Daily Health Policy Report

Monday, November 11, 2013

Last updated: Mon, Nov 11

KHN Original Reporting & Guest Opinion

Health Reform

Capitol Hill Watch

Coverage & Access

Public Health & Education

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

FAQ: How Does The Health Law Impact Federal Employees' Health Benefits

Kaiser Health News staff writer Mary Agnes Carey reports: "Open enrollment season begins Monday for the approximately eight million federal workers and their dependents who receive health care coverage through the Federal Employees Health Benefits Program or FEHB. The 2010 health law calls for some changes in that coverage. Below are some frequently asked questions and answers about how the measure will impact federal workers’ health insurance" (Carey, 11/11). Read the story.

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Health On The Hill: Detailing Long-Awaited Mental Health Parity Law Regulations

Kaiser Health News' Mary Agnes Carey and CQ HealthBeat's Rebecca Adams discuss the final rules released Friday by the Obama administration for the 1996 and 2008 laws that expanded the kinds of mental health and substance abuse care insurers must cover (11/9). Listen to the audio or read the transcript.

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How Much Is That X-Ray? Still Hard To Say, Even In Massachusetts

WBUR’s Martha Bebinger, working in partnership with Kaiser Health News and NPR, reports: "Finding out how much an X-ray costs sounds like a simple question. But it is actually very difficult to get an answer. In Massachusetts, a new state law requires insurers to be able to tell members how much a test, treatment or surgery will cost. But while the new law pulls back the curtain on prices of health procedures to some degree, the burden is still on the patient to ask for information. And, as a recent test drive of the new law showed, there are quite a few hoops for patients to jump through" (Bebinger, 11/9). Read the story.

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Political Cartoon: 'By A Nose?'

Kaiser Health News provides a fresh take on health policy developments with "By A Nose?" by Pat Bagley.

Here's today's health policy haiku: 


Papers Piled High
Technology Is Too Tough
Oregon Still Bare.


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

GOP Sees Potential In Health Law's Problems, As Roll-Out Takes Toll On Obama's Ratings

Even as Republican lawmakers took a hard line during the weekend talk shows, Democrats still maintain the measure will, in the end, be a political advantage.   

The Associated Press/Washington Post: Republicans Seize On Health Law's Growing Problems To Slam Democrats, Brighten Hopes For 2014
The health care law’s seemingly endless problems are giving congressional Republicans a much-needed boost of energy, helping them to move past the government-shutdown debacle and focus on a theme for next year’s elections. Republicans are back on offense, and more quickly than many had expected, after seeing their approval ratings plunge during last month’s partial shutdown and worrisome talk of a possible U.S. debt default (11/11).

The Wall Street Journal: Health-Law Rollout Weighs On Obama's Ratings, Agenda
President Barack Obama, bogged down by problems with his signature health-care program, is seeing both his approval and personal-favorability ratings with Americans sag, creating new complications for his second-term agenda. During past turbulence in Washington, Americans' approval of the job Mr. Obama is doing dipped. But in those stretches, Mr. Obama was buoyed by voters' general admiration for him as a person and by their trust in his credibility (Nicholas and Nelson, 11/10).

CBS News: GOP On Obamacare Rollout: 'This Is What Betrayal Looks Like'
Rep. Todd Young, R-Ind., slammed President Obama for committing "betrayal" in the weekly Republican address on Saturday, claiming the president misled Americans when he assured them that, under the new health care reform law, they could keep their insurance plan if they liked it. Young relayed stories of Indiana residents whose insurance has been canceled or become more expensive under the new law. "This is what betrayal looks like," he said. "Here you have hardworking people who were repeatedly told not to worry, that their coverage would stay the same and - if anything - their costs would go down. Just the opposite is happening” (Miller, 11/9).

Kaiser Health News also tracked weekend health policy headlines, including news about how how both parties are trying to spin the issues related to the health law's roll-out (11/10).

Politico: Wasserman Schultz: Future Dems Will Run On Obamacare
Obamacare didn’t harm Democrats in last week’s elections and, in fact, could be a boon to future candidates, the chairwoman of the Democratic National Committee said Sunday. "I think actually that Democrats will be able to run on Obamacare as an advantage," Rep. Debbie Wasserman Schultz (D-Fla.) said on CNN's "State of the Union." Despite recent issues with the Obamacare rollout and the website, she said Americans are starting to see the benefits of the new health plan (Munsil, 11/10).

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Zients Warned Years Ago About Problems With Federal IT

News outlets report on the various approaches being taken to healthcare.gov's problems.

The New York Times: Health Website Tests A Tycoon And Tinkerer
Jeffrey D. Zients, a multimillionaire entrepreneur and management consultant, joined the Obama White House in 2009 with a mandate to streamline the federal bureaucracy. A year later, he issued a prescient warning. The government "largely has missed out" on the information technology revolution, Mr. Zients said in a 2010 internal memo. "I.T. projects too often cost hundreds of millions of dollars more than they should, take years longer than necessary to deploy and deliver technologies that are obsolete by the time they are completed," he wrote. These days, Mr. Zients is witnessing that ineptitude up close as the emergency fix-it man charged with righting HealthCare.gov (Stolberg, 11/10).

