Daily Health Policy Report

Wednesday, November 13, 2013

Last updated: Wed, Nov 13

KHN Original Reporting & Guest Opinion

Health Reform

Capitol Hill Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Medicaid Questions Delay Some Health Insurance Purchases In Colorado

Reporting for Kaiser Health News and NPR, Eric Whitney writes: "If you want to find somebody who's really happy with the Affordable Care Act, meet Colorado's Medicaid director, Sue Birch. Colorado has been enrolling just under a thousand people a week in new private health insurance since its Obamacare marketplace opened. But the number enrolling in Medicaid is ten times that" (Whitney, 11/13). Read the story.

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Capsules: Medicaid Chief Thanks State Leaders, Even As They Skip Expansion Option; Emails Ask Those Who Failed To Try Healthcare.gov Again; Why Some People Can’t Keep Their Insurance Plans

Now on Kaiser Health News’ blog, Phil Galewitz offers this report from a meeting of state Medicaid directors: "It wasn't all hugs and kisses,  but the nation’s top Medicaid official on Tuesday told Medicaid directors from around the country that she was proud of the job they were all doing — even though half of their states opted against expanding the state-federal health insurance program for the poor under the health law. 'Hats off to you,' Cindy Mann, director of the federal Center for Medicaid and CHIP, told a meeting of the National Association of Medicaid Directors. 'I am enormously encouraged by the commonality of purpose'" (Galewitz, 11/13).

In addition, on PBS NewsHour Tuesday, KHN’s Mary Agnes Carey discussed why insurers are canceling many individual insurance policies, the political fallout and what options consumers have for finding affordable insurance plans. You can watch the report (11/13).

Also on the blog, Marissa Evans reports on an effort by the Centers for Medicare & Medicaid Services to connect with people who started the healthcare.gov enrollment process, but couldn't finish: "Roughly 275,000 'come back, we miss you' emails will be sent in waves this week encouraging consumers who couldn’t create an account or log-in to the  malfunctioning Healthcare.gov website to try again, officials at the Centers for Medicare & Medicaid Services said Tuesday" (Evans, 11/12). Check out what else is on the blog.

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Political Cartoon: 'Rained In?'

Kaiser Health News provides a fresh take on health policy developments with "Rained In?" by Adam Zyglis.

Here's today's health policy haiku: 


You're a Democrat?
And Clinton is on your case,
Ya gotta worry!

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

Healthcare.gov Troubles Continue To Claim Headlines

The Washington Post offers a not-so-rosy progress report on repairs to the federal online health insurance marketplace. Other news outlets examine what went wrong in terms of the project management and what might be gleaned from the soon-to-be released enrollment numbers.  

The Washington Post: Troubled Healthcare.gov Unlikely To Work Fully By End Of November
Software problems with the federal online health insurance marketplace, especially in handling high volumes, are proving so stubborn that the system is unlikely to work fully by the end of the month as the White House has promised, according to an official with knowledge of the project. The insurance exchange is balking when more than 20,000 to 30,000 people attempt to use it at the same time — about half its intended capacity, said the official, who spoke on the condition of anonymity to disclose internal information. And CGI Federal, the main contractor that built the site, has succeeded in repairing only about six of every 10 of the defects it has addressed so far (Goldstein, Eilperin and Sun, 11/12).

Politico: The Making Of An Obamacare Management Failure
In the days after HealthCare.gov went live, White House chief of staff Denis McDonough quietly dispatched Jeff Zients, a favorite West Wing fixer, to assess the operation and report back. When Zients did, President Barack Obama learned the project was in worse shape than suspected — riddled with coding problems, management issues and communication gaps, according to a senior administration official. It was only then that Obama and his top aides realized the extent of what they didn't know (Budoff Brown, 11/12).

CNN: What Will Obamacare Enrollment Numbers Tell Us About Its Health?
Technical failures have plagued HealthCare.gov since its October 1 launch, although officials say it's slowly getting better. White House spokesman Jay Carney says enrollment numbers "will be lower than we hoped and we anticipated." Just how low and what effect all of those online roadblocks had on enrollment remain to be seen. But what will the numbers mean about the health of Obamacare? (Aigner-Treworgy, 11/12).

Meanwhile, administration officials are urging healthcare.gov users to give the website another try -

NPR: Administration Invites HealthCare.gov Users To Try Again
If at first you don't succeed, try again. That's the message from the White House on Tuesday, with the Centers for Medicare & Medicaid Services (CMS) asking more than 275,000 people who tried and failed to sign up for health plans on the stalled HealthCare.gov website to give it another shot (Neuman, 11/12).

Politico: HHS To Obamacare Website Shoppers: Please Come Back
The Obama administration is asking people frustrated by early application problems with HealthCare.gov to give the website a second chance. So they're reaching back out to the earliest HealthCare.gov shoppers who may have given up on the broken website after the awful Oct. 1 launch, hoping they'll try again (Millman, 11/12).

Bloomberg: Obamacare Web Users Invited By U.S. To Try Signup Again
About 275,000 people who tried and failed to sign up for Obamacare health plans are being asked by the U.S. government to return to the website as the software flaws that initially shut them out are being corrected. People are being contacted this week in a "series of e-mails in waves" to avoid too many getting on the website at the same time, Julie Bataille, a spokeswoman for the Centers for Medicare & Medicaid Services, told reporters today on a conference call. Additional people who weren't able to complete applications on the insurance exchange will be solicited later (Wayne and Nussbaum, 11/12).

Kaiser Health News: Capsules: Emails Ask Those Who Failed To Try Healthcare.gov Again
Roughly 275,000 "come back, we miss you" emails will be sent in waves this week encouraging consumers who couldn’t create an account or log-in to the  malfunctioning Healthcare.gov website to try again, officials at the Centers for Medicare & Medicaid Services said Tuesday (Evans, 11/12).

