Daily Health Policy Report

Tuesday, November 12, 2013

Last updated: Tue, Nov 12

KHN Original Reporting & Guest Opinion

Health Reform

Capitol Hill Watch

Health Care Marketplace

Editorials and Opinions


KHN Original Reporting & Guest Opinion

Insuring Your Health: Prevention Programs For People Without Insurance Still Play Key Role

Kaiser Health News consumer columnist Michelle Andrews writes: "The health law gave a huge boost to insurance coverage for preventive care, requiring nearly all health plans to provide cancer screenings, check-ups and, more controversially, contraceptives, to patients free of charge. But that doesn’t help the 30 million people who are expected to remain uninsured under the law and who will continue to rely on a patchwork of federal and state prevention programs whose funding is anything but certain" (Andrews, 11/12). Read the column.

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P.R. For Obamacare Stalls In Illinois, Missouri

The St. Louis Post-Dispatch’s Tara Kulash, working in partnership with Kaiser Health News, reports: "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. And despite assurances by the administration of President Barack Obama that all would be fixed by the end of November, criticism about the site has turned into broad complaints about the Affordable Care Act" (Kulash, 11/11). Read the story.

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Capsules: Washington State To 8,000 Obamacare Enrollees: 'We Goofed On Cost Estimate'

Now on Kaiser Health News' blog, The Seattle Times' Amy Snow Landa, working in partnership with Kaiser Health News, reports: "About 8,000 Washington residents will soon receive letters informing them that the price they are expecting to pay for health insurance purchased on the new online exchange marketplace is incorrect. The letters are part of an effort by the Washington Health Benefit Exchange, which operates the exchange, to correct a major error that resulted in the miscalculation of tax credits that help qualified enrollees pay for insurance premiums" (Landa, 11/11). Check out what else is on the blog.

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Political Cartoon: 'Boom Times?'

Kaiser Health News provides a fresh take on health policy developments with 'Boom Times?' By Nate Beeler.

Here's today's health policy haiku: 


Federal exchange
enrollees would not fill up
Yankee Stadium.

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

Early Enrollment Numbers Far Below Administration Targets

The projections, which put the total number of enrollees so far at fewer than 50,000 people, are just a fraction of the tally the Obama administration initially was hoping for.

The Wall Street Journal: HealthCare.gov Enrollment Falls Far Short Of Target
Fewer than 50,000 people had successfully navigated the troubled federal health-care website and enrolled in private insurance plans as of last week, two people familiar with the matter said, citing internal government data. The figure is a fraction of the Obama administration's target of 500,000 enrollees for October. The early tally for the HealthCare.gov site, which launched Oct. 1, worries health insurers that are counting on higher enrollment to make their plans profitable (Weaver, Martin and Radnofsky, 11/11).

The Washington Post: About 40,000 Americans Are Said To Have Signed Up For Plans On Healthcare.gov
Roughly 40,000 Americans have signed up for private insurance through the flawed federal online insurance marketplace since it opened six weeks ago, according to two people with access to the figures. That amount is a tiny fraction of the total projected enrollment for the 36 states where the federal government is running the online health-care exchange, indicating the slow start to the president’s initiative. The first concrete evidence of the popularity — and accessibility — of the new federal insurance exchange emerged as the White House has been preparing to release this week the first official tally of how many people have chosen coverage using the Web site, HealthCare.gov (Goldstein and Kliff, 11/11).

NPR: The First Estimate On Insurance Signups Is Pretty Darned Small
The Obama administration later this week will issue much anticipated enrollment numbers for the first month of the Affordable Care Act. But Monday afternoon the Wall Street Journal reported that fewer than 50,000 people have signed up for health insurance in the federal health exchange the during October. Even with the administration's efforts to lowball expectations in recent days, that's a pretty small number. And the while the White House won't confirm it, it's not specifically denying it, either (Rovner, 11/11).

Politico: Early Reports Show Obamacare Enrollment Low
About 40,000 to 50,000 people have enrolled in private health care plans using HealthCare.gov — a range far short of White House hopes, according to new numbers reported by the Wall Street Journal Monday. That figure does not include people who signed up using state exchanges. Avalere Healthcare, a consulting firm, estimated Monday that about 49,000 people had successful enrolled in insurance in 12 of the 15 states running their own insurance exchange. The largest state exchange, California, has not released numbers (Cheney, 11/12).

