Daily Health Policy Report

Tuesday, November 5, 2013

Last updated: Tue, Nov 5

KHN Original Reporting & Guest Opinion

Health Reform

Administration News

Capitol Hill Watch

Health Care Marketplace

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Insuring Your Health: For Many Workers, It's Time To Consider Insurance Options

Kaiser Health News consumer columnist Michelle Andrews writes: "It's annual enrollment time, the autumn period when many people with job-based health insurance ante up for another year. Although news reports have fixated on the problems with the online health marketplaces that launched Oct. 1, for the vast majority of people that’s a nonissue. If they get insurance through a job at a company that has at least 50 employees, they probably won’t be using the marketplaces, also called exchanges" (Andrews, 11/4). Read the story.

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Call Centers Got Big Contracts From Health Law, But How Big Is Unclear

WNPR's Jeff Cohen, working in partnership with Kaiser Health News and NPR, reports: "Before the Affordable Care Act was even open for enrollment, Viviana Alvarado was already taking calls from people who wanted to know more. She and about 40 of her colleagues are answering the phones for Maximus, the company Connecticut contracted to run its call center. The contractors running the troubled federal healthcare.gov website have been under intense scrutiny in the past month, but those businesses aren’t the only ones being paid to roll out Obamacare" (Cohen, 11/5). Read the story.

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Oregon's State Exchange May Be Worse Than Healthcare.gov

Oregon Public Broadcasting's Kristian Foden-Vencil, working in partnership with Kaiser Health News and NPR, reports: "As the federal government consumes humble pie over failures in the health insurance exchanges, some states that have set up their own exchanges are also struggling. Oregon has yet to enroll one single person, and it's been reduced to pawing through paper applications to figure out eligibility. When Cover Oregon opened Oct. 1, executive director Rocky King was excited. He’d been preparing for years. 'Day one, we are accepting applications. And staff at the Oregon Health Authority and Cover Oregon are ready to process those applications,' he said on opening day" (Foden-Vencil, 11/4). Read the story.

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Blue Shield of California Delays Cancellations for Some Individual Policyholders

Kaiser Health News staff writer Anna Gorman reports: "One of California's largest insurers said Monday that about 80,000 individual policy holders whose plans were set to expire Dec. 31 can keep them for three more months as part of an agreement with state insurance officials. Blue Shield of California agreed to the extension after the California Department of Insurance threatened legal action, insurance company spokesman Steve Shivinsky said. The state argued that the company should have given a 180-day notice rather than 90 days, he said (Gorman, 11/5). Read the story.

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Capsules: 17 Million People Eligible For Premium Subsidies, Study Finds; Study Points To 'Imbalance' In Spending On Doctor Training

Now on Kaiser Health News’ blog, Mary Agnes Carey reports on a new study regarding eligibility for health law subsidies: "Seventeen million people who are now uninsured or who buy their own health insurance will be eligible for tax credits next year to help purchase coverage on the health law’s online marketplaces or exchanges, according to an analysis released Tuesday" (Carey, 11/5).

Also on the blog, Phil Galewitz reports on findings about a spending "imbalance" related to doctor training: "Florida and New York have roughly the same population, but New York has five times as many Medicare-sponsored residency training positions and seven times the Medicare funding graduate medical education. The numbers give a glimpse into the 'imbalance' in how Medicare distributes its $10 billion a year for graduate medical education (GME), according to a study by George Washington University researchers published Monday in Health Affairs" (Galewitz, 11/4). Check out what else is on the blog.

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Political Cartoon: 'Faint Praise?' By Steve Kelley

Kaiser Health News provides a fresh take on health policy developments with "Faint Praise?" by Steve Kelley.

Here's today's health policy haiku: 

BUT WOULD YOU CARD THEM?

Young adults needed 
How to entice them to join?
Happy hour, maybe?
-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

Obama Administration Worried Over Paper Applications When Healthcare.gov Problems Persisted

A myriad of issues related to enrolling people in the health law's insurance marketplaces include new revelations that officials worried that allowing people to fill out paper applications for coverage on the federal marketplace would bring its own problems. Other issues examined include the roles of exchange call centers, "navigators," and other paid or volunteer workers.

