Daily Health Policy Report

Monday, November 4, 2013

Last updated: Mon, Nov 4

KHN Original Reporting & Guest Opinion

Health Reform

Administration News

Capitol Hill Watch

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

In Alabama, Lack Of Competition May Be Behind Insurance Premium Costs

Kaiser Health News staff writer Jay Hancock, working in collaboration with USA Today, reports: "The letters landed in early October, cancelling health plans for thousands of BlueCross BlueShield of Alabama members and offering to enroll them in new coverage at often substantially higher cost. ‘I thought my plan might go up like $30. I didn't know it was going to [nearly] double’ to $478 a month, said Merry Hardy, who is self-employed and lives in Alexander City, in the middle of the state. 'I'm thinking, please God, let Obamacare fail'" (Hancock, 11/4). Read the story.

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Doctors Treat New Condition: Questions About Health Law

Kaiser Health News staff writer Anna Gorman, working in collaboration with McClatchy, reports: "Carolyn Senger, a preventive medicine doctor, regularly treats uninsured patients, coaching them how to stay healthy. Now she is teaching them one more thing -- how to sign up for insurance under the nation’s Affordable Care Act. ‘Not only can I help you with your health, but I can also help you get some coverage,’ Senger says to her patients. Despite the ongoing controversy over the website and the rocky rollout of the law, the Obama administration still hopes that millions will sign up for new insurance options before the March 31 deadline. To make that happen, health officials are counting on physicians to shift the conversation from the online problems to the benefits of coverage. They are motivated by a longstanding principle: People trust their doctors" (Gorman, 11/4). Read the story.

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So You Found An Exchange Plan. But Can You Find A Provider?

WNYC’s Fred Mogul, working in partnership with Kaiser Health News and NPR, reports: "Consumers shopping for coverage on the new health insurance exchanges have been focused on the lowest-cost options. But some shoppers are trying to determine which plans offer the widest array of doctors and hospitals — and are finding that can be trickier than it sounds" (Mogul, 11/4). Read the story.

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Adding To Health Insurance Confusion, Other Groups Try To Cash In

WFSU’s Lynn Hatter, working in partnership with Kaiser Health News and NPR, reports: "The 30 or so attendees at St. Mary Primitive Baptist Church on a recent evening believed they were about to hear an official presentation by the 'Obamacare Enrollment Team' on all of their options to get insurance because of the Affordable Care Act. They were told: 'If anybody is interested in getting enrolled we can get you enrolled tonight.' Signs outside the church even looked official:  A familiar large 'O' with a blue outline, white center and three red stripes" (Hatter, 11/4). Read the story.

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Capsules: N.Y. Hospital Group Turns The Tables On Hospital Graders

Now on Kaiser Health News' blog, Jordan Rau reports: " Judge not, that ye be not judged. Irked by the growing number of report cards assessing the quality of hospitals, a New York State hospital association has taken this biblical admonition to heart by putting out a report card grading the quality of hospital graders. Five of the 10 report cards that were evaluated were given low marks" (Rau, 11/4). Check out what else is on the blog.

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Political Cartoon: 'Liability Coverage?'

Kaiser Health News provides a fresh take on health policy developments with "Liability Coverage?" by Lee Judge.

Here's today's health policy haiku:

    ANOTHER WAY TO USE THAT EXTRA HOUR...

Healthcare.gov site
must have been pretty tired:
Took long weekend nap
-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

Senate Dems Express Increasing Alarm Over Website Issues

With its first rocky month down, some say the most critical days are beginning for healthcare.gov. Meanwhile, the technical difficulties that have plagued the site are starting to chip away at the Democratic unity that has, so far, surrounded it. Some senators, for instance, are beginning to express concerns about its impact on the upcoming mid-term election and are calling for a delay in the individual mandate penalties if the website is not soon operational.

ProPublica: A Month In To Healthcare.Gov, Real-Life Winners and Losers
Today marks one month since the disastrous start of Healthcare.gov, the seriously impaired federal health insurance marketplace. And what a month it's been (Ornstein, 11/1).

The Wall Street Journal: Critical Weeks Begin For Health Law Rollout
A potentially decisive month for the Affordable Care Act is beginning, with the Obama administration racing to meet its target of getting its health-insurance website functioning normally by the end of November. As a notice on the HealthCare.gov website suggests, normalcy is still a ways off.  The site's core function–allowing people to sign up for health insurance–"isn't available from approximately 1 a.m. to 5 a.m. EST daily while we make improvements," says the notice (Paletta, 11/3).

The Wall Street Journal: Officials Rebuff Call To Suspend Health Site
The Obama administration said Sunday it had rejected a call from a senior Democratic senator to shut down HealthCare.gov until it is fully fixed, saying that wouldn't help the government team racing to have the website up to scratch by the end of the month. November is developing into a challenging month for the administration, which is likely to face calls for more far-reaching changes to the Affordable Care Act if it can't get HealthCare.gov in shape by Nov. 30. Some Democrats have said that if the site isn't fixed soon, they would act to delay the law's requirement that most Americans carry health insurance in 2014 or pay a tax penalty (Radnofsky and Paletta, 11/3).

Politico: Max Baucus: Delay Obamacare Penalties If Website Still Lags
Senate Finance Committee Chairman Max Baucus says Congress would need to consider delaying Obamacare’s penalties if the website is not repaired, but he said such conversations are "premature" at this point. "If it looks like Humpty Dumpty isn’t getting good, back together, maybe we should start thinking about delaying the penalties," Baucus (D-Mont.) told News Talk 730 radio in Billings, Mont. But Baucus, one of the chief authors of the law, said he’d rather just see HealthCare.gov repaired (Haberkorn, 11/4).