Reuters: Initial Obamacare Enrollment Estimates Far Short Of Targets: Reports
Initial enrollment estimates for President Barack Obama's healthcare reform program show participation is falling far short of expectations, according to a report in the Wall Street Journal, raising pressure on the White House to get its rollout back on track. Fewer than 50,000 Americans were able to sign up for new Obamacare health insurance plans in October through the error-plagued HealthCare.gov website, below the federal government's target, the newspaper reported on Monday, citing two people familiar with the matter. The data is from 36 states (Humer, 11/11).

Reuters: State Obamacare Exchanges Enroll 3 Pct Of Target So Far – Report
President Barack Obama's healthcare reform has reached only about 3 percent of its enrollment target for 2014 in 12 U.S. states where new online health insurance marketplaces are mostly working smoothly, a report released on Monday said. States with functioning exchanges have signed up 49,100 people compared with the 1.4 million people expected to be enrolled for 2014, according to the report by healthcare research and consultancy firm Avalere Health (Humer, 11/11). 

The Fiscal Times: Low Obamacare Enrollment More Proof Of A 'Disaster'
Robert Laszewski, a consultant to many major insurance companies, said in an interview that about 50,000 people have signed up for coverage in the 36 states that have federally designed insurance markets – or about 10 percent of the overall goal for the first month. That figure closely matches the 40,000 to 50,000 enrollments reported by The Wall Street Journal on Monday afternoon. Laszewski based his estimate on the number of completed transactions between individuals and their families and insurance companies (Pianin and Ehley, 11/12).

Bloomberg: Obamacare Debut Falls Short in Threat to Health Exchanges
The number of people enrolled in private insurance plans through Obamacare’s federal and state exchanges may total less than 100,000, a lower-than-projected tally that could threaten the program’s viability unless the U.S. can repair its flawed exchange website. Officials are set to report numbers this week for both the federal exchange and the 14 sites run independently by the states. While there was an early U.S. goal of about 800,000 sign-ups nationally for the first two months, health officials have recently said they anticipated lower initial enrollment that would increase over time (Wayne & Nussbaum, 11/12).

The Hill: ACA Stats Include Expanded Enrollee Tally
The Obama administration will count individuals who have selected a healthcare plan but not yet sent in their first payment when releasing a count of enrollees in the new healthcare exchanges, an administration official told The Washington Post on Monday. That decision should boost what are still expected to be a paltry number of early enrollees in the embattled ObamaCare plans (Sink, 11/11).

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Insurers Push For Workaround That Would Allow Them To Directly Enroll People

The New York Times reports on this push, which is one of several ways some are discussing to get around the current technology problems plaguing the Obama administration's enrollment effort. Also in the news, The Wall Street Journal reports that some of these difficulties are trickling down from the federal online insurance marketplace to certain state exchanges.

The New York Times: Insurers Press For Way Around Healthcare.gov
Some major health insurers are so worried about the Obama administration's ability to fix its troubled health care website that they are pushing the government to create a shortcut that would allow them to enroll people entitled to subsidies directly rather than through the federal system. The idea is only one of several being discussed in a frantic effort to find a way around the technological problems that teams of experts are urgently trying to resolve (Abelson, LaFraniere and Craig, 11/11).

The Wall Street Journal: Tech Troubles Slow Some State Exchanges
As officials struggle to fix technical problems with the new federally run health-insurance exchange, some states that are operating their own programs are facing similar problems. Oregon hasn't fully opened its website to the public and is directing residents to insurance brokers and counselors. Maryland officials Friday delayed until April the opening of its small-business exchange, so they could focus on improving a website that has prompted many residents to apply on paper (Ante and Dooren, 11/11).

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Searching For A Fix To The Canceled Policy Problem

Politico reports that finding a fix that won't disrupt the insurance market is no easy task. Meanwhile, in California, Anthem Blue Cross has announced that it will grant a two-month extension to a portion of its canceled policyholders.  

Politico: Viable Fix For Individual Market May Be Non-Starter
It's not so easy to repair the White House's broken promise that millions of consumers would be able to keep their insurance coverage under Obamacare, according to several health and insurance industry experts. President Barack Obama apologized Thursday to the Americans who are losing their coverage despite his pledge and has ordered aides to look into options to try to fix the problem. But there are no obvious solutions that would restore their plans without significantly disrupting the insurance market (Haberkorn and Norman, 11/12).

