Daily Health Policy Report

Monday, November 25, 2013

Last updated: Mon, Nov 25

KHN Original Reporting & Guest Opinion

Health Reform

Capitol Hill Watch

Medicare

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Administration Tests Fixes That Would Allow Insurers, Brokers To Enroll More Consumers

Kaiser Health News staff writer Julie Appleby reports: "Insurers and the Obama administration are testing fixes to healthcare.gov designed to allow insurers and web-based brokers to directly enroll consumers who qualify for subsidies under the health law. Allowing insurers and online brokers to directly enroll customers in subsidized coverage could be key to signing up the millions of people the government had projected would gain coverage this year. …. But so far, some of those same technical difficulties have prevented most insurers and brokers from being able to do that. Late Friday afternoon, the administration said it had made progress in tweaking the website’s design, and was launching a pilot test of the fixes with insurers in Texas, Ohio and Florida" (Appleby, 11/24). Read the story.

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Health Law Enrollment Efforts For Asian Americans Face Challenges Of Language Diversity, Cultural Differences

Kaiser Health News staff writer Ankita Rao, working in collaboration with USA Today, reports: "But there is no easy prescription for reaching such a diverse group. Health care workers and advocates must consider dozens of languages and dialects — from Bengali to Tagalog — when communicating with the approximately 3 million Asian Americans who have trouble speaking and understanding English. In addition, their religions, cultures and socioeconomic status add complexity to the challenge of developing educational campaigns" (Rao, 11/24). Read the story.

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Capsules: Obamacare Deadline For Jan. 1 Coverage Extended One Week; Sex Sells … Health Insurance?

Now on Kaiser Health News' blog, Mary Agnes Carey reports on the deadline extension: "Consumers will have an extra week — until Dec. 23 – to enroll in health insurance coverage that begins Jan. 1, Obama administration officials said Friday. … While the administration has said the site will work smoothly for most customers by Nov. 30, some advocates had been concerned that consumers still might not have enough time to sign up for coverage that would take effect Jan. 1. The previous deadline was Dec. 15" (Carey, 11/22).

Also on Capsules, Eric Whitney reports on a provocative health insurance advertising campaign in Colorado: "The Affordable Care Act is good for young adults because it’ll save them money on health care, leaving them more to spend on liquor and birth control. That’s one way to interpret the message from a provocative new ad campaign in Colorado. Not everyone is thrilled with it. In a federal hearing in October, Rep. Cory Gardner, R-Colo., showed Health and Human Services Secretary Kathleen Sebelius one of the ads" (Whitney, 11/24). Check out what else is on the blog.

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Political Cartoon: 'Acts Of Gods?'

Kaiser Health News provides a fresh take on health policy developments with "Acts Of Gods?" by Jen Sorensen.

Here's today's health policy haiku:  

DIRECT CONNECTION?

Maybe insurers
can do a better job of 
selling insurance.
-Anonymous 

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

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Health Reform

Healthcare.gov Progress Reports And Post-Mortems

A KHN report looks forward about what is next in the queue in efforts to fix the website -- including possible fixes that would allow insurers and web-based brokers to enroll customers directly into subsidized coverage. Meanwhile, other news outlets analyze the factors that contributed to the balky rollout. Still, Obama administration officials stay positive.   

Kaiser Health News: Administration Tests Fixes That Would Allow Insurers, Brokers To Enroll More Consumers
Insurers and the Obama administration are testing fixes to healthcare.gov designed to allow insurers and web-based brokers to directly enroll consumers who qualify for subsidies under the health law. Allowing insurers and online brokers to directly enroll customers in subsidized coverage could be key to signing up the millions of people the government had projected would gain coverage this year. …. But so far, some of those same technical difficulties have prevented most insurers and brokers from being able to do that. Late Friday afternoon, the administration said it had made progress in tweaking the website’s design, and was launching a pilot test of the fixes with insurers in Texas, Ohio and Florida (Appleby, 11/24).

The Wall Street Journal: Spanish-Language Health Site Delayed
It isn't just the English-language federal website that is weighing on the success of the health-care law. Consumers still can't enroll for insurance on CuidadoDeSalud.gov, the U.S. government's Spanish-language health website. The site was supposed to be fully operational by mid-October, but a Centers for Medicare & Medicaid Services spokeswoman said it won't be ready until the end of this month (Schatz, 11/24).

The New York Times: Tension And Flaws Before Health Website Crash
Interviews with current and former Obama administration officials and specialists involved in the project, as well as a review of hundreds of pages of government and contractor documents, offer new details into how tensions between the government and its contractors, questionable decisions and weak leadership within the Medicare agency turned the rollout of the president’s signature program into a major humiliation. The online exchange was crippled, people involved with building it said in recent interviews, because of a huge gap between the administration’s grand hopes and the practicalities of building a website that could function on opening day. Vital components were never secured, including sufficient access to a data center to prevent the website from crashing. A backup system that could go live if it did crash was not created, a weakness the administration has never disclosed. And the architecture of the system that interacts with the data center where information is stored is so poorly configured that it must be redesigned, a process that experts said typically takes months (Lipton, Austen and LaFranier, 11/22).

The Washington Post: HealthCare.gov Contractor Had High Confidence But Low Success
At 9 a.m. on Aug. 22, a team of federal health officials sat down in a Baltimore conference room with at least a dozen employees of CGI Federal, the company with the main contract to build the online federal health insurance marketplace. For six weeks, the federal officials overseeing the project had become increasingly worried that CGI was missing deadlines, understaffing the work and overstating its progress. ... A final "pre-flight checklist" before the Web site’s Oct. 1 opening, compiled a week before by CMS, shows that 41 of 91 separate functions that CGI was responsible for finishing by the launch were still not working (Goldstein and Eilperin, 11/23).

