Daily Health Policy Report

Thursday, October 31, 2013

Last updated: Thu, Oct 31

KHN Original Reporting & Guest Opinion

Administration News

Capitol Hill Watch

Health Reform

Health Spending And Fiscal Battles

State Watch

Weekend Reading

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Key Senate, House Committee Chairs Offer Plan To Fix Medicare Doctor Payments

Kaiser Health News staff writer Mary Agnes Carey reports: “The Democratic And Republican leaders of two key congressional committees have agreed on a framework to scrap the problematic Medicare payment formula for physicians and replace it with one that would link physician reimbursement to the quality of care provided, a step that could put an end to the annual ‘doc fix’ debate” (Carey, 10/31). Read the story.

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Why Insurers Cancel Policies, And What You Can Do When It Happens

Kaiser Health News staff writer Julie Appleby reports: “News that health insurers are ending the policies of what could be millions of Americans has rattled consumers and added to the debate over the health care law.  If you or a family member has been notified that your individual policy is being cancelled at year’s end, you may be stunned and upset. Here is a guide to help you understand the bigger picture, including why your premiums and benefits are likely to change next year and what you should consider as you shop for a new policy (Appleby, 10/30). Read the story.

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Health On The Hill: Sebelius Says Healthcare.gov Problems Are Her Responsibility

Kaiser Health News staff writer Mary Agnes Carey and CQ Roll Call’s Emily Ethridge discuss the days events on Capitol Hill, including Health and Human Services Secretary Kathleen Sebelius’ testimony in which she said she couldn't give firm numbers on how many people have enrolled for health insurance using the website because the data are not yet trustworthy (10/30). Read the transcript or listen to the audio.

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Help Flies In For Troubled Hospital In Estes Park, Colo.

Reporting for Kaiser Health News, in partnership with NPR, Eric Whitney writes: “Estes Park, Colorado, is weathering a tough season. Seven weeks ago floods wiped out all but one road into the small, tourism-dependent community adjacent to Rocky Mountain National Park. Hotels and businesses were just getting cleaned up and the town was hoping to salvage some kind of fall color season, when the government shutdown hit, closing the park for ten days” (Whitney, 10/30). Read the story.  

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Capsules: Rep. Ryan And CMS Chief Tavenner’s Exchange Muddles Subsidies For Young Adults

Now on Kaiser Health News’ blog, Michelle Andrews reports: “In a contentious House Ways and Means Committee hearing Tuesday about the problem-plagued launch of the federal health insurance exchange, Rep. Paul Ryan, R-Wis., and Marilyn Tavenner, the administrator of the Centers for Medicare & Medicaid Services, managed to agree about one thing: Young adults who have access to their parents’ health insurance can’t get subsidies if they choose instead to buy a plan on a health insurance exchange. Unfortunately, they’re both wrong, say health policy experts” (Andrews, 10/30). Checkout what else is on the blog.

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Political Cartoon: 'Happy Hollow-een?'

Kaiser Health News provides a fresh take on health policy developments with "Happy Hollow-een?" by Eric Allie.

Here's today's health policy haiku:

LET THEM... USE THE EXCHANGE

No Obamacare!
No no no, no no no... But...
Give it to my staff...
-Katie Alexander

And, as a special Halloween treat, here's a bonus -

SEBELIUS' EARLY HALLOWEEN

Testifying on
the Hill was more menacing 
than fright night's goblins.
-Anonymous

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

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Administration News

Obama Offers Spirited Health Law Defense, Pledges To 'See It Through'

President Barack Obama, speaking in Boston, appeared "contrite" about health law difficulties, but he took a hard line against the continuing GOP criticism.

The New York Times: Contrite White House Spurns Health Law’s Critics
The White House on Wednesday blended expressions of contrition for the troubled rollout of its health care law with an aggressive rejection of Republican criticism of it, as the administration sought a political strategy to blunt the fallout from weeks of technical failures and negative coverage. While Kathleen Sebelius, the secretary of health and human services, apologized profusely during a politically charged hearing on Capitol Hill, President Obama traveled to Massachusetts to argue forcefully that the Affordable Care Act will eventually be just as successful as the similar plan pioneered by Mitt Romney, his onetime rival and a former governor of the state (Shear and Pear, 10/30).

Politico: Obamacare's Split-Screen Day
President Barack Obama’s prescription for health care law critics: Take a deep breath — and move on. Never mind that House Republicans have beaten up on two of his top health officials on consecutive days; that one of them, Health and Human Services Secretary Kathleen Sebelius, faces new calls to resign seemingly every day; or that the Obamacare website crashed while Sebelius was testifying on the Hill Wednesday (Allen and Budoff Brown, 10/31).

The Washington Post: Obama On Health Care Law: ‘We Are Going To See It Through’
President Obama delivered a spirited defense of his health-care law Wednesday in the face of problems with the launch of its online insurance marketplace, vowing that “we are going to see it through.” In a speech in Boston, Obama took responsibility for making sure that problems with the Web site, HealthCare.gov, are fixed as soon as possible (Rucker and Branigin, 10/30).

The Associated Press/Washington Post: Obama Claims ‘Full Responsibility’ For Health Care Website Fixes As Security Concerns Surface
Obama underscored the administration’s unhappiness with the problems so far: “There’s no excuse for it,” he said during a Boston speech to promote his signature domestic policy achievement. “And I take full responsibility for making sure it gets fixed ASAP.” The website HealthCare.gov was still experiencing outages as Sebelius faced a new range of questions at the House Energy and Commerce Committee about a security memo from her department. It revealed that the troubled website was granted a temporary security certificate on Sept. 27, just four days before it went live on Oct. 1 (10/30).

Bloomberg: Obama Says Health Law Critics ‘Grossly Misleading’
President Barack Obama defended his health-care law, saying the flawed online insurance exchange will get fixed and accusing critics of “grossly misleading” the public about how the program works. Speaking at a rally in Boston yesterday, Obama said the experience of Massachusetts with the start of its health-care system in 2006 shows that the federal version, passed in 2010, will succeed (Talev, 10/31).

CBS News: Amid Obamacare Controversies, States Keep Up Medicaid Debate
As he defended his health care law in Boston on Wednesday, Mr. Obama criticized the Republican governors who've rejected the Medicaid expansion, charging they "are so locked into the politics of this thing that they won't lift a finger to help their own people." "That's a shame," Mr. Obama said. "If they put as much energy into making this thing work as they did into attacking the law, Americans would be better off” (Condon, 10/31).

