Daily Health Policy Report

Thursday, October 3, 2013

Last updated: Thu, Oct 3

KHN Original Reporting & Guest Opinion

Health Reform

Capitol Hill Watch

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

On Day 2, Federal Insurance Marketplace Offers Mixed Bag Of Problems, But Also Successes

Kaiser Health News staff report: "The federal online marketplace selling newly available health insurance in 36 states continued to frustrate consumers Wednesday with delays and software failures, although some reported success in signing up" (Hancock, Evans, Galewitz, Gold and Rao, 10/2). Read the story.

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Across The Country, Consumers Carefully Weigh Rollout Of Marketplaces

Kaiser Health News compiled this report based on stories provided by reporters at our partner public radio stations detailing some of those experiences. “Across the country, consumers, advocates and officials are carefully watching the rollout of the health law’s insurance marketplaces as they try to evaluate what works and what doesn’t. Many people have encountered technical glitches, especially in the first hours after the marketplaces opened Tuesday. But for some of those who rushed to see what plans would be available, those snags didn’t dampen their initial enthusiasm” (10/2). Read the story.

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Back To Work After A Baby -- But Without Insurance This Time

Kaiser Health News staff writer Sarah Varney, working in collaboration with NPR, reports: "Pardit Pri had insurance until she decided to quit her job as a legal administrative assistant and stay home with her newborn son 20 months ago. And she expected to have it again. But it didn’t work out that way" (Varney, 10/3). Read the story.

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Small Businesses May Find Relief In Health Insurance Exchanges Designed For Them

Southern California Public Radio’s Stephanie O’Neill, working in partnership with Kaiser Health News and NPR, reports: "But while about 45 employees work here to make Hollywood magic happen, general manager Sunder Ramani is focused on the less exotic work of paying the bills and figuring out how to provide insurance to about 15 employees who don't have union-provided health coverage" (O’Neill, 10/3). Read the story.

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Capsules: R.I. Woman Among First To Enroll In Obamacare Exchange; What’s In A (Domain) Name? Lookalike Site In Wash. Raises Concerns

Now on Kaiser Health News' blog, Phil Galewitz reports on a women who just signed up for health coverage: "Uninsured for more than five years, Leslie Peters says she was 'chompin' at the bit' to get coverage to afford regular medical care that she often has gone without. That’s why as soon as HealthSource RI, the Rhode Island online health insurance exchange, went live Tuesday, she enrolled. 'I was so excited,' said Peters, who lives in Tiverton, R.I." (Galewitz, 10/2).

Galewitz also reports on how health exchange websites must be on the look out for look-alikes: "Washington Healthplanfinder is the name of the state’s online insurance exchange. But a private insurance agency is using the domain name 'washingtonhealthplanfinder.org' to sign people up for policies. Confused? State officials want to make certain consumers won't be. 'We are aware of this site and … forwarded to our Washington State Office of the Insurance Commissioner for investigation,' said exchange spokeswoman Bethany Frey. Officials in many states have long been monitoring the Web for look-alike websites that can result in fraud — or simply consumer confusion" (Galewitz, 10/3). Check out what else is on the blog.

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Political Cartoon: 'Conspiracy Theory?'

Kaiser Health News provides a fresh take on health policy developments with "Conspiracy Theory?" by Jimmy Margulies.

Here's today's health policy haiku:


Exchange website girl:
My attraction grows to hate
as my login fails.

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

Day 2: Consumers Shopping For Insurance On Exchanges Continue To Confront Delays, Challenges

Interest and demand appeared to overload websites and clog phone lines. Federal officials, who were taking steps to build additional capacity into the system, said traffic to the website exceeded expectations.

The New York Times: As Demand Stays High, Officials Try To Address Problems In Exchanges
Federal and state officials moved Wednesday to strengthen the computer underpinnings of the new online health exchanges, which proved inadequate to handle a flood of consumer inquiries that began as soon as the system opened on Tuesday and continued into the next day (Perez-Pena, Goodnough and Pear, 10/2).

The Associated Press/White House: Computer Glitches In Health Insurance Marketplace Signal Strong Demand For Coverage
Overloaded websites and jammed phone lines frustrated consumers for a second day as they tried to sign up for health insurance under the nation’s historic health care overhaul. That was putting pressure on the federal government and the states that are running their own insurance exchanges to fix the problems amid strong demand for the private insurance plans (10/3).

Kaiser Health News: On Day 2, Federal Insurance Marketplace Offers Mixed Bag Of Problems, But Also Successes
The federal online marketplace selling newly available health insurance in 36 states continued to frustrate consumers Wednesday with delays and software failures, although some reported success in signing up (Hancock, Evans, Galewitz, Gold and Rao, 10/2).

The Wall Street Journal: Health Insurance Website Still Sees Delays
Efforts to clear logjams in the federal health law's new online insurance marketplaces met with only modest success Wednesday, with strong traffic exacerbating waits and relatively few consumers able to enroll in policies during the system's second day. Blue Cross & Blue Shield of North Carolina, for one, said it was able to enroll only a single person in a subsidized health plan under the law by Wednesday afternoon (Martin, Weaver and Campo-Flores, 10/2).

Politico: Obamacare Day 2: More Turmoil, Some Progress
Obamacare’s second day didn’t look much different from its tumultuous first day. The problems that plagued the system on its launch Tuesday remained prevalent one day later, as error messages and indefinite waits stymied online visitors to the federal exchange. There was scant evidence that many people were able to even browse the online insurance offerings, much less actually sign up for a plan. The situation varied widely in the 15 states that opted to build their own Obamacare exchanges, with some tallying large numbers of visitors and applications and others continuing to stumble. Most, though not all, of the state exchanges are in Democratic-led states that support the president’s health law (Norman and Millman, 10/3).