McClatchy: Officials Appeal To Frustrated HealthCare.Gov Users: Come Back
Confident that repairs to its HealthCare.gov website are progressing as planned, the Obama administration has begun notifying some 275,000 people who couldn’t enroll in coverage at the troubled website's Oct. 1 debut to try again. "Those consumers who have perhaps created an account, but not submitted an application; those consumers who have submitted an application, but not selected a plan; those would be the kinds of individuals that we anticipate reaching out to and speaking with directly over time," said Julie Bataille, the communications director for the federal Centers for Medicare & Medicaid Services (Pugh, 11/12).

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Bill Clinton Says Health Law Should Be Changed

Comments by the former president piled pressure on to the White House's efforts to find a solution to the policy cancellations that may affect several million consumers who buy their own insurance. His statements were immediately pounced upon by Republicans.

Los Angeles Times: Bill Clinton Says Americans Should Be Able To Keep Their Health Plans
In an interview released Tuesday, former President Bill Clinton said President Obama should make sure Americans can retain their current health insurance plans, even if it means revamping the Affordable Care Act. "I personally believe, even if it takes a change to the law, the president should honor the commitment the federal government made to those people and let them keep what they've got," Clinton told OZY, a news website (Little, 11/12).

The Associated Press: Clinton: Obama Should Honor Health Care Pledge
The former president, a Democrat who has helped Obama promote the 3-year-old health law, becomes the latest in Obama's party to urge the president to live up to a promise he made repeatedly, declaring that the if Americans liked their health care coverage, they would be able to keep it under the new law. Instead, millions of Americans have started receiving insurance cancellation letters. That, coupled with the troubled launch of the health care law’s enrollment website, has prompted Republican critics and frustrated Democrats to seek corrections in the law (Kuhnhenn, 11/12).

The Wall Street Journal: Bill Clinton Says Health Law May Need To Be Changed
Mr. Clinton's remarks come amid growing unease among Democrats about a balky website performance, low enrollment levels and mounting cancellations of existing policies by health insurers. Democratic lawmakers, who successfully beat back efforts to repeal the law, now worry that they will be blamed for its problems at the ballot box. Insurers, who have sent thousands of cancellation notices to people, say the policies aren't compliant with new requirements for coverage and have changed too much since 2010 to be eligible for a "grandfathering" exemption that allows some people to keep plans that existed before the law was passed (Schatz, 11/12).

Politico: Obama's Critic-In-Chief Strikes Again
President Bill Clinton — the man President Barack Obama once dubbed his "Secretary of Explaining Stuff" — once again has some explaining of his own to do with the Obama White House. In an interview released Tuesday, Clinton called for a fix to the Affordable Care Act that would put an end to the wave of insurance cancellations that have been a public relations disaster for the White House and prompted Obama to apologize last week for having repeatedly assured Americans that they could keep their insurance if they liked it (Gerstein, 11/12).

Reuters: With A Nudge From Bill Clinton, Democrats Seek To Tweak Health Law
The growing pressure on President Barack Obama to adjust his problem-plagued healthcare law seemed to boil over on Tuesday, as leaders of Obama's Democratic Party called on him to allow a change in the law so that Americans who are happy with their health plans could keep them. In what became the clearest sign yet of Democrats' increasing anxiety over the troubled rollout of the healthcare law, former President Bill Clinton told the web magazine Ozymandias that Obama should support such a change to fulfill a promise he and his administration have made to Americans for years (Rampton and Ferraro, 11/12).

The Fiscal Times: Bill Clinton Just Undercut Obama's Health Plan
With former President Bill Clinton now urging President Obama to find a way to make good on his promise that Americans could keep their current health insurance plans if they like them, it may only be a matter of time before the administration is forced to make wholesale changes in the beleaguered Affordable Care Act to placate restless Democrats fearful of a growing voter backlash. ... [White House spokesman Jay] Carney pooh-poohed any suggestion of a fundamental disagreement between Clinton and Obama and told reporters that the former president was still Obamacare's "explainer-in-chief." However, Carney dodged the question of whether the two men share views on possible solutions (Pianin, 11/13).

McClatchy: GOP Seizes On Clinton's Remarks Urging Obama To Keep His Health Care Promise
House Speaker John Boehner, R-Ohio, applauded Clinton for joining a bipartisan call for Obama to act. "These comments signify a growing recognition that Americans were misled when they were promised that they could keep their coverage under President Obama’s health care law," Boehner said (Kumar, 11/12).

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With Political Pressures Increasing In Response To Health Law Roll-Out And Policy Cancellations, The White House Spin Machine Moves Into Overdrive

News outlets report on the pressure coming from both Democrats and Republicans regarding what some are calling President Barack Obama's "broken promise."

The New York Times: Obama In Bind Trying To Keep Health Law Vow
Under intense bipartisan pressure to answer mounting consumer complaints about the botched health care rollout, White House officials are struggling to make good on President Obama’s promise that Americans can keep their insurance coverage without undermining the new health law or adding unaffordable costs (Shear and Pear, 11/12).

Politico: White House Fires Up Its Obamacare Spin Machine
But after the website debacle, the bad press of people losing their health plans and President Barack Obama’s defense and then walk-back of his “if you like your plan, you can keep it” slogan, the White House has a tougher job on its hands. There’s essentially no avoiding a bad news cycle, but there are ways to mitigate the damage (Epstein, 11/13).

NPR: With Pressure From All Sides, Obamacare Vise Tightens On Dems
Democrats at the White House and in Congress find themselves in an ever-tightening vise over all those canceled health insurance policies. House Republicans plan a vote as soon as Friday on a bill that would allow people to keep health plans they like, just as President Obama said they'd be able to (until it became clear they couldn't) under the Affordable Care Act (James, 11/12).

The New York Times’ Political Memo: Fighting To Stop An Entitlement Before It Takes Hold, And Expands
Underlying fierce Republican efforts to stop President Obama’s health care law and the White House drive to save it is a simple historical reality: Once major entitlement programs get underway, they quickly become embedded in American life. And then they grow (Harwood, 11/12).