The Washington Post: White House Relying More On Insurance Carriers To Help Fix HealthCare.gov
The White House is increasing its reliance on insurers by accepting their technical help in efforts to repair the problem-ridden online health insurance marketplace and prioritizing consumers’ ability to buy plans directly from the carriers. The Obama administration's broader cooperation with insurers is a tacit acknowledgment that the federal insurance exchange — fraught with software and hardware flaws that have frustrated many Americans trying to buy coverage — might not be working smoothly by the target date of Nov. 30, according to several health experts familiar with the administration's thinking (Eilperin and Goldstein, 11/9).

The Wall Street Journal: HealthCare.gov Getting Fresh Dose Of 'Agile' Treatment
The HealthCare.gov contractor hired to fix the troubled online marketplace is assigning programming teams to release multiple software releases each week to fix specific portions of the site, according to the Obama administration. Experts say that focused fixes, conducted by contractor QSSI, could end up doing greater harm to the website if programmers fail to bring a holistic view to the project (Boulton, 11/8).

Marketplace: Fixing Healthcare.Gov Could Open The Door To More Problems
There are two sides to the ill-fated rollout of the Affordable Care Act. The big one, the one we've all been hearing about, is the front end -- the website. The bigger one, quite possibly, is the back end. It's the plumbing of actually making sure people and their policies get matched up at insurance companies and at doctors' offices (Ryssdal, 11/8).

CBS News: Panetta: Obama May Have To Accept Changes To Obamacare If Site Not Fixed Fast
If the HealthCare.gov site cannot be fixed by the end of November, Leon Panetta said President Obama "may very well have to accept some changes in order to make sure that we can continue to implement it." Panetta, a former Congressman and top aide to President Clinton, ran both the Central Intelligence Agency and Defense Department during Mr. Obama's administration. He said that even though speedy repairs will be tough, the administration doesn't need to take down the federal website where consumers can shop for and purchase health insurance, but that they should be able to fix the system while it is live -- and should have fixed it before the launch (Kaplan, 11/10).

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More Numbers Expected This Week On October Health Law Enrollment

In related news, The New York Times reports that state and federal exchanges are using "happy talk" to market the new health coverage options available through the online insurance marketplaces, but they rarely mention the penalty. Other news outlets report on developments from Maryland, Oregon and Colorado.

Reuters: Early Obamacare Data To Signal How Many Still Waiting To Enroll
The Obama administration will release healthcare enrollment numbers for Obamacare's rocky October rollout this week that could be more important for what they fail to say, than for what they do. President Barack Obama's Democratic administration, which is under intense pressure from Republicans to release the data, has signaled that the total will be low after weeks of technical problems with the federal website, HealthCare.gov (Morgan, 11/10).

The New York Times: Talk Of Penalty Is Missing In Ads For Health Care
New York's health exchange slogan is "Today's the Day." Minnesota has enlisted Paul Bunyan. Oregon held a music contest, and California stresses the "peace of mind" that will come with insurance. The state and federal health insurance exchanges are using all manner of humor and happy talk to sell the Affordable Care Act’s products. But the one part of the new system that they are not quick to trumpet is the financial penalty that Americans will face if they fail to buy insurance (Hartocollis, 11/10).

St.Louis Post-Dispatch: As Federal Health Website Stalls, So Does Marketing
Marketing campaigns to promote the new health insurance exchanges hit a speed bump the size of a boulder last month. The problem-plagued launch of HealthCare.gov on Oct. 1 made it all but impossible for most people to sign up for insurance on the exchanges (Kulash, 11/10).

The Wall Street Journal: Maryland Delays Full Rollout of Health Website
Maryland officials decided Friday to delay the rollout of the small-business insurance exchange program until April so it can continue fixing  problems with marylandhealthconnection.gov, its new online marketplace. Maryland launched the exchange on Oct. 1 for uninsured individuals, and had planned to open it to small companies in January (Corbett Dooren, 11/8).

Baltimore Sun: State Delays Small-Business Health Marketplace
Continued technical problems with the state's health insurance exchange have prompted another delay of the opening of a site for small businesses to buy health plans. Citing the problems on marylandhealthconnection.gov, which include sluggish navigation and error messages, state officials also postponed when the exchange would begin collecting payments from people who have already bought plans. The state exchange is where uninsured Marylanders — estimated to number 800,000 — can buy health plans under the Affordable Care Act (Walker, 11/8).