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Speaking In Massachusetts, Obama Cites Success Of State Health Reforms, Credits Romney

Mitt Romney, the former governor of Massachusetts and former GOP presidential nominee, rejected President Barack Obama's efforts to draw parallels between the Massachusetts measure that Romney signed into law and Obama's health overhaul.

Los Angeles Times: Obama: GOP Critics Of Obamacare Should Follow Romney Example
President Obama said the buck stops with him on the failures of healthcare.gov but accused Republican governors of working against the success of the Affordable Care Act. Speaking to a crowd in Boston, at the historic hall where onetime Republican Gov. Mitt Romney signed that state’s 2006 healthcare reform into law, Obama pointed to his former rival as an example of bipartisan cooperation (Parsons, 10/30).

Politico: Obama Can’t Quit Mitt
President Barack Obama just can’t leave Mitt Romney alone. The former Massachusetts governor and 2012 GOP presidential nominee serves as a perpetual foil for the White House – and he’s one who can’t effectively fight back, has no base of support among Republicans and just happened to be the only other American politician to sign a universal health care law (Epstein, 10/30).

Fox News: Romney Rejects White House Effort To Compare Mass. Health Law Rollout To ObamaCare
Romney, who as the GOP's 2012 presidential nominee ran in part on repealing ObamaCare, emerged from his post-election private life to counter the White House message. “In the years since the Massachusetts health care law went into effect nothing has changed my view that a plan crafted to fit the unique circumstances of a single state should not be grafted onto the entire country,” he tweeted (10/30).

The Boston Globe: In Boston Speech, Obama Defends National Health Law
Before a boisterous crowd of health care executives, former Massachusetts legislators, and families that had been invited, Obama acted part salesman (“The deal is good, the prices are low”) and part as an angry defender (“We are going to see this through!”). Obama spoke in the same room where Romney signed the state’s groundbreaking law in 2006 with the late senator Edward M. Kennedy, a Democrat, watching on. “Mitt Romney and I ran a long and spirited campaign against one another,” Obama said. “But I always believed that when he was governor here in Massachusetts he did the right thing on health care” (Viser, 10/30).

WBUR: In Defense Of Health Care Law, Obama Cites Mass. Success
The criticism that the president broke a promise will likely continue, and there will be new problems. Health care is complicated, Obama said, and trying to fix a broken system is difficult. “It’s hard but it’s worth it. It is the right thing to do and we’re going to move forward,” Obama said. “We are going to keep working to improve the law just like you did here in Massachusetts.” But Massachusetts had something the Affordable Care Act does not: unified support. That unity is something many states can’t replicate, or at least that’s been the perception. Blue Cross Blue Shield CEO Andrew Dreyfus said that perception isn’t quite right (Bebinger, 10/31).

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Capitol Hill Watch

Sebelius Apologizes For Health Website Troubles, Vows To Get It Fixed

In nearly four hours of testimony before the House Energy and Commerce Committee, the secretary of Health and Human Services faced a barrage of complaints about the rollout of the health law.

The Washington Post: Sebelius On Health-Care Law Rollout: 'Hold Me Accountable For The Debacle. I’m Responsible.'
The battle over the government's problem-plagued health-care Web site escalated on Wednesday as Republicans attacked the Obama administration over an array of emerging issues involving the health law, including potential security vulnerabilities on the site and complaints from Americans facing cancellations of existing policies (Kliff, Rucker and Somashekhar, 10/30).

NPR: Congressmen Berate Sebelius For Cancellations, Website Woes
Health and Human Services Secretary Kathleen Sebelius headed to Capitol Hill Wednesday for a date with lawmakers frustrated by the rocky rollout of the HealthCare.gov website. What she got at the House Energy and Commerce Committee was four hours of venting from Democrats and Republicans alike (Rovner, 10/31).

The New York Times: Sebelius Apologizes For Health Site's Malfunctions
In three and a half grueling hours of testimony before a House committee, Ms. Sebelius apologized for the missteps and problems in efforts to carry out the president's most important domestic initiative (Pear, 10/30).

Los Angeles Times: Sebelius Apologizes For Obamacare 'Debacle'
Sebelius acknowledged that enrolling in insurance plans through the federal government's online marketplace was a "miserably frustrating experience for way too many Americans" — an observation Republicans repeatedly underscored by pointing to a screen that showed in real time that the website, healthcare.gov, was displaying an error message (Memoli, 10/31).

The Wall Street Journal: Sebelius Apologizes For Health Site's Woes
Despite calls from some Republicans for her resignation, Mrs. Sebelius gave no indication that she had plans to do so, saying she was "committed to earning your confidence back" by fixing the site (Schatz and Radnofsky, 10/30).

The Associated Press: Fact Check: A Sebelius Dodge At Hearing
But her response to Republicans who pressed her Wednesday to sign up under a health insurance exchange was problematic. She said that because she's part of the federal employee health plan, she's not eligible to switch to the exchanges. In fact, Americans who have workplace health insurance, as most with coverage do, can drop it in favor of individual policies offered by the exchanges. But doing so would not make financial sense for most (Woodward, 10/30).

NBC News: 'Miserably Frustrating': Sebelius Apologizes For Glitchy Obamacare Site
The Cabinet secretary responsible for Obamacare apologized Wednesday to Americans frustrated by the glitch-prone website that has blocked them from comparing and enrolling in health insurance plans. Kathleen Sebelius, the secretary of health and human services, called it "a miserably frustrating experience for way too many Americans." "I am as frustrated and angry as anyone with the flawed launch of healthcare.gov," she told the House Energy and Commerce Committee. "So let me say directly to these Americans: You deserve better. I apologize" (McClam, 10/30).

Kaiser Health News: Health On The Hill: Sebelius Says Healthcare.gov Problems Are Her Responsibility
Kaiser Health News staff writer Mary Agnes Carey and CQ Roll Call's Emily Ethridge discuss the days events on Capitol Hill, including Health and Human Services Secretary Kathleen Sebelius' testimony in which she said she couldn't give firm numbers on how many people have enrolled for health insurance using the website because the data are not yet trustworthy (10/30).

The Fiscal Times: 4 Key Obamacare Questions Sebelius Didn't Answer
Health and Human Services Secretary Kathleen Sebelius began her testimony today in front of the House Energy and Commerce Committee with an apology.  So, yes, there was plenty of political grandstanding. But that doesn't gloss over the fact that a lot of questions about ObamaCare remain unanswered. Here are four questions that Americans should still be asking (Wagstaff, 10/30).