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Will Healthcare.gov Troubles Slow Medicaid Expansion Too?

Medicaid sign-ups, part of the health law working the way many officials thought it should, could also be hurt by technological malfunctions. But one state is finding the opposite to be true. In the meantime, states consider new Medicaid expansions or report on how many new Medicaid enrollees are signing up.

Politico: Obamacare Glitches Shadowing Medicaid
Another under-the-radar Obamacare malfunction could stymie January health coverage for some of the nation's poorest people, state Medicaid officials say. And that's casting a shadow on one of the parts of the Affordable Care Act that's actually working quite well -- sign-ups for Medicaid, which is being expanded under the health law (Cheney, 11/13).

Kaiser Health News: Medicaid Questions Delay Some Health Insurance Purchases In Colorado
If you want to find somebody who's really happy with the Affordable Care Act, meet Colorado's Medicaid director, Sue Birch. Colorado has been enrolling just under a thousand people a week in new private health insurance since its Obamacare marketplace opened. But the number enrolling in Medicaid is ten times that (Whitney, 11/13).

The Associated Press: Wis. Assembly OKs Mental Health Medicaid Expansion
The Wisconsin Assembly has approved a bill that would expand Medicaid coverage for mental health treatment. The measure would allow an emotionally disturbed child to access in-home therapy without having to show a failure to succeed in outpatient therapy; allow families to participate in in-home therapy even if a child in that family is enrolled in a day treatment program; and allow Medicaid reimbursement for mental health service providers who work with patients through interactive video and audio links (Wayne and Nussbaum, 11/12).

The Associated Press: 73 Percent Of HealthSource Signups For Medicaid
Seventy-three percent of enrollees in Rhode Island's new health insurance marketplace in the first month signed up for Medicaid rather than private insurance plans (11/12).

The Associated Press: Food Stamp Outreach Raises Illinois Medicaid Enrollment
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 Milwaukee Journal Sentinel: Tammy Baldwin Seeks More Time For Shift From BadgerCare To Obamacare
U.S. Sen. Tammy Baldwin on Tuesday warned Gov. Scott Walker that thousands of low-income Wisconsin residents are at risk of losing health coverage, and urged him to keep them on BadgerCare Plus through March by extending a key deadline for enrolling in the new federal exchange. Baldwin also called on the governor to expand the Medicaid program temporarily at no cost to the state to offset any costs linked to delaying that deadline (11/12).

The Associated Press: NH House Panel Working On Medicaid Expansion Plan
A New Hampshire House panel is getting more information on how long it took Arkansas to obtain federal permission to expand Medicaid to its poor adults by using private insurance. The Finance Committee on Wednesday is working on a plan to expand Medicaid to an estimated 49,000 poor New Hampshire adults and wants to hear from a consultant working with the Insurance Department who also played a role in developing Arkansas' plan (11/13).

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State Marketplaces Still Plagued By Technical Problems

The New York Times examines how states running their own insurance exchange websites are doing. Meanwhile, USA Today looks at how insurance choices vary across the country.

The New York Times: Some State Insurance Exchanges Continue To Battle Technical Problems
Six weeks into the rollout of President Obama's new health care law, some of the online insurance exchanges run by states are continuing to have serious technological problems, often mirroring the issues plaguing the much larger federal exchange (Goodnough and Abelson, 11/12).

USA Today: For Some Areas, Insurance Plan Choices Are Paltry
Some counties in the U.S. have almost 30 times more choices of health insurance plans than others do, a stark example of the lack of competition in many parts of the country as consumers try to shop for affordable coverage on the new federally run exchanges. USA Today analyzed data from Healthcare.gov, the federal health insurance exchange selling plans for 34 of the states that didn't set up their own exchanges. The analysis clearly shows the impact of insurers' hesitancy to move into states where they aren't already doing business (O’Donnell and Overberg, 11/12).

In news from the states --

Los Angeles Times: Washington State Is Making Health Exchange Work
More than 55,000 people in Washington state enrolled in health coverage in October -- most in Medicaid -- and about 40,000 more applied for coverage, making the Evergreen State one of the brightest success stories in the rocky national rollout of the federal health law. Here in the home of online shopping giant Amazon.com, officials credit the exchange's success in part to the Pacific Northwest's high-tech bent (La Ganga, 11/12).

Seattle Times: Healthplanfinder Tax-Credit Goof Was $100 On Average
If you enrolled in a health plan through Washington Healthplanfinder last month and were given a tax credit to help cover the cost, you might want to check your Healthplanfinder account. The Washington Health Benefit Exchange, which operates the online exchange marketplace, has begun posting notices to the Healthplanfinder accounts of about 8,000 state residents affected by an error that caused a miscalculation of their tax credits (Landa, 11/12).

The Associated Press/Wall Street Journal: N.Y. Says 197,000 Have Applied In Health Marketplace
New York's new online health exchange reports 197,011 New Yorkers have completed applications to get insured, while 48,162 have subsequently enrolled in plans, nearly half in the government-funded Medicaid program for low-income New Yorkers. The exchange, which opened Oct. 1 as the state's response to the federal Affordable Care Act, includes low-cost plans for individuals and small businesses with coverage starting Jan. 1 (11/12).

The CT Mirror: Connecticut Is Only State Enrolling More in Private Insurance Than Medicaid Under Obamacare
Connecticut is the only state in the country in which more people have applied for private coverage than Medicaid through the health insurance exchange, an exchange official said Tuesday. James Wadleigh, Access Health CT's chief information officer, said the state's exchange has taken more than 11,000 applications for individual and small-business coverage. About 6,000 are for private insurance customers, and about 4,700 will receive Medicaid (Levin Becker, 11/12).