The Hill: Baucus: ObamaCare Site Is 'Humpty Dumpty'
Sen. Max Baucus (D-Mt.) said Friday the penalty for the individual mandate should be delayed if the "Humpty Dumpty" ObamaCare website can't be put back together again. "I think it makes better sense to see how much of this can be put together, how much Humpty Dumpty can be fixed in the next month," Baucus said in an interview with Scott Fredericks of NewsTalk 730 KYYA (Easley, 11/1). 

CBS News: Take HealthCare.Gov Offline Until It Is Fixed, Feinstein And Rogers Say
Both Sen. Dianne Feinstein, D-Calif., and Rep. Mike Rogers, R-Mich., said on CBS' "Face the Nation" that the HealthCare.gov website should go offline until it is fully functional. The website has been plagued by problems since its Oct. 1 launch. Earlier this month, President Obama appointed former CEO Jeffrey Zients, one of his economic advisors, to lead a "tech surge" intended to fix the site by the end of November. "It's pretty clear, I think, to those of us who have been watching this rollout, that the technological base was not sufficient, and that the website didn't function," said Feinstein, who added that she told White House Chief of Staff Denis McDonough that she thought the administration should take the site down "until it was right” (Kaplan, 11/3).

Politico: Senate Dems To W.H.: Fix Obamacare
Democratic senators have a warning for the White House: Fix Obamacare's problems or put Senate seats at risk next year. In interviews, Democratic senators running in 2014, party elders and Senate leaders said the Obama administration must rescue the law from its rocky start before it emerges as a bigger political liability next year (Raju, 11/3).

Bloomberg: Health Site Flaws Test Democrats' Unity As Attacks Rise
Senate Democrats will get to question the administrators of President Barack Obama's flawed health-care website next week amid mounting anxiety that may test their party's unity. Democratic senators shot questions at White House Chief of Staff Denis McDonough and other officials responsible for the website at a lunch at the Capitol Oct. 30, said a Senate Democratic aide (Dorning and Hunter, 11/2).

ABC News: Obamacare Paper, Phone, Web Apps 'Stuck In The Same Queue,' Memos Note
A series of internal Obama administration memos obtained exclusively by ABC News reveal for the first time how dysfunction with HealthCare.gov has upended the entire Affordable Care Act enrollment process, including applications by paper and phone that officials have been pushing as more reliable alternatives. "The same portal is used to determine eligibility no matter how the application is submitted (paper, online)," reads a Center for Consumer Information and Insurance Oversight memo from Oct. 11. "The paper applications allow people to feel like they are moving forward in the process and provides another option," it says. "At the end of the day, we are all stuck in the same queue" (Dwyer and Karl, 11/4).

The efforts to fix the site continued over the weekend when officials took the site down.

Reuters: Obamacare Website To Be Down Again For Maintenance Late Saturday
The glitch-ridden website used to sign up for insurance under President Barack Obama's healthcare law will be down for "extended maintenance" overnight on Saturday, the Department of Health and Human Services said. The website has been plagued by technology problems and has not worked reliably since its launch on October 1, embarrassing the administration and providing ammunition for Republicans seeking to roll back the law known as Obamacare (Rampton, 11/2).

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Politics, Implementation Pressures May Have Worked Against Website's Technical Needs

News outlets take a long look at the moving parts that were in play as the problem-plagued federal health exchange website was under construction.

The Washington Post: HealthCare.gov: How Political Fear Was Pitted Against Technical Needs
In May 2010, two months after the Affordable Care Act squeaked through Congress, President Obama’s top economic aides were getting worried. Larry Summers, director of the White House’s National Economic Council, and Peter Orzag, head of the Office of Management and Budget, had just received a pointed four-page memo from a trusted outside health adviser. It warned that no one in the administration was "up to the task" of overseeing the construction of an insurance exchange and other intricacies of translating the 2,000-page statute into reality. ... For weeks that spring, a tug of war played out inside the White House, according to five people familiar with the episode (Goldstein and Eilperin, 11/2).

Bloomberg: Obamacare Expedited Bidding Limited Who Could Build Site
The race to construct an online insurance exchange by Oct. 1 spurred the Obama administration to use an expedited bidding system that limited its choice of a builder to just four companies, including CGI Group Inc. Eighteen months elapsed after passage of the 2010 health-care overhaul before CGI was selected to begin work, government documents show (Wayne and Miller, 11/3).

Los Angeles Times: President Was Told Healthcare Website Would Work, Official Says
President Obama was assured that the healthcare insurance website was ready to launch on Oct. 1, even as private contractors and some administration officials knew the site had failed in early testing, a senior White House advisor said Sunday (Hennessey, 11/3).

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Consumers Losing Their Health Policies Could Become Potent Political Force

Several news stories examine how this group is adept at generating attention, especially among its elected representatives.

The San Francisco Chronicle: Why So Many Face Shifts In Medical Insurance
Despite President Obama's oft-stated promise that you can keep your insurance if you like it, most people with individual policies will have to get a new one in 2014 because their existing one does not comply with the myriad requirements of the Affordable Care Act and therefore must be terminated. Companies that discontinue a policy must offer customers a new one that complies. One exception: If a person had a policy before the act was signed in March 2010, and that plan has not changed, that person is considered grandfathered and can keep the existing policy as long as the company offers it. In California, no existing policies comply with the act, according to Janice Rocco, the state's insurance commissioner (Pender, 11/2).