Wonkblog: From 'Brosurance' To Tricycles, The Sebelius Hearing Was Pretty Weird
A quick review of five genuinely bizarre topics that have occurred this morning (Kliff, 10/30).

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Congressional Leaders Offer New Bill To Fix Medicare Doctor Pay

Two key congressional committee leaders -- one from each party -- are offering a new bill to fix the way Medicare pays doctors -- by repealing the Sustainable Growth Rate. The bill would freeze current payment rates until 2023, but would create a new budget-neutral incentive pay program in 2017.

Kaiser Health News: Key Senate, House Committee Chairs Offer Plan To Fix Medicare Doctor Payments
The Democratic And Republican leaders of two key congressional committees have agreed on a framework to scrap the problematic Medicare payment formula for physicians and replace it with one that would link physician reimbursement to the quality of care provided, a step that could put an end to the annual 'doc fix' debate (Carey, 10/31).

Politico: Bipartisan, Bicameral Pathway Possible For SGR Repeal
The top Republicans and Democrats on the Senate Finance and House Ways and Means committees have agreed on a basic framework for a permanent doc fix, a potentially momentous step in reforming the Medicare payment system. The plan, to be released in detail on Thursday, could be the most serious step yet in the effort to permanently repeal the flawed Sustainable Growth Rate. But there is not yet legislative language or a discussion of how to pay for it — potentially one of the biggest obstacles in permanent repeal (Haberkorn, 10/31).

Medpage Today: SGR Repeal Bill: 10-Year Pay Freeze, But P4P Incentives
The latest version of a bill to repeal Medicare's sustainable growth rate formula freezes payment levels through 2023 but creates a performance-based incentive program in 2017, according to a discussion draft obtained by MedPage Today. That program -- dubbed the "value-based performance (VBP) payment program" -- would replace the myriad of current incentive programs for physicians and create a "single budget-neutral incentive payment program," according to the draft from the Senate Finance and House Ways and Means Committees (Pittman, 10/30).

In related news -- 

Medpage Today: Final Medicare Fee Schedule Release Delayed
The final version of Medicare's 2014 physician fee schedule -- originally due to be published later this week -- won't be issued for nearly 4 more weeks, Medicare officials announced. The government shutdown caused the Centers for Medicare and Medicaid Services (CMS) to delay the release of the final fee schedule, which was set to be out by Nov. 1. A proposed version of the schedule -- which usually is very similar to the final version -- was released on July 8. "We intend to issue the final rules on or before November 27, 2013, generally to be effective on January 1, 2014," the agency stated on its website. The effective date of the fee schedule -- Jan. 1 -- is the same as usual (Pittman, 10/30).

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Senate Democrat To Offer Bill Allowing Americans To Keep Their Insurance Plan -- If They Like It

Sen. Mary Landrieu, D-La., will offer a bill to keep President Barack Obama's promise that under the health care law Americans could keep the health insurance they had if they liked it. Elsewhere, lawmakers on Capitol Hill have until Thursday afternoon to sort out if they have to make their staffs get coverage on the D.C. health exchange.

Politico: Landrieu To Propose Saving Vanishing Health Plans
Sen. Mary Landrieu said Wednesday she would propose legislation to ensure all Americans could keep their existing insurance coverage under Obamacare, a fresh sign of the political problems the law's rollout has created for congressional Democrats. Landrieu, a Democrat who faces a tough reelection in Louisiana in 2014, said she would either offer her own bill or formally sign onto another measure that would ensure that the law would not force anyone off of their existing health policies. "The promise was made, and it should be kept," Landrieu said in the Capitol Wednesday. "And it was our understanding when we voted for that bill that people when they have insurance could keep with what they had. So I’m going to be working on that fix" (Raju, 10/30). 

Politico: Democrats Differ On Putting Hill Aides On Exchanges
An informal survey of Democrats in both chambers shows there is simply no consensus on how to implement vague guidance on whether to put thousands of Capitol Hill denizens on the District’s DC Health Link exchange or keep aides on the Federal Employee Health Benefits Program. Undecideds don’t have much time to put the politically charged issue behind them: The deadline is Thursday afternoon for lawmakers to make the final decision (Everett and Sherman, 10/31).

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Health Reform

Obama Softens Keep-Your-Insurance Promise After Political Hardship

News outlets dive into the hit President Barack Obama is taking over his oft-repeated line about the health law that if you like the health insurance you have, you can keep it -- a sound bite that turned out to be untrue for thousands getting cancellation notices from their insurance companies. Obama walked back his promise Wednesday, saying those people can expect better coverage than that they previously had, and blamed the cancellations on "bad apple" insurance companies.

Politico: GOP Rides Wave Of Insurance Cancellation Notices
Since the Affordable Care Act was introduced in 2009, Republicans have dismissed President Barack Obama's oft-repeated promise that anyone who liked their insurance plan would be able to keep it. But was anyone paying attention? (Byers, Gold and Samuelsohn, 10/31). 

NPR: Notices Canceling Health Insurance Leave Many On Edge
President Obama repeated this line or a variation of it many times during the campaign to pass his landmark health care bill: "If you like your health care plan, you'll be able to keep your health care plan, period." But while that might be true for people who get health insurance through their employer, it's not true for many people who buy their policies in the individual market -- about 5 percent of the nation's policyholders (Ydstie, 10/30). 

The Washington Post: Obama's Health-Care Promise That People Can Keep their Insurance Comes Back To Haunt Him
It is a catchy sound bite that has turned around to bite the hand that fed it to the country: If you like the health insurance you have, you can keep it. President Obama's credibility has taken a hit over that line, which he tossed off in various versions during countless campaign stops and policy speeches (Tumulty, 10/30). 

The Associated Press/Washington Post: Promises, Promises: A Big Obama Health Insurance Promise That Never Stood A Chance
President Barack Obama's soothing promise that Americans happy with their health insurance could simply keep it was doomed from the start, and everyone familiar with the market seemed to recognize that except the president. Even his aides said four years ago, early in the huge push for his health care law, that he wasn't to be taken literally on that point. But he kept making the promise, literally and forcefully, through the long debate about the overhaul, after it became law and directly to voters in the campaign for the 2012 election. The words sometimes varied but the message didn't: Not only was a better day coming for people with no insurance or bad insurance -- but everyone else could just relax (10/31).