Health Policy Solutions (a Colo. news service): Exchange Revamp Not Likely Till Mid-December
Health exchange board members on Monday pressed for immediate improvements to Colorado's mandatory Medicaid application, but state officials, who contend that Colorado is a "shining example" among the states, refused to promise that a full slate of short-term fixes will be completed before Dec. 15. That's the deadline for customers to buy health insurance if they want it to kick in on Jan. 1. And Colorado now could have as many as 1 million customers who need it. New data from the statewide Colorado Health Access Survey estimate Colorado has 741,000 uninsured people while the Colorado’s Division of Insurance recently reported that 250,000 Coloradans have received cancellation notices and presumably will want new coverage (Kerwin McCrimmon, 11/12).

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Policy Developments: SCOTUS Won't Hear Appeal Of Ruling Striking Down Okla. Abortion Law

The Supreme Court won't hear an appeal of a ruling striking down an Oklahoma abortion law that would have required pregnant women to have an ultrasound before having an abortion. In the meantime, The Washington Post fact-checks an insurance premium claim by HHS Secretary Sebelius. 

Los Angeles Times: Supreme Court Decision Disappoints Abortion Foes
For the second week in a row, the Supreme Court let stand a ruling that strikes down a major abortion regulation from Oklahoma, disappointing abortion foes who had hoped conservative justices would impose new limits on a woman's right to terminate a pregnancy. The justices Tuesday turned down Oklahoma's appeal seeking to revive a law that would have required pregnant women to undergo an ultrasound and hear about the fetus' size and possible heartbeat (Savage, 11/12).

The Washington Post's The Fact Checker: Sebelius's Claim That Insurance Premiums Are 16 Percent Lower Than CBO Projected
Estimates from the nonpartisan Congressional Budget Office are considered the gold standard in Washington. The budget impact of every bill voted on by Congress is calculated by CBO analysts -- and their findings often make a difference in whether legislation passes or not. That’s why politicians often tout CBO’s estimates. So we were curious last week when Secretary Sebelius cited a CBO projection of insurance rates -- and how actual premiums turned out to be lower than expected. What’s the source of this factoid? (Kessler, 11/13).

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State Regulators Explore Options On Insurance Plan Cancellations

Oregon regulators rejected calls to push back the cancellation dates of 140,000 health insurance policies in the state, even as momentum to delay the cancellations builds among California officials and some national Democratic figures. Meanwhile, PBS NewsHour explores the reasons for the cancellations of policies which are sold directly to individuals. 

The Oregonian: Oregon Insurance Commissioner Says State Won’t Delay 2013 Health Coverage Cancellations
State regulators have rejected an idea to push back the cancellation dates of more than 140,000 Oregonians' health insurance policies despite public confusion and momentum among California officials and some national Democratic Party leaders to do so. But despite confidential discussions over the last week between insurance executives and top state officials of potential changes that included a mandatory three-month delay of cancellations, Oregon Insurance Commissioner Laura Cali has decided against the idea for now due to logistical difficulties (Budnick, 11/12).

The Associated Press: Calif. Insurance Commissioner: More Than 1M Californians Having Insurance Cancelled Due To ACA
Health insurer Anthem Blue Cross of California has agreed to a two-month extension of about 104,000 individual policies after failing to give the required 90-day cancellation notice, state Insurance Commissioner Dave Jones announced Tuesday. The policies had been set to expire on Dec. 31 but will be extended until Feb. 28 for those who choose to re-enroll. Notices informing customers of the extension will be sent out this week, Anthem said (11/12).

PBS NewsHour: Understanding Why Americans’ Insurance Plans Are Being Canceled
Despite being happy with her health care plan, Deborah Persico of Washington, D.C., received notice that her insurance policy was being canceled. To understand some setbacks and some successes of the law Judy Woodruff speaks with Mary Agnes Carey of Kaiser Health News (Woodruff, 11/12).

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Health Law Outreach Efforts Try New Enrollment Tactics, Controversial Ads

Colorado officials launch controversial ads geared toward women and Enroll America changes how it tries to get people to sign up for health coverage. In the meantime, Republicans are releasing their own set of ads mocking the law.

The Wall Street Journal's Washington Wire: OMG: Sequels to 'Brosurance' Ad Target Women
While many of the new spots feature messages on the benefits of insurance for children, expectant moms and others, some of the ads are more provocative. One ad has the title "Let's Get Physical," with the text: "OMG, he's hot! Let's hope he's as easy to get as this birth control. My health insurance covers the pill, which means all I have to worry about is getting him between the covers." Another ad, playing on a Ryan Gosling meme, starts, "Hey girl, you're excited about easy access to birth control and I'm excited about getting to know you." Colorado runs its own health exchange under the new federal health law. The spots from the Colorado Consumer Health Initiative and ProgressNow Colorado Education target 20-somethings -- the young, healthy demographic needed to keep rates down -- and are designed to be shared on social media such as Twitter and Pinterest (Hanrahan, 11/12).

The Wall Street Journal’s Washington Wire: With Healthcare.gov’s Woes, Enroll America Adjusts Its Pitch
Enroll America, a group whose sole focus is help people sign up for insurance programs through Obamacare, is readjusting its outreach campaign as HealthCare.gov works out its technological problems. The group, which has been running a “Get Covered America” grassroots campaign, plans to launch a “Coverage is Coming” campaign in December, when the Obama administration has said the website’s biggest problems will be fixed (Dooren, 11/12).

McClatchy: Republicans Release New Ads Mocking 'Obamacare'
Republicans released a new round of comical web ads attacking the health care law's bungled rollout. The Republican National Committee videos are set to run on ESPN and Comedy Central YouTube pages in college towns. An earlier round of ads ran last month. The ads mock Obama on his promise that people buying insurance on the individual market would be able to keep their plans if they liked them and Health and Human Services Secretary Kathleen Sebelius's congressional testimony (Kumar, 11/12).

And in California --

California Healthline: Groups Gear Up For Big Enrollment Events
An estimated 1,500 people attended an enrollment fair over the weekend in Sacramento. That may be the largest event of its kind but definitely not the last of its kind, organizers said. … Dayanna Carlos, a program associate with the California Endowment, said the Endowment has set up enrollment events this size in the past but this had a little extra zip, she said, because it was the first one since Covered California opened enrollment Oct. 1. The Endowment has hosted events in Oakland, Riverside, San Bernardino and San Diego over the past two years to help people enroll in existing programs, such as the Low Income Health Plan (Gorn, 11/12).