The Associated Press/Washington Post: Obama Officials Upbeat About Health Site Fixes
There won't be a magic moment, but the Obama administration's much-maligned health insurance website should be able to weather an expected year-end crush of customers, officials asserted Friday. A combination of software fixes, design changes, added hardware and newly announced wiggle room should provide the right combination to finally deliver a workable website, White House troubleshooter Jeffrey Zients said in an upbeat assessment. Zients is a management consultant parachuted in by the White House to extricate President Barack Obama from a technology debacle that has sent his poll ratings into a nose dive (11/22).

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Administration Moves Health Plan Sign-Ups To Mid-November In 2015

On Friday, the Obama administration announced that starting next year, it will push back the start of the sign-up period for those buying insurance until mid-November, rather than mid-October.  Republicans called the shift a blatantly political move. The White House also pushed back this year's deadline -- to Dec. 23 from Dec. 15 -- for coverage that takes effect Jan. 1.

NPR: White House Pushes Next Year's Health Plan Sign-Ups Later
Another day brings another delay for the federal health law known as the Affordable Care Act. On Friday, the Obama administration announced that, starting next year, it is pushing back the start of the sign-up period for those buying individual and small business insurance until mid-November, rather than mid-October. That will give insurance companies some extra time to set their premiums, given this year's difficulties (Rovner, 11/22).

CQ HealthBeat: HHS -- Not GOP -- Points To 2015 Exchange Rates As Reason For Deadline Shift
The Obama administration is signaling that it plans to move back the deadline for insurers to file 2015 rates on insurance exchanges by one month in hopes of keeping premiums down in the second year of the new marketplaces. But Republicans protested Friday that the shift, which also delays the start of next fall’s open enrollment period from Oct. 15 until Nov. 15, is a blatantly political move by the White House (Reichard, 11/22).

The Wall Street Journal: Health-Law Sign-Up Period Extended For A Week
Officials cited difficulties with the federal HealthCare.gov website in pushing back the deadline to Dec. 23 from Dec. 15 for coverage that takes effect Jan. 1. That is the earliest day that coverage under President Barack Obama's health-care law can begin. The move highlights the time pressure to get the law's new health-insurance exchanges running (Radnofsky and Martin, 11/22). 

Kaiser Health News: Capsules: Obamacare Deadline For Jan. 1 Coverage Extended One Week
Consumers will have an extra week — until Dec. 23 – to enroll in health insurance coverage that begins Jan. 1, Obama administration officials said Friday. … While the administration has said the site will work smoothly for most customers by Nov. 30, some advocates had been concerned that consumers still might not have enough time to sign up for coverage that would take effect Jan. 1. The previous deadline was Dec. 15 (Carey, 11/22).

Bloomberg: Obama Giving People More Time To Enroll In Health Plans
President Barack Obama is seeking to give consumers more time and options to enroll in Affordable Care Act health plans, delaying an application deadline and allowing insurers in three states to sign up customers directly. Consumers can now sign up for health coverage as late as Dec. 23, for policies that would begin Jan. 1, the Centers for Medicare & Medicaid Services said yesterday (Wayne and Nussbaum, 11/23).

Fox News: Republicans Cry Foul Over ObamaCare 2015 Enrollment Period Pushback
Congressional Republicans accused the administration of shifting the dates for political reasons, to hide a spike in 2015 premiums, though information may already be available about 2015 premiums before the elections on Nov. 4. "That means that if premiums go through the roof in the first year of ObamaCare, no one will know about it until after the election," Sen. Chuck Grassley, R-Iowa, said in a statement. "This is clearly a cynical political move by the Obama administration to use extra-regulatory, by any means necessary tools to keep this program afloat and hide key information from voters” (11/23).

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Enforcement Of Health Law Mandate A 'Crucial Test' For IRS

The Washington Post reports that enforcing the requirement that almost all Americans have health insurance represents the biggest boost in the agency's responsibilities in decades. A USA Today story looks at how the analysis of large data sets, such as medication usage or hospital readmissions, is being driven by industry trends as well as the health law, and is enabling providers and policymakers to make smarter decisions.

The Washington Post: For Beleaguered IRS, A Crucial Test Still Awaits After Troubled Rollout Of Health-Care Law
The success of the Affordable Care Act could ultimately turn on the performance of an agency that has so far eluded the public spotlight amid the program’s tumultuous rollout. Whether the new law can be enforced will be up to the Internal Revenue Service, an already beleaguered agency charged under the act with carrying out nearly four dozen new tasks in what represents the biggest increase in its responsibilities in decades. None is more crucial than enforcing the requirement that all citizens secure health insurance or pay a penalty (Hamburger and Kliff, 11/24).

USA Today: Analysis Of Huge Data Sets Will Reshape Health Care
Insurers will soon reassess how they predict costs; patients will let doctors know what medications won't work with their particular genomes; and researchers will look at hospital records in real time to determine the cheapest, most effective ways to treat patients — all because of developments in what is known as big data. Driven by industry trends and the Affordable Care Act, the analysis of large sets of data, such as medication usage or hospital readmissions, has enabled health care providers and policymakers to make smarter decisions and predict future trends (Kennedy, 11/24).