Los Angeles Times: Glitches Continue To Plague Health Insurance Marketplaces
Obama administration officials attributed the problems to high traffic at the federal website — healthcare.gov — which is the main portal for consumers in 36 states to select a health plan. Residents of the remaining 14 states, including California, Connecticut and Maryland, and the District of Columbia can use state-operated websites, many of which also continued to struggle to keep up with demand. Californians encountered computer problems and call-center hold times of more than 30 minutes. The Department of Health and Human Services reported Wednesday that there were 6.1 million unique visits to the federal website on the first day and a half after the site opened Tuesday (Levey, 10/2).

USA Today: High Volume Spurs Health Exchange System Crash
A high number of visitors to the new federal health insurance exchange site Wednesday caused the system to crash or cause prospective insurance customers to endure long waits. The Department of Health and Human Services has tried to limit the problems by changing how site visitors enter the site and reach details on how to shop for and buy insurance (Kennedy, 10/2).

McClatchy: Computer Glitches Still Ail Some State Health Care Signup Sites
The delays, crashes and glitches have marred the October debut of the marketplaces, which serve as a one-stop, online shopping mall for 2014 health insurance coverage required under the Affordable Care Act, also known as Obamacare. The U.S. Department of Health and Human Services, which provides the operating systems for 36 state marketplaces, is adding additional capacity to handle the high user volume. Nearly 5 million unique visits and 104,000 web chat requests were logged on the department’s healthcare.gov website on Tuesday, along with 190,000 calls to its 24-hour telephone call center, at 800-318-2596. Those numbers "exceeded anyone's expectations," Health and Human Services Secretary Kathleen Sebelius said Wednesday on MSNBC. "We were planning on a lot of people being interested. We had no idea of quite how many" (Pugh, 10/2).

Reuters: U.S. Government Scrambles To Provide Access To Obamacare Sites
The U.S. government on Wednesday scrambled to add computer capacity to handle an unexpectedly large number of Americans logging onto new online insurance marketplaces created under Present Barack Obama's healthcare reform law. Technical glitches and heavy traffic slowed Tuesday's launch of the marketplaces, particularly for the federal Healthcare.gov website serving 36 states (Morgan and Krauskopf, 10/2).

Bloomberg: Overwhelming Demand For Obamacare Shows Potential Success
Obamacare’s opening day drew millions of consumers to the law’s core insurance exchanges, offering supporters and investors hope that if the websites can stay up and running, customers will follow. In New York, officials said their exchange had 2.5 million visitors in its first half hour yesterday (Nussbaum, 10/2).

San Jose Mercury News: Day Two Of Obamacare: Computers Still Trying To Catch Up With Intense Interest In Insurance Exchanges
It took Clifford Brown until about noon Wednesday to finally access California's online health insurance exchange. Even then, he got as far as creating an account but still couldn't log in. "If my mother was trying this, she would have quit by now,'' said Brown, a 32-year-old musician and independent producer who lives in Emeryville. He hoped for greater success later in the day or by Thursday morning. It didn't help that for two hours Wednesday morning, the enrollment function on the Covered California website was shut down after logos of some of the health plans did not appear because of a computer glitch, according to spokesman Larry Hicks (Seipel, 10/2).

Bloomberg: Lady Gaga Tweets For Obama Health Law To Counter Cruz
Never mind the denunciations by Senator Ted Cruz and other Republican opponents of President Barack Obama’s signature health care law: Lady Gaga has spoken. Forty million Twitter followers received a message yesterday from the pop star: “It’s time to #GetCovered at Healthcare.gov.” (Dorning, 10/3).

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States Seek Ways To Address Marketplace Trouble Spots; Also Report Progress

News outlets report on the fits and starts of state online health insurance marketplaces in Maryland, New York, Kentucky, Minnesota, Texas, Florida, California and Colorado -- just to name a few.

Kaiser Health News: Across The Country, Consumers Carefully Weigh Rollout Of Marketplaces
Across the country, consumers, advocates and officials are carefully watching the rollout of the health law’s insurance marketplaces as they try to evaluate what works and what doesn’t. Many people have encountered technical glitches, especially in the first hours after the marketplaces opened Tuesday. But for some of those who rushed to see what plans would be available, those snags didn’t dampen their initial enthusiasm (10/2).

The Associated Press/Washington Post: Md. Explores Alternative Ways To Create Accounts To Use Online Health Insurance Marketplace
As Maryland’s new online marketplace for health insurance continues to have trouble handling a deluge of requests to set up accounts, state health officials are exploring alternative ways to create those accounts, the state’s health secretary said Wednesday. Dr. Joshua Sharfstein said tens of thousands have visited the site but fewer than 100 people so far have actually enrolled in a health plan through Maryland Health Connection. Sharfstein estimated that hundreds have been able to create accounts online (10/2).

The Associated Press/Washington Post: NY Health Care Website Slammed By 30 Million Hits; State Monitoring For Any Attack, Protest
State Department of Health Executive Director Donna Frescatore said the agency doubled the website’s capacity after users experienced delays and other difficulties entering. New York is constantly monitoring the website for “robots” which could inundate the system as a protest or as a way to disrupt the health care program. But no evidence has been found. The department said evidence of an attack or protest could be seen immediately (10/2).

The Wall Street Journal: New York Health Insurance Exchange Launches
Thousands of New Yorkers struggled Tuesday as they sought to use a balky new website that hosts the state's new health-insurance exchange, but officials pledged to fix the bugs and took heart that the site received unexpectedly high traffic on its first day. … The state's online marketplace, which opened for business as enrollment for insurance under the federal Affordable Care Act began around the U.S., was receiving upgrades to handle more traffic late Tuesday, Ms. Frescatore said. The website recorded more than 10 million hits, while about 9,000 people were able to shop. The site counts every hit, regardless of whether someone was able to get onto the site, a spokesman said (Dawsey, 10/2).