The Associated Press: Cover Oregon Clings To Grand Vision Despite Delays
Oregon officials set out to build one of the biggest and best in the nation — a model that other states would want to copy. But more than a month after Cover Oregon's online enrollment was supposed to launch, reality is lagging far behind Gov. John Kitzhaber's grand ideas. The online system still doesn't work, and the exchange has yet to enroll a single person in health insurance (Cooper, 11/10).

Health Policy Solutions (a Colo. news service):  Impatience Mounts For Immediate Exchange Fixes
Colorado’s health exchange needs to be fixed now, not next month or next year, say increasingly frustrated board members for Connect for Health Colorado. “It really had to be fixed yesterday,” said Nathan Wilkes, an IT expert and chair of the exchange board’s Operations Committee, who earlier this week called the mandatory Medicaid application that customers must fill out before they can move forward “onerous, odious and embarrassing” (McCrimmon, 11/8).  

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Health Law Overview: At The State Level, Divided Gov't Still Appears To Function

Some states have had more success striking compromises that expand health insurance coverage.

The New York Times: As Washington Keeps Sinking, Governors Rise
Washington these days is the symbol of governmental failure, rocked by a shutdown, legislative paralysis and the disastrous debut of President Obama's health care program. ... One striking difference between the federal and state level is how governors have dealt with the new health care law. Even as lawmakers in Washington have been embroiled in battles to repeal it, governors in Arkansas and Iowa, to name two, have successfully worked with both parties in search of a compromise to expand insurance coverage for their constituents (Nagourney and Martin, 11/9).

The Associated Press: In Iowa, Divided Government Means Compromise
While the recent federal government shutdown was the perfect example of split-party gridlock in Washington, in other parts of the country opposing parties are actually working together. Welcome to Iowa: a state with a Republican-controlled state House, a Democratic-majority state Senate and a Republican governor. The leaders in this triangle disagree on issues ranging from abortion to taxation, but this year came to bipartisan agreements on a massive property tax cut, increased education spending and an expansion of Medicaid under the newly enacted federal health care overhaul (Lucey, 11/10).

USA Today: Adjoining States Face Differences With Health Care Law
When Joe Atkins hunkered down to draft legislation outlining how Minnesota would implement the Affordable Care Act, he had no idea the results would be so dramatic. The Gopher State is now enrolling individuals through its health-insurance exchange by the thousands and at premium rates that are among the lowest in the country. Next door in Wisconsin, the numbers of Obamacare enrollees have barely hit the hundreds and rates are between 25 and 35 percent higher than in Minnesota (Slack, 11/10).

Los Angeles Times: Californians Have Their Doubts About Healthcare Law
Californians are more supportive of President Obama's healthcare law than the country at large, but they still worry it will raise healthcare costs and hurt the economy, a new poll of registered voters shows. Statewide, 50% said they backed the Affordable Care Act and 42% opposed it, according to the USC Dornsife/Los Angeles Times poll. That runs counter to national polls that show more people disapprove of Obamacare than support it (Terhune, 11/9).

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In States Not Expanding Medicaid, Hospitals Face A Squeeze As Federal Funds Dry Up

The New York Times examines the dilemma for some safety-net hospitals that will not see a drop in the uninsured but will lose federal money that used to help pay for those patients. Meanwhile on another issue affecting the health law, a federal appeals court blocked the administration's effort to require employers to provide contraception coverage.

The New York Times: Cuts In Hospital Subsidies Threaten Safety-Net Care
The uninsured pour into Memorial Health hospital here: the waitress with cancer in her voice box who for two years assumed she just had a sore throat. ... Many of these patients were expected to gain health coverage under the Affordable Care Act through a major expansion of Medicaid, the medical insurance program for the poor. But after the Supreme Court in 2012 gave states the right to opt out, Georgia, like about half the states, almost all of them Republican-led, refused to broaden the program. Now, in a perverse twist, many of the poor people who rely on safety-net hospitals like Memorial will be doubly unlucky. A government subsidy, little known outside health policy circles but critical to the hospitals' survival, is being sharply reduced under the new health law (Tavernise, 11/8).

The Wall Street Journal: Appeals Court Blocks Health Law's Contraception Requirement
A federal appeals court on Friday blocked a provision of the Obama administration's health-care law requiring employers to provide birth-control coverage in employee insurance, ruling that it imposed a "substantial burden" on religious rights of two Midwestern companies. The move by the Seventh U.S. Circuit Court of Appeals in Chicago marked the first time a federal appeals court has issued a ruling preventing the federal government from enforcing the provision (Palazzolo, 11/8).

In other news on health law -

The New York Times: Con Men Prey On Confusion Over Health Care Act
To the list of problems plaguing President Obama's health care law, add one more — fraud. With millions of Americans frustrated and bewildered by the trouble-prone federal website for health insurance, con men and unscrupulous marketers are seizing their chance. State and federal authorities report a rising number of consumer complaints, ranging from deceptive sales practices to identity theft, linked to the Affordable Care Act (Silver-Greenberg and Craig, 11/9).

