Daily Health Policy Report

Wednesday, October 30, 2013

Last updated: Wed, Oct 30

KHN Original Reporting & Guest Opinion

Health Reform

Capitol Hill Watch

Administration News

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Health On The Hill: Medicare Head Tavenner Apologizes For Healthcare.gov Problems

Kaiser Health News staff writer Mary Agnes Carey talks with Politico Pro's Jennifer Haberkorn about events on Capitol Hill, including the Tuesday testimony of Centers for Medicare & Medicaid Services Administrator Marilyn Tavenner in which she said that some website subcontractors hadn’t met expectations, but offered few other details on the problems (10/29). Listen to the audio or read the transcript.

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Wellness Apps And Websites Go For New Clients: Insurance Companies

Kaiser Health News staff writer Ankita Rao reports: "Consumers like Kuecker aren’t the only ones noticing the benefits of programs like MyFitnessPal, which also functions as a smartphone app. Last month, the insurance company Cigna announced it will offer services from MyFitnessPal, which has reported more than 40 million users, to the insurer’s customers" (Rao, 10/30). Read the story.

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Minnesota Marketplace's Latino Outreach Events Get Off To A Slow Start

Minnesota Public Radio’s Elizabeth Stawicki, working in partnership with Kaiser Health News and NPR, reports: "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 health care coverage are only now getting underway. That's what brought employees of Southside Community Health Services on Saturday to Karina's Beauty Salon in the heart of the city's Latino community. The organization has received part of a $4 million federal grant to help explain what MNsure is about and help people sign up for coverage, and the Latino community is an important target for MNsure outreach efforts" (Stawicki, 10/29). Read the story.

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Capsules: Health Law Requirements Squeeze Some Part Timers

Now on Kaiser Health News' blog, The Philadelphia Inquirer's Kelly April Tyrrell, working in partnership with Kaiser Health News, reports: "Some school districts and state and local governments are limiting part-time workers’ hours or letting them go to comply with the Affordable Care Act. And it’s not all political. This month in Delaware, which has embraced the health law, officials decided to limit all casual and seasonal employees, including substitute teachers, to fewer than 30 hours a week to save on health insurance. About 376 workers from education, corrections, and homeland security agencies could be affected" (Tyrrell, 10/30). Check out what else is on the blog.

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Letters To The Editor: Nurse Practitioners In Primary Care; The Future Of Bare-Bones Health Plans

Letters to the Editor is a periodic Kaiser Health News feature in which readers can comment on our recent stories (10/29). See what our readers had to say.

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Political Cartoon: 'Digital Deluge?'

Kaiser Health News provides a fresh take on health policy developments with "Digital Deluge?" by Nate Beeler.

Here's today's health policy haiku:


It's not a fun day
for Kathleen Sebelius.
Everyone's watching.

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

Cancellation Letters Put White House On The Defensive

Even as the Obama administration struggles to recover from the troubled launch of healthcare.gov, a new issue has cropped up that is calling into question one of President Barack Obama's often-repeated health law promises -- that if a person has health insurance they like, they'll be able to keep it.

Politico: White House Playing Defense On Obamacare
For every positive statistic about the law, there’s a horror story that calls into question the broad promises of Obamacare and gives Republicans something else to criticize. It’s forced the White House into yet another frustrating round of Whac-A-Mole, beating back one negative development only to find several more right behind it (Budoff Brown, 10/29).

The Wall Street Journal: White House Races To Quell Health Uproar
The White House is racing to rebuild confidence in a new health-care system that has so far fallen short of President Barack Obama's promises, as the mounting uproar threatens to overwhelm his second-term agenda. Just two weeks ago, Mr. Obama seemed to prevail in a face-off with congressional Republicans over the federal shutdown and was seeking to shift the public focus to an immigration overhaul, one of his top priorities (Nelson and Nicholas, 10/29).

The Washington Post: Obama Accused Of Breaking Promise To Consumers As Health Plans Cancel Policies
A new controversy over the president’s health-care law is threatening to overshadow the messy launch of its Web site: Notices are going out to hundreds of thousands of Americans informing them that their health insurance policies are being canceled as of Dec. 31. The notices appear to contradict President Obama’s promise that despite the changes resulting from the law, Americans can keep their health insurance if they like it. Republicans have seized on the cancellations as evidence that the law is flawed and the president has been less than forthright in describing its impact (Sun and Somashekhar, 10/29).