Los Angeles Times: Anthem Blue Cross Extends Some Canceled Health Insurance Policies
Amid an uproar over widespread cancellations of health insurance policies, Anthem Blue Cross of California said it is granting a two-month extension through February to 104,000 customers. California's largest for-profit insurer is offering more time to a small portion of its canceled policyholders because the insurance giant didn't send termination notices in time under state rules (Terhune, 11/11).

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Challenge Of Signing Up Young Adults; Subsidies Key To Insurance Decisions

NewsHour looks at the efforts in Wisconsin to interest the "young invincibles" in health care coverage. Meanwhile, news organizations in Connecticut and Minnesota look at the complicated calculations for premium subsidies.

PBS NewsHour: Wisconsin Aims To Convince 'Young Invincibles' To Sign Up For Health Coverage
Experts have said the success of the Affordable Care Act will depend on Americans aged 18-34 signing up. Often referred to as the "young invincibles," this pivotal, generally healthy demographic must weigh the option of signing up for coverage or paying a fine (Freyberg, 11/11).

The CT Mirror: Teetering At The Obamacare 'Subsidy Cliff'
Martin Klein says he recently got some unusual advice from his insurance agent: Work less. A clinical psychologist who lives in Fairfield, Klein buys his own health insurance. For years, he had the same plan from Anthem Blue Cross and Blue Shield. But recently, he got a letter saying the company was discontinuing the plan and he'd need to buy a new policy (Becker, 11/11).

Minnesota Public Radio: $0 Credit Subsidy Confuses MNsure Consumers
A recent study finds 90,000 Minnesotans are eligible for tax credits if they buy health insurance through MNsure. The tax credits are applied at the outset, bringing down the effective price of health coverage. But being eligible for a credit doesn't mean consumers will definitely receive a credit. The tax credit problem is one of the most asked questions coming into the MNsure call center. That's because there are a lot of moving parts in the tax credit determination (Stawicki, 11/12).

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Medicaid Enrollment Is 'Early Success Story,' But Website's Problems Are Still Causing Sign-Up Difficulties

The Associated Press reports on the larger enrollment in states that are expanding their Medicaid programs. However, The New York Times points out that the snags on the marketplace websites may be holding up thousands of others who will be eligible for the state-federal program for low-income people.

The Associated Press: Medicaid Is Health Overhaul's Early Success Story
The underdog of government health care programs is emerging as the rare early success story of President Barack Obama’s technologically challenged health overhaul. Often dismissed, Medicaid has signed up 444,000 people in 10 states in the six weeks since open enrollment began, according to Avalere Health, a market analysis firm that compiled data from those states. Twenty-five states are expanding their Medicaid programs, but data for all of them was not available (Alonso-Zaldivar, 11/12).

The New York Times: Problems With Federal Health Portal Also Stymie Medicaid Enrollment
Problems with the federal health insurance website have prevented tens of thousands of low-income people from signing up for Medicaid even though they are eligible, federal and state officials say, undermining one of the chief goals of the 2010 health care law (Pear, 11/11).

And in news from the states --

The Associated Press: Illinois Boosts Medicaid Rolls Under Obama Health Law
Although only a few hundred middle-class Illinois residents were able to sign up for health insurance last month on the crippled federal HealthCare.gov website, the poor appear to be having an easier time enrolling in an expansion of Medicaid -- and are doing so by the thousands. Illinois is among states expanding Medicaid under President Barack Obama's health care law. It's the state, not the federal government, that's overseeing efforts to enroll new clients, and state officials have come up with some effective ways to do it -- especially for people already getting food stamps (11/11).

The Associated Press: Judge Sets Date To Hear Medicaid Expansion Lawsuit
A judge will hear arguments in a lawsuit seeking to block Arizona Gov. Jan Brewer's Medicaid expansion plan early next month. Maricopa County Superior Court judge Katherine Cooper set a Dec. 9 date to hear the suit filed in September on behalf of 36 Republican state lawmakers and a pair of citizens. The suit targets Brewer's plan to expand the state's health care program for the poor to about 300,000 additional Arizonans (11/12).

