Daily Health Policy Report

Tuesday, October 29, 2013

Last updated: Tue, Oct 29

KHN Original Reporting & Guest Opinion

Health Reform

Capitol Hill Watch


State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Insuring Your Health: Short-Term Plans Can Skirt Health Law Requirements

Kaiser Health News consumer columnist Michelle Andrews writes: "What a difference a day makes. Consumers who buy a health insurance policy good for only 364 days might save hundreds of dollars in premiums, but they could also find themselves without important benefits and charged a penalty for not having insurance next year" (Andrews, 10/28). Read the column.

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My Other Pre-Existing Condition: Unstable Insurance

Writing for Kaiser Health News, Randy Dotinga tells his personal story of seeking health coverage on the individual insurance market: "I'd like to start a long-term relationship with a health plan, but all I've had are flings -- seven insurers in the last 13 years. Is it something I said? Nope, it's something I am: a self-employed, 45-year-old single guy with a heart that beats funny" (Dotinga, 10/28). Read the story.

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Capsules: Updating The Latest Efforts On Fixing Healthcare.gov

Now on Kaiser Health News' blog, watch a video of Mary Agnes Carey on C-SPAN's Washington Journal Monday talking about efforts the federal government is making to fix the troubled healthcare.gov website for purchasing health insurance (10/28). Watch the video or check out what else is on the blog.

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Political Cartoon: 'Comparison Shopping?'

Kaiser Health News provides a fresh take on health policy developments with "'Comparison Shopping?" by Chris Weyant.

Here's today's health policy haiku:


Recent problem with
Website is from Verizon?
Now, we sympathize!

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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Health Reform

Health Plan Cancellations: White House's Next Set Of Challenges

News coverage is focusing on the notion that a large percentage of people who currently have individual health coverage are receiving cancellation notices because their plans don't meet the standards created by the health law. Many of these people, according to reports, will face "sticker shock" with their new insurance. A critical emerging question is whether the Obama administration expected this scenario.

NBC News: Obama Administration Knew Millions Could Not Keep Their Health Insurance
President Obama repeatedly assured Americans that after the Affordable Care Act became law, people who liked their health insurance would be able to keep it. But millions of Americans are getting or are about to get cancellation letters for their health insurance under Obamacare, say experts, and the Obama administration has known that for at least three years. Four sources deeply involved in the Affordable Care Act tell NBC News that 50 to 75 percent of the 14 million consumers who buy their insurance individually can expect to receive a "cancellation" letter or the equivalent over the next year because their existing policies don’t meet the standards mandated by the new health care law. One expert predicts that number could reach as high as 80 percent. And all say that many of those forced to buy pricier new policies will experience "sticker shock" (Lisa Myers and Hannah Rappleye, 10/29).

Bloomberg: Health Policies Canceled In Latest Hurdle For Obamacare
The rollout of Obamacare is leading to the cancellation of hundreds of thousands of health insurance plans nationwide, contradicting President Barack Obama’s repeated pledge that people who like their coverage can keep it. The cancellation notices started to arrive in recent weeks, compounding the political headaches for the White House from the troubled start of its health insurance exchange, the federal website created to give millions of people access to new plans by Jan. 1 (Bloomberg, 10/29).

The Hill: Report: Millions Will Lose Health Plans As Obamacare Takes Hold
More than 7 million people will lose their healthcare coverage as a result of Obamacare's new standards and normal turnover in the insurance market, according to a new report from NBC News. Sources told the network that 50 to 75 percent of people who buy health plans individually will receive a cancellation letter in the next year (Sink and Viebeck, 10/28).

USA Today: Report: W.H. Knew Plans Would Be Cancelled Under ACA
Millions of Americans are getting their health insurance cancelled under the Affordable Care Act and the Obama administration has known for about three years that this would happen, NBC News is reporting. Between half and three quarters of 14 million consumers who buy health insurance individually will receive a cancellation letter or its equivalent in the next year because their current policies don't meet the standards laid out by the new law, the news organization reports (Eversley, 10/29).

Politico: White House Rejects NBC Obamacare Report
The Obama administration is strongly pushing back Monday night on an NBC News report that the White House has known for years that millions of consumers would lose their insurance under Obamacare. "NBC 'scoop' cites 'normal turnover in the indiv insurance market'. That's a) not new b) not caused by #ACA c) the problem #ACA will solve," White House principal deputy press secretary Josh Earnest said in a tweet (Haberkorn, 10/28).

CBS News: Policy Cancellations, Higher Premiums Add To Frustration Over Obamacare
For many, their introduction to the Affordable Care Act has been negative: a broken website, and now cancellation notices from insurance companies followed by sticker shock over higher prices for the new plans. It's directly at odds with repeated assurances from the president, who has said "if you like your insurance plan, you will keep it. No one will be able to take that away from you." But people across the country are finding out they're losing their existing insurance plans under Obamacare because requirements in the law, such as prenatal and prescription drug coverage, mean their old plans aren't comprehensive enough (10/28).