Kaiser Health News: FAQ: How Does The Health Law Impact Federal Employees' Health Benefits
Open enrollment season begins Monday for the approximately eight million federal workers and their dependents who receive health care coverage through the Federal Employees Health Benefits Program or FEHB. The 2010 health law calls for some changes in that coverage. Below are some frequently asked questions and answers about how the measure will impact federal workers' health insurance (Carey, 11/11).

ProPublica: Health Care Delays Squeeze Patients In State High-Risk Pools
Case is executive director of the Oklahoma Temporary High Risk Pool, funded by the federal government to sell insurance to people denied coverage by private health insurers. Her worry is about some 300,000 people in her program and others like it who now must quickly find health insurance under the Affordable Care Act. Many of the programs are set to close by law on Dec. 31 (Ornstein, 11/8).

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Capitol Hill Watch

Proposals Likely This Week To Respond To Health Law Policy Cancellations

Sen. Jeanne Shaheen, D-N.H., is among those who are expected to advance legislation. Her measure would extend the open enrollment period by at least two months.

McClatchy: Congress Weighing Laws To Let People Keep Health Insurance
Proposed bills in both the Senate and the House of Representatives would stop cancellations of individual insurance policies that don’t meet the requirements of the health care law. Hundreds of thousands of Americans have been notified their existing policies will be canceled, most to make way for new policies that meet the new law’s standards. The president said Thursday that his staff was looking into ways to solve the problem, but he gave no details. On Friday, White House spokesman Josh Earnest said that Obama was "determined to address some of the challenges from this law," but he declined to say whether the president agreed with the congressional proposals (Schoof, 11/8).

Politico: Jeanne Shaheen To Introduce Obamacare Bill Next Week
Sen. Jeanne Shaheen will introduce a bill next week extending Obamacare’s open enrollment period by at least two months. The bill from the New Hampshire Democrat, who Republicans hope will be challenged by former GOP Sen. Scott Brown next year, would extend the Affordable Care Act’s enrollment deadline through at least May 31 and contain flexibility to further lengthen the enrollment period. The legislation will allow Health and Human Services Secretary Kathleen Sebelius to use her discretion to further stretch the period “if there are ongoing problems,” a Democratic aide said (Everett, 11/8). 

Meanwhile, Politico reports that the heatlh law's catastrophic coverage may offer a solution -

Politico: ACA's 'Catastrophic' Coverage Flies Under Radar
President Barack Obama promised to find ways to help people whose health plans have been canceled and are scrambling for an affordable alternative. For some of them, there may be an option: a little-known, little-discussed slimmed-down Obamacare "catastrophic" health plan. But it, too, is caught up in the HealthCare.gov mess. People don’t know about it, have trouble finding out about it — and can’t yet tap into it because of a gap in the sign-up process. Plus, health policy experts note that it might not help all that many people — and could divert people from the main insurance plans needed to make Obamacare sustainable (Cheney, 11/11).

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Issa Issues Another Subpoena -- His Target: Top White House Tech Officer

So far, the White House has resisted congressional Republican efforts to speak with chief technology officer Todd Park about the roll-out of healthcare.gov.

Los Angeles Times: White House Calls Subpoena For Top Tech Official 'Unnecessary'
The White House is reviewing a subpoena for testimony from its top technology chief, but a spokesman called the request from the House Oversight and Government Reform Committee an "unnecessary" distraction from the administration's work to fix the broken health insurance website. Rick Weiss, a spokesman for the Office of Science and Technology Policy, said officials will "respond as appropriate" to the subpoena issued Friday by committee Chairman Darrell Issa (R-Vista). Issa is investigating why the federal website, three years in the making, was not ready for launch on Oct. 1 (Hennessey, 11/9).

CNN: Issa Issues Another Subpoena On Obamacare Website
House Oversight Chairman Rep. Darrell Issa has issued another subpoena in the GOP's assault on the disastrous rollout of HealthCare.gov, this time summoning the chief White House technology officer to testify. The White House has resisted congressional Republicans' efforts to speak to Todd Park, chief technology officer in the Office of Science and Technology Policy, saying that he's too busy trying to fix the online exchanges. The resistance has infuriated Republicans, finally resulting in Issa's subpoena, which calls on Park to testify on Wednesday (11/8).

Politico spotlights who Todd Park is -

Politico: White House Tech Chief Now In Obamacare Spotlight
President Barack Obama's chief technology officer didn't build HealthCare.gov, but he's busy trying to fix it. Todd Park, one of the most accomplished health IT entrepreneurs in the country, is just the kind of techie Obama needs to save the botched website — so much so that many wonder why Park wasn't tasked to oversee the project in the first place (Norman, 11/9).

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Coverage & Access

Administration's Mental Health Parity Rule Is Part Of Effort To Curb Gun Violence

The long-awaited final regulation will guarantee most insurance coverage offers access to mental health services on par with physical health coverage.

