Daily Health Policy Report

Friday, October 4, 2013

Last updated: Fri, Oct 4

KHN Original Reporting & Guest Opinion

Health Reform

Capitol Hill Watch

State Watch

Health Policy Research

Weekend Reading

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Experts Suggest Software Problems, Not Just Demand, May Be Behind Marketplace Glitches

Kaiser Health News staff writers Jay Hancock and Phil Galewitz report: "Three insurance companies confirmed Thursday that they have enrolled customers through the federal online marketplace created by the health law, but the numbers were meager and signup frustration continued for many people" (Hancock and Galewitz, 10/4). Read the story.

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A Former 'Young Invincible' Looks Forward to Health Insurance

Kaiser Health News staff writer Sarah Varney, working in collaboration with NPR, reports: "Have you heard of the young invincibles? That’s the name given to young people who think nothing bad can happen to them -- healthy people whose enrollment in Obamacare insurance is key to offsetting the costs of older, less healthy buyers. Brad Stevens is a 54-year-old, not-so-young invincible— recently reformed" (Varney, 10/3). Read the story.

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Insurance Brokers Look For Relevance As Health Exchanges Grow

Reporting for Kaiser Health News, Eric Whitney writes: "When states and the federal government rolled out online marketplaces to help people buy health insurance on Tuesday, you'd think that old-fashioned insurance brokers would be worried. All told about $200 million is being spent on a new army of people to help consumers find their way. These navigators, guides or assisters, as they're called, would seem to threaten the business of traditional brokers" (Whitney, 10/3). Read the story.

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Insuring Your Health: 5 Things To Remember About Shopping On The Health Insurance Marketplaces

Kaiser Health News consumer columnist Michelle Andrews writes: "They're here. The state health insurance marketplaces, a signature feature of the Affordable Care Act, open for business today. More than three years in the making, the marketplaces, or exchanges, allow consumers to compare a range of health plans online that meet the standards of the law, apply for subsidies and pick the best policy for their needs. Here are a few things to keep in mind" (Andrews, 10/4). Read the column.

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Political Cartoon: 'Inessential Benefit?'

Kaiser Health News provides a fresh take on health policy developments with "Inessential Benefit?" by David Fitzsimmons.

Because it is Friday, here are two health policy haikus:


Summer budget war!
Fall debt and delay battle
Winter coverage?
-Team Haiku, Altarum


Wedding bells for love;
divorce for health insurance.
That is modern life.

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

Insurers See Trickle Of Enrollees From Obamacare Exchanges

Insurers report that a small number of people are enrolling in coverage through the federal insurance exchange, but the government has declined to release any numbers. Meanwhile, the federal government scrambles to make fixes as experts debate whether the glitches are a result of the high level of consumer interest or if other issues are at work.

Politico: Obamacare Has Time To Fix Exchanges – But Not Forever
In Week One, Obamacare health insurance exchanges have been so swamped with traffic that they have been groaning under the strain. That could be a good sign for a law that America supposedly hated — if the Obama administration can get the federal website bugs worked out before those potential customers get scared away (Nather, Norman and Millman, 10/3).

The Washington Post: Government Continues Streamlining New Health Exchanges
Health insurers and individuals began reporting a trickle of enrollments in the new online marketplaces created by the health-care law, as federal and state officials scrambled to try to fix technical problems that have prevented many consumers from buying coverage. The White House has declined to release any national statistics on sign-ups, saying complete information was not yet available (Kliff, Somashekhar and Sun, 10/3).

The Washington Post: 'A Trickle, Not A Wave:' What Insurers Are Seeing In Obamacare Enrollment
Health insurers and individuals began reporting a trickle of enrollments in the new online marketplaces created by the health-care law, as federal and state officials scrambled to try to fix technical problems that have prevented many consumers from buying coverage. The White House has declined to release any national statistics on sign-ups, saying complete information was not yet available (Kliff, Somashekhar and Sun, 10/3).

Bloomberg: Obamacare Window Shoppers Meet Bottleneck In Slow Sign-Up
Health insurers in the Obamacare marketplaces are starting to slowly enroll new customers after computer bottlenecks and window shoppers complicated the debut of the exchanges. Molina Healthcare Inc. (MOH), Cigna Corp. (CI) and the other insurers selling plans in the government-run exchanges are reporting a trickle of applications. They anticipate sign-ups will increase as technological issues in the enrollment process are corrected and consumers gain familiarity with their options (Armstrong, Nussbaum and Pettypiece, 10/4).

The Wall Street Journal: Insurers See Enrollment On New Health Exchanges
Insurers said they are now getting enrollees through the health law's new online marketplaces, though some state websites and the federally run exchange continued to be slow amid heavy traffic (Weaver, 10/3).

The Associated Press: Breakthrough Reported In New Pa. Insurance System
Philadelphia-based health insurer Independence Blue Cross said Thursday it began enrolling people into its health insurance plans through the federal government's online portal, a breakthrough after two days of widespread system glitches. Independence Blue Cross spokeswoman Kathleen Conlon said she did not know the exact number of people who had enrolled into the company's plans through the healthcare.gov website (Levy, 10/3).

Reuters: With Obamacare Systems Still Slow, Backlog Builds Among the Uninsured
Americans trying to find out how much health coverage will cost under Obamacare endured a third day of limited access to new online health insurance exchanges on Thursday, leading to a growing backlog of people waiting to enter the system. Health clinics and other nonprofit groups that offer in-person assistance reported unexpectedly high numbers of walk-in visits and phone calls from potential enrollees, who were unable to enter federal and state marketplace websites that were overwhelmed by millions of online hits (Skinner, 10/3).

CQ HealthBeat: HHS Says More Than 7 Million Have Visited Exchange Site, But Who Is Enrolling?
Federal officials on the third day of insurance exchange operations faced a new emerging narrative in the battle for public perceptions of the launch — lots of shoppers, but not many buyers. HHS officials countered, however, that the system is working. Americans across the country are starting to enroll in plans, they said. But they aren’t divulging numbers, and it’s unlikely they will do so for a while (Reichard, 10/3).

Kaiser Health News: Experts Suggest Software Problems, Not Just Demand, May Be Behind Marketplace Glitches
Three insurance companies confirmed Thursday that they have enrolled customers through the federal online marketplace created by the health law, but the numbers were meager and signup frustration continued for many people (Hancock and Galewitz, 10/4).