Reuters: Obama Blames 'Bad Apple' Insurers For Canceled Coverage
President Barack Obama said on Wednesday that "bad apple" insurance companies, not his signature healthcare law, are to blame for hundreds of thousands of people losing their coverage in the past few weeks. As administration officials scrambled to fix technical problems on an online insurance marketplace that is central to the success of the Affordable Care Act, Obama blamed private insurers for a separate problem that has critics questioning his honesty (Rampton and Morgan, 10/30).

The Wall Street Journal: Obama Tempers Insurance Pledge As Health Fight Rages
President Barack Obama on Wednesday said Americans who are losing insurance under the health law would find better coverage, rebutting a rising chorus of complaints that he had oversold the law's benefits. With Republican criticism in Congress intensifying over canceled policies and the new online insurance marketplaces malfunctioning, Mr. Obama used a speech in Boston to tell Americans that they could obtain improved insurance if they shopped around. This comes after the president has long said that people who like their health plans would be able to keep them after the new law takes effect next year (Nelson and Nicholas, 10/30).

ABC News: Obama Walks Back Promise That 'If You Like Your Health Plan, You Can Keep It'
Addressing what he called the "flurry in the news" about the cancellations, Obama urged Americans receiving these notices to shop for new coverage in the marketplace. "Most people are going to be able to get better, comprehensive health care plans for the same price or even cheaper than projected. You’re going to get a better deal," he said. The administration has said it should come as no surprise that the 5 percent of the population who purchase insurance on their own may be forced to switch plans because their coverage doesn’t meet the new standards required under the Affordable Care Act (Bruce, 10/30).

Kaiser Health News: Why Insurers Cancel Policies, And What You Can Do When It Happens
News that health insurers are ending the policies of what could be millions of Americans has rattled consumers and added to the debate over the health care law.  If you or a family member has been notified that your individual policy is being cancelled at year’s end, you may be stunned and upset. Here is a guide to help you understand the bigger picture, including why your premiums and benefits are likely to change next year and what you should consider as you shop for a new policy (Appleby, 10/30). 

Miami Herald: Florida Says It Didn't Drop Members, Just Insurance Plans
Hundreds of thousands of Floridians are currently afflicted with something critics of the Affordable Care Act long have warned about: rate shock. It’s the unpleasant experience of seeing your health insurance rates jump as a result of the health care reform law -- in contradiction with President Barack Obama’s often-repeated promise that, "If you like your plan, you can keep it" (Chang, 10/30).

CQ HealthBeat: Democrats Try To Shift Cancellation Controversy To Battle Over Individual Market
Republicans have pursued one line of attack after another on the health law since its 2010 passage without much success -- until now. The current wave of cancellation notices going out to policyholders in the individual market has led to complaints from around the country that people are being forced to pay higher premiums to enroll in new plans they don’t want (Reichard, 10/30).

Meanwhile, some news on public opinion -- 

NBC News: Poll: Majority Think Health Law Needs Overhaul Or Elimination
A majority of Americans – 52 percent – believe the health care law needs either a major overhaul or to be completely eliminated, a new NBC News/Wall Street Journal poll finds. Forty-four percent think it either needs minor modifications or that it’s working well as is. The Obama administration maintains that the health insurance exchange website can be fixed, but acknowledges major problems (Montanaro, 10/30).

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Concerns About Security Risks Raised Before Health Website Opened, Government Memo Shows

Reuters reports on the memo, which says a lack of testing put the site at "high risk." But a government spokeswoman says steps were taken to fix those concerns. At the same time, CBS examines the system failures in tests before the launch.

Reuters: Obamacare Website Security At 'High Risk' Before Launch -- Memo
The security of the Obama administration's healthcare website was at "high risk" because of lack of testing before it opened for enrollment on October 1, according to a government memorandum reviewed by Reuters on Wednesday. The HealthCare.gov site collects a trove of sensitive data, such as Social Security numbers, email addresses, phone numbers and birth dates that could be used by criminals in an array of schemes. A government spokeswoman said on Wednesday that steps to mitigate security concerns have been implemented since the memo was written on September 27 and that consumer data is secure (Finkle, 10/30).

CBS News: Obamacare Website Failed In Tests Just Before Launch Date
One of the mysteries of the problems with the Obamacare website is why Secretary of Health and Human Services Kathleen Sebelius would give the "all clear" after the system failed, repeatedly, during tests days before its debut. CBS News has learned the website failed with a small test pool of 200 to 300 people that included employees from the government and insurance companies. The government employees worked at their own computers and desks within the Centers for Medicare and Medicaid Services, which oversaw the health care implementation. According to sources familiar with the process, CMS employees were provided fake personal information to enter into HealthCare.gov rather than their own data and were given a date that testing would begin. However, on that date, the employees were told it was being postponed (Attkisson, 10/30).

Meanwhile - 

Politico Pro: Few House  Republicans Show Up For HHS Briefing
House Republicans clamored for an Obamacare briefing from administration officials — just like the one Democrats got. But when they got that meeting Wednesday, a handful of members showed up. Republicans emerging from the closed-door session with Mike Hash, director of HHS's Office of Health Reform, said about 10 to 20 members came to hear what Hash had to say about the health care law's bungled rollout — even though they've been complaining that they're not getting enough details from the administration about it (Cunningham, 10/30).  

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State, Federal Health Insurance Marketplace Issues Expose Struggles, Few Successes

The very public struggles of these exchanges make news in California, Colorado, Pennsylvania, Maryland, Texas, Connecticut and Minnesota. Some issues include a lack of workers to help people navigate the systems in California, prices in the new marketplaces and an absence of accurate doctor provider lists.

Los Angeles Times: Lack Of Enrollment Workers Hampers Insurance Exchange Sign-Ups
A month into enrollment under the Affordable Care Act, hundreds of health care workers and insurance agents are still unable to sign up consumers for health coverage through California's new exchange. Despite promises of an army of workers blanketing the state to help, many aren't in place -- or they're hitting one state roadblock or another (Terhune and Brown, 10/30).

The Wall Street Journal: Doctors Fault Provider Lists Exchanges Get From Insurers
Many new health exchanges don't yet let shoppers see which doctors accept which insurance plans. Where exchanges do post the so-called provider lists, they often contain inaccurate or misleading information, some doctors say, including wrong specialties, addresses and language skills, and no indication whether providers are accepting new patients (Beck, 10/30). 