The New York Times: Cancellation of Health Care Plans Replaces Website Problems As Prime Target
The rising concern about canceled health coverage has provided Republicans a more tangible line of attack on the law and its most appealing promise for the vast majority of Americans who have insurance: that it would lower their costs, or at least hold them harmless. Baffled consumers are producing real letters from insurance companies that directly contradict Mr. Obama’s oft-repeated reassurances that if people like the insurance they have, they will be able to keep it (Weisman and Pear, 10/29).

The Wall Street Journal: Canceled Policies Heat Up Health Fight
Highlighting a growing number of such notices, Republicans trained their fire on President Barack Obama, who said in 2009, "If you like your health-care plan, you will be able to keep your health-care plan. Period." The president repeated that message numerous times before the law passed in 2010, and some Democrats said he had left them ill-prepared to respond to the latest charge, which follows the botched launch of the website intended to help Americans sign up for new policies (Radnofsky and Martin, 10/29).

Los Angeles Times: Obama's Healthcare Promises Return To Haunt Him
As the pitchman for his landmark healthcare law, President Obama promised to make buying insurance as easy as buying a plane ticket online or a "TV on Amazon." It would be simple, he said. … With the federal website hobbled by bad design and thousands of policyholders receiving cancellation notices, Obama's promises are not being met — prompting charges of deception from some Republicans and concessions from some allies that elements of the law were oversold (Hennessey and Parsons, 10/29).

Bloomberg: Obama Health Vow Won’t Shield Millions From Cancellation
President Barack Obama’s advisers deliberately crafted his signature health-care law to fulfill his oft-repeated promise: if you like your insurance, you can keep it. Even with that provision, Obama administration officials knew by June 2010 that as many as 10 million people with individual insurance probably would be thrown off existing plans anyway (Dorning, 10/30).

The Washington Post's The Fact Checker: Obama's Pledge That 'No One Will Take Away' Your Health Plan
Many readers have asked us to step back into time and review these statements by the president now that it appears that as many as 2 million people may need to get a new insurance plan as the Affordable Care Act, a.k.a. Obamacare, goes into effect in 2014. As we were considering those requests, one of the president's most senior advisers then tweeted a statement on the same issue that cried out for fact checking (Kessler, 10/30).

ABC News: Keep Your Coverage Under Obamacare: Fact Or Fantasy?
Today, for the first time, the Obama administration issued a direct apology for the snafus that have hampered signups to Healthcare.gov. “I want to apologize to you that the website has not worked as well as it should,” Marilyn Tavenner, chief for the Center for Medicare and Medicaid Services, said in testimony before the House Ways and Means Committee. But there is no apology for the latest dustup over Obamacare—the claim that no one will force you to change your current insurance plan (Avila, 10/29).

NBC News: White House: President Didn’t Mislead On Insurance Promise
The White House argued Tuesday that President Barack Obama didn’t mislead the public when he repeatedly promised Americans “If you like your health plan, you will be able to keep your health plan” under the Affordable Care Act. Press secretary Jay Carney said the president’s declaration was still technically true even as almost two million Americans across the country are getting, or are about to get, letters canceling policies purchased on the individual market (O’Brien, 10/29).

CBS News: Obamacare: More Than 2 Million People Getting Booted From Existing Health Insurance Plans
CBS News has learned more than two million Americans have been told they cannot renew their current insurance policies -- more than triple the number of people said to be buying insurance under the new Affordable Care Act, commonly known as Obamacare. CBS News has reached out to insurance companies across the country to determine some of the real numbers -- and this is just the tip of the iceberg, Crawford said. The people who are opening the letters are shocked to learn they can't keep their insurance policies despite President Obama's assurances to the contrary (Crawford, 10/29).

Bloomberg: California Coverage Cancellations Show Obamacare Price Increases
San Francisco writer Lisa Buchanan said she and her husband got notices that they’ll have to pay almost twice as much for health insurance because their current coverage doesn’t comply with Obamacare. In Mill Valley, California, retiree Diane Shore got a letter saying her plan is being eliminated and she’ll be moved to a new one with higher premiums (Vekshin, 10/30).

In some cases, consumers will face higher prices -

The New York Times: People Who Buy Own Health Policies Face Big Changes
As Washington and much of the rest of the nation debate whether President Obama misled Americans when he said that people who like their health plans may keep them, tens of millions of people are finding that their insurance is largely unchanged by the new health care law. … Insurers are informing many of those people that their old plans have been discontinued and that they must choose new plans at new prices (Abelson, 10/29).

The Wall Street Journal: Some Consumers Face Jump In Prices As Old Policies End
Many consumers, particularly those who are healthy and don't qualify for government subsidies, will have to pay more—sometimes double their current rates. Peter Fritzinger, a retired 55-year-old business executive who lives in Denver with his wife and three children, got notice in late August that his Humana Inc. plan would be canceled at the end of the year (Martin and Weaver, 10/29).

