Daily Health Policy Report

Tuesday, November 19, 2013

Last updated: Tue, Nov 19

KHN Original Reporting & Guest Opinion

Health Reform

Capitol Hill Watch


Women's Health

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Insuring Your Health: Readers Ask If They Can Buy A Policy

Kaiser Health News consumer columnist Michelle Andrews writes: "The news has been focused on the troubles of people trying to use the health care law's insurance exchanges and new options for people whose individual policies are being canceled. But open enrollment continues, and people who are shopping for individual or job-based coverage have many questions. Here are some answers" (Andrews, 11/19). Read the column.

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Scott Walker's Medicaid Maneuver

WUWM’s Erin Toner, working in partnership with Kaiser Health News and NPR, reports: "Wisconsin Gov. Scott Walker, who appears to be laying the groundwork for a 2016 presidential run, is getting attention for his entitlement reform. He is one of 25 Republican governors who are rejecting the health law’s expansion of Medicaid. But Wisconsin’s own Medicaid program, known as BadgerCare, was more generous than many states, and now Walker wants to transfer many of those people to the insurance marketplace created by the law. It’s a plan that allows Walker to reject Obamacare, turn down federal money on the table, but still provide health coverage to many of Wisconsin’s poor and working poor residents" (Toner, 11/19). Read the story.

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In Pa., A Big Gap In Health Insurance Coverage

The Philadelphia Inquirer’s Robert Calandra, working in partnership with Kaiser Health News, reports: "As many as 400,000 Pennsylvanians will plunge into the hole between traditional Medicaid and the new marketplace come Jan. 1, according to the Pennsylvania Health Access Network. … That gap was supposed to be filled with federal money states could use to cover more people. Gov. Corbett first chose to turn down the so-called Medicaid expansion. Officials have since presented a 12-page plan called Healthy Pennsylvania to the federal government. The aim is to reform Medicaid, increase access, and stabilize financing. The feds have yet to render a decision on the plan" (Calandra, 11/19). Read the story.

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Capsules: 3 State Exchange Leaders Try To Get Good News Out

Now on Kaiser Health News’ blog, Jenny Gold writes: "Democrats in states running their own exchanges are seeking to put a more positive spin on the rollout of the Affordable Care Act, despite the mostly negative news coming out of Washington. 'What we’re seeing is incredible momentum,' Peter Lee, executive director of Covered California, said during a conference call for reporters held by Families USA on Monday. 'We need to remind everyone that one-third of Americans are enrolling in state exchanges,' he added. 'We're showing that [the ACA] can and is working for Americans'" (Gold, 11/18). Check out what else is on the blog.

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Political Cartoon: 'Tortured Logic?'

Kaiser Health News provides a fresh take on health policy developments with "Tortured Logic?" by Matt Wuerker.

Here's today's health policy haiku: 


Are staffers asking...
Should I have read that report?
Hmmm. Would it have helped?

If you have a health policy haiku to share, please send it to us at http://www.kaiserhealthnews.org/ContactUs.aspx and let us know if you want to include your name. Keep in mind that we give extra points if you link back to a KHN original story. 

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Health Reform

Health Law Travails Drag Down Obama Approval Rating

A Washington Post-ABC News poll finds President Barack Obama's disapproval reaches an all-time high. The fallout from the beleaguered rollout of healthcare.gov also seems to be shaping voters' thoughts about upcoming congressional races.

The Washington Post: Obama's Ratings Tumble After Health Care Flaws
The flawed rollout of the Affordable Care Act has pushed President Obama to the lowest point of his presidency, with dwindling faith in his competence and in many of the personal attributes that have buoyed him in the past, according to a new Washington Post-ABC News poll. Opposition to the new health care law also hit a record high in the survey, with 57 percent saying they oppose the president's most significant domestic initiative. Forty-six percent say they are strongly against it. Just a month ago, as the enrollment period was beginning, the public was almost evenly divided in its assessments of the law (Balz and Craighill, 11/19).

ABC News: Botched ACA Rollout Hammers Obama; Job Disapproval Reaches A Career High
Barack Obama has been hammered by the botched rollout of the Affordable Care Act, with disapproval of his job performance reaching a career high, opposition to the new health care law up sharply and evidence of potential fallout in the midterm elections a year off. The president's job approval rating has fallen to 42 percent in a new ABC News/Washington Post poll, down 13 percentage points this year and 6 points in the past month to match the lowest of his presidency. Fifty-five percent disapprove, a record. And 70 percent say the country's headed seriously off on the wrong track -- up 13 points since May to the most in two years (Langer, 11/19).

The Hill: Poll: Obamacare Could Drag Down Candidates
Nearly four in 10 people said a congressional candidate's support for the president's signature health care law would make them less likely to vote for that candidate on Election Day, according to a new poll (Trujillo, 11/19).

Politico: Obamacare Vs. ACA: What's In A Name?
President Barack Obama and loyal Democrats once embraced the term Obamacare to sell the American people on health care reform. Not anymore. With the president’s approval ratings at record lows, a broken website and Obama under fire for his pledge that people could keep their plans, the "Affordable Care Act" has returned (Epstein, 11/19).

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Report Issued Early Warnings About Healthcare.gov Risks

An analysis done in late March by McKinsey & Co. called attention to a number of trouble spots. Meanwhile, Politico details a "Red Team" report done by the Centers for Medicare & Medicaid Services that also sounded alarms.   

