Daily Health Policy Report

Monday, October 7, 2013

Last updated: Mon, Oct 7

KHN Original Reporting & Guest Opinion

Health Reform

Women's Health

Administration News

Capitol Hill Watch

Public Health & Education

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Marketplace Plans Vary Widely In Costs, Within Counties And Across The Country

Kaiser Health News staff writers Jordan Rau and Julie Appleby report: "Consumers shopping in the new health insurance marketplaces will face a bewildering array of competing plans in some counties and sparse options in other places, with people in some areas of the country having to pay much more for the identical level of coverage than consumers elsewhere" (Rau and Appleby, 10/4). Read the story.

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A Reader Asks: If I Don’t Have Insurance, How Can I Pay For A Colonoscopy?

Kaiser Health News consumer columnist answers a reader’s question about paying for this procedure (10/7). Read the answer.

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Capsules: Federal Insurance Marketplace Can't Yet 'Talk' To State Medicaid Agencies; Seattle Hospital Sues State Over Exclusion From Exchange Plan Networks

Now on Kaiser Health News' blog, Phil Galewitz reports on issues emerging between the federal online health insurance marketplace and state Medicaid agencies: "The health law's online insurance exchanges were supposed to be a one-stop shop where consumers browsing for coverage could enroll in a private health plan or in Medicaid if they qualified" (Galewitz, 10/4).

Also on the blog, reporting for the Seattle Times in partnership with KHN, Amy Snow Landa writes about a Seattle hospital's lawsuit: "Seattle Children’s Hospital filed suit Friday over the state Office of the Insurance Commissioner’s “failure to ensure adequate network coverage” in several of the health plans sold on the state’s new online insurance marketplace, called Washington Healthplanfinder. Most health plans now being sold through the state’s new health-insurance exchange do not include Seattle Children’s as an in-network provider. As a result, families that enroll in those plans could face significantly higher cost-sharing if they seek care at Children’s than if they seek care at the plans’ preferred providers" (Landa, 10/7). Check out what else is on the blog.

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Political Cartoon: 'Ask Your Doctor?'

Kaiser Health News provides a fresh take on health policy developments with 'Ask Your Doctor?' by Steve Kelley.

Here's today's health policy haiku:


Uninsured start up
Obama care did not help
Need multi-state plan.
-Patrick Brennan

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

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Health Reform

Health Exchanges Grapple With Software, Server Issues

The Wall Street Journal reported that the Obama administration acknowledged Sunday that it needs to make design, as well as capacity, fixes to the website set up to help consumers shop for health coverage. Other news outlets examined the capacity challenges faced both by the federal and state exchanges and the adjustments made over the weekend.

The Wall Street Journal: Software, Design Defects Cripple Health-Care Website
The Obama administration said last week that an unanticipated surge of Web traffic caused most of the problems and was a sign of high demand by people seeking to buy coverage under the new law. But federal officials said Sunday the online marketplace needed design changes, as well as more server capacity to improve efficiency on the federally run exchange that serves 36 states (Weaver, Ovide and Radnofsky, 10/6).

Earlier, related KHN story: Experts Suggest Software Problems, Not Just Demand, May Be Behind Marketplace Glitches (Hancock and Galewitz, 10/4).

The Associated Press: Health Care Website Gets Down Time For Repairs
The enrollment function was back online at little before 8 a.m. EDT Saturday, but was working slowly because of heavy traffic. ... Credit card companies, banks and other online service providers regularly take down websites for repairs. That may also become a feature of the new insurance program
(Alonso-Zaldivar, 10/5).

Los Angeles Times: Flood Of Consumer Inquiries Could Make – Or Break – Obama Health Law
By the end the week, more than 16,000 Kentucky individuals and families had begun online applications to get health coverage next year. It has been a similar story across the country. Since the new marketplaces opened Tuesday, millions of Americans have flooded websites, call centers and insurance offices seeking information about health coverage offered through the Affordable Care Act, also known as Obamacare (Levey and Terhune, 10/5).

USA Today: Obama Adviser: Demand Overwhelmed HealthCare.gov
The government website launched this week to sell health insurance was overwhelmed by up to five times as many users as it was designed to handle, President Obama's top technology adviser said Saturday in an exclusive interview with USA TODAY. U.S. Chief Technology Officer Todd Park said the government expected HealthCare.gov to draw 50,000 to 60,000 simultaneous users, but instead it has drawn as many as 250,000 at a time since it launched Oct. 1. Park's comments are the administration's most detailed explanation for the glitches that have frustrated millions of consumers who have tried to enter the site or complete applications for health insurance (Mullaney, 10/6).

Politico: Lew Says Obamacare Website Issues 'Not Uniques'
Treasury Secretary Jack Lew said on Sunday he didn’t have an exact number of people who signed up for Obamacare and dodged questions about the issues with the signup website. “What happened this week is we saw 7 million people rush to go on to the webpage to find out, what are their choices in this new marketplace to buy affordable health care,” he said on “Fox News Sunday.” “You know, they have six months to sign up. This is a big decision" (Parti, 10/6).