The Wall Street Journal’s Washington Wire: Obamacare Notes Show Worries About Pushing Paper Applications
Top health officials worried that encouraging people to fill out paper applications for insurance after they couldn't sign up through the troubled HealthCare.gov website wouldn't get them coverage any faster, but they gave in as the site's troubles persisted, internal meeting notes released Monday show (Radnofsky, 11/4).

CBS News: WH Docs: Paper Application For Obamacare Were Problematic, Too
While the Obama administration last month worked on resolving issues with HealthCare.gov, it had concerns that it was misleading consumers by suggesting they'd make more progress signing up for an Obamacare insurance plan with a paper application, documents recently turned over to Congress show. "The paper applications allow people to feel like they are moving forward in the process and provides another option; at the end of the day, we are all stuck in the same queue," the notes from an Obama administration meeting on Oct. 11 say. The notes were turned over to the House Oversight and Government Reform Committee, one of the multiple congressional committees investigating the botched HealthCare.gov rollout and the ongoing implementation of the Affordable Care Act (Condon, 11/4).

McClatchy: White House Defends Use Of Alternatives For HealthCare.Gov
The Obama administration on Monday defended its request that consumers frustrated with the malfunctioning HealthCare.gov website apply for coverage by phone after it emerged that customer service operators must still use the troubled website to assist callers. The issue flared up at Monday’s White House news briefing after ABC News reported that an Oct. 11 memo from the Department of Health and Human Services claimed that all applications -- whether submitted by phone, paper or online -- are processed through the HealthCare.gov website, which serves as the entry portal for the federal health insurance marketplace (Pugh and Kumar, 11/4).

Kaiser Health News: Call Centers Got Big Contracts From Health Law, But How Big Is Unclear
Before the Affordable Care Act was even open for enrollment, Viviana Alvarado was already taking calls from people who wanted to know more. She and about 40 of her colleagues are answering the phones for Maximus, the company Connecticut contracted to run its call center. The contractors running the troubled federal healthcare.gov website have been under intense scrutiny in the past month, but those businesses aren’t the only ones being paid to roll out Obamacare (Cohen, 11/5).

The New York Times: For Uninsured, Clearing A Way To Enrollment
Known as "navigators" or "assisters," people like Ms. Cauley are going to work across the country, searching for the uninsured and walking them through the enrollment process. Under the Affordable Care Act, these trained, paid counselors typically work for community groups or government agencies, with a mandate to provide impartial guidance. Given the problems plaguing the federal online insurance exchange used by 36 states, the workers have become even more important in helping people understand their insurance options. But in Kentucky and some of the 13 other states that have their own exchanges, which in general are running more smoothly than the federal site, watching navigators on the job also provides the clearest view yet of how enrollment could work once the technical problems of HealthCare.gov are resolved (Goodnough, 11/4).

The San Jose Mercury News: Health Care Law’s Ground Game: Armies Of Paid Workers, Volunteers Fan Out Throughout State
Although media attention on the implementation of the health law has focused primarily on buggy websites that debuted on Oct. 1, a large part of the effort to enroll tens of millions of uninsured people is on display on neighborhood stoops and at health fairs, town hall meetings and cultural centers. The stakes are enormous because the success of the new health care law, officially the Affordable Care Act, depends greatly on its success in the nation's most populous state (Seipel, 11/4).

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Despite Some Success, State Health Exchanges Get Mixed Reviews

Though most of the state-run online insurance marketplaces have not been hobbled by the same types of difficulties that marred the federal exchange's launch, some states are successfully enrolling their residents while others still confront hurdles.

Politico: State Health Exchanges Are Showing Mixed Results
On the Obamacare racetrack, Washington, Kentucky and New York are leading the pack. Relatively free of the technical problems that have plagued the federally run insurance exchanges -- but still encumbered by some glitches of their own -- the 15 state-run exchanges tell a varied story. Some states are charging ahead on enrollment while others have run up against roadblocks (Cunningham, 11/5).