The Associated Press: N.H. Panels Considering Medicaid Expansion Bills
House and Senate committees are holding public hearings on competing plans to expand Medicaid in New Hampshire while legislative leaders work behind the scenes with the governor on a possible compromise. The House holds a hearing Tuesday morning while the Senate's hearing on its plan is in the afternoon. The committees working on the bills will vote on a recommendation Thursday (11/12).

The Associated Press: Enrollment Forms Mailed To Those Losing Medicaid
The state is mailing paper health insurance applications to an estimated 77,000 Wisconsin residents slated to lose Medicaid coverage in January but are having trouble accessing the federal online marketplace. Oshkosh Northwestern Media reported Monday that the move comes amid growing pressure from health care advocates and county officials who are calling on Gov. Scott Walker to take action as the Dec. 15 deadline for enrolling in coverage through the marketplace approaches (11/11).

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Unlike Health Law Counterparts, Young Adults Can't Stay On TRICARE To Age 26

Young adult dependents are not allowed to stay on TRICARE until age 26 unlike under the health law, Fox News reports. Some health law fine print means states have significant leeway in deciding how much or how little dental coverage to offer to children.

Fox News: Military Members, Veterans Missing Out On Key Obamacare Provision
One of the most touted benefits of President Obama's health care overhaul law is the provision allows parents to keep their adult children on their health insurance until age 26. However, Trace Gallagher reported on "The Kelly File" Monday, this benefit is not being extended to a significant group of Americans: members of the U.S. military. TRICARE, the Department of Defense program that provides health coverage to active duty and retired military members and their families, only covers young adult dependents up until age 21, or age 23 if they are enrolled full-time in college (11/11).

Stateline: Kids’ Dental Coverage Uncertain Under ACA
Children’s health advocates were overjoyed when they learned that dental care for kids would be one of the "essential benefits" in the insurance policies on the Affordable Care Act health exchanges.  Suddenly, it appeared possible that combined with other ACA-related changes, as many as 8.7 million children would gain dental coverage by the year 2018. That was before they read the fine print (Ollove, 11/12).

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Capitol Hill Watch

The Political Challenge For Health Law Supporters: Proving The Health Law Is A Success, Rather Than An SNL Skit

For vulnerable House Democrats, the task of blunting criticism of the overhaul is especially important. Meanwhile, House Republicans have a plan to keep playing offense on the issue, with a number of votes planned this week.

Politico: For Hollywood, The Joke's On Obamacare
Obamacare has gone from Hollywood leading lady to comic relief. When the Obamacare exchanges launched last month, celebrities were out front, with everything from nearly topless #GetCovered tweets from young actresses touting affordable care to Funny or Die videos going viral. But since then, amid mounting bad press on everything from the faulty website to the "you can keep it" controversy, Obamacare has become the punch line instead of the star (Kopan, 11/12).

Politico: Obamacare: What Defines Success?
After a month of devastating stories and late-night jokes about the launch of the health care law, the administration needs to convince the public that Obamacare is more than a series of canceled policies and computer hiccups. It's just not clear how the Obama team can convincingly do that, especially now that the early enrollment in the federal website could be as low as 40,000 to 50,000 people, according to the Wall Street Journal — way below the administration's goal. And it's not just President Barack Obama's reputation that's on the line — it's every Democrat who's up for re-election in a year, especially the red-state Senate Democrats who are facing the closest races (Nather, 11/12).

The Associated Press: Health Care Law Could Be Liability For Democrats
Rep. Patrick Murphy had been a cautious defender of President Barack Obama’s health care law for much of the last year, telling constituents in his swing-voting district that the far-from-perfect measure is critical to helping cover uninsured Americans. Then the new health care law made its disastrous debut. The federal health care website repeatedly crashed, blocking millions from browsing insurance plans. Questions about its security mounted. And cancellation notices hit people who buy their own plans, undercutting the president’s vow that those who liked their coverage could keep it (Mishak, 11/11).

The Hill: GOP On ObamaCare Offense
House Republicans hope to keep the White House on the defensive over ObamaCare this week with a vote on legislation allowing people to keep their existing health plans. The GOP has scheduled five healthcare-related hearings over the next three days, each of which is designed to keep the administration on its back foot (Sink, 11/12).

