Daily Health Policy Report

Thursday, November 14, 2013

Last updated: Thu, Nov 14

KHN Original Reporting & Guest Opinion

Administration News

Health Reform

Capitol Hill Watch

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Will Low Online Enrollments In The Fall Hobble The Health Law?

Kaiser Health News staff writers Jay Hancock and Phil Galewitz report: "Hope that the health law's online insurance marketplaces will work well enough to enroll millions this fall had already faded before the administration disclosed results Wednesday. News that only 27,000 had signed up for private coverage on the federally run marketplaces through October amplified the doubts" (Hancock and Galewitz, 11/14). Read the story.

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Capsules: Strange Pricing Details Can Bedevil Medicare Beneficiaries; California Bright Spot In Obamacare, Makes Up One-Third Of All Marketplace Enrollees; Video: Health Law Offers Help For Many With Chronic Illness; About 91,000 Enroll In Medicaid As Result Of ACA ‘Woodwork’ Effect

Now on Kaiser Health News' blog, Susan Jaffe reports on this Medicare pricing issue: "Pharmacist Gina Upchurch knows all the ins and outs of the Medicare prescription drug benefit and was sure she discovered something very wrong:  using the government’s online plan finder tool to help seniors compare dozens of 2014 drug policies, she noticed that some insurers charge higher prices for a prescription filled every two or three months compared to the same drug bought every month" (Jaffe, 11/13).

Also on the blog, Anna Gorman reports on California’s enrollment numbers: "Nearly 60,000 Californians have enrolled in insurance plans under the nation’s health law since its launch on Oct. 1, officials from the state’s marketplace announced Wednesday" (Gorman, 11/14).

Meanwhile, Phil Galewitz reports on the "woodwork effect" and Medicaid enrollment: "The Obama administration’s first enrollment report released Wednesday shows the phenomenon is real. It is happening even in Republican-led states that have fought the health law and refused to take advantage of a provision that would expand their Medicaid programs" (Galewitz, 11/14).

In addition, KHN’s Mary Agnes Carey once again joined PBS NewsHour to discuss the implementation of the 2010 health law. Wednesday night’s program focused on what the law means for consumers with preexisting health conditions. Watch the report and check out what else is on the blog.

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Political Cartoon: 'Hoodwinked?'

Kaiser Health News provides a fresh take on health policy developments with "Hoodwinked?" by Nick Anderson.

Here's today's health policy haiku: 


Brown leaves on the ground,
Clinton in the spotlight:
Cycles of nature.

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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Administration News

Obama Faces Trust Issues As A Result Of Health Law Woes

President Barack Obama -- and Democrats, by proxy -- face big political problems as a result of the botched rollout of the insurance website and the debunking of his pledge that Americans could keep their health plans if they liked them. Recent polls have Democrats and Republicans neck-and-neck in midterm election polls, and Fox News reports that half of voters think the president "knowingly lied" about the health law.

The Washington Post: For Obama, Loss Of Trust Over Health Care Law Poses Major Problems for His Agenda, Legacy
Essential elements of Brand Obama in 2008 were trustworthiness and competence, virtues the candidate used to contrast himself with his predecessor, George W. Bush. Obama promised honesty in foreign policy -- no unfounded claims of weapons of mass destruction to justify a military invasion. He pledged precision in governing -- no Hurricane Katrinas. … But his likability among the general public has fallen sharply in recent weeks amid the self-inflicted problems with implementation of his health care law (Wilson, 11/13).

Politico: Obamacare Decision Time For Democrats: Fight Or Flight
A White House under siege. A signature policy initiative turning into an embarrassing public spectacle. Dissent within the president's own party that threatens to turn into a full-blown revolt. For Republicans, such a moment came in 2005, as the party faced a daunting midterm election under the shadow of the disastrous Iraq War and a presidency in the dumps. For Democrats, the fear now is that the Affordable Care Act’s clumsy rollout -- complete with a botched enrollment website and a debunked presidential pledge that Americans could keep their existing insurance plans -- could produce a similar rout at the ballot box, with candidates dragged down by President Barack Obama’s dropping job approval and dimming public perceptions of the law known as Obamacare (Burns and Glueck, 11/13).

The Wall Street Journal's Washington Wire: Poll: Health Care Woes Wipe Out Democrats' Lead
The controversy surrounding the rollout of the health-care law has wiped out the ratings boost Democrats received from last month’s government shutdown, with a new poll showing voters are now split on whether they would vote for a Democrat or a Republican in midterm elections. A Quinnipiac University poll has voters divided 39 percent-39 percent on which party they would vote for in a generic matchup. That's a significant shift from last month, when an Oct. 1 poll showed 43 percent of voters would choose a Democrat, versus 30 percent who would choose a Republican (Ballhaus, 11/13).

The Fiscal Times: How Democrats Could Kill Obamacare
The White House needs to convince 7 million people to sign up for coverage in order for Obamacare to work as intended, according to the Congressional Budget Office. His most pressing task, however, might be convincing Democrats that Obamacare can be salvaged. Millions of voters have lost their insurance, and millions more are expected to lose it in the coming months and years, according to a McClatchy report. They’re letting their displeasure with the law be known, sending shivers up the spines of vulnerable Democratic lawmakers (Francis, 11/14). 

Politico: President Obama's Trust Gap
Six weeks of website follies and anger that the president either misspoke or made a bungled oversimplification of his claims that people could keep health care plans they like appear to have damaged the core of the Obama brand more than Hillary Clinton, John McCain, Mitt Romney or five years of sustained attacks on his presidency ever did (Dovere and Epstein, 11/13).