The Wall Street Journal: Outspoken Group Bears Brunt Of Canceled Health-Insurance Policies
Somebody has to pay more to enable America's uninsured to take part in the Obama administration's health-insurance marketplace—somebody like Dave Hamilton, for example. Unfortunately for the Obama administration, Mr. Hamilton and others in his situation tend to be politically savvy and very vocal. ... He is one of the 10 million or so who buy insurance on the individual market, don't qualify for subsidies under the Affordable Care Act and recently received notice that their current plans don't comply with the law's standards and will be canceled. Mr. Hamilton, 42, said he expected to pay more. But his rates are expected to rise by far more than the 20% he had calculated (Williamson, 11/1).

The Washington Post: For Consumers Whose Health Premiums Will Go Up Under New Law, Sticker Shock Leads To Anger
Americans who face higher insurance costs under President Obama's health-care law are angrily complaining about "sticker shock," threatening to become a new political force opposing the law even as the White House struggles to convince other consumers that they will benefit from it. The growing backlash involves people whose plans are being discontinued because the policies don't meet the law's more-stringent standards. They're finding that many alternative policies come with higher premiums and deductibles (Cha and Sun, 11/3).

Politico: Obamacare Losers Could Pack Political Punch
Meet the new Soccer Mom: Obamacare losers. Millions of married, older, white, college-educated, GOP-leaning Americans have quickly seen their political profile rise after their health insurance companies sent them cancellation letters with the launch of the giant new health care law. It's not a huge segment of the population — estimates show between 10 million to 19 million people bought health insurance from what Health and Human Services Secretary Kathleen Sebelius dubbed the "Wild West" individual marketplace. But the ones who are making the most anti-Obamacare noise are part of this group (Samuelsohn and Millman, 11/1).

The Associated Press: Sticker Shock Often Follows Insurance Cancellation
The Griffins are among millions of people nationwide who buy individual insurance policies and are receiving notices that those policies are being discontinued because they don't meet the higher benefit requirements of the new law. They can buy different policies directly from insurers for 2014 or sign up for plans on state insurance exchanges. While lower-income people could see lower costs because of government subsidies, many in the middle class may get rude awakenings when they access the websites and realize they'll have to pay significantly more. Those not eligible for subsidies generally receive more comprehensive coverage than they had under their soon-to-be-canceled policies, but they'll have to pay a lot more (Kennedy, 11/2).

The Wall Street Journal: Aides Debated Obama Health-Care Coverage Promise
As President Barack Obama pushed for a new federal health law in 2009, he made a simple pledge: If you like your insurance plan, you can keep your plan. But behind the scenes, White House officials discussed whether that was a promise they could keep. ... At one point, aides discussed whether Mr. Obama might use more in-depth discussions, such as media interviews, to explain the nuances of the succinct line in his stump speeches, a former aide said. Officials worried, though, that delving into details such as the small number of people who might lose insurance could be confusing and would clutter the president's message (Nelson, Nicholas and Lee, 11/2).

Kaiser Health News: In Alabama, Lack Of Competition May Be Behind Insurance Premium Costs
The letters landed in early October, cancelling health plans for thousands of BlueCross BlueShield of Alabama members and offering to enroll them in new coverage at often substantially higher cost. "I thought my plan might go up like $30. I didn't know it was going to [nearly] double" to $478 a month, said Merry Hardy, who is self-employed and lives in Alexander City, in the middle of the state. "I'm thinking, please God, let Obamacare fail" (Hancock, 11/4).

The Associated Press: Health Law Leads To Cancellation Of N.D. Policies
About 42,500 North Dakota residents, or roughly 6 percent of the state, were covered by individual plans at the end of 2013, according to state insurance records. In North Dakota, the health care changes will wipe out virtually all the 2,500 individual plans carried by Medica and Sanford Health. Blue Cross Blue Shield North Dakota, the state's largest insurer, covered more than 32,000 through individual plans last year, and would not disclose how many of its customers' current plans will be discontinued (11/3).

The Associated Press/The Wall Street Journal: NY Expects 100,000 To Change Insurance
New York health officials say that about 100,000 individuals will have to change their health insurance under the federal health care overhaul. According to the state Health Department, those changes are required where current insurance plans don't comply with the terms of the Affordable Care Act (11/2).

The Sacramento Bee: In California, Hundreds Of Thousands To Pay More For Health Insurance
Hundreds of thousands of Californians who purchase their own health insurance are bracing to pay more for their plans, as the cost of the federal health care overhaul lands harder on middle-class customers. Notices began arriving in recent weeks informing consumers that their plans are being phased out and replaced with policies that comply with requirements of the health care law. Many are being told to expect double-digit percentage increases in monthly costs, in part to help balance the cost of covering the underprivileged and those with pre-existing medical conditions who may not have had coverage (Cadelago, 11/4).

The Associated Press: Health Care Plans Ending For 26K New Mexicans
Nearly 26,000 New Mexicans are having health plans terminated at the end of the year because the insurance policies fail to provide expanded benefits and other coverage mandated by a federal health care law, according to insurance industry officials. State Insurance Superintendent John Franchini estimates most of those individual policyholders will pay an average of 35 percent more for new coverage, but will have plans with more health care benefits (Massey, 11/2).

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Study Finds One In Five People Who Visited Health Website Enrolled In A Plan

A Commonwealth Fund survey also finds that 17 percent of those eligible for a marketplace plan have reached out online, on the phone or in person to get information, PoliticoPro reports. Other outlets look at news about state marketplaces.

Politico Pro: Survey: 17 Percent Of Those Eligible For Exchanges Have Accessed Them
Seventeen percent of Americans who are potentially eligible for coverage have accessed the new health insurance marketplaces in their state either online, over the phone or in person, according to the survey from The Commonwealth Fund. One in five people who visited the marketplaces said they enrolled in a health plan. Those who did not enroll reported that they were unsure whether they could afford the plans, were still deciding on a plan or encountered difficulties with the federal exchange website. More than half — 58 percent — said they were planning to enroll before March 31, when the open enrollment period ends (Villacorta, 11/4).