The New York Times: Officials Were Warned About Health Site Woes
Senior Obama administration officials, including several in the White House, were warned by an outside management consultant early this year that the effort to build the HealthCare.gov site was falling behind and at risk of failure unless immediate steps were taken to correct the problems, according to documents released by House investigators. The report, by McKinsey & Company, which was prepared in late March at the request of the Department of Health and Human Services, said that management indecision and a "lack of transparency and alignment on critical issues" were threatening progress, despite the tight deadline (LaFraniere and Lipton, 11/18).

The Washington Post: Private Consultants Warned Of Risks Before Healthcare.gov's Oct. 1 Launch
The Obama administration brought in a private consulting team to independently assess how the federal online health insurance enrollment system was developing, according to a newly disclosed document, and in late March received a clear warning that its Oct. 1 launch was fraught with risks. The analysis by McKinsey & Co. foreshadowed many of the problems that have dogged HealthCare.gov since its rollout, including the facts that the call-in centers would not work properly if the online system was malfunctioning and that insufficient testing would make it difficult to fix problems after the launch (Eilperin and Somashekhar, 11/18).

Politico: Report Warned Of Healthcare.gov Flaws Last Spring
The administration was warned last spring that its website didn’t meet key requirements for a successful rollout, including relying too heavily on outside contractors, according to a copy of a "Red Team" report prepared for the Centers for Medicare and Medicaid Services and obtained by Politico. The report, which was delivered at the end of March, identified six tests that the developing healthcare.gov website didn’t meet: Its needs were evolving, rather than clearly articulated; there was no clear definition of success; the program relied too heavily contractors and other outside parties; the design, build and test phases were stacked on top of each other rather than sequential, there wasn’t enough time allotted or a side enough scope for valid end-to-end testing of the system; and the site was expected to launch at full volume rather than phasing in over time (Allen, 11/19).

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White House Officials Say 20% Won't Be Able To Complete Healthcare.gov Process To Buy Insurance

In a progress report, Obama administration officials are predicting that, despite fixes that have been made, one in five people won't be able to buy health insurance via the online process. Still, the pace of enrollments has more than doubled, the New York Times reports.

The Associated Press/Washington Post: White House: 1 In 5 People Won’t Make It Through Health Exchange Website Despite Fixes
The White House says 20 percent of Americans won’t make it through the website to buy health insurance through new exchanges. The Obama administration is scrambling to fix the malfunctioning website by Nov. 30. But White House spokesman Jay Carney says there will still be 1 in 5 who will start the process online but won’t be able to purchase insurance (11/18).

USA Today: Fix Speeds Health Site’s Insurance Account Choices
Technicians working to repair the HealthCare.gov website have fixed most of the problems that stymied health insurance customers from creating personal accounts, the spokeswoman for the Centers for Medicare and Medicaid Services said Monday. Those fixes mean the system can "easily" handle 20,000 to 25,000 people in the area of the site where they choose their insurance plans, said Julie Bataille, the CMS spokeswoman. Bataille did not comment on the site's total capacity, although last week, the total capacity for all areas of the site was 20,000 to 25,000 people (Kennedy, 11/18).

New York Times: Pace Of Enrollments On Health Site Accelerates
The pace of enrollment in health plans through the troubled federal insurance marketplace has nearly doubled since the end of October as software engineers have resolved some 200 of the more than 600 initial defects that had rendered the site all but unusable, according to people familiar with the repair effort. As of mid-November, the number of enrollees, which the Obama administration defines as people who have selected a marketplace plan, was more than 50,000 — up from 27,000 in the entire month of October but still a fraction of the number the administration once hoped for (Shear, 11/19).

Meanwhile, in related news -

The Washington Post's The Fact Checker: How Much Did Healthcare.gov Cost? (Part 2)
At the hearing, held by the House Oversight and Government Reform Committee, Powner repeated the $600 million figure several times. He made clear he was speaking about all IT funding for the health care exchanges, including what was spent at the Internal Revenue Service. One lawmaker lauded him as the “$600 million man” and several other lawmakers, including Chairman Darrell Issa (R-Calif.), cited the number as well. The Fact Checker contacted Powner and asked how he came up with this figure, and he shipped us a document that he said appears on the federal government’s IT Dashboard for the health-insurance exchanges. He also made it clear that he believes any cost-figure for the Web site should include back-end and front-end expenses necessary for it to run, such as creating the data hub (Kessler, 11/19).

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Some States See Health Plan Enrollment Surge

While the balky federal website has made enrollment difficult for residents of 36 states, tens of thousands of consumers are signing up for coverage in places like California, Connecticut and Kentucky, which have functioning websites, reports the Los Angeles Times. Meanwhile, states and advocacy groups are tweaking their marketing. In Maryland, for instance, radio and TV ads encourage residents to call 211, rather than go to a website, to get coverage.

Los Angeles Times: Healthcare Plan Enrollment Surges In Some States After Rocky Rollout
Despite the disastrous rollout of the federal government's healthcare website, enrollment is surging in many states as tens of thousands of consumers sign up for insurance plans made available by President Obama's health law. A number of states that use their own systems, including California, are on track to hit enrollment targets for 2014 because of a sharp increase in November, according to state officials (Levey, 11/18).

CQ HealthBeat: That’s Not Us, Folks: State Exchanges Scramble To Dodge Healthcare.Gov’s Bad Press
The botched rollout of the federal marketplace website is forcing states and advocacy groups to adjust their marketing strategies, even in areas where state-based insurance websites are working just fine (Adams, 11/18).