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Lawmakers Face Their Own Health Law Reality: Navigating The Online Exchanges

Lawmakers and some of their aides are preparing to navigate the health law's online insurance exchanges to buy coverage. An Alaskan senator is declining the employer contribution to buy coverage, and some senators will ask for a full investigation of the troubled startup of Healthcare.gov.

The Wall Street Journal: Lawmakers And Aides Start Shopping For Coverage
Members of Congress and some of their staff are about to get personal experience with the Affordable Care Act. The law says they will cease to be eligible for federal government employees' health-insurance plan on Jan. 1. So starting Monday, lawmakers and their aides will be able to sign up for health insurance through a special section of an online marketplace being run by the District of Columbia (Radnofsky, 11/11).

Politico: Mark Begich Declines Health Insurance Subsidy
Sen. Mark Begich, a Democrat facing a competitive reelection race next year, has enrolled in the Obamacare health exchange and has turned down a federal government contribution. "I want to have the exact same experience and go through the same steps as other Alaskans when it comes to signing up for health care, which is why I have decided to refuse any federal subsidy and have signed up on Alaska's federally run marketplace," Begich said in a statement (Haberkorn, 11/11).

Politico: Kay Hagan Seeks 'Complete' Obamacare Probe
Senators will ask the Obama administration for a full investigation into the bungled launch of HealthCare.gov, according to a letter being circulated by Sen. Kay Hagan. The North Carolina Democrat is collecting signatures this week for a letter to Government Accountability Office Comptroller General Gene Dodaro and Health and Human Services Inspector General Daniel Levinson asking for "a complete, thorough investigation to determine the causes of the design and implementation failures of HealthCare.gov" (Everett, 11/11).

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Senate Compounding Pharmacy Oversight Bill Faces 'Obamacare' Test

The Washington Post: Pharmacy Bill Set For Test Vote In Senate
A year after a meningitis outbreak from contaminated pain injections killed at least 64 people and sickened hundreds, Congress is ready to increase federal oversight over compounding pharmacies that custom-mix medications. Before the bill reaches President Obama's desk, it must clear a hurdle put in its path by Sen. David Vitter (R-La.) in his effort to discredit the president's health-care overhaul. A test vote is set for Tuesday evening (Perrone, 11/11).

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Health Care Marketplace

Tech Companies Ready New Tools To Cash In On Health Law Enrollment

Tech companies are preparing new software and apps to cash in on the million of Americans who will soon be making insurance decisions for the first time. In the meantime, how three 20-somethings were able to get an insurance-shopping website up and running when more than 50 contractors could not.

The Wall Street Journal: Tech Startups See Opportunity In New Health Care Law
In the coming months, the Affordable Care Act will produce millions of newly insured Americans, many of whom will be making decisions about health care for the first time. A host of software startups plans to court the newly insured with slick online tools geared toward simple management of personal health (MacMillan, 11/11).

ABC News: 3 Guys, 3 Days To Build A Better Obamacare Website
Three twenty-something programmer dudes did something in three days that 55 U.S. government contractors couldn't do in more than 2 years: Build a workable healthcare.gov website. Health Sherpa lets users quickly shop for health insurance plans by ZIP code, and calculates their federal tax subsidy eligibility. Unlike the federal and state exchange websites, the site does not force users to go through a lengthy sign up and application process to get their information. Instead, users can find what they need by clicking through a few clean, Google-like screens (Neporent, 11/12).

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Editorials and Opinions

Viewpoints: Health Law Foes Wage Battle To Keep Young Adults From Coverage; Sen. Rubio: Website's Snags Could Open The Door To Con Artists

The New York Times: No Health Insurance? Just Drink.
This is the strangest P.R. campaign yet against the Affordable Care Act. Generation Opportunity, the Koch-funded group behind the Creepy Uncle Sam ads, is throwing tailgate parties to "educate" young people about the exchanges. Read: To convince young people to forgo health insurance (Juliet Lapidos, 11/11). 

Los Angeles Times: Did Obama Lie About Healthcare Reform Or Just Omit A Crucial Detail?
President Obama apologized last week to people whose health insurance was canceled despite his repeated assurances that if you like your policy, it won't change. The charitable way of putting it is that Obama oversold details of the healthcare-reform law in his speeches. His critics say he flat-out lied (David Lazarus, 11/11). 