Los Angeles Times: Health Insurer Alameda Alliance Dropped From Covered California
California's health insurance exchange lost one of its 12 insurers because a nonprofit health plan failed to get a necessary state license, reducing the number of choices for some consumers (Terhune, 11/1).

California Healthline: Insurance Broker Wants To Be In Exchange
A number of legislators this week signed letters urging Covered California officials to include web-based insurance brokers in the state's new health benefit exchange. It's a push by e-Health, an online insurance company based in Mountain View, to be directly included in the exchange's enrollment effort. … Gary Lauer, CEO of eHealth, said he doesn't understand the reluctance of the exchange to include his company and other web-based brokers (Gorn, 11/1).

The Baltimore Sun: About 1,500 Enroll In Health Care Through State Website This Week
The number of consumers buying health insurance on Maryland's online marketplace for the uninsured climbed by about 1,500 to 4,651 as of Friday, according to weekly statistics released by the Maryland Health Connection. Officials say the prime contractor, Noridian Healthcare Solutions, has dedicated more resources to the website, which has been experiencing technical difficulties since its launch Oct. 1 (Cohn, 11/1).

The Oregonian: Cover Oregon: Kitzhaber Says Forget About Problem-Wracked Online Exchange, Get Applications In Now
With federal deadlines looming to get health coverage, Oregonians need to stop waiting for the state's new insurance exchange website to be fixed and submit their applications now, Gov. John Kitzhaber said Friday. His comments marked a departure from past expressions of hope that the high-tech website, Cover Oregon, might be able to enroll people in insurance and hand out tax credits soon (Budnick, 10/1).

The CT Mirror: CT Exchange's First Month: 7,615 People Enrolled, 53 Percent In Private Coverage
In its first month, Access Health CT, the state's health insurance exchange, enrolled 7,615 people in health care coverage, according to figures released Friday. Of those, 53 percent -- 4,065 -- have signed up for private insurance plans. The other 47 percent are signed up for Medicaid (Becker, 11/1).

And on the Medicaid expansion front -  

Caspar Star-Tribune: Medicaid Expansion Debate Returns To Wyoming
The debate over whether to expand Wyoming Medicaid will resume Tuesday when a legislative committee considers new alternatives for growing the government health program. One approach would follow the Wyoming Department of Health's recommendation to develop an alternative version of Medicaid that shares some similarities to private insurance. Another option would use Medicaid funding to help the poor buy private insurance through the federal health insurance marketplace (Wolfson, 11/3).

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Figuring Out Health Law Winners And Losers Involves Trade-Offs; Triggers Anxiety, Confusion

News outlets examine a range of policy issues related to the health law and its implementation.  

The New York Times: Under Health Care Act, Millions Eligible For Free Policies
Millions of people could qualify for federal subsidies that will pay the entire monthly cost of some health care plans being offered in the online marketplaces set up under President Obama's health care law, a surprising figure that has not garnered much attention, in part because the zero-premium plans come with serious trade-offs (Abelson and Thomas, 11/3).

The Associated Press/Washington Post: Americans See Potential For Winners And Losers Under Health Law, Causing Anxiety And Confusion
Now is when Americans start figuring out that President Barack Obama's health care law goes beyond political talk, and really does affect them and people they know. With a cranky federal website complicating access to new coverage and some consumers being notified their existing plans are going away, the potential for winners and losers is creating anxiety and confusion (11/3).

USA Today: Small Businesses Race To Renew Health Plans Early
Thousands of small businesses around the U.S. are racing to renew their health insurance policies Dec. 1 to beat large premium increases their brokers say will hit them Jan. 1 when the Affordable Care Act takes full effect. Some health insurance brokers also say 2014 may be the last year many of the companies even offer health insurance (O’Donnell, 11/3).

Kaiser Health News: So You Found An Exchange Plan. But Can You Find A Provider?
Consumers shopping for coverage on the new health insurance exchanges have been focused on the lowest-cost options. But some shoppers are trying to determine which plans offer the widest array of doctors and hospitals — and are finding that can be trickier than it sounds (Mogul, 11/4).

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Appeals Court Decision Is Latest Blow To Birth Control Mandate, Setting Up Possible Supreme Court Consideration

A divided federal appeals court on Friday ruled against the health law's requirement that businesses with 50 or more workers cover birth control in employee health plans.

Medpage Today: Court Strikes Down ACA’s Birth Control Mandate
In a ruling issued Friday, a federal appeals court struck down the Affordable Care Act (ACA)'s mandate that businesses cover birth control in employees' health plans. The D.C. Circuit Court of Appeals said requiring companies to cover employees' contraception was a violation of its owners' religious rights. The 2-1 decision marks another defeat for the mandate. … The plaintiff in this case, Sidney, Ohio-based Freshway Foods and Freshway Logistics, sued, seeking an injunction, a request denied by a lower court (Pittman, 11/1).

The Associated Press: Appeals Court Sides With Business Owners Who Challenged Health Care Law Contraceptive Mandate
A divided appeals court panel sided Friday with Ohio business owners who challenged the birth control mandate under the new federal health care law. The business owners are two brothers, Francis and Philip M. Gilardi, who own Freshway Foods and Freshway Logistics of Sidney, Ohio., and challenged the mandate on religious grounds (11/4). 

Bloomberg: Obamacare Birth Control Mandate Ruled Unconstitutional
A requirement of President Barack Obama’s health-care law that group insurance plans cover contraceptives may violate religious freedom, a U.S. appeals court said, widening a split among the circuits and making it more probable the U.S. Supreme Court will take up the issue. A three-judge panel in Washington said a lower court was wrong to deny an injunction sought in a lawsuit by two brothers who are Catholic (Gullo, 11/2).