The Associated Press/Washington Post: Once Considered A Leader, Oregon's Insurance Exchange Still Hasn’t Enrolled Anyone
With all the problems facing the rollout of President Barack Obama’s health care overhaul, nowhere is the situation worse or more surprising than in Oregon, a progressive state that has enthusiastically embraced the federal law but has so far failed to enroll a single person in coverage through the state’s insurance exchange. Despite grand ambitions, an early start, millions of dollars from the federal government and a tech-savvy population, Oregon’s online enrollment system still isn’t ready more than a month after it was supposed to go live. The state has resorted to hiring or reassigning 400 people to process insurance applications by hand (11/18).

Kaiser Health News: Capsules: 3 State Exchange Leaders Try To Get Good News Out
Democrats in states running their own exchanges are seeking to put a more positive spin on the rollout of the Affordable Care Act, despite the mostly negative news coming out of Washington. "What we’re seeing is incredible momentum," Peter Lee, executive director of Covered California, said during a conference call for reporters held by Families USA on Monday. "We need to remind everyone that one-third of Americans are enrolling in state exchanges," he added. "We're showing that [the ACA] can and is working for Americans" (Gold, 11/18).

Los Angeles Times: California Health Exchange Is Hesitant To Extend Canceled Policies
California's health insurance exchange remained hesitant to embrace a controversial request from President Obama to extend canceled insurance policies for another year. The state exchange, called Covered California, said Monday that it won't decide until later this week whether 1 million policyholders with expiring policies can keep their coverage for 2014 (Terhune, 11/18).

The Seattle Times: Doctors, Hospitals Catch Goofs On State Insurance Exchange
The Washington Healthplanfinder insurance exchange has a feature on its website that allows consumers to see if particular doctors and hospitals are in a plan’s network of health-care providers…Hospitals and physician groups have been busy trying to catch the mistakes and tell the Washington Health Benefit Exchange, which operates Healthplanfinder, to correct the errors (Landa, 11/18).

The Baltimore Sun: Work-Arounds Are Used To Get Consumers Health Care
Beginning Tuesday, radio and TV ads will encourage residents to call 211 and get health coverage under the Affordable Care Act. With technical difficulties still frustrating efforts to enroll in health plans through online exchanges — and deadlines looming to enroll — health care advocates and state officials are looking for ways to work around the malfunctioning websites (Cohn, 11/18).

Health Policy Solutions (a Colo. news service): Colorado Health Sign-Ups Continue To Lag
Only 2,593 people signed up for private health insurance through Colorado’s exchange during the first half of November, a pace that will make it difficult for Colorado to reach a mid-level goal of 135,000 new customers by next year. In all, 6,001 Coloradans have bought private health plans since Colorado’s exchange opened on Oct. 1, according to new data that Connect for Health Colorado released [Monday] (Kerwin McCrimmon, 11/18).

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Health Law's Supporters and Opponents Working Hard To Woo Young Adults

Enrolling young people in the marketplaces is vital to making those exchanges work, and some critics are trying to keep those healthy people off the exchanges.

Los Angeles Times: Obamacare's Backers And Foes Vie To Recruit Young People
The raucous scene at a University of Miami tailgate party on a recent weekend might have seemed an unlikely spot for a debate over Obamacare. But with six dozen pizzas in hand, the youthful staffers from Generation Opportunity rolled up in Hummers and Ford F-150s to claim their spot. ... Conservative groups including Generation Opportunity — which counts the Koch brothers among its major donors — are trying to push young people away from the exchanges. ... Groups aligned with Obama, such as Enroll America and the Young Invincibles, have marshaled their own teams to find and help sign up young people for plans through the insurance exchanges (Reston, 11/18).

Meanwhile, the president Monday night urged his supporters to help drum up support for the health law.

The Associated Press: Not Just The Website: Obama Asks For Health Enrolling By Mail, On Phone, In Person
President Barack Obama urged his supporters Monday to help Americans enroll for health insurance by mail, in person and over the phone, seeking to tamp down expectations that the error-riddled HealthCare.gov website will ever be a panacea for the uninsured — even once it's fixed (Lederman, 11/18).

The Wall Street Journal’s Washington Wire: Obama Seeks Help From Supporters For Health Law
President Barack Obama on Monday sought help from his former campaign supporters in implementing the troubled health law, urging them to get people enrolled in insurance plans and telling them that doing so will save lives. "My main message is, I'm going to need your help," Mr. Obama said in a call with Organizing for Action, previously named Obama for America, the campaign group that helped him win re-election. "As a consequence of that work, you're going to save somebody’s life" (Favole, 11/18).

Los Angeles Times: Obama, Admitting Problems, Asks Backers To Rally For Healthcare Law
President Obama told supporters to tune out the "noise" and the "setbacks" to his floundering healthcare law on Monday as he tried to motivate his network of activists to join a campaign to boost enrollment. During an online call hosted by Organizing for Action, Obama acknowledged problems with the federal health insurance website, saying he believed the bugs and errors on healthcare.gov had "created and fed" a lot of misinformation about the law. Obama asked his backers to fight against criticism and spread the word about the benefits of the law (Hennessey, 11/18).

USA Today: Obama To Backers: Don't Depend On Healthcare.gov Alone
President Obama said Monday that his backers will play a crucial role in whether implementation of his signature health care law is a success. Obama again acknowledged problems with the glitch-plagued HealthCare.gov website, but framed the battle for his troubled health care law as one he'll fight with his supporters. Obama's comments came in a call organized by Organizing for Action, a political group founded by alumni of his two presidential campaigns (Madhani, 11/18).