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Swept Up In Healthcare.gov's Troubled Launch, The 'Mona Lisa Of Health Care' Speaks

Identified only as "Adriana," the woman whose face appeared on the federal online insurance website says she does not understand the reasons behind the mockery and speculation of which she became the focus.

ABC News: Exclusive: Obamacare's Mystery Woman Says She Fell Victim To Cyberbullies
On Oct. 1, 2013, when the ACA's website launched to enroll Americans in health insurance through federally run exchanges, it was Adriana's face that greeted them. Dubbed the "enigmatic Mona Lisa of health care," her face was soon mocked, Photoshoped, altered. She became the subject of late-night jokes, partisan hatred and intense speculation. "I mean, I don't know why people should hate me because it's just a photo. I didn't design the website. I didn't make it fail, so I don't think they should have any reasons to hate me," Adriana told ABC News (Phillip, 11/13).

The Associated Press: Healthcare Website Model Felt Bullied By Critics
The model whose face appeared on the much-maligned Obama health care website says she felt intimidated by harsh public criticism of the program. The woman, who identified herself only as "Adriana" in an interview with ABC News, says she was never paid for appearing on the website's home page (11/13). 

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Capitol Hill Watch

Issa Panel To Grill Top Tech Official About Health Law Rollout

Rep. Darrell Issa, R-California, who heads the House oversight committee, plans to put the nation's chief technology officer, Todd Park, on the hot seat today about the flawed rollout of the government website where consumers are supposed to be able to buy health insurance. The New York Times writes that Issa has long been one of the most aggressive thorns in the side of the Obama administration.

The New York Times: Health Law Rollout Provides Rich Target For Oversight Chief
Representative Darrell Issa has long been known on Capitol Hill as one of the most aggressive — some would say overzealous — thorns in the side of Obama administration, using his seat as chairman of the House oversight committee to trumpet any missteps that can be traced to the White House (Lipton and Stolberg, 11/12).

Los Angeles Times: Obama’s Top Tech On House Panel Hot Seat
Todd Park, the nation's chief technology officer, is the top tech expert in the U.S. government and the face of President Barack Obama's effort to bring the federal bureaucracy into the iPad era. The onetime entrepreneur, a 40-year-old wunderkind with two startups in his rearview mirror, is a Silicon Valley success story. But House Republicans are seeking to add a new chapter by forcing him to answer for one of the nation's highest-profile technology debacles: the flawed federal health insurance website (Parsons and Hennessey, 11/12).

The Wall Street Journal: White House Tech Team Missed Health-Site Alert
Even before he took office in 2009, President Barack Obama knew the government had problems with technology. So he introduced the concept of a White House "SWAT team," designed to swoop in and rescue big projects before they became disasters. … Members of Congress are zeroing in on White House Chief Technology Officer Todd Park, whose position was created by Mr. Obama. Rep. Darrell Issa (R., Calif.), the House oversight committee chairman, subpoenaed Mr. Park to testify at a Wednesday hearing, and the White House said late Tuesday that Mr. Park would comply (Nagesh, 11/12).

The Associated Press/Washington Post: House Panel Investigates Whether White House Played A Role In ‘Obamacare’ Technology Debacle
Probing whether the White House shares blame for health-care website woes, the House’s chief investigator is delving into technical issues behind the dysfunctional rollout of HealthCare.gov. Rep. Darrell Issa, R-Calif., the chairman of the House Oversight and Government Reform Committee, will explore concerns about online security in the sixth major congressional hearing since President Barack Obama’s computerized insurance markets went live Oct. 1 and millions of consumers encountered frozen screens (11/13).

Politico: Darrell Issa Panel To Grill Tech Officials On Obamacare
Obama administration tech gurus will get a rare time in the spotlight when they testify about the failed Obamacare rollout at a House hearing Wednesday. Congress has heard from the lead contractors on the HealthCare.gov project and top health officials. But the House Oversight and Government Reform hearing Wednesday will be the first time that five administration officials who were directly engaged with the technology behind the dysfunctional site will face questions in public about what went wrong (Norman and Villacorta, 11/13).

Reuters: Obama Tech Chief To Testify In Congress About Healthcare Website
A top White House technology adviser will testify at a congressional hearing on Wednesday about the troubled launch of the website at the heart of President Barack Obama's signature healthcare reform despite the administration's assertions that he was too busy. The White House confirmed late on Tuesday that Todd Park, its chief technology officer, would comply with a subpoena to testify at a hearing of the Republican-controlled House of Representatives Oversight Committee (Rampton, 11/12).

CBS News: Congress Turns Up The Heat In Hunt For Obamacare Answers
The House Oversight and Government Reform Committee invited five administration officials to testify Wednesday morning on the rollout of HealthCare.gov, the dysfunctional website that serves as a portal to the Obamacare marketplaces for consumers in 36 states. One person they expect to hear from is Henry Chao, HealthCare.gov's chief project manager at the Centers for Medicare and Medicaid Services (CMS). According to excerpts CBS News obtained of closed-door testimony that Chao gave the committee earlier this month, he said he was unaware of a memo that laid out major security risks with the program (Condon, 11/13).

The Hill: Issa’s Next To Take A Swing At Botched ObamaCare Rollout
House Oversight Committee Chairman Darrell Issa (R-Calif.) will take his turn at hammering the rollout of ObamaCare on Wednesday when his panel hears testimony from five administration witnesses. The hearing will mark the culmination of a strategic assault on President Obama’s healthcare plan by congressional Republicans (Viebeck, 11/13).