Roll Call: Contraception Case Adds Fuel To Senate’s ‘Nuclear Option’ Debate
A federal appeals court ruling Friday makes plain the reason that judicial nominations so often lead to chaos in the Senate: Like it or not, the courts affect policy. Indeed, just as Senate Democrats began gearing up for a renewed fight over confirming more liberal judges to the U.S. Court of Appeals for the District of Columbia Circuit, that court handed down a ruling to invalidate the Obama administration’s requirement that health insurers pay for contraception (Lesniewski, 11/1).

CQ HealthBeat: Appeals Court Rules In Favor Of Employer Challenging Contraception Mandate
The federal appeals court in Washington, D.C., ruled Friday that the health care law’s requirement that employers cover contraception violates the constitution’s religious freedom protections. The decision is one of several that sets up the case for a probable resolution by the Supreme Court (Adams, 11/1).

CNN: Appeals Court Strikes Down Obamacare Birth Control Mandate
In a ruling likely to set the stage for a battle in the U.S. Supreme Court, a federal appeals court has struck down an Obamacare mandate requiring some businesses to provide insurance coverage for birth control. A key provision of Affordable Care Act championed by President Obama requires employers with 50 or more workers to provide medical insurance and coverage for contraceptives and pregnancy-related care. The companies must provide the coverage or pay a substantial financial penalty (Clary, 11/2).

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Officials Give Drug Companies The OK To Help Patients With Costly Drug Co-Pays In Insurance Exchanges

Federal officials last week OK'd allowing pharmaceutical companies to help cover patient out-of-pocket costs for costly drugs in the health law's insurance exchanges, a closely watched move by drug companies and patient advocates.

The Wall Street Journal: Branded Drugs Chalk Up A Win Under Health Law 
Drug makers scored a significant win last week in their effort to increase sales from the rollout of the health care overhaul, when the Obama administration cleared a path for the companies to help pay patients' out-of-pocket costs of prescriptions. At issue was whether drug makers could help cover the cost of copayments on brand-name drugs for patients who get insurance through the overhaul's new insurance exchanges. The pharmaceutical industry spent about $4 billion on copayment assistance to patients in private health plans in 2011, according to an estimate by Amundsen Group, a consulting firm (Rockoff and Loftus, 11/3).

The Wall Street Journal: Kickbacks From Drug Makers Given All-Clear On Health Exchanges
The federal Department of Health and Human Services said it won’t hold the new insurance offerings available on state and federally run exchanges to the same anti-kickback standards maintained for federal health programs such as Medicare. The decision was closely watched by the drug industry and patient advocacy groups, which worried long-standing -- but controversial -- programs in which drug makers help patients pay copays for costly medicines would be barred in the new health plans (Weaver, 11/1).

In other pharmaceutical marketplace news -

NewsHour: Generic Drugs Don't Necessarily Mean Low Prices
NewsHour Weekend's Megan Thompson reports on the surprising disparity in pricing for generic drugs. Generics, generally thought to be cheap, can actually vary widely in price from pharmacy to pharmacy, causing some to skip medications altogether (Thompson, 11/2).

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Administration News

Obama Seeks To Rally Health Law Support With Appearances This Week

President Barack Obama will push the benefits of the health law at appearances this week to rally support to help the fledgling law.

USA Today: Obama's Day: Health Care And Hockey
President Obama will spend part of his Monday rallying supporters to help his administration's push to get uninsured Americans signed up for coverage under the Affordable Care Act. Obama is set to deliver remarks on Monday evening at the Organizing for Action health care summit. He'll also hold a question-and-answer session at a working dinner with a smaller group at the summit, which is being hosted by OFA, a group run by the alumni of the president's two campaigns (Madhani, 11/4).

Politico: Obama To Talk Health Care In Dallas
President Obama will try to turn the tide from explanations of problems with the individual health care marketplace to a discussion of successful enrollment efforts as he travels to Dallas on Wednesday. Obama will use the visit to highlight work that's being done in communities across the country to explain and help Americans prepare for the full implementation of the Affordable Care Act as he meets with local volunteers, a White House official said (Epstein, 11/3).

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Capitol Hill Watch

Tracking Health Law Policy, Politics On Capitol Hill

A Democratic House member grapples with the troubles in the health law rollout. CBO releases numbers on adding Capitol Hill staffers to the exchanges and a House committee ponders subpoenas to get exchange enrollment numbers. Also, Sen. Lindsey Graham, R-S.C., readies a bill that would ban abortions after 20 weeks of pregnancy.

The Washington Post: Rep. Matt Cartwright, Loyal Democrat, Stands By Health-Care Law, Takes Stage To Defend It
Rep. Matthew Cartwright (D-Pa.) is in Congress today because of the Affordable Care Act. He did not vote for it, but he won because the veteran moderate Democrat he challenged in a primary voted against it. That's the kind of deep-blue district he now represents. ... He still believes in the law and his support remains strong, but he knows the troubled rollout has shaken his constituents’ confidence (O'Keefe, 11/3).

The Hill: CBO: Ending ObamaCare 'Exemption' Adds To Deficit 
The non-partisan Congressional Budget Office said Friday that a Republican-backed plan to force more high-level officials and staffers to obtain their insurance through Obamacare would add nearly $1 billion to the deficit. The CBO estimates that ending the so-called Obamacare exemption for members of Congress and staff and forcing officials like President Obama to enroll in an Obamacare exchange would add $978 million to the deficit over 10 years. The plan would deny the office-holders and staff the premium support they now get from the government (Wasson, 11/1). 