Politico: Obamacare Glitches Give Paper Applications New Life
Obamacare is supposed to be a 21st-century shopping experience, but the health law can’t escape living in an older paper world. One of President Barack Obama’s favorite claims about his health law is that finding coverage is as easy as going online to buy a plane ticket. That’s always been an overstatement, even before the online insurance marketplaces’ glitch-filled launch (Millman, 10/7).

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State Websites Stumble With First Steps; Provider Rates, Coverage Questions Emerge

News outlets report on state efforts to smooth out glitches in health insurance web sites.

The Washington Post: Maryland's Health Insurance Web Site Stumbles Badly In First Days
Barely 24 hours after President Obama signed his landmark health law, Gov. Martin O’Malley promised that Maryland would "lead the nation"in putting it in place. ... But when Tuesday arrived, Maryland’s Web site stumbled badly. People couldn’t log on, forcing state officials to delay the opening of the exchange for four hours. Even after it opened, many frustrated users were unable to create accounts, the first step in buying coverage. All told, fewer than 100 people have managed to enroll (Sun, 10/4).

The Baltimore Sun: Glitches Persist On Maryland Health Insurance Exchange
The issues with marylandhealthconnection.gov, the online exchange set up under national health reform, prompted some analysts to suggest that the system's software and servers aren't robust enough. ... Consumers are supposed to be able to visit Maryland Health Connection, create an individual account and browse a variety of health insurance plans before buying one, much as they would book an airline flight. The exchange was created to provide a place for Maryland's 800,000 uninsured to find health coverage (Walker, 10/4).

NPR: Glitches Slow Health Exchange Sign-ups
The launch of Georgia's health care exchange began with a great deal of optimism at the East Point Pubic Library, just south of Atlanta. The chair of the Fulton County Commission, John Eaves, stressed that despite the federal government's shutdown, the exchanges would be open. ... About 22 million Americans are uninsured and eligible for the exchanges. More than 1.8 million live in Georgia and it's that group that federal officials and new health care navigators want to reach (Lohr, 10/5).

Also: analysis of how much the health law will affect Connecticut residents' coverage and how some California provider rates aren't yet set.

The CT Mirror: For Thousands Of Connecticut Residents Obamacare Means Changing Insurance Plans
It’s been a consistent talking point for supporters of the federal health reform law: If you like your health plan, you’ll be able to keep it when the major provisions of the law take effect. But for many people in Connecticut who buy their own insurance, that’s not the case. Instead, many customers in the state’s individual market will have to find new plans because insurance carriers are discontinuing current policies and creating new ones that fit the requirements of the health law (Levin Becker, 10/4).

California Healthline: Some Exchange Provider Rates Up In Air
[S]ome provider rates have been established for the exchange, for the individual market, according to Nicole Evans, vice president for communications at the California Association of Health Plans. With three short months until actual coverage benefits begin, however, not all provider rates have been set. In California, the small business exchange (or SHOP, the Small-Business Health Options Program) has established plans and premium rates, while the provider rates should be worked out by the end of November, according to Evans  (Gorn, 10/4).

Related, earlier KHN/NPR story: Small Businesses May Find Relief In Health Insurance Exchanges Designed For Them (O'Neill, 10/3)

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Consumers See Big Variations In Costs And Networks

A Kaiser Health News analysis shows that a buyer's home county may make a big difference in the insurance options they can choose from on the new online insurance marketplaces, while Politico reports that areas where co-op plans are offered are seeing lower prices.

Kaiser Health News: Marketplace Plans Vary Widely In Costs, Within Counties And Across The Country
Consumers shopping in the new health insurance marketplaces will face a bewildering array of competing plans in some counties and sparse options in other places, with people in some areas of the country having to pay much more for the identical level of coverage than consumers elsewhere (Rau and Appleby, 10/4).

Politico: Lower Premiums In Co-Op States
States with new member-owned CO-OP health plans as part of Obamacare have premiums that are more than 8 percent lower than states that don't, a new study shows. The Consumer Operated and Oriented Plans, with startup money loaned by the health care law, have zero or very few customers yet, given all the problems with the sign-up system. But they are going toe-to-toe with traditional insurers on the exchanges in 22 states, introducing new competition to insurance markets. And there's some early evidence that they may be helping to lower costs (Norman, 10/7).

And in other reports on coverage concerns -

The Kansas City Star: Check Before You Click 'Yes' On A Bargain Obamacare Plan
If you're persistent enough to get onto the Obamacare marketplace website to shop for a health insurance plan, here's something to keep in mind: The best bargains to be found in the federal marketplace might not include all the hospitals or doctors you're familiar with (Bavley and Stafford, 10/6).