The Wall Street Journal's CIO Journal: Health Exchanges Ignore Lessons Of Consumerization
The online state health marketplaces that launched Tuesday to qualify and register applicants for health insurance are difficult to use, say IT experts. They say the sites’ goal of guiding applicants through a complex process is being defeated by poor navigation and pages cluttered with too much information. But a CIO who built one state marketplace says that design decisions were hampered by strict government guidelines on how information could be presented (Boulton, 10/3).

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States Still Wrestling With Health Exchange Bugs, Challenges

News outlets report on state health exchange operations in California, Kentucky, Maryland, Wisconsin and Minnesota.  

Los Angeles Times: California Health Insurance Exchange Still Lacks Doctor Search Tool
Several days into enrollment, California's insurance exchange still has no answers for people wanting to know if their doctors are included in health plans being sold on the state-run market. Covered California, the state's new insurance marketplace, said Thursday that its online search tool for doctors and hospitals won't be ready until Monday at the earliest (Terhune, 10/3).

Los Angeles Daily News: Fewer Californians Visit Health Exchange Than First Reported
The number of people who tried to access the state run health plan exchange was misstated and the 5 million reported hits to the site were different than actual visits, officials with Covered California said Thursday. In a statement, Covered California’s executive director Peter Lee said that more than 514,000 individuals viewed 5 million pages on the website (Abram, 10/3).

CNN: Obama Cites Success In Kentucky, Yet Healthcare Rollout Has Hiccups
President Obama highlighted Kentucky's Obamacare roll-out efforts Thursday noting that almost 11,000 people in that state have applied for health insurance. But even a state that earned presidential praise for its smooth execution is experiencing some hiccups. When Kentuckians visit the health exchange's login website, they are greeted by a warning that suggests their personal information could be disclosed to state and even foreign officials (Frates, 10/3).

The Associated Press/Washington Post: Maryland Health Care Website Improves After Technicians Find Cause Of Online Bottleneck
Maryland's online marketplace for health insurance is working better after technicians found the cause of a bottleneck that hampered efforts to create accounts online, the executive director of the Maryland Health Benefit Exchange said Thursday, but visitors to the website were still running into delays (10/3).

The Milwaukee Journal Sentinel: New Online Health-Insurance Marketplaces Still Not Working
Federal officials continued to attribute the problems to the heavy volume of visitors to the healthcare.gov website. But that explanation has stirred skepticism. Robert Laszewski, a health policy consultant and former insurance executive, said he tried to access the website at 6 a.m. and at midnight. "What volume do they have at 6 a.m. and midnight?" he said. "It is not volume” (Boulton, 10/3).

The CT Mirror: Access Health: 753 Applications Processed In Three Days
Access Health CT, the state's health insurance exchange, has processed 753 applications for coverage since opening Tuesday, including 153 on Thursday. On its third day in operation, the exchange reported receiving 11,058 website visitors and 1,033 calls as of 4 p.m. Since Tuesday morning, Access Health counted 82,939 website visitors and 5,094 phone calls (Becker, 10/3).

Minnesota Public Radio: MNsure Not Releasing Enrollment Numbers Yet
The state's new health insurance marketplace really has one goal: to insure more Minnesotans. But MNsure isn't releasing enrollment numbers yet. "We have information coming in, we are tracking that, but we're not going to report enrollment numbers at this time," said Executive Director April Todd-Malmlov. "We are trying to figure out how we are going to be reporting them." The hold-up stems from unresolved questions about how to define enrollment, she said. Some people have paid for plans, others have just selected a plan (Richert, 10/3).

Minnesota Public Radio: MNsure Expecting A Big Weekend
MNsure's executive director, April Todd-Malmlov, says consumers will still be able to peruse health plans on the site Sunday but won't be able to create accounts. "The website will be open on Sunday but the eligibility and enrollment functionality will not be," she said. "They'll be able to go on to our public site to see information but we are going to bringing the site down on Sunday for maintenance." The call center will also be open on Saturday but closed Sunday (Stawicki, 10/4).

Minnesota Public Radio: Feds Ease Restrictions That Were Causing MNsure Lockouts
In the past two days, some consumers said they couldn't create accounts on Minnesota's new health insurance marketplace. MNsure officials said Wednesday that consumers who made three unsuccessful attempts at creating accounts were booted off the system for a week under federal security rules. MNsure Board Chairman Brian Beutner says the problem stems from the federal government, not MNsure."The fed system has been so overwhelmed that people are timing out and when they get timed out it's registering as a miss," Beutner said (Stawicki, 10/3).

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Consumers Share Tales Of Success, Frustration Buying Coverage

A couple of consumers vaulted into the headlines as the first to complete the sign-up process for health coverage through new online marketplaces. Other shoppers, including those who have coverage but who are looking for better, lower-cost options, tell their stories, too.

The Wall Street Journal: Meet One Of The First Obamacare Enrollees
While millions of consumers stared down error messages on the online insurance marketplaces launched this week, some did make it through to shop the slate of coverage choices under the new federal health law. Leslie Foster, a 28-year-old freelance filmmaker in Hollywood, is among the first to sign up for an insurance plan (Weaver, 10/3).

Politico: Rare Health Exchange Enrollee Gets 15 Minutes Of Obamacare Fame
Chad Henderson, a college student who is one of the few people to have signed up for health insurance on a federal exchange, is having his 15 minutes of Obamacare fame. The 21-year-old Georgian and former Obama campaign volunteer hit "send" on his online health insurance when the exchanges opened Tuesday, and was catapulted quickly into the Obamacare spin wars (Cheney, 10/3).

The Associated Press: Texans Bypass Website Glitches To Get Health Care
Luis Veloz wasn't going to wait for the federal government to work out the kinks in its website before enrolling in the nation's new health insurance system. Instead, he rushed to fill out a paper application and mailed it in, eager to have a plan that would prevent him from racking up major medical bills like his parents. As Texas residents encountered difficulties with the website for a second day, those trained to assist with the process said callers are simply asking for a nearby location where they can complete the process the old-fashioned way: in person and on paper (Plushnick-Masti, 10/3).

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

Kaiser Health News: A Former 'Young Invincible' Looks Forward to Health Insurance
Have you heard of the young invincibles? That’s the name given to young people who think nothing bad can happen to them -- healthy people whose enrollment in Obamacare insurance is key to offsetting the costs of older, less healthy buyers. Brad Stevens is a 54-year-old, not-so-young invincible— recently reformed (Varney, 10/3).