The Washington Post: Obama's Non-Apology
There is nothing to focus the presidential mind like finding out that your Gallup approval rating has dropped below George W. Bush's in the wake of Hurricane Katrina. So little wonder that after spending weeks denying he had promised Americans they could keep their health plans, President Obama finally said the words "I'm sorry." But let's be clear: He didn't really apologize (Marc A. Thiessen, 11/11).

Miami Herald: Protect Americans From Obamacare Con Artists
As Obamacare's website failures push more people toward non-web enrollment options, the same kind of con artists who have been defrauding Medicare, Medicaid and immigrants will be inclined to do the same through Obamacare's navigator network. And as time goes on, we will inevitably see more cases of people fraudulently posing as navigators, collecting personal information and then exploiting innocent victims. And while some states like Florida have taken proactive steps to raise standards for aspiring navigators and toughen consumer protection safeguards, many states have not. This is a recipe for people falling prey to fraud, identity theft or gross incompetence by those operating as Obamacare navigators (Sen. Marco Rubio, R-Fla., 11/11).

The Wall Street Journal: Despite A Botched Rollout, The Health-Care Law Is Worth It
The botched rollout of the Patient Protection and Affordable Care Act (commonly called the ACA or "Obamacare") has been an unmitigated disaster. Choose your favorite adjective: horrible, embarrassing, inexcusable. They all fit. But a badly designed website doesn't signify a badly designed policy. The goals, principles and major design features of the ACA are barely affected by the government's health-exchange website catastrophe. If you liked the basic ideas before, you still should. If you didn't, you still shouldn't (Alan S. Blinder, 11/11). 

Philadelphia Inquirer: Obamacare's Unspoken Intentions Likely To Bring Host Of Unfavorable Results
We are one month into the official roll out of the Affordable Care Act (ACA).  It is quickly becoming clear that the ACA has explicit policies, and the Obama Administration has unspoken intentions that will produce unforeseen consequences for our healthcare system and could have broad societal implications (Howard J. Peterson, 11/11).

Bloomberg: Hope Is All Obamacare Has Left
Just how bad could this get? Well, here's one scenario, maybe not the most likely, but possible: The exchanges aren't ready by Dec. 1. In fact, they continue to experience problems in January and February. The administration's poll numbers continue to plummet, and the reputation of the exchanges is such that come spring, young people don't bother to sign up -- or are afraid to hand over their personal data to such a buggy system. The insurance pool is much smaller, older and sicker than expected, which is to say, much more expensive than expected (Megan McArdle, 11/11).

USA Today: Medicaid's Awful Results
As the Obamacare debacle rolls on -- looking even worse than it did a week ago, if that's possible -- there's a separate but related issue involving Medicaid expansion. ... Insurance programs, whether Obamacare or Medicaid, only provide coverage. It's doctors who provide care. But because government insurance programs -- even money-sucking ones like Medicaid, which costs $450 billion a year -- can't pay doctors enough and smother them with paperwork, doctors are hard to find. Without doctors, coverage doesn't mean much (Glenn Harlan Reynolds, 11/11).

The Star Tribune: Reaching Out To Sell Health Care To Somalis
The Friday afternoon call to prayer echoed through the cavernous Somali Mall 24, sending scores of men, and a few women, up the stairs to worship. Others shopped for clothes or jewelry, and a warren of small, dark cafes was filled with men drinking super sweet Somali tea and watching international news on flat-screen televisions. Lucky Ahmed stood at a small table a few feet away from piles of colorful carpets, selling something else that drew the curious. Health care. Ahmed was handing out brochures and answering questions about MNsure, the state’s health care marketplace answer to the Affordable Care Act (Jon Tevlin, 11/11).

The Richmond Times-Dispatch: Obamacare Ends The Doctor-Patient Relationship
It was this relationship between doctor and patient, a basic human bond, that became my own calling. As a result of Obamacare, this relationship is now in danger of becoming a distant memory. Forget about the recent website debacle and the accusations of who in the White House knew what and when; the real problem with Obamacare will be the destruction of this most sacred bond where a doctor and a patient come together to overcome illness and suffering, together (Dr. Travis Shaw, 11/12).

The San Francisco Chronicle: Yes, Health Coverage Costs Less In L.A.
Covered California divided the state into 19 regions. The price in each region mainly reflects the cost of providing health care in that area. Prices are higher in Northern than Southern California "because the provider networks in Northern California are larger, so there is less competition," says Nate Purpura, director of communications with Ehealthinsurance.com. This was true before Covered California and the Affordable Health Care Act came along (Kathleen Pender, 11/11).