The Associated Press: 4 Tips For Buying Health Insurance Without Help From The Overhaul's Income-Based Subsidies
The health care overhaul is expected to help millions of uninsured obtain coverage, but that assistance has limits. Individuals who do not have the option to obtain insurance from their employer, and who make more than about $46,000 — or a family of four bringing in more than $94,200 — will not be eligible for income-based tax credits under the new health care law. ... Here are some shopping tips to consider (Murphy, 10/4).

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With Marketplace Open, Outreach Efforts Swing Into Full Gear

A navigator in Philadelphia finds strong interest among consumers in the health law's coverage options. Meanwhile in Minnesota, diverse groups of advocates prepare to help insurance buyers.

The Philadelphia Inquirer: Navigators, Counselors Supplying Answers
Nothing was going to squelch Kyle Rouse's enthusiasm. Not even the Healthcare.gov website's clogged Internet arteries could suppress the newly minted navigator's energy (Calandra, 10/6).

The Star Tribune: Diverse Crew Is Spreading The Word On MNsure
Minnesota is about to unleash one of the most unorthodox insurance sales forces in state history as it moves to the next phase of enrolling people for health coverage under the grand experiment known as Obamacare. Even before last week's launch of the MNsure online marketplace, state leaders had begun certifying thousands of Minnesotans who will get paid to help people sign up for health insurance. They come from groups as wide-ranging as the liberal Planned Parenthood family planning organization and the conservative Teen Challenge addiction program. While the initiative might inspire a new round of insurance jokes — have you heard the one about insurance salesmen being premium lovers? — MNsure officials said these "navigators" will be essential to the law's ultimate success because many of the nation's uninsured won’t pursue coverage unless someone finds them and explains their options (Olson and Crosby, 10/6).

CBS News: Marketing The Affordable Care Act
According to the most recent CBS News poll, 51 percent of Americans are still confused about the Affordable Care Act. State governments and non-profit groups are using video ads on TV and social media to try and explain Obamacare, especially to young adults. Elaine Quijano reports (Quijano, 10/6).

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State Medicaid Programs Pose Problems For Federal Insurance Markeplace

Communications issues between the state agencies that administer the program and the federal exchange are interfering with the concept of one-stop shopping.

Kaiser Health News: Capsules: Federal Insurance Marketplace Can't Yet 'Talk' To State Medicaid Agencies
The health law's online insurance exchanges were supposed to be a one-stop shop where consumers browsing for coverage could enroll in a private health plan or in Medicaid if they qualified (Galewitz, 10/4).

Meanwhile, in Ohio, lawmakers appear to be moving toward expanding Medicaid -

Politico: Ohio Inching Toward Medicaid Expansion
Obamacare may be on the verge of a Buckeye boost as the Republican-controlled Ohio state government inches toward an embrace of Medicaid expansion. Senior lawmakers on both sides of the aisle say they’re increasingly convinced the state will back expansion — in days or weeks, not months. That decision would extend basic health care to hundreds of thousands of the state’s poorest residents and reframe the Obamacare debate in a crucial presidential swing state. “All players are ready,” said Rep. Tracy Maxwell Heard, the Democratic leader of the Ohio House. “We’re moving forward assuming that there will be expansion at some point in Ohio” (Cheney, 10/4).

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Health Law Provisions Also Help Those Who Already Have Insurance; Enrollment Fights In Texas, Calif. Could Heavily Impact Law

Although many people think of the federal health law's focus on the uninsured, it also is driving changes for those who have coverage. Meanwhile, two news outlets look at the importance of signing up young, healthy individuals in Texas and California.

USA Today: Health Law Changes Everyone's Open Enrollment
The Affordable Care Act, which led to the creation of state and federally run health insurance exchanges that launched last week, is generally thought of as being for the uninsured. But that's not entirely true. It could help the Callaways, too. The law offers many new protections for anyone who has employer-provided health insurance. It could even help some people with hard-to-afford plans and/or plans that don't cover enough of their health costs (O’Donnell, 10/6).

Politico: Obamacare Showdown In Texas
The ground war over Obamacare — the one that will determine whether people sign up — will be won and lost in places like Texas. If Obamacare fails in the Lone Star State — that is, if a significant portion of the 6.1 million uninsured Texans don't or can't enroll — then the White House could miss its national enrollment targets, the new health insurance exchanges could falter and insurance rates could spike (Haberkorn, 10/7).

Politico Pro: Cal State Pushes ACA For Students, State
If California — with its huge, diverse population of uninsured residents — is a test for Obamacare in the United States, then the California State University system is a test for Obamacare in California. The university’s 437,000 students hit a demographic sweet spot for the health care law. The system serves a large number of young adult students, too old for their parents’ insurance but still young enough to be the healthy, uncomplicated clients insurance companies need. Nonwhite students make up about two-thirds of the student body, and a third are Hispanic or Latino — another group the administration is counting on to get coverage through the Affordable Care Act (Nelson, 10/4).