Fox News: Fox News Poll: Half Think Obama 'Knowingly Lied' To Pass Health Care Law
Half of voters believe President Obama "knowingly lied" when he repeatedly told Americans they could keep their plans under his signature health care law. Obama repeatedly vowed that under the Affordable Care Act, "If you like your health care plan, you can keep it.  Period." Fifty percent of voters believe the president knew he was lying. Four in 10 think Obama didn’t know the law would cause people to lose their insurance (40 percent) (Blanton, 11/13). 

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Health Reform

HHS Health Insurance Enrollment Figures Far Below Targets

Only about a fourth of the enrollees signed up through the federal health exchange. The low initial sign up could set up a steep challenge for the health law.

The New York Times: Only 106,000 Pick Health Insurance Plans In First Month
Only about a fourth of the new enrollees — 26,794 — signed up through HealthCare.gov, the problem-plagued federal exchange, according to figures released by the Centers for Medicare and Medicaid Services. A much larger number, 76,319, signed up through the 14 state-run marketplaces (Stolberg and Craig, 11/13).

Los Angeles Times: Obamacare Enrollments Far Below Targets
Newly released figures show enrollments for coverage under President Obama's healthcare plan fell far below official projections, underscoring the damage inflicted by the botched rollout and further endangering the administration's support among restive Democrats on Capitol Hill. Just 106,185 Americans successfully enrolled in health coverage in October. The administration had hoped to get half a million people signed up in Obamacare's first month. About a third of the enrollments — 35,364 — came from California (Mascaro, Levey and Memoli, 11/13).

The Washington Post: Administration: 106,000 Enrolled In Health Insurance In First Month Of Healthcare.gov
Slightly more than 106,000 Americans signed up for health plans in the first month of new state and federal insurance marketplaces, the Obama administration reported Wednesday. The figure, which was far lower than the administration predicted, points to the steep challenge ahead as the White House tries to overcome public and congressional frustration with the program’s problem-plagued rollout. The tally showed that just a quarter of the enrollments were in the federally run marketplace, while the rest were in the state exchanges (Goldstein and Kane, 11/13).

NPR: The Health Care Numbers Are Out, And They're Disappointing
The Obama administration released its much anticipated enrollment numbers for the first month of the troubled HealthCare.gov website Wednesday. And as predicted, the numbers were disappointing. Just over 100,000 people managed to navigate the process and choose a health plan between Oct. 1 and Nov. 2 — 106,185 people, to be precise (Rovner, 11/13).

The Associated Press/Washington Post: Fewer Than 27,000 Health Care Sign-Ups Through Federal Website, 79,000 More In State Sites
Planting a paltry number on a national disappointment, the Obama administration revealed Wednesday that just 26,794 people enrolled for health insurance during the first, flawed month of operations for the federal "Obamacare" website. Adding in enrollment of more than 79,000 in the 14 states with their own websites, the nationwide number of 106,000 October sign-ups was barely one-fifth of what officials had projected — and a small fraction of the millions who have received widely publicized private coverage cancellations as a result of the federal law (11/13).

The Wall Street Journal: Obama Administration Gives First Month Health-Site Tallies
The news that only 106,185 people nationwide were able to get through the sites in a month comes as a significant blow to the administration. In one memo, it had projected some 500,000 people would obtain private-insurance coverage nationwide. The Congressional Budget Office projected in May 2013 that seven million people nationwide would sign up for private plans by the end of March 2014 (Radnofsky and Ante, 11/13).

Politico: Takeaways: Obamacare By The Numbers
The Obama administration did everything possible to dress up the ugliness of the first month of Obamacare enrollment numbers — adding in people who haven’t even paid and throwing in figures that have nothing to do with actual signups. The one true bright spot is there seems to be interest, so enrollment could pick up in the coming months, just like the White House always said it would (Nather, 11/13).

McClatchy: Only 25% Of New Health Care Enrollees Signed Up On Federal Website
Just 26,794 people managed to complete enrollment on HealthCare.gov, the problem-plagued federal government website, which serves as the portal for consumers to enroll in insurances plans available through the federal marketplace. The federal enrollment figure was in line with the “very low” numbers that Health and Human Services Secretary Kathleen Sebelius had projected in recent congressional testimony. Technical problems with the website have frustrated users, as many became stuck and were unable to create the personal accounts required for enrolling in coverage. The problems have vexed people across the country working to enroll consumers (Pugh, 11/13).

PBS NewsHour: Initial ACA Enrollment Numbers Come Up Short Of Expectations
Technology chiefs in charge of HealthCare.gov were grilled by lawmakers on Capitol Hill about the problematic rollout of the website. Kwame Holman reports on their testimony, while Judy Woodruff talks to Mary Agnes Carey of Kaiser Health News about the lower-than-expected enrollment numbers for the insurances exchanges (Holman and Woodruff, 11/13).

The Fiscal Times: Obamacare: How The Federal And State Exchanges Stack Up
California, the state with the largest population of uninsured, saw more than 35,000 individuals select an insurance plan, by far the most of any state – and thousands more than the federal exchange covering 36 other states. In North Dakota, by contrast, just 42 people signed up through the federal exchange, and just 58 people signed up in South Dakota. Enrollments in the California exchange plans have accelerated since the beginning of November, state officials announced Wednesday in releasing numbers that cover a broader time period than those released by the U.S. Department of Health and Human Services (Rosenberg, 11/14).

