will be running smoothly for consumers by mid-December. The agency quarterbacking the repair process told reporters Thursday that any fixes to HealthCare.gov would be “incremental.” Consumers may not even detect them (Cheney, 10/24).

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Health Spending And Fiscal Battles

'Grand Bargain' Remains Elusive; Negotiators Focus On Sequester Cuts

Democrats remain committed to raising the necessary revenue to do this by closing tax loopholes for corporations and wealthy people. Republicans continue to call for spending trims to Medicare and other entitlement programs. Meanwhile, new estimates by the Congressional Budget Office find that raising the Medicare eligibility age produces less savings than previously thought.  

The Associated Press/Washington Post: Both Sides Agree: No 'Grand Bargain' Budget Agreement In Upcoming Congressional Negotiations
Long-standing, entrenched differences over taxes make a large-scale budget pact virtually impossible, according to lawmakers, their aides and observers who will be monitoring the talks. Republicans say they simply won’t agree to any further taxes atop the 10-year, $600 billion-plus tax increase on upper-income earners that President Barack Obama and Democrats muscled through Congress in January. Without higher taxes, Democrats say they won’t yield to cuts in benefit programs like Medicare (10/25).

The Washington Post: Lawmakers Now Focusing On Replacing Sequester Spending Cuts
But the two parties remain far apart on the question of how to replace the sequester cuts, which are scheduled to slice about $100 billion a year out of agency budgets through 2021. Democrats are insisting that even a partial replacement of the cuts — which are set to hit the Pentagon particularly hard next year — must include new revenue raised by closing tax loopholes for corporations and the wealthy. Republicans want to replace the agency cuts by trimming spending on Medicare and other long-term expenses, such as pensions for federal workers. House Speaker John A. Boehner (R-Ohio), Senate Minority Leader Mitch McConnell (R-Ky.) and on Thursday, Ryan, have ruled out new taxes, saying they would rather stick with the sequester (Montgomery, 10/24).

The Associated Press/Washington Post: CBO: Raising Medicare Eligibility Age Produces Smaller Savings Than Previously Thought
Raising the eligibility age for enrolling in Medicare won’t produce nearly the cost savings that had been assumed previously, said a new report issued Thursday. The Congressional Budget Office analysis says that phasing in an increase in the eligibility age from 65 to 67 years old would lower the budget deficit by just $19 billion over the coming decade. Savings would rise more in future years, however (10/24).

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Health Care Marketplace

Medical School Enrollment Exceeds 20,000 For First Time

The number is 2.8 percent higher than in 2012, according to the Association of American Medical Colleges.

Medpage Today: Enrollment In MD, DO Schools Hits New Highs
Medical school applications and enrollment reached record highs this year as organized medicine's cries for more funding for residency slots continued with little response from Congress. The number of first-year medical students exceeded 20,000 for the first time in 2013, reaching 20,055, the Association of American Medical Colleges (AAMC) said Thursday in its annual report on medical school enrollment and applications. Meanwhile, first-year student enrollment at osteopathic medical colleges increased 11.1 percent in 2013, to 6,449, according to the American Association of Colleges of Osteopathic Medicine (AACOM) (Pittman, 10/24).

Kaiser Health News: Capsules: Medical Schools See Record Numbers Of Enrollees
About 20,000 students enrolled in medical school in 2013, around 2.8 percent more than the year before, according to the data distributed by the Association of American Medical Colleges on Thursday. First-time applications were also up by almost 6 percent (Rao, 10/24).

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Public Health & Education

FDA Moves To Tighten Prescribing Limits On Vicodin, Other Hydrocodone Pain Meds

The Food and Drug Administration on Thursday recommended that the most widely prescribed and abused painkillers be made Schedule II drugs, which would restrict when the oft-abused narcotics can be prescribed, and by whom.