Kaiser Health News: Health Law Enrollment Efforts For Asian Americans Face Challenges Of Language Diversity, Cultural Differences
But there is no easy prescription for reaching such a diverse group. Health care workers and advocates must consider dozens of languages and dialects — from Bengali to Tagalog — when communicating with the approximately 3 million Asian Americans who have trouble speaking and understanding English. In addition, their religions, cultures and socioeconomic status add complexity to the challenge of developing educational campaigns (Rao, 11/24).

CNN: CNN Analysis: No Obamacare Subsidy For Some Low-Income Americans
One of the basic tenets of Obamacare is that the government will help lower-income Americans -- anyone making less than about $45,900 a year -- pay for the health insurance everyone is now mandated to have. But a CNN analysis shows that in the largest city in nearly every state, many low-income younger Americans won't get any subsidy at all. Administration officials said the reason so many Americans won't receive a subsidy is that the cost of insurance is lower than the government initially expected (Aigner-Treworgy, 11/23).

Other media outlets look at how states are responding to the White House's recommendation to extend canceled insurance policies in the individual market -

Fox News: States Rejecting Obama's 'Fix' Shows Plan Will Have Little Impact On Improving ObamaCare
Connecticut is the most recent state to reject President Obama's plan to "fix" his signature health-care law after millions of Americas received policy cancellation notices -- a trend that suggests the president's proposed solution will have little impact on the issue. At least eight others states -- California, Indiana, Massachusetts, Minnesota, New York, Rhode Island, Vermont and Washington -- have rejected the president’s Nov. 14 proposal that insurance companies offer plans that don’t comply with ObamaCare requirements for at least a year. Connecticut decided Friday (11/23).

The Oregonian: Nine Oregon Health  Insurers Opt To Renew Cancelled Individual Policies
Nine insurance companies will extend individual health policies that were supposed to be cancelled at year end, though the range of the extensions differed, Oregon officials said today. PacificSource Health Plans and Moda Health Plan Inc. will grant three-month extensions to individuals whose insurance policies were to be cancelled Dec. 31 because they didn't meet federal health reform requirements. The others - covering about 60 percent of the individual market - will extend such policies through all of 2014, the Oregon Insurance Division said (Hunsberger, 11/22).

The Star Tribune: Health Beat: Weighing Impact Of Obamacare’s Broken Promise
President Obama’s “you-can-keep-your-plan” promise has undermined public confidence in Obamacare, polls show, because it turned out to be a promise he couldn’t keep. But while Obama’s promise was off, the impact has been exaggerated — especially in states like Minnesota — according to a new analysis by Families USA, an advocacy group that favors the new law (Olson, 11/23).

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State Exchanges Report November Surge

Still, reports on the ground vary -- with some states offering positive news, while others still are limping along. Here is a sampling of coverage from Kentucky, Minnesota, Illinois, Colorado, Hawaii, Oregon and Massachusetts.  

The Washington Post: State-Run Health Insurance Exchanges Report November 'Enrollment Surge'
After anemic enrollment in the federal health insurance marketplace, several states running their own online exchanges are reporting a rapid increase in the number of people signing up for coverage, a trend officials say is encouraging for President Obama’s health-care law. By mid-November, the 14 state-based marketplaces reported data showing enrollment has nearly doubled from last month, jumping to about 150,000 from 79,000, according to state and federal statistics. The nonprofit Commonwealth Fund, which has been tracking the data, called the most recent numbers "a November enrollment surge" (Sun and Kliff, 11/22).

The Washington Post: In Rural Kentucky, Health-Care Debate Takes Back Seat As The Long-Uninsured Line Up
On the campaign trail, Senate Minority Leader Mitch McConnell was still blasting the new health-care law as unsalvageable. At the White House, President Obama was still apologizing for the botched federal Web site. But in a state where the rollout has gone smoothly, and in a county that is one of the poorest and unhealthiest in the country, Courtney Lively has been busy signing people up: cashiers from the IGA grocery, clerks from the dollar store, workers from the lock factory, call-center agents, laid-off coal miners, KFC cooks, Chinese green-card holders in town to teach Appalachian students (McCrummen, 11/23).

The Star Tribune: Obamacare Mishaps Taint State Exchange
Against a backdrop of mishaps on the federal health insurance exchange, Minnesota and other states that built their own websites are trying to separate themselves from the crush of bad publicity. The state-built sites, while not flawless, have gotten off to a much better start, analysts say. Now, some are worried that the confusion between the two could keep healthy consumers away (Crosby, 11/25).

The Associated Press: Politics Affected Health Care Exchange
Most states led by Democratic governors have opted to run their own online health insurance marketplaces as part of the Affordable Care Act. But in President Barack Obama’s home state, Gov. Pat Quinn pushed unsuccessfully for three years for a state-run marketplace, so Illinois residents now must rely on a crippled federal website (Lester, 11/24).

The Associated Press: MNsure ‘Navigators’ Charged With Spreading Word
Standing at the front of a small classroom on the fourth floor of St. Paul's library, Maureen O'Connell attempted to help the five people at the "MNsure Crash Course" understand how federal health care reform affects their lives...O'Connell is the co-founder and project manager for Health Access MN, a major beneficiary of $3.91 million from a federal government grant to private groups that pledged to recruit Minnesotans to sign up for coverage through MNsure, the state's health insurance exchange (Condon, 11/24).

Kaiser Health News: Capsules: Sex Sells … Health Insurance?
The Affordable Care Act is good for young adults because it’ll save them money on health care, leaving them more to spend on liquor and birth control. That’s one way to interpret the message from a provocative new ad campaign in Colorado. Not everyone is thrilled with it. In a federal hearing in October, Rep. Cory Gardner, R-Colo., showed Health and Human Services Secretary Kathleen Sebelius one of the ads (Whitney, 11/24).