The Wall Street Journal: Rules Spell Out How Insurers Must Cover Mental Health
The long-awaited final rule caps decades of efforts by psychiatrists, patients and other advocates to broaden coverage for the estimated one in four Americans who suffer from mental illness or substance abuse. It also ends mounting criticism from lawmakers who say the delay has allowed insurers to continue to impose barriers to care (Beck, 11/8).

The Associated Press: New Rule Demands Parity For Mental Health Coverage
It's final: Health insurance companies must cover mental illness and substance abuse just as they cover physical diseases. The Obama administration issued new regulations Friday that spell out how a 5-year-old mental health parity law will be administered (Freking, 11/8).

The Washington Post: Insurers Directed To Treat Mental Health Issues The Same As Physical Ailments
It also represents a fulfillment of a promise made by President Obama, who vowed to put the finishing touches on the regulations as part of a broader effort to address the problem of mass shootings, which have thrust mental health issues into the spotlight in recent years. "For way too long, the health-care system has openly discriminated against Americans with behavioral health problems. In the past, it was legal for insurance companies to treat these disorders differently than medical and surgical needs," Health and Human Services Secretary Kathleen Sebelius said in announcing the rule Friday (Somashekhar and Eilperin, 11/8).

Reuters: New U.S. Rules Require Equal Insurance Coverage For Mental Ills
Most Americans with health insurance will be guaranteed access to mental health services, including for depression and alcoholism, equal to medical and surgical treatment under long-delayed rules issued on Friday by the Obama administration. But the protections do not apply to tens of millions of people, including the elderly. The rules implement the 2008 Mental Health Parity and Addiction Equity Act, which took on greater urgency with the administration's vow to address gun violence after a series of mass shootings across the United States in the past few years (Begley 11/8).

McClatchy: Regulation Required Parity From Insurers For Mental Illness Coverage
In the aftershock of December's shooting in Newtown, Conn., when a mentally ill gunman stormed a school and killed 20 children and six adults, Congress and the White House have emphasized better mental health services, among other approaches, as one way to combat gun violence. Sen. Richard Blumenthal, D-Conn., said the rules were "long overdue" but constitute the "single most important step to stem and stop gun violence since the Newtown tragedy" (Pugh, 11/8).

Kaiser Health News: Health On The Hill: Detailing Long-Awaited Mental Health Parity Law Regulations
Kaiser Health News’ Mary Agnes Carey and CQ HealthBeat's Rebecca Adams discuss the final rules released Friday by the Obama administration for the 1996 and 2008 laws that expanded the kinds of mental health and substance abuse care insurers must cover (11/9).

Marketplace: Mental Health Coverage Rules Could Change Business Of Therapy
The rule is pretty clear. Everything -- co-payments, deductibles -- has to be the same for mental or physical care. So you'd think Walter Teague would want to celebrate. He's been a therapist in private practice for 32 years. And he's had lots of run-ins with insurance companies. "Therapists have been burned," he says (Marshall-Genzer, 11/8).

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Public Health & Education

FDA Proposes Change In Generic Drug Makers' Labels

The change would allow generic manufacturers to put new safety information on the labels without having to get FDA permission.

The New York Times: Label Updates May Be Allowed For Generics
The Food and Drug Administration proposed a rule on Friday that would permit generic drug makers to update their labels if they received information about potential safety problems. The move puts the companies on equal footing with brand-name manufacturers, but it also opens the door to lawsuits against them for the first time since the Supreme Court barred such cases two years ago. Until now, only brand-name drug makers had the ability to independently update their labels if important new information surfaced about one of their drugs (Thomas, 11/8).

The Wall Street Journal: FDA Proposes Letting Generic-Drug Makers Change Labels
The step Friday by the FDA means that generic companies—which sell about 84% of the prescription drugs by volume in the U.S.—would have the same ability to change their labels as brand companies. The FDA would review any proposed changes, as it already does with changes to branded-drug labels. "Our effort is to keep all the labels the same, and to level the playing field," said Janet Woodcock, director of the FDA's center for drug evaluation and research. The proposal, she said, "would change current procedures, where only the brand companies can unilaterally put certain safety information in the label" (Burton and Kendall, 11/8).

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State Watch

State Highlights: Wide Variation In Indigent Care Among California Counties, Report Finds

A selection of health policy stories from Massachusetts, Oregon and Iowa.

The Associated Press: New Hampshire House, Senate Panels Consider Medicaid Expansion
House and Senate committees are holding public hearings and work sessions on rival plans to expand Medicaid in New Hampshire this week. The House holds its public hearing Tuesday morning while the Senate's hearing on its plan is that afternoon. The committees working on the bills will vote on a recommendation Thursday, but whatever they decide may be superseded by any compromise negotiated behind closed doors by legislative leaders and Gov. Maggie Hassan (11/10).