The New York Times' The Caucus: Another Website, Another Problem For Obama
Some supporters who tried to log in to hear President Obama defend his embattled health care law on Monday night were unable to hear him because the website of the group behind the call, Organizing for Action, failed to work for them. The website problems were an inconvenient moment for a president who has spent the last six weeks trying to explain the failure of HealthCare.gov, the online marketplace for Mr. Obama’s Affordable Care Act (Shear, 11/18).

Reuters: Obama: Website To Be 'Easiest Place' To Get Healthcare, Eventually
President Barack Obama urged his supporters on Monday to help get people signed up for health insurance and declared that the troubled website HealthCare.gov would eventually be the "easiest place" to get care despite its many glitches. Obama has faced one of the biggest political crises of his presidency since the website's rocky rollout last month (11/18).

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Minn., Mass. Officials Say They Will Not Follow Obama's Advice On Fixing Canceled Policies, But N.C. Does

States are considering whether to allow insurers to continue offering current plans that are sold on the individual market and that don't meet the standards of the health law. The president suggested that fix last week.

The Associated Press: Dayton: No Extension Of Existing Health Coverage
Gov. Mark Dayton announced Monday that Minnesotans will not be able to keep existing insurance coverage under the federal health-care law, despite saying last week that he supported President Obama's plan to allow it (Condon, 11/19).

MinnPost: Dayton Says Minnesota Will Not Adopt Obamacare 'Fix'
Gov. Mark Dayton, responding to health insurers’ concerns, said Monday afternoon that Minnesota would not adopt an optional fix for those whose coverage had changed because their plans didn’t comply with the federal health reform law (Nord, 11/18).

The Associated Press: Massachusetts Consumers Cannot Keep Health Plans
Massachusetts' top insurance official said Monday that the state won't allow consumers to keep health insurance policies that fall below the minimum requirements of the federal health care law. State Insurance Commissioner Joseph Murphy said in a letter sent Monday to the Obama administration that substandard insurance policies are "virtually non-existent" in Massachusetts because of its first-in-the-nation health care law that took effect in 2007 (LeBlanc, 11/18).

North Carolina Health News: State Expedites Obamacare Fix
Hundreds of thousands of North Carolinians who buy insurance on the individual marketplace will be able to keep their current coverage plans after several days of scrambling by federal and state officials (Hoban, 11/18).

The Associated Press: Friday Deadline For Health Insurers To Decide
Health insurance providers in Oregon have until Friday to decide if they will be restoring any of the policies set to be canceled because they don't measure up to the federal health care law. Oregon Insurance Commissioner Laura Cali announced Monday that the Insurance Division will post a list of insurers offering extensions by 5 p.m. Friday on its website (11/18).

San Francisco Chronicle: California Weighing Obama's Shift On Health Plans
California and New York said the president's one-year reprieve for insurance policies that don't meet the stricter requirements of the Affordable Care Act undermines the risk pool of patients needed to make the law viable. California will decide this week whether to comply with President Obama's request, Peter Lee, the executive director of the state's health exchange, told reporters Monday. New York also is "still considering the president's option," said Danielle Holahan, deputy director of that state's insurance marketplace (Wayne, 11/18).

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Jousting Over Medicaid Expansion

In Alaska, Gov. Sean Parnell said Friday his state will not expand Medicaid under the health law, while reports from Wisconsin, Pennsylvania, North Carolina and Maine assess the decisions -- and, in some cases, continued lobbying -- in those states.

The Washington Post: Alaska Says No To Medicaid Expansion
Alaska Gov. Sean Parnell (R) said Friday his state will not expand Medicaid under President Obama’s signature health-care law after a report estimated it would cost the state about $200 million over seven years. “I believe a costly Medicaid expansion, especially on top of the broken Obamacare system, is a hot mess,” Parnell said at a news conference on Friday. “The bottom line is: Obamacare failed to launch, is failing to deliver on its promises, and remains in disarray. We simply cannot bail out this failed experiment by expanding Medicaid” (Wison, 11/18).

Kaiser Health News: Scott Walker's Medicaid Maneuver
Wisconsin Gov. Scott Walker, who appears to be laying the groundwork for a 2016 presidential run, is getting attention for his entitlement reform. He is one of 25 Republican governors who are rejecting the health law’s expansion of Medicaid. But Wisconsin’s own Medicaid program, known as BadgerCare, was more generous than many states, and now Walker wants to transfer many of those people to the insurance marketplace created by the law. It’s a plan that allows Walker to reject Obamacare, turn down federal money on the table, but still provide health coverage to many of Wisconsin’s poor and working poor residents (Toner, 11/19).

Kaiser Health News: In Pa., A Big Gap In Health Insurance Coverage
As many as 400,000 Pennsylvanians will plunge into the hole between traditional Medicaid and the new marketplace come Jan. 1, according to the Pennsylvania Health Access Network. … That gap was supposed to be filled with federal money states could use to cover more people. Gov. Corbett first chose to turn down the so-called Medicaid expansion. Officials have since presented a 12-page plan called Healthy Pennsylvania to the federal government. The aim is to reform Medicaid, increase access, and stabilize financing. The feds have yet to render a decision on the plan (Calandra, 11/19).

The Associated Press: NC AG Says Refusal Of Medicaid Expansion Was Wrong
Democratic Attorney General Roy Cooper said Monday he can't see any reason why Gov. Pat McCrory and other Republicans leading the legislature refused to expand Medicaid coverage this year except for politics (Robertson, 11/18).