The Hill: Chief Of Hawaii's O-Care Exchange To Resign
The official charged with launching Hawaii's troubled ObamaCare insurance exchange will resign next month, according to multiple reports. Coral Andrews, the executive director of Hawaii Health Connector, is the first marketplace director to leave her post since Oct. 1, when the exchanges launched. The Hawaii Health Connector went live on Oct. 15 due to software problems and had only enrolled 257 people in its first month of operation, according to the Honolulu Star Advertiser. Andrews will reportedly depart on Dec. 6 and be replaced on an interim basis by Tom Matsuda, who headed up ObamaCare's implementation in the state (Viebeck, 11/22).

The Oregonian: Cover Oregon Application Fairs Try To Jumpstart Ailing Health Exchange Enrollment
More than a dozen Cover Oregon staff in turquoise t-shirts dotted the hotel exhibition hall Sunday, calling numbers, helping people and directing traffic. Volunteer application assisters and agents staffed a ring of  tables helping people complete applications. Another group helped check whether applications were complete. The fairs are part of the exchange's backup plan after putting its website mostly on the shelf for repairs due to enrollment problems (Budnick, 11/24).

The Oregonian: Cover Oregon: Keep These Tips In Mind While You Shop The Exchange
Save for another time the question of who in Congress thought a household earning three times the poverty rate could afford to devote 9.5 percent of income to health insurance premiums. Not to mention deductibles. What’s lost in all the furor over the federal and state health exchanges’ bumbled but very complicated rollout is this: There are some good deals in Oregon’s individual health insurance market for 2014 (Hunsberger, 11/23).

The Boston Globe: Snarls In Retooled Mass. Insurance Site
About 105,000 people who have state subsidized coverage, through a program called Commonwealth Care, must enroll in a new plan in the coming months, and many more people want to shop for insurance. As of Wednesday night, 23,275 people had completed applications, about twice the number at the end of October. Just 1,047 had selected a plan, the last step before paying and becoming fulling enrolled. The website is not yet accepting online payments. In the first days of troubleshooting the website, Connector spokespeople said that they were fixing relatively minor glitches and that some of the more significant problems were related to difficulty accessing the troubled federal data hub. But weeks later, many of the most common complaints are about the state website itself (Conaboy, 11/25). 

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Health Law's Medicaid Expansion Running Smoothly

While many Americans have struggled to sign up for insurance on the troubled healthcare.gov website, enrollment is moving faster for Medicaid in states that opted into the expanded program. The New York Times looks at the particular challenges of enrolling homeless adults, while media outlets examine related issues in Illinois, New Jersey, Wisconsin and Pennsylvania.

The New York Times: Medicaid Expansion Faces Major Logistical Challenges Among the Homeless
Today, most state Medicaid programs cover only disabled adults or those with dependents, so [Terry] Cannon and millions of other deeply impoverished Americans are left without access to the program. But starting Jan. 1, President Obama's health care law will expand Medicaid coverage to adults with incomes under 138 percent of the federal poverty line, and enrollment is expected to increase by about nine million next year. Thousands of homeless people will be among the newly covered (Lowry, 11/24).

Milwaukee Journal Sentinel: Wisconsin To Delay Changes To Income Rules Along With Medicaid Switch
Gov. Scott Walker's administration is delaying putting in place a new system to help determine who receives state BadgerCare Plus health care for the needy. The move, state officials said, is tied to the Republican governor's response to the troubled rollout of the federal health law. Because of the Obamacare problems, Walker said earlier this month that he would delay for three months his plan to move more than 70,000 state residents out of BadgerCare and into an online federal insurance market (Stein, 11/23).

Medpage Today: ACA’s Medicaid Enrollment Fairly Smooth
In a time where not much seems to be going as planned in the Affordable Care Act's rollout, it's no surprise that Medicaid enrollment is going as expected and sign-ups outnumber those for private coverage by nearly 4-to-1, experts said Friday. For one thing, states that have expanded their Medicaid programs are also the same ones doing aggressive outreach, as they generally support the act and its coverage expansions, said Matt Salo, executive director of the National Association of Medicaid Directors. Furthermore, states have had an easier time enrolling those eligible for Medicaid than they have enrolling people in private health coverage, even when the latter is subsidized, Salo said [in Washington] at an Alliance for Health Reform briefing on initial results for enrollment in the ACA's exchanges, or marketplaces (Pittman, 11/24).

Chicago Sun-Times: State's Medicaid Applications Adding Up
In Illinois, just 1,370 individuals selected an insurance plan in October through HealthCare.gov, which was created by President Barack Obama’s health care law. But the other part of the Affordable Care Act, also known as Obamacare, that kicked in Oct. 1 — expanding Medicaid — shows better turnout. More than 47,000 low-income people in Illinois have applied for Medicaid since October on the state-run website, abe.illinois.gov/abe/access/. Illinois also got 42,000 additional Medicaid applicants by sending a letter to the 123,000 people receiving food stamps in August. Another more than 100,000 people in Cook County, where an early Medicaid pilot program began a year ago, have already enrolled (Thomas, 11/22).

Newark Star-Ledger: Medicaid Applications Up 35 Percent Since Obamacare Exchange Opened
The opening of the Obamacare health exchange last month drove a 35 percent surge in new applications for Medicaid, the health insurance program for low-income people, the state Department of Human Services confirmed today. The number of applicants to the State’s Medicaid program -- known as New Jersey FamilyCare -- during October totaled 21,946, an increase of 35 percent from September when 16,339 applicants were reported, according to NJ Citizen Action Health Policy Advocate Maura Collinsgru (Livio, 11/22). 