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State Marketplaces Have Some Different Issues Than The Federal Health Website

California officials worry that highly publicized problems of the federal website will scare customers away from the state marketplace, which is open for business. Meanwhile, news outlets look at issues in New York, Connecticut, Texas and Minnesota.

Los Angeles Times: Q&A: Don't Confuse California Obamacare Exchange With U.S. One, Exec Says
Despite fixing many of its own technical glitches, California's health insurance exchange is worried that consumers may still be confused by high-profile enrollment problems through a federal website. Peter Lee, executive director of Covered California, said the state exchange is adjusting its marketing to address this concern and to ensure that people know it's open for business (Terhune, 10/29).

The New York Times: Errors Rife In New York State's List Of Health Insurance Assistance Sites
Computer issues are not the only problem plaguing the rollout of the Affordable Care Act. A 228-page list of navigators -- businesses and organizations that help people sign up for coverage -- on New York State's health exchange website has turned out to be littered with places whose owners and employees have no clue how to offer health insurance advice (Hartocollis, 10/29).

The CT Mirror: Connecticut Health Exchange 'Backup Plan' To Help During National Outage
A backup plan Connecticut's health exchange developed to help insulate it from Washington's problems in the rollout of Obamacare was no help at all Sunday, when the federal system that checks information from applicants went down, stalling most enrollments. "There are some things that still have to be worked through, some technical problems," said Jason Madrak, chief marketing officer for Access Health CT, Connecticut's health care exchange (Radelat, 10/29).

The Texas Tribune: Animation: Explaining The Health Insurance Marketplace
The online health insurance marketplace that the federal government launched on Oct. 1 offers dozens of health plans and tax credits. Some consumers have found the application process confusing and technically frustrating. This Tribune animation explains how the marketplace works, and whom it's designed to help (Wiseman and Aaronson, 10/30).

The Star Tribune: Insurance Shoppers Find MNsure Prices, Choices, Vary Widely By Area
Despite the promises of choice and affordability offered by the federal health care overhaul, many Minnesotans outside the Twin Cities area aren't seeing much of either. In certain pockets of the state, shoppers on the new MNsure website have just a handful of insurance companies to choose from and face much higher premiums than those available in the metro area (Crosby, 10/30).

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IRS Will Face Difficulties In Collecting Health Law Penalties

When Congress passed the health law in 2010, it also banned the Internal Revenue Service from using its regular enforcement techniques.

USA Today/Des Moines Register: IRS Hamstrung On Collecting Health Law Penalties
The Internal Revenue Service probably will bark at you if you fail to obtain health insurance next year, but the agency won't have much bite. On this issue, Congress pulled the watchdog's teeth (Leys, 10/29).

The Fiscal Times: How IRS Incompetence Can Bring Down Obamacare
The Internal Revenue Service —which will be responsible for implementing 46 new tax penalties and verifying millions of dollars in subsidies -- cannot ensure the security of more than 306,000 IT assets worth up to $720 million. A new report from the Treasury Inspector General for Tax Administration (TIGTA) found the embattled agency does not have proper oversight over its information technology programs, leaving sensitive data at risk (Ehley, 10/29).

In other implementation news -  

Fox News: HHS Quietly Cancels Contract With Group To Promote ObamaCare To Recently Released Convicts
The Dept. of Health and Human Services has quietly canceled a contract to a Chicago-based advocacy group that planned to promote ObamaCare benefits to recently paroled prisoners, after GOP Sen. Jeff Sessions wrote a letter to the agency in July questioning how the contract was funded. The HHS awarded the no-bid contract to Treatment Alternatives for Safe Communities in July in order to “increase insurance enrollment for… individuals involved in the criminal justice system,” but then quietly updated the solicitation’s status to “canceled” on its website, saying it would be re-issued (McNeal, 10/29).

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Capitol Hill Watch

Sebelius Faces Withering Criticism On And Off Capitol Hill

The Health and Human Services secretary is testifying before the House Energy and Commerce Committee today, as critics question her leadership of the department.

The Associated Press/Washington Post: Sebelius Heads To Hill To Defend Health Law And Her Job As Problems Plague Website's Rollout
Eager to cast blame, lawmakers are preparing to grill President Barack Obama’s top health official over problems with the rollout of the government’s health care website. A growing number of Republicans in Congress are calling for Health and Human Services Secretary Kathleen Sebelius to step down or be fired because of problems consumers are having signing up for insurance coverage on the government’s new website (10/30).