The Washington Post: Carney Admits Some Americans Will Lose Existing Plans Under Health-Care Law
Back in 2009, President Obama assured Americans that even under the health-care law he was pressing Congress to adopt, nothing in their insurance would change if they were satisfied with their current plan. On Monday, White House press secretary Jay Carney acknowledged that some consumers would lose their "substandard plans" and have to pay higher premiums because of the new health-care law (Eilperin, 10/28).

The Fiscal Times: Obama Breaks Promise As Many Lose Health Coverage
Over the weekend, Florida Blue’s chief executive, Patrick J. Geraghty, defended his company’s action, noting that people being dropped from coverage will be able to enroll in a better plan under Obamacare – and that in many cases they’ll qualify for a federal tax subsidy that will bring their costs down further. “We’re not cutting people – we’re transitioning these people,” Geraghty told David Gregory, host of NBC’s “Meet the Press.” But what about Obama’s oft-stated pledge: “If you like your insurance plan, you will keep it. No one will be able to take that away from you”? That seemed a bedrock promise to Americans as the president sought to counter stiff Republican opposition to his health reform measure (Pianin, 10/28).

Related KHN coverage: Thousands Of Consumers Get Insurance Cancellation Notices Due To Health Law Changes (Gorman and Appleby, 10/21).

The Hill: GOP Floats ‘Keep Your Health Plan’ Bill
A key Republican lawmaker is floating a bill that would allow some consumers to retain healthcare plans that do not meet new coverage standards under ObamaCare. House Energy and Commerce Committee Chairman Fred Upton (R-Mich.) will introduce legislation that expands the Affordable Care Act's "grandfather" clause to include plans sold on the individual market in January 2013 (Viebeck, 10/28).

In addition, news outlets are offering more localized takes on this development -

The Associated Press: Many Insured SC Residents Must Buy New Health Plan
Nearly a month into the health care rollout, at least one group tasked with helping South Carolina's uninsured sign up for coverage in 2014 hasn't been able to assist anyone through the problem-riddled federal website. However, several thousand residents have sought Medicaid coverage through the state's new online application (Adcox, 10/28).

The Associated Press: Middle Class Family Braces For Higher Premiums
As many as nine in 10 Texans buying health insurance on the new federally run exchange will get a break on costs, according to federal health officials. Steve and Maegan Wolf won’t be among them. The Wolfs, who live in an upscale area outside Austin, make too much money to qualify for tax credits that will help other people afford coverage. That leaves them wondering how much they’ll wind up paying (Johnson, 10/28).

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Healthcare.gov's Technical Problems Persist Even As Some Hiccups Are Fixed

For instance, the troubled healthcare.gov was recovering Monday from an outage caused by one of the companies supporting the site.

The New York Times: U.S. Health Insurance Website's Problems Continue Despite Improvements
The Obama administration on Monday reported improvements in the operation of the federal health insurance marketplace, but insurers said that severe technical problems were still making it difficult to enroll new subscribers (Pear, 10/28).

Los Angeles Times: Health Care Law Also Faces Plenty Of Low-Tech Problems
When advocates for the president's healthcare law strategized about how to reach the uninsured, they knew exactly whom to tap: mothers who could spread the word about the law's benefits, sign up their younger children and nudge their twentysomethings to take part. But beyond the widely publicized problems with the federal website, low-tech challenges also are complicating that part of the drive to sell the program -- even in California, where the state website is running more smoothly and officials are fully behind the push (Reston, 10/28).

The Wall Street Journal: Health Site Recovers From Latest Snafu
The troubled federal health-insurance website was recovering Monday after another outage, this time caused by a network failure at one of the companies supporting the site. Health-insurance exchanges in all 50 states couldn't function for about 16 hours Sunday and Monday due to the outage, which affected a data hub on which the exchanges rely to transmit information about enrollees' identity and income (Radnofsky, 10/28).

Reuters: HealthCare.gov Up Again After Data System Crash, May Be Slow: Agency
The website at the center of the U.S. healthcare reform law was back up Monday after a data center outage prevented Americans from enrolling in subsidized health insurance, the latest technical problem to plague the online insurance exchanges (Humer and Begley, 10/28).

The Hill: Microsoft Offered To Help Fix ObamaCare Site
Microsoft offered to help fix HealthCare.gov but has not provided specific services yet, the software giant told lawmakers in a letter Friday. The House Oversight Committee sent letters to several technology companies last week to gain details on the little-described "tech surge" to fix Obamacare's botched enrollment site (Viebeck, 10/28).

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Administration Officially Extends Deadline For Health Insurance Sign-Up

The AP reports that "previously you had to sign up by the middle of February, guaranteeing that your coverage would take effect March 1, in order to avoid fines for being uninsured."

USA Today: HHS Issues Formal Insurance Deadline Clarification
People who have purchased insurance by March 31, even if they are not covered by their plans until May 1, don't need not file a waiver to avoid paying a fine for violating the individual mandate law under the Affordable Care Act, according to new guidance released Monday by the Department of Health and Human Services (Kennedy, 10/28).

The Associated Press: White House OKs Limited Waiver On Health Policy
The move had been expected since White House spokesman Jay Carney promised quick action last week to resolve a "disconnect" in the implementation of the law. It comes as technical problems continue to trouble the website designed as the main enrollment portal for people who don't get health care at work. As a consequence, Republican lawmakers, and some Democrats as well, are calling for a one-year delay in the penalties most Americans will face starting next year if they remain uninsured. Monday's action by the administration stops well short of that, and amounts only to a limited adjustment (Alonso-Zaldivar,10/28).