The Associated Press: Medicaid And Minimum Wage Making Way Into Pa. Race
Democrats who are vying for the party's nomination to run for governor are positioning themselves to run on issues including expanding Medicaid, extending kindergarten to full day and increasing the minimum wage (11/24).

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Health Law Issues Bring Optimism To The GOP But Make Democrats Wring Their Hands

The health law's rollout is triggering a range of political postures, plans and strategies.     

The Associated Press/Washington Post: Analysis: To GOP, All Roads Lead To 'Obamacare'
Republican leader Mitch McConnell, with his eyes on the political road ahead and a GOP-damaging partial government shutdown in the rearview mirror, chalked the Senate shift up to "broken promises, double standards and raw power -- the same playbook that got us Obamacare." The calculation seems to be that there will be time for Republicans to retaliate for the Democratic maneuver that swept away generations of precedent in the tradition-bound Senate. The change didn't eliminate filibusters, and a spirit of revenge actually may give the GOP an incentive to launch them in greater numbers (11/22).

Politico: Dems Worry Leaders In Denial On Obamacare
Democratic leaders claim the bungled launch of Obamacare is just the latest news sensation -- a media-stirred tempest that looks in the heat of the moment like it could upend the midterm election, but ends up fizzling well before voters head to the polls. Some party strategists say they're in denial (Isenstadt, 11/25).

Politico: As Deadline Nears, Ticking Clock On Democratic Patience
Some Capitol Hill Democrats are preparing to launch broadsides against President Barack Obama if the Affordable Care Act website isn't fixed by the end of the month. That will come in the form of more aggressive scrutiny in Republican-led oversight hearings, open advocacy for further delay in the enrollment deadline and individual coverage mandate, and more calls for a staff shake-up in the White House (Allen, 11/25).

Los Angeles Times: Biden Keeps A High Profile -- Except On Health Care
The week of his 71st birthday, in a two-day trip to Houston and Panama City, Biden was hardly hiding. He toured the Houston port, walked a stretch of the Panama Canal, met with Panama's president and squeezed in meetings with opposition candidates and elected officials when he wasn't making calls to foreign leaders from Air Force 2. But at the same time, he was conspicuously avoiding the health care spotlight that has been glaring on the president, Health and Human Services Secretary Kathleen Sebelius and other senior officials. Biden did discuss health care at some events. In Houston, he talked with volunteers seeking to sign people up for coverage, meeting with them for more than an hour and reassuring them that healthcare.gov would get back on track (Parsons, 11/22).

The New York Times: Don't Dare Call The Health Law 'Redistribution'
"Redistribution is a loaded word that conjures up all sorts of unfairness in people's minds," said William M. Daley, who was Mr. Obama's chief of staff at the time. Republicans wield it "as a hammer" against Democrats, he said, adding, "It's a word that, in the political world, you just don't use." These days the word is particularly toxic at the White House, where it has been hidden away to make the Affordable Care Act more palatable to the public and less a target for Republicans, who have long accused Democrats of seeking "socialized medicine." But the redistribution of wealth has always been a central feature of the law and lies at the heart of the insurance market disruptions driving political attacks this fall (Harwood, 11/23).

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N.Y. Medical Providers Considering Which Exchange Plans To Join

Medical providers in New York are making deals with insurers to provide care to their patients buying health coverage on the state's health insurance marketplace. In California, Molina Healthcare looks for growth opportunities.

The Associated Press: NYC Medical Providers Negotiate Insurance Deals
With deadlines looming, medical providers and insurers in New York are negotiating deals that may determine which doctors you can see if you buy a health plan through the state's new insurance marketplace. One of the world's most respected cancer hospitals, Memorial Sloan-Kettering Cancer Center, announced Friday that it had signed agreements to join the networks of three plans being sold through the exchange: Health Republic Insurance, Oscar Insurance and Oxford Health Plans. Oxford will only be available to small businesses (11/22).

Los Angeles Times: Molina Healthcare Poised For Healthy Growth
Molina Healthcare Inc. of Long Beach was looking after the medical needs of low-income people long before Obamacare debuted. Molina Healthcare began 33 years ago after emergency room physician C. David Molina had seen too many poor people with easily treatable and preventable illnesses. He opened three small clinics in Long Beach to serve them (White, 11/24).

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New Small Businesses See Health Law Help In Clearing Major Expense Hurdle

Some new small businesses see the health law's insurance marketplaces as a way past one of the major expenses in starting a business -- providing health care coverage for their employees. In the meantime, some companies prepare to ask workers to share more of the cost of their health care coverage.

The New York Times: In The Health Law, An Open Door For Entrepreneurs
In the weeks since the health insurance marketplaces of the Affordable Care Act went online, a well-publicized ripple of alarm and confusion has permeated the ranks of small-business owners. But less well known is the response of another contingent: newcomers to entrepreneurship who see the legislation as a solution to the often insurmountable expense of getting health insurance. Some even view the Affordable Care Act itself as a business opportunity (Martin, 11/23).

The Wall Street Journal: Companies Prepare To Pass More Health Costs To Workers
Companies are bracing for an influx of participants in their insurance plans due to the health-care overhaul, adding to pressure to shift more of the cost of coverage to employees. Many employers are betting that the Affordable Care Act's requirement that all Americans have health insurance starting in 2014 will bring more people into their plans who have previously opted out (Francis, 11/24).