Health Policy Solutions (a Colo. news service): Exchange Snafus Linked To Only 3,164 Purchases So Far
Just over 3,100 people purchased health insurance through Colorado's new health exchange from Oct. 1 through Oct. 26, according to new data released Monday. Purchases on Connect for Health Colorado will need to pick up steam dramatically in the coming months if the new marketplace for public and private insurance is going to meet a mid-level goal of enrolling at least 136,000 people in new health plans in Colorado in 2014. Board members expressed dismay Monday that computer glitches both at the federal level and in Colorado may be preventing customers from purchasing health insurance. Without purchases by a broad spectrum of people -- including young, healthy customers -- Obamacare may not work as planned (Kerwin McCrimmon, 10/30).

The Philadelphia Inquirer: Amid Health-Care Woes, Would-Be Buyers Do What They Can
With the federal website still on the fritz after four weeks, people here seeking the affordable insurance promised by Obamacare are doing what they can on their own. Some are finding policies on insurers' websites, or estimating subsidies using independent calculators. Others are going as far as they can in the sign-up process at Healthcare.gov, hoping they can return to finish choosing coverage later (Sapatkin, 10/30).

The Baltimore Sun: Md. Health Exchange Working Better, But Glitches Remain
Maryland has resolved many of the problems with its new health insurance exchange and more people are signing up, officials said Tuesday, though they acknowledged that a number of glitches remain. On the same day that a top Obama administration official apologized for the troubled federal health care website, the head of Maryland's system said some state residents are still unable to complete their enrollments online (Walker, 10/29).

The Texas Tribune: Texas Hospitals Looking Beyond ACA Website Glitches
Even proponents of the Affordable Care Act admit the rollout of its signature website, healthcare.gov, has been rocky. But the Texas Hospital Association said Monday that criticisms of the website are a distraction from more significant problems with health care in Texas: the high number of people without insurance and the state's decision not to expand Medicaid (Walters, 10/30).

The CT Mirror: CT Exchange Chief: Obamacare Focus Will Turn To Price 
While much attention has been focused nationally on technological problems hampering the rollout of the federal health reform law, the head of Connecticut's health insurance exchange said Wednesday that another issue is likely to become more prominent: Price. Kevin Counihan, CEO of Access Health CT, predicted the focus will shift to rates and coverage as people who buy their own insurance begin learning about their options for 2014 (Becker, 10/30).

Minnesota Public Radio: New Health Insurance Options Coming To The Rochester Area
Residents in Olmsted and Dodge counties will now have multiple health insurance options on MNsure, the state's online health insurance marketplace, state regulators said today. Rochester had been the only part of Minnesota offering only one insurance option on MNsure. Insurance companies have stayed out of the Rochester market largely because Mayo sets prices in the region, and they're higher than anywhere else in Minnesota. ... The addition of seven new health insurance plans will let consumers look for more affordable health care options, while staying with current health providers, Minnesota Health Commissioner Ed Ehlinger said (Baier, 10/30).  

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White House, Insurers Resisting Efforts To Delay Health Law's Individual Mandate

The effort to set back that requirement could hamper efforts to get young, healthy people in the insurance system, and that could undermine the insurance system, they argue.

Los Angeles Times: Insurers, White House Argue Against Delaying Healthcare Deadline
Even with its health insurance marketplace floundering for the fourth week, the Obama administration is resisting what some Democratic allies contend is the most logical response to the problem: giving consumers more time to sign up. According to insurers and the White House, delaying the deadline could undermine efforts to lure a broad, young and healthy mix of consumers to the market. That would end up costing insurers, and possibly taxpayers, money (Hennessey and Parsons, 10/30).

Meanwhile, one group is filing a lawsuit about another mandate in the law. 

The Associated Press: Conservative Group Files Lawsuit Seeking To Have New Health Care Law Declared Unconstitutional
The Association of American Physicians and Surgeons is seeking to have the health care law overturned. The group is seizing on a provision that was supposed to go into effect next year but ultimately was postponed for 12 months. That provision requires employers with 50 or more workers to offer affordable coverage or face fines, but it's been put off until 2015 (Ramde, 10/30).

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eHealth CEO Says His Company Can Run Healthcare.gov While It's Being Fixed

The health law's policy ramifications make news as eHealth's CEO offers to take over the troubled healthcare.gov, and other groups consider the coverage their workers -- including some part-timers -- receive. Also, business groups get new lawmaker allies in their fight to delay a health law tax on insurance.

Los Angeles Times: eHealth CEO To Obama: Let Us Take Over Healthcare.gov
eHealth Inc., the nation's largest online seller of health insurance, is offering to run Obamacare enrollment for the federal government while the balky healthcare.gov website is being fixed. Gary Lauer, chief executive of eHealth, said in a letter this week to President Obama that his Mountain View, Calif., company was willing to operate the federal exchange through its website as a temporary stopgap to give officials more time to repair the troubled online marketplace (Terhune, 10/30).

The Wall Street Journal: Some Factories Stick With Old Health Plans
Some small manufacturers facing soaring costs for employee health insurance say they are likely to continue coverage for their workers, even though they won't be required to under the Affordable Care Act. They are wary of discontinuing coverage and sending their employees to new insurance exchanges to obtain their own insurance. They say the problem-filled rollout of the federal government's online insurance market has raised further doubts about whether their employees would have access to sufficient coverage at lower costs (Tita, 10/30).

The Richmond Times-Dispatch: Obamacare Prompts Cutbacks For School Part-Timers
The health care reform law championed by President Barack Obama and Democrats in Congress is prompting Richmond-area school divisions to cut part-timers' hours. Henrico and Chesterfield counties and Richmond schools have already established policies that limit part-time workers to less than 30 hours per week to avoid paying for their health insurance. Hanover County school officials are considering setting a cutoff (Shulleeta, 10/31).

The Hill: Business Groups Call For Repeal Of Obamacare Insurance Tax
Two groups of business associations and state and local chambers of Commerce are calling on Congress to pass new legislation that would delay an Obamacare tax on health insurance companies for two years. This week, Reps. Charles Boustany (R-La.) and Ami Bera (D-Calif.) proposed a bill delaying the tax for two years. The tax is expected to collect anywhere from $8 billion to $15 billion per year over the next few years (Kasperowicz, 10/30).

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Health Spending And Fiscal Battles

Budget Talks Proceed, But With The Same Old Sticking Points

Structural changes to federal health programs, the spending cuts put in place by the sequester and new taxes continue to be the buzz words.  