Kaiser Health News: How Much Is That X-Ray? Still Hard To Say, Even In Massachusetts
Finding out how much an X-ray costs sounds like a simple question. But it is actually very difficult to get an answer. In Massachusetts, a new state law requires insurers to be able to tell members how much a test, treatment or surgery will cost. But while the new law pulls back the curtain on prices of health procedures to some degree, the burden is still on the patient to ask for information. And, as a recent test drive of the new law showed, there are quite a few hoops for patients to jump through (Bebinger, 11/9).

California Healthline: New Report Highlights Needs Of California's Residually Uninsured Residents
A report released yesterday by Health Access, a not-for-profit consumer advocacy group, shows a wide variation in indigent care from county to county in California. That variation is particularly important now, said Anthony Wright, executive director of Health Access, because counties will decide in the next two weeks how their indigent care will be designed (Gorn, 11/8).

The Lund Report: New Insurance Data Could Put Insurers On Hook For 2015
The Oregon Health Policy Board appears poised to recommend that insurance companies report a set of cost containment metrics in their April rate filings. The data could create a baseline to make them more accountable for future cost increases (Gray, 11/7).

Des Moines Register: Iowa Gets A Health Insurance Reprieve
Iowa’s dominant insurer, Wellmark Blue Cross and Blue Shield, decided in June to extend current plans for individuals and small businesses until Dec. 30, 2014 (Leys, 11/11).

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Editorials and Opinions

'Crunch Time' For Obama On Health Law; The Problems With That Apology; Young People Feeling The Sting Of Higher Prices

The Washington Post: For Obama, And Democrats, It's Crunch Time
But today, it’s Obama in the spotlight. A president famous for his unflappability, he is now struggling to square assurances that he is on top of the problems confronting his administration with assertions that he was unaware of the problems as they were developing. The president's apology for misleading people about whether they could keep their health insurance under the terms of the Affordable Care Act, which came during an interview with NBC's Chuck Todd, was a remarkable step, underscoring just how concerned he and his advisers are about the damage caused by the chaotic rollout of the new law (Dan Balz, 11/8).

The New York Times: Salvaging Obama
The first job is obvious, not least to the president. The bungling of the health care rollout was a humiliation for an administration whose campaign wizards famously tamed the social network in 2012. It has given Republicans license to feign indignation even as they do their best to undermine the new program. It has distracted the press from both the success stories (like Kentucky, where the rollout worked the way it was supposed to) and the episodes of Republican mischief (like Georgia, where the state blocked the hiring of "navigators" to help applicants through the enrollment process). I have no doubt that the administration will get the system working and that the program will ultimately prove popular. But the longer it takes, the more the president squanders the already meager public confidence that he can do anything right (Bill Keller, 11/10).

The New York Times: Why I (Still) Support Obamacare
In the end, this transition we're going through could prove more exciting than people think, but right now sking large numbers of people to go from being an "employee" to a "work entrepreneur" feels scary and uncertain. Having a national health care safety net under the vast majority of Americans — to ease and enable people to make this transition — is both morally right and in the interest of everyone who wants a stable society (Thomas L. Friedman, 11/9). 

The Washington Post: The Health-Care Law's Success Story: Slowing Down Medical Costs
The anger over the botched rollout of the Affordable Care Act’s federal health insurance exchange — and over the conflicting explanations about whether people can keep their coverage — has been bipartisan and well-deserved. The administration needs to make personnel and management changes to get enrollment back on track. But the focus on insurance coverage obscures other parts of the ACA that are working well, even better than expected. It is increasingly clear that the cost curve is bending, and the ACA is a significant part of the reason (David Cutler, 11/8).

The Washington Post: Immediate Lessons From Health-Care Reform
As President Obama has recognized, his administration’s failure to deliver a functioning Web site that Americans can use to enroll in Obamacare represents an inexcusable error. The Affordable Care Act, which legislates near-universal health insurance, was passed after more than a century of failed efforts to achieve this progressive dream in this country. It is tragic to be falling short on the mundane task of enrolling Americans in health-care exchanges. Even if the goal of getting the health-insurance exchanges working by Nov. 30 is achieved — and objective observers cannot regard this as a certainty — a shadow has been cast on the federal government’s competence (Lawrence Summers, 11/10). 

The Washington Post: What Obama Forgot To Apologize For
He’s sorry that some people have been inconvenienced by HealthCare.gov’s computer disaster. He’s sorry that some people have lost the policies he promised they could keep. He’s sorry that the Affordable Care Act (ACA) wasn’t adequately "crafted." But is he sorry that he intentionally misled people? I must have missed that part (Kathleen Parker, 11/8).

The Wall Street Journal: The ObamaCare Dozen
The ObamaCare Dozen are receiving an overdue education in the damaging consequences of the bill they supported, all of which were predicted by critics in 2010. Any one of these Senators could have prevented the current madness by voting no. And now the President they empowered to govern from the ideological left has rejected even their de minimis fixes and is promising to "grind it out" even if the problems get worse. These Senators deserve to be held accountable at the ballot box (11/8).