In other news about the health law policies -

Bloomberg: Obamacare Seen Straining Clinics With Medicaid Expansion
They start showing up at the St. John's Well Child and Family Center in Los Angeles at 5 a.m. By the time the doors open at 8 a.m., as many as 60 patients are queued up in a line that stretches down the street. In South L.A., where St. John's is one of the few organizations that makes doctors available to the poor, the lines may soon get much longer. More than 5 million additional Americans are expected to enroll over the next two years in Medicaid, the taxpayer-funded insurance for the poor that's expanding Jan. 1 under the Affordable Care Act. Yet 43 percent of doctors in California and a third nationwide won’t take new Medicaid patients (Pettypiece, 10/7).

CQ HealthBeat: Employers Trimming Benefits Now To Avoid Cadillac Tax In 2018
Even though it won't take effect for several years, the so-called Cadillac tax in the health law already appears to be causing employers to try to rein in the costs of health coverage. As employees at many private companies prepare for the open enrollment season, some will find out soon about decisions their employers have made about benefits in order to escape a tax on expensive health care coverage that hits in 2018 (Adams, 10/4).

The Star Tribune: Aided By Obamacare, Private Health Exchange Ready For Growth
A Minnesota firm, quietly working for two years on employer-sponsored private insurance exchanges stimulated by Obamacare, plans to double in size over the next year, thanks in part to the Affordable Care Act. CieloStar soon will announce the first of several agreements it has reached with state chambers of commerce that could help thousands of small employers and their workers acquire health and other types of insurance through chamber-sponsored exchanges on CieloStar’s customized online benefits-selection system  (St. Anthony, 10/6).

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The Health Law And Older Americans

A pair of stories examine the health law and Medicare's prescription drug "doughnut hole" as well as what might change for people who are near retirement age, but not yet eligible for Medicare.

The Wall Street Journal: Obamacare Aims To Close Medicare 'Doughnut Hole'
There's a Medicare prescription-drug coverage abyss that is playfully referred to as the "doughnut hole," though there is nothing sweet or amusing about it. But thanks to the Affordable Care Act, which had a rocky launch last week, Medicare beneficiaries will see that gap shrink again in 2014 and in each year until 2020, according to Medicare.gov. The doughnut hole is the temporary limit on what Medicare drug plans pay after certain dollar thresholds for drugs have been met (Waters, 10/6).

The Wall Street Journal: How Obamacare Benefits Older Workers
For those 65 years or older and on Medicare, the health-care reform law doesn't require doing anything different. It will lead to slightly expanded coverage, but won't dramatically change the landscape. It's a different story for those in the years approaching retirement who don't already have health insurance. For that group, the ACA could provide an opportunity to get more-affordable insurance than in the past and make it possible to get coverage for those who might otherwise be denied insurance or find it too costly. And it's a particular plus for those considering early retirement (Lauricella, 10/6).

Related KHN story: FAQ: Seniors On Medicare Don’t Need To Apply To The Health Law Marketplaces (Carey, 9/23).

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Women's Health

Supreme Court Likely To Rule On Abortion Laws, Contraception Mandate In New Term

The Supreme Court's new session will almost certainly see a ruling on state power to limit the use of some abortion-inducing drugs and one on Arizona's law outlawing abortions after 20 weeks of pregnancy. The court is also expected to rule on the health law's mandate that almost all employer health plans cover contraception.

The New York Times: Supreme Court Has Deep Docket In Its New Term
The court has two cases concerning abortion on its docket. One of them, McCullen v. Coakley, No. 12-1168, is a challenge to a Massachusetts law that restricted protests near reproductive health care facilities. The court upheld a similar Colorado law in 2000 in Hill v. Colorado. … The second one concerns whether states may limit the use of abortion-inducing drugs. The case, Cline v. Oklahoma Coalition for Reproductive Justice, No. 12-1094, has taken a detour to the Oklahoma Supreme Court, which has been asked for a clarification (Liptak, 10/7).

Los Angeles Times: In New Term, Supreme Court May Steer To Right On Key Social Issues
And last month, Arizona's attorneys asked the court to uphold the state's ban on abortions after 20 weeks of pregnancy, a measure that was blocked on the basis of Roe vs. Wade. By next spring, the justices are likely to revisit part of President Obama's healthcare law to decide a religious-rights challenge to the requirement that large private employers provide their workers with coverage for contraceptives. Dozens of employers who run for-profit companies have sued, contending that providing health insurance that includes a full range of contraceptives violates their religious beliefs (Savage, 10/6).

The Washington Post: Political Gridlock Puts Supreme Court At Center Of Controversial Social Issues
A year ago, some conservatives outraged by Roberts’s vote finding Obama’s health-care law constitutional openly wondered whether they had been duped by President George W. Bush’s nominee. Roberts dispelled any fears that he had gone “wobbly” by sharply criticizing Congress’s actions in reauthorizing the Voting Rights Act and objecting to the decision in the DOMA case. He filed a dissent in the latter, attempting to limit the reach of the ruling. (Barnes, 10/6).