The Washington Post: Beneath Conference Committee’s Sweet Words Lurks Old Sticking Point: Taxes
Chastened by three years of budget showdowns and economic near-calamities, the 22 senators and seven House members on a new budget conference committee expressed fresh eagerness to end the era of government by crisis. Democrats, for instance, said they are ready to swap sharp but temporary cuts to federal agencies, known as the sequester, for permanent “structural changes” to federal health programs long sought by Republicans (Montgomery, 10/30).

Los Angeles Times: Budget Talks To Ward Off Another Shutdown Begin
The panel, created from this month's budget agreement, has until Dec. 13 to negotiate a budget framework. Funding to keep the federal government open runs out by Jan. 15. Republicans resisted new taxes, saying they would rather reduce spending on Medicare and other safety-net programs. Democrats want wealthy individuals and corporations to contribute more tax revenue to help solve the nation's fiscal problems (Mascaro, 10/30).

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State Watch

State Roundup: Federal Appeals Court Set To Review Texas Abortion Law

A selection of health policy stories from Texas, Colorado, California and Connecticut.

Los Angeles Times: Federal Appeals Court Could Rule Soon On Texas Abortion Law
A federal appeals court in New Orleans had yet to rule Wednesday on Texas officials' request for an emergency order allowing a set of new abortion restrictions to take effect in their state as scheduled. On Monday, a federal judge in Texas issued a ruling that blocked some of the restrictions that he found unconstitutional, including a provision requiring doctors at abortion clinics to have admitting privileges at nearby hospitals and limits on medication-induced abortions (Hennessy-Fiske, 10/30).

Kaiser Health News: Help Flies In For Troubled Hospital In Estes Park, Colo.
Estes Park, Colorado, is weathering a tough season. Seven weeks ago floods wiped out all but one road into the small, tourism-dependent community adjacent to Rocky Mountain National Park. Hotels and businesses were just getting cleaned up and the town was hoping to salvage some kind of fall color season, when the government shutdown hit, closing the park for ten days (Whitney, 10/30). 

California Healthline: Assembly Member Urges Senate To Create New Committee On Aging, Long-Term Care
The California Senior Legislature yesterday awarded its Legislator of the Year award to Assembly member Mariko Yamada (D-Davis) at the group's annual meeting in Sacramento. Yamada, chair of the Assembly Committee on Aging and Long-Term Care, said it's unthinkable that the state Legislature doesn't have a similar subcommittee on the Senate side. "I would be remiss, as I enter my final year [as an Assembly member], to fail to note that, for some reason, there is no committee on aging -- or even a subcommittee -- on the Senate side," Yamada said (Gorn, 10/30).

The CT Mirror: Health Care Redesign Plan Focuses On primary Care, Doctor Payments And Reducing Waste
A team of state officials and health care industry representatives are trying to redesign the way health care is paid for and delivered to the vast majority of Connecticut residents. According to a draft of their plan, their vision includes bolstering primary care practices to take on a larger role in patient care and offer treatment during expanded hours. It calls for better linking of medical practices with social services and other supports that could help people in high-risk communities. And it includes changing the way health care providers are paid by giving them an incentive to rein in what their patients' care costs -- a model that's been embraced by Medicare and insurance companies but has drawn fire from patient advocates (Becker, 10/30).

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Weekend Reading

Longer Reads: Impact Of Missing November Deadline For Health Website Fix

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

New Republic: Obamacare's Worst-Case Scenarios
Administration officials are saying that healthcare.gov will be "functioning smoothly" by the end of November. And maybe they are right, in which case all the fuss about broken websites will become a historical footnote. But what if administration officials are wrong? What if it's December and Obamacare's official online portals are still barely functional? It's easy to assume that Obamacare would simply unravel. As the argument goes, the only people willing to put up with such a slow, cumbersome process for enrollment would be the people who need health insurance the most—in other words, people with serious medical conditions (Jonathan Cohn, 10/28).

The New York Times: The President Wants You To Get Rich On Obamacare 
Tom Scully bolted through the doors and up the stairs to a private dining room on the third floor of the "21" Club. Scully, 56, is slightly taller than average and has tousled graying hair, an athletic build and a lopsided smile. … During the past year, anxiety about the onset of Obamacare has created a chill in some parts of the economy. While large health care businesses — insurance companies, for instance, and hospital chains — have poured significant resources into preparing for millions of new customers, countless investors have appeared spooked by the perpetual threats to repeal, or at least revise, the law (Adam Davidson, 10/30).

National Review: Serco's Checkered History
The CEO of Serco, a British-based company whose North American division received one of the largest contracts to work on the Obamacare insurance exchanges, resigned Friday amid allegations that the company had defrauded the British government of millions of pounds. Even as myriad other allegations emerged about its work around the globe, Serco spent heavily on lobbying in Washington, D.C., and secured a multi-year contract potentially worth $1.249 billion to handle paper applications for the Obamacare exchanges. Serco did not respond to e-mail and voice-mail requests for comment (Jillian Kay Melchior, 10/30).

National Review: Obamacare's Unlikely Coverage Goal
The Obama administration has spent the last several months telling reporters that the benchmark by which to measure Obamacare's success is 7 million new exchange enrollees. That number comes from the Congressional Budget Office's most recent baseline estimates of how the law will affect spending and taxes as well as enrollment in public programs and private insurance. But focusing just on enrollment in the exchanges is misleading, as many millions of individual-market participants are now discovering. They are receiving cancellation notices from their current insurers and are being told that they need to pick their coverage for next year from among the Obamacare-compliant plans offered in and outside of the exchanges. Some of these individuals will make the switch and buy new coverage, assuming the Obama administration is able to make Healthcare.gov minimally functional at some point. But there also will be some current individual-market participants who don't sign up for an Obamacare plan and go without insurance for some or all of 2014. The interesting number, then, is not gross enrollment in the exchanges, but the net number of newly insured Americans (James C. Capretta, 10/29).

The Atlantic: Mental Illness, The Video Game
Kara Stone has recently taken up gardening. Her floral dependents—Echinacea, sage, and geranium—have only yet grown into big sprouts, but she finds the activity a nice change from time spent in front of glowing screens. It's worth noting Stone recently put in a lot of that kind of time while creating her first video game, MedicationMeditation. It's also worth noting that she's planted these seeds in discarded antidepressant bottles. … Though making it caused momentary negligence of her own, Kara Stone's game, of sorts, seeks to make players conscious of their own bodies (Zack Kotzer, 10/28).