The Associated Press: Obama Official Urges Maine To Expand Medicaid
President Barack Obama's administration urged Maine officials to expand Medicaid coverage under the federal health overhaul Monday and expressed confidence that the number of residents enrolled in the new insurance marketplace will grow substantially over the next couple of months. White House spokesman Josh Earnest touted the benefits of expanding Medicaid coverage to about 70,000 Mainers, a signature aspect of Obama's health care law, and encouraged the state to put politics aside and pass such legislation, which lawmakers will consider again in January (Durkin, 11/18).

Raleigh News & Observer: Attorney General Roy Cooper Says State Should Expand Medicaid
State Attorney General Roy Cooper said the state should reconsider its decision to not expand Medicaid, saying Republicans “put politics over policy” to deny the state financial benefits and working poor people health insurance. ... Cooper, a Democrat planning a run for governor in 2016, hit many of the pro-expansion talking points: the federal government would pay 100 percent of the cost of expansion in the first three years, expansion would add jobs, and more people would have health insurance. After three years. federal support would drop gradually to 90 percent by 2020. The state Republican Party blasted Cooper, calling him an “Obamacare supporter” who wants to raise taxes (Bonner, 11/18).

Columbus Dispatch: Medicaid Puts Kasich On Spot Over Obamacare
But the governor’s embrace of Medicaid expansion alongside his frequent harangues of Obamacare has required Kasich to justify an aspect of a law that overall he decries as unjustifiable. Without Obamacare, Medicaid expansion is not possible. “He jams through Medicaid expansion at the same time he’s saying, ‘Join me in repealing the Affordable Care Act,’” said Tom Zawistowski, an Ohio tea party leader. “It’s schizophrenic. They’re one and the same.” The debate exposes the eccentricity of Ohio politics: Seething that Kasich bypassed a recalcitrant GOP-controlled legislature and used the State Controlling Board to get Medicaid expansion, the tea party has vowed to withhold its support from him. Democrats, who support Medicaid expansion, criticize Kasich for opposing Obamacare. Meanwhile, the Ohio Republican Party, which hates Obamacare, lauds Kasich for expanding Medicaid (Hallett, 11/19).

The Spokesman-Review: Medicaid Gets Idaho Association Of Commerce And Industry Support
Idaho’s biggest business lobby has come out in favor of expanding Medicaid for Idaho’s poor, a move expected to save state taxpayers hundreds of millions of dollars. It’s a sign that Medicaid expansion is gaining traction despite Idaho lawmakers’ intense dislike of the Affordable Care Act, or Obamacare. Broader coverage for the poor could help Idaho more than most other states because of the way it handles catastrophic medical costs. The Idaho Association of Commerce and Industry is intrigued by pilot programs in other states that use the federal expansion money to buy private insurance for Medicaid patients (Russell, 11/19).

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Obama Tells Insurers His 'Fix' May Cost Them

President Barack Obama acknowledged to insurance executives that reinstating millions of insurance policies might cost them, according to Politico. Other media outlets report that brokers are worried about their role in the insurance marketplace and how one company is forecasting that a failure to enroll the uninsured could cut prescription drug sales by 30 percent in 2017.

Politico: President Obama To Insurers: No Bailout
President Barack Obama had some bad news for the insurance company CEOs who met him at the White House: His "fix" might cost them. Obama asked the CEOs to reinstate millions of Americans' health insurance plans that were cancelled because they fell short of coverage requirements under the law, according to two executives who attended the session Friday (Cheney and Haberkorn, 11/19).

Politico: Brokers Feel Pain Of Obamacare
Add insurance brokers to the list of people stymied by HealthCare.gov. And it's not just a headache. It's their income. Some brokers are waiting for the site to be fixed before they deal with clients using it. But those that are sticking with the arduous online enrollment journey are facing a new question: Will I get paid for this? (Villacorta, 11/19).

Bloomberg: Obamacare Failure May Shave 30% From U.S. Drug Sales
Potential shortfalls in enrollment for President Barack Obama's health care overhaul would put a 30 percent dent in projections for U.S. prescription-drug sales in 2017, a report from IMS Health Inc. shows. That worst-case scenario would translate to $320 billion in drug spending, according to the report. The best case is supposed to be $460 billion, boosted by demand from the health law's expansion of insurance coverage and medical screenings, and removal of restrictions on pre-existing conditions (Edney, 11/19).

Reuters: Insight: Health Site Woes Show Washington Misses Out On Cutting Edge Technology
One part of the Obama administration's technically flawed Healthcare.gov website is actually working as promised. Unfortunately, the company that built it does not intend to seek more government business (Sullivan, 11/19).

The Texas Tribune: Dewhurst Wants Closure Of High-Risk Insurance Pool Postponed
Amid ongoing technical issues with the federal health insurance marketplace created under the Affordable Care Act, Lt. Gov. David Dewhurst is urging state officials to postpone the planned Jan. 1 cancellation of the state's high-risk insurance pool, which provides health coverage to some of the state's sickest residents (Maly, 11/18).

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GOP Candidates Hope To Use Botched Health Law Startup To Their Advantage

Some veteran Democratic lawmakers are being called to the carpet as a result of the difficulties with healthcare.gov and news of health policy cancellations. Meanwhile, also in the news, New Jersey Gov. Chris Christie also offers a bleak prediction of the health law's future.  

The Associated Press: GOP: Health Care Law Big 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 (11/18).