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California Beating All Other States In Health Law Exchange Enrollment

California is the bright spot in enrolling people in the health law's insurance exchanges -- beating even the federal Healthcare.gov in how many have signed up. Still, California's enrollment figures -- representing about a third of all signups around the nation -- mean less than 1 percent of uninsured Californians have signed up for plans.

The New York Times: California Health Exchange Beats All Others in Enrollment, Officials Say
In its first month of business, California's insurance exchange enrolled more people than any other state-run exchange and more than the federal exchange serving 36 states, which has been paralyzed by technological failures. About 2,000 people are enrolling in private health plans daily through California's exchange, officials there said, a rate that has picked up considerably over the last few weeks (Goodnough, 11/13).

Kaiser Health News: Capsules: California Bright Spot In Obamacare, Makes Up One-Third Of All Marketplace Enrollees
Nearly 60,000 Californians have enrolled in insurance plans under the nation's health law since its launch on Oct. 1, officials from the state's marketplace announced Wednesday (Gorman, 11/14).

Los Angeles Times: State Is On Track With Its Health Sign-Ups 
In contrast to lackluster results so far in the troubled federal exchange, California said it remains on track to reach its enrollment goals by having signed up 131,000 people in private health insurance or Medicaid through the state's marketplace. California's first enrollment figures, released Wednesday, marked a rare bright spot for the Obama administration as it faces intense criticism over its error-prone enrollment website and millions of consumers getting insurance cancellation notices because their coverage doesn't meet requirements of the Affordable Care Act (Terhune and Brown, 11/13).

The Associated Press: Only 35,000 Enrolled In First Month Of California Health Care Exchange
California's new health insurance exchange tentatively enrolled 35,000 people during its first month of operation, a fraction of the eventual goal in the state with the nation's largest uninsured population, federal health officials said Wednesday. A report released by the U.S. Department of Health and Human Services provided the first glimpse into the operations of Covered California, which faces a monumental task to reach millions of people without insurance and sway them to sign up under the federal Affordable Care Act (11/13).

The Hill : Calif. Beats 36 States Combined In Obamacare Enrollments
California registered more ObamaCare enrollments in October than the 36 states served by HealthCare.gov combined, according to figures released Wednesday. The striking contrast highlights the shakiness of the federally facilitated health care exchanges relative to their -- mostly -- stronger state-run counterparts (Vieback, 11/13).

The California Health Report: Covered CA Enrolls 31,000 In First Month 
California’s new online insurance marketplace signed up 31,000 customers in the first month it was open for business and another 18,000 in the first two weeks of November, officials said Wednesday. That’s less than 1 percent of the number of people without insurance in the state, but California, through Nov. 2, still accounted for more than a third of those who signed up for insurance nationwide under the Affordable Care Act, President Obama’s signature program to overhaul the health insurance industry. Peter Lee, executive director of CoveredCa.com, said 75 percent of those who enrolled in California in October did so despite not being eligible for tax credits offered by the federal government to help make coverage more affordable (Weintraub, 11/13).

News outlets in other states consider how many -- or how few -- in their states have signed up --

Georgia Health News: Sign-Up Figures Tell Disappointing Tale 
An additional 396,000 people were deemed eligible either for Medicaid or the Children’s Health Insurance Program under the law, including 7,709 in Georgia. That comes despite the fact that Georgia is not expanding its Medicaid program under the Affordable Care Act. About half the states have opted to expand the program for the poor. Cindy Zeldin of consumer advocacy group Georgians for a Healthy Future said Wednesday that the enrollment figures “weren’t a surprise, given the technical problems with the website.’’ Major new programs often get off to a slow enrollment start, said Zeldin, an ACA supporter (Miller, 11/13).

The Chicago Sun-Times: 1,370 Illinoisans Enrolled In Obamacare In First Month 
In Illinois, 1,370 individuals have enrolled and selected a plan through Nov. 2, and 30,901 have completed the information on the application necessary to determine whether they qualify for tax credits, but have not yet purchased a specific plan. That amounted to 56,636 Illinoisans who could be covered by those completed applications. "We have consistently urged Illinois residents to take their time getting educated, rather than make an impulsive decision on something as important as health care for themselves and their families," Jennifer Koehler, the director of the Illinois Health Insurance Marketplace said. "When HealthCare.gov is ready to handle more users, we expect to see more website traffic to Get Covered Illinois and significant growth in our enrollment numbers" (Thomas, 11/13).

Houston Chronicle: Only 3,000 Enrolled So Far For Obamacare In Texas
Fewer than 3,000 Texans selected a health insurance plan in the first month of enrollment for the Affordable Care Act, according to much-anticipated federal data released Wednesday (Hines, 11/14).

Miami Herald: Obamacare Count: 100,000 So Far, 3,500 In Florida
More than 106,000 eligible people -- including about 3,500 in Florida -- selected a health insurance plan in October using the federal- and state-based marketplaces that are key to the Affordable Care Act, the U.S. Department of Health Human Services reported on Wednesday (McGrory, Borns & Chang, 11/14).

The Milwaukee Journal Sentinel: Wisconsin's Obamacare Tally: 877
The Obama administration released figures Wednesday on participation so far in the health insurance marketplaces set up through the Affordable Care Act. In Wisconsin, 877 people had picked a health plan sold on the federal marketplace as of Nov. 2, according to the Department of Health and Human Services. In addition, 19,098 electronic and paper applications to cover 34,678 people had been completed, with 8,911 people determined to be eligible for subsidized coverage (Boulton, 11/13).