The Wall Street Journal: FDA Recommends New Limits On Pain Drugs
The Food and Drug Administration Thursday recommended imposing far more severe restrictions on the prescribing of the most commonly used narcotic painkilling drugs in the U.S., an effort to combat their widespread abuse. The move will fundamentally change the use of medicines taken by millions of Americans to alleviate acute pain, such as broken bones or following dental surgery (Burton and Martin, 10/24).

Bloomberg: U.S. Recommends Tighter Control On Hydrocodone Pain Pills
Vicodin and other hydrocodone-based painkillers, the most popular pharmacy drugs in the U.S., would be placed under stricter prescribing limits to curb abuse, in a policy reversal by the Food and Drug Administration.  The FDA agreed to recommend by early December reclassifying the pills as a Schedule II substance, Janet Woodcock, director of the agency’s Center for Drug Evaluation and Research, said in a statement (Edney and Lopato, 10/25).

The Hill: FDA Moves To Tighten Rules On Painkiller
The Food and Drug Administration (FDA) announced it is shifting its policy on how patients can obtain painkillers.  Hydrocodone drugs, such as Vicodin, have long had less stringent prescribing regulations, but that could all change in early 2014, the regulator said Thursday (Wilson, 10/24).

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State Watch

State Highlights: Texas Abortion Clinics Close As Court Fight Continues

A selection of health policy stories from Texas, New York, Kentucky, California and Virginia.

NPR: Clinics Close As Texas Abortion Fight Continues
The fight over abortion in Texas is being played out in federal court, where abortion rights activists are challenging a new state law. The measure bans abortions at 20 weeks, adds building requirements for clinics and places more rules on doctors who perform abortions. Some clinics have shut down, saying they can't comply with the law set to go into effect Oct. 29 (Lohr, 10/25).

The New York Times: Visiting Nurse Service Cuts 500 Workers
The move is new evidence of the turbulence in the home-care industry under Gov. Andrew M. Cuomo's sweeping redesign of Medicaid, which has transferred tens of thousands of people receiving long-term help from a fee-for-service system to managed care, in an effort to save money and reduce nursing home use (Bernstein, 10/24).

Louisville Courier-Journal: Gov. Steve Beshear Cites Improvements To Kentucky's Medicaid Managed-Care System
Nearly two years after Kentucky's Medicaid managed-care system sparked fallout with health care providers and patients, Gov. Steve Beshear says complaints have declined and claims are being processed more quickly -- despite critics who argue otherwise. Beshear, at a Capitol press conference Thursday, attributed the improvements to a corrective action plan he announced six months ago amid accusations that managed-care companies were delaying payments and denying drug coverage to boost their bottom line (Wynn, 10/24).

Lexington Herald-Leader: Beshear Says Medicaid Managed Care Program Saving Money, Improving Health
Six months after unveiling a plan to quickly resolve payment disputes between medical providers and Medicaid managed-care companies, Gov. Steve Beshear said the program is working. "In both health outcomes and financial savings, Medicaid managed care is succeeding in Kentucky," Beshear said Thursday at a Capitol news briefing (Brammer, 10/24).

California Healthline: Medi-Cal Transition 'Lessons Learned'
The Assembly Committee on Health oversight hearing yesterday on the many transitions of programs within the Department of Health Care Services was aimed at making sure shifts to Medi-Cal managed care plans are done with a maximum of consumer input and a minimum of disruption to Medi-Cal beneficiaries, according to committee chair Richard Pan (D-Sacramento). … The transitions into Medi-Cal managed care include about 380,000 seniors and persons with disabilities and about 860,000 children in the Healthy Families program, in addition to the upcoming duals demonstration program and the rural expansion into Medi-Cal managed care (Gorn, 10/24).

Politico: 'Serious' Ken Cuccinelli Keeps Calm At Debate
Cuccinelli tried to paint McAuliffe, the former chairman of the Democratic National Committee, as a creature of Washington. He said he has fought the Environmental Protection Agency while McAuliffe supports President Barack Obama's "war on coal." He also used the botched rollout of Obamacare against McAuliffe, noting that his rival once supported a single-payer option and that expanding Medicaid in the state -- as he wants -- would bring even more headaches. "Send Washington a message and say no to Terry McAuliffe’s expanded Obamacare by voting for me on November 5th," Cuccinelli said (Hohmann, 10/24).