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Capitol Hill Watch

Lawmakers Join State Exchanges Ahead Of Tough 2014 Election Battles

Some Washington lawmakers are joining their home state insurance marketplaces ahead of 2014's elections so they can say they are getting the same health law choices as constituents. In the meantime, Politico looks at the premium costs for one prominent member, and The Washington Post fact checks some claims about health law coverage made by Sen. Ted Cruz.

Politico: Politics Shadow Senators' Health Exchange Choices
Some of the Senate's most vulnerable members in the 2014 elections are giving up government contributions toward their own health insurance under Obamacare next year as voter sentiment turns against the president's signature program. Several are signing up for their home state exchanges instead of Washington's, allowing them to say they're in the same boat as constituents (Villacorta and Haberkorn, 11/25).

Politico: John Boehner's Premiums Spike Under Obamacare
Don't expect to hear the Ohio Republican complain about his personal price spike, but he's one of many older lawmakers and aides who are just finding out how much more they will have to pay as they move from the old Federal Employees Health Benefits system to coverage in the District of Columbia's new health insurance exchange, as required by a provision in the Affordable Care Act and subsequent federal regulations. That will be true, too, for some consumers across the country who are transitioning into the exchanges (Allen, 11/24).

The Washington Post's The Fact Checker: Ted Cruz's Fuzzy Math About The 'Trade-Off At The Heart Of Obamacare'
Cruz's math in this interview was quite unlike any figures The Fact Checker had heard or seen before, so let’s explore how the senator came up with his numbers. Under Cruz's calculations, 200 million people are at risk of losing their insurance in order to benefit just 15 to 20 million people -- while leaving 30 million uninsured (Kessler, 11/25).

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Medicare

Medicare Reverses Course And Opts Not To Revamp Dialysis Payments

Federal officials announce that they will reduce what the program pays by less than 1 percent over the next two years.

The Wall Street Journal: Medicare To Cut Dialysis Payments Much Less Than Expected
The Centers for Medicare and Medicaid Services said it would reduce payments to kidney dialysis providers by less than 1% over the next two years in a reversal of the much-larger cuts it had proposed this summer (Walker, 11/22).

Reuters: U.S. Medicare Program Leaves 2014 Dialysis Payments Unchanged
Medicare, the U.S. government healthcare program for elderly and disabled people, will leave its overall reimbursement rates for kidney dialysis treatment unchanged for next year, and said it will take three to four years to implement a mandated adjustment to its base rates (Beasley, 11/22).

Meanwhile, in another health issue often confronting seniors --

The Wall Street Journal: New Strategies For Long-Term Care
As long-term-care insurance becomes more expensive and harder to get, what are families who want it left to do? Fewer carriers are offering the coverage, which helps pay for future nursing-home, assisted-living and home care. Those that still do are raising premiums on new and longtime policyholders (Greene, 11/22).

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State Watch

State Highlights: KanCare Gets Nursing Home Critics; Patient Access To Records In Wis.

A selection of health policy stories from Virginia, Kansas, Wisconsin and Minnesota.

The Washington Post: What Are Gov.-Elect Terry McAuliffe's Plans For Virginia's Mental Health System? 
In the wake of the Creigh Deeds family tragedy, it seems instructive to look ahead to how Gov.-elect Terry McAuliffe plans to deal with Virginia's mental health system. I wrote a story last month about the views of both gubernatorial candidates on the state system, based in part on their platforms and in part on questions I asked about key issues. McAuliffe fully favors Virginia expanding its Medicaid coverage through the Affordable Care Act, saying it would provide new health care coverage for about 400,000 Virginians and would increase money for mental health treatment (Jackman, 11/25). 

Kansas Health Institute: Nursing Homes Feel KanCare And Other Pressures
Kevin Unrein, chief executive and co-owner of a company that operates three Kansas nursing homes, said there is something he would like state policymakers to know about KanCare. "It's a mess," he said last week, leaving a meeting at a Topeka hotel conference room that brought together dozens of nursing home managers and representatives of the state’s three KanCare managed care companies (Shields, 11/25).

The Milwaukee Journal Sentinel: Patients Get Access To Doctors’ Notes Online In Milwaukee-Area First 
Most of the health care systems in the Milwaukee area give patients access to key information in their medical records, such as lab results and prescriptions, through secure Internet portals. But Columbia St. Mary's is the first to give them access to physicians' and clinicians' notes. The initiative -- OpenNotes -- is an outgrowth of a study that involved more than 100 primary care doctors from three medical centers and health systems across the United States. The response by patients was enthusiastic: 99 percent of the 5,391 patients who completed a survey recommended the notes remain available, the study found (Boulton, 11/24).

The Star Tribune: Fewer Minnesota Children Found To Be Uninsured 
The number of uninsured children in Minnesota dropped by 16,000 between 2010 and 2012, according to a new national analysis -- exactly the number that officials predicted when Gov. Mark Dayton and legislators expanded access to the state's MinnesotaCare program last July. Although the change in MinnesotaCare access can't be entirely credited for the two years of progress, officials with the Children's Defense Fund-Minnesota believe it contributed to the gains (Olson, 11/25). 

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Editorials and Opinions

Viewpoints: Senate Should Reconsider Treaty On Protections For People With Disabilities; HHS Treading Wrong Way On Payments For Bone Marrow Donors

The New York Times: How To Do Right By The Disabled
About a year ago the Senate fell five votes short of ratifying an international treaty that would improve protections for the disabled. It was an ignoble spectacle as the opponents rebuffed Bob Dole, a former colleague and disabled veteran, who came to the Senate floor to lobby for it. The Senate now has a chance to redeem itself (11/24).