Politico: Issa Panel Turns To Obamacare Tech
Henry Chao, the deputy IT chief at the Centers for Medicare and Medicaid Services, the agency responsible for overseeing the website project, was deeply immersed in the nitty gritty of HealthCare.gov. A long-time CMS official who has served under both Democrats and Republicans, Chao is also in a position to address some of Issa’s key allegations. The White House announced Tuesday night that its chief technology officer, Todd Park, will testify. The administration initially refused to make Park available this week, saying it would divert him as he’s immersed in helping lead the repair work for HealthCare.gov (Norman, 11/13).

Meanwhile, tech experts express skepticism that healthcare.gov can be fixed in less than three weeks --

The Fiscal Times: No Hope Left For Obamacare’s Website, Techies Say
According to tech experts, the sorry state of the current website does little to inspire confidence that it can be fixed and functional in less than three weeks. “When I visited healthcare.gov on October 1, that was the worst piece of software I’ve ever experienced in my life,” said Luke Chung, founder and CEO of the software company FMS. “It had nothing to do with too many users. It couldn’t serve one user.” According to Sumit Nijhawan, CEO of Infogix, a data security firm working with private insurers, even if the White House can fix the problems associated with the site, they're going to find new ones immediately. Nijhawan also warned that the systems that allow CMS and health insurance companies to exchange information are nowhere close to being ready, meaning tech problems could last years (Francis, 11/13).

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Some Democrats Supporting GOP Bill Allowing Americans To Keep Canceled Health Plans

Democrats consider or profess their support for a Republican plan that would allow Americans to keep their canceled health insurance plans. In the meantime, fights continue to rage over the health law's navigators, and in political races.

The Associated Press: John Barrow Becomes First Democrat To Support House GOP's 'Keep Your Health Plan Act'
Rep. John Barrow (D-Ga.) became the first Democrat to support House Republicans' "Keep Your Health Plan Act" on Tuesday, backing a bill that would allow Americans to keep their current health insurance plans amid the Obamacare rollout. Health plan cancellations have drawn widespread criticism, after President Barack Obama promised Americans, "if you like your plan, you can keep it." (Alman, 11/12).

Roll Call: Hoyer 'Not Closed' To Voting for Upton Obamacare Bill
Just minutes before the White House slammed a House GOP bill aimed at President Barack Obama's "if you like it, you can keep it" promise regarding health care plans, the No. 2 House Democrat said he was open to supporting the proposed change to the Affordable Care Act. House Minority Whip Steny H. Hoyer’s willingness to consider voting for the bill, scheduled for floor consideration on Friday, underscores the difficulty many Democrats face in wanting to deal with the dust-up over health insurance policy cancellations while still supporting the president (Dumain, 11/12).

Fox News: Top Democrat Joins Push To Keep Health Plans After Clinton's Obamacare Critique
Sen. Dianne Feinstein, D-Calif., said Tuesday she is cosponsoring a bill by Sen. Mary Landrieu, D-La., that would force insurance companies to reinstate canceled policies that Obama repeatedly vowed that people could keep. "The Affordable Care Act is a good law, but it is not perfect," Feinstein said in a statement. "I believe the Landrieu bill is a commonsense fix that will protect individuals in the private insurance market from being forced to change their insurance plan” (11/13).

Fox News: Cornyn Calls For Halt To Obamacare Navigators On Heels Of Undercover Video
Republican Sen. John Cornyn -- citing Health Secretary Kathleen Sebelius' recent admission that felons potentially could become Obamacare navigators as well as new undercover video showing questionable behavior by these officials -- called Monday for the program to be halted. Cornyn ripped the program after conservative activist James O'Keefe released a new video that appears to depict Obamacare navigators, in Cornyn's home state of Texas, encouraging applicants to fib on their applications (11/12).

Politico: A GOP Split Over Obamacare In Louisiana Race
Since the start of Barack Obama's presidency, Republicans have marched in lock step in opposition to his health care plan. That's not the case in Saturday's special election for a northeast Louisiana congressional seat, however. In a conservative district that spans a massive part of the state, Obamacare has emerged as a bold dividing line between two Republicans who have sharply broken over key stipulations in the law (Isenstadt,11/12).

Politico: Tax Writer Dave Camp Wages Own Battle Of Sorts Against Obamacare
Dave Camp is waging a different sort of battle against Obamacare. His Republican colleagues are finally getting traction in undercutting the president’s signature health-care law, and that’s proving to be unexpectedly bad news for the Ways and Means Chairman. That’s because some of his fellow Republicans now don’t want him to release his long-awaited tax reform bill for fear it will allow Democrats to change the subject (Faler, 11/13).

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Editorials and Opinions

Viewpoints: Some Who Supported Health Law Learning First-Hand About The Downsides; Small Businesses Not Finding Better Deals; Clinton Should Know There Is No 'Magic Solution'

Los Angeles Times: Obama Supporter Miffed At Botched Healthcare Rollout
Margaret Davis of West L.A. voted for President Obama and appreciates the ideas behind the Affordable Care Act. She agrees that everyone should have access to healthcare and no one should be denied coverage because of pre-existing conditions. But here's the problem: She knows firsthand, as the new law of the land rolls clumsily into being, that it's not working out to everyone's advantage (Steve Lopez, 11/12).

The Wall Street Journal: ObamaCare Questions Nobody Asked
"If we had to do it all over again . . . there would have been a whole lot more questions that were asked," President Obama told NBC last week. In this now-famous TV interview, Mr. Obama was referring to his health-care rollout, but there are plenty of other questions somebody should have asked. Here are a few: During the 2008 primary race, Mr. Obama, you rejected Hillary Clinton's proposed individual mandate. You said if health insurance were a good deal, nobody would have to be forced to buy it. ... why implement the mandate in a way that forces many people to buy insurance at inflated prices (a bad deal) in order to subsidize others? (Holman W. Jenkins Jr., 11/12). 