Kaiser Health News: Oregon's State Exchange May Be Worse Than Healthcare.gov
As the federal government consumes humble pie over failures in the health insurance exchanges, some states that have set up their own exchanges are also struggling. Oregon has yet to enroll one single person, and it's been reduced to pawing through paper applications to figure out eligibility. When Cover Oregon opened Oct. 1, executive director Rocky King was excited. He’d been preparing for years. 'Day one, we are accepting applications. And staff at the Oregon Health Authority and Cover Oregon are ready to process those applications,' he said on opening day (Foden-Vencil, 11/4).

Health Policy Solutions (a Colo. news service): 'Odious, Embarrassing' System Driving Down Health Sign-Ups
Colorado has no quick fix for a seemingly endless Medicaid application that health exchange board members believe is driving away customers and decreasing the number of people buying health insurance through Colorado’s new multi-million dollar health exchange. Finger-pointing between state and exchange managers escalated on Monday as exchange board members said Colorado should have been better prepared and that the state's lagging system is an embarrassment (Kerwin McCrimmon, 11/4).

A new studies estimates the number of people who will be eligible for subsidies when shopping on the exchanges --  

Kaiser Health News: Capsules: 17 Million People Eligible For Premium Subsidies, Study Finds
Seventeen million people who are now uninsured or who buy their own health insurance will be eligible for tax credits next year to help purchase coverage on the health law's online marketplaces or exchanges, according to an analysis released Tuesday (Carey, 11/5).

Politico: Kaiser Study Sees Broad Access To Insurance Subsidies
Nearly six in 10 people eligible for the insurance exchanges next year will qualify for subsidies to help buy coverage, a new Kaiser Family Foundation analysis says. The group estimates that 29 million Americans will qualify to shop on the new state-based marketplaces — and 17 million of those earn little enough that they could collect income-based subsidies. More live in Texas, California and Florida than anywhere else (Cunningham, 11/5).

Meanwhile, here's the latest news about healthcare.gov - 

The Hill: HHS: Expect Outages At HealthCare.Gov
Federal health officials said that consumers can expect further outages at Obamacare's troubled enrollment portal as the site undergoes repairs in the next four weeks. A spokeswoman for the Department of Health and Human Services (HHS) downplayed the site's semi-regular breakdowns, widely interpreted as a sign of the deep technical problems facing repair teams (Viebeck, 11/4).

Modern Healthcare: 'Significant Fixes' Made To HealthCare.Gov's Electronic Submissions Process, CMS Says
Obama administration officials reported progress Monday in fixing problems with electronic submissions between the federal HealthCare.gov insurance marketplace and insurance companies. They also claimed consumers' ability to complete enrollment applications has improved (Dickson, 11/4).

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Two Calif. Residents File Suit Against Anthem Blue Cross Over Cancellations

In California and nationwide, millions of people have received insurance cancellation notices of their individual health plans, triggering new criticism of the health law. Kaiser Health News reports that Blue Shield will delay cancellations for some policy holders. Meanwhile, The Fiscal Times attempt to explain why insurance companies are cancelling plans.

Los Angeles Times: Anthem Blue Cross Is Sued Over Policy Cancellations
In a new line of attack on canceled health policies, two California residents are suing insurance giant Anthem Blue Cross, alleging they were misled into giving up their previous coverage. About 900,000 Californians and many more nationwide have received cancellation notices on their individual health insurance policies, triggering a public uproar against the rollout of President Obama's health care law (Terhune, 11/4).

Kaiser Health News: Blue Shield of California Delays Cancellations for Some Individual Policyholders
One of California's largest insurers said Monday that about 80,000 individual policy holders whose plans were set to expire Dec. 31 can keep them for three more months as part of an agreement with state insurance officials (Gorman, 11/5).  

The Fiscal Times: Why Insurers Are Cancelling Millions Under Obamacare
The plans under Obamacare's chopping block must have been purchased on or before 2010 on the individual market instead of through an employer or group. If no changes were made by the insurer or the consumer to the plan, the consumer would theoretically be "grandfathered in" and be able to keep her plan. Obama refers to these as "cut-rate plans" offered by "bad-apple insurers." Since changes are made to most plans every year; however, the "grandfather" clause really doesn't apply (Ehley, 11/4).