The Wall Street Journal: Sebelius To Testify Before House Panel
The testimony by Health and Human Services Secretary Kathleen Sebelius, who has borne the brunt of criticism over the HealthCare.gov website, comes a day after Marilyn Tavenner, administrator of the Centers for Medicare and Medicaid Services, testified before the House Ways and Means Committee. Ms. Tavenner apologized on Tuesday, saying the site "can and will be fixed" (Schatz and Radnofsky, 10/30).

Politico: As Turmoil Swirls, Kathleen Sebelius Takes Hot Seat
Not so long ago, Kathleen Sebelius was a popular two-term governor with bipartisan appeal, a possible Democratic vice presidential prospect, a woman whom President Barack Obama could entrust with overhauling the nation’s health insurance system. Even Bob Dole volunteered to introduce her at her confirmation (Dovere and Haberkorn, 10/30).

NBC News: How Did Obamacare Site Go So Wrong? 5 Questions Sebelius Must Answer
Marilyn Tavenner, administrator of the Center for Medicare and Medicaid Services, apologized outright on Tuesday at a hearing before the House Ways and Means Committee. Last week, officers of four of the main government contractors that built and are running different parts of the site, said the final testing had been too rushed — and a CMS spokesperson agreed. Now, it’s time for Health and Human Services Secretary Kathleen Sebelius to take her turn at hearing today. These questions remain unanswered (Fox, 10/30).

Fox News: Sebelius To Face Grilling At Hearing On Glitch-Ridden Obamacare Website Rollout
In written testimony released ahead of Wednesday's hearing, Sebelius vowed to improve the website and said the consumer experience to date is "not acceptable." But she defended the law itself and said extensive work and testing is being done. "We are working to ensure consumers' interaction with HealthCare.gov is a positive one, and that the Affordable Care Act  fully delivers on its promise," she said in the prepared remarks. Sebelius blamed the website contractors and the "initial wave of interest" for the glitches, but expressed confidence in the experts and specialists working to solve "complex technical issues” (10/30).

Bloomberg: Republicans Seeking Obamacare Accountability Tag Sebelius
A day after her deputy apologized for the botched Obamacare exchange, U.S. Health Secretary Kathleen Sebelius will have to stare down accusations that she wasn’t forthcoming enough about the potential problems. Republicans said they primarily want to know at a hearing today about the lack of transparency ahead of the rocky Oct. 1 debut of the insurance exchange, which is supposed to let people compare and buy health plans (Wayne, 10/30).

The Washington Post: Kathleen Sebelius, Welcome To An Unwelcome Washington Tradition: The Deathwatch.
It’s Kathleen Sebelius’s turn now. On the Hill, they’re calling for her resignation and tossing around words like “subpoena.” Pundits are merrily debating her future. (She’s toast! Or is Obama too loyal to fire her so soon?) Her interviews, more closely parsed than usual, seem wobbly. Though never a colorful presence on the political scene, she’s suddenly a late-night TV punch line (Argetsinger, 10/29).

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House Panel Grills CMS Chief Tavenner On Health Law Website, Cancellations

Tavenner, who oversees the agency responsible for developing Healthcare.gov, apologized for the many problems consumers are encountering as Republicans expand their concerns.

The Associated Press: Obama Official Blames Insurers For Wave Of Policy Cancellations, Apologized For Website Woes
Move over, website woes. Lawmakers confronted the Obama administration Tuesday with a difficult new health care problem — a wave of cancellation notices hitting individuals and small businesses who buy their own insurance. At the same time, the federal official closest to the website apologized for its dysfunction in new sign-ups and asserted things are getting better by the day (Alonso-Zaldivar and Ohlemacher, 10/29).

NPR: Insurance Cancellations Elbow Out Website Woes At Health Hearing
When the head of the agency responsible for the troubled Healthcare.gov went before Congress for the first time since its foibles became apparent Oct. 1, she probably didn't expect that many questions would be on something else altogether. But the website turned out not to be the focus of questions for Marilyn Tavenner by Republicans at the Ways and Means Committee hearing Tuesday. They were more interested in asking about cancellation notices being received by people who purchase their own insurance (Rovner, 10/29).

Politico: Obamacare Woes Move Beyond Website
Tuesday's hearing about the fumbled Obamacare roll-out was all the proof we needed that the Republicans are serious about their talking point that the law's problems go beyond the website. They've moved on to other things — cancelled individual insurance policies, privacy concerns, and possible nasty surprises for young adults who may not know they can't get subsidies (Nather, 10/29).

The New York Times: Health Site Chief Expects Low Initial Enrollment Number
Ms. Tavenner, the administrator of the federal Centers for Medicare and Medicaid Services, said that "nearly 700,000 applications have been submitted to the federal and state marketplaces" in the last four weeks. But she repeatedly refused to say how many of those people had actually enrolled in health insurance plans since the federal and state marketplaces, or exchanges, opened on Oct. 1 (Pear, 10/29).