The CT Mirror: Feds: Fewer Than Half Of Obamacare Applicants Qualify For Subsidies 
According to the federal figures, Connecticut’s exchange, Access Health CT, received 12,337 applications from Oct. 1 through Nov. 2. Because some of the applications were for family coverage, the number of people represented by those applications is 18,815. About a third of Connecticut’s applicants -- 6,490 -- were deemed eligible for the state’s HUSKY program, which provides Medicaid and Children’s Health Insurance Program coverage. The other 12,325 were found to be eligible to buy a private insurance plan through the exchange. Fifty-five percent of those would qualify for subsidized premiums, while the rest would have to pay the full cost of coverage (Becker, 11/13).

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Both Sides In The Health Law Battle Spin Insurance Sign-Up Figures

Health law advocates offered positive messages about the enrollment numbers released Wednesday by the Obama administration while the measure's critics pounced on the low figures and renewed calls for action.

Los Angeles Times: New Obamacare Numbers Give Incomplete Picture, Advocates Say
Some figures released Wednesday on the enrollment of Californians in insurance programs under President Obama's healthcare overhaul exclude many low-income applicants and fail to present a complete picture of those receiving coverage, experts said. Many Californians who qualify for newly expanded government insurance for the poor have been enrolling directly with county health systems. Those enrollees are not included in the preliminary Obamacare participation numbers released Wednesday, officials said (Brown, 11/13).

Los Angeles Times: Obamacare: Critics Seize On Low Enrollment Numbers
Immediately after the numbers were released, House Speaker John A. Boehner (R-Ohio) renewed his call for legislation that would change the law to prevent Americans from losing access to the healthcare plans they currently have. Obama has been looking for ways to make such changes without involving Congress, where Republicans are looking for any opportunity to repeal the entire law (Levey, 11/13).

NBC News: GOP Pounces On Obamacare Enrollment Figure
Republicans hammered the White House on Wednesday for low October Obamacare enrollment, saying the paltry number of Americans who have bought insurance through the new health care exchanges demonstrates that the legislation, as a whole, has failed. The Department of Health and Human Services released data showing that fewer than 27,000 signed up for an Affordable Care Act plan through the federal website Healthcare.gov between Oct. 1 and Nov. 2.  Including those who signed up through state-based exchanges, just over 100,000 Americans have picked health plans through the program (Dann, 11/13).

The Washington Post’s The Fact Checker: The White House’s Happy Tweet About ‘Obamacare’ Enrollment
This tweet from the White House is a great example of trying to make lemonade out of lemons. Let’s explain what these numbers mean — and how the administration has shifted its goals (Kessler, 11/14).

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What The Health Law's Future Holds: Fixing The Website And Everything After

News outlets report on the various ways the website issues and sign-up woes could be addressed, as well as what a variety of experts say about the global outlook for the health law.  

NPR: 6 Ideas Being Floated To 'Fix' Obamacare Sign-Up Woes
As technical problems with the government's new health insurance marketplace slow the pace of sign-up, a variety of "fixes" have been proposed. But some of these would create their own challenges. In rough order from least to most disruptive, here are some of the ideas (Horsley, 11/14).

Kaiser Health News: Will Low Online Enrollments In The Fall Hobble The Health Law?
Hope that the health law's online insurance marketplaces will work well enough to enroll millions this fall had already faded before the administration disclosed results Wednesday. News that only 27,000 had signed up for private coverage on the federally run marketplaces through October amplified the doubts (Hancock and Galewitz, 11/14).

Politico: Fateful Dates Ahead On Obamacare Calendar
Over the next five months, the calendar is loaded with dates and deadlines that will shape the fate of Obamacare. The October enrollment figures released Wednesday underscored the damage done by the health law's technical problems since it launched on Oct. 1; 106,000 signing up in the first 32 days was a poor showing, even by the White House's own admission. The Obama administration insists that the poor numbers can be reversed, momentum restored. Here are some key dates on that road to redemption -- or further dysfunction (Cheney and Millman, 11/13).

The Fiscal Times: 4 Things The White House Still Hasn't Told Us About Obamacare
The White House finally released its much anticipated enrollment numbers on Wednesday, revealing that some 106,000 Americans selected insurance policies on the state and federal health exchanges in October, the first month those marketplaces went live. While the report offers some insight into the demand for the new policies -- about 1.5 million people have applied for coverage -- it lacks specific information, like who is enrolling and how many people have actually purchased plans. In order to determine how Obamacare is really shaping up, the administration must answer these four crucial questions (Ehley, 11/14).

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Why California Could Delay Anthem's Cancellations; Young People's Coverage Costs

NPR examines an administration claim that half of young people can get coverage for $50 per month or less, while California Healthline explores the reasons the state insurance commissioner was able to delay Anthem's cancellations.

NPR: Can Young People Get Obamacare For $50 A Month? Sometimes
For Obamacare to succeed, it's crucial for young people to sign up. Healthy young Americans need to pay into the insurance system to help cover the costs for older, sicker people. So the White House is reaching out. Its website sent emails to subscribers with a big, orange graphic that says half of young people can get coverage for $50 a month or less (Arnold, 11/13).