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States Struggle With Enrollment Data, Outreach To Minority Populations

News outlets report on state health exchange developments in Colorado, Maryland, California and Minnesota.

The Denver Post: Colorado's Health-Exchange Board Is Frustrated By Slow Enrollment Pace
State health insurance exchange officials said Monday they have 3,164 enrollments in Obamacare so far, expressing frustration with the slow pace during a special meeting. More than 44,000 Coloradans have created accounts with the exchange since its launch Oct. 1, but the difficulty of educating new customers in preparation for enrollment has been compounded by a series of computer glitches (Booth, 10/28).

The California Health Report: Covered California In Translation
State agencies and social service organizations have made highly publicized attempts to include non-English-speaking immigrants in either the Medi-Cal expansion or Covered California. In addition to English, officials have prepared materials on health reform in a dozen languages, trying to inform the state's largest immigrant populations. But with more than 200 languages spoken in California, there's concern that smaller populations might not get needed health care information (Richard, 10/29).

The San Jose Mercury News: Covered California Chief, Peter Lee, Defends Delay Of Enrollment Figures
Peter Lee, the head of the state's new health insurance exchange, said Monday that he will not reveal how many Californians have enrolled in health plans until mid-November. But once the figures are posted, Covered California's executive director told this newspaper's editorial board in a wide-ranging interview, the enrollment numbers will be among the most detailed in the country. He said they will be broken down by city and region, the age of the enrollees and which kind of plans they have selected (Seipel, 10/28).

California Healthline: Exchange Wants Covered California Days
The idea started in Sacramento, but it wasn't a statewide scheme at first, said Covered California executive director Peter Lee at the exchange board meeting last week. "A lot of state policy happens in Sacramento, but Sacramento is a local community, too. And locally, a lot of policy can happen," Lee said. "The idea is, [Sacramento] Mayor Kevin Johnson announced that Nov. 16 is going to be Covered Sacramento Day." That relatively small acknowledgement of the state's health benefit exchange now has taken off, Lee said (Gorn, 10/28).

The Baltimore Sun: Evergreen Faces Challenges In Delivering Health Insurance
Four weeks since it began selling health insurance on the state's new marketplace for the uninsured, Evergreen Health Cooperative Inc. has signed up only five people. That's a long way from the nonprofit health insurance provider's first-year goal of 15,000 people, so Evergreen is already shifting focus (Cohn, 10/28).

Minnesota Public Radio: Latino Outreach Event Lands No MNsure Enrollments
Minnesota's new online health insurance marketplace, MNsure has been open for four weeks. But efforts to inform hard-to-reach populations about how they can sign up for heath care coverage are only now getting underway. That's what brought employees of Southside Health Services on Saturday to Karina's Beauty Salon in St. Paul's West Side neighborhood, the heart of the city's Latino community (Stawicki, 10/29).

Meanwhile, in news related to how states are doing with the federal exchange --

Health News Florida: Spanish Language Marketplace Site Up, But Not Running
The Spanish-language version of HealthCare.gov, CuidadoDeSalud.gov, was supposed to be up and running this past Monday, but instead, the U.S. Department of Health and Human Services is directing users to its Spanish call center. Altamonte Springs resident Miriam Lopez said she heard it's better to apply online, so she's been reluctant to enroll by phone (Mandigo, 10/25).

Fox News: Obamacare Sites Fail To Rate Insurance Plans
Shopping for health insurance on the ObamaCare exchanges? Good luck. Not only will you have to navigate the technical problems that have plagued the site -- but in most states, those running the exchanges are not posting ratings that could give shoppers a clear sense of how good the plans are (La Jeunesse, 10/28).

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In Health Enrollments, Medicaid Outpacing Private Plans; Ohio Gov.'s Stance On Expansion Puts Him At Odds With GOP Strategy

The New York Times examines how Gov. John Kasich, once a Republican leader in Washington, has defied the party orthodoxy on Medicaid. And Politico looks at the large number of Medicaid enrollments.

The New York Times: Ohio Governor Defies G.O.P. With Defense Of Social Safety Net
In his grand Statehouse office beneath a bust of Lincoln, Gov. John R. Kasich let loose on fellow Republicans in Washington. “I’m concerned about the fact there seems to be a war on the poor,” he said .... “The very people who complain ought to ask their grandparents if they worked at the W.P.A.” Ever since Republicans in Congress shut down the federal government in an attempt to remove funding for President Obama's health care law, Republican governors have been trying to distance themselves from Washington ... But few have gone further than Mr. Kasich in critiquing his party’s views on poverty programs (Gabriel, 10/28).

Politico: Medicaid Enrollment Surges Ahead Of ACA Sign-Ups
HealthCare.gov may be limping along to full viability, but Medicaid is flying off the shelves. New Medicaid enrollment is far outpacing new insurance customers under Obamacare so far, a subtle sign that the program could play a greater role in the law's coverage expansion than first anticipated. Some people are signing up for the Medicaid expansion created by the president's health law. Others were already eligible for their state's current Medicaid program, but until this outreach campaign about health coverage, they had never signed up (Haberkorn, 10/29).