Fox News: House Committee Threatens Subpoena Over Obamacare Enrollment Numbers
The Republican-led House Ways and Means Committee may subpoena the Obama administration in an effort to obtain enrollment numbers for the new health care exchanges amid reports only six people signed up for Obamacare on its first day. Rep. Dave Camp, R-Mich., the committee's chairman, wrote to Medicare chief Marilyn Tavenner, the senior Obama administration official closest to the problem-plagued rollout of the health law, requesting that enrollment figures be released immediately. "We are facing a crisis," Camp wrote. "The failed launch of the exchanges combined with the millions of cancellation notices is putting Americans health care coverage at risk. By all media accounts, enrollment in the exchanges is thus far significantly behind the administration's projections" (11/2).

And on the issue of abortion -

Politico: Graham Calls 20-Week Abortion Ban A Debate 'Worthy Of A Great Democracy'
As he moves to introduce a bill in the Senate banning abortions after 20 weeks of pregnancy, Sen. Lindsey Graham said Sunday the issue is a conversation a "humane" society needs to have. "This is a debate worthy of a great democracy. When do you become you? At 20 weeks of a pregnancy, what is the proper role of the government in protecting that child?” Graham said on "Fox News Sunday." Despite concerns about the constitutionality of such a ban, the South Carolina Republican who is up for re-election, said he and other advocates would make the case to the Supreme Court that it's a legitimate government interest to ban such abortions, making an exception for the health of the mother and cases of rape or incest (Kopan, 11/3).

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State Watch

State Hightlights: GOP Tries Abortion Issue To Lure Hispanic Vote

A selection of health policy stories from Texas, New York, Virginia, Pennsylvania, California and West Virginia.

Texas Tribune/New York Times: G.O.P. Pursues Hispanic Votes With Abortion Stance
Following this summer’s divisive abortion debate in the State Legislature, Texas Republicans see an opening for the 2014 election as they work to reach out to Hispanic voters who could be spurred to the polls by the party's anti-abortion stance. But Democrats see the plan as a losing proposition for Republicans, arguing that the reputation of most Hispanics as socially conservative is inaccurate and that Hispanics tend to side with Democrats on the issues that matter most to them (Ura, 11/2).

The New York Times: Long-Term Care Agency To Repay Millions To Medicaid For Enrolling Ineligible Patients
The largest managed long-term care agency in New York has agreed in principle to repay $33.6 million to the state’s Medicaid program for improper billings linked to the use of social adult day care centers, the attorney general, Eric T. Schneiderman, announced on Friday. As part of the settlement with the attorney general’s Medicaid fraud control unit, the state will allow the agency, VNSNY Choice, to resume enrolling patients in its long-term care plan (Bernstein, 11/1).

The New York Times: Both Sides Invoke Obama in Climax of Virginia Governor’s Race
At the same time, Mr. Cuccinelli, Virginia's attorney general, sought to turn the race into a referendum on the disastrous rollout of the federal health care exchange, mockingly welcoming Mr. Obama to Virginia. "Come on in, Mr. President, we're happy to see you," Mr. Cuccinelli told supporters on Saturday. "You just bring everybody's focus to Obamacare." Outside of a high school here where Mr. Obama spoke, a sizable band of protesters waved signs reading "You Lie!" referring to the hundreds of thousands of people whose health insurance is being canceled under the overhaul law, despite Mr. Obama's pledge that people who liked their plans could keep them (Gabriel, 11/3).

Pittsburgh Post-Gazette: 147,000 Children Across Pa. Found To Lack Health Insurance
More than 147,000 children in Pennsylvania lack health insurance, according to a recent study, despite the commonwealth's goal of ensuring coverage for all kids. Between private insurance, Medicaid for kids from low-income families and the Children's Health Insurance Program -- which covers children whose families make too much to qualify for Medicaid, but can't afford private insurance -- children in the commonwealth ought to be universally covered. So why are some kids still uninsured? (Giammarise, 11/4).

Reuters: Texas Women Turned Away At Abortion Clinics After Court Ruling
Women seeking to terminate their pregnancies were turned away at clinics across Texas on Friday, providers said, after strict new regulations for physicians who perform abortions prompted a dozen facilities to stop offering them. Facilities that continue to perform abortions were flooded with calls from women trying to find alternatives, clinic officials said (Brooks and Garza, 11/1).

The Associated Press: Access To Calif. Assisted Care Records Difficult
Despite a California law requiring assisted-care facility licensing reports to be easily viewable to the public, access to important background information on the facilities can be difficult to find, a newspaper reported Sunday. Records detailing elder care home evaluations were locked behind a security checkpoint at a state Department of Social Services regional office in Oakland, and access to case files were denied over concerns about confidentiality, the Contra Costa Times reported (11/3).

The Associated Press: Study: W. Va. Inmate Health Care Costs Rise 38%
West Virginia's spending on prisoner health care shot up 38 percent between 2001 and 2008, but the state still ranks 36th out of 44 states included in a recent study by the Pew Charitable Trusts. The Charleston Daily Mail reports West Virginia's health care costs rose from $15.7 million to $21.7 million during the period (11/1).

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Editorials and Opinions

Viewpoints: Website Is Like 'A Patient Bleeding From Self-Inflicted Wounds;' Remembering Patients Who Never Had Care And The Need For Health Law

USA Today: Obamacare's Critics Justified: Our View
Obamacare is starting to resemble a patient bleeding from self-inflicted wounds. A month after launch, the online health exchanges where individuals are supposed to shop for insurance remain slow or unusable, except in states that opted to run their own marketplaces and did a more competent job than the administration. As if that weren't trouble enough, critics are justifiably mocking President Obama for his repeated, untrue promise that if people liked their health plans, they could keep them. Oops. Hundreds of thousands of people are getting termination notices for plans that don't meet the strict new requirements of the Affordable Care Act. Presumably, not all those people disliked their plans (11/3). 