The Wall Street Journal’s Washington Wire: Why Kentucky’s Health Exchange Worked Better Than Many Others
While Kentucky’s health-insurance exchange experienced some glitches when it launched Tuesday, it seemed to perform better than many of its peers. State officials and outside experts attribute the smoother rollout to a variety of factors, including intensive testing of the system, a less-flashy but more-efficient website and strong coordination among state agencies involved in the effort. As a result, Kentucky’s exchange, dubbed Kynect, logged solid results in the first day and a half of operation. As of 4:00 p.m. Wednesday, 10,766 applications for health coverage had been initiated, 6,909 had been completed and 2,989 individuals or families had enrolled in new coverage (Campo-Flores, 10/2).

Pioneer Press: MNsure Shoppers Find New Website’s Waters Still Choppy
People in Minnesota and around the country seeking health insurance online reported some trying times Wednesday. Several Internet users of MNsure, the new state-run health exchange, said they couldn't create the accounts needed to see premium discounts that might come with federal tax credits and later to buy coverage (Snowbeck, 10/2).

Minnesota Public Radio: Some MNsure Glitches Persist
The glitch started with a MNsure server problem that was corrected yesterday. But agency officials now say the problem is largely out of MNsure's hands. It stems from a security policy that bars users who make three failed attempts at creating accounts from trying again for seven days. The site also is hampered by heavy use of the federal hub, a massive database that contains personal information required to verify someone's identity. While state officials urge patience, insurance companies that participate in the exchange already are complaining about the problems. Locally and nationally, the "overall [exchange] experience is pretty clunky," said Scott Keefer, vice president of Policy and Legislative Affairs for Blue Cross and Blue Shield of Minnesota. "I think with that clunky experience comes concerns as to whether enrollment is going to go as smoothly" as possible (Richert and Stawicki, 10/2).

Minnesota Public Radio: Problems Using MNsure? Officials Urge Patience
MNsure officials say that consumers have created more than 2,500 accounts, but won't say how many of those users actually enrolled in a health plan. Frustration about the enrollment glitches is spreading to the health insurance industry and social service providers, where officials are raising concerns that prolonged problems may reduce overall enrollment (Stawicki, 10/3).

The Star Tribune: MNsure Health Insurance Exchange Busy, But Still Bumpy
Frustrations with identity verification were among the complaints that emerged as Minnesotans started logging on to the MNsure health insurance exchange, a new online marketplace that launched Tuesday as part of the federal health care law. But volume remained high. By early Wednesday afternoon, more than 2,500 accounts had been created, though no data was given for how many people bought insurance. The call center had received 425 calls by 2 p.m., and the website was seeing 2,000 to 3,000 users at a time. MNsure executive director April Todd-Malmlov has acknowledged “a few bumps in the road,” including a server crash shortly after the site went live, but said MNsure’s IT crew was tracking issues and “fixing them as they come up” (Olson and Crosby, 10/3).

The Associated Press: Texans Getting Health Care In Person; Web Glitches Not A Deterrent
Luis Veloz wasn’t going to wait for the federal government to work out the kinks in its website before enrolling in the nation’s new health insurance system. Instead, he rushed to fill out a paper application and mailed it in, eager to have a plan that would prevent him from racking up major medical bills like his parents. As Texas residents encountered difficulties with the website for a second day, those trained to assist with the process said callers are simply asking for a nearby location where they can complete the process the old-fashioned way: in person and on paper (Plushnick-Masti, 10/2).

Miami Herald: Insurance Exchange Woes Continue In Florida
South Florida consumers reported a second consecutive day of technical problems on Wednesday that locked them out of the online health insurance exchange on HealthCare.gov that is key to the Affordable Care Act. Wednesday marked day two of a six-month open enrollment period, during which eligible low- and middle-income consumers can sign up for subsidized health insurance through the federally run website (Benn, Borns and Chang, 10/2).

California Healthline: Exchange Opens For Business, Officials Call It A Bridge To Health Care For Millions
Yesterday, as people were still absorbing the news from Washington about the largely Republican move to shut down the government if they can't shut down health care reform, Lee said that the public response in California to health care reform was a little different. The three call centers in the state are fully staffed and answering phones nonstop, and the Covered California website activity is off the charts, [California Exchange Executive Director Peter] Lee said (Gorn, 10/2).

Health Policy Solutions (a Colo. news service): Clogged Websites, Swamped Phone Lines Mark Obamacare Opening Day
In Colorado, exchange managers gathered at their Denver headquarters just before 8 a.m. to switch the system on. They said about 79,000 individuals had visited the Connect for Health Colorado website and the website had gotten over 12 million hits by 8 p.m. on the first day. In the first hours, many customers could not create new accounts, and technology managers had to re-boot the system to try to handle traffic jams (Kerwin McCrimmon, 10/2).

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Security Specialists Say Obamacare Glitches Not Caused By Online Attack

The New York Times reports that the technical problems plaguing the federal exchange websites are not the work of hackers. Meanwhile, Politico looks at the playful security questions that some state exchanges are using.

The New York Times: Problems At Health Care Web Site Not From Online Attack, Experts Say
As the federal government struggled on Wednesday to explain the technical problems experienced by would-be users of the health exchange Web site, www.healthcare.gov, computer security specialists say they had ruled out a cyberattack known as a denial of service, or DDoS, attack. Those occur when attackers fire huge amounts of traffic at a Web site until it collapses under the load. Such attacks typically entail hundreds of millions of data requests to a site per second. The federal health care site experienced 4.7 million unique visitors in the first 24 hours. New York State’s site experienced 30 million Web requests, which could have been fueled at least in part by a New York advertising blitz on sites like CNN.com, media coverage, and links from news sharing sites like Reddit (Perlroth, 10/2).

Politico: Obamacare’s Funny Bone
Obamacare may be full of glitches, but who knew it had a sense of humor? Forget those staid online security questions about your mother’s maiden name or the street where you grew up. New York’s health insurance exchange — known as the New York State of Health (get it?) — asks: “What band poster did you have on your wall when you were in high school?” Connecticut’s health exchange wants to know how many bones you’ve broken (Kenen, 10/2).

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People Without Insurance Seek New Options From Insurance Marketplaces

For consumers who are seeking insurance through the new law, the marketplace's technical problems have been frustrating, but many remain eager. 