The Washington Post: Beyond HealthCare.gov, Obamacare's Other Challenges
A health insurance exchange is more than a Web site. It is an insurance store, and to manage it well requires insurance experience, technical know-how, and savvy marketing and sales tactics. The administration has a few months to put together a management team with these skills, dedicated exclusively to running the world's largest store for private insurance. The Centers for Medicare and Medicaid Services have talented staff, and Jeffrey Zients, a former budget official who’s been called up to help fix the federal exchange's online enrollment, may be just the guy to corral wayward technology vendors. But selling insurance is not what policy analysts and turnaround specialists do. I had 45 employees dedicated to operating the Massachusetts Health Connector; California has budgeted more than 300. Who’s minding the federal store? (Jon Kingsdale, 11/8).

The Washington Post: There Is No 'Fix' To The Affordable Care Act That Has Everyone Paying Less
The unvarnished truth is that neither president nor Congress can — or should — "fix" the fundamental logic of the new system, which will inevitably result in many people paying less but some people paying more after they transition into a reformed insurance market. As long as implementation troubles don’t do long-term damage, and there isn't evidence of that yet, the overall structure will be an improvement over what we have today (11/9).

The New York Times: Good Deals on Pills? It's Anyone's Guess
This month, a dysfunctional website stymied hundreds of thousands of Americans trying to check out new health insurance options under the Affordable Care Act. But that embarrassing technical glitch may have masked a more fundamental question: Can Americans shop effectively for health care? (Elisabeth Rosenthal, 11/9). 

The New York Times: High And Low Premiums In Health Care
The debate over the effect the Affordable Care Act will have on individuals and families who buy their own policies has mostly been waged in anecdotes. Supporters of the law point to grateful individuals who were previously unable to get insurance or paid exorbitant premiums but found affordable coverage on the new health insurance exchanges. Critics counter with frustrated people who liked their old policies but will now be forced to buy a more comprehensive policy and pay a higher premium for it (11/10).

The New York Times: Daring To Complain About Obamacare
The Anthem Blue Cross representative who answered my call told me that there was a silver lining in the cancellation of my individual P.P.O. policy and the $5,400 annual increase that I would have to pay for the Affordable Care Act-compliant option: now if I have Stage 4 cancer or need a sex-change operation, I’d be covered regardless of pre-existing conditions. Never mind that the new provider network would eliminate coverage for my and my son’s long-term doctors and hospitals (Lori Gottlieb, 11/10). 

USA Today: Obamacare Options Grim For Young People
I don't know about you, but as a young adult I'm not as disturbed as some Americans by the technical glitches delaying access to the Obamacare website. My lack of enthusiasm for signing up has to do with the unappealing options health care reform has presented my generation (Katrina Trinko, 11/10).

The Washington Post: What's The Matter With Motherhood?
If you’re a conservative strongly opposed to abortion, shouldn’t you want to give all the help you can to women who want to bring their children into the world? In particular, wouldn’t you hope they’d get the proper medical attention during and after their pregnancy? This would seem a safe assumption, which is why it ought to be astonishing that conservatives are positively obsessed with trashing the Affordable Care Act’s regulation requiring insurance policies to include maternity coverage (E.J. Dionne Jr., 11/10).

The Wall Street Journal: Healthcare.Junk
So the national embarrassment known as Healthcare.gov and the 36 federal ObamaCare exchanges won't be fixed by the end of November after all, notwithstanding a month of assurances from the White House. In updates for reporters on Thursday and Friday, the Affordable Care Act's lead repairman Jeff Zients more or less conceded that the website three years in the making won't work until sometime after the end of this month. He explained that every problem that is resolved and taken off the "punch list"—already several hundred items long—reveals new problems that the tech people didn't know about. "Where we are is not where we want to be," he said (11/10).

CNN: Obamacare And The Failure Of Half-Baked Liberalism
While it is true that the challenges facing the program have received much more attention than the successes, the problems are impossible to ignore. There are many reasons for Obamacare's troubles, ranging from the failure of White House officials to adequately prepare for the launch of the website to the successful Republican efforts to undermine its operations, including the refusal of many governors to establish exchanges in their own states (Julian Zelizer, 11/11).  

Fox News: The Real Cost Of ObamaCare – The Loss Of Good Doctors
Medical care costs had gone up, but those with good insurance made up for those with no insurance and doctors were generally happy to take care of everyone. That’s how the haves took care of the have-nots. People without insurance would be offered the best medical care at any American hospital’s emergency room, whether or not they were U.S. citizens. Soon I fear that unbeknownst to most Americans, the good, smart, well-rested physicians won’t be there to take care of us (Kristin Bianco, 11/9).