In the background, how the public confusion and reaction surrounding this development came to be -

The Associated Press/Washington Post: Obama's Promises On Health Care Return To Haunt As Simple Sales Pitch Meets Complex Reality
It sounded so simple. Too simple, it turns out. President Barack Obama's early efforts to boil down an intricate health care law so Americans could understand it are coming back to haunt him, leaving a trail of caveats and provisos in place of the pithy claims he once used to sell the law (11/5).

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Who's Signing Up On Exchanges, And What's Available, Trigger Questions

News outlets report on health law implementation issues, such as an early indication that customers on the marketplace tend to be older and how that could impact insurance prices for everyone.    

The Wall Street Journal: Young Avoid New Health Plans
Insurers say the early buyers of health coverage on the nation's troubled new websites are older than expected so far, raising early concerns about the economics of the insurance marketplaces. If the trend continues, an older, more expensive set of customers could drive up prices for everyone, the insurers say, by forcing them to spread their costs around. "We need a broad range of people to make this work, and we're not seeing that right now," said Heather Thiltgen of Medical Mutual of Ohio, the state's largest insurer by individual customers. "We're seeing the population skewing older" (Weaver and Martin, 11/4).

The New York Times: Strategic Move Exempts Health Law From Broader U.S. Statute
The Affordable Care Act is the biggest new health care program in decades, but the Obama administration has ruled that neither the federal insurance exchange nor the federal subsidies paid to insurance companies on behalf of low-income people are "federal health care programs." The surprise decision, disclosed last week, exempts subsidized health insurance from a law that bans rebates, kickbacks, bribes and certain other financial arrangements in federal health programs, stripping law enforcement of a powerful tool used to fight fraud in other health care programs, like Medicare (Pear, 11/4).

CBS News: "Free" Health Insurance Under Obamacare Has Drawbacks
As many as 6 million people who are uninsured, and another million with individual plans, may qualify for "free" health insurance under the Affordable Care Act, according to recent analysis by several Wall Street firms and the consulting firm McKinsey. ... While the prospect of getting health insurance for "free" may sound appealing, it may not be the best way to go (Martin, 11/5).

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Calif. Nonprofit Provides Grant To Get TV Shows To Include Stories About Health Law

The California Endowment is giving $500,000 to ensure TV episodes add stories about the need to enroll in health coverage under the health law.

The Associated Press: Hollywood Targeted To Give Affordable Care Act A Boost With TV Story Lines About The New Law
The health care overhaul might get a Hollywood rewrite. The California Endowment, a private foundation that is spending millions to promote President Barack Obama’s signature law, recently provided a $500,000 grant to ensure TV writers and producers have information about the Affordable Care Act that can be stitched into plot lines watched by millions. The aim is to produce compelling prime-time narratives that encourage Americans to enroll, especially the young and healthy, Hispanics and other key demographic groups needed to make the overhaul a success (Blood and Cohen, 11/4).

Meanwhile, The New York Times notes an interesting association between CNN's ratings and the problems with the health care website.

The New York Times: CNN Ratings Fall As Health Care Coverage Rises
CNN provided heavy coverage last week of the troubled introduction of the website tied to the Affordable Care Act. The result was the lowest weekly ratings for CNN in more than a year. Did that mean people didn't want to hear wall-to-wall coverage of the failure of the site? Maybe not, if they were viewers already committed to the one of the partisan corners: Both Fox News and MSNBC did far better last week, with heavy coverage of issues related to the health care law. But CNN, which led most of its news hours last week with reporting related to the site's inadequacies, drew little interest from viewers, even on the day that Kathleen Sebelius, the secretary of Health and Human Services, testified in Congress and took many hostile questions from Republican representatives (Carter, 11/4).

But opponents of the law are also working hard to get their message out. Monday, former Florida Gov. Jeb Bush made such a pitch.