Kaiser Health News: Back To Work After A Baby -- But Without Insurance This Time
Pardit Pri had insurance until she decided to quit her job as a legal administrative assistant and stay home with her newborn son 20 months ago. And she expected to have it again. But it didn't work out that way (Varney, 10/3).

Kaiser Health News: Small Businesses May Find Relief In Health Insurance Exchanges Designed For Them
But while about 45 employees work here to make Hollywood magic happen, general manager Sunder Ramani is focused on the less exotic work of paying the bills and figuring out how to provide insurance to about 15 employees who don't have union-provided health coverage (O'Neill, 10/3).

Kaiser Health News: Capsules: R.I. Woman Among First To Enroll In Obamacare Exchange
Uninsured for more than five years, Leslie Peters says she was "chompin' at the bit" to get coverage to afford regular medical care that she often has gone without. That's why as soon as HealthSource RI, the Rhode Island online health insurance exchange, went live Tuesday, she enrolled. "I was so excited," said Peters, who lives in Tiverton, R.I. (Galewitz, 10/2).

The Wall Street Journal: Micro Businesses Find Health-Care Rollout Is Slow
Porche Lovely of Denver attempted to enroll in a health-care plan through her state's new insurance exchange Tuesday because her employer doesn't offer health benefits. Her employer? Porche Lovely. Among the 22 million Americans expected to sign up for health insurance through the new state exchanges over the next two years are owners of micro businesses—companies with just a few or no employees (Needleman, 10/2).

Reuters: Covered And Looking For Deals, Americans Shop Obamacare
Stephanie Desaulniers is among the millions of Americans seeking information on new Obamacare health insurance plans launched this week, not because she lacks coverage, but because she's ready for a better deal. The 26-year-old geologist has health benefits through her employer, an environmental consulting firm in Cumberland County, Pennsylvania (Skinner, 10/2).

Politico also reports on the work of "navigators" and other enrollment assisters, who will help people through the health law's insurance shopping process as well as how Enroll America, an advocacy group, is scouting for people to target for enrollment.

Politico: ACA’s Foot Soldiers Help Families Deal With System
Forget the technical glitches. Navigators and other enrollment assisters are trying to prepare for the hundreds of different scenarios families are going to bring to Obamacare. A single mother with expiring unemployment benefits? A mom who is undocumented and a father who has papers? A family that earns too much money for Medicaid but not enough to get subsidies? (Haberkorn, 10/3).

Politico Pro: Enroll America Ads Use Microtargeting For Obamacare Signup
The White House wants 7 million people to get covered in the first year, and the pro-Obamacare organization hopes to scout out as many as possible by New Year's. The medium of choice: Digital ads that can microtarget exactly those they're trying to reach — young people, women and minorities who lack insurance and live in states that aren't doing enrollment outreach. Good thing for Enroll America, these are also the folks who spend the most time online. The buy isn't huge compared to the hundreds of millions already poured into negative advertising about the health law. But Enroll America is convinced that using Internet targeting techniques, which are getting more precise all the time, will make up for whatever they lack in funds (Cunningham, 10/2).

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States' Refusal To Expand Medicaid Will Prevent Millions From Getting Coverage

The New York Times reports that the decision by about half the states to not expand Medicaid coverage will prevent two-thirds of poor black consumers and single mothers and more than half of low-wage workers from getting insurance.

The New York Times: Millions Of Poor Are Left Uncovered By Health Law
A sweeping national effort to extend health coverage to millions of Americans will leave out two-thirds of the poor blacks and single mothers and more than half of the low-wage workers who do not have insurance, the very kinds of people that the program was intended to help, according to an analysis of census data by The New York Times. Because they live in states largely controlled by Republicans that have declined to participate in a vast expansion of Medicaid, the medical insurance program for the poor, they are among the eight million Americans who are impoverished, uninsured and ineligible for help (Tavernise and Gebeloff, 10/2).

The New York Times: Despite Criticisms, Health Care Law's Impact On Jobs Is Still Unclear
To Speaker John A. Boehner, it is "job-killing." To Senator Ted Cruz, it is "hurting the American people." To Senator Mitch McConnell, it is a "big reason we are turning into a nation of part-time workers." But to many independent economic analysts, it remains too early to tell how the sweeping Affordable Care Act will affect the jobs market (Lowrey and Harwood, 10/2).

In other news about the policy effects of the law --

The Wall Street Journal's Washington Wire: U.S. Citizens Abroad Avoid Health-Law Mandate
The Affordable Care Act requires most Americans to carry health insurance or pay a tax penalty–and there's a reason we say "most" rather than "all." Americans who live abroad at least 330 days of the year will be treated as if they have qualifying insurance coverage and won't owe any tax penalty, according to the Internal Revenue Service. That's true regardless of whether the U.S. citizen actually has health insurance in the country where he or she lives (Schatz, 10/2).

USA Today: Is Health Law Really To Blame For Plan Changes?
A handful of big-name firms and many small ones are making major changes to their health care plans this fall, and while some big companies are blaming the Affordable Care Act, insurance and economic experts call those claims an exaggeration. Making health insurance changes, including big premium and deductible hikes when the rate of increase in health care costs has slowed, creates a "messaging issue," says University of Michigan business economics professor Thomas Buchmueller, "That's not an easy conversation," says Buchmueller. "It's convenient to say, 'the ACA is raising our costs'" (O’Donnell and McGinnis, 10/2).

The New York Times: Conversations: The Landscape Of Small-Business Health Insurance
Five years ago, a start-up called Liazon began offering businesses a new way to provide health insurance to employees. On Liazon's Bright Choices, an online marketplace, a company can specify how much money it wants to spend on each employee's benefits, and employees can use that contribution to buy the plan of their choice (Mandelbaum, 10/2).

