Daily Health Policy Report

Monday, November 18, 2013

Last updated: Mon, Nov 18

KHN Original Reporting & Guest Opinion

Administration News

Health Reform

Capitol Hill Watch

State Watch

Editorials and Opinions


KHN Original Reporting & Guest Opinion

California Sends Incorrect Information To 246,000 Low-Income Patients

Kaiser Health News staff writer Anna Gorman, working in collaboration with McClatchy, reports: "California has mistakenly sent letters to 246,000 low-income residents, warning they may need to find new doctors next year under the state’s newly expanded Medicaid program. The error frustrated counties and community health centers which have repeatedly assured patients they can keep their providers when the Affordable Care Act takes effect in 2014. The patients are part of the state’s 'bridge to reform' program, which was designed to cover uninsured, poor Californians until they became eligible for Medicaid, known as Medi-Cal here" (Gorman, 11/17). Read the story.

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Uninsured In Mich. County Can Pay For Dental Care With Volunteer Work

Kaiser Health News staff writer Phil Galewitz, working in collaboration with USA Today, reports: "Kelly Price knows too well the pain of infected teeth and how they become so sensitive it hurts to eat or drink. He has suffered with that in the past and still has several teeth that need to be extracted, but the 51-year-old unemployed machinist can’t afford to see a dentist. That’s why on a morning last month he was helping out at the Food Bank of South Central Michigan filling bags for weekend meals for needy children with Special K cereal, cans of spaghetti and meatballs, green beans, and a juice drink" (Galewitz, 11/17). Read the story.

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Capsules: Florida Regulator, Blues Plan Agree To Insurance Fix Proposed By Obama; Practical Challenges For Insurers Studying Whether To Extend Canceled Plans

Now on Kaiser Health News' blog, Phil Galewitz reports on news from Florida: "Florida Insurance Commissioner Kevin McCarty said he will allow insurers to adopt President Barack Obama's plan to extend current policies facing cancellation so that consumers can keep the coverage they have now. In fact, he was permitting plans to do that months before the president suggested it" (Galewitz, 11/15).

In addition, KHN’s Julie Appleby appeared on PBS NewsHour Friday and discussed what insurers are weighing as they decide whether or not to extend previously canceled health insurance policies into 2014. Watch the report or check out what else is new on the blog.

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Health Insurers Face An Uncertain Future

The St. Louis Post-Dispatch's Jim Doyle, working in partnership with Kaiser Health News, reports: "WellPoint Inc., the parent of Anthem Blue Cross and Blue Shield in Missouri, took a huge gamble when it dove headfirst into many of the new health insurance marketplaces around the country. Aetna Inc. hedged its bets by entering a patchwork of federal- and state-run health exchanges, but skipped California and New York, two of the most populous markets. UnitedHealth Group Inc., the nation’s largest health insurer, decided to participate in only a dozen or fewer exchanges in 2013. Given the current disarray on the federal-operated website, its strategy may prove wise — or overly cautious" (Doyle, 11/18). Read the story.

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Political Cartoon: 'Caught In The Crosshairs?'

Kaiser Health News provides a fresh take on health policy developments with "Caught In The Crosshairs?" by Darrin Bell.

Here's today's health policy haiku: 


Some rated as good.
But some others, bad – get mad.
Bad ones get less cash.

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

White House Struggles To Save Health Law

The Associated Press reports the president needs breakthroughs on three fronts: the cancellations and technology messes and the crisis in confidence among his own supporters. Meanwhile, The Wall Street Journal reports the White House is probing how the rollout flopped despite what they had believed was sufficient planning.

The Associated Press: Obama Struggles To Save His Cherished Health Law
President Barack Obama's health care law risks coming unglued because of his administration's bungles and his own inflated promises. To avoid that fate, Obama needs breakthroughs on three fronts: the cancellations mess, technology troubles and a crisis in confidence among his own supporters. Working in his favor are pent-up demands for the program's benefits and an unlikely collaborator in the insurance industry. But even after Obama gets the enrollment website working, count on new controversies. On the horizon is the law's potential impact on job-based insurance. Its mandate that larger employers offer coverage will take effect in 2015 (Alonso-Zaldivar, 11/16).

The Associated Press: Obama Health Care Woes Becomes Credibility Fight
Throughout President Barack Obama's first four years in office, he prided himself on his ability to bounce back when much of Washington thought his presidency was in peril. ... This time, the president is fighting to regain trust and credibility with the American people. Those are the same qualities that helped keep him afloat during those earlier battles. ... The widespread problems have spurred questions about the normally cool and confident president's management style and his competence (Pace, 11/17).