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Administration News

Obama Asks Americans To Give Exchanges And Obamacare Time To Work

President Barack Obama defended the problem-plagued rollout of the health law's insurance exchanges late last week. In an interview with The Associated Press, he asked Americans to not give up on changes the law is making and to give it time to work. Later, Obama said he didn't know how many people had signed up for coverage through the exchanges and reiterated his unwillingness to repeal parts of the law to get Republicans to help reopen the federal government.

The Associated Press/NBC: Obama Tells Americans Not To 'Give Up' On Problem-Plagued Health Care Program 
Defending the shaky rollout of his health care law, President Barack Obama said frustrated Americans "definitely shouldn't give up" on the problem-plagued program now at the heart of his dispute with Republicans over reopening the federal government. Obama said public interest far exceeded the government's expectations, causing technology glitches that thwarted millions of Americans when trying to use government-run health care websites. "Folks are working around the clock and have been systematically reducing the wait times," he said. The federal gateway website was taken down for repairs over the weekend, again hindering people from signing up for insurance (Pace, 10/4).

Fox News: President Repeats Willingness To Negotiate Obamacare Changes
President Obama is saying he's willing to negotiate changes to his signature health care law, Obamacare, but won't until Congress resolves its budget issues -- reaching a spending deal to reopen the government and raising the debt ceiling. Obama has said before that he’s open to improving the law and would negotiate on anything when it comes to a bigger deal, or a so-called "grand bargain." However, his remarks, as part of a wide-ranging interview with the Associated Press, come amid increasing pressure to make changes to ObamaCare (10/5).

Politico: Obama Doesn't Know Number Of People Who've Gotten Insurance Through Exchanges 
There's been skepticism from Republicans and the press about whether the White House really doesn't know how many people have enrolled this week. Obama said that early interest in the exchanges far exceeded the government's expectations for the first few days, but "folks are working around the clock and have been systematically reducing the wait times." HealthCare.gov is down for the weekend to give the administration uninterrupted time to improve the site. Ultimately, Obama said, the outlook for the exchanges is good. By the time signups end in March, "we are going to probably exceed what anybody expected in terms of the amount of interest that people had (Epstein, 10/5).

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Capitol Hill Watch

Boehner: No Change In Shutdown, No Debt Vote Without Health Law Concessions

The White House hit back on House Speaker Boehner's threats, saying the president is willing to negotiate over the budget but not until the government reopens and Republicans drop the health care fight. Some cracks are appearing in the GOP stance among tea-party aligned members.

The New York Times: Boehner Hews To Hard Line In Demanding Concessions From Obama
Speaker John A. Boehner stood his ground on Sunday alongside the most conservative Republicans in Congress, insisting that the House would not vote to finance and reopen the government or raise the nation's borrowing limit without concessions from President Obama on the health care law (Calmes and Peters, 10/6).

The Washington Post: Boehner, White House Harden Stances As Shutdown Continues, Potential Default Nears
As Boehner hardened his stance, the White House did the same, dispatching Treasury Secretary Jack Lew to appear on four of the six major Sunday talk shows. Repeatedly, Lew said Obama is willing to enter negotiations to address the nation's long-term budget problems but not until Republicans drop their campaign against Obama's health-care initiative, end the government shutdown and lift the $16.7 trillion debt limit (Montgomery, 10/6).

The Wall Street Journal: Boehner Ties Deal To Talks On Debt 
The fight to this point has centered on Republican demands to delay or dismantle parts of the 2010 health-care law in exchange for funding the government. Now, by pairing the standoffs over funding the government and raising the debt ceiling, the speaker is trying to force President Barack Obama and Senate Majority Leader Harry Reid (D., Nev.) to agree to GOP priorities on deficits and federal spending in return for movement on both (O’Connor and Nicholas, 10/6).

Bloomberg: Some Tea Party-Backed Lawmakers Yield In Obamacare Fight
The first cracks are appearing in the Tea Party's push to dismantle the nation's health law as three House lawmakers with ties to the movement said they'd back a U.S. spending bill that doesn't center on Obamacare.  Republican Representatives Blake Farenthold of Texas, Doug Lamborn of Colorado and Dennis Ross of Florida, all of whom identify with the Tea Party, said they'd back an agreement to end the government shutdown and lift the debt ceiling if it included major revisions to U.S. tax law, significant changes to Medicare and Social Security and other policy shifts (Bender 10/6).