The Wall Street Journal's Venture Capital Dispatch: Psilos Partner Sees Opportunity in ObamaCare Exchanges
The state and federal health-insurance exchanges central to ObamaCare have been getting a bad rap this week, as millions of consumers flocking to websites have caused crashes and delays. But when the dust settles, the exchanges will present opportunities for businesses to save money, for entrepreneurs to develop new technologies and for investors to reap returns, said venture capitalist Lisa Suennen, whose firm Psilos Group has made a number of investments over the years in startups that do business with or alongside the insurance industry (Hay, 10/2).

USA Today: Some Physicians Still Charge Co-Payments Banned By Law
Some doctors' offices are still charging patients co-payments for preventive exams, such as annual physicals and well-baby checkups, even though the Affordable Care Act prohibits the practice (Kennedy, 10/3).

CNN: Fact Check – Premiums Will Go Up
On CNN’s Crossfire Tuesday night, Senator Tom Coburn (R-Okla.) took issue with the context in which new health insurance premiums under Obamacare are being described. The presentation of states' new premium data has been all over the map (pardon the pun). States whose leaders are opposed to the ACA have presented their data in a way that makes new premiums look overly burdensome to consumers. Democratic governors in favor of the ACA have presented their state's premiums in a way that makes them sound like a great benefit to consumers. The Department of Health and Human Services has chosen to use the nonpartisan Congressional Budget Office's and the Kaiser Family Foundation's predictions that, as Coburn notes, project that the premiums will be less costly than previously estimated. But that doesn't help compare new plans to ones available before the health care law took effect. So where's the truth? (10/2).

CNN: Doctor Shortage, Increased Demand Could Crash Health Care System
Dr. Ryan A. Stanton is worried that this coming flood of newly insured patients may crash the U.S. health care system as well. Stanton works at the emergency room at the busy Georgetown Community Hospital right outside of Lexington, Kentucky. While he sees trauma cases often, a good number of the patients he sees don't involve trauma. They're the uninsured who can't afford to pay for a regular doctor's visit -- so they use the emergency room instead. "People turn to the ER because they have no other place to go after hours or they don't have access to a level of appropriate primary care," Stanton said. "The ER has become the safety net of our health care system. We can't turn anyone away like a doctor's office could. ... I worry though with (Obamacare) this will significantly increase patient volume” (Christensen, 10/2).

Fox News: Obamacare Reg On Digital Patient Records Raises Security Concerns
A provision in ObamaCare requiring medical providers to switch from paper patient charts to electronic records is intended to reduce costs and improve care. But privacy advocates fear the transition is too fast for security measures to keep pace.  "The thing I worry about is not that we are doing it, but that we're doing it without the right safeguards," said Lee Tien, a senior staff attorney with the Electronic Frontier Foundation. "We have been giving (medical providers) incentives to move into the electronic-health-records era. But we haven't been giving them enough guidance on how they're supposed to do it" (Serrie, 10/2).

Martketplace: Obamacare Costs Jobs: Insurance Brokers
Like it or not, buying health insurance online is the future. And while that may be convenient consumers, it's not such great news for the more than 100,000 insurance agents and brokers who depend on commissions for a living. As the curtain comes up on the new health exchanges, Virginia-based insurance broker Jonathan Katz reports business has been hopping. "In the last two days, I've received over 40 calls and 50 emails a day," he says. "Current clients asking 'what are we going to do with my current plan? What's my situation?'" Katz knows that questions and sales aren't the same thing. And with millions of new customers shopping for insurance under Obamacare, a lot of future sales are going to happen on line without a broker (Gorenstein, 10/2).

CQ HealthBeat: Health Law's Impact On Part-Time Work Murky
Perhaps one of the sharpest attacks on the health law is that it's causing a big shift to part time work. But is that really true? A survey released Wednesday by the Mercer consulting firm lends credence to the charge. It says 11 percent of large employers next year are considering cutting back hours for at least part of their work force. They're taking that step to avoid triggering the overhaul's requirement that they provide health benefits to employees who work 30 or more hours per week (Reichard, 10/2).

CQ HealthBeat: Conservative Study Highlights High Exchange Premiums For The Young
A conservative think tank is questioning whether the very group of Americans that the Obama Administration needs to sign up for insurance coverage in the health law marketplaces — the so-called young invincibles — will actually enroll because premiums for that group are so much higher than they now pay (Bunis, 10/3).

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Capitol Hill Watch

President Says He'll Negotiate Budget Only After Gov't Reopens Without Changes To Health Law

President Barack Obama said Wednesday that he will only compromise on the federal budget -- including addressing long-term Medicare and Medicaid costs -- after Republicans agree to reopen the federal government without changing the health law. Republicans may shift their focus to these budget battles and seek savings in entitlement programs and tax reform.

The Wall Street Journal: No Movement In Shutdown Standoff
House Speaker John Boehner (R., Ohio) said after the meeting that Republicans continue to want changes to the new federal health law, the Affordable Care Act. Democrats have said they won't agree to changes to the law as a condition of reopening the government. … Mr. Obama has said he is willing to compromise on a wide-ranging budget deal -- but only after Republicans take two steps: reopening the government without changing the health law, and raising the nation's borrowing limit. After the White House meeting, Senate Majority Leader Harry Reid (D., Nev.) repeated that Democrats stood firm against changing the health law (Hook, Lee and Peterson, 10/2).

The New York Times: Obama Says He Won’t Negotiate Until Government Reopens
The meeting was the first time that the president linked the two actions that he and a divided Congress are fighting over this month: a budget for the fiscal year that began on Tuesday, and an increase in the debt ceiling by Oct. 17 ... Only when those actions are taken, Mr. Obama said, would he agree to revive bipartisan talks toward a long-term budget deal addressing the growing costs of Medicare and Medicaid and the inadequacy of federal tax revenues. … Yet the refusal of the Republican-led House earlier this week to approve government funding until Mr. Obama agrees to delay his signature health-care law … raised fears from Washington to Wall Street that Republicans likewise would carry out their threat to withhold approval for an increase in the debt ceiling (Calmes and Weisman, 10/2).