Politico: Obamacare's Threat To Liberalism
From the moment of his improbable emergence as a presidential contender seven years ago, Barack Obama has always positioned himself as something better than a politician. And he has always presented his goals for progressive change as something bigger than the bare minimum a Democrat might hope for in a country that skews center-right. So the fiasco of the launch of Obama’s sweeping health care overhaul has put the reputation of Big Government progressivism at risk for at least this generation. And its future now rests on the president’s ability to reverse that debacle and to demonstrate that his approach to covering millions of uninsured Americans is not only an enlightened — but workable — policy. He set the bar himself (Purdum, 11/18).

Los Angeles Times: White House Optimistic Obama Will Bounce Back From Healthcare Glitches
He's vented, attacked, apologized and adjusted. Now, President Obama has one move left in his attempt to salvage the rollout of his healthcare law: hope the website works soon. The White House, knowing a functional website is needed to calm its panicky allies, has now entered the wait-and-see period of its triage after the turmoil that has followed the Oct. 1 rollout. With the latest fix to the law unveiled, a bruising House vote behind them and experts working feverishly on the broken website, administration officials believe they may have weathered the worst (Hennessey and Parsons, 11/16).

The Wall Street Journal: White House Soul-Searches As Errors Mount
The White House has begun a quiet self-assessment in the wake of the troubled health-law launch, recognizing that administration officials missed warning signs and put too much trust in their management practices in implementing a program that is the centerpiece of President Barack Obama's domestic legacy. White House officials want to learn how the rollout flopped, despite what they believed had been sufficient planning, preparation and attention to the issue. Although not a full-bore "forensic" inquiry into what went wrong, the administration aims to organize itself so that "going forward, we don't have these problems," a senior White House official said in an interview (Nicholas and Lee, 9/17).

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Health Reform

Obama Administration's Fix On Policy Cancellations Triggers Confusion Among Consumers, Doubts Among Insurers

News outlets examine the continuing reaction to President Barack Obama's fix as well as how the news is playing on the state level.  

USA Today: After Obamacare Fix, Consumers Remain Uncertain
Cathy Pedersen is in what amounts to health insurance limbo. When President Obama announced a rule change last week to his Affordable Care Act that potentially would allow hundreds of thousands of Americans to keep their old insurance plans, Pedersen saw a glimmer of hope that the inexpensive, high-deductible plan she's been purchasing for nearly 20 years wouldn't be canceled after all (Madhani and Barnett, 11/17).

The New York Times: After Obama Meeting, Insurers Question Plan's Workability
A day after they were caught off guard by President Obama's proposal to prevent cancellation of insurance policies for millions of Americans, top executives of some of the biggest insurance companies emerged from a meeting at the White House on Friday, expressing mixed feelings about whether the idea could work in every state.  The hastily called meeting was an attempt by the White House to address the growing frustration of the nation’s insurers over the administration’s fumbling of the health care law. It came just a day after the president announced on television that insurers could now continue coverage for people whose policies were being canceled because they did not meet the new law’s standards (Abelson and Craig, 11/15).

Politico: States Divided Over Complying With Obamacare 'Fix'
State regulators aren't rushing to President Barack Obama’s rescue after the White House's attempt to fix the rising wave of canceled health insurance policies. The president's decision to extend the renewal window for existing health plans won't work for the millions losing their coverage unless insurers and state insurance regulators give their blessing (Millman and Cheney, 11/18).

CQ HealthBeat: State Leaders, Insurers In No Rush To Embrace Obamacare Fix
State officials and insurers continued to react cautiously on Friday to the Obama administration’s plan to let health insurance companies extend policies that were slated for cancellation under the health care law (Adams, 11/15).

Politico: Insurance Lobby: ACA Fix No Panacea
Two top insurance industry executives bent over backwards on Sunday not to pick a fight with the Obama administration, even as they said the president's latest Obamacare fix will be a real pain for them. Former Sen. Ben Nelson (D-Neb.), the namesake of the infamous and discarded Cornhusker Kickback in the Affordable Care Act who is now the chief executive of the National Association of Insurance Commissioners, said President Barack Obama’s fix to allow insurance companies to continue offering substandard plans through 2014 has no teeth (Epstein, 11/17).

Fox News: Obama's Fix For Canceled Insurance Policies Could Raise Costs, Experts Warn
President Obama's proposal to allow insurance companies to keep offering consumers plans that would otherwise be canceled under the federal health care law could lead to an increase in premiums, according to insurance industry experts and state regulators. America's Health Insurance Plans, the main industry trade group, said Obama's offer comes too late and could lead to higher premiums, since companies already have set 2014 rates based on the assumption that many people with individual coverage will shift over to the new markets created under the law (11/16).

The Associated Press: 4 Questions To Consider About Insurance Extensions
President Barack Obama is trying to make it possible for Americans to keep their health insurance coverage if they like it. But his now infamous promise may not be realistic. … Here's what you need to know if you have received a cancellation notice (Murphy, 11/18).