Marketplace: Obamacare Day One In Camden, N.J.
After a decade of working together and sharing data, Camden's providers made some painful discoveries. Nearly half the city's residents visited the ER in one year alone. The most common diagnoses? Colds, sore throats, earaches and viral infections. Ninety percent of Camden's healthcare costs were being spent on just 20 percent of patients. Something had to give. But those in the health business here insist the collaboration isn't driven purely by dollars. "It's not just the money that it costs us as a provider," says Patient Access Director at Lourdes Health System, Joan Braveman. "It's [also about] the quality of life for the patient” (Reid, 10/3).

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Roles Of Insurance Brokers, Navigators Explored

News outlets examine how brokers, navigators and other counselors are supposed to help consumers understand their coverage options through the online insurance marketplaces.

Kaiser Health News: Insurance Brokers Look For Relevance As Health Exchanges Grow
When states and the federal government rolled out online marketplaces to help people buy health insurance on Tuesday, you'd think that old-fashioned insurance brokers would be worried. All told about $200 million is being spent on a new army of people to help consumers find their way. These navigators, guides or assisters, as they're called, would seem to threaten the business of traditional brokers (Whitney, 10/3).

Modern Healthcare: Training Lagging For Counselors To Help Consumers Use Exchanges
Healthcare providers and community organizations across the country that have been designated as certified application counselors to help consumers enroll in health plans on the new state health insurance exchanges are still waiting for their staff to receive certification because of delays by state and federal officials (Johnson, 10/3).

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Medicaid Expansion An Unsettled Issue For Some States

In Virginia, one member of the panel charged with exploring the idea of expanding the health insurance program for people with low incomes said any broadening of the program was unlikely to happen in the near future. In Mississippi, many low-income people will soon realize they won't be eligible for Medicaid  because the state opted against the expansion.    

The Washington Post: Virginia Medicaid Panel Member Calls 'Obamacare' Expansion Unlikely In Near Term
The vice chairman of a panel exploring Medicaid reform and expansion in Virginia told fellow House Republicans this week that the program is unlikely to be broadened anytime soon. It could take months, if not years, to determine if the federal-state health-care program has been sufficiently reformed to merit expansion, Del. Steve Landes (R-Augusta) said in a confidential memo to his caucus. A copy of the memo was obtained by The Washington Post (Vozzella, 10/3).

Reuters: Mississippi Blues: The Cost Of Rejecting Medicaid Expansion
As Americans across the nation begin to find out what Obamacare has in store for them, many of Mississippi's most needy will find out the answer is nothing. That is likely the case for William and Leslie Johnson of Jackson County, since the state decided not to expand the Medicaid program for the poor under President Barack Obama's Affordable Care Act. As a result, nearly 300,000 adults there will fall through the cracks of healthcare reform (Steenhuysen, 10/4).

Meanwhile, reports from California and Oregon about how the decision to pursue the expansion will impact people and the program -

Bloomberg: California Cuts Medicaid Payments Amid Wave Of New Users
When Ruth Haskins, a gynecologist in Folsom, California, does a pelvic exam and pap smear on a woman with insurance, she gets $95 to $200. If the patient is elderly, federal Medicare pays $36. For the low-income on Medicaid, the state gives $25, and it's about to go down. The reduction comes as Medi-Cal, California's Medicaid program for 8.5 million people too poor to afford health care, is on the verge of adding 1 million participants under President Barack Obama's health-system overhaul, according to the state Health Care Services Department (Melnicoe, 10/4).

The Oregonian: Oregon's Low-Income Health Plan Primed For Growth Under Reform Law
Bruce Lovan makes no bones about it, he's a member of the working poor. He sleeps on a mattress on the living room floor of his father's La Grande duplex and lives on food stamps while pulling a couple of graveyard shifts a week as a $9-an-hour security guard. He's also one of more than 200,000 low-income Oregonians who will newly qualify for the Oregon Health Plan starting in January, as its waiting list and lottery to enroll become a thing of the past (Budnick, 10/3).

And in Oklahoma, the health law is not welcome -

Los Angeles Times: Obamacare Meets Extra Resistance In Oklahoma
The nation's healthcare law was written with the residents of rural counties like Choctaw in mind. A quarter of the Oklahomans who live in the ranch country near the southeastern corner of the state are uninsured, one of many reasons their health ranks near the bottom of Oklahoma's 77 counties. But that does not mean people here want Obamacare (Reston, 10/3).

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Health Law Policy Issues Grab Headlines

The Milwaukee Journal Sentinel draws parallels between policies included in the health law and some of those that have historically been advanced by conservatives. Meanwhile, other news outlets revisit central issues of the overhaul, including the individual mandate, the costs of coverage borne by businesses and accountable care organizations.

The Milwaukee Journal Sentinel: Psst! A Little Secret About Obamacare
Supporters downplay the notion. Opponents ignore it. Yet at the core of the Affordable Care Act are many ideas backed by conservatives and decried by liberals. The law makes use of tax credits, partially relies on commercial health plans and enables people to shop online for a plan of their choice — all concepts championed by conservatives (Boulton, 10/4).

CBS News: Why Does Obamacare Mandate Health Insurance?
One of the most unpopular features of the Affordable Care Act seems to be the mandate that every American be covered by medical insurance. Under basic insurance principles, however, this is the price that must be paid for one of the most popular features of Obamacare, as the new health law is known -- the ban on insurers denying coverage to people with pre-existing medical conditions. Many people think it's unfair that an insurance company can deny you insurance if you're applying for it and have a pre-existing condition. But without such an exclusion, insurance companies would most likely be bankrupted by people who could "game" the system by only buying insurance when they got very ill or had a serious accident (Vernon, 10/3).

WBUR: Businesswoman: Obamacare Hurting Plans To Expand
Here & Now has been talking with private businesses and also state governments and school districts that have cut hours of employees in response to the Affordable Care Act. Starting in 2015, larger employers will be required to provide health insurance to employees working 30 hours or more. Those workers will be considered full time. Kelly Gilreath, owner of Kelly’s Professional Cleaning Service in Greenville, S.C., says she has to cut her workers' hours and wants the law repealed. "To make it a law that one person has to pay for another person's insurance, in my opinion, is not a good thing," Gilreath told Here & Now (10/3).