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Health Policy Research

Research Roundup: What Workers Know About Health Care; Screening Harms

Each week, KHN compiles a selection of recently released health policy studies and briefs.

National Business Group on Health: Employee Perspectives On The Future Of Health Benefits And Health Care Delivery
As health care evolves in response to the Affordable Care Act, employers are trying to determine how they will provide health benefits to employees in the future, while still addressing the immediate challenges of employee health care costs. To assist large employers with this challenge, the National Business Group on Health commissioned Mathew Greenwald and Associates to survey employees [and found that] ... Employees have some knowledge of the ACA and its impact on them but employees need to understand that the ACA brings with it additional costs for employers and that employees will be sharing in these costs. Employees have gained some confidence in the last year when it comes to purchasing health care on their own. This confidence probably arises from the emergence of the public marketplaces. ... Employees do not necessarily understand what is comparative effectiveness research, overuse of care or what Centers of Excellence are (10/22).

The New England Journal of Medicine: Urologists' Use Of Intensity-Modulated Radiation Therapy For Prostate Cancer
Some urology groups have integrated intensity-modulated radiation therapy (IMRT), a radiation treatment with a high reimbursement rate, into their practice. This is permitted by the exception for in-office ancillary services in the federal prohibition against self-referral. ... Using Medicare claims from 2005 through 2010 ...  I compared the use of IMRT in the periods before and during ownership and used a difference-in-differences analysis to evaluate changes in IMRT use according to self-referral status. ... Urologists who acquired ownership of IMRT services increased their use of IMRT substantially more than urologists who did not own such services. Allowing urologists to self-refer for IMRT may contribute to increased use of this expensive therapy (Mitchell, 10/24).

JAMA Internal Medicine: Overdiagnosis And Overtreatment -- Evaluation Of What Physicians Tell Their Patients About Screening Harms
Overdiagnosis is the detection of pseudodisease—screening-detected abnormalities that meet the pathologic definition of cancer but will never progress to cause symptoms. The consequence of overdiagnosis is overtreatment—surgery, chemotherapy, or radiation—that provides the patient no benefits, but only adverse effects. For instance, for every 2000 women attending mammography screening throughout 10 years, 1 less dies of breast cancer. Concurrently, approximately 10 women with pseudodisease receive a diagnosis of breast cancer and are unnecessarily treated. Are patients informed about overdiagnosis by their physicians when discussing cancer screening? How much overdiagnosis would they tolerate when deciding to start or continue screening? (Wegwarth and Gigerenzer, (10/21).

Journal of Hospital Medicine: Do Internal Medicine Interns Practice Etiquette-Based Communication? A Critical Look At The Inpatient Encounter
Trained observers evaluated the use of 5 key communication strategies by internal medicine interns during inpatient clinical encounters: introducing one's self, explaining one's role in the patient's care, touching the patient, asking open-ended questions, and sitting down with the patient. ... A convenience sample of 29 interns was observed on a total of 732 patient encounters. Overall, interns introduced themselves 40% of the time and explained their role 37% of the time. Interns touched patients on 65% of visits, asked open-ended questions on 75% of visits, and sat down with patients during 9% of visits. ... Residents surveyed tended to overestimate their own practice of etiquette-based medicine (Block et al., 10/12).

JAMA Psychiatry: State Parity Laws and Access To Treatment For Substance Use Disorder In The United States 
The passage of the 2008 Mental Health Parity and Addiction Equity Act and the 2010 Affordable Care Act incorporated parity for substance use disorder (SUD) treatment into federal legislation. ... The implementation of any SUD parity law increased the treatment rate by 9% in all specialty SUD treatment facilities and by 15% in facilities accepting private insurance. ... the positive association is more pronounced in states with more comprehensive parity laws (Wen, Cummings, Hockenberry, Gaydos and Druss, 10/22).