Medpage Today: Patient Engagement: Is It Us Or Is It Them?
Much is being made of the Meaningful Use requirement to use secure online messaging to communicate with patients about relevant health information. The new Stage 2 measure requires that more than 5 percent of unique patients seen by the eligible professional during the reporting period were sent a secure message using the electronic messaging function of Certified EHR Technology. But to meet that goal, we have to get our patient population engaged and using our patient portal. Worries about that very thing abound in medical practices of all specialties across all communities (Rosemarie Nelson, 11/11).

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Oversight Investigation Turns Up CMS Memo About 'High' Website Security Risks

But news outlets are reporting that the project manager working on the healthcare.gov website was not made aware of these issues.   

The New York Times: Official At Health Site Says He Didn't Know Of Potential Risk
The chief digital architect for the federal health insurance marketplace has told congressional investigators that he was not aware of tests that indicated potential security flaws in the system.... The official, Henry Chao, made the statement Nov. 1 to investigators for the House Committee on Oversight and Government Reform, led by Representative Darrell Issa of California. ... The [Sept. 3] memo, from Tony Trenkle, the chief information officer at the federal Centers for Medicare and Medicaid Services, noted six security problems, two of which were described as posing high risks (Pear, 11/11).

CBS News: Memo Warned Of “Limitless” Security Risks For HealthCare.Gov
CBS News has learned that the project manager in charge of building the federal health care website was apparently kept in the dark about serious failures in the website's security. Those failures could lead to identity theft among those buying insurance. The project manager testified to congressional investigators behind closed doors, but CBS News has obtained the first look at a partial transcript of his testimony (Attkisson, 11/11).

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State Highlights: U. of Va. Hospital CEO Says Health Law Could Cost Millions; D.C. Hospital Cutting Jobs

A selection of health policy stories from Virginia, the District of Columbia and California.

Modern Healthcare: Reform Update: States Make Progress In Medicaid Parity Payments
States are making progress carrying out a provision of the health care reform law that calls for increasing Medicaid primary-care payments for 2013 and 2014 to match what Medicare pays. Anecdotal evidence has suggested that few physicians were getting the promised pay bump (Robeznieks, 11/11).

The Associated Press/Washington Post: U.Va. Medical Center CEO Says Hospital Could Lose Millions Of Dollars Under ACA
The University of Virginia Medical Center's CEO says provisions of the federal health care law could cost the hospital hundreds of millions of dollars over the next decade. Chief executive officer R. Edward Howell tells The Daily Progress that a reduction in Medicare reimbursements could cost the hospital $140 million by 2020. He says much of the money is used to pay for recent medical school graduates' residencies (11/11).

The Washington Post: MedStar Washington Hospital Center to Cut Jobs, Citing Financial Pressures
MedStar Washington Hospital Center, the region's largest private hospital, is cutting jobs because of mounting financial pressures, a hospital spokeswoman said Monday. A first round of management positions was eliminated Thursday, and non-management employees whose jobs are being cut will be informed Tuesday, said Donna Arbogast, vice president of public affairs. None of the positions to be cut involve bedside nurses, she said (Sun, 11/11).  

California Healthline: Ballot Proposals Take Aim At Hospitals
A California union filed paperwork Friday to launch two ballot measures that would curb salaries of hospital executives and impose limits on the prices hospitals charge for care. The proposals were submitted Friday to the state Attorney General's office in Sacramento by representatives of the Service Employees International Union-United Healthcare Workers West union. It's the first step in a long process to try to get the measures on the November, 2014 ballot (Gorn, 11/11).

California Healthline: How Can State Hasten Payment Reform?
According to the California Scorecard on Payment Reform released last month, almost 42 percent of commercial payments to providers in California are tied to how well the providers deliver care, measuring quality, outcomes and efficiency. Compared with a national average of about 11 percent in the National Scorecard on Payment Reform released in the spring, California is ahead of the curve. However, the 42 percent of providers who are reimbursed for care based on value in California are countered by the 58 percent reimbursed for the number of tests and procedures they perform. We asked stakeholders what California can do to hasten and improve health care payment reform (11/11).

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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.