The Milwaukee Journal Sentinel: Obamacare Is Flawed, Jeb Bush Says At Milwaukee Event
Former Florida Gov. Jeb Bush said Monday that President Barack Obama's health care law "is flawed to its core" and will be a "big problem" for Democrats heading into the 2014 elections. "I don't think it will work," Bush said of the Affordable Care Act, known as Obamacare. Bush added, "If the objective is, don't worry about the budget, we'll just finance it the same way we're financing our deficits right now, build a bigger debt, you could see this thing surviving," he said (11/4).

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Administration News

Obama Pledges Campaign To Make Sure Health Law Works

As part of an effort to reframe the national discussion, President Barack Obama appeared before health law supporters at an Organizing For Action summit, asking them to help spread the word "far and wide" about the overhaul's good news.   

The New York Times: Obama To Campaign To Ensure Health Law's Success
On the fifth anniversary of his election, President Obama told a rally of grass-roots supporters on Monday evening that "I've got one more campaign in me" -- to make sure his signature health care law works. The president, who has faced four years of Republican attacks against the law in Congress, state capitals and the Supreme Court, sought to reassure about 200 leaders of his Organizing for Action network at its health care summit meeting. His comments followed a month of controversy since the law's health insurance exchanges opened, including the program’s malfunctioning website and complaints about canceled policies (Calmes, 11/4).

The Washington Post: Obama On Health Care: 'I've Got One More Campaign In Me … To Make Sure This Law Works.'
Obama has come under heavy criticism for his promises before the law was passed in 2010 that Americans who were happy with the plans they purchased on the open market could keep them. Since then, millions of people have received notices from their insurers that their plans have been canceled because of the new federal requirements. But at a health care summit of supporters, Obama said the change was necessary because many of those insurance plans would not cover the costs of medical care (Nakamura, 11/4).

Los Angeles Times: Obama Says He's Got One More Campaign In Him: The Fight For Obamacare
President Obama put a new shine on his Obamacare pitch Monday night and asked his most loyal supporters to help him sell it to the American people. Obama urged Organizing for Action volunteers to help him spread "far and wide" the good news of the Affordable Care Act, which he said had always been about "making the insurance market better for everybody" (Reston and Parsons, 11/4).

USA Today: Obama Asks Supporters To Hang Tough On Health Care
Speaking to more than 200 organizers and activists gathered by Organizing for Action, the political group founded by high-ranking alumni of his two political campaigns, Obama began an effort to reframe the public conversation over the Affordable Care Act that has been overshadowed by the problems with the roll-out (Madhani, 11/4).

Politico: Obama's ACA Message Evolves Again
Obama on Monday sought to push back against the most recent tide of inconvenient Obamacare headlines -- tales of insurance companies ending inexpensive individual market plans that provide insufficient coverage under the ACA. Allowing those plans to be changed or sold to new customers, Obama told supporters of his Organizing for Action political arm who gathered in Washington to celebrate and strategize for the implementation of his signature law, would be "breaking an even more important promise" of extending "quality, affordable" health coverage to all (Epstein, 11/4).

The Wall Street Journal's Washington Wire: Obama Says People Losing Plans Will Get Better Ones
President Barack Obama tried to beat back criticism of the Affordable Care Act Monday, assuring supporters that those who want coverage will get it and that people who are losing their insurance will end up with better health care plans. After facing a month's worth of complaints about the botched rollout of HealthCare.gov, Mr. Obama found a friendlier crowd in Washington as he appeared at an "Obamacare summit," held by Organizing for Action, the advocacy group that supports the White House's agenda (Nelson, 11/4).

Bloomberg: Obama Enlists Support To Counter Health Care Law Critics
President Barack Obama urged his most loyal supporters to promote the benefits of his health care law, as his White House works to stem the political damage caused by weeks of technical failures and criticism (Lerer, 11/4).

Fox News: Obama Tweaks Message About Keeping Health Plans Under Obamacare
The president told about 200 of his campaign supporters and health care activists Monday that the administration had promised Americans they could keep their current coverage -- as long as their plans hadn't changed since Obamacare was signed into law. "If you have or had one of these plans before the Affordable Care Act came into law and you really liked that plan, what we said was you could keep it if it hasn't changed since the law's passed," Obama said. "So we wrote into the Affordable Care Act you are grandfathered in on that plan. But if the insurance company changes it, then what we're saying is they have got to change it to a higher standard. They've got to make it better" (11/5).