The Associated Press/Washington Post: Government Shutdown In 3rd Day After White House Meeting Leaves Obama, Hill Leaders At Odds
House Speaker John Boehner, R-Ohio, complained to reporters that Obama had said anew that "he will not negotiate." Boehner made clear that curbing the health care overhaul that Obama pushed into law three years ago remains part of the price for returning 800,000 furloughed federal workers to their jobs and resuscitating programs ranging from feeding pregnant women to staffing Internal Revenue Service call centers (10/3).

Los Angeles Times: House Republicans Turn Toward Seeking A Deal On The Debt Ceiling
Knowing that a delay of Obamacare remains unlikely to be accepted by the president, Republicans are expected to revisit the components of past budget battles: cuts to Medicare, Social Security and other entitlement programs, as well as reforming the tax code, a long-standing interest (Memoli and Mascaro, 10/2).

The Washington Post: Focus Shifts To Looming Debt-Ceiling Deadline As Shutdown Talks At White House Go Nowhere
On Capitol Hill, senior Republicans began to suggest that a broad agreement to overhaul entitlements and the tax code could be used as a resolution to both the shutdown and debt limit clash. But Democrats view that approach as hostage taking, and say Congress must reopen the government and authorize additional borrowing before serious negotiations can occur (Goldfarb, 10/2).

The Associated Press/Washington Post: Analysis: In Quest To Scuttle Obama's Health Care Overhaul, GOP Gets Unintended Result
Republicans insisted they wanted to shut down the nation's 3-year-old health care overhaul, not the government. They got the opposite, and now struggle to convince the public that responsibility for partial closure of the federal establishment lies with President Barack Obama and the Democrats. There's ample evidence otherwise, beginning with Speaker John Boehner's refusal to permit the House to vote on Senate-passed legislation devoted solely to reopening the government (10/3).

Most Americans are against defaulting on the nation's debt to refight the Obamacare fight, a new poll says --

Politico: Poll: Most Against Default Over Obamacare
As the likelihood grows that the fight over the government shutdown will merge with a fight to raise the debt ceiling, a new poll shows Americans are against defaulting on the nation's debt over Obamacare. Asked what is more important for Congress to do, 51 percent said it was more important for Congress to raise the debt ceiling, compared with 43 percent that said it was more important to delay Obamacare, in a CNN/ORC International poll out Wednesday (Kopan, 10/2).

And the shutdown has hit medical research as well --

NPR: From Therapy Dogs To New Patients, Federal Shutdown Hits NIH
The National Institutes of Health is the biggest source of funding for medical research in the world. An the partial federal government shutdown has put it in a precarious position. Universities and hospitals across the country are grappling with what the NIH shutdown will mean for them. The NIH also has its own hospital at its main campus in Maryland called the NIH Clinical Center and is dedicated solely to medical research. Patients often go there to receive experimental treatments. The shutdown has affected the NIH hospital in ways both large and small (Greenfieldboyce, 10/3).

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The Parts Played By Boehner And Reid In The Shutdown, The Health Law Defunding, And Party Dynamics

Media outlets examine how House Speaker John Boehner and Senate Majority Leader Harry Reid have contributed to the Capitol Hill tensions surrounding the government shutdown and Obamacare fight-- both in their relationship with each other and their places within their respective parties.

The Washington Post: John Boehner, Between A Rock And A Hard Place On Shutdown And Debt Limit
Within the increasingly right-leaning GOP caucus, Boehner might survive one big vote that relied heavily on Democratic support. But two important votes — on the government funding and the debt ceiling — with mostly Democratic backing would leave the already embattled speaker on political life support. The result is that Boehner has thrown in with the most conservative Republican lawmakers. A few dozen of them have urged holding up the government funding legislation to extract concessions from Democrats on President Obama’s Affordable Care Act (Kane, 10/2).

The Wall Street Journal: Reid Sets Tone For Democrats In Shutdown Fight
Mr. Reid has emerged as the GOP's new public enemy No. 1 because he is the man driving his party's hard bargain against Republican leaders in the legislative back-and-forth over funding the government. Democrats have refused to negotiate with Republicans as long as they insist on delaying or defunding the 2010 health-care law. More than any other Democrat, Mr. Reid seems to be setting the tone of his party in the showdown over the shutdown. The impasse marks a shift this year by Democrats in Congress and the White House, who are no longer willing to barter with GOP leaders demanding major concessions in exchange for short-term government-funding bills or extending the nation's borrowing limit (O’Connor and Hook, 10/2).

And one GOP senator second-guesses if shutting the government down over funding the health law was a mistake --

St. Louis Beacon: Blunt Says Forcing Federal Shutdown Over Obamacare Was A Mistake
Although he’s no fan of Obamacare, U.S. Sen. Roy Blunt said Wednesday that it was a mistake for House Republicans to have forced a government shutdown unless the health insurance program was repealed (Mannies, 10/2).

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State Watch

Calif. Legislator Seeks To Move All State Lawmakers To Marketplace

Republican Assemblyman Brian Nestande doesn't like the health law but says state legislators should have to live with it. Meanwhile Gov. Jerry Brown signs a bill easing secrecy around the state agency overseeing the health law. In Virginia, Fairfax's water authority says taxes on generous health plans will cause it to drop coverage for workers.

Los Angeles Times: Assemblyman Wants Lawmakers To Enroll In Health Insurance Exchange
Assemblyman Brian Nestande is no fan of Obamacare, but he's pushing a proposal to require all state lawmakers to get their benefits through the newly launched healthcare exchanges. The Palm Desert Republican said he'll be introducing a bill that would require lawmakers who want to get health benefits offered by the Legislature to enroll through Covered California, the state's healthcare exchange (Mason, 10/2).

The Washington Post: Fairfax Utility: Obamacare Will Likely Lead To Dropped Coverage
The Fairfax County Water Authority said that it will likely drop insurance coverage for its nearly 400 employees if taxes on generous health-care plans take effect as planned in 2018 under the federal Affordable Care Act. The public utility, a quasi-governmental entity that provides water to 1.7 million Northern Virginians, said that the tax would eventually cost it millions of dollars a year (Vozzella, 10/2).