USA Today: Rep. Fred Upton: Let People Keep Their Coverage
Implementation of the president's health care law has generated confusion and concern. That's not what health reform should be about. Americans deserve to know that in times of need, they will have the coverage and care that they want, need and can afford. That is why the law's broken promises matter. "We'll lower premiums by up to $2,500 for a typical family per year" has been replaced with premium increases as high as 400%. Administration officials insisted the law would be ready Oct. 1, but a month later the website still does not work and has questionable security (Rep. Fred Upton, R-Mich., 11/3).

USA Today: White House: Affordable Care Act Adds Many Protections
Recently, some Americans with insurance they bought on their own have received notices suggesting that, because of this law, their plan may be canceled. The individual market has historically had few standards. Thousands of Americans were dropped every year and countless others were denied access to coverage altogether due to minor medical conditions. On average, premiums for those who re-upped in these plans rose about 15% annually — and when they couldn't pay the bills and became uninsured, everyone else picked up the tab. If you owned one of these plans before this law took effect, you can keep it. That was the president's promise. But since the law passed, many people left these plans. New plans or so-called grandfathered plans that downgraded coverage must adopt the new consumer protections. Some news outlets reported this as insurers cutting people loose. But that's not true. The ACA requires these plans to be replaced with quality, comprehensive coverage. That was a central promise of the law, too (Chris Jennings, 11/3).

The New York Times: Insurance Policies Not Worth Keeping
Indeed, in all the furor, people forget how terrible many of the soon-to-be-abandoned policies were. Some had deductibles as high as $10,000 or $25,000 and required large co-pays after that, and some didn’t cover hospital care. This overblown controversy has also obscured the crux of what health care reform is trying to do, which is to guarantee that everyone can buy insurance without being turned away or charged exorbitant rates for pre-existing conditions and that everyone can receive benefits that really protect them against financial or medical disaster, not illusory benefits that prove inadequate when a crisis strikes (11/2).

The New York Times: This Is Why We Need Obamacare
The biggest health care crisis in America right now is not the inexcusably messy rollout of Obamacare. No, far more serious is the kind of catastrophe facing people like Richard Streeter, 47, a truck driver and recreational vehicle repairman in Eugene, Ore. His problem isn't Obamacare, but a tumor in his colon that may kill him because Obamacare didn't come quite soon enough. Streeter had health insurance for decades, but beginning in 2008 his employer no longer offered it as an option. He says he tried to buy individual health insurance but, as a lifelong smoker in his late 40s, couldn't find anything affordable — so he took a terrible chance and did without (Nicholas D. Kristof, 11/2).

The Wall Street Journal: Politics Counts: Clues In Early Traffic To ObamaCare.gov
Traffic numbers for HealthCare.gov compiled by the web analytics firm comScore show visits climbed last week after dropping from the first week’s 5.3 million unique visitors. Visitors dropped to 2.4 million in the second week, and 1.6 million in the third before rising to 2.3 million last week. Those numbers are not a good start, but they may indicate something other than a catastrophe (Dante Chinni, 11/1).

Los Angeles Times: Yes, Men Should Pay For Pregnancy Coverage, And Here's Why
Anti-Obamacare conservatives are chuckling over an exchange from the House's grilling of Health and Human Services Secretary Kathleen Sebelius on Wednesday morning, in which Rep. Renee Ellmers (R-N.C.) challenged Sebelius to explain why men should have to pay for maternity coverage in their health insurance plans. "To the best of your knowledge, has a man ever delivered a baby?" Ellmers asked. Ellmers and her cheering section seem to think this was hilarious, a conclusive, slam-dunk, let-me-hear-a-rimshot punchline. "Ellmers was on her 'A' game," the deep thinkers over at Breitbart decided. The reality is, of course, that Ellmers' question revealed only her profound ignorance about how health insurance works, and her lack of desire to learn. And that goes for everyone else who thought this was a smart, telling blow (Michael Hiltzik, 11/1).

The Washington Post: Want To Keep People Out Of The Hospital? Make Sure They Have A Place To Live.
In Illinois' Medicaid program last year, 3.2 percent of patients accounted for half of all spending. The top 0.15 percent – 4,500 people in a program covering 3.2 million people – required annual expenditures upward of $285,000 each. In the health-policy world, these heavy spenders are known as "frequent fliers:" patients with severe conditions, disabilities and life problems whose complex care accounts for such a disproportionate share of the medical economy. However the health-reform debate proceeds in Washington, improving the quality and economy of care provided to this concentrated group will remain a central challenge (Harold Pollack, 11/2).

The Wall Street Journal: You Also Can't Keep Your Doctor
For almost seven years I have fought and survived stage-4 gallbladder cancer, with a five-year survival rate of less than 2% after diagnosis. I am a determined fighter and extremely lucky. But this luck may have just run out: My affordable, lifesaving medical insurance policy has been canceled effective Dec. 31. My choice is to get coverage through the government health exchange and lose access to my cancer doctors, or pay much more for insurance outside the exchange (the quotes average 40% to 50% more) for the privilege of starting over with an unfamiliar insurance company and impaired benefits (Edie Littlefield Sundby, 11/3). 

USA Today: Obama Got Carried Away With Health Care Reform
But the inability of the world's most lavishly funded government to produce a working website after more than three years of effort ought surely to encourage caution about its ability to administer the plan that the website was simply intended to enroll people for (Glenn Harlan Reynolds, 11/3).