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Capitol Hill Watch

Tavenner To Testify Before Senate Panel Today On Website Problems

In prepared testimony, she says improvements are being made each day to the site and she still thinks it will be working by the end of the month.

The Associated Press: Senators Grapple With Health Care Rollout Woes
A month into the rollout of President Barack Obama's health care overhaul and no end to problems, the senior administration official closest to the law's implementation will answer questions Tuesday from a Senate panel that wrote much of it. Medicare chief Marilyn Tavenner will go before the Health, Education, Labor and Pensions, or HELP, committee as the balky HealthCare.gov website continues to experience service problems. Adding to website woes is the political fallout from a wave of cancellation notices reaching millions of consumers who currently buy individual policies. Those plans don't meet requirements of the law taking effect next year (Alonso-Zaldivar, 11/5).

Politico: CMS Head Cites Website Improvements
CMS Administrator Marilyn Tavenner in prepared testimony for the Senate HELP committee says the troubled HealthCare.gov website is slowly improving. "We are seeing improvements each week and by the end of November, the experience on the site will be smooth for the vast majority of users," her statement prepared for Tuesday’s hearing said. She also said the Centers for Medicare and Medicaid Services has added capacity by doubling the number of servers (Kenen, 11/4).

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Dems, GOP Both Consider Bills To Let People Keep Their Health Coverage

Lawmakers on both sides of the aisle consider legislation that would allow people to keep the health insurance coverage they had that was canceled as a result of the health law. Elsewhere, Virginia's governor race continues to hinge on the candidates' stances on the law, and Senate Democrats may allow a vote on legislation that would end health law subsidies for lawmakers and their aides.

The Associated Press/Washington Post: Lawmakers Push To Keep Obama's Health Care Pledge To Allow People To Keep Their Policies
Little more than a week after millions of consumers received health care cancellation notices, lawmakers in both parties are pushing legislation to redeem President Barack Obama's long-ago pledge that anyone liking their coverage will be allowed to keep it under the nation's controversial new law. The result is a stern new challenge for the White House as it struggles to fix website woes for the signup portal for those seeking to enroll under the law, and simultaneously copes with angry consumers who rightly or wrongly blame "Obamacare" for cancellation letters mailed by insurers (11/4).

The Washington Post: GOP Lawmaker Proposes 'Keep Your Health Plan' Bill 
A top House Republican has proposed legislation that would allow the continued use of health plans that existed before January 2013, regardless of whether the coverage meets Affordable Care Act standards. The move comes as a growing number of Americans are complaining about losing their insurance or facing higher premiums because of the law, in addition to ongoing troubles with the online health exchange where individuals can purchase new coverage (Hicks, 11/4).

CQ HealthBeat: Landrieu Bill Would Get Democrats Off The Hook With Policyholders Angry About Cancellations
Congressional Democrats are clearly feeling the heat from simmering public anger over the cancellation of individual market policies that don’t comply with the health law’s essential benefits requirement. Sen. Mary Landrieu plans to introduce a bill that would let people keep those plans, something that would take the pressure off defenders of the overhaul (Reichard, 11/4).

Politico: Touting Ken Cuccinelli, Ron Paul Urges 'Nullification'
Headlining the final rally of Ken Cuccinelli's underdog campaign for Virginia governor, Ron Paul suggested the "nullification" of Obamacare on Monday night. "Jefferson obviously was a clear leader on the principle of nullification," the former Texas congressman said of the third president. "I've been working on the assumption that nullification is going to come. It's going to be a de facto nullification. It's ugly, but pretty soon things are going to get so bad that we're just going to ignore the feds and live our own lives in our own states" (Hohmann, 11/5).

Politico: Democrats Offer David Vitter A Vote On Obamacare Amendment
Senate Democrats have made an offer for Sen. David Vitter: You can have a vote on your health care amendment, but you have to live with the outcome. The idea is to get the issue out of the way once and for all, so Vitter doesn't continuously push for a vote on virtually every bill that comes to the floor, according to several people familiar with the matter. The Vitter plan -- which would kill federal dollars to help pay for lawmakers' and their aides' Obamacare coverage -- has become a major sticking point as the Louisiana Republican has demanded a vote (Raju and Kim, 11/4).