California Healthline: Insurance Commissioner Explains Reasons Behind Reversing Anthem Cancellations
Insurance Commissioner Dave Jones yesterday laid out the reasons for the premature cancellation of 104,000 individual market health insurance policies by Anthem Blue Cross, and what led the California Department of Insurance to temporarily reinstate those policies. Anthem was cancelling non-grandfathered individual-market policies, the kind of policies people will be able to get with more benefits and possibly lower rates from Covered California. Anthem still plans to cancel them, but it jumped the gun on timing by making the policies end Dec. 31, Jones said. The insurer should have given at least 90 days' notice before cancelling policies, Jones said (Gorn, 11/13).

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Capitol Hill Watch

Congressional Democrats Fuming At White House Handling Of Health Law

An increasing number of these lawmakers say they favor a legislative plan offered by Sen. Mary Landrieu of Louisiana to allow people whose insurance has been canceled because of the law to keep it. 

The New York Times: With Enrollment Slow, Some Democrats Back Change in Health Law
Anxious congressional Democrats are threatening to abandon President Obama on a central element of his signature health care law, voicing increasing support for proposals that would allow Americans who are losing their health insurance coverage because of the Affordable Care Act to retain it. The dissent comes as the Obama administration released enrollment figures on Wednesday that fell far short of expectations, and as House Republicans continued their sharp criticism of administration officials at congressional hearings examining the performance of the health care website and possible security risks of the online insurance exchanges (Parker and Shear, 11/13).

The Associated Press: Low 'Obamacare' Enrollment Causing  Heartburn For Democrats Looking To Next Year's Elections
The White House also is taking a more open approach to changes in the law itself. "We welcome sincere efforts," presidential press secretary Jay Carney said Wednesday at the White House as Democratic impatience grew over a program likely to be at the center of next year’s midterm elections for control of Congress (Espo, 11/14).

The Wall Street Journal: Obama Open To Health-Law Change
In the past, White House officials had said they strongly preferred an administrative remedy to the law's shortcomings. But on Wednesday, officials suggested that President Barack Obama was open to a bill by Sen. Mary Landrieu (D., La.), that would require insurers to continue offering plans that were in existence this year, even if that meant reinstating ones that had been canceled because they didn't meet the health law's standards (Hughes, Hook and Nelson, 11/13).

San Francisco Chronicle: Health Law Brouhaha Pits Feinstein Versus Pelosi
House Minority Leader Nancy Pelosi, a key architect of the Affordable Care Act, is trying to restrain nervous Democrats from backing a measure that could knock the foundations from under the law -- even as erstwhile Democratic allies Sen. Dianne Feinstein of California and former President Bill Clinton endorse similar changes. The changes would allow millions of people who bought health policies on the individual market, including 1 million people in California, to keep their plans even if those plans fail to meet minimum coverage standards under the new law. Insurance companies' mass cancellations of such policies since the law took effect Oct. 1 have been a public relations nightmare for President Obama, who promised repeatedly over the years that no Americans who liked their current plans would be forced to change them under his signature law (Lochhead, 11/13).

The Oregonian: Jeff Merkley Acknowledges He Failed To Foresee Wave Of Health Insurance Cancellations Oregon Sen. Jeff Merkley, acknowledging that he failed to anticipate how the new health care law would lead to a wave of health insurance cancellations, on Wednesday  co-sponsored legislation that would allow consumers to keep their current policies if they want. Merkley, who is up for re-election next year, joined fellow Democratic Sen. Mary Landrieu in pushing legislation aimed at reassuring millions of Americans who have received insurance cancellation notices as the new health care law goes into full effect in January. In a telephone interview, Merkley said that he and other supporters of the 2010 law failed to understand that it didn't have strong enough "grandfather" provisions ensuring that people could keep policies that existed at the time (Mapes, 11/13).

Politico: Senate Democrats Seek Obamacare Balance
Senate Democrats are trying to find a precarious balance on Obamacare by distancing themselves from the law's troubled rollout without running away from it. In dribs and drabs, moderates and liberals, endangered incumbents and lawmakers with safe seats alike are working to get on the right side of increasingly sour public opinion on President Barack Obama's landmark domestic achievement (Everett and Kim, 11/13).

The New York Times: Senator Manchin Takes On Democratic Party Leaders In Pursuit Of A Middle Ground
It has been that way all year for [Sen. Joe Manchin, D-W.Va.], a centrist Democrat from an increasingly Republican state who has shown an impulsive, almost reflexive, willingness to reject the position of his leaders and try to entice fellow senators to a middle ground. Now he is trying to delay parts of the new health care law, the latest effort by Mr. Manchin, a former governor and the grandson of an Italian immigrant, to engage on virtually every issue flaring up on Capitol Hill, just as he did in West Virginia (Weisman, 11/13).

The Hill: Vulnerable Dems Scramble To Keep Distance From ObamaCare
Vulnerable Democrats are scrambling to find ways to stand apart from the White House on ObamaCare as the rollout of the high-profile law continues to struggle -- and threatens their reelections. A number of red state Democrats in the House and Senate are rushing to embrace legislation to amend ObamaCare, seeking to improve parts of the law that have led to public outrage, and insulate themselves from attacks as they head into election year in 2014 (Joseph and Jaffe, 11/14).

Roll Call: Democrats Fume at White House Over Affordable Care Act's Troubles
A broken promise, plunging poll ratings and the disastrous start for HealthCare.gov have rattled President Barack Obama's party, and the impatient rank and file want solutions, not just an apology, from the commander in chief. "There's a brewing revolt among Democrats," said one member of the House Democratic Caucus who spoke on the condition of anonymity in order to describe the scene at Wednesday's closed-door meeting, where members vented their frustration at White House officials for the rocky rollout of the Affordable Care Act (Dumain, 11/13).