The Washington Post: The Noise Around Obamacare
Opponents of Obamacare want government to let the market do what the market does. ... If the market generates vast inequalities, this must be because such inequalities maximize efficiency. Thus, foes of the new health-care law aren't against it because its Web site worked badly or because the president once said that everybody could keep their current policies when it turned out that some in the small individual insurance market got cancellation notices. For those trying to kill the law, such noise is designed to distract attention from what they really think, which is that we should let non-elderly Americans sink or swim in the insurance arrangements that existed before Obamacare (E.J. Dionne Jr., 11/3).

Bloomberg: Where Would Obamacare Be With Romney At The Wheel
With President Barack Obama invoking Mitt Romney to defend the Patient Protection and Affordable Care Act this week in Boston, it's worth considering what U.S. health-care policy would look like today if Romney had won the presidency a year ago. The answer: very different in many important ways, but frustratingly similar in others (Lanhee Chen, 11/1).

Bloomberg: Health Consumers Finding Out They Were Sold A Lemon
A lot of folks with employer-sponsored insurance are also going to see their insurance changed, though not quite as quickly. And not "The benefits will get so much more awesome!" but "The Cadillac tax kicked in and we had to drop most of our plans except for the ones with high deductibles." A friend who sits on the benefits committees of two organizations says that their experts predict that pretty much all plans will end up being of the "consumer-driven" (read: high-deductible) model once the so-called Cadillac tax kicks in (Megan McArdle, 11/1).

The Boston Globe: Obama’s Rosy Speech At Faneuil Hall Isn’t Enough
President Obama came to Massachusetts looking for love and preaching bipartisanship as he tries to fix the debacle known as the rollout of his signature health care law. Love, he got. An adoring crowd assembled at Faneuil Hall cheered his plea for compromise and patience. Bipartisanship is another matter (Vennochi, 11/3).

The Boston Globe: Obama's Bogus Claims Pile Up
Remember Joe Wilson, the South Carolina congressman who yelled “You lie!” during Obama’s health care speech to Congress in 2009? His outburst was inexcusably rude. But in retrospect, it looks increasingly prescient. First, it was the debacle of the health care website. Then it was news that policies were being canceled. Which shoe will be the next to drop? What other Obamacare promise will voters discover was bogus? (Jeff Jacoby, 11/3).

The Denver Post: Healthcare.gov Website Glitches Symptom Of Larger Problem
There's been a white-hot glare of media coverage of the significant stumbles of the Healthcare.gov website over the past month. Most of the criticism focuses on the ailing website itself and the government's rather sorry efforts at playing software developer. That's an interesting story, but I think all the cacophony is distracting us from a bigger, more foundational problem that threatens the success of the Affordable Care Act (Dave Maney, 11/3).

And on other health issues -

Los Angeles Times: How Much Are We Willing To Pay For The Pursuit Of Happiness?
It's also an important study, in a political environment where the cost and benefits of social programs are on the table as never before. Social Security and Medicare are again on the table in fiscal negotiations on Capitol Hill. The Affordable Care Act, which represents the largest restructuring of a social service since the 1960s, is being intensely debated in households and news programs across the nation, though invariably not with the depth and understanding it deserves. Radcliff's research suggests that higher levels of social programs produce a happier population and that public policies such as social insurance and strong labor market protections are among the most important factors (Michael Hiltzik, 11/3).

The Washington Post: We Need To Stop Coddling The Elderly
Two analysts at the Federal Reserve Bank of St. Louis have produced an important study that should (but probably won’t) alter the climate for Washington’s stalemated budget debate. The study demolishes the widespread notion that older Americans need exceptional protection against spending cuts because they’re poorer and more vulnerable than everyone else. Coupled with the elderly’s voting power, this perception has intimidated both parties and put Social Security and Medicare, which dominate federal spending, off-limits to any serious discussion or change (Robert J. Samuelson, 11/3). 

The New York Times: Doctor, First Tell Me What It Costs
If an antibiotic would cure your infection, your doctor would probably still warn you about the chance of sun sensitivity before prescribing the pill. But even when the costs of a medical intervention might force patients to choose between paying the bill or keeping up with their mortgages, American physicians rarely discuss that serious side effect with them. One physician recently explained to me that he felt money talk would "violate the doctor-patient relationship." Given how much attention we have been focusing on health care costs and the Affordable Care Act, now is the time to change such thinking (Dr. Peter A. Ubel, 11/3).

Los Angeles Times: Abortion Rights Battle In Texas Is Far From Over
This law is not an attempt to make abortion safer for women, as some Texas officials who support it claim. It's an attempt to chip away at abortion rights. Hopefully the federal appellate court will see through that attempt when it hears the case next year (Carla Hall, 11/1).

The Washington Post: The Truth About Paying The Medicare Part D Penalty
If you do not sign up for Part D when you're first eligible for Medicare Part A and/or Part B, and you didn't have prescription drug coverage that met Medicare's minimum standard, you may have to pay a late enrollment penalty if you eventually decide to join the plan. ... You don't incur a late penalty if you opt out of getting Plan D because you already have creditable prescription coverage or if you participate in the government program called Extra Help. (This is a Medicare program that assists people with limited incomes and financial resources to pay for their prescriptions.) The key word here is "creditable," which means that your plan's coverage is expected to pay on average as much as the standard Medicare prescription drug coverage (Michelle Singletary, 11/1).

The Seattle Times: Taking Care Of Health, Tax Dollars
Sometimes the prevention of health-related problems can also be a way to save money in the long run. Being smart about health care and tax money can go together (Jerry Large, 11/3).

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EDITOR:
Stephanie Stapleton

ASSOCIATE EDITOR:
Andrew Villegas

WRITERS:
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.