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Health Care Marketplace

Johnson & Johnson To Pay $2.2 Billion Fine To Resolve Drug Marketing Case

The government alleged that the drug company and its subsidiaries promoted psychiatric medications for uses that had not been approved by the Food and Drug Administration.

Los Angeles Times: Johnson & Johnson To Pay $2.2 Billion To Settle Federal Cases
The world's eighth-largest drug maker, Johnson & Johnson, has agreed to pay the U.S. government $2.2 billion to settle cases in which the government has alleged that the company and its subsidiaries promoted powerful psychiatric medications for uses not approved by the Food and Drug Administration and offered financial kickbacks for physicians who prescribed those medications frequently (Healy, 11/4).

CQ HealthBeat: Johnson & Johnson Faces Fines For Illegally Marketing Drugs And Playing Kickbacks
Johnson & Johnson and its subsidiaries will pay more than $2.2 billion to resolve criminal and civil claims that they marketed three drugs for uses that the Food and Drug Administration did not approve, federal officials said Monday (Adams, 11/4).

And in other legal action, another company is seeking to end a lawsuit.

The Wall Street Journal: Rural/Metro Strikes Deal To Settle Whistleblower Suit
Rural/MetroCorp. is seeking bankruptcy-court approval to settle a whistleblower lawsuit over the alleged submission of false Medicare claims. The ambulance company would pay $8 million to the U.S. Department of Justice under the settlement, which would resolve a whistleblower lawsuit against two Rural/Metro subsidiaries, according to court papers filed Fri (Palank, 11/4).

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State Watch

SCOTUS Won't Hear Appeal Seeking To Reinstate Okla. Abortion Law

The U.S. Supreme Court is refusing to hear an appeal seeking to reinstate an Oklahoma law that would effectively ban abortion-inducing drugs. In Texas, opponents of an abortion law are appealing to the Supreme Court to reinstate their injunction against the law that requires those performing the procedure have admitting privileges at nearby hospitals.

Los Angeles Times: High Court's Refusal To Hear Oklahoma Appeal Is Blow to Abortion Forces
The legal push in some Republican-controlled states to restrict abortion rights suffered a setback Monday when the U.S. Supreme Court declined to hear Oklahoma's appeal seeking to reinstate a law that effectively banned the use of abortion-inducing drugs. The court's decision delivered a surprise victory for abortion rights groups and was seen as a sign that while conservative justices may be open to giving states new powers to restrict abortion, they are not ready to impose sweeping new limits that would significantly interfere with women's constitutionally protected rights (Savage and Hennessy-Fiske, 11/4).

Los Angeles Times: Opponents Of New Texas Abortion Law Appeal To Supreme Court
Planned Parenthood and others opponents of new Texas abortion restrictions have appealed to the U.S. Supreme Court to reinstate an injunction blocking portions of the law concerning doctors' admitting privileges. The appeal was filed with U.S. Supreme Court Justice Antonin Scalia, who gave state officials until next Tuesday to file a response before he rules. Scalia could rule on the injunction himself or refer the issue to the full court (Hennessy-Fiske, 11/4).

The Texas Tribune: Abortion Providers Ask SCOTUS To Reinstate Injunction
Abortion providers on Monday asked the U.S. Supreme Court to reinstate a lower federal court's injunction that blocked Texas from implementing strict new abortion rules…The 5th Circuit Court of Appeals on Thursday lifted a lower court’s injunction, allowing the state to implement two provisions in House Bill 2 that require abortion providers to obtain hospital admitting privileges nearby the facility and follow federal guidelines, rather than a common, evidence-based protocol, when administering drug-induced abortions (Aaronson, 11/4).

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State Highlights: Calif. Hospital Chain Settles Anesthesia Billing Suit

A selection of health policy news from California, New York, Florida, Louisiana, Kansas and North Carolina.