Some are asking what might happen next -

Politico: Obamacare: So, What Could Go Wrong Next?
The stumble-filled debut of President Barack Obama’s health care law is drawing new attention to the other risks that have been on the radar screen of health care wonks for months. Think health insurance plans sinking under the weight of sick customers, newly insured people being stunned that they still have to spend on health care, and possibly another wave of canceled policies — right before the 2014 elections (Nather, 11/18).

Meanwhile, state officials and lawmakers start taking action -

Kaiser Health News: California Sends Incorrect Information To 246,000 Low-Income Patients
California has mistakenly sent letters to 246,000 low-income residents, warning they may need to find new doctors next year under the state’s newly expanded Medicaid program. The error frustrated counties and community health centers which have repeatedly assured patients they can keep their providers when the Affordable Care Act takes effect in 2014. The patients are part of the state’s "bridge to reform" program, which was designed to cover uninsured, poor Californians until they became eligible for Medicaid, known as Medi-Cal here (Gorman, 11/17).

Kaiser Health News: Capsules: Florida Regulator, Blues Plan Agree To Insurance Fix Proposed By Obama
Florida Insurance Commissioner Kevin McCarty said he will allow insurers to adopt President Barack Obama’s plan to extend current policies facing cancellation so that consumers can keep the coverage they have now. In fact, he was permitting plans to do that months before the president suggested it (Galewitz, 11/15).

The CT Mirror: McKinney Calls For Special Session To Prevent Obamacare Insurance Cancellations
Senate Minority Leader John McKinney, R-Fairfield, introduced Obamacare as a gubernatorial issue Friday by challenging Gov. Dannel P. Malloy to call a special legislative session to allow insurance companies to extend insurance policies slated for cancellation at the end of the year. In a late afternoon press conference, McKinney, a candidate for governor, characterized the Democratic governor as a strong backer of the president on health care, echoing efforts by the national GOP to use Obamacare as a wedge issue in next year's mid-term congressional races (Becker and Pazniokas, 11/15). 

The Oregonian: Oregon Announcement Could Mean Good News For People With Expiring Health Coverage
More than 140,000 Oregonians whose health insurance policies face cancellation on Dec. 31 could soon be able to renew them, but only if their insurers take advantage of a policy reversal on Friday. Insurance Commissioner Laura Cali said insurers can now extend health plans that otherwise were set to be cancelled, meaning many Oregonians who otherwise face higher 2014 premiums could get a break (Budnick, 11/15) .

Georgia Health News: Insurers Try To Figure Out Next Moves
Officials in the state’s insurance industry were busy Friday puzzling over what exactly President Obama’s decision on canceled policies means for them and their customers. "This is going to be a very confusing customer experience,’" said Graham Thompson, executive director of the Georgia Association of Health Plans, an industry trade group (Miller, 11/15).

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What's The Healthcare.Gov Goal? 80 Percent Enrollment Success Rate

Obama administration officials are quietly hoping 80 percent of users will be able to enroll in health insurance plans on the federal health law's healthcare.gov website once it is fixed, The Washington Post reports. In the meantime, other website snags come to light -- a lack of Spanish-language materials and early alarm at some problems at rolling out the site.

The Washington Post: Healthcare.gov Goal Is For 80% Of Users To Be Able To Enroll For Insurance
The Obama administration will consider the new federal insurance marketplace a success if 80 percent of users can buy health-care plans online, according to government and industry officials familiar with the project. The goal for how many people should be able to make it through the insurance exchange is an internal target that administration officials have not made public. It acknowledges that as many as one in five Americans who try to use the Web site to buy insurance will be unable to do so (Goldstein and Eilperin, 11/16).

Los Angeles Times: Health Care Coverage Counselor Stymied By Website Problems 
Passport and tax records in hand, Nela Barboza fiddled nervously with a plastic folding fan as she approached Jessie Orozco's desk. "Buenas tardes," she said cordially. "I'm here to sign up for Obamacare." Orozco, a benefits counselor at St. John's Well Child & Family Center in South Los Angeles, was thrilled. ... The sense of anticipation quickly dissipated. Orozco encountered problems with the state website created for counselors like her. She couldn't find forms in Spanish, the language Barboza best understands. She had trouble estimating the costs Barboza would pay and confirming details of what would be covered (Brown, 11/16).

Los Angeles Times: Emails Show Officials Alarmed By Healthcare.gov Months Before Debut
As work on healthcare.gov -- the federal online portal to sign up for new health insurance plans -- backed up during the summer, employees of the agency responsible for it started to raise alarms. In emails, they listed problems that included "seriously substandard staffing," shoddy work and a lack of coordination between contractors (Tanfani, 11/15).