The Washington Post: Administration Official Marilyn Tavenner Apologizes For Healthcare.gov Problems
[She] also defended her agency’s management of the project and blamed some of the setbacks on the main contractor, Fairfax-based CGI Federal. Tavenner is the first administration official to testify publicly about the problems plaguing the Web site that supports the health law. She told members of the House Ways and Means Committee that the site is working, though not as well or as fast as officials would like (Somashekhar, 10/29).

McClatchy: HealthCare.Gov Official Apologizes; Website Problems "Took Us By Surprise"
[Tavenner] said the inability of the Healthcare.gov website to establish individual user accounts and handle the initial volume of users shortly after open enrollment began on Oct. 1 "was not anticipated" and "did not show up in testing" (Pugh, 10/29).

Los Angeles Times: Top Official Apologizes For Obamacare Website Glitches
Even as she acknowledged problems with the online exchanges Tavenner, a former nurse and secretary of health and human resources in Virginia, highlighted successes of the law. Seventy-eight million Americans have saved $3.4 billion as insurance companies lowered rates to meet a requirement of the law, she said, and millions more already have coverage because of it (Memoli, 10/29).

Kaiser Health News: Health On The Hill: Medicare Head Tavenner Apologizes For Healthcare.gov Problems
Kaiser Health News staff writer Mary Agnes Carey talks with Politico Pro's Jennifer Haberkorn about events on Capitol Hill, including the Tuesday testimony of Centers for Medicare & Medicaid Services Administrator Marilyn Tavenner in which she said that some website subcontractors hadn't met expectations, but offered few other details on the problems (10/29).

Politico: CMS Mantra: It'll Work By December
November's shaping up to be a major test of Obamacare functionality. That's when new features of the health law’s enrollment system — some of which have been put off repeatedly because of insufficient testing — are slated to go online. Among them: online enrollment in the marketplace for small businesses, a Spanish-language enrollment website and the transfer of Medicaid applications from the feds to the states (Cheney, 10/30).

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

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Healthcare.gov Contractor Says It Flagged Problems

A House committee released a letter from CGI, one of the main developers of the government's health insurance website.  

The Hill: Oversight Documents: Contractor Kicks Blame Back To HHS
House Oversight Committee chairman Darrell Issa (R-Calif.) released documents late Tuesday from one of the primary ObamaCare contractors that show the company warned a key government agency that there wasn't adequate time to test the system before going live. According to the documents, employees at CGI Federal said in a status report that "due to the compressed schedule, there is not enough time built in to allow for adequate performance testing" (Easley, 10/29).

The Washington Post: CGI Warned Of Healthcare.gov Problems A Month Before Launch, Documents Show
The firm, which was responsible for both constructing key elements of the sites and helping interweave them, cautioned that "hub services are intermittently unavailable" and the time allotted for testing was "not adequate to complete full functional, system, and integration testing activities." They rated problems as "near certainty" and "highly likely" and rated the impact as "significant" or "severe."  CGI turned over the report to the House panel in response to an Oct.23 letter asking for more information (Eilperin, 10/29).

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Lawmakers Face Deadline To Decide Which Staffers Will Use Health Exchanges

By Thursday, lawmakers must make decisions about who among their aides will be obtaining health insurance via the health law's online marketplaces. Many GOP senators have plans to place their staffers on the exchanges.

Fox News: Lawmakers Have Until Thursday To Decide Which Aides Must Take Obamacare Plan
House lawmakers have until Thursday to decide whether to designate staffers as "official" or "non-official," in order to determine whether they will keep their existing government insurance or be forced into ObamaCare. So what qualifies as an "official" staffer? According to internal rules, House employees whose salaries are paid entirely from a "Members Representational Allowance" will be determined "official office" staff and eligible only for ObamaCare insurance through the District of Columbia-run health care exchange (10/29).

Politico: Republicans Senators Put Aides On Exchanges
All but one of the top-ranking Senate Republican leaders plan to place all of their staffers on the Obamacare health exchanges. But it's still unclear whether the Democratic Senate leadership will follow suit. House leaders haven't yet said whether they will put their aides on the D.C. health-insurance exchange, or keep them under their current health care plan (Everett, Sherman and Bresnahan, 10/29).

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New Round Of Ads About Health Law Fight Targets Senate Incumbents Of Both Parties

Americans for Prosperity is targeting Democrats like Kay Hagan of North Carolina and Mary Landrieu of Louisiana, while a conservative PAC is hitting Senate Minority Leader Mitch McConnell for not holding a hard enough line against the overhaul.