On other Medicaid expansion news -

Charlotte Observer: McCrory Rejects Call For Special Session To Expand Medicaid
Gov. Pat McCrory rejected a call to convene a special legislative session to add more low-income residents to the state and federal health insurance program. His comments came in response to a news conference called Monday by expansion supporters who again pushed their reasons for allowing more low-income people to sign up for Medicaid (Bonner, 10/28).

The Associated Press: Activists Want NC Medicaid Expansion Reconsidered
Democratic lawmakers and health advocacy groups asked Gov. Pat McCrory on Monday to reconsider his refusal to expand Medicaid in North Carolina to cover hundreds of thousands of additional low-income individuals through the federal health care overhaul (Robertson, 10/28).

Tennessean: Tennessee Medical Groups Urge Expansion Of Medicaid
The associations representing the state's doctors and nurses are jointly calling for Gov. Bill Haslam and the legislature to expand TennCare, the Medicaid program in Tennessee. Dr. Chris Young, president of the Tennessee Medical Association, and Jill Kinch, immediate past president of the Tennessee Nurses Association make an economic argument for expansion. They are asking state leaders to make pragmatic decisions until future elections determine the final fate of the Affordable Care Act. The repercussions of not expanding Medicaid will affect Tennesseans of all incomes, they said (Wilemon, 10/27). 

Pittsburgh Post-Gazette: Health Care For All In State Urged
The head of the lobbying group representing Pennsylvania hospitals reiterated his call Monday for all Pennsylvanians to have health coverage, and said Gov. Tom Corbett's proposal to provide insurance subsidies for low-income residents is an avenue to that goal (Langley, 10/28).

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What Would A Mandate Delay Mean For Insurers, The Health Law

As talk continues over possibly putting off parts of the health law, news outlets look at what delaying the mandate that nearly all Americans have health insurance could do to insurers and just how smart the move really would be -- despite the seemingly good politics of a delay.

Marketplace: Delaying Obamacare: How Do Insurers Feel? 
As Healthcare.gov continues to frustrate, the chorus calling for delay of the Affordable Care Act is growing. A handful of Senate Democrats have joined Republican calls to hold off on the individual mandate (the part of the law that fines people who don't get insurance). But a delay would be trouble for health insurance companies. ... The insurance companies set their premiums based on one set of rules: rules in which everyone without insurance has to sign up. But, if those rules change, and people don’t have to get health insurance right away, says [Bradley Herring, a professor of health economics at the Johns Hopkins Bloomberg School of Public Health], "then they are kind of left holding the bag" (Hill, 10/28). 

McClatchy: Critics Point To Drawbacks In Changing Health Law Deadline, 'Individual Mandate'
Extending the Affordable Care Act's March 31 open enrollment deadline has become a familiar plea for congressional Democrats frustrated with the poor performance of the federal insurance marketplace. Republicans on Capitol Hill want to go even farther and waive the health law's "individual mandate," which requires most Americans to have coverage in 2014 or face a fine. While both consumer-friendly fixes make for good politics, neither proposal is as simple or as smart as it sounds, according to experts (Pugh, 10/28).

On the topic of enrolling young people --

PBS NewsHour: Will Health Care Premiums Be Affordable For Young People? White House Says Yes
White House and insurance industry officials are counting on relatively healthy young population to help share the costs of older Americans with pre-existing conditions. The law will ban insurance companies from charging the latter significantly higher premiums, making cost-sharing with a wider group of people crucial. But some analysts said that insurance plans wouldn't be cheap enough for young adults, that the fine would be more attractive, and the entire scheme would fall apart (Kane, 10/28).

And, in other implementation news --

Politico: Obamacare And The Limits Of The Wayback Machine
It just means that President Barack Obama's signature health care law shouldn't be written off just yet. Everything depends on what happens in the next few months. A full recovery is possible, if the federal enrollment website stops having comical breakdowns within the next month and the rest of the implementation runs more smoothly. If that doesn't happen, none of the lessons of Medicare Part D's rollout will be able to save Obamacare (Nather, 10/29).

The Fiscal Times: Is The Embattled IRS The Next Obamacare Nightmare? 
Lurking down the road, however, could be another crisis when the IRS moves center stage in the next year or two to assume responsibility for enforcing 46 new tax-related provisions and tasks associated with Obamacare. Those include imposing new taxes on medical devices and Medicare, overseeing new itemized deductions for medical expenses, and imposing penalties on uninsured Americans who fail to purchase coverage on the new exchanges (Pianin and Ehley, 10/29).

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Obama's Labor Allies Sitting On Sidelines Of Health Care Rollout

Unions, which were disappointed in an administration decision to keep a tax on their group health plans, are not jumping in to help the White House in the battle to get the public signed on to the law. Meanwhile advocates and insurers are spending time with general messaging about the health care law until the marketplace website is working.

Politico: Unions Sitting Out ACA Enrollment
President Barack Obama's loyal allies in the labor movement aren't jumping to help the administration in the public battle over the problematic Obamacare website. Put off by new reinsurance fees on group health care plans that affect union members, Big Labor is largely sitting out the effort to enroll people for health care coverage or make the White House's public case that the mangled rollout of HealthCare.gov doesn't mean the entire Affordable Care Act is flawed (Epstein, 10/29).