CBS News: How Will Democrats Deal With Obamacare's Political Fallout?
With the end-of-the-month deadline looming to fix HealthCare.gov, there is a growing realization among President Obama and his allies that they need a long-term strategy to mitigate the rocky rollout of the Affordable Care Act. What exactly that strategy is remains to be seen, but it is increasingly necessary as Democrats grow frustrated with the slow pace of repairs and how that will impact their own political futures (Kaplan, 11/18).

The Washington Post's The Fact Checker: False Claims About A Health-Care Memo Persist Even After Testimony
The committee's news release asserted that a Sept. 3, 2013, memo outlined "serious security vulnerabilities" in the exchange and quoted Chao, who had not seen it before being shown it by committee staff, as saying it "presented a significant risk to the system."  But it turned out that, upon close examination of the memo, it had nothing to do with the parts of the Web site that launched on Oct. 1. Instead, the memo dealt with modules of the Web site that would not be operational until spring of 2014 -- and even when these modules go online, they will not submit or share personally identifiable information (Kessler, 11/18).

Bloomberg: Obamacare Rollout-Rescue Model Seen In Romney's Massachusetts
The flaws plaguing the rollout of President Barack Obama's health-insurance exchanges may matter the least to those the president needs the most. If enrollment in the online marketplaces repeats the pattern set in the Massachusetts exchange that was the model for Obamacare, the young people vital to the plan's financial stability are paying little attention to the federal website's mishaps as they wait for the March 31 deadline to sign up (Dorning, 11/18).

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High-Risk Insurance Pools Gaining Second Life In Some States

The Wall Street Journal reports on developments related to insurance coverage and high-risk patients, as well as emerging concerns about how insurance costs could impact consumer spending.

The Wall Street Journal: High-Risk Patients Fuel More Health-Law Worry
So-called high-risk pools for people rejected by commercial health-insurance companies were supposed to be largely phased out when President Barack Obama's health law kicked in. Instead, they are gaining a brief second life in some states due to the problems with the federal health-insurance exchange created by the law (Radnofsky, 11/17).

The Wall Street Journal: Wal-Mart Says Insurance Costs May Hurt Customer Spending
Wal-Mart Stores Inc. has a long list of reasons why its customers aren't spending as much as hoped: the expiration of the payroll tax cut in January, the November rollback of food-stamp benefits and continued uncertainty in Washington. Now, the world's largest retailer is hinting at a new one: the looming individual mandate to buy health insurance under the Affordable Care Act (Banjo, 11/17).

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Capitol Hill Watch

Furor Over Health Law May Alter 2014 Campaign Calculus

Media outlets analyze the impact of public anger over the troubled implementation of the health law on prospects for congressional deals on immigration reform and the budget, as well as on 2014 election campaigns.

The Wall Street Journal: Health Law Fracas Leaves Congress In Limbo
Furor over the botched implementation of President Barack Obama's health care law has allowed Congress to engage in a familiar activity: procrastination. Prospects already were dim for substantial legislation in the dwindling days of 2013, but the headline-grabbing fights over the federal health exchange and canceled insurance policies have given House Republicans no incentive to change the subject. The issue has drowned out talk of an immigration overhaul, taken the focus off high-stakes budget talks and stalled efforts to rewrite the tax code (Peterson and McKinnon, 11/17).

The Associated Press: GOP Sees Health Care Law As Big 2014 Opportunity
In his West Virginia district, the TV ads attacking Democratic Rep. Nick Rahall over the calamitous startup of President Barack Obama's health care law have already begun. The 19-term veteran, a perennial target in a GOP-shifting state, is among many in the president's party who have recited to constituents Obama's assurance that they could keep insurance coverage they liked under the 2010 overhaul. ... Rahall was among 39 Democrats who, despite an Obama veto threat, voted Friday for a GOP measure that would let insurers continue selling policies to individuals that fall short of the health care law's requirements. ... Republicans are emboldened by Obama's reversal and the Democrats' scramble for cover (Fram, 11/16).

The Washington Post: Health Care Law Has Changed Game For Democrats Looking To 2014 Election
Few places may better explain how the bungled launch of President Obama’s health care law has scrambled the political landscape for Democrats than this hamlet north of Philadelphia. Democrats have been hoping to capitalize on the political fallout for the GOP from the recent government shutdown. If they can do so anywhere, it should be in the suburbs north and west of the city where three adjoining congressional districts represent a confluence of Democratic Party ambitions for the 2014 midterm elections. ... The recent debacle over Healthcare.gov's rollout may have narrowed whatever perceived advantages Democratic candidates may have had over Republican opponents. In some minds, the health-care law’s flubs have merged with the government shutdown to render an unfavorable verdict on all of Washington (O'Keefe and Kane, 11/16).