Star Tribune: GOP Targets Franken Over Shaky Rollout Of Obama's Health Care Overhaul
The Minnesota Democrat, facing re-election to the Senate, ups his fundraising goal as Republicans mount a new line of attack. Republicans preparing to challenge U.S. Sen. Al Franken next year may not have a leading candidate, but they believe they’ve been handed a gold-plated issue in the tumultuous rollout of President Obama's health care overhaul (Diaz, 11/19).

The Associated Press/Washington Post: Christie Predicts Health Care Overhaul Will Not Succeed
New Jersey Gov. Chris Christie says President Barack Obama's health care overhaul is a "failure" and predicts it "will not succeed -- it just won’t." The potential 2016 presidential candidate says the leaders of both political parties, including Obama, are to blame for a 16-day partial federal government shutdown in October. He says the effort by some Republicans to defund the so-called Obamacare law by shutting down the government failed and "absolutists" from both parties hurt the process (11/18).

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Capitol Hill Watch

Senate Gives Final Approval To Bill Tightening Control Over Drug-Compounding Pharmacies

The Senate gave final approval to a bill Monday that gives federal regulators greater oversight of compounding pharmacies like the ones responsible for a deadly meningitis outbreak last year. The president is expected to sign the bill. 

The New York Times: Bill On Drug Compounding Clears Congress A Year After A Meningitis Outbreak
A bill that would give the Food and Drug Administration more power to police compounding pharmacies passed its final hurdle in Congress on Monday, in what experts said was an important step to a safer drug supply in the United States (Tavernise, 11/18).

Modern Healthcare: Bill Boosting FDA Authority Over Compounding Pharmacies Heads To Obama
The U.S. Senate voted Monday to strengthen the Food and Drug Administration's authority over compounding pharmacies that produce large volumes of mixed drugs. The president is expected to sign the legislation, which will reach his desk about a year after drugs distributed by one such compounder led to a deadly multistate meningitis outbreak (Lee, 11/18).

In other news --

Medpage Today: SGR Repeal Bill Still Gets AMA Support
The American Medical Association's policymaking House of Delegates voted nearly unanimously to continue its support of a congressional proposal to repeal Medicare's payment formula despite opposition to a 10-year pay freeze that's part of the draft. The vote, which came … Monday afternoon at the group's interim meeting, comes with the added caveat that the AMA continue to push for future positive updates to physician payments under Medicare. The AMA -- while backing the broader concept of a repeal of Medicare's sustainable growth rate (SGR) formula -- has strongly opposed the concept of freezing physician payments for a decade as part of the move to kill the SGR (Pittman, 11/18).

CQ HealthBeat: Hospital 'Bad Debt' Reimbursements Could Be Targeted In Budget Talks
Hospitals are sure to resist efforts to further reduce the amount of "bad debt" that Medicare lets them write off, as budget negotiators look for savings in entitlement programs. Last year, Congress reduced the amount of Medicare reimbursements to hospitals and other medical facilities that make up for patients who do not pay their out-of-pocket costs (Ethridge, 11/18).

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ProPublica: Medicare Could Save Billions With Generic Drugs

The nonprofit news service analyzed millions of prescriptions. Also, a CMS official says "the Medicare program is stronger today than in recent memory."

ProPublica: Medicare's Failure to Track Doctors Wastes Billions on Name-Brand Drugs
Medicare is wasting hundreds of millions of dollars a year by failing to rein in doctors who routinely give patients pricey name-brand drugs when cheaper generic alternatives are available. ProPublica analyzed the prescribing habits of 1.6 million practitioners nationwide and found that a tiny fraction of them are having an outsized impact on spending in Medicare’s massive drug program (Ornstein, Weber and LaFleur, 11/18).

Georgia Health News: Who Likes The ACA? Top Medicare Official Says Law Is Boon For Seniors
Recent problems with the Affordable Care Act -- a poorly functioning insurance exchange website and an uproar over canceled policies -- have dominated headlines and reignited political debates. But Jonathan Blum has a positive message to deliver about the ACA and its effect on the Medicare program, which covers about 1.4 million Georgians (Miller,11/18).

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Women's Health

Contraception Coverage, Abortion Loom As Issues For High Court, Advocacy Groups

Advocacy groups are wondering about a future boomerang effect of the "nuclear option," which could keep Senate Republicans from filibustering judicial nominations.

Roll Call: Abortion Dilemma In 'Nuclear Option' Debate
Outside advocates of abortion rights have largely steered clear of public involvement in the latest round of ratcheting up of "nuclear option" talk in the Senate, and there might be good reason for that. The dilemma for groups like Planned Parenthood is clear: Back the nuclear option for victories on issues like birth control now, and you’ll increase the risk that a Republican president will be able to put hostile nominees on the bench in the future (Lesniewski, 11/18).

Roll Call: Will The Supreme Court Take On Contraception Coverage Challenge?
While Congress continues to focus on the rocky rollout of the health care overhaul, the Supreme Court is expected to mull over challenges to another piece of the law two days before the justices sit down to their Thanksgiving dinners. On Nov. 26, the court is scheduled to meet privately to decide which of four cases, if any, to take up this term that challenge the Obama administration's requirements that most health insurance plans cover birth control free of charge (Attias, 11/18).

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State Watch

State Highlights: Calif. Fines Three Insurers For Denying Therapy

A selection of health policy stories from California, Colorado, Kansas and Florida.