Here is a selection of news coverage of other recent research:

MedPage Today: No Need For Risk Counseling After All HIV Tests
Brief risk counseling at the time of a negative HIV test had no effect on the risk of new sexually transmitted infections (STI), researchers reported. In a randomized trial, about one patient in eight who got a rapid HIV test combined with risk counseling developed a new STI within 6 months, according to Lisa Metsch, PhD, of Columbia University's Mailman School of Public Health in New York City, and colleagues (Smith, 10/22).

Medscape: Editorial Claims Bad Rap For Saturated Fat, Disputes Dietary Dogma
The contention that dietary saturated fats aren't the bad guys that policies and guidelines have portrayed for decades has reemerged in the literature, this time in an "Observations" opinion piece in published in BMJ. "The mantra that saturated fat must be removed to reduce the risk of cardiovascular disease has dominated dietary advice and guidelines for almost four decades," according to the author, Dr Aseem Malhotra (Croydon University Hospital, London, UK). "Yet scientific evidence shows that this advice has, paradoxically, increased our cardiovascular risks" (Stiles, 10/23).

Medscape: Pediatrician Numbers Outpace Family Physicians
Although the number of primary care physicians, including family physicians, internists, and pediatricians, has grown faster than the overall population in the last 3 decades, growth has been uneven for those 3 categories. The growth in general pediatrics has far outpaced that of family medicine and general internal medicine, which have grown only incrementally, according to a policy brief article published in the October 1 issue of American Family Physician (Frellick, 10/23).

Reuters: Obstetricians Change Definition Of On-Time Delivery
For years, babies born after a pregnancy lasting 37 to 42 weeks have been considered to be on time, or "term." But a group of U.S. doctors is now separating deliveries that happen during that span in an effort to improve newborn health. "We have increasingly recognized that newborn outcomes are not uniform between 37 and 42 weeks," Dr. Jeffrey Ecker said. Babies delivered between 37 weeks and 39 weeks of pregnancy will now be considered "early term," according to the American College of Obstetricians and Gynecologists (Seaman, 10/22).

NPR's SHOTS blog: A Toddler Remains HIV-Free, Raising Hope For Babies Worldwide
A 3-year-old girl born in Mississippi with HIV acquired from her mother during pregnancy remains free of detectable virus at least 18 months after she stopped taking antiviral pills. New results on this child, published online by the New England Journal of Medicine, appear to green-light a study in the advanced planning stages in which researchers around the world will try to replicate her successful treatment in other infected newborns (Knox, 10/23).

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Editorials and Opinions

Viewpoints: Marketplace Snags Spook Democrats; Government Seldom Gets Tech Initiatives Right; New Revenue Is 'Fair Trade' For Entitlement Changes

The Wall Street Journal: Democrats Run For ObamaCare Cover
Jeanne Shaheen doesn't sound like a Democrat who just won a government-shutdown "victory." Ms. Shaheen sounds like a Democrat who thinks she's going to lose her job. The New Hampshire senator fundamentally altered the health-care fight on Tuesday with a letter to the White House demanding it both extend the ObamaCare enrollment deadline and waive tax penalties for those unable to enroll. Within nanoseconds, Arkansas Sen. Mark Pryor had endorsed her "common-sense idea." By Wednesday night, five Senate Democrats were on board, pushing for . . . what's that dirty GOP word? Oh, right. "Delay" (Kimberley A. Strassel, 10/24).

USA Today: Obama's Y2K Moment
While the website mess will certainly go down as one of the great case studies on how not to launch an Internet service, it will not dictate the legacy of the Affordable Care Act. Indeed, several of the state websites are doing just fine, and once the political grandstanding on HealthCare.gov is over -- it's not by a long shot -- we'll be able to finally begin assessing just how well the Affordable Care Act works and whether it indeed helps reduce costs. The inevitable calls for a delay in the mandate, beyond the penalty assessments, may still be a matter of hot debate for both practical and political reasons. But even a small delay will not affect how this initiative will ultimately be judged. Democracy is a messy business. Plenty of major government programs are still argued about decades later. Yet the politics behind their implementation is seldom remembered (David Callaway, 10/25). 