The New York Times: A Federal Budget Crisis Months In The Planning 
Shortly after President Obama started his second term, a loose-knit coalition of conservative activists led by former Attorney General Edwin Meese III gathered in the capital to plot strategy. ... Out of that session, held one morning in a location the members insist on keeping secret, came a little-noticed "blueprint to defunding Obamacare." ... The groups have also sought to pressure vulnerable Republican members of Congress with scorecards keeping track of their health care votes; have burned faux "Obamacare cards" on college campuses; and have distributed scripts for phone calls to Congressional offices (Stolberg and McIntire, 10/5).

Fox News: Boehner Hits White House Over Obamacare Website Repairs
House Speaker John Boehner criticized the Obama administration's plan to disable a key part of its health overhaul website this weekend to resolve glitches that overwhelmed the launch of new health insurance markets. "The news that its enrollment system is already going offline confirms that the launch of the president’s health care law has been an unmitigated disaster," Boehner said in a statement Friday (10/5).

Kaiser Health News also tracked additional weekend coverage of the continuing budget impasse on Capitol Hill (10/6).

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Shutdown Spurs Relitigation Of Obamacare

Editors at the prestigious New England Journal of Medicine urge the nation's physicians to make their views on the health law known to their congressional representatives, noting their own favorable stance, while a conservative Georgia district urges the House GOP to keep up its fight to defund the law.

Los Angeles Times: Government Shutdown: Doctors Urged To Tell Congress Their Views On ACA
As the political standoff over the Affordable Care Act keeps the federal government shut down for a fourth day, the editors of the New England Journal of Medicine are urging the nation’s physicians to “lead by example” and “make your views known to your representatives in Congress.” In an editorial published online Friday, Drs. Jeffrey M. Drazen and Gregory D. Curfman write that the journal – the oldest and arguably most prestigious medical publication in the country – has no official stance on the merits of the law that has come to be known as Obamacare. But as physicians who treat patients in Massachusetts, they write that their personal experience with a similar law has been overwhelmingly positive (Kaplan, 10/4).

The New York Times: Conservative Georgia District Urges G.O.P. To Keep Up The Fight
Just down the road from where Union troops suffered their worst defeat of the Civil War, Jeff Epperson sang the praises of his congressman, Representative Tom Graves, whose Defund Obamacare Act set the table for the partial government shutdown. ... The Republican insistence in the House on tying financing of the federal government to dismantling the Affordable Care Act is being driven by a deeply conservative caucus from places like Mr. Graves’s 14th Congressional District, newly created by Georgia’s Republican-controlled Legislature. Voters here viewed the Washington stalemate just as Mr. Graves and many of his party members in Congress portray it: a tale of Republicans who have repeatedly shown a willingness to compromise, while Democrats petulantly refuse to meet halfway (Gabriel, 10/5).

The Washington Post: Cuccinelli, Cruz Address Conservatives In Richmond
Democrats have pounded Cuccinelli all week over his plans to appear at a Family Foundation dinner headlined by Cruz, widely considered the architect of the shutdown as a means of defunding the Affordable Care Act. Cuccinelli has said repeatedly that he disagrees with the tactic despite his fierce opposition the federal health-care law known informally as Obamacare. The impasse in Washington has forced Cuccinelli to walk a fine line: between his longtime tea party supporters, who regard Cruz as a hero, and independent voters in a state with a large federal workforce, who tend to take a dim view of Obamacare but an even dimmer one of the shutdown (Vozzella, 10/6).

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Public Health & Education

Drug Companies Paid To Attend FDA Advisory Panel Meeting On Painkillers' Safety And Effectiveness

The Washington Post: Pharmaceutical Firms Paid To Attend Meeting Of Panel That Advises FDA
A scientific panel that shaped the federal government’s policy for testing the safety and effectiveness of painkillers was funded by major pharmaceutical companies that paid hundreds of thousands of dollars for the chance to affect the thinking of the Food and Drug Administration, according to hundreds of e-mails obtained by a public records request. The e-mails show that the companies paid as much as $25,000 to attend any given meeting of the panel, which had been set up by two academics to provide advice to the FDA on how to weigh the evidence from clinical trials. A leading FDA official later called the group “an essential collaborative effort” (Whoriskey, 10/6).

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State Watch

State Highlights: N.C.'s Medicaid Managed Care Plan Attracts Companies

A selection of health policy stories from New York, North Carolina, California, Virginia and Washington.

The New York Times: Abortion Vote Exposes Rift At A Catholic University
Trustees of the Jesuit [Loyola Marymount University] will decide on Monday whether to remove coverage for elective abortions from the faculty and staff health care plans. The coming vote has exposed a deep rift over just how Catholic a Catholic university should be in the 21st century -- and how to maintain that distinctive Catholic identity amid growing diversity on campus (Lovett, 10/6).

North Carolina Health News: Medicaid Managed Care Companies Display Newfound Confidence In NC
Since Gov. Pat McCrory has proposed privatizing Medicaid, managed care companies from out of state have been increasing their presence in North Carolina (Hoban, 10/4).