Los Angeles Times: State Says 3 Health Insurers Denied Medically Necessary Therapy
California officials said three of the state's largest health insurers illegally denied speech and occupational therapy to patients, and regulators fined one of the companies, Health Net Inc., $300,000 for repeated violations. The state Department of Managed Health Care said Monday that it ordered Health Net, Anthem Blue Cross and Blue Shield of California to stop denying medically necessary therapy in cases of developmental disabilities, autism and other medical conditions (Terhune, 11/18).

Health Policy Solutions (a Colo. news Service): Struggling In The Red, Denver Health Cuts 170 Jobs
A loss of $7 million so far this year and fewer hospital patients have prompted Denver Health to cut 170 jobs. Often cited as a national leader in providing top-notch, low-cost health care for the poor, Denver Health also now faces a new penalty under the Affordable Care Act. Denver Health managers are calculating exactly how big that hit will be -- perhaps around $500,000 -- but federal Medicare managers are penalizing 1,500 hospitals across the country for not meeting various new quality measures, including low marks from patients (Kerwin McCrimmon, 11/18).

Los Angeles Times: O.C. Ambulance Company Pays $3 Million To Settle Fraud Suit
An Orange County ambulance company has paid $3.05 million to settle a lawsuit alleging that it billed Medicare and other federal health care programs to transport patients who didn't need an ambulance, federal prosecutors said. The suit was filed on behalf of the United States by two former employees of Lynch Ambulance, which is based in Anaheim, under whistle-blower provisions of the federal False Claims Act, according to a written statement by the U.S. attorney’s Central District of California office (Esquivel, 11/18).

Kansas Health Institute: KanCare Open Enrollment Approaches
Open enrollment for thousands of the state's KanCare enrollees will start Dec. 1 and run through March 2, 2014, state Medicaid officials announced today. Enrollment packets are being put in the mail and members can expect to receive them by the end of the month, officials at the Kansas Department of Health and Environment said in a prepared statement (11/18).

Miami Herald: HIV-Disclosure Law Sparks Unique Legal Battle In  Florida
In Florida, and almost three dozen other states, it is a crime to have intercourse without disclosing a sexually transmitted disease. So prosecutors thought they had a solid case when they charged a Manatee County woman who failed to tell her female partner that she was HIV-positive (Ovalle, 11/18).

I-News/Health Policy Solutions (a Colo. news service): Mental Health Funding Cuts Fueled Homelessness In Colorado
The president of the Colorado Coalition for the Homeless, John Parvensky, says there are many more like Maseros who want help but can’t get it. His organization stopped carrying a waiting list for mental health services when it reached 2,000 people. Parvensky believes there is a straight line between the decrease in funding for mental health – and especially the decline in inpatient capacity – and the increase in homelessness in Colorado (Jones, 11/18).

California Healthline: Innovation, Policy Outlook For Autism
A Senate select committee last week held a hearing in Santa Ana to examine a successful public-private autism research and treatment partnership in Orange County, and to see what legislation might be needed for autism care in the next year. Lou Correa (D-Santa Ana) is a member of the Senate Select Committee on Autism and Related Disorders and chaired the Santa Ana hearing. … One part of the solution is the autism work that's been done within the public Children and Families Commission of Orange County and the private not-for-profit Thompson Center for Autism, Correa said (Gorn, 11/18). 

California Healthline: More Changes Coming For California's Disparate County Health Systems
California's 58 counties, each operating its own health system under an established set of rules over the past several decades, are undergoing fundamental shifts in how they provide health care for low-income residents. The rules are changing. The two biggest vehicles of change are the Affordable Care Act and its Medicaid expansion. In addition, the relationship between state and county governments in California is being realigned, shifting responsibility and funding for physical and mental health care (Lauer, 11/18).

California Health Report: Public Mental Health Centers Face New Competition Under ACA
The small changes also have big implications for the Los Angeles County Department of Mental Health. Under the Affordable Care Act, health plans are now required to provide mental health services. That means the newly insured, even the low income, will have the option to seek care anywhere they want, even outside the county health system (Abram, 11/18).

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Editorials and Opinions

Viewpoints: GOP Excuse For 'Doing Nothing;' Sen. Rubio: No Taxpayer-Funded Bailout Of The Insurance Industry

The Wall Street Journal: No Bailouts For Obamacare
As the people's representatives, the U.S. Congress should completely eliminate the possibility of a bailout of insurance companies. On Tuesday I am introducing legislation that would eliminate the risk corridor provision, ensuring that no taxpayer-funded bailout of the health insurance industry will ever occur under ObamaCare. If this disaster of a law cannot survive without a bailout rescue valve, it is yet another reason why it should be repealed (Sen. Marco Rubio, R-Fla., 11/18).

The New York Times: A New G.O.P. Excuse For Doing Nothing
With unrestrained glee, Republicans are using the calamitous debut of the Affordable Care Act as their latest justification for undermining all of health care reform. But they're not stopping there. The Obama administration's fumbling is apparently a good excuse for them to do nothing on immigration reform, on a budget agreement, and on any other initiative coming out of the White House (11/18).

Los Angeles Times: The Myths Of Obamacare's 'Failure'
Attacks on the Affordable Care Act have stepped up over the last week or so. You'd think that the healthcare reform known as Obamacare is leading to the wholesale loss of affordable insurance by huge sectors of the American public, ... Don't buy the hype. The numbers tell an entirely different story. ... the number of victims is much smaller than you're being led to think and is swamped by the ranks of beneficiaries (Michael Hiltzik, 11/18).