Meanwhile, a historical perspective --

The New York Times' Congressional Memo: Lesson Is Seen In Failure Of 1989 Law On Medicare
Angry Americans voice outrage at being asked to pay more for health coverage. Lawmakers and the White House say the public just doesn’t appreciate the benefits of the new health law. Opponents clamor for repeal before the program fully kicks in. The year was 1989, and the law was the Medicare Catastrophic Coverage Act, which was supposed to protect older Americans from bankruptcy due to medical bills. Instead it became a catastrophe for Democratic and Republican lawmakers, who learned the hard way that many older Americans did not want to be helped in that particular way (Hulse, 11/17).

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Pelosi Downplays Democratic Defections On Health Law

House Minority Leader Nancy Pelosi, D-Calif., minimized reports of unrest within her caucus after 39 Democrats voted for a bill allowing insurers to sell plans for one more year that don't meet the health law's requirements.

Reuters: Top Democrat Pelosi Denies Party Members Retreating From Obamacare
The top Democrat in the U.S. House of Representatives said on Sunday that her party would not retreat from President Barack Obama's landmark healthcare reform law, despite unrelenting Republican opposition and emerging signs of market turmoil for consumers and health insurers (Morgan and Zabarenko, 11/17).

Bloomberg: Democrats Downplay Lawmaker Defections Over Affordable Care Act
Democratic lawmakers downplayed the support some members of their party gave to a Republican bill that would let insurers sell for another year health policies that don’t meet the requirements of the Affordable Care Act. House Democratic leader Nancy Pelosi of California, speaking yesterday on NBC’s "Meet the Press," said the 39 House Democrats who supported the Nov. 15 measure were basically those who had already opposed an insurance mandate for individuals and businesses (Gallu, 11/18).

Roll Call: Pelosi Dismisses Obamacare Defections, Defends Statements
House Minority Leader Nancy Pelosi defended her rhetoric leading up to passage of the 2010 health care law Sunday while seeking to minimize the reports of unrest in her caucus and the potential for political fallout in the wake of the law’s rocky rollout (Dumain, 11/17).

CNN: Pelosi Defends Obamacare Claims, Can’t Predict Effect On Dems In Midterms
House Democratic leader Nancy Pelosi said Sunday neither she nor President Barack Obama misled the American people when they said, during the run-up to the passage of Obamacare, that people could keep their health insurance plans (Clary, 11/17).

And on another health policy issue -

The Associated Press: Senate Candidate Proposes Medicare For All Ages
Like his Republican opponents, Democratic Senate candidate Rick Weiland of South Dakota thinks President Obama's healthcare law is flawed. But unlike the Republican candidates, who want to repeal the Patient Protection and Affordable Care Act, Weiland thinks voters will support keeping the law if people of all ages have the option of signing up for Medicare (11/17).

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State Watch

D.C. Insurance Commissioner Fired After Questioning Obama's Fix For 'Canceled Plans'

After publicly criticizing the president's proposed fix for plans that had been canceled under the health law and saying the District of Columbia might not go along, D.C.'s insurance commissioner was fired by the mayor's office late last week.

The Washington Post: Fired D.C. Insurance Commissioner Tried To Apologize For Criticizing Obamacare Fix
A fuller accounting of D.C. Mayor Vincent C. Gray’s (D) firing of the city's insurance commissioner is coming into view. Documents and interviews show that criticism of William P. White was immediate and fierce inside Gray's office last week when White issued a statement critical of President Obama's proposed fix to part of the botched rollout of the Affordable Care Act (Davis, 11/18).

Politico: D.C. Names Insurance Commissioner
The D.C. city government has named Chester A. McPherson as the new acting insurance commissioner, days after the former commissioner was fired following his statement against the White House's administrative fix on cancelled insurance plans. McPherson, the acting commissioner, had been the deputy commissioner of market operations at the Department of Insurance, Securities and Banking since August 2011 (Haberkorn, 11/17).

The Washington Post: D.C. Insurance Commissioner Fired A Day After Questioning Obamacare Fix
A day after he questioned President Obama's decision to unwind a major tenet of the health care law and said the nation's capital might not go along, D.C. insurance commissioner William P. White was fired. White was called into a meeting Friday afternoon with one of Mayor Vincent C. Gray’s (D) top deputies and told that the mayor "wants to go in a different direction," White told The Washington Post on Saturday. White said the mayoral deputy never said that he was being asked to leave because of his Thursday statement on health care. But he said the timing was hard to ignore. Roughly 24 hours later, White said, he was "basically being told, 'Thanks, but no thanks'" (Davis, 11/16).

The New York Times: Washington Insurance Official Is Ousted
The insurance commissioner for the District of Columbia was dismissed from his job just a day after he publicly questioned a decision by President Obama to reverse a provision of the Affordable Care Act, a person with knowledge of the events said on Sunday (Craig and Shear, 11/17).