The New York Times’ Economix: The Midterm Grade For HealthCare. Gov
President Obama taught constitutional law at the University of Chicago Law School. How would he have graded a student's performance on, say, a term paper or test that the professor viewed as "unacceptable," especially when there was "no excuse" for the paper’s deficiencies? One would hope that the grade would have been F, even under modern grade inflation. I certainly would affix that grade to such inexcusably deficient work. But who exactly should be assigned the F for the troubled rollout of HealthCare.gov? (Uwe E. Reinhardt, 10/25). 

The New York Times: Why The Government Never Gets Tech Right
Millions of Americans negotiating America's health care system know all too well what the waiting room of a doctor's office looks like. Now, thanks to HealthCare.gov, they know what a "virtual waiting room" looks like, too. Nearly 20 million Americans, in fact, have visited the Web site since it opened three weeks ago, but only about 500,000 managed to complete applications for insurance coverage. And an even smaller subset of those applicants actually obtained coverage. ... But HealthCare.gov is only the latest episode in a string of information technology debacles by the federal government. Indeed, according to the research firm the Standish Group, 94 percent of large federal information technology projects over the past 10 years were unsuccessful  (Clay Johnson and Harper Reed, 10/24).

The New York Times' Taking Note: GOP Roots For Failure
In theory, lawmakers hope that government programs work well, and if they don’t, try to fix them. In theory, our representatives hope that government agencies carry out their missions smoothly, and if something goes wrong, try to figure out what happened to avoid making the same mistake in the future. Obviously that's not how things work in the United States, where one of the two parties doesn't even believe in government (Juliet Lapidos, 10/24). 

Los Angeles Times: Wrong Rx For Healthcare Website
The problems at the federal government's new health insurance website are so severe that even Democrats are starting to talk about neutering a key provision of the 2010 healthcare law: the requirement that adult Americans obtain coverage next year. But now is not the time to take such a drastic step, which could lead to sharper increases in premiums for individuals. It is true that the federal government hasn't yet fixed its website's problems, but there is still time to do so before Jan. 1, the first day coverage is supposed to go into effect. The focus should remain on fixing the site quickly and signing up more people for insurance (10/25).

Los Angeles Times: What FDR Would Say About Obamacare's Botched Launch
Yes, Obamacare's website debacle is a problem for the healthcare reform program and for many customers still unable to apply for and secure health insurance. But no, it's not the first time a big government program experienced birth pangs. The go-to source on how to manage the launch of a major federal undertaking, of course, is Franklin D. Roosevelt, who launched dozens of such programs during the New Deal--several of them every bit as revolutionary as the Affordable Care Act (Michael Hiltzik, 10/24).

The Washington Post: GOP: Stop Being So Negative
The American political class is facing a perfect storm of public contempt. Congressional Republicans have proved themselves divided and incapable of adopting a coherent strategy, with a significant minority determined to light the way with an auto-da-fé. Meanwhile, an administration that seeks to transform U.S. health care cannot run a Web site — a breathtaking gap between ambition and competence. And its responses to failure — denial, defensiveness and secrecy — have been as discrediting to Obamacare as any technical breakdown (Michael Gerson, 10/24).

The Washington Post: How Uncle Sam Can Avoid Another Healthcare.gov
HealthCare.gov was launched Oct. 1 with bugs that made it impossible for many Americans to purchase insurance. Although these problems are the focus of many tirades and jokes , it's not a disaster — in a few months the site will work as expected. Moreover, in the range of federal IT debacles, HealthCare.gov doesn't come anywhere close to the worst. Over the past five years, agencies including the Justice Department have had to scrap software projects that cost far more than the $70 million to $125 million (at least) reportedly spent on HealthCare.gov. ... But HealthCare.gov's issues remain troubling, and the government can still learn from the site’s failures (Evan Burfield, 10/24).