The Associated Press/Washington Post: GOP Outside Groups Airing Health Care Ads Challenging Senate Incumbents
A Republican outside political group says it will spend more than $2 million in advertising in the coming weeks to tie Senate Democrats Kay Hagan of North Carolina and Mary Landrieu of Louisiana to the health care overhaul. Americans for Prosperity says it will spend $1.7 million in North Carolina and $500,000 in Louisiana during the next three weeks on television ads critical of the two Democrats facing re-election next year, with an additional amount on radio and web ads. Republicans have several candidates competing in the primary in both states (10/29).

Politico: Group Hits McConnell On Obamacare
A conservative super PAC is hitting Sen. Minority Leader Mitch McConnell on Obamacare in a new negative ad buy going up in Kentucky. "Conservatives asked Mitch McConnell to lead the fight over Obamacare," the ad, from the super PAC affiliated with the Senate Conservatives Fund, begins. "He didn’t listen. Instead, McConnell helped Barack Obama and Harry Reid fund Obamacare. Now Kentucky families are paying the price" (Glueck, 10/29).

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Administration News

President To Invoke 'Romneycare' To Defend Health Law

President Barack Obama heads to the same room in Boston where the Massachusetts health law was signed to call for bipartisanship to help the Affordable Care Act succeed.

The Associated Press: Obama To Cite Massachusetts Health Care Law's Slow Start
President Barack Obama is citing the Massachusetts health care system’s slow start to keep expectations low for early sign-ups for his own overhaul. And he’s pointing to the bipartisan effort to get the program launched in Massachusetts to encourage his opponents to stop rooting for his law’s failure. The president planned to speak about the embattled law Wednesday from Boston's historic Faneuil Hall, where Massachusetts Republican Gov. Mitt Romney was joined by the late Democratic Sen. Ted Kennedy to sign the state's 2006 health care overhaul bill (Pickler, 10/30).

The Boston Globe: Besieged President Obama Heads To Boston
The Massachusetts law shares the mandate that most people obtain insurance; subsidies for low-income individuals and families to purchase coverage; and an online marketplace featuring plans, offered by private insurance companies, that individuals and small businesses can purchase at group rates (Rowland, 10/30).

Politico: Romneycare Returns
But for all the Boston ballyhoo, the two laws simply aren’t the same — a fact acknowledged by some in the White House — and there’s no chance that national Republicans will beat their swords into stethoscopes to help diagnose and solve problems in the implementation of Obamacare. Still, Obama’s needs greater cooperation from Republican governors and state legislatures to make the law work, and his public appeal for bipartisanship could stoke constituents to pressure elected Republicans to get on board (Cheney and Allen, 10/30).

The New York Times: In Boston, Obama Will Point To A Health Law’s Success
“The bottom line is it ramped up to success,” Jonathan Gruber, a professor at the Massachusetts Institute of Technology, said of the state program. Mr. Gruber, who advised both Mr. Romney, the Massachusetts governor at the time, and Mr. Obama on the health care laws, spoke to reporters on Tuesday evening during a White House conference call. “We’ve covered two-thirds of our uninsured citizens. We’ve lowered premiums in the individual market. And we have a widely popular law, with about two-thirds public support for our law,” (Shear, 10/30).  

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State Watch

Courts In Texas, Okla. Wrestle With State Abortion Laws

Meanwhile, in California, autism advocates take exception with positive reviews of the transition to Medi-Cal.

Los Angeles Times: Oklahoma Abortion Law Clarified, Headed Back To Supreme Court
Oklahoma's high court on Tuesday set the stage for the U.S. Supreme Court to decide whether states can restrict doctors from prescribing two drugs used to induce abortion in the early stages of pregnancy. The case could be the first test of whether the court's conservative majority will uphold a string of new state laws across the country that seek to strictly regulate legal abortions (Savage, 10/29).

Bloomberg: Texas David Gets Judge's Help In Abbott Abortion Fight
Wendy R. Davis spoke for more than 10 hours from the floor of the Texas Senate in June, trying to block a legislative package that would limit the availability of abortion in the second-most populous U.S. state. A Democrat from Fort Worth, Davis failed in her bid to block the bill, which was signed by Republican Governor Rick Perry July 18. This week, a federal judge revived Davis’s argument in her now-famous filibuster (Harris and Mildenberg, 10/30).