The Wall Street Journal's Washington Wire: Sacked DC Insurance Chief Admits 'Misstep'
The District of Columbia's insurance commissioner lost his job after he publicly criticized President Barack Obama's decision to allow an extension of health policies that don't comply with new federal law, making his comments without approval from the mayor's office on a politically sensitive topic. William P. White, who had been the district's top insurance watchdog since 2011, was replaced over the weekend by a deputy commissioner in the department, who will serve as acting commissioner "effective immediately," according to a statement released Sunday by the Department of Insurance, Securities and Banking (Scism, 11/17).

The Hill: D.C. Official Fired After Obamacare Criticism
The Washington, D.C., insurance commissioner was fired Friday after criticizing President Obama's plan to address the millions of people who have lost insurance on the individual market. William White was let go by Mayor Vincent Gray’s office after he released a statement critical of the president without first clearing it with the mayor's office, according to reports (Trujillo, 11/18).

Fox News: D.C. Insurance Commissioner Fired After Criticizing President's Proposed Obamacare Fix 
The District of Columbia's insurance commissioner says he was fired after questioning President Obama's plan to fix Obamacare and saying the city might not follow his suggestions. Commissioner William White told The Washington Post on Saturday that he was called into Mayor Vincent Gray's office the prior day and told the Democratic mayor "wants to go in a different direction" (11/17).

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Editorials and Opinions

Viewpoints: Obamacare Has Resisted Death Throes Before; Website Success Stories From 3 Governors; Health Law Taking A Toll On Choice Of Doctors In Medicare Advantage

The New York Times: The Three Burials of Obamacare
The first time Obamacare seemed finished, doomed, doornail-dead, the voters of Massachusetts played the would-be executioner. In January 2010, they sent a pickup-driving Republican to the Senate to fill Ted Kennedy’s seat, apparently depriving the health care bill of its crucial 60th vote and sending Democrats scrambling for a Plan B. ... the deeper force at work, the reason that these near-death experiences keep happening, isn't a website or a broken presidential promise. It's a problem inherent to contemporary liberalism, which is that liberals' proudest achievement, the modern welfare state, tends to resist, corrupt and baffle their efforts at comprehensive reform (Ross Douthat, 11/16).

The Washington Post: The Sinking Ship Of Obamacare
Let's recap: If you like your insurance policy, you can keep it. No, wait. If you liked your policy, it was probably worthless anyway. Scratch that. If your junk policy was canceled and you still want it, you can keep it. Er, get it back. Whatever (Kathleen Parker, 11/16).

The New York Times: The Shame Of American Health Care
Even as Americans struggle with the changes required by health care reform, an international survey released last week by the Commonwealth Fund, a research organization, shows why change is so necessary. The report found that by virtually all measures of cost, access to care and ease of dealing with insurance problems, Americans fared poorly compared with people in other advanced countries (11/17). 

The Washington Post: How We Got Obamacare To Work
Sure, having functioning Web sites for our health-care exchanges makes the job of meeting the enormous demand for affordable coverage much easier, but each of our state Web sites has had its share of technical glitches. As we have demonstrated on a near-daily basis, Web sites can continually be improved to meet consumers' needs. The Affordable Care Act has been successful in our states because our political and community leaders grasped the importance of expanding health-care coverage and have avoided the temptation to use health-care reform as a political football (Gov. Jay Inslee, D-Wash., Gov. Steve Beshear, D-Ky., and Gov. Dannel P. Malloy, D-Conn., 11/17). 

The Wall Street Journal: ObamaCare's Union Favor
The Affordable Care Act's greatest hits keep coming, and one that hasn't received enough attention is a looming favor for President Obama's friends in Big Labor. Millions of Americans are losing their plans and paying more for health care, and doctors are being forced out of insurance networks, but a lucky few may soon get relief (11/17). 

USA Today: Insurance Industry Readied While Obama Slept
On Thursday, President Obama announced that he was giving insurance companies the option of continuing health insurance policies they have already canceled. Given the political trouble he has been in over these cancellations, and much of the Obamacare rollout, that is smart politics. But that is the only thing smart thing about this (Robert Laszewski, 11/15). 

Los Angeles Times: The LA Times Editorial Board’s Lonely Defense Of Obamacare
Here's something you don't see every day: the Los Angeles Times editorial board parting company with President Obama on Obamacare. OK, so I'm exaggerating. The Times' board criticized several aspects of the 2010 Patient Protection and Affordable Care Act as it worked its way through Congress, particularly on the cost-containment front. Nevertheless, because the board supported the law's passage and embraced many of its specific reforms, some right-of-center readers accused The Times' "looney left" editorial writers of acting as cheerleaders for the president (Jon Healey, 11/15).

The Seattle Times: Washington State Right To Forge Ahead With Health Policies
Washington Insurance Commissioner Mike Kreidler is right not to allow canceled health insurance plans to be extended into 2014, even though it means turning down President Obama's offer (11/17).