5280, The Denver Magazine: Rude Awakening
Im dying. I'm dying. I'm dying. I kept repeating the words as I stared at my 10-year-old reflection in a bathroom mirror at Bonanza Steakhouse, a cheap buffet-style restaurant in my home state of North Dakota. It was 1990, and outside the door I could hear my sister’s volleyball teammates chattering. I tried to picture my parents smiling tolerantly at the middle-schoolers as they ate their iceberg lettuce salads with ranch dressing. How was I going to break their complacent reverie to tell them that their youngest daughter was deathly ill? ... In many cases, a girl with precocious puberty will get her first period at a normal age. Others will need hormone intervention—a drug regimen similar to those used to halt puberty for transgendered children—to stall the development process. Either way, parents of a child with precocious puberty are faced with a dilemma: Let nature happen, or chemically alter their child’s transition to adulthood (Natasha Gardner, 10/2013). 

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Editorials and Opinions

Viewpoints: Sebelius Hearing Is A 'Grudge Spectacle;' Obama's 'Politically Convenient Falsehood' About Coverage

The New York Times: Grudge Spectacle
The Obamacare hearings before the House Energy and Commerce Committee are a grudge spectacle. They aren't about fixing problems but affixing blame. They want to make the problems with HealthCare.gov into a problem with "government health care" (Charles M. Blow, 10/30).

Politico: The Obamacare Whiners
Henry Waxman made a plea at the end of Wednesday’s House hearing grilling of Health and Human Services Secretary Kathleen Sebelius. The California Democrat and liberal lion asked Republicans to reach across the aisle to work with Democrats to improve Obamacare. Yes, Henry Waxman, who has made a career of ideological witch hunts and smash-mouth partisanship, wants a cease-fire over Obamacare, or so he says. ... It's a little late to get or expect any Republican buy-in, though. That would have required serious compromise back in 2009, when Democrats, at the high tide of their power in the Obama era, saw no reason to make any (Rich Lowry, 10/30).

Bloomberg: Obama's Foolish Promise About Obamacare
Americans are beginning to realize that under the Patient Protection and Affordable Care Act, many people will in fact not be able to keep their current insurance plans. That reflects poorly on President Barack Obama. But it doesn't necessarily reflect badly on Obamacare (10/30).

The New York Times' Taking Note: The Uproar Over Insurance 'Cancellation' Letters
Kathleen Sebelius, the Health and Human Services secretary, took a lot of grief Wednesday from Republicans on the House Energy and Commerce Committee who were outraged that some people's individual insurance policies had been "cancelled" because of health care reform. Some of the rants bordered on the comical. Cory Gardner, Republican of Colorado, brandished his "cancellation" letter and demanded that Ms. Sebelius nullify the health law for all residents of his congressional district (David Firestone, 10/30). 

The Wall Street Journal: You Can Keep Your Health Plan*
President Obama has intoned "if you like your health plan, you can keep your health plan" hundreds if not thousands of times. Sometimes he has even added that "no one will take it away, no matter what" or "nothing will change, period." But now that reality is repudiating the President's unequivocal promise, Democrats want you to know that there was always a secret footnote: If you're losing a health plan you liked, the President didn't mean your plan (10/30).

The Wall Street Journal: The President's Broken Health-Care Promises
Either Mr. Obama's staff did not know about the CBO estimates (hardly likely), or they did not care the president was routinely offering a politically convenient falsehood (seems right), or they did not have the fortitude to tell the president that what he was saying wasn't true (also probably so). Neither ignorance, arrogance nor sycophancy is an excuse for such presidential dissembling. This is a serious breach of trust with the American people (Karl Rove, 10/30).

Los Angeles Times: Democrats Scramble To Cancel Insurance Cancellations
One of the arguments made for the 2010 healthcare law was that it attacked the problem of underinsurance -- the threadbare policies that offered such poor coverage, they allowed millions of Americans to be bankrupted by medical bills. Now, however, Democrats are confronting the fact that the law they wrote is forcing thousands of people to lose their current insurance plans because the coverage doesn't meet the new standards. It's a perfect example of the road to political hell being paved by good intentions (Jon Healey, 10/30).

Los Angeles Times: Obamacare Hysteria: Don't Believe The Canceled Insurance Hype
Obamacare's critics are going to town on the cancellation letters millions of Americans are receiving from their health insurers, informing them that their health plans won't conform to the new federal standards for health coverage as of Jan. 1. We're supposed to be scandalized by this, since President Obama himself assured everyone that if they liked their insurance they'd be able to keep it. And people just love plans that in some cases cost just $50 a month. At that price, what's not to love? Back in March, Consumer Reports published a study of many of these plans and placed them in a special category: "junk health insurance." Some plans, the magazine declared, may be worse than none at all (Michael Hiltzik, 10/30).

The Washington Post: Kathleen Sebelius Vs. A Party Without A Brain
It was their big chance to flambé the secretary of health and human services and the person who has overseen the disastrous launch of Obamacare. Instead, they wound up casting her as Judy Garland's Dorothy. "In 'The Wizard of Oz,' there is a great line," [Rep. Joe] Barton, one of the first Republican questioners, informed Sebelius, a former two-term governor of Kansas (Dana Milbank, 10/30).

The Washington Post: Eight Sebelius Takeaways
In the semi-disastrous testimony of Health and Human Services (HHS) Secretary Kathleen Sebelius — with such doozies on Healthcare.gov as, "The Web site never crashed. It is functional, but at a very slow speed and very low reliability," with a split scene of the site down — there was more than a new batch of gotcha moments for the Republicans to gloat about. There is a fundamental assumption critical to not only Obamacare, but also to the liberal welfare state more generally, namely that it requires a sophisticated and competent bureaucracy. In its collapse and in the testimony of Sebelius, we saw that this assumption may simply be wrong. Forget ideology for a moment. If the liberal welfare state can't run its own creations, it is not sustainable (Jennifer Rubin, 10/30).

The Washington Post: Is Obamacare A Job Killer? Yes And No.
Is the Affordable Care Act (ACA), also known as Obamacare, a job killer? Along with the fate of HealthCare.gov, this question stalks the ACA. Critics — including me — say yes. We argue that businesses will try to avoid the requirement to provide health insurance to workers by changing their employment practices. This would include cutting hours to ensure that workers are "part time" under the ACA, exempting them from coverage. The Obama administration says the facts don't justify the fears. In a study, the White House Council of Economic Advisers found "no economy-wide evidence . . . [of] increasing part-time employment" tied to Obamacare. Who’s right? Maybe we both are (Robert J. Samuelson, 10/30).