Politico: Affordable Care Act Advocates Press Outreach, Downplay Website
The faulty Obamacare sign-up site has created a dilemma for advocates of the health law organizing outreach and education efforts. Now that open enrollment has begun, they need to get out the word about new coverage options and try to overcome years of public confusion about the law. But using scarce dollars to point people to a website that's not working can be counterproductive. ... So several states and insurers are delaying their marketing campaigns or choosing to focus on more general messaging at this point (Villacorta, 10/29).

In other political news about the health law --

Politico: Ads Hit Red-State Democrats On Obamacare
Americans for Prosperity is targeting two red-state Democrats over Obamacare with a pricey new ad buy that launches this week. The conservative group singles out Sens. Kay Hagan (D-N.C.) and Mary Landrieu (D-La.) in two new health care-related television ads, viewed first by Politico. The North Carolina and Louisiana 2014 contests will play key roles in determining which party controls the Senate (Glueck, 10/29).

CBS News: Poll: Bad Press Is Increasing Interest In Obamacare
The sea of bad press for the federal government's Obamacare website may be doing more good than harm for the Affordable Care Act, according to a new poll. A survey released Monday by Bankrate.com shows awareness and interest in the plan is growing among key demographics. The poll found 51 percent of all those surveyed -- Democrats and Republicans alike -- say the House Republican attacks and troubled launch of the Obamacare website have made them more interested in the new medical insurance plan. Only 4 percent say they're less interested (Von  Hoffman, 10/28).

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Capitol Hill Watch

CMS Head Tavenner Set To Testify Tuesday About Healthcare.gov On Capitol Hill

Republican lawmakers on Tuesday will question Centers for Medicare and Medicaid Services Administrator Marilyn Tavenner over healthcare.gov's troubled rollout, taking the stage in a debate that could bolster their political fortunes on the health law.

The Associated Press: GOP Ready To Turn Health Care Website Woes Into A Battlefield
Republicans plan to seek answers from Health and Human Services Secretary Kathleen Sebelius on the Obama administration's troubled start for its health care website to buy insurance, and are raising concerns about the privacy of information that applicants submit under the new system (Thomas, 10/28).

CBS News: Obamacare Glitches Give Republicans A Chance To Get Healthy
When House Republicans return to Washington Tuesday, they will get their first crack at questioning high-level members of the administration about the troubled rollout of the HealthCare.gov site. For years, the GOP has been making hay over the perceived shortcomings of the health care law, and now a major problem -- one of operations, not politics -- has fallen into their laps. Now comes the challenge: can they proceed with a light touch and not overplay their hand? (Kaplan, 10/29).

The New York Times: Health Site Puts Agency And Leader In Hot Seat
Ten days before HealthCare.gov opened for business, Marilyn Tavenner, the obscure federal bureaucrat whose agency oversaw the creation of the troubled online insurance marketplace, had a bad omen. It was a Sunday, and her mobile device was on the fritz, forcing her to go into the office. “It reminded me that I can still be brought to my knees by a malfunctioning BlackBerry,” she joked in late September, recounting her technology woes to a group of insurance executives. Nobody at [CMS] is joking now (Stolberg, 10/28).

The Washington Post: Medicare Chief Marilyn Tavenner To Testify Before Congress About HealthCare.gov
On Tuesday, Tavenner will be the first Obama administration official to testify before Congress about the efforts of her agency -- the Centers for Medicare and Medcaid Services -- to implement the 2010 law. The agency recently hired contractor Quality Software Services Inc. to be the general manager for the effort to fix the troubled Web site. Tavenner is likely to face a barrage of questions about the lead-up to the site's botched debut -- as well as the administration's previous claims that everything was on track for a successful launch (Kliff, 10/28).

The Associated Press/Washington Post: Medicare Chief Tavenner Faces Lawmakers' Questions Over Botched Health Overhaul Rollout
Trying to earn a second chance, the senior administration official closest to the implementation of the health care law's malfunctioning enrollment website will answer questions from Congress at the start of a pivotal week. Medicare Chief Marilyn Tavenner will be questioned Tuesday by the House Ways and Means Committee not only on what went wrong with HealthCare.gov, but also whether lawmakers can trust Obama administration promises to have things running efficiently by the end of November (10/29).

Politico: Somehow, Marilyn Tavenner Still Has Backers
Plenty of people have called for heads to roll after the Obamacare rollout -- including that of Kathleen Sebelius, the secretary of Health and Human Services. But so far, they haven't called for the head of Marilyn Tavenner, the administrator for the Centers for Medicare & Medicaid Services, which oversaw the office that created HealthCare.gov (Cunningham, 10/28).

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Medicare Part B Premium Costs Will Hold Steady in 2014

For the upcoming year, premiums will be $104.90 a month. In 2013, beneficiaries experienced a $5-per-month increase.