The Wall Street Journal: ObamaCare Takes On Water
The ObamaCare rollout is a disaster for the White House, not a problem or a challenge or an embarrassment, not a gaffe or a bad few weeks. It is a political disaster, and the only question is whether it is partially recoverable, meaning the system can be made to work in a generally satisfactory way in the next few weeks. But—it has to be repeated—they had 3½ years after passage of the Affordable Care Act to make the program into something the American people could register for and feel they were benefiting from. Three and a half years! (Peggy Noonan, 10/24). 

Bloomberg: Obamacare’s Virtual Fantasy Couldn't Handle Messy Reality
So why didn’t the administration realize that integrating a bunch of incompatible government databases into a seamless system with an interface just about anyone could understand was a really, really hard problem? Why was even the president seemingly taken by surprise when the system didn't work like it might in the movies? We have become seduced by computer glamour (Virginia Postrel, 10/24).

The Wall Street Journal: ObamaCare's Political Choices
It's been another lousy week for the Affordable Care Act, as hundreds of thousands of Americans learned they're losing their current coverage and new details emerged about the 36 federal insurance exchanges that are still as useful as a cement wall. But the truth is that these and other events aren't "glitches." They're the intentional or inevitable results of political control of the health economy (10/24). 

The Wall Street Journal: Another 'Affordable Care' Sticker Shock Looms
President Obama and supporters of his health-care law have defended it by saying that the Affordable Care Act is "the law of the land." However, the spending reductions in the 2011 Budget Control Act—the so-called sequester—also remain "the law of the land." ... Some have claimed that the sequester "exempts" ObamaCare's subsidies from spending reductions. That is only half true. The Budget Control Act does exempt from sequestration the premium subsidies for households with incomes up to 400% of the federal poverty level ($94,200 for a family of four) and that meet other eligibility criteria. But other ObamaCare subsidies, paid directly to insurance providers on behalf of eligible beneficiaries, are subject to the sequester—namely "cost-sharing subsidies." These include subsidies for households with incomes below 250% of the federal poverty level ($58,875 for a family of four) to reduce copayments and deductibles (Chris Jacobs, 10/24).

Charlotte Observer: Another McCrory Mistake On Medicaid
If only Pat McCrory were right this week when he told a conservative group in Washington that a new federal regulation might force North Carolina to expand its Medicaid program. If that were true, hundreds of thousands more N.C. residents could get medical coverage, and the state could see some economic benefits, too. But the governor, once again, got it wrong on Medicaid (10/25).

And on other health issues -

The Washington Post: A Fair Trade For Entitlement Reform Includes Increased Revenue
The Post’s Oct. 20 editorial on the budget challenge ["A fiscal quid pro quo"] made important points but was way off-base on the issue of revenue. It suggested that a fair trade would be reductions to the "sequester" budget cuts in exchange for reforms to Medicare and Social Security and said that Democrats should not insist on additional revenue because that's a non-starter with many Republicans. Democrats would make a serious mistake by following that advice. Our country needs more revenue to help us get back on track (Kent Conrad, 10/24).

The New York Times: Raising The Medicare Age, Revisited
Back in 2011, we almost had a "grand bargain" whose centerpiece would have been a rise in the Medicare eligibility age. Liberals were horrified, but it actually would have happened if Republicans hadn't balked at the idea of any revenue increases at all. Now we learn that it would have been not just cruel and a betrayal of promises, but bone-stupid too (Paul Krugman, 10/25).

Los Angeles Times: Antibiotics For People, Not Animals
Antibiotics are modern medical miracles that rendered lethal infections minor nuisances. But that 20th century success story is turning into a 21st century parable about shortsightedness and denial. The president and Congress have more than enough scientific justification to curb antibiotic overuse in food animal production. It is time for them to act (Gail Hansen, 10/23).

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EDITOR:
Stephanie Stapleton

ASSOCIATE EDITOR:
Andrew Villegas

WRITERS:
Marissa Evans
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.