The Boston Globe: Obama's Health Care Law Roils Democrats
The White House is scrambling to devise a plan to prevent hundreds of thousands of Americans from losing their health insurance as the growing political damage from President Obama's health care law threatens to divide the Democratic Party over his signature achievement. House Democrats berated White House officials during a private meeting Wednesday, imploring them to devise a way to stop the rash of insurance policy cancellations before they are forced on Friday to take a politically difficult vote on a Republican-sponsored remedy (Bierman and Jan, 11/14).


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House Oversight Panel Grills Administration Tech Officials On Website Woes

The White House's chief technology officer, Todd Park, told the committee that teams are working aggressively to get the website functioning "for the vast majority" of consumers by the administration's Nov. 30 deadline. Meanwhile, a second panel heard testimony about website and security concerns.

The New York Times: Health Website Official Tells Of White House Briefings
The chief digital architect for the federal health insurance marketplace said Wednesday that he met periodically with White House aides to discuss the status of the website over the last three years, but he said the meetings focused narrowly on specific technical issues and therefore gave the president no clear warning of the disaster that ensued on Oct. 1 (Pear and Lipton, 11/13).

Los Angeles Times: Officials Won't Commit To Meeting Deadline For Health Website Fix
A top administration official Wednesday stopped short of guaranteeing that technical issues with the new healthcare website would be largely resolved by the president's Nov. 30 deadline, heightening Democrats' concerns about the political fallout of ongoing problems with the implementation of the new law. Asked whether the government's HealthCare.gov site would be working properly by the end of the month as expected, Chief Technology Officer Todd Park sounded less confident than the recent assurances coming from the White House (Memoli, 11/13).

The Wall Street Journal: White House Aides Grilled On Website Woes
A top White House technology official told a House committee Wednesday that HealthCare.gov can currently handle up to 25,000 website users at the same time. White House chief technology officer Todd Park said technology teams were working aggressively to fix the website and get it working "for the vast majority" of Americans by the Nov. 30 deadline set by the administration.  The federal agency running HealthCare.gov, the Centers for Medicare and Medicaid Services, originally envisioned a site with capacity to handle up to 60,000 concurrent users, Mr. Park said. Heavy usage of the site is expected near the Dec. 15 deadline for people to sign up for coverage effective Jan. 1 (Corbett Dooren and Radnofsky, 11/13).

Politico: Darrel Issa Hearing Shows Obamacare Deadline Slipping
For the few dribbles of information that came out about the Obamacare website at the latest congressional hearing Wednesday, there sure were a lot of fireworks. Members of the House Oversight and Government Reform Committee spent four and half hours at each other's throats. Chairman Darrell Issa snarked his way through several rounds of questions, Democrats complained that Republicans were pointing fingers at the White House without any proof, and Issa accused Democrats of trying to "rehabilitate" Obama administration witnesses (Nather, 11/13).

The Wall Street Journal’s Washington Wire: Official: HealthCare.Gov Shopping Feature Failed 'Miserably'
A feature of HealthCare.gov that would allow consumers to comparison shop for insurance plans without identifying themselves was blocked when the insurance exchange opened on Oct. 1 because it wasn’t working well, an Obama administration official said, denying allegations from Republican lawmakers that it was disabled to prevent "sticker shock" (Dooren, 11/13).

Other testimony examined security issues -

ABC News: Obamacare Website Targeted About 16 Times By Cyber Attacks
The troubled Affordable Care Act website has been subject to "a handful" of hacking attempts, including at least one intended to bring the site down, a Department of Homeland Security official told lawmakers today. But considering that some federal websites get hundreds of cyber-assaults each day, the approximately 16 reported attacks on healthcare.gov is a surprisingly small number, experts said (Newcomb & Larontonda, 11/13).

CNN: Official: Hackers Tried Repeatedly To Attack Obamacare Website
Hackers have attempted more than a dozen cyber attacks against the Obamacare website, according to a top Homeland Security Department official. The attacks, which are under investigation, failed, said the official. Authorities also are investigating a separate report of a tool designed to put heavy strain on HealthCare.gov through a so-called distributed denial of service. It does not appear to have been activated (Johns and Samuel, 11/13).

Politico: New Security Issues Emerge For ACA Site
The government team working most closely to launch HealthCare.gov sought little advice from cybersecurity experts at the Department of Homeland Security — but DHS said it's limited by law in the help it could have provided in the first place. An incensed Rep. Mike McCaul (R-Texas), leader of the House Homeland Security Committee, opened a hearing on the website Wednesday with charges that DHS "has not participated in any meaningful way in developing, monitoring or ensuring the security of HealthCare.gov, the health exchanges or the federal data services hub" (Romm, 11/13).

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State Watch

State Highlights: In Ohio, Enrollment In Expanded Medicaid Will Begin Next Month

In other Medicaid news, federal prosecutors are looking into a recent settlement between the District of Columbia and a former Medicaid contractor.

The Associated Press: Ohioans Can Enroll In Expanded Medicaid Next Month
The state says low-income Ohioans who are newly eligible for Medicaid under an expansion of the program can start signing up for health coverage next month. Gov. John Kasich's administration got approval from Washington in October to extend Medicaid eligibility to those with incomes up to 138 percent of the federal poverty level - or $15,856 for an individual. A legislative panel cleared the way for its funding about three weeks ago (Sanner, 11/13).