Reuters: Analysis: Tenet Stands Out By Experimenting With Core Model Of Obamacare
Patients and investors gauging the impact of President Barack Obama's healthcare reform law on hospitals, clinics and other providers need look no further than Tenet Healthcare Corp, the country's No. 3 for-profit hospital chain. The Dallas, Texas-based company stands out among its peers for experimenting with a core concept of the legislation -- the lofty goals of coordinating treatment in a single, integrated system that reins in costs by improving care (Kelly, 10/2).

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Capitol Hill Watch

GOP Rank-And-File Push To Reopen Gov't, Eye Medical Device Tax Repeal

Some Republicans are moving away from efforts to repeal the entire health law and are turning their focus instead to repealing the health law's medical-device tax and reopening the federal government. In the meantime, Speaker John Boehner is telling members of his party that he will not allow the federal government to default on its debt -- which was slated to be the next big fight on Capitol Hill.

The Wall Street Journal: GOP Group Urges Detente On Health Law
A small but increasingly vocal coalition of Republican lawmakers is urging the party's top brass to stop trying to dismantle the entire health care law, believing the fight is a losing one for their party. On Thursday the group proposed a narrower approach: repeal the health law's medical-device tax and restore funding for federal agencies for the next six months (Peterson, 10/3).

The Hill: Bipartisan Group Calls For Six-Month Funding Bill With Medical Device Tax Repeal
A bipartisan group of House lawmakers say they’d support legislation to fund the government that repealed a medical device tax that's helping to fund President Obama's health care law. The measure was put together by Reps. Ron Kind (D-Wis.) and Charlie Dent (Pa.), one of a handful of House Republicans who has called for moving a clean bill to fund the government (Lillis and Becker, 10/3).

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

Los Angeles Times: As Government Shutdown Persists, Focus Shifts To Debt Limit
With the federal government shutdown in its third day, both sides of the dispute that started with a Republican drive to end Obamacare shifted their focus Thursday to the next fiscal deadline: the need to raise the debt limit by mid-October to avoid a default (Mascaro and Memoli, 10/3).

The Washington Post: GOP Aides: Boehner Tells Colleagues He Will Avoid A Default On Federal Debt
With the government shuttered and a deadline for raising the debt limit just two weeks off, anxious Republicans began steering the party away from a dead-end debate about the health-care law and toward discussion of a broader deal to reduce the nation's debt. … In meetings with small groups of rank-and-file lawmakers, House Speaker John A. Boehner (R-Ohio) has emphasized that he will not permit the country to default for the first time on its debt. Given that a bloc of hard-line conservatives is unlikely to vote to increase the limit under any circumstances, Boehner has told fellow Republicans that they must craft an agreement that can attract significant Democratic support (Montgomery and O'Keefe, 10/3).

The Wall Street Journal: GOP Begins Search For Broad Deal On Budget
Senior Republicans in Congress, frustrated over their inability to strike a deal to reopen the government, began shifting from their drive to undercut the 2010 health-care law, which has been the central element of the dispute, toward a broader budget deal. Unlike the summer 2011 debt-ceiling debacle, President Obama and his administration appear to be pushing for market unrest, with the hope that it will spur Republicans to end the current budget standoff. The new focus comes as Congress is beginning to confront the need to raise the U.S. debt ceiling, which the Treasury said must be done this month in order to pay the nation's obligations (Hook and O'Conner, 10/3).

Politico: Government Shutdown: Democrats Preempt Entitlement Change Talk
Liberal Democrats are already railing against the notion that entitlement programs could be scaled back as part of any grand bargain to end the government shutdown and hike the debt ceiling. At a press conference of the Congressional Progressive Caucus led by Rep. Keith Ellison (D-Minn.), the group said they aren’t waiting to see if the murmurs that it’s a possibility become reality (Gibson, 10/3).

The New York Times: G.O.P. Elders See Liabilities In Shutdown
The hard-line stance of Republican House members on the government shutdown is generating increasing anger among senior Republican officials, who say the small bloc of conservatives is undermining the party and helping President Obama just as the American people appeared to be losing confidence in him. From statehouses to Capitol Hill, frustration is building and spilling out during closed-door meetings as Republicans press leaders of the effort to block funding for the health care law to explain where their strategy is ultimately leading (Martin, 10/3).

The New York Times: Rattled Congress Seeks Way Out Of Its Standoff
Representative Paul D. Ryan of Wisconsin, chairman of the House Budget Committee, has initiated conversations with senior House Republicans on a broad deficit reduction deal that would allow some increases to federal programs squeezed by the automatic cuts known as sequestration in exchange for long-term changes to programs like Medicare and Social Security. The package would most likely include instructions to try to move along efforts to simplify the tax code as well. Aides described those talks as "conversations about conversations," not true negotiations, and they favored the term "down payment" on the deficit over "grand bargain" (Weisman, 10/3).

Meanwhile, more news from the pollsters about how the public views the budget battle --

The New York Times: Majority Disapprove Of Shutting Down Government Over Health Law
A wide majority of Americans disapprove of shutting down the federal government over differences about the 2010 health care law, including a majority of those who oppose the law, according to the latest CBS News poll. Americans are also overwhelmingly dissatisfied, and increasingly angry, with the way things are going in Washington. More than 4 in 10 now say they are angry, up 13 percentage points since March (Sussman, 10/3).

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Congress, Their Staffs Face Scrutiny Around Exchange Plan Choice, Federal Gov't Contribution

Some question if members of Congress and their staffs should continue getting a federal employer contribution toward the cost of buying insurance on the health law exchange. In the meantime, the Obama administration issues rules that would require members of Congress to buy the marketplace's "gold" plans.

The Boston Globe: Congressional Pay, Health Care Benefits Under Scrutiny
The debate over lawmakers' health care benefits has been raging since the coverage expansion was passed in 2010. The law requires that members of Congress and their staffs sign up for coverage on the insurance marketplaces that opened Tuesday, kicking them off the federal health benefits system beginning 2014. That has generated a secondary storm of controversy, over whether the members and their staff should continue receiving a federal employer contribution towards their premiums (Jan, 10/4).

The Hill: Congress, Staff Required To Buy Gold ObamaCare Plans
Regulations issued by the Obama administration this week would require members of Congress to buy one of the top-tier insurance plans from the ObamaCare exchanges.The Chief Administrative Officer (CAO) of the House sent guidance to members of Congress this week, based on a directive from the Office of Personnel Management (OPM), that says they must choose plans from the "gold" level of insurance coverage, not "bronze" or "silver" plans. "Platinum" is the only higher level of coverage under the exchanges (Kasperowicz, 10/3).