Los Angeles Times: Hospital Chain Sutter Health Settles Suit Over Anesthesia Billing
A major California hospital chain, Sutter Health, agreed to pay $46 million and disclose more pricing information to consumers to resolve a whistle-blower complaint alleging false and misleading charges for anesthesia. Sutter Health, which runs 24 acute-care hospitals in Northern California, said it reached the settlement Monday just prior to a trial starting this month over the allegations that it added thousands of dollars for "Code 37x" anesthesia charges that were already covered by other billing for the hospital operating room (Terhune, 11/4).

The Associated Press/Wall Street Journal: Study Shows NY Medical Residents Get Most Support
Researchers at the George Washington University School of Public Health and Health Services say New York doesn't lack physicians. But it received $2 billion out of $10 billion available in 2010 federal funding to support residencies. Lead author Dr. Fitzhugh Mullan faults "the rigid formula" governing the system that sends "a disproportionate share" of the federal investment in the physician work force to certain states, including Massachusetts and Rhode Island (11/4).

Kaiser Health News: Capsules: Study Points To 'Imbalance' In Spending On Doctor Training
Florida and New York have roughly the same population, but New York has five times as many Medicare-sponsored residency training positions and seven times the Medicare funding graduate medical education. The numbers give a glimpse into the 'imbalance' in how Medicare distributes its $10 billion a year for graduate medical education (GME), according to a study by George Washington University researchers published Monday in Health Affairs" (Galewitz, 11/4).

Reuters: Doctor Demand Will grow By Up To A Third By 2025 -- Study
Driven by an aging population and increased access to health insurance, the U.S. will need more doctors by 2025, says a new study. The expected rise in demand varies by state and medical specialty, according to the study's lead author (Seaman, 11/4).

New Orleans Times Picayune: Louisiana Medicaid Paid Companies To Care For People Already Dead 
For a year and a half, Louisiana paid to provide care for almost 2,000 Medicaid recipients who were already dead. The Department of Health and Hospitals gave out approximately $1.9 million to provide health coverage for around 1,700 deceased people enrolled in the Medicaid programs called Louisiana Behavioral Health Partnership and Bayou Health. The irregular payments occurred from February 2012 to June 2013, according to a report released by the Louisiana Legislative Auditor today (O'Donoghue, 11/4). 

Kansas Health Institute: Less Than 60 Days Remain: Officials Prepare For Next Phase Of KanCare
With fewer than 60 days remaining before the second major phase of KanCare is scheduled to start, state and managed care company officials say they continue to lay groundwork for as smooth a launch as can be managed, though there are important details and major tasks that remain to be worked out or completed (Shields, 11/4).

North Carolina Health News: Rate Cuts Threaten Dementia Care Facilities
Proposed cuts to the Medicaid rate paid for caring for people with Alzheimer’s disease and dementia threaten facilities’ ability to survive, say advocates (Hoban, 11/4).

California Healthline: Rural Medi-Cal Managed Care Effort Begins
Californians in 28 rural counties now have access to Medi-Cal managed care plans, bringing state-linked managed care plans to all 58 California counties. The expansion will affect roughly 274,000 residents in rural areas, according to Toby Douglas, director of the Department of Health Care Services, which is coordinating the effort. "Managed care increases patient satisfaction and delivers higher quality care and more positive health outcomes," Douglas said in a written statement. State officials hope managed care will reduce costs and improve quality of care and access to services (Gorn, 11/4).

California Healthline: Campaign Advocates Health Coverage For Undocumented Immigrants In California
The California Endowment has launched a statewide campaign to shine a light on the estimated one million Californians who aren't eligible for coverage under the Affordable Care Act because they don't have the right paperwork. Television ads, billboards and other advertising showcase undocumented immigrants in California who are not eligible to buy insurance through the ACA's health exchanges. The California Endowment has identified a handful of Californians -- mostly young professionals and students -- to illustrate the situation. The crusade, not tied to any specific legislation or ballot measure nationally or in California, has wide-ranging goals (Lauer, 11/4).

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Editorials and Opinions

Viewpoints: Law Is Not The Fault Of Health System's 'Age-Old Woes;' Obama's 'Empty Pledge;' Dysfunctional Website Was Inevitable

The Boston Globe: Don't Blame Obamacare For