The New Republic: Six Things The Media Doesn't Understand About Obamacare
The Obamacare cancellation stories have dominated the media for the past two weeks. And it’s easy to understand why. People losing their insurance is a bigger story than people getting insurance for the first time—particularly when the folks losing coverage remember, quite distinctly, the president vowing they can keep their insurance if they like it. ... there are at least six reasons to think the real story is smaller—and way more complicated—than a credulous media would have everybody believe (Jonathan Cohn, 11/18).

Los Angeles Times: A California-Style Fix For Obamacare's Runaway Premiums 
[T]he cancellations or the HealthCare.gov website, is[not] the fundamental problem with the Affordable Care Act: The law places no limits on the price insurance companies can charge for the coverage we are required to buy. ... Consumer Watchdog has qualified an initiative for the November 2014 ballot that would place health insurance companies doing business in California under Proposition 103's regulatory controls. The nation will be watching as California voters once again lead the way in insurance reform, this time with a state-based strategy to close the loophole in the Affordable Care Act (Harvey Rosenfield, 11/19).

The Wall Street Journal's Capital Journal: Why New Health Law Is So Complicated
The rollout of the Affordable Care Act is in trouble, functionally and politically, and the simplest critique of the new health law is that it's simply proving too complicated. Indeed, its complexity—the need for multiple pieces to work in harmony from the outset—is the single best explanation of why its introduction has been so problematic. What's less recognized is why the new law is so complex in the first place: It represents what may be the biggest attempt ever to weave together big-government impulses with free-market forces (Gerald F. Seib, 11/18). 

The Wall Street Journal: Katrina And Obamacare
Granted, it's an imperfect analogy. So is every other analogy, but there are some particularly glaring differences here. As Karl Van Zandt observes on Twitter, President Bush didn't push Hurricane Katrina through Congress without a single vote from the other party. And, Global-warmist superstitions notwithstanding, Katrina was a natural disaster, not a man-caused one (James Taranto, 11/18).

Reuters: GOP On Obamacare: Divide And Conquer
Congressional Democrats don't seem especially happy with the president's fix. They are trying to put together their own legislative remedy. Senator Mary Landrieu (D-La.) is proposing a bill that would allow people to keep their old health insurance plans — not for one year as Obama has proposed, but indefinitely. ... The threat to Obamacare is clear. Allowing people to keep cut-rate, shoddy policies that do not meet the standards of the Affordable Care Act will create two separate risk pools. A lot of young, healthy Americans will stay with their old, cheap policies, while older and sicker people, desperate for coverage, will enroll in Obamacare (Bill Schneider, 11/19).

Chicago Sun-Times: Poetic Justice Of Unraveling Obamacare 
The talking heads love presidential analogies. Is Obamacare’s rollout Obama’s Hurricane Katrina or his Iraq? ... These comparisons don’t take you far. The president’s troubles are unique to his particular vanities and blind spots. ... The unraveling of Obamacare is a kind of poetic justice, not just for Obama, whose overweening and utterly groundless arrogance now stands rebuked, but also for liberalism. Until Obamacare, liberals had been able to boast of providing benefits to various constituencies while forever pushing the costs onto future generations. This time is different (Mona Charen, 11/18).

The Washington Post: From Promise To Fine Print
The vast majority of Americans listening to the vast majority of words coming out of Jay Carney’s mouth would find it a vastly confusing user experience. The presidential press secretary has spent a week or so trying to explain what White House officials mean when they say the beleaguered HealthCare.gov Web site will "work smoothly for the vast majority of users" by month's end. ... what he is engaged in is defining a “vast majority” in a way that doesn’t commit the White House to a promise it can’t keep (Dana Milbank, 11/18).

And on Medicare -

The New York Times: The Geezers Are Not Alright
The Washington Post editorial board wants to cut Medicare and Social Security. ... what it has pushed repeatedly are things like a rise in the Medicare age. These are the kind of moves that are considered serious inside the Beltway. ... But perceived seriousness is not the same as actual seriousness, which depends on the facts. We now know that raising the Medicare age is a truly terrible idea, which would create a lot of hardship while making next to no dent in the budget deficit. And the central premise of the latest editorial — that the elderly are doing fine — just isn’t true (Paul Krugman, 11/18).

The New York Times' Economix: Medicare Part D: Republican Budget-Busting
Ten years ago this week, Republicans enacted the largest expansion of the welfare state since the creation of Medicare in 1965 by adding a huge unfunded program providing coverage for prescription drugs to the Medicare program. ... By 2003, strong bipartisan support existed for expanding Medicare to include prescription drugs (Bruce Bartlett, 11/19). 

JAMA: Is The Time Right For A Permanent Fix To Medicare’s Formula For Physician Payment
The annual panic affecting the nation's physicians is in full swing. "Medicare docs face 24% pay cut… again," reported CNN Money this month. But after almost a decade of kicking the can down the road, Congress is closer than ever to solving one of Medicare's most vexing problems (Drs. Darshak Sanghavi, John O’Shea and Mark McClellan, 11/18).

On another issue -

Los Angeles Times: A Second Opinion On Statins
According to two respected medical organizations, up to twice as many of us — nearly a third of all adults — should be taking statins to avoid heart attack and stroke. ... These are exactly the kinds of complicated issues that the U.S. Preventive Services Task Force excels in examining. Before the nation embarks on a radical shift that could double the number of people taking statins, this independent, congressionally authorized group should deliver a second opinion (11/19).

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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.