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State Watch

Shutdown To Stop Payments To D.C. Medicaid Providers

The District of Columbia's payments to medical providers treating more than 200,000 poor people enrolled in Medicaid will stop until the federal shutdown ends, city officials said. In Virginia, GOP gubernatorial candidate Ken Cuccinelli called on Congress to reopen the federal government -- and then cut off funding for the health law.

The Washington Post: Shutdown Will Halt D.C. Medicaid Payments
The federal shutdown will mean another setback for a beleaguered group: D.C. medical providers, particularly those serving low-income residents. The federal government shutdown means payments related to publicly funded health programs will cease until further notice, city health care finance officials said Thursday. That includes payments made directly to health providers, as well as the massive "capitated" payments made to the managed-care organizations that handle most city Medicaid enrollees (DeBonis, 10/3).

The Wall Street Journal's Washington Wire: Shutdown To Stop D.C. Medicaid Payments
The District of Columbia's Medicaid program, which covers around 220,000 low-income and disabled city residents, said Thursday it is stopping paying health providers until the federal government shutdown is resolved. Many D.C. government services such as trash pick-up have continued to run because the city is drawing on a $144 million contingency fund to pay for them in the absence of being able to use its 2014 budget, hamstrung by the budget showdown (Radnofsky, 10/3).

The Associated Press/Washington Post: Cuccinelli Finally Urges Congress To Restart Government, Then Strangle Health Law Separately 
After days of equivocation, Republican gubernatorial nominee Ken Cuccinelli on Thursday called on Congress to reopen the federal government, then fight over whether to starve the new health care law of funding. Cuccinelli told reporters after a Thursday-morning event that shuttering the government is not the right way for opponents of the 2010 Affordable Care Act to gain leverage to defeat the law he wants to see repealed (10/3).

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State Highlights: Calif. Gov. Signs Pharmacist Scope-Of-Practice Bill

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

Politico: Wendy Davis Launches Bid For Texas Governor
Wendy Davis, the Democratic state senator whose abortion filibuster catapulted her to national fame, announced Thursday that she will run for Texas governor, a race that looks to be a banner 2014 contest (Glueck, 10/4).

California Healthline: Pharmacist Scope-Of-Practice Bill Now Law
Gov. Jerry Brown (D) this week signed into law a bill (SB 493) that would give more responsibility to certain pharmacists. The measure is designed to ease the increasing burden on primary care providers by having pharmacists help with some of their tasks. … SB 493 will become law on Jan. 1, 2014. It will allow pharmacists to initiate certain kinds of prescriptions and to provide clinical advice and patient consultation. The bill was part of a suite of four bills introduced this year to expand scope of practice for optometrists, nurse practitioners, physician assistants and other mid-level practitioners (Gorn, 10/3).

The Texas Tribune: Embattled Cancer Center Chief Plans A New Approach
Ronald DePinho, the president of the MD Anderson Cancer Center, part of the University of Texas, becomes animated when he talks about his ambitious plans in leading the institute's efforts to combat the disease. In two weeks, Depinho plans to give a public report on the first year’s progress of MD Anderson’s "moon shots" program (Hamilton, 10/4).

California Healthline: Stanislaus County ACO Shows Remarkable Results In Four Key Benchmark Metrics
In its first year of operation, the Central Valley ACO has posted some impressive numbers. Hospital admissions have been reduced by 28.8 percent. The number of days spent in the hospital was cut back by 29.3 percent. Average length of stay in the hospital has dropped slightly (0.6 percent). Visits to the emergency department have declined by 9.3 percent (Gorn, 10/3).

The Associated Press/Washington Post: Legislative Budget Writers In Delaware Discuss Medicaid Spending, Other Big Expenditures
Budget writers from Delaware's legislature met Thursday to consider how to curb spending on the state’s Medicaid program, which is costing state taxpayers about $700 million a year. State Medicaid director Stephen Groff briefed members of the Joint Finance Committee on how the subsidized health care program for the poor and disabled operates and outlined some of the biggest cost drivers, including a 40 percent increase in enrollment over the past five years (10/3).

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Health Policy Research

Research Roundup: Health Law's Effects On Consumer Spending

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

Rand Corporation: Effects of the Affordable Care Act On Consumer Health Care Spending And Risk of Catastrophic Health Costs 
The authors find that average out-of-pocket spending is expected to decrease for all groups considered in the analysis, although decreases in out-of-pocket spending will be largest for those who would otherwise be uninsured. People who would otherwise be uninsured who transition to the individual market under the ACA will have higher total health care spending on average after implementation of the ACA because they will now incur the cost of health insurance premiums. The authors also find that risk of catastrophic health care spending will decrease for individuals of all income levels for the insurance transitions considered; decreases will be greatest for those at the lowest income levels (Nowak, Eibner, Adamson and Saltzman, 10/1).

Journal of Health Management, Policy and Innovation: Examples of How Health Insurance Exchanges Can Create Greater Value for Consumers: Lessons From Three Other Marketplaces 
By examining how other markets provide greater value for consumers we can anticipate certain choices that HIXs [health insurance exchanges] can make to provide higher-value insurance plans to buyers, as well as certain pitfalls they should avoid. The most important choice might be whether to function only as a clearinghouse for all qualified health plans (QHPs) that want to sell through the exchange, or to adopt an 'active purchaser' model that limits the choices available through the exchange. ... These choices will ultimately drive the success of HIXs, which we define in terms of enrollment and quality of care (Lieberthal et al., Oct. 2013). 

Annals of Oncology: Discrepancies In Cancer Incidence And Mortality And Its Relationship To Health Expenditure In The 27 European Union Member States
We hypothesized that increased health expenditure would be associated with better cancer outcome and that this would be most apparent in breast cancer, because of the availability of effective screening methods and treatments. Using publically available data from the World Health Organization, the International Monetary Fund, and the World Bank, we assessed associations between cancer indicators and wealth and health indicators. ... Higher wealth and higher health expenditures were associated both with increased cancer incidence and decreased cancer mortality. In breast cancer, the association with incidence was stronger (Ades et al., 10/1).