USA Today: Medicare Part B Premiums Won’t Go Up In 2014
The premiums for Medicare Part B will remain flat in 2014 and seniors have saved $8.3 billion on Part D prescriptions since the Affordable Care Act was enacted in 2010, the Department of Health and Human Services announced Monday. Medicare Part B covers medically necessary services, as well as preventive services (Kennedy, 10/28).

The Associated Press/Washington Post: Medicare Monthly Premium Will Stay At $104.90 A Month
Medicare says the “Part B” premium most seniors pay for outpatient care will stay the same in 2014, at $104.90 a month. That’s good news for beneficiaries, following a $5-per-month increase this year (10/28).

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State Watch

Federal Judge Blocks Parts Of Texas Abortion Law

A federal judge in Texas Monday partially blocked an abortion law there that would have required abortion doctors to have admitting privileges at nearby hospitals in order to perform the procedure -- a move that abortion rights advocates say would have shuttered nearly all the state's abortion clinics. The judge also blocked part of the law that restricted the use of medication-induced abortion. Law proponents plan to appeal.

The New York Times: Judge In Texas Partly Rejects Abortion Law
A federal judge in Texas on Monday blocked an important part of the state's restrictive new abortion law, which would have required doctors performing the procedure to have admitting privileges at a nearby hospital (Eckholm, 10/28).

Los Angeles Times: Judge Rules Part Of Texas Abortion Law Unconstitutional 
Some controversial new Texas abortion restrictions are unconstitutional and will not take effect as scheduled Tuesday, a federal judge ruled Monday. "Today's ruling marks an important victory for Texas women and sends a clear message to lawmakers: It is unconstitutional for politicians to pass laws that take personal, private decisions away from women and their doctors," said Cecile Richards, president of Planned Parenthood Federation of America (Hennessey-Fiske, 10/28).

The Washington Post: Judge Blocks Parts Of Texas Abortion Law
The ruling by U.S. District Judge Lee Yeakel represents a legal victory for abortion providers, who had challenged new requirements that abortion doctors must have admitting privileges at a hospital within 30 miles of their clinic and that all abortions must take place in surgical centers, rather than allowing women to take abortion drugs at home (Eilperin, 10/28).

The Associated Press/Washington Post: After Judge's Ruling To Throw Out New Law, Texas Abortion Clinics Set To Resume Appointments
The only abortion clinic in a 300-mile swath of West Texas can resume taking appointments Tuesday, after a federal judge struck down new restrictions that would have effectively shuttered it and at least a dozen other clinics across the state. Lubbock's Planned Parenthood Women’s Health Center had stopped making appointments last week, bracing for this week's scheduled enforcement of a new requirement that all doctors performing abortions in the state must have admitting privileges at a hospital less than 30 miles away (10/29).

The Wall Street Journal: Abortion Law Partly Blocked
The case concerning the new law, which was scheduled to take effect Tuesday, will now head to federal appeals court. A group of abortion-rights groups filed suit last month claiming the admitting-privileges requirement would unconstitutionally infringe on women's abortion rights, forcing many of the state's licensed abortion providers to stop performing the procedure. Similar lawsuits challenging admitting-privileges requirements have been filed in Alabama, Mississippi, North Dakota and Wisconsin (Koppel, 10/28).

Politico: Judge Blocks Texas Abortion Restrictions
A federal district court has ruled that one abortion restriction passed by the Texas state Legislature over the summer is unconstitutional and has partially blocked another. District Judge Lee Yeakel has blocked the state from enforcing a requirement that abortion-providing doctors obtain admitting privileges at local hospitals -- a restriction that would have ended abortion services at one-third of the health centers currently providing them. He also blocked restrictions on the use of medication abortion. Both restrictions would have gone into effect on Tuesday (Villacorta, 10/29).

Bloomberg: Texas Abortion Ruling May Begin Climb To Supreme Court
A federal judge struck down a Texas law requiring abortion doctors to be affiliated with local hospitals, a tactic tried by opponents in several states to restrict the procedure, beginning what may be a climb to the U.S. Supreme Court.  U.S. District Judge Lee Yeakel in Austin ruled that compulsory affiliation "does not bear a rational relationship to the legitimate right of the state in preserving and promoting fetal life or a woman's health" (Young and Harris, 10/29).

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State Highlights: Ala., Catholic Media Group File New Lawsuit

A selection of health policy stories from Alabama, California, Texas and Massachusetts.

The Associated Press/Washington Post: State Of Alabama, Catholic Media Group Sue Over Health Care Law
The state of Alabama and a Roman Catholic broadcasting network based near Birmingham are again suing over the nation's new health care law. Attorney General Luther Strange and Eternal Word Television Network filed suit Monday in federal court (10/28).

Los Angeles Times: Amid Obamacare Signup Glitches, Thousands Head To Free Clinic Event
Organizers of a high-profile annual free clinic in Los Angeles that attracts thousands of uninsured and underinsured patients have hoped that improvements in the nation's health care system would greatly reduce demand for their services. The massive Care Harbor event returns to town this week, amid the rollout of new and shifting insurance options for millions of Californians under the Obama administration's overhaul of the health care system. Once again, thousands showed up Monday at the Sports Arena to secure appointments for everything from mammograms to teeth cleaning -- but with new expectations for the future (Brown, 10/28).