Seattle Times: Exploring The Wild West Of Health Insurance
Washington state has gotten plenty of props for a health-insurance website that works better than most. At last count, 55,000 residents had enrolled in Medicaid or individual insurance through the state exchange. Yet Washington Healthplanfinder has its limitations. So what’s a health-insurance consumer to do in the new world of the Affordable Care Act? One option is to ditch the official sites and explore the sometimes deceptive but potentially informative world of the private sector. That’s right folks, you can go rogue. The best site for comparative shopping that we at HealthCare Checkup have found bills itself as the “Washington Health Insurance Exchange.” (Stiffler, 11/8).

Kansas City Star: Numbers Look Good For Medicaid Change In Missouri
One study after another has made the case that Missouri could vastly reduce its hefty number of medically uninsured residents and also improve its finances. Now there is one more, Rep. Jay Barnes, a Republican from Jefferson City, presented data this week showing how the state could get nearly all of its residents under some form of health coverage and achieve a modest savings while doing so (11/8).

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Viewpoints: Shinseki's Efforts Haven't Yet Solved VA's Problems; Treating Children With Mental Illness Is Complicated; Abuse Of Painkillers

Los Angeles Times: No Longer The Greatest Generation's VA
Just in time for Veterans Day, the embattled secretary of Veterans Affairs, Eric K. Shinseki, announced last week that his department had reduced its backlog of overdue disability claims from more than 600,000 in March to about 400,000. "The trend line is in the right direction," Shinseki told reporters, noting that the VA had cut the number of claims older than a year by 93%. With hundreds of thousands of cases still unresolved, Shinseki hasn't gotten much credit so far — but to the surprise of his critics, he's on track to achieve his goal of eliminating the backlog by 2015. Still, that won't solve all the VA's problems; far from it (Doyle McManus, 11/10). 

The New York Times: Equal Coverage For The Mentally Ill
A struggle over decades to force insurers to cover mental health and addiction services on the same basis as medical and surgical costs is headed for success under new rules issued on Friday by the Obama administration. The rules will cover most Americans with health insurance, including those in many employer-sponsored plans, in other group plans, in some but not all Medicaid plans, and in policies bought on the individual markets (11/8).

The New York Times: After Mental Illness, An Up And Down Life
Two decades later, we are now able to see inside the brain with startling precision, thanks to sophisticated imaging techniques. And we know a lot more about brain biology. But we have been unable to transform much of that knowledge into definitive treatments. Caring for the mentally ill adult is challenging. Children are considerably more complicated, because they are constantly changing and developing (Lee Gutkind, 11/9).

USA Today: FDA Cracks Down, Finally, On Painkillers: Our View
The deadliest drug problem in America is not heroin or cocaine or even crack cocaine. It's the abuse of perfectly legal prescription pain medications — familiar names such as Vicodin and Lortab and generic hydrocodone. Last month, federal regulators finally got around to recommending stronger restrictions on access to these medications by limiting refills and mandating more frequent visits to doctors to obtain prescriptions. Now doctors, who helped create the problem, need to do their share to control it (11/10).

USA Today: New Drug Rules Could Harm Patients: Opposing View
Prescription drug diversion and abuse is a serious public health problem that has reached crisis levels across the U.S. At the same time, patients suffering from pain too often must go without adequate access to effective pain medications, resulting in needless suffering (Ardis Dee Hoven and Chris Hansen, 11/10).

The New York Times: Dear Governor Christie
In New Jersey, for instance, you’ve been able to successfully isolate public-sector unions, portraying them as drains on middle-class tax dollars and enemies of the common good. But in national budget debates, the biggest issues are popular entitlement programs, not teacher salaries or bureaucrats’ health benefits. And you probably aren’t going to win the presidency wagging your finger at Social Security recipients, or painting the poor and elderly as dangerous special-interest groups. You need a different way to convince voters that you’re on the middle class’s side (Ross Douthat, 11/9). 

The Wall Street Journal: Dr. Francis Collins: Politics On The Frontier Of Science
If the early years of the 21st century often feel like a retread of the 1970s—economic anxiety, turmoil overseas, American leaders who don't seem to understand what the problems are much less how to fix them—the geneticist Francis Collins suggests less dispiriting resemblances. The "arrow of progress that we're riding in biomedicine" took flight 40 or so years ago but is traveling faster and further now (Joseph Rago, 11/8).

The Wall Street Journal: You Can't Predict Destiny By Designing Your Baby's Genome
It may seem like creating the perfect child will eventually be a matter of who can pay for it. But predicting whether a couple's offspring will be the next Mozart or Einstein is about as easy as predicting the precise location and airspeed of a hurricane nine months in advance. Even if we know that a combination of genes might result in a 12% increase in musicality, parents have better odds just by signing a child up for piano lessons. That's because our genes are too complex to predict (Megan Allyse and Marsha Michie, 11/8).

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Stephanie Stapleton

Andrew Villegas

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Shefali Luthra

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