The Associated Press: Calif. Eases Secrecy Rules Around Health Contracts
Gov. Jerry Brown signed legislation Tuesday stripping broad secrecy provisions from the state agency overseeing health care reform in California that gave it the power to shield from the public how hundreds of millions of dollars are spent. The Democratic governor signed the bill on the same day online insurance marketplaces that are at the heart of President Barack Obama's health care overhaul went into business around the country (Blood, 10/2).

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State Highlights: Texas Ads To Target Wendy Davis

A selection of health policy stories from California, Texas, Florida and Oregon.

Los Angeles Times: UC Irvine And MemorialCare Health System Agree to Partner, Not Merge
Amid growing health care consolidation as Obamacare rolls out, UC Irvine and MemorialCare Health System have agreed to a partnership deal. The UC Board of Regents said Wednesday it has approved an affiliation between UC Irvine Health and MemorialCare, two major hospital systems in Southern California. It's not a merger and both will remain independent (Terhune, 10/2).

California Healthline: It’s More Than An Emergency: Calif. Among States Seeking To Expand EMS Care
Each state, to some degree, is preparing for widescale changes to its health care system under the Affordable Care Act. But some, including California, are pursuing smaller efforts, separate from the health reform law, that could help bridge gaps in care and reduce spending. Beginning as early as summer 2014, California's Emergency Medical Services Authority and the Office of Statewide Health Planning and Development plan to oversee the launch of pilot programs that would expand EMS workers' responsibilities (Wayt, 10/2).

Politico: Texas Anti-Abortion Ad To Hit Wendy Davis
Wendy Davis, the Texas state senator who is poised to announce a Democratic bid for governor on Thursday, is an "abortion zealot" out-of-step with the rest of the state, according to a new ad going up in Texas this weekend (Glueck, 10/3).

Miami Herald: Florida Prison Health Care Providers Sued Hundreds Of Times
The Florida Department of Corrections awarded a five-year, $1.2 billion contract to provide medical care for thousands of state prisoners in North and Central Florida to a Tennessee company that was sued 660 times for malpractice in the past five years. Nearly half of those cases remain open. Of those that are closed, 91 -- one in four -- ended with confidential settlements that Corizon declined to discuss. The company, Corizon, began work in August providing care at 41 correctional facilities (Christensen, 10/2).

The Lund Report: Dental Plans Closer To Reaching Agreement
Behind closed doors, coordinated care organizations are negotiating with dentists to reach agreement on Oregon's most vulnerable population -- people on the Oregon Health Plan. Next January, thousands of low-income Oregonians start flocking onto Medicaid once income eligibility jumps up to 138 percent of the federal poverty level. The Legislature made a clear-cut decision to coincide with Gov. Kitzhaber's efforts to transform the publicly-funded health system (Lund-Muzikant, 10/3).

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Editorials and Opinions

Opinions On Shutdown: Opening Marketplaces Makes This Impasse Different; Don't Repeal Medical Device Tax; Democrats Are 'Intransigents'

The Washington Post: Why This Government Shutdown Is Different
It’s different because the new health-care system got up and running on the very day the shutdown began. Conceding to the GOP would take health insurance away from people and ruin a program for which we now know there is a public appetite. It's not going to happen (E.J. Dionne Jr., 10/2).

The Washington Post: Shutdowns Have Been Frequent Tools Of Policy. Just Ask Reagan.
In one sense, government shutdowns have often been part of the push and pull of Washington’s appropriations process. But this time things are different. Democrats who chose to force through a fundamental change in the nation's health-care system without a single Republican vote when they controlled both legislative branches are simply refusing to come to terms with the fact that the House is now controlled — by a wide margin — by the other party. House Republicans have won two successive elections based in no small part on their opposition to Obamacare. The president ignores that fact only at his — and the nation's — peril (Joseph A. Morris, 10/2).

The Washington Post: Medical-Device Tax Repeal Is An Idea Full Of Holes
The excise tax amounts to asking the medical-device industry to chip in 2.3 percent of the tab, just as other health-care interests, such as insurance companies and the drug industry, were also asked to pony up. We hasten to add that this is hardly the optimal financing method; a generally applicable program ought to be financed with generally applicable taxes. Still, the $100 billion-plus medical-device industry is highly profitable. While the tax might impose some pain on the business, we doubt that it would doom it (10/2).

Politico: The Intransigents
The real problem with the Republican position isn't that it is unprecedented or inherently out of bounds but that is unlikely to achieve much. To put it mildly, the Republican handling of the continuing resolution has lacked the forethought traditionally associated with successful strategy. Republicans are now on their third version of the continuing resolution. Defunding is so last Tuesday. They have bid themselves down to a delay of the individual mandate and imposing Obamacare on Congress. Every indication is that [Senate Majority Leader Harry] Reid welcomed a shutdown on the assumption that Republicans could be made to pay the price. It's not a bad bet, but the risk to Democrats is that they make their eagerness to press their partisan advantage too blatant (Rich Lowry, 10/13).

Reuters: Shutdown: A Fight With No Room For Compromise
Hard-line conservatives are blocking majority rule so they can get their way. They insist they are taking a stand on principle. Why? "Because we're right, simply because we're right," one of them told the New York Times. What principle? The principle that the Affordable Care Act is an unconstitutional expansion of government power and that President Barack Obama is not a legitimate president. But didn't the Supreme Court rule back in June that Obamacare is constitutional? It did. ... And didn't the voters re-elect Obama last year? They did. But hard-line conservatives insist that's only because Republicans put up a candidate who wasn't a true conservative (Bill Schneider, 10/2).

The New York Times: The Cost Of The Shutdown
Many Republicans seem to be celebrating the government shutdown as an opportunity to show that less spending isn't really so bad. "People are probably going to realize they can live with a lot less government than what they thought they needed," said Representative Marsha Blackburn of Tennessee on Fox News. Her upbeat attitude helps explain why so many in her party thought nothing of shutting down a government they distrust, all to dismantle a health care law they oppose (10/2).