The Texas Tribune: State Seeks Emergency Stay Over Abortion Ruling
The Texas attorney general's office is seeking an emergency stay, asking the 5th U.S. Circuit Court of Appeals to reverse U.S. District Judge Lee Yeakel's ruling against abortion regulations in House Bill 2. Beginning Tuesday, abortion providers would have been required to obtain hospital admitting privileges within 30 miles of the abortion facility and follow federal standards for the administration of abortion-inducing drugs (Aaronson, 10/29).

California Healthline: Autism Advocates Disagree With Rosy Assessment Of Health Families Transition
Toby Douglas, director of the state's Department of Health Care Services, called the withdrawal of autism services "some bumps" in the transition of Healthy Families children to Medi-Cal managed care. Autism advocates begged to differ, characterizing it as a disaster in the lives of many families with autistic children because kids who received applied behavior analysis -- known as ABA therapy -- under Healthy Families stopped receiving it in the Medi-Cal system (Gorn, 10/29).

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Editorials and Opinions

Viewpoints: House Republicans Help Themselves, And The Country, With Smart, Tough Questions To Tavenner; Kentucky Senators Out Of Step With Eager Constituents; Replace Health Law With Single Payer System

Bloomberg: Republicans Get Smart On Obamacare
When House Republicans direct their opposition to Obamacare toward aggressive oversight rather than apocalyptic budget shenanigans, they can do themselves and the country a lot of good. That was obvious when the House Ways and Means Committee posed some smart, tough questions about HealthCare.gov to Marilyn Tavenner, who, as the administrator of the Centers for Medicare and Medicaid Services, is perhaps the person most directly responsible for the fiasco. Yes, there were a few "gotcha" questions meant to showcase individual representatives' hatred of the health-care law. But for the most part, the queries seemed designed to find a path toward more competent management of the Patient Protection and Affordable Care Act (10/29).

The Wall Street Journal: Peggy Noonan's Blog: Questions For Secretary Sebelius
Former White House press secretary Dana Perino has good, commonsensical advice for Republicans on the House Energy and Commerce Committee who'll be questioning Health and Human Services Secretary Kathleen Sebelius on ObamaCare tomorrow. Boiled down: Can the theatrics, know your stuff, we don't need re-enactments of constituent rage, be serious and sober. If members take this advice—Speaker John Boehner and Chairman Fred Upton should be sending it out—they'll better their chances of meeting the moment and providing a service to their country. Dana's advice made me think of what I'd add (Peggy Noonan, 10/29).

USA Today: Don't Delay Obamacare Deadline: Our View
The Obama administration's botched roll out of its signature health law is producing new calls for delays — and not just from Republicans. At least 11 Senate Democrats want to extend the sign-up period on the health exchanges past the March 31 deadline, or postpone for a year the mandate that individuals have health insurance or pay a penalty. ... They're risky ideas that could undermine the new health law or, at the very least, drive up premiums for individual buyers (10/29). 

USA Today: Sen. Jeanne Shaheen: Extend Health Care Enrollment
Choosing new health insurance is a big deal, which is why consumers were supposed to have six months to consider their available options, make decisions about what is best for their families and sign up for health care through the new insurance marketplaces. I think Americans in New Hampshire and across the country still deserve six months. That is why I am proposing an extension of the enrollment deadline in the Affordable Care Act (ACA) (Sen. Jeanne Shaheen, D-N.H., 10/29).

The New York Times' Taking Note: Kentucky's Senators Versus Kentuckians
Senator Rand Paul of Kentucky hates the Affordable Care Act. So does Kentucky's senior senator, Mitch McConnell — though apparently not quite enough to stave off a primary challenge. The Senate Conservatives Fund has endorsed Mr. McConnell’s Tea Party challenger, Matt Bevin, who charged in a television spot that "McConnell helped Barack Obama and Harry Reid fund Obamacare." ... And yet, with this bickering in the background, Kentucky has been unusually successful in rolling out its health insurance marketplace. Dylan Scott wrote in Talking Points Memo yesterday that "more than 26,000 people have enrolled in coverage, more than 50,000 have started applications and more than 300,000 unique visitors have checked out what the marketplace has to offer." That's in a state where roughly one in six are uninsured. (Juliet Lapidos, 10/29).

Los Angeles Times: Separating The Day's Myths And Realities On Obamacare
Developments in the rollout of Obamacare are coming with dizzying speed, though not as fast as the pileup of fiction and misunderstanding created by politicians, pundits and the news media. So here's a list of the latest themes you're hearing on America's healthcare reform, and what they mean (Michael Hiltzik, 10/29).

Los Angeles Times: Throw Out Obamacare? Yes, And Give Us A Single-Payer System
As the old saying goes, even a blind pig finds an ear of corn sometimes. And so it is with Republicans and Obamacare: They're right; it's a mess and deserves to be euthanized, perhaps by its own special "death panel." And I have just the thing to replace it with: a single-payer healthcare system (Paul Whitefield, 10/29).