The Associated Press/Washington Post: Feds Investigating Settlement Between DC And Contractor, Say City Is Withholding Documents
Federal prosecutors are looking into a $7.5 million settlement between the District of Columbia government and its former Medicaid contractor, businessman Jeffrey Thompson, and the investigation has led to an unusual public spat between the U.S. Attorney and the city’s attorney general (11/13). 

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Editorials and Opinions

Viewpoints: Despite Website Woes, Administration Should Be Given More Time; Health Law Credibility 'Going Up In Smoke'

The Washington Post's Plum Line: What The Obamacare Enrollment Numbers Really Tell Us
The enrollment numbers are in, and as expected, they are well short of projections. Around 106,000 enrolled in new plans during October — with approximately 27,000 coming from states where the federal government is running the exchange (with its extensive problems), and another 79,000 coming through the state exchanges. Republicans are gleefully pointing to the numbers as proof Obamacare needs to be scrapped entirely. That confirms two things we’ve long known to be true: the website is a disaster, and short term enrollment figures are a serious political problem for the White House and Democrats (Greg Sargent, 11/13).

Los Angeles Times: Obamacare's Dismal Stats
The Obama administration made it official Wednesday: The number of people who signed up for health coverage through new state and federal insurance exchanges last month was dwarfed by the number whose policies have been canceled as a result of the 2010 Affordable Care Act. The figures were disappointing but not surprising, considering how badly the federally run exchanges' website, HealthCare.gov, has malfunctioned. Yet as tempting as it may be for lawmakers to delay or reverse some of the changes set in motion by the law, they should give the administration more time to get HealthCare.gov back on track and consumers more time to learn about their options (11/14). 

The Wall Street Journal: The Affordable Care Act 26,794
The White House briefly lifted its Affordable Care Act information embargo on Wednesday, sort of, and now we know why the political pros imposed the blackout. The millions of Americans who are losing their private health insurance greatly exceed the handful who signed up for an ObamaCare plan. ... But don't make too much of the numbers because they're deliberately inflated through junk accounting. A technical footnote in the HHS release explains that the agency is only reporting people who "selected a plan." That means they may or not have paid for it as required (11/13).

USA Today: Obamacare Credibility Going Up In Smoke: Our View
Administration troubleshooter Jeffrey Zients promised the website would be working smoothly for most users by the end of this month. Even if the exchanges begin to work well by then -- a big if -- that will leave people whose insurance policies run out at the end of the year little time to sign up for insurance that kicks in on New Year's Day. ... That's frightening for two reasons. One is that the White House has next to no credibility left when it comes to promises about its website. The other is that the administration's disastrous incompetence is panicking Democrats, emboldening Republicans and threatening to unravel health reform. That would be a sickening outcome, but with each passing day, there is more to do and less time to do it (11/13).

The Washington Post: Obamacare Is In Much More Trouble Than It Was One Week Ago
The Affordable Care Act's political position has deteriorated dramatically over the last week. President Bill Clinton's statement that the law should be reopened to ensure everyone who likes their health plans can keep them was a signal event. It gives congressional Democrats cover to begin breaking with the Obama administration. The most serious manifestation of that break is Sen. Mary Landrieu's "Keeping the Affordable Care Act Promise Act." It's co-sponsored not just by the usual moderate Democrats ... but also by Oregon liberal Jeff Merkley. It's worth noting that Merkley is up for reelection in 2014 (Ezra Klein, 11/13).

The New York Times: Obamacare And Character
The president's job approval numbers have hit new lows. That's actually not the worst news in a new round of polling. The worst news — or what the White House should find most worrisome — is that the president's character has taken a hit (Charles M. Blow, 11/13). 

The Washington Post: Obama Needs His Friends Back
In situations of this sort, there is always a search for an instant repair. "Fix the Web site" is the most obvious, and it's certainly necessary. But a tech problem has been compounded by the reality of health-care reform itself. The small but highly visible individual-insurance market was volatile before Obamacare. It's hardly surprising that some who are in it are angry when plans are canceled and premiums rise. The very purpose of insurance reform is to create a broad market in which the less healthy will be able to get coverage at affordable prices (E.J. Dionne Jr., 11/13).

Bloomberg: Congress Shouldn't Repeat Obama's Mistake
The idea is deceptively simple: Because President Barack Obama promised Americans they could keep their existing insurance under his new health-care-reform law, Congress should pass a law guaranteeing that they can. In reality, though, Obama was wrong to have made that promise -- and Congress would be compounding his foolishness by forcing insurance companies to keep it. The primary goal of the Patient Protection and Affordable Care Act is to make the health-care system more efficient and comprehensive. It has never been to preserve individual insurance plans (11/13).

The New York Times' Evaluations: Does Individual Insurance Work?
Amid this week's hints that the federal exchange still won't be anywhere close to functional on December 1st, Matt Yglesias offers the latest noble attempt to explain to Americans losing their individual-market coverage why they're actually better off paying higher premiums for new, Obamacare-era plans. Instead of focusing on the more comprehensive benefits that the new plans offer, he takes a different tack — suggesting that most people with cheapish individual-market coverage didn't really have insurance at all (Ross Douthat, 11/13).

The Wall Street Journal: Escape From ObamaCare
The Affordable Care Act appears to be misfiring in every imaginable way, and Democrats are having second thoughts about serving as human shields for White House ineptitude. If they really want to make amends, they'll join Republicans in trying to repair some of the damage they caused. The first act of penance is modest legislation the House will vote on Friday that would try to honor President Obama's promise that people who liked their insurance could keep it (11/13).