Politico: Who Needs HealthCare.gov?
In the weeks since Oct. 1, [Dr. Stephen P.] Morse has done what it seems the federal government could not. He built a simple, user-friendly, anonymous shopping tool that compiles pricing information from all of the plans on the state and federal health insurance exchanges and provides custom, premium readouts according to age, location, tobacco use and income. ... And Morse’s isn’t the only HealthCare.gov alternative out there. ValuePenguin.com, a start-up consumer finance website, has an even more elegant anonymous shopping tool that lists premium and subsidy calculations along with cost-sharing options that can be compared across plans (Andrew Steinmetz and Ezekiel Emanuel, 11/15).

Bloomberg: Obamacare's Latest Victim: Immigration Reform
Unwilling or unable to follow the Senate's bipartisan effort -- Tea Party intransigence is stronger, and more consequential, in the House -- Boehner appears to have decided to take time off from the nettlesome issue of immigration reform to return to House Republicans' old standby: attacking Obamacare. If the Patient Protection and Affordable Care Act’s troubles continue, Republicans hope to ride the Democrats’ pain to victory in the 2014 midterm elections. If those troubles begin to ease, however, and Obamacare gradually gains its footing, the House leadership will find itself back in familiar territory -- scrambling for another excuse to avoid legislating on a substantively complex and politically difficult issue (11/15).

Bloomberg: A Conservative Cure For Obamacare
The reality is that large constituencies are in place to work to preserve Obamacare. States that have embraced the law's Medicaid expansion -- about half -- will fight tooth and nail to keep huge new federal subsidies in place. And the conservatives who are lambasting the disastrous rollout should realize that the electorate that is uninsured, getting large subsidies and generally older will also fight to keep their newly minted policies. ... What strategy, then, would move us closer to the patient-and consumer-focused health-care system that conservatives desire while also recognizing the facts on the ground? The answer might be simple: Propose changes that will make plans more affordable and drive enhanced competition among insurers and providers. In other words, make Obamacare a Trojan horse for conservative health-care reform (Paul Howard and Yevgeniy Feyman, 11/18).

Forbes: Do You Like Your Doctor? Obamacare Drives UnitedHealth To Downsize Its Medicare Physician Networks
Over the past two weeks, there’s been a lot of coverage of the President’s misleading promise that “If you like your plan, you can keep your plan. No matter what. Period.” But we mustn’t forget that there was a second part to that promise: “If you like your doctor, you will be keep your doctor. Period.” It turns out that isn’t necessarily true, either. On Saturday, the Wall Street Journal reported that, due to Obamacare’s cuts to Medicare Advantage, among other factors, UnitedHealth expects its network of physicians “to be 85 percent to 90 percent of its current size by the end of 2014.” The result? Some retirees enrolled in Medicare Advantage will need to find new doctors. And it’s a trend that could accelerate in future years (Avik Roy, 11/18). 

The New Republic: People Complaining About Obamacare Insurance Cancellations Want To Get Something For Nothing
What did people think when they heard President Obama say that no one would have to give up their current health care arrangements if they preferred to keep them? This is not to excuse Obama, but anyone who knew anything at all about the two-year-long debate about health care reform should have known that what he said wasn’t true. This applies especially to the pundits and Republican politicians who now react with such horror and mock surprise (Michael Kinsley, 11/17).

MinnPost: As Health-Insurance Problems Keep Arising, Vermont Offers A Ray Of Hope
I am a cancer survivor. After being diagnosed with breast cancer last year, I chose to undergo medical treatment in the country of Colombia in South America. I received first-class treatment – surgery, chemotherapy and radiation – at a fraction of what it would cost in the United States. Since I have been uninsurable in the U.S. because of pre-existing conditions, I went to another country for treatment rather than paying the shamefully high costs of care in this one. I have been following the implementation of the Affordable Care Act with great personal interest. I am extremely grateful that I will be able to get health-care coverage next year (Debra Axness, 11/18).

On other issues -

The New York Times: Why Doctors Don't Take Sick Days
So most doctors ignore their symptoms and resist taking the day off unless they are sick enough to be hospitalized in the next bed over. This, of course, is ridiculous behavior on the part of medical professionals who would never recommend such nonsense to their patients. Medical workers with respiratory infections are contagious. ... What explains this toxic brew of denial, ignorance and bravado? Part of it is a professional but often exaggerated sense of responsibility to colleagues and patients (Dr. Danielle Ofri, 11/15).

The New York Times: Alzheimer's Anxiety
All of us are afraid of Alzheimer's. ... So it’s only natural that, in recent years, people have trumpeted the development of a new test that can measure the presence of beta-amyloid — the protein clumps in the brain that are one of the hallmarks of Alzheimer's dementia. ... In September, Medicare announced that it would pay for the test — which costs between $3,000 and $5,000 and is often not covered by private insurance — but only if the patient was part of a randomized, controlled trial, which is the only way to definitively determine the value of the scan. ... Alzheimer's disease is scary. But that is no reason for society to waste a lot of money on a test that really doesn't help (Dr. Ezekiel J. Emanuel, 11/16).