The New York Times: Minority Rules
And long-range G.O.P. statisticians no doubt worry about something worse: that the Republicans have oversold their opposition to the law, that it won't fail and kill jobs, but will succeed and keep thankful voters alive and healthy. In this scenario, in a year, or five, or 10, or in a generation, voters will come to like and depend on the law and associate its success with the Democratic Party and opposition to it with the Republican Party (Charles M. Blow, 10/2).

The New York Times: Excuses, Excuses, Excuses
They're insisting that Obama make concessions on a 3-year-old law, or else they will dock wages of government employees and damage the national economy to the tune of $300 million a day. In effect they're assuming that Obama is more responsible than they are, and that he will capitulate to this blackmail and protect the economy (Nicholas D. Kristof,10/2).    

USA Today: Why Shutdown Needs To End Now: Our View
Starting to feel public pressure, the House Republicans who forced the government closure as part of their quixotic quest to kill Obamacare offered to reopen some of the most popular programs, such as parks and the Department of Veterans Affairs, on a piecemeal basis. That might spare them some political heat. But it's like seizing a school bus full of kids then offering to release the cutest ones. Some of the serious problems just mentioned wouldn't be touched, nor would myriad others that will pop up in coming days. It was swiftly rejected (10/2).                                                                       

The Washington Post: Republicans Are Going To Need A Bigger Lifeboat
On the second day of the shutdown, House Republicans continued what might be called the lifeboat strategy: deciding which government functions are worth saving. In: veterans, the troops and tourist attractions. Out: poor children, pregnant women and just about every government function that regulates business or requires people to pay taxes. ... On Tuesday, GOP House members introduced bills that would exempt three entities: the national parks, the Department of Veterans Affairs and the District of Columbia. On Wednesday, they added the National Institutes of Health and pay for National Guard members and military reservists (Dana Milbank, 10/2).

The Wall Street Journal: The Treacherous Politics Of The Fiscal Showdown
House Republicans have landed on more defensible ground, offering on Monday to fund the government at current levels while making two important changes to ObamaCare. First, the House approved a one-year delay for the individual insurance mandate. The president already delayed the employer mandate, saving businesses $12 billion next year. A delay in the individual mandate will save $15 billion. It is politically popular (Karl Rove, 10/2).

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Viewpoints: Obamacare's Redistribution Will 'Wreck' U.S. Work Ethic; Health Law Problems Can't Obscure Pent Up Demand

The Wall Street Journal: How ObamaCare Wrecks The Work Ethic
A new wave of redistribution will arrive in America on Jan. 1, primarily thanks to the Affordable Care Act. The president's health-insurance plan forces those who hire, work and produce to pay full price for health care, while creating generous discounts for practically everyone else (Casey B. Mulligan, 10/2).

The Wall Street Journal: Brendan Mahoney Saves ObamaCare
Moreover, whether ObamaCare "works" will be determined not by how many people are signing up but what kind of people. ObamaCare relies on price controls that jack up premiums on the young and healthy in order to keep them low on the old and sickly. If the latter but not the former are signing up in huge numbers--that is, if people are responding rationally to incentives--then the scheme is unsustainable (James Taranto, 10/2).

The New Republic: Obamacare Glitches Are Real—And Matter Less Than You Think
Obamacare's new websites opened for business on Tuesday morning, just as they were supposed to do. And they promptly ran into problems, just as both critics and some advocates had predicted they would do. People who visited the websites had to endure long delays and in some cases they could not use the sites at all. … And while federal officials blamed the problems on high traffic, the nature of the glitches suggests at least some of the sites still had some design issues—the kind that simply adding bandwidth might not fix. ... The high traffic to Obamacare websites may have given Democrats a convenient way to spin the technological problems, but it was every bit the heartening, and validating, sign they proclaimed. Obamacare critics have spent the last few months and, really, the last few years dwelling on the law's shortcomings, real and perceived -- whether some young people would have to pay more for their coverage, whether regulations would force employers to change their behavior, and so on. But the single biggest impact of Obamacare is that many millions of people are finally getting access to decent, affordable insurance (Jonathan Cohen, 10/2).

Montgomery Advertiser: Alabama Should Follow Kentucky's Lead -- Expand Medicaid
Alabama and Kentucky have a lot in common. Historically, both have low rankings in most socioeconomic measures. Both have low rankings in most health categories. Both states have a lot of poor people, a lot of people who work hard and don't make much money. Both states stand to benefit enormously under the expansion of Medicaid that is part of the Affordable Care Act. There the similarities end, for Kentucky, under the leadership of Gov. Steve Beshear, is vigorously implementing the act, while Alabama's Gov. Robert Bentley has washed his hands of the whole thing (10/3). 

St. Louis Beacon: Obamacare: Mulling The Known Unknowns
The adage has it that a camel is a horse that was designed by a committee. Understood thusly, the Affordable Care Act — a.k.a. "Obamacare" — is a steed worthy of Lawrence of Arabia. The eponymous proponent of the measure, Barack Obama, spent his pre-political career as a constitutional law professor/community organizer. The care bill he championed reflected the Janus-faced nature of the president’s civilian occupations as it sought to provide health insurance to the needy — thereby appealing to his inner social worker — while trying to convince members of Congress that doing so was their idea in the first place (M.W. Guzy, 10/3).

Roll Call: Obamacare's Acute Affliction On Restaurant Industry
Without changes, the Affordable Care Act will hurt economic growth and make flexible work schedules for employees more limiting to offer. Across the country, many restaurant operators are being forced to make a difficult choice: Do they hire fewer employees, reduce the hours of current employees or raise menu prices? For some, the answer may be a combination of the three. But regardless of the conclusion they reach, there are no easy solutions (Jack Crawford, 10/2).

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Stephanie Stapleton

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.