The Wall Street Journal: Rationing Bone Marrow
You know an agency has gone off the rails when its rules make the Ninth Circuit Court of Appeals look like a beacon of sanity. So it goes at the Department of Health and Human Services, where a proposed rule-making is seeking to override the court's decision to allow bone-marrow donors to be compensated for their donations (11/24).

The New York Times: Responding To A Meningitis Outbreak
A vaccine approved for use in Europe and Australia but not in the United States will be imported to help quell an outbreak of bacterial meningitis at Princeton University. This is a good example of how two federal agencies -- the Centers for Disease Control and Prevention and the Food and Drug Administration -- can collaborate to reach a common-sense solution to protect the public's health (11/22).

The Wall Street Journal: Should The Eligibility Age For Medicare Be Raised?
With increasing demographic and financial pressures on Medicare, there's a growing consensus in the U.S. that something has to be done about the decades-old social program. With this in mind, we posed the following question to The Experts: Should the eligibility age for Medicare be raised? (11/23).

Los Angeles Times: 40-Plus Years As A Pediatrician
In my early years of practice, I also saw cases of measles, rubella and whooping cough, and, of course, almost all children developed chickenpox. Today, there are immunizations against all these diseases, so it is uncommon to see them. But that could change. A new wave of uninformed, anti-vaccine sentiment is persuading some parents to forgo or delay immunizing their children. The science is clear-cut: Vaccines save lives, and serious side effects are exceedingly rare (Dr. Richard M. Buchta, 11/24).

Los Angeles Times: So Much Data-Gathering, So Little Doctoring
I'm a stomach doc. I've seen thousands of patients, inside and out, for 25 years. I've done research, I've taught, I've been an administrator. And as the years rolled by, I've watched the healthcare industry begin to undo healthcare itself. It's complex, cumbersome and bureaucratic, and the bigger the practice or the clinic or the hospital and research facilities — like the universities I used to work at — the worse the problem (Dr. Michael P. Jones, 11/24).

The Washington Post: Creigh Deeds's Son, My Daughter And My Fears About Virginia's Mental Health System
I was coming home from visiting my 11-year-old daughter at a Virginia psychiatric hospital Tuesday when I heard about the stabbing of state Sen. Creigh Deeds and the suicide of his son, Austin. According to some reports, the younger Deeds had been denied admittance to a psychiatric hospital the day before. I was heartbroken. This family was let down by the same broken mental health system my family depends on (Cristy Gallagher, 11/22). 

The New York Times: Curing Insomnia To Treat Depression
Psychiatrists have long thought that depression causes insomnia, but new research suggests that insomnia can actually precede and contribute to causing depression. The causal link works in both directions. Two small studies have shown that a small amount of cognitive behavioral therapy to treat insomnia, when added to a standard antidepressant pill to treat depression, can make a huge difference in curing both insomnia and depression in many patients. If the results hold up in other studies already underway at major medical centers, this could be the most dramatic advance in treating depression in decades (11/23).

The New York Times: Danger Lurks In That Mickey Mouse Couch
Researchers this summer purchased 42 children's chairs, sofas and other furniture from major retailers and tested them for toxic flame retardants that have been linked to cancer, birth defects, diminished I.Q.'s and other problems. In a study released a few days ago, the Center for Environmental Health reported the results: the toxins were found in all but four of the products tested. ... These flame retardants represent a dizzying corporate scandal. It's a story of corporate greed, deceit and skulduggery, powerfully told in a new HBO documentary, "Toxic Hot Seat," that is scheduled to air on Monday evening (Nicholas D. Kristof, 11/23).

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Health Law Commentaries: 'A Reader's Guide' To Possible 'Traumas To Come;' California Shows The Way To Success

Commentators look at the rollout of the health law and the implications for the nation and individual states.

The Wall Street Journal: Manias, Panics And Obamacare Crashes
President Obama says not to worry about the Affordable Care Act's botched rollout because the country will love it once the website is fixed and subsidies start rolling. But what if the troubles are only beginning because they're built into the law? In the tradition of service journalism, we thought we'd offer a reader's guide to the many potential Obamacare traumas to come (11/22).

The Wall Street Journal: The Medicare-For-All Diversion
Many on the left tell us the solution is Medicare-for-All, because Medicare is so much more efficient than private insurers, spending a mere 2 percent on overhead compared to 20 percent or higher for private plans. Extraordinary claims require extraordinary proof, and the idea that a bureaucratic agency with no obvious incentive for efficiency is inexplicably efficient certainly qualifies. Yet many in the media are prepared to pass along this claim as a found item. This requires overlooking a lot (Holman W. Jenkins Jr., 11/22).

The Washington Post: Health-Insurance "Assisters" Comb D.C. To Educate, Sell
Hard as it might be to believe for those who've been pushing, pulling or just writing about the Affordable Care Act for years, not everybody has been following it, even within a couple of miles of Capitol Hill. So at several Washington Metro stops Friday, smiling "assisters" for the local insurance exchange, D.C. Health Link , were out with megaphones, calling themselves "fact mobs." "Good morning!" they shouted. "We are the D.C. fact mob, and we have facts for you!" (Melinda Henneberger, 11/22).