California Healthline: For Californians Who Can Afford It, Autism Coverage Should Improve Under ACA
Some California families dealing with autism are "relatively lucky," according to advocates. California is one of 24 states, along with Washington, D.C., requiring autism coverage on the list of essential benefits in policies sold through new Affordable Care Act health insurance exchanges. However, for low-income families the pathway to autism coverage is full of obstacles in California, according to officials at Autism Health Insurance Project, a not-for-profit helping families find coverage and lobbying for policy changes (Lauer, 10/23).

The Texas Tribune: Lawmaker Delays Leave Facility For Mentally Ill Youths In Limbo
Months after lawmakers cut millions of dollars in funding for the Texas Juvenile Justice Department and ordered the closure of a detention facility, movement to shutter a facility for mentally ill youths remains stalled as state leaders seek to reconsider its demise (Grissom, 10/29).

WBUR: 'Minute Clinics' In Boston Mayor's Race: Not An Issue, Should They Be?
In-store clinics can be cheaper and more convenient than the usual primary care. (Though the one time I tried to use one in Cambridge, the minute was more like a half hour, and then came the staffer's hour-long lunch break, so I left in disgust.) On the other hand, they can fragment the health care system and siphon off lucrative pieces. ModernPhysician.com (note: doctors tend to oppose the clinics) lays out some of the pros and cons nicely in a 2009 piece here: "MinuteClinic Struggles in Mass., still not welcome in Boston." So why would this be a Boston issue? (Goldberg, 10/28). 

The Associated Press: Medicaid Chief Could Seek Managed-Care Expansion
Mississippi's Medicaid director wants to expand a managed-care program that he says has helped save the state about $40 million. David Dzielak said 22 percent of Medicaid recipients are in managed care, in which a company is paid a set fee to provide medical services, regardless of the services' actual cost (10/28).

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Editorials and Opinions

Viewpoints: Policy Cancellations Raising Ire; One Woman's Story On More Affordable Insurance; Daschle: Democrats Want Deal On Entitlements

The New York Times: A Delayed Deadline Could Disrupt Reform
The insurers have assumed that everyone would be required to have coverage by March 31. If the enrollment period is extended for a significant period, the sickest people are most likely to sign up early and the healthiest will likely hang back, driving up the costs ... there is no need for despair. In the long run, the technical problems can and will be fixed and most Americans will be better off. (10/28). 

USA Today: How HealthCare.gov Can Improve
I feel for the Obama administration's technology team. I've been there. While I was chief information officer for President George W. Bush, the technology team was tasked with redesigning WhiteHouse.gov. ... I know that the Obama technology team had a far larger challenge to create a new health care system from scratch. But once the HealthCare.gov website clears its major technological hurdles, I can offer a few lessons I've learned that might help the Obama administration (Theresa Payton, 10/28). 

The Washington Post: Delaying The Individual Mandate Won't Fix Obamacare
And let’s say, by some miracle, all those people do manage to get into the exchanges just under the wire. What exactly would the Obama administration have accomplished? It would have presided over the massive, chaotic, involuntary transfer of millions of people out of private health insurance they were happy with into Obamacare plans they did not want — all in violation of President Obama’s promise that if you’ve got health insurance you like “you can keep your plan" (Marc A. Thiessen, 10/28). 

Los Angeles Times: Obama's Big Lie
"All we've been hearing the last three years is if you like your policy you can keep it. ... I'm infuriated because I was lied to," one woman told this newspaper, as part of a story on how some middle-class Californians have been stunned to learn the real costs of Obamacare. And that lie looks like the biggest lie about domestic policy ever uttered by a U.S. president (Jonah Goldberg, 10/29).

Miami Herald: Delay Obamacare? No Way, Say Florida Democrats
It's tough to find an Obamacare success story. But one of them — Plantation resident Carolyn Newman — found her local congresswoman, Democratic National Committee Chairwoman Debbie Wasserman Schultz touting her case ... A 50-year-old cancer survivor, Newman got a letter from insurer Florida Blue that informed her Sept. 26 that it was canceling her high-risk plan. But then came the good news, she said: The plan they were offering had more benefits and a significantly lower monthly premium cost, $640.82 — 49 percent less than she pays now (Marc Caputo, 10/27).

The New York Times' Taking Note: Creepy Uncle Sam Is Back, With More Bad Advice
The conservative group Generation Opportunity is back with another creepy Uncle Sam ad attacking the Affordable Care Act. When we last saw the health-insurance-is-evil mascot, in September, he was performing gynecological exams on young women ... In the new, Halloween-themed spot, he’s part of a pressure-campaign — with hints of the movie “Videodrome”— to make a young man sign up for insurance through an exchange. It’s more of the same the-government-is-coming-to-get-you nonsense (Juliet Lapidos, 10/28).

Bloomberg: Dear Obamacare Officials: Fix The [Redacted] Sites!
If we delay the mandate/whatchamacallit, we’re going to be taking a big risk with the budget numbers and the enrollment numbers, and we’ll get even more Tea Party I-told-you-sos (which are already incredibly annoying). We’re in pretty bad shape, but I think we would have to be in even worse shape before we would do that. (Can we maybe get the Republicans to shut down the government again? That was great.) So how do we fix this? Heck if I know. I do political strategy, not computer work. All I know is we’ve got to fix the sites. And maybe start lowering expectations for what the law is going to accomplish. Best, [Democratic Strategist] (Ramesh Ponnuru, 10/28).