The New Republic: Bill Clinton Is Wrong. This Is How Obamacare Works.
[Former President Bill Clinton] made a statement that's likely to create some misimpressions about the possibilities of health care reform, while giving the administration and its allies yet another political headache. But maybe it's also an opportunity to have a serious conversation about the law's tradeoffs—the one that should have happened a while ago. ... Clinton’s statement makes it seem as if there is some simple way to let people keep their current plans—to avoid any disruption in the existing non-group market while still delivering the law’s benefits. As readers of this space know, no such magic solution exists (Jonathan Cohn, 11/13).

The Wall Street Journal: Small Business And Obamacare
One of President Obama's proudest boasts about the Affordable Care Act is that it helps small business. The White House website says the health law "makes it easier for businesses to find better coverage options" and "stops insurance companies from taking advantage of you, giving the consumer and business owner more control and making health-care coverage more affordable." Small businesses aren't buying it (11/12).

The New York Times' Economix: The Slow Death Of The Employer Mandate
Students of health reform can be informed and entertained by revisiting a book by the health reform champion John E. McDonough. As a member of the Massachusetts House of Representatives from 1985 to 1997, Mr. McDonough had worked for state health reform well before the now famous Romneycare health reform of 2006. During that time he also earned a doctorate in public health. Like many other former legislators, he wrote a book about his experiences and relationships in office. "Experiencing Politics" (published 13 years ago) organizes his stories around social science models of the political process, including the principal-agent model and punctuated equilibrium theory (Casey B. Mulligan, 11/13).

The New York Times: Trouble For The Contraception Mandate
With a ruling on Friday by the Seventh Circuit, a total of five federal circuit courts have weighed in on religious challenges to the health care law's contraception mandate. It now seems virtually certain that the Supreme Court, which is due to consider pending petitions for review on November 26th, will agree to decide the issue this term (Dorothy J. Samuels, 11/12).

The Wall Street Journal: Peggy Noonan's Blog: Obamacare Is The Story
Republicans should stop taking the boob bait of the press. The story of the day is ObamaCare and the pain it is causing the Democrats. That story is not being fully explored. We are not seeing pieces on Capitol Hill Democrats rethinking their four-year-long lockstep backing of a program that is failing massively and before the nation's eyes. ... The focus of political journalism now should be on what's happening on the Democratic side, because ObamaCare is a Democratic program. They bought it, they built it, what now? (Peggy Noonan, 11/12). 

The Washington Post: A Reversal Of Fortune For Democrats After Obamacare
Two months ago, polls showed Democrat Kay Hagan leading prospective opponents by double digits in her quest for a second term representing North Carolina in the Senate. So why is she so nervous? Well, her problem begins with Obamacare, ends with Obamacare and has a whole lot of Obamacare in between (Dana Milbank, 11/12). 

The Washington Post's The Plum Line: Dems To White House: Fix Obamacare, And Fast
This Friday, House Republicans are expected to vote on a proposal — championed by GOP Rep. Fred Upton — that would allow insurance companies the option of continuing all existing health plans for a year, in response to the loss of plans that has taken place despite Obama's vow otherwise. The White House points out that this will undermine the law. Dem leadership aides have predicted that some House Dems will vote for the plan. And CNN's Dana Bash stirred up chatter today when she Tweeted that "lots" of House Dems will vote for it if the White House has not put forth its own fix by the end of the week — in effect giving the White House a deadline. Obviously, "a lot" of Dems voting for this proposal would constitute another major Obamacare headache (Greg Sargeant, 11/12). 

The Milwaukee Journal Sentinel: Gov. Chris Christie Calls Obamacare A Failed Policy
The Obamacare rollout has been a failure, but it's too early to say that the exchanges won't work. They need to work because there are too many people without health insurance. Health care is a civil rights issue and a person should not lose everything they worked for because of a medical issue. Christie is starting to position himself as a leader. In the interview he called himself a "can-do" chief executive but he was careful not to label himself as a moderate or a conservative leaning Republican. He doesn't want to give away too much too soon (James Causey, 11/12). 

Health Policy Solutions (a Colo. news service): Obamacare Problems Much Bigger Than Flawed Websites
We should stop and remember that all previous health care acts did not turn on the success of a website. Medicare, Medicaid, ERISA and OMBRA83 never required heavy technological support. To this day, old Blue Cross mainframe software is used to pay Medicare claims and most of the insurance industry's legacy software is in sorry, pitiful shape (Francis Miller, 11/12).

Fox News: At Least One Group Of Americans Loves ObamaCare
Take a quick glance at ObamaCare's busted multimillion-dollar website and the 3.5 million health insurance cancelation notices hitting American mailboxes and you might be tempted to dub the whole thing a disaster. But it's not -- at least not for the politically-connected crony companies and big money Obama fundraisers poaching your tax dollars to fix the debacle they helped create. As CNBC recently put it: "Thanks to ObamaCare, the health-care industry is going to get a big makeover during the coming years and venture capitalists have wasted no time looking for ways to cash in." Put simply, ObamaCare’s complexity and catastrophic rollout create rivers of cash for Obama's cronies. So who are some of the winners in the ObamaCare crony capitalist giveaway? (Peter Schweizer, 11/12).

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JAMA Asks Experts To Examine 'Critical Issues' In Health Care

The Journal of the American Medical Association's current edition, published Tuesday, invited well-known health policy experts to comment on some of the big questions in their fields.

Journal of the American Medical Association: The Toxic Politics Of Health Care
It could be exciting. The ambitious nation that rallied to create the Marshall Plan, get to the moon first, and birth Medicare and Medicaid decides to move toward the health care it needs: universal, responsive, and affordable. But that task does not unite the nation; it rends it into political tatters. Health care reform could have been a moon shot, but instead it is a battlefield: red states against blue, north against south, coasts against the midland, and liberals, who trust in government, against conservatives, who don’t. For me, this battle became personal (Dr. Donald M. Berwick, 11/12).