The New York Times' Room For Debate: When Medical Experts Disagree
Guidelines released last week by the American Heart Association and the American College of Cardiology could transform the way cholesterol-lowering statin medicines, like Lipitor, ... are used. But despite the pedigree of the recommendations, some physicians objected to them. ... This isn't the first time respected authorities have disagreed on medical recommendations. How should doctors and patients react to new findings that come out about health concerns? How do you know whom to trust? (11/17).

Los Angeles Times: AIDS Healthcare Foundation Vs. LA Country
Critics of the [AIDS Healthcare Foundation], citing the county audits, have expressed concern that the nonprofit is oriented more toward self-promotion than treating and combating sexually transmitted disease. Medical staff have criticized its management and are involved in a union organizing drive. "We're David," AHF President Michael Weinstein insists. "The county is Goliath." Los Angeles County is indeed more than a bit Goliath-like in its size — and even, to some (like the brutally beaten jail inmates), a bully. Fixing its problems will require some heat. But the AHF appears to be bringing only heat, and leaving the light behind (11/17).

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State Highlights: Tenn. Gov. Hesitates On Medicaid Expansion

A selection of health policy stories from Tennessee, California, Michigan, Minnesota and Texas.

The New York Times: Tennessee Governor Hesitates on Medicaid Expansion, Frustrating Many
Gov. Bill Haslam of Tennessee describes it as "trying to thread a needle from 80 yards." Mr. Haslam is only the latest Republican tailor trying to figure out whether to expand the state's Medicaid rolls as prescribed by President Obama's Affordable Care Act. In his case, it involves trying -- so far unsuccessfully -- to balance some sharply conflicting concerns: struggling hospitals, local business groups, dwindling state resources and fierce conservative opposition to the new health care law. And it has left him hanging out there, with no resolution in sight (Lyman, 11/16).

Los Angeles Times: Health Measures To Dominate 2014 Voter Ballot
Obamacare's troubled rollout -- and its more successful California start -- may be dominating the news now. But wait till next year. An election year ballot full of health issues awaits California voters next November. And the lineup could spur a campaign free-for-all that may prompt hundreds of millions of dollars in campaign spending (Lifsher, 11/17).

The Texas Tribune: Abortion Opponents Draw Attention To Remaining Clinics
As U.S. Supreme Court Justice Antonin Scalia weighs Texas abortion providers' request to reinstate an injunction on strict abortion regulations that took effect in November, abortion opponents are calling attention to the availability of abortion procedures across the state, hoping to prove new regulations haven't created an undue burden on women (Aaronson, 11/15).

Kaiser Health News: Uninsured In Mich. County Can Pay For Dental Care With Volunteer Work
Kelly Price knows too well the pain of infected teeth and how they become so sensitive it hurts to eat or drink. He has suffered with that in the past and still has several teeth that need to be extracted, but the 51-year-old unemployed machinist can't afford to see a dentist. That's why on a morning last month he was helping out at the Food Bank of South Central Michigan filling bags for weekend meals for needy children with Special K cereal, cans of spaghetti and meatballs, green beans, and a juice drink (Galewitz, 11/17).

California Healthline: As Stimulus Money Ends, Summit Looks At Future Of Health Information Effort
Health information exchange leaders [Friday] will meet in Sacramento for the industry's annual summit. The HIE effort in California has been a success in part because it's publicly funded and privately driven, said Pamela Lane, deputy secretary of HIE for the state's Health and Human Services agency. Federal stimulus funding for HIE will end in February 2014. Lane said the summit is an important bridge to the next wave of HIE innovation. … Although federal funding is ending, the effort to expand the use and exchange of electronic health information will continue in California, Lane said (Gorn, 11/15).

Minnesota Public Radio: 21 Minn. Hospitals Penalized For Poor Quality Scores
Twenty-one Minnesota hospitals will receive slightly lower Medicare reimbursement payments because they failed to meet federal quality benchmarks, according to a compilation by the non-partisan Kaiser Health News. Medicare also gave bonuses to 21 Minnesota hospitals that scored high on quality. The hospitals are penalized or rewarded based on a small fraction of their Medicare payment reimbursement (Stawicki, 11/15).

Stateline: Grants Help States Combat High-Cost, Low-Quality Health Care
The key to cutting costs and improving quality, many experts believe, is to reward health care providers for keeping their patients healthy and keeping costs down, instead of giving them a financial incentive to provide as many services and procedures as possible. That’s where states come in. Under an ACA program called the State Innovation Models Initiative, Arkansas, Maine, Massachusetts, Minnesota, Oregon and Vermont this year began testing new health care financing models. Another 19 states are in various stages of developing similar experiments (Vestal, 11/18).

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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.