The Wall Street Journal: Voters May Cancel Democratic Coverage in 2014
The mounting cancellations of people's health plans is not a result of faulty implementation. The Affordable Care Act was designed to make unavailable health-insurance policies that didn't include its extensive, expensive and often unnecessary provisions (Karl Rove, 11/13). 

The Wall Street Journal: A Conservative Alternative To ObamaCare
As ObamaCare's failures and victims mount by the day, Republicans have so far mostly been watching in amazement. ... What Republicans can and should do is offer the public something better. Now is the time to advance a conservative reform that can solve the serious, discrete problems of the health-care system in place before ObamaCare, but without needlessly upending people's arrangements or threatening what works in American medicine (Ramesh Ponnuru and Yuval Levin, 11/13).

The Washington Post: Darrell Issa’s Obamacare Kangaroo Court
No human makes leaps quite like Darrell Issa. He leaps to conclusions. He makes huge leaps of logic. He leaps before he looks. And he invariably leaps right into the White House, alleging high-level political misbehavior and administration corruption for just about everything that goes wrong. On Wednesday, the topic was Obamacare, but the California Republican followed the script he used when investigating "Fast and Furious" gun-running, the Benghazi attack, and IRS targeting: make inflammatory allegations of high-level skullduggery, release selective information that appears to support the case while withholding exculpatory details, then use his chairman’s privileges to turn hearings into episodes of "The Darrell Issa Show" (Dana Milbank, 11/13).

Politico: The Obamacare Lie That Can't Be Fixed
Who knew that the day would come when Bill Clinton would be in a position to lecture President Barack Obama about honoring his word? In an interview with Ozy.com, the former president addressed those millions of Americans getting cancellation notices from their insurance companies, even though Obama had infamously promised that they could keep their plans. "I personally believe," Clinton said, "even if it takes a change in the law, the president should honor the commitment the federal government made to these people and let them keep what they got." Clinton has a black belt in verbal escape hatches and has never been one to let a strict adherence to truthfulness become an obstacle, so his statement hit with extra force (Rich Lowry, 11/14).

Health Policy Solutions (a Colo. news service): Protecting Patients Central To Physical, Behavioral Health Reforms
All this hostility obscures the fact that at the core of these reforms are the health and health care of all Americans — almost half of whom will experience a mental health condition in their lifetime. … More to the point, given recent announcements by insurance companies that they are canceling policies held by hundreds of thousands in Colorado alone, it is vital to understand how this landmark legislation protects all of us by extending and strengthening parity for mental health and substance use disorder services (Michael Lott-Manier, 11/13).

The Fiscal Times: Beyond Healthcare.Gov: Testing The Private Market
One of the numerous "proof's in the pudding" tests for the Affordable Care Act (ACA) will be if the plans offered on state and federal online exchanges are competitive with similar plans on the private market. To test this idea on a practical basis – I'm looking for a plan for my family of four – I sampled some policy quotes on ehealthinsurance.com, a privately run site I've used many times in the past. It's a practical model for how online exchanges can work. It's fast, efficient and easy to contact a live person. The site claims to offer 13,000 plans from more than 150 carriers (John F. Wasik, 11/14).

In other health issues -

The American Prospect: The Supply-Side Economics Of Abortion
Last June, Ohio Republicans quietly slipped a handful of abortion restrictions into the state’s budget, alongside provisions to invest in Ohio’s highway system and a new funding model for the state’s colleges and universities. Eight states, including Ohio, already require clinics that perform or induce abortion to have a “transfer agreement” with a local hospital so that patients can be transported quickly to a more sophisticated medical center in case of an emergency. The budget, which Republican Governor John Kasich signed into law with the abortion provisions intact, included an innovative new rule, making Ohio the first state to prohibit abortion clinics from entering into transfer agreements with public hospitals (Thomson-Deveaux, 11/13).

The New York Times: Don't Give Patients More Statins
On Tuesday, the American Heart Association and the American College of Cardiology issued new cholesterol guidelines that essentially declared, in one fell swoop, that millions of healthy Americans should immediately start taking pills — namely statins — for undefined health "benefits." This announcement is not a result of a sudden epidemic of heart disease, nor is it based on new data showing the benefits of lower cholesterol. Instead, it is a consequence of simply expanding the definition of who should take the drugs — a decision that will benefit the pharmaceutical industry more than anyone else (John D. Abramson and Rita F. Redberg, 11/13). 

Health Policy Solutions (a Colo. news service): Providers Who Address Social Determinants Maximize Patient Outcomes
These social determinants of health, such as income, education, access to quality food and housing, and race or ethnicity, exert powerful influences in our patient’s lives before they ever set foot into our office. It is our responsibility as providers to appreciate each patient’s unique situation and ability to follow through on a treatment plan or access necessary resources (Dr. Paul Melinkovich, 11/13).

The Star Tribune: Rosenblum: Program Sheds Light On Mental Illness Issues
While most individual and small-group policies remain exempt, our state’s new online health insurance exchange, called MNsure, will follow parity in coverage of mental health and substance-abuse issues. “Even more people will get covered,” said a buoyed Sue Abderholden, executive director of NAMI, the National Alliance on Mental Illness Minnesota. But mental health parity is only part of the healing (Gail Rosenblum, 11/13).

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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.