Journal of the American Medical Association: Toward A New Social Compact For Health Research
Over the past 10 years, US public investment in health research has been erratic. This recent pattern reverses decades of increasing support, initiated by the conviction and persuasiveness of visionary leaders such as Mary Lasker and Sidney Farber and realized through the continued commitment of legislative champions of biomedical science. Between 1999 and 2003, congressional appropriators doubled the budget of the National Institutes of Health (NIH) from about $15 billion to nearly $30 billion. The nominal budget then remained flat for the next 5 years, until the American Recovery and Reinvestment Act (ARRA) injected another $10 billion over 2 years, 2009-2010, a financial pulse that has since dissipated (Dr. Harvey V. Fineberg, 11/12).

Journal of the American Medical Association: Going To The Moon In Health Care
What is the simple, measurable, decades-long vision that will catalyze a transformation in US medicine? The answer today is unclear. Once the notion of universal coverage was medicine's [big hairy audacious goal]. It was clear and simple. It was long range. It was not assured though still attainable. However, it was transformative for the US polity but not really for the US health system. The Affordable Care Act may result in universal coverage, but that goal no longer has the qualities of a [big hairy audacious goal]. The US health care system needs a new [big hairy audacious goal]: ... by the end of the decade, health care costs per person will not grow faster than the economy as a whole (Dr. Ezekiel J. Emanuel, 11/12).

Journal of the American Medical Association: The Disruptive Innovation Of Price Transparency In Health Care
Until very recently, health care in the United States was delivered behind the secure walls of a fortress that kept information on the prices charged for health care and the quality of that care opaque from public view. Over time, enormous and ever-increasing amounts of money have disappeared behind the fortress walls. Much good undoubtedly was done for patients entering the castle in search of succor. But it has been nearly impossible for prospective patients thinking of entering the health care system to know what they or someone else will have to give up in return for whatever care they will receive from the inhabitants of the fortress (Uwe E. Reinhardt, 11/12).

Journal of the American Medical Association: Academic Health Centers And The Evolution Of The Health Care System
Today there are approximately 135 academic health centers (AHCs) in the United States. These institutions exist to ensure sustainable health care through their multifold, integrated missions of patient care, education, and research. Yet AHCs have in some ways contributed to the intractable problems that threaten both their viability and the sustainability of health care. To flourish—indeed to survive—AHCs must reconfigure and transform rapidly and broadly in size, speed, value, and innovation, driven by self-reflection and leadership (Drs. A. Eugene Washington, Molly J. Coye and David T. Feinberg, 11/12).

Journal of the American Medical Association: Unraveling The Physician Supply Dilemma
Over the past decade, physician shortages have worsened, patients’ frustrations have increased, and the profession has molded itself around these new realities. Some forecasters project that the shortages will further deepen, and many organizations and individuals are urging that residency training programs be expanded. But others argue that additional physicians would simply work in places where there are enough already, that additional physicians would induce the demand for unneeded care, that fewer physicians would be necessary if more were primary care physicians, and that any gaps in service could be filled by nurse practitioners and physician assistants. Although desired by many, the expansion of residencies faces a wall of opposition (Dr. Richard A. Cooper, 11/12).

Journal of the American Medical Association: Resolving The Tension Between Population Health And Individual Health Care
Perhaps the de facto organizing principle for US health care—approaching each patient strictly as an individual—is obsolete. The population health approach is an alternative. It aims to improve and maintain health across a defined population. A “defined population” can mean a clinician’s patients or a health plan’s enrollees, but the defined population for the population health approach includes everyone in the community. This Viewpoint addresses 3 related questions. First, can the population health approach improve the outcomes of US health care? Second, for the population health approach to succeed, must it reconcile the needs of the individual and the community? Third, how might these needs become reconcilable? (Dr. Harold C. Sox, 11/12).

Journal of the American Medical Association: Reliable And Sustainable Comprehensive Care For Frail Elderly People
As the incidence of sudden and premature deaths has declined in the United States, the last part of most individuals’ lives has come to be marked by progressive chronic illnesses and diminishing physical reserves that engender self-care disabilities and frailty. Those who live past age 65 years now average 3 years of self-care disability at the end of life, needing long-term services and supports (LTSS). For those living past 85 years old, nearly half will have serious cognitive decline. ... the United States needs arrangements that allow elderly people to live with confidence, comfort, and meaningfulness at a cost that families can afford and the nation can sustain. Failing to meet this predictable demographic change would force frail elderly people to live without critical services, effectively abandoned (Dr. Joanne Lynn, 11/12).

Journal of the American Medical Association: A Health Care Encounter Of The 21st Century
More patients are now living with multiple chronic conditions, but the health care system today is not equipped, nor has it evolved, to provide the integrated and coordinated care that meets the needs of patients of the 21st century (Dr. Denis A. Cortese, 11/12).

Journal of the American Medical Association: Consumers Gaining Ground In Health Care
At long last public and private initiatives are on the verge of giving consumers more information and more fair opportunities when it comes to obtaining health insurance and health care, reducing the uneven care and dysfunctional financing that have long plagued the health care system in the United States. The Affordable Care Act (ACA) is recasting the marketplace for health insurance, allowing consumers who shop on their own to make more informed choices among a better selection of health plans. Health insurers must now play by a different set of rules. Consumers with preexisting conditions are no longer denied insurance. The products for sale are more standardized, and important loopholes such as misleading out-of-pocket maximums have been closed (James A. Guest and Lynn Quincy, 11/12).

Journal of the American Medical Association: The Media And Health Care Reform
As implementation of the Affordable Care Act (ACA) moves ahead this fall, Americans remain startlingly uninformed about the landmark law and its prescriptions for the country’s health care system. Fewer than 4 in 10 adults in a recent national survey were familiar with the new insurance marketplaces at the center of the law. In any democracy, public misunderstanding on this scale is troubling. Still more disturbing, this misunderstanding has helped paralyze policymaking at a critical point for the nation and its ailing health system. Ideological claims and counterclaims, often based on erroneous information, have displaced informed discussion about the trade-offs and compromises necessary in any major legislative reform. The uninformed public and policymaking paralysis are not the product of an information vacuum (Noam N. Levey, 11/12).

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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.