California Healthline: Some Exchange Provider Rates Up In Air
In California, which was first in the nation to create an exchange under the Affordable Care Act, the process has been slightly more advanced than most other states, including Web enrollment capability and the setting of health plan rates within the exchange. In California, some provider rates have been established for the exchange, for the individual market, according to Nicole Evans, vice president for communications at the California Association of Health Plans. With three short months until actual coverage benefits begin, however, not all provider rates have been set (Gorn, 10/4).

The Washington Post: Arlington-Based Evolent Adds $100M In Venture Capital As It Looks To Revolutionize Health Care Industry
Arlington-based Evolent Health got off the ground more than two years ago as the battle over health care reform raged on Capitol Hill and beyond. As the shutdown of the federal government last week illustrates, that debate is far from settled. But to chief executive Frank Williams and Evolent’s other co-founders, it was clear then that the way hospitals deliver and get paid for care was changing, regardless of the political wrangling (Overly, 10/6).

The Seattle Times: Caring For Mentally Ill: 3 Counties' Success Stories
Valerie Thompson felt herself losing control. She started seeing imaginary men, then hearing knocks on her door. In a past life, these types of symptoms ended in suicide attempts and involuntary detentions. But this time, Thompson knew what to do (Rosenthal, 10/6).

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Editorials and Opinions

Viewpoints: U.S. 'Designed For Stalemate'; Tea Party's Last Stand?; 'War Over Obamacare' Not Over

The Washington Post: The 'Non-Essential' Parts Of Government That Shut Down Are Actually Quite Essential
Though the big social insurance programs are still running, many federal programs that directly target those in the most need are either empty or running on fumes. ... The growth of the modern state is tied to the awareness of public issues in health and the need to address them. The state has a responsibility to provide responses to a wide range of public issues including pollution, clean air and water, sanitation and epidemics, because there’s no way individuals alone can do this. Yet this state is not showing up for work these days (Mike Konczal, 10/6). 

The Washington Post: Why Are We Still Fighting Over Obamacare? Because America Was Designed For Stalemate
The health-care law is no doubt a flawed piece of legislation, like any bill written to satisfy the demands of legions of lobbyists and interest groups. But only in America can a government mandate to buy something that is good for you in any case be characterized as an intolerable intrusion on individual liberty. ... The House Republicans see themselves as a beleaguered minority, standing on core principles like the brave abolitionists opposing slavery before the Civil War. ... But while the showdown over the Affordable Care Act makes America exceptional among contemporary democracies, it is also perfectly consistent with our history (Francis Fukuyama, 10/4).

The Washington Post: Shutdown: The Tea Party's Last Stand
If the nation is lucky, this October will mark the beginning of the end of the tea party. ... People who knew better followed Sen. Ted Cruz down a path of confrontation over Obamacare. Yet even before the shutdown began, Republicans stopped talking about an outright repeal of Obamacare, as House Speaker John Boehner’s ever-changing demands demonstrated (E.J. Dionne Jr., 10/6).

The Wall Street Journal: Now Obama Rescues The GOP
Both sides made big mistakes the past 10 days. The Republicans' mistake was to force a shutdown over the defunding of ObamaCare. "Defunding" isn't even a word they can win on, never mind a concept. The dark side of their brand is that they're always "defunding," they’re always trying to take away and not adding, they're all about cutting and never expanding. You should never play to the dark side of your brand. "Delay" would have been better—better as sheer policy, more in line with the anxieties of the public, and more in line with the needs of the administration. We saw what happened this week when they didn’t delay: the embarrassing, nonstop glitch that is ruining ObamaCare’s brand. But the White House this week has made an equally dramatic and consequential mistake, and it is balancing out the Republicans' mistake. The Democratic mistake is the punitive, crude, pain-bringing shutting down of things that everyone knows don’t have to be shut down—the World War II memorial, the Iwo Jima memorial, parks, landmarks, etc. (Peggy Noonan, 10/6).

The Wall Street Journal: Kentuckians For Obamacare?
"More than 6 million people [nationwide] visited the website HealthCare.gov the day it opened; nearly 200,000 people picked up the phone and called the call center," said the president. "In Kentucky alone—this is a state where—I didn't win Kentucky. So I know they weren't doing it for me. In Kentucky, nearly 11,000 people applied for new insurance plans in the first two days—just in one state, Kentucky." It's true that Kentucky had among the fewest exchange glitches during this week's rollout. But if ObamaCare is so popular in the Blue Grass State, why doesn't Democratic Senate candidate Alison Grimes, who is challenging Senate Minority Leader Mitch McConnell next year, want to talk about it? (Jason L. Riley, 10/6).

The New York Times: The Boehner Bunglers
To see what I’m talking about, consider the report in Sunday’s Times about the origins of the current crisis. Early this year, it turns out, some of the usual suspects — the Koch brothers, the political arm of the Heritage Foundation and others — plotted strategy in the wake of Republican electoral defeat. Did they talk about rethinking ideas that voters had soundly rejected? No, they talked extortion, insisting that the threat of a shutdown would induce President Obama to abandon health reform. This was crazy talk. After all, health reform is Mr. Obama’s signature domestic achievement (Paul Krugman, 10/6).