Clinical Infectious Diseases: Infectious Diseases Specialty Intervention Is Associated With Decreased Mortality And Lower Healthcare Costs
We used administrative fee-for-service Medicare claims to identify beneficiaries with inpatient hospitalizations between 2008 and 2009 involving at least one of 11 infections. ... The ID [infectious disease] intervention cohort demonstrated significantly lower mortality and readmissions compared to the non-ID intervention cohort. Medicare charges and payments were not significantly different; ... ID interventions are associated with improved patient outcomes. Early ID interventions are associated with improved outcomes and reduced costs for Medicare beneficiaries with select infections (Schmitt et al., 9/25).

Stroke: Effect Of Socioeconomic Status On Inpatient Mortality And Use of Postacute Care After Subarachnoid Hemorrhage Background And Purpose
This study investigated socioeconomic status-related differences in risk of inpatient mortality and use of institutional postacute care after subarachnoid hemorrhage in the United States and Canada. ... The cohort consisted of 31,631 US patients and 16,531 Canadian patients. Mean age (58 years) and crude inpatient mortality rates (22%) were similar in both countries. A significant income–mortality association was observed among US patients, which was absent among Canadian patients  (Jaja et al., 10/1).

JAMA Surgery: Massachusetts Health Care Reform and Reduced Racial Disparities in Minimally Invasive Surgery
Racial disparities in receipt of minimally invasive surgery (MIS) persist in the United States and have been shown to also be associated with a number of driving factors, including insurance status. However, little is known as to how expanding insurance coverage across a population influences disparities in surgical care. ... The 2006 Massachusetts health care reform serves as a unique natural experiment to analyze the impact of expanded health insurance coverage on the delivery of surgical care for government-subsidized and uninsured patients. ...our data show that after health care reform in Massachusetts, racial/ethnic disparities in the probability of undergoing MIS disappeared in Massachusetts, while variation by patient race/ethnicity persisted in other states (Loehrer et al., 10/3).

JAMA Internal Medicine: Antibiotic Prescribing To Adults With Sore Throat In The United States, 1997-2010
Antibiotic prescribing to patients who are unlikely to benefit is not benign. All antibiotic prescribing increases the prevalence of antibiotic-resistant bacteria. The financial cost of unnecessary antibiotic prescribing to adults with sore throat in the United States from 1997 to 2010 was conservatively $500 million. ... despite decades of effort, we found only incremental improvement in antibiotic prescribing for adults making a visit with sore throat. Combining our previous and present analyses, the antibiotic prescribing rate dropped from roughly 80% to 70% around 1993 and dropped again around 2000 to 60%, where it has remained stable. This still far exceeds the 10% prevalence of [group A Streptococcus infection] GAS among adults seeking care for sore throat. The prescription of broader-spectrum, more expensive antibiotics, especially azithromycin, was common. Prescribing of penicillin, which is guideline-recommended, inexpensive, well-tolerated, and to which GAS is universally susceptible, remained infrequent (Barnett and Lindner, 10/3).

The Heritage Foundation: Obamacare's Insurance Exchanges: "Private Coverage" in Name Only
A health insurance exchange is essentially a mechanism that enables people to choose among different health insurance options. Yet, the declared purposes—and resulting effects—of the Obamacare exchanges are very different from those of consumer-oriented approaches. Consumer-choice health insurance exchanges facilitate defined-contribution financing of health insurance. They increase not only the number, but also the variety, of health plan choices. The objective is not merely to increase supplier competition, but also to make suppliers more responsive to the preferences of individual consumers. A different type of exchange operates on a government “procurement model.” A good example is a state that contracts with selected managed care plans to insure Medicaid enrollees. In those cases, while a private insurer may provide the coverage, the covered individuals have little or no say in the decision. The Obamacare health insurance exchange system, though often sold as a mechanism to provide consumer choice and competition, is, in fact, a vehicle for the detailed federal regulation of insurance. Americans can expect less choice and less competition (Moffitt and Haislmaier, 9/26).

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

MedPage Today: Family Docs Worried About Payment Reform
Aspects of health reform are some of the biggest disrupting factors facing family medicine today, a recent survey of family physicians showed. Nearly half (49%) of respondents identified payment reform as a disrupting factor, a satisfaction survey of American Academy of Family Physicians (AAFP) members showed. The survey was presented here at the AAFP Scientific Assembly. Almost a third (31%) said preserving bonus payments for primary care under the Affordable Care Act (ACA) was a concern (Pittman, 9/27).

Medscape: Primary Care Malpractice Cases 'More Difficult To Defend'
Primary care practices account for fewer than 1 in 10 malpractice cases, but those cases are far more likely to be either settled or lost in a jury trial compared with non-general medical claims, according to a new study published online today in JAMA Internal Medicine. In short, such cases in the primary care realm "seem more difficult to defend," write study author Gordon Schiff, MD, the associate director of the Center for Patient Safety Research and Practice at Harvard Medical School, Boston, Massachusetts, and coauthors (Lowes, 10/3).

Medscape: Telemedicine Eases Rising Burden Of Macular Degeneration
Telemedicine is as effective as a face-to-face office consultation for the follow-up evaluation of patients with age-related macular degeneration. Retreatment decisions made during office consultations and those made by a remote ophthalmologist were in agreement 90% of the time, a new study has found (McNamara, 10/1).

Medscape: Residents Learn From Fall-Prevention Program
A simple program to educate family practice residents can significantly increase their ability to prevent falls in elderly patients, a new study shows (Harrison, 10/1).

Reuters: Insurance May Narrow Race Gap In Access To Surgery
Wider insurance coverage erased racial differences in who got minimally invasive surgery in Massachusetts, according to a new study. After the state increased access to insurance in 2006, racial disparities in the proportion of people having gallbladders or appendixes removed with minimally invasive techniques - versus traditional "open" surgery - disappeared, researchers found (Seaman, 10/2).

Medpage Today: Out-Of-Pocket Costs Projected To Fall Under ACA
Most Americans flocking to HealthCare.gov this week to sign up for health coverage under the Affordable Care Act (ACA) will see their out-of-pocket costs fall with expanded insurance options, an analysis found. "Decreases in out-of-pocket spending will be largest for those who would otherwise be uninsured," a study from the RAND Corporation found. "In some cases, these reductions will be dramatic." However, total health spending -- which includes out-of-pocket costs and spending on health insurance premiums -- will increase for many newly insured people, except those who will be covered by Medicaid (Pittman, 10/3).