Politico: The Obamacare 'Fix' Is Illegal
The fix is not in. One week later, states are still wrestling with whether to implement Barack Obama's answer to the wave of dropped plans that greeted the launch of his signature health care initiative. The president's "fix," announced last Thursday in a somber news conference, allows insurance companies to renew policies that do not meet the minimum care standards of the Affordable Care Act (ACA), which go into effect on Jan. 1 (Eugene Kontorovich, 11/22).

The New York Times: California, Here We Come?
It goes without saying that the rollout of Obamacare was an epic disaster. But what kind of disaster was it? Was it a failure of management, messing up the initial implementation of a fundamentally sound policy? Or was it a demonstration that the Affordable Care Act is inherently unworkable? ... At a time like this, you really want a controlled experiment. What would happen if we unveiled a program that looked like Obamacare, in a place that looked like America, but with competent project management that produced a working website? Well, your wish is granted. Ladies and gentlemen, I give you California (Paul Krugman, 11/24).

Lexington Herald-Leader: Editorial Ignores Facts; New Health Law Is A Failure
I read with amusement your recent editorial twisting the facts of the disastrous Affordable Care Act. As much as this newspaper loves to root for Obamacare, the fact remains that most Kentuckians oppose it, and for good reason. For starters, the law has resulted in less coverage, causing 280,000 Kentuckians to lose the health insurance plans they already have. It's taking away many Kentuckians' ability to visit the doctors and hospitals they like. And it will increase health care costs and add so many new enrollees to Medicaid (read: paid for by taxpayers) that even Gov. Steve Beshear told The Paducah Sun in early 2011, "I have no idea how we're going to pay for it." In short, Obamacare is a failure (Sen. Mitch McConnell, R-Ky., 11/25).

Bloomberg: The Health-Care Spoiler In California's Rosy Budget
Despite a 30 percent increase in the top income tax rate, higher sales taxes and fees, and greater total revenue, the state is spending less on education, transportation, courts, welfare and parks than it was six years ago. The reason: State spending on health care, employee compensation and benefits, interest, and prisons is greater than it was six years ago. The largest spending growth is in Medi-Cal, which is California’s version of Medicaid. The program is the state's second-largest and fastest-rising expenditure, and accounts for most of the Department of Health Care Services' outlays, which grew 65 percent over the six-year period, to $24 billion a year, from $14 billion (David Crane, 11/22).

The Anchorage Daily News: Parnell's Medicaid Decision Affects 43,000 Alaskans
I was struck, however, by the governor's evident disconnect with the health care issues affecting Alaskans, or even how health care works. ... Here's one example from the briefing: "Medicaid expansion does not necessarily address the poor's actual access to health care. It does, however, affect their eligibility to have it covered financially ... The real issue in Alaska is, and always has been, access, not insurance ..." Huh? Insurance means access. Low-income Alaskans have difficulty accessing health care mainly because they can't pay for it. That's what health insurance does -- it assures access to care (Tim Bradner, 11/23). 

Charleston (S.C.) Post and Courier: Another Shaky Obamacare Pitch
The Obama administration's expansion advocates pitched the upward shift as a sweet deal for the states. They stressed that Washington would cover all of the extra costs of the expansion through 2017. Then the states' share of the additional financial obligation would rise in increments to a maximum of 10 percent. But some governors, including South Carolina’s Nikki Haley, were rightly wary about that guarantee from Washington. After all, the administration making the promise is led by the president who repeatedly assured Americans while pushing Obamacare: "If you like your health insurance plan, you can keep it" (11/24).

The Salt Lake City Tribune: No Amount Of Committees Can Justify Not Expanding Medicaid
Thus a great deal of effort has been expended by the Utah Legislative Health System Reform Task Force for it to come up with reasons why the state should not accept the challenge, and the federal money, to fully expand Medicaid health care coverage under the provisions of the Affordable Care Act. It is an effort designed to make it easy for Gov. Gary Herbert to reject or downsize the Medicaid expansion option included in the ACA and, by so doing, uphold ideological dogma for the well off at the expense of human suffering, bankruptcy and death for the working poor (11/24).

Deseret News: Utah Needs Balanced Medicaid Expansion
Utah must soon decide whether and how to expand Medicaid. It is a momentous choice. For two generations, Medicaid has provided health care to some needy Utahns -- children, women with children and the disabled. Many groups note the federal government's generous Medicaid matches and conclude that full expansion is a "no-brainer." ... the Utah Hospital Association (UHA) has carefully considered the various options for Medicaid expansion, including not expanding it at all. UHA supports a limited and balanced approach to Medicaid expansion (Greg Bell and David Entwistle, 11/24).

Concord Monitor: With No Medicaid Deal, Needy Residents Continue To Wait
In that context, the inability of New Hampshire political leaders to come to agreement last week on a proposal to extend health care coverage to some of the state's neediest residents is all the more discouraging. At issue was a remarkably generous deal by the federal government: expand the eligibility of the New Hampshire Medicaid program to cover another 50,000 residents, and the feds would pick up 100 percent of the cost for the first three years. After that, the federal share would drop to 90 percent. As has happened elsewhere, Democrats liked the deal, Republicans didn't (11/24).

St. Louis Beacon: Hard Lessons From The ACA Roll-Out
As a professor of public policy I am always on the lookout for events that I can use as Teachable Moments in the classroom. The rollout of the Affordable Care Act, aka Obamacare, certainly qualifies as a case study of what not to do when implementing a new public policy (Robert Cropf, 11/25).

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EDITOR:
Stephanie Stapleton

ASSOCIATE EDITOR:
Andrew Villegas

WRITERS:
Lisa Gillespie
Marissa Evans

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.