The Washington Post: Coverage Under Health-Care Law May Change – For The Better
President Obama famously claimed that Americans who liked their insurance plans would be able to keep them under health-care reform. Well, that's not completely true, nor is it the only example of the Obama administration failing to prepare the public for the Affordable Care Act's phase-in. And it was one of the only things Republicans at a House Ways and Means Committee Hearing on Tuesday wanted to talk about. ... But, despite what the president may have said, this news should not have come as a shock, and it is not evidence that the law is a failure (10/29).

The Wall Street Journal: The Obamacare Awakening
For all of the Affordable Care Act's technical problems, at least one part is working on schedule. The law is systematically dismantling the individual insurance market, as its architects intended from the start (10/29).

The Wall Street Journal: The Outrage Arrives
The White House has issued a clarification. When the president said if you like your insurance plan you can keep it, what he meant was you can keep it if he likes it. Hundreds of thousands of Americans who are getting policy cancellation notices this month can't be as surprised as they pretend to be. President Obama made it clear at his 2010 health care summit what he thought of their taste in insurance (Holman W. Jenkins Jr., 10/29). 

Politico: Health Care Lessons From Massachusetts
While our political leaders in Washington appear hopelessly divided about the future of health-care reform, the conflict and mistrust that has beset the ACA remains notably absent in Massachusetts. So, it's natural to ask if our experience might offer a ray of hope for the rest of the country. Based on many years of involvement, I believe the answer is yes – if the focus remains on the real lessons of what we have accomplished here and how we did it (Andrew Dreyfus, 10/30).

Reuters: What About Social Security's Rollout?
The tortuous, often controversial implementation of both Medicare and Social Security serves as an early template for the current controversies over the Obamacare rollout. The ultimate success of those social programs ought to calm the overheated atmosphere surrounding the first days of enrollment for the Affordable Care Act (Bruce J. Schulman, 10/29). 

Reuters: Opposing Obamacare: GOP's Defining Issue
For Republicans, opposition to Obamacare has become a defining issue, like antiwar sentiment was for Democrats during the war in Iraq. Of course, people were being killed in Iraq. But look at what Representative Michele Bachmann (R-Minn.) said about Obamacare: "Let's repeal this failure before it literally kills women, kills children, kills senior citizens" (Bill Schneider, 10/28).

The Fiscal Times: What Obamacare Ignores: Cutting Health Care Costs
Outside of some pilot programs in Medicare, most of the Affordable Care Act (ACA) does little to reduce the actual cost of care. Nor does it increase the efficiency of the U.S. health care system, which will still likely maintain its status as providing the most expensive medical care in the world. Will the private sector embrace the kinds of change needed to make the health care system fiscally sustainable? (John F. Wasik, 10/30).

Health Policy Solutions (a Colo. news service):  Costs Still Out Of Control Even If Obamacare Succeeds
Obamacare’s advocates are self-righteous in pressing for implementation. The loyal opposition conservatives are skirmishing and employing guerrilla tactics. They hope the law will fail of its own accord. The problem with this drama-of-the-gifted is that it obscures health care's central issue and begs several really important questions. By now even the most fervent advocate of Obamacare has to admit that this law will do nothing to bend the cost curve (Francis Miller, 10/29).

And on other health issues -

The New York Times: A Mixed Decision On The Texas Abortion Law
Under a phony guise of protecting the health and safety of women, states with Republican governors and state legislatures have been keeping busy enacting one burdensome scheme after another designed to radically curtail access to safe and legal abortion care. On Monday, a federal judge in Texas rejected one of the most underhanded of these legislative efforts (10/29).

The New York Times: Putting More Controls On Painkillers
The Food and Drug Administration took an important step last week to curb an epidemic of overdose deaths from misuse of prescription painkillers that contain hydrocodone, such as Vicodin, Lortab and their generic equivalents, in combination with another painkilling drug. The only regret is that it took so long for the agency to make up its mind (10/29). 

The Washington Post: Check Out Medicare Changes During Open Enrollment
With so much fuss and frustration over the open enrollment for the health-care marketplaces, some people might be missing important information about another open-enrollment season. Open enrollment for the exchanges is overlapping and overshadowing the importance of the Medicare open-enrollment period, which started Oct. 15 and ends Dec. 7. It is during this period that those covered by Medicare can change their health plan and prescription drug coverage for 2014 (Michelle Singletary, 10/29).

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Stephanie Stapleton

Andrew Villegas

Lisa Gillespie
Shefali Luthra

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