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Weekend Reading

Longer Looks: Chinese Medicine; Revolutionary Doctors; Frozen Embryos

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

The New York Times: The Enigma Of Chinese Medicine
A few years ago, while visiting Beijing, I caught a cold. My wife, who is Chinese, and wanted me to feel better, took me to a local restaurant. After we sat down, she ordered a live turtle. The proprietors sent it over. I startled as the waiters unceremoniously cut the turtle's throat, then poured its blood into a glass. ... Many Westerners will scoff at the very idea that turtle blood could have medicinal effects. But at least some of those same people will quaff a tree-bark tincture or put on an eggplant compress recommended by Dr. Oz to treat skin cancer. We are all living in the vast gray area between leech-bleeding and antibiotics. Alternative medicine has exploded in recent years, reawakening a philosophical problem that epistemologists call the "demarcation problem" (Stephen T. Asma, 9/28).

The New York Review Of Books: The Doctor Who Made A Revolution
The Lower East Side of New York was one of the most densely populated square miles on the face of the earth in the 1890s. ... It was in the 1890s that Sara Josephine Baker decided to become a doctor. Not the Josephine Baker who would become celebrated as a cabaret star and dance at the Folies Bergère in a banana miniskirt but the New York City public health official in a shirtwaist and four-in-hand necktie, her short hair parted in the middle like Theodore Roosevelt, whom she admired. By the time Baker retired from the New York City Health Department in 1923, she was famous across the nation for saving the lives of 90,000 inner-city children (Helen Epstein, 9/26).

The Atlantic: Dark Days For Medical Research
Scientists at the National Institutes of Health, the federal agency with a $30 billion budget responsible for funding medical research across the country, probably woke up Tuesday morning with, at best, audible sighs. First, in the spring, there was sequestration -- the automatic, across the board spending cuts that lopped off 5.5 percent of their budget. Now, thanks to the government shutdown, 73 percent of NIH staff is sitting at home, furloughed -- among them, some of the most brilliant scientists and medical researchers in the word -- and, thanks to a Congress whose mental health is open to debate, they've been put in the untenable position of turning away 200 patients to the NIH Clinical Center, including 30 children, many of them cancer patients (Mark Micheli, 10/2).

The New York Times: Easing Doctor Burnout With Mindfulness
According to the nurse's note, the patient had received a clean bill of health from his regular doctor only a few days before, so I was surprised to see his request for a second opinion. He stared intently at my name badge as I walked into the room, then nodded his head at each syllable of my name as I introduced myself. Shifting his gaze upward to my face, he said, "I'm here, Doc, to make sure I don't have anything serious. I’m not sure my regular doctor was listening to everything I was trying to tell him." ... Research over the last few years has revealed that unrelenting job pressures cause two-thirds of fully trained doctors to experience the emotional, mental and physical exhaustion characteristic of burnout. Health care workers who are burned out are at higher risk for substance abuse, lying, cheating and even suicide. They tend to make more errors and lose their sense of empathy for others. And they are more prone to leave clinical practice (Dr. Pauline W. Chen, 9/26).

Elle: Determining The Fate Of Frozen Embryos: Do You Know Where Your Children Are
When my wife and I did in vitro fertilization, the doctor put two blastocysts in her because that bettered the odds that one would take. He handed my wife a picture, two lumpy circles in black-and-white on slippery thermal paper. They looked like rice cakes. Blastocysts are early embryos. These had been fertilized five days prior -- which, because we’d actually fertilized four of them, left two embryos for later. So in one of the surprises of my married life, my wife and I became custodians of about 200 cells that reside in a freezer at a clinic in New York City, not far from Times Square (Paul Ford, 9/30).

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Editorials and Opinions

Opinions On Shutdown: Both Sides Have Moved To Indefensible Positions; Health Law Is Not 'Settled,' Finding A 'Non-Disastrous' Debt Deal

The Wall Street Journal: To Lead Is To Negotiate
Acrimony, insults, the government shut down. Time to talk to a wise man, someone from the days when government worked. I turned to the famous Mr. Baker—James A. Baker III. ... The Republicans made a mistake early on with a "maximalist" position on Obamacare—they could not realistically achieve their aim of defunding when the Democrats hold the White House and Senate. But the president's position is a "pretty damn maximalist position itself, and people will say that" (Peggy Noonan, 10/3).

Los Angeles Times: The Real Story Behind All Those Obamacare Waivers
Readers have been asking why The Times' editorial board has been so critical of House Republicans for trying to defund or delay key provisions of the 2010 healthcare law without faulting President Obama for supposedly granting Congress and hundreds of big businesses and politically connected unions waivers and exemptions from the law. That's because, with one notable exception, the exemptions aren't what they're cracked up to be (Jon Healey, 10/3).

The Washington Post: Who Shut Down Yellowstone?
President Obama indignantly insists that GOP attempts to abolish or amend Obama¬≠care are unseemly because it is "settled" law, having passed both houses of Congress, obtained his signature and passed muster with the Supreme Court. Yes, settledness makes for a strong argument — except from a president whose administration has unilaterally changed Obama¬≠care five times after its passage, including, most brazenly, a year-long suspension of the employer mandate (Charles Krauthammer, 10/3).

The Washington Post: Why Obamacare Isn't 'Settled'
The Affordable Care Act was passed by Congress, signed by President Obama, upheld by the Supreme Court and reconfirmed by the president's reelection. Many of its provisions have gone into effect. As Democrats have taken to saying, it is the law of the land. But contrary to what the president suggested in the Rose Garden this past week, that does not mean Obamacare is "settled, and it is here to stay." And it is not illegitimate for Republicans to use every lawful means at their disposal to stand in its way (Gerard Magliocca, 10/3).

The Wall Street Journal: The Budget Reform Pivot
The exit ramp is for both sides to pivot from the Obamacare stalemate to negotiations over tax and entitlement reform. The Ted Cruz Republicans would have to give up their mission to defund the Affordable Care Act with only one house of Congress. President Obama would have to show he's willing to negotiate with Republicans over the debt limit. Both sides would step back from the brink and give themselves a chance for some long-term political gains (10/3).