Bloomberg: Obamacare's Biggest Threat Isn't The Website
This past weekend, thinking enough time had passed for the kinks to be ironed out, I installed the latest versions of Apple Inc.’s operating systems on my laptop and iPhone. Trying to sync the phone after this was accomplished, I became trapped in what I’ll call an upgrade death spiral. With each failed attempt, vast chunks of my music vanished. ... Yet a few days and a great deal of hassle later - - wipe this, reset that -- the devices seem to be communicating amicably again. ... Perhaps you’ve heard the rollout of the government’s health-insurance website hasn't gone so well, either. That’s so shocking. The world’s most successful and admired maker of computers and software can’t create new information technology without driving its customers crazy now and then, but one expects so much more from the federal government. In due course, the bugs will be fixed and the site will work. There’s still time to get it right, and, provided the shambles doesn't drag on too long, it’s unlikely to do much harm to the economics of the reform (Clive Crook, 10/30).

JAMA: With A Bumpier Rollout Than Expected, Better Transparency Needed On Health Insurance Exchanges
As we all now know, the start-up of the federally run insurance exchange websites and the first few weeks that the exchanges have been operating have been extremely bumpy—certainly bumpier than anyone (including me) had been predicting (Gail Wilensky, 10/30).

Health Policy Solutions (a Colo. news service): Rep. Polis Needs To Recall His Commitment To Health Care Justice
Solutions last week reported that U.S. Congressman Jared Polis, D-Boulder, will seek waivers from the Affordable Care Act/Obamacare insurance purchase mandate for his constituents living in some of the mountain towns.  These waivers would relieve many people from paying the high premiums for health insurance coverage available on the ACA exchanges that reflect the mountain counties’ overall wealth and health care costs. Many of the people who most need coverage in those communities cannot afford the high premiums. Rep. Polis is forgetting the simplest and most humane way to solve this problem is not to waive the requirement to purchase insurance coverage (Donna Smith, 10/30).

The Wall Street Journal: The Affordable Care Act Is A Socialist Ponzi Scheme
As a writer of 24 books mostly on health and wellness and by using my celebrity to get to the best and brightest doctors, scientists and medical professionals in the alternative and integrative health-care world, I have come to the following conclusions: First of all, let's call affordable health care what it really is: It’s socialized medicine (Suzanne Somers, 10/28).

Los Angeles Times: Suzanne Somers Should Disavow Her Lame Argument Against Obamacare
In a much-mocked essay published by the Wall Street Journal on Monday, the 67-year-old self-help author and star of the 1970s TV show "Three’s Company" [Suzanne Somers] held forth on what she believes are the evils of Obamacare and the terrible effects it will have on retirees. She didn’t really use facts, as such, or even logic, as such. Instead, using personal anecdotes about relatives and friends in Canada, a misremembered newsmagazine headline and apparently fabricated quotes by Stalin and Churchill, she maintained that Obamacare is a "socialist Ponzi scheme" (Robin Abcarian, 10/30).

On other health topics -

USA Today: Budget Negotiators Avoiding Big Benefits: Our View
Washington has yet to address the main threat to the nation's solvency: the growth in entitlement programs. Big ones such as Medicare, Medicaid and Social Security. And smaller ones such as food stamps, farm subsides, and benefits for federal workers and military retirees. These programs account for nearly two-thirds of federal spending, which is why the House and Senate budget negotiators who belatedly began work Wednesday need to go where the money is. Instead, they are downplaying prospects for a "grand bargain" that combines significant entitlement restraint with tax simplification. They are focusing on a small-ball approach that averts another government shutdown and undoes some of the more harmful effects of sequestration, the automatic budget cuts that are overwhelmingly targeted on the one-third of federal money that's not spent on benefit programs. This minimalist outcome would be another failure in a long line of failures (10/30). 

USA Today: Sen. Bernie Sanders: Don't Cut The Big Benefit Programs
At a time when almost all new income created is going to the top 1% and when the gap between the very rich and everybody else is growing wider, we must not balance the budget on the backs of the most vulnerable people in our country: working families, the elderly, children, the sick and the poor. We must not cut Social Security, Medicare or Medicaid (Sen. Bernie Sanders, I-Vt., 10/30).

The Washington Post: Budget Talks Bring Diminished Expectations
For the most part, however, revenue is not indispensable to achieve the task at hand: a short-term deal that avoids most or all of the sequester — which would otherwise drive the spending rate down to $967 billion — while re-allocating spending among defense and non-defense programs. This could be paid for by savings in entitlement programs not subject to the sequester, such as federal retirement, farm subsidies or even tweaks to Medicare such as higher premiums for upper-income seniors — a $5 billion per year item that Mr. Obama, like Mr. Ryan, has previously embraced (10/30).

The Wall Street Journal: One Quick Fix to Ease The Coming Doctor Shortage
Ryan Scully wanted to be a doctor from the moment he began volunteering as a paramedic and firefighter during his freshman year of college. In medical school at George Washington University, he passed all of his preclinical and clinical requirements, as well as two national licensing exams required of all medical students. Just before graduation in 2012, though, he learned that he had not been accepted into a residency training program necessary for gaining his certification as a practicing physician. He would receive his M.D. degree in May with the rest of his class—but without a hospital training spot, he could not practice medicine (Atul Nakhasi, 10/30). 

The New England Journal of Medicine: State Politics And The Fate Of The Safety Net
Only 2% of acute care hospitals nationwide are safety-net facilities, but they provide 20% of uncompensated care to the uninsured. ....The Medicaid Disproportionate Share Hospital (DSH) program was established to help defray their costs for uncompensated care. ... Because the Affordable Care Act (ACA) was expected to dramatically expand insurance coverage, safety-net hospitals were expected to need less DSH money. ... if the state governments that refused to expand Medicaid also refuse to rethink their approach to allocating DSH funds, there will be little money left to sustain their safety-net hospitals when the cuts deepen in 2017. The cascade of service reductions and facility closures that this could trigger would have sweeping consequences. Safeguarding the safety net in such politically perilous times will require creative rulemaking by CMS. The proposed DSH rule is a good start, but much remains to be done (Dr. Katherine Neuhausen, Michael Spivey and Dr. Arthur L. Kellermann, 10/31). 

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EDITOR:
Stephanie Stapleton

ASSOCIATE EDITOR:
Andrew Villegas

WRITERS:
Marissa Evans
Lisa Gillespie
Shefali Luthra

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