The Los Angeles Times: The Unsettled Healthcare Law
Last week's glitch-filled rollout of Obamacare's health exchange websites, combined with Republicans' furious refusal to accept the program as what President Obama calls "settled law," confirmed something political strategists in both parties had already predicted: The war over Obamacare is far from over (Doyle McManus, 10/6).

The Los Angeles Times: Did The Obamacare Insurance Exchanges Launch Too Soon? [Poll]
With any venture on this scale, there are bound to be unexpected bumps in the road. But critics of the Patient Protection and Affordable Care Act, better known as Obamacare, say that the problems documented by Terhune and his counterparts around the country show that the exchanges simply weren't ready for the roll out -- and providing all the more reason for Congress to delay implementation of the law (Jon Healey, 10/4).

USA Today: U.S. Failure To Pay Bills Hurts Everyone
It might be hard to believe, but there is a dangerous debate underway in Congress right now over whether the United States, the world's strongest economy, should pay all of its bills. ... The United States cannot be put in a position of having to choose which commitments it should meet. How could we possibly decide among supporting our veterans, maintaining food assistance for children in need, or sending Medicare payments to hospitals? (Treasury Secretary Jack Lew, 10/3).

Bloomberg: Washington Trash Talk Won't End Stalemate
What we have here is definitely not a failure to communicate. Throughout the federal government shutdown last week, partisans voiced their contempt, even loathing, for the other side. White House communications director Dan Pfeiffer declared there would be no negotiations "with people with a bomb strapped to their chest." Republican Senator Ted Cruz, who hails from a state where a quarter of the population lacks health insurance, insisted that political chaos was a small price to pay to prevent "the enormous harms that Obamacare is inflicting on millions of Americans." Among the mind-numbing barrage was this tweet promoted by the National Republican Senatorial Committee: "Obamacare Sucks. It Must Be Repealed. Sign the Petition." Even President Barack Obama’s Twitter account succumbed to blunt posting: "Take Note, Obamacare is here to stay," it tweeted on the second day of the shutdown (10/6). 

Bloomberg: Exchanges Will Raise U.S. Health-Care Costs
Ignore the inevitable startup glitches. The new health-insurance exchanges will work just fine -- in the sense that all government health-care programs work: Many people will ultimately become dependent on them for coverage. That won’t mean the exchanges have fulfilled their promise, however (David Goldhill, 10/6). 

Bloomberg: Republican Insurgents Forget Their Political ABCs
"I am not a member of any organized political party," the humorist Will Rogers said. "I am a Democrat." Even Will Rogers would be shocked at the disjointed and self-destructive congressional Republican Party of today. By forcing a government shutdown and possibly a credit default in a few weeks, a minority of rank-and-file Republican members have run roughshod over the leadership. They are pushing a futile effort to kill President Barack Obama’s health-care law, enacted in 2010, upheld by the Supreme Court and hotly debated in last year’s presidential campaign (Albert R. Hunt, 10/6).

And on other topics -

Politico: There Is No War On Women
Earlier this week, Cecile Richards, president of Planned Parenthood, cried wolf once more regarding a "war on women" because House Republicans voted on Saturday to delay Obamacare for a year. She argues that "a narrow group of Republican leaders in the House are pushing to shut down the entire federal government over women’s access to birth control, cancer screenings and other basic health care." ... The truth is that much of this battle is more complicated than Richards chooses to admit. We, as women of faith, are standing our ground against another group of women who seek to force us to subsidize choices we find immoral (Penny Young Nance, 10/4).

The New York Times: Why the Bad Rap on Generic Drugs?
It's been nearly 30 years since Congress kick-started the generic drug industry by passing the Hatch-Waxman Act ...  Many generic drugs cost pennies per pill, yet pack the same punch as brand-name medicines. So why can't they get more respect? ... Some studies have found that lower-income patients — those who could benefit the most from generics — are among the groups that are most skeptical. ... One recent study found that almost 50 percent of doctors held negative views of the quality of generic medications (Katie Thomas, 10/5).

The New York Times: Doctors' Bad Habits
We doctors constantly lament how difficult it is get our patients to change their behavior. We rant about those who won't take their meds, who won't quit smoking, who never exercise. But the truth is, we are equally intransigent when it comes to changing our own behaviors as caregivers. ... I thought about this as I read the latest recommendations from the Choosing Wisely campaign — a project led by the American Board of Internal Medicine to inform doctors and patients about overused and ineffective tests and treatments (Dr. Danielle Ofri, 10/5).

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Stephanie Stapleton

Andrew Villegas

Lisa Gillespie
Shefali Luthra

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