Bloomberg: How To Make A Non-Disastrous Debt-Limit Deal
Republicans, meanwhile, have adopted an unrealistic sense of how much of their policy agenda they can achieve by tying it to the debt limit. (An unrealistic sense of leverage seems to be a pattern with them this year.) Many of them want to force President Barack Obama to make major changes to his health-care law, and in return give him nothing but the debt-limit increase. There is no precedent for the satisfaction of such demands. Look back at every previous piece of legislation that raised the debt limit while also making changes to other government policies, and almost always the debt limit was the occasion for a bipartisan deal rather than the achievement of only one party’s goals (Ramesh Ponnuru, 10/3).  

The Wall Street Journal: The Defunding Way Of Fundraising
To understand the depths of the anger many good Washington conservatives are feeling for the ringleaders of the defund ObamaCare movement, follow the money. ... The defund campaign is best viewed as just one (lucrative) moment in a larger power play by a handful of outside conservative groups (Kimberley A. Strassel, 10/3).

The Washington Post: John Boehner's Turn To Give In
Most galling for them — and most beneficial for the country — is that they failed to defund or delay Obamacare. The health insurance exchanges created by the Affordable Care Act are up and running, despite technical glitches. People across the country are buying coverage for themselves and their families. This fight is over, people. Republicans lost (Eugene Robinson, 10/3).

The New York Times: Opinionator: Wrong Side Of History
Sarah Palin finally got her death panels — a direct blow from the Republican House. In shutting down the government, leaving 800,000 people without a paycheck and draining the economy of $300 million a day, the Party of Madness also took away last-chance cancer trials for children at the National Institutes of Health. And now that the pain that was dismissed as a trifle on Monday, a "slimdown" according to the chuckleheads at Fox News, is revealed as tragic by mid-week, the very radicals who caused the havoc are trying to say it’s not their fault. It’s too late. They flunked hostage-taking (Timothy Egan, 10/3).

The Washington Post: The GOP Should Speed Obamacare's Demise. Right Now, It's Not.
After much struggle and internal strife, Republicans seeking to block Obamacare have arrived at this achievement: Much of the government is closed — except for Obamacare. The national parks are deserted but the health exchanges sputter and wheeze to life (Michael Gerson, 10/3). 

Bloomberg: The Secret to Ending Washington's Standoff
Boehner and the Tea Party Republicans who have been calling the shots up to now have all but given up trying to end or even delay the Affordable Care Act. Reports of children being turned away from federal cancer-treatment programs are aligning the public against them. Polls say that Republicans are getting more of the blame than Democrats, and hopes for big Republican wins in 2014 are diminishing. The beginnings of a backlash could turn into something vicious if the calamity of a default should come to pass in two weeks and Boehner can't plausibly blame President Barack Obama (10/3).

The New Republic: The Republicans Are Starting To Reek Of Desperation
Boehner knows that shutting down the government was a bad idea and that allowing the federal treasury to default would be a much, much worse idea. He has said so explicitly. And yet here he is, shutting down the government and threatening to allow a default if Democrats won’t agree to undermine Obamacare. Every move Boehner has made in the last few days has reeked of panic. This talk of a new grand bargain does too (Jonathan Cohn, 10/3).

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Viewpoints: Marketplaces Offer Americans The Kind Of Shopping They Like; Enrollment Isn't As Robust As Administration Claims

The Wall Street Journal: Obamacare—A Game-Changer In The Making?
Americans have grown accustomed to online comparison shopping, as the overwhelming number who clicked on health-exchange websites demonstrates. Over time, more Americans may actually comparison-shop for health insurance—a new experience for many—choosing lower premiums for higher deductibles and narrower networks of doctors and hospitals or vice versa. They might like it. If they do, shifting basic Medicare to a similar approach might follow. The government shutdown is temporary. The exchanges may be permanent (David Wessel, 10/2).

The New York Times: Reform Turns Real
But this confrontation did start with a real issue: Republican efforts to stop Obamacare from going into effect. It's long been clear that the great fear of the Republican Party was not that health reform would fail, but that it would succeed. And developments since Tuesday, when the exchanges on which individuals will buy health insurance opened for business, strongly suggest that their worst fears will indeed be realized: This thing is going to work (Paul Krugman, 10/3).

Forbes: Enrollment In Obamacare's Federal Exchange, So Far, May Only Be In 'Single Digits'
I fully expect that the people who get a good deal out of Obamacare—poorer and sicker individuals—will sign up. The enrollment figures will increase. But the real question isn’t how many people enroll: it’s what kind of people enroll. Two-thirds of the uninsured in America are under the age of 40. What will be the average age of an enrollee on the exchanges? If most enrollees were born before or during the Nixon administration, start worrying (Avik Roy, 10/3).

The New York Times: A Population Betrayed
It is outrageous that millions of the poorest people in the country will be denied health insurance because of decisions made mostly by Republican governors and legislators. These people will neither qualify for their state's Medicaid program for the poor nor for subsidized coverage on new insurance exchanges that are being established in every state by the health care reform law (10/3).

USA Today: Obamacare Mandates Threaten Religious Freedom
Because Catholic social teaching emphasizes the dignity of work and workers, it has always been important to me to offer our employees good wages and benefits. I write because the mandate is forcing me and my family to choose between the teachings of our faith and the operation of our business. It gives us three options, all of which are unconscionable according to our beliefs: (1) violate our faith by complying with the mandate and provide our employees with insurance that covers contraception and sterilization; (2) pay over $16,000,000 in fines per year, destroying our business and putting our employees out of work; or (3) cut our employees' health benefits so that we do not have to violate our beliefs (John Kennedy, 10/3). 

The Washington Post: Sometimes 'Unnecessary' Medical Tests Save Lives
A few months ago, my 65-year-old mother had "screening" blood tests, which showed inflammation of the liver. She was healthy and had no symptoms of liver disease. The cause of the inflammation was unclear. To investigate, doctors ordered more tests. As a physician, I have seen how excessive testing can lead to worry and more tests. That seemed to be transpiring — but this time, the patient was my mother (Jason H. Wasfy, 10/3). 

The Wall Street Journal: A Sound Bite Can Save A Child's Life
On Monday, hundreds of people with rare diseases will gather with medical researchers, pharmaceutical executives and life-sciences investors in Bethesda, Md., for the annual U.S. Conference on Rare Diseases and Orphan Products. For the patients and their parents—about two-thirds of those who have rare diseases are children—it will be a singular opportunity to capture the attention of someone who might be able to make a lifesaving difference (Mary Dunkle, 10/3).

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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.