Bloomberg: Obamacare Will Survive Its Botched Rollout
[I]t's worth stepping back from the website mess to remember the deeper problems that made this law necessary in the first place -- and, by extension, why the issues with HealthCare.gov, which seem so important today, pale in comparison. ... expanding government-subsidized insurance and standardizing what it means to be covered, along with removing co-pays for preventive care, should start to close the gap in health outcomes between the U.S. and other countries (Christopher Flavelle, 10/28).

The Boston Globe: A Necessary Sense Of Urgency On Fixing Obamacare Website
But vexing as the rollout has been, the problems with the website shouldn't discredit the law itself. The website is a technological means to an end. It is not the end in and of itself. And it is, of course, fixable (10/28).

Fox News: Five Tips For Republicans Questioning Secretary Sebelius About ObamaCare This Week
This is a critical opportunity to get to the bottom of the "fiasco" of the ObamaCare roll out, and just as important, to demonstrate to America that there is a better alternative. ... My advice to the Republicans on the committee -- this is a great opportunity … the seriousness of the moment requires your gravitas, not your rage. Your constituents will get plenty angry on your behalf; you don't have to get angry for them. If you come across as the responsible adults in the room, it will be clear that the other guys are not (Dana Perino, 10/29). 

CNN: GOP's Hypocrisy On Obamacare
I still maintain that the administration has had a failure in management in overseeing and reporting on progress towards October 1. But I'm also sympathetic that they've had a hard job to do. I would like to see this go better. I'd like to see millions more get insurance. I'd like to see the law of the land function as well as it can, and if it doesn't, I'd like to see Congress continue to amend it to make it work better. I'd like a better health care system (Dr. Aaron Carroll, 10/28).

Bloomberg: Obamacare: The Return Of The HMOs
I wrote last week about the "magic pot of money" that everyone thought they had found to fund the Patient Protection and Affordable Care Act -- money that didn't harm patients or anger important interest groups. One of those magic pots was Medicare Advantage overpayments; it costs more to provide Medicare Advantage (in which Medicare money is used to purchase a private insurance policy) than it does to run patients through traditional Medicare (Megan McArdle, 10/28).

Tennessean: Medicaid Expansion Right Call For TN
The Affordable Care Act changed the way the federal government helps offset the hundreds of millions of dollars of uncompensated care provided to Tennesseans every year. Direct payments to hospitals, called disproportionate-share payments, ended Sept. 30, with the expectation that low-income uninsured patients would be added to an expanded Medicaid program. Without Medicaid expansion, the resulting shortfall threatens the trauma, pediatric and other specialty care we all rely on (Dr. Chris Young and Jill Kinch, 10/27). 

On other health topics -

The New York Times' Taking Note: Replace The Sequester, Not Sebelius
An embarrassing mistake, which should be considered a scandal, has caused the Internal Revenue Service to perform far fewer tax reviews and cut back its fraud investigations, costing the Treasury billions of dollars. Have there been any angry House hearings? No. That same mistake has forced the National Institutes of Health to cut more than 700 advanced research grants, delaying the progress of vaccines and experimental treatments. No hearings. ... That’s because the mistake is called the sequester, and Republicans know what went wrong: they caused it (David Firestone, 10/28). 

Politico: Seize Moment On Entitlement Reform
[A]s legislators and others consider ways to reduce federal spending on entitlements, they have always had only two real choices. They can arbitrarily cut costs of health entitlements and merely shift those costs to others — including states, beneficiaries, employers or providers, as we have done innumerable times in the past. Or they can redesign and improve federal health programs to make them more efficient, with modernized benefits, vastly improved quality of delivery and significantly reduced cost. We know how to do this (Tom Daschle, 10/28).

Los Angeles Times: A Good Day For Texas Women In Judge's Ruling On Abortion Law
In a big win for abortion rights — not to mention common sense — a federal judge on Monday gutted a portion of a new Texas law that would have forced the closure of many abortion clinics by requiring their doctors to have unnecessary admitting privileges with local hospitals. The ostensible point of the law, House Bill 2, versions of which have been successfully challenged in several other abortion-unfriendly states, is to make the procedure safer for women. That's disingenuous. First-trimester abortions are extremely safe. Laws like these are part of the religious right's never-ending strategy to restrict access to abortion in order to end it (Robin Abcarian, 10/28).

The Washington Post: FDA Seeks To Curb Abuse Of Prescription Painkillers
Few blessing of modern science are entirely unmixed, and so it is with the development of powerful synthetic or semi-synthetic opioid analgesics — painkillers such as fentanyl and hydrocodone. Prescribed by the tens of millions in recent years for their power to relieve otherwise crippling pain in the victims of disease and injury, these pills have turned into a $7.3 billion-per-year business. Yet they also pose a major public health risk because of their ready availability and addictiveness to many patients. ... The FDA has struck the right balance, based on its correct assessment that the public interest lies not in more use of pain medicines but in the proper use of them (10/28).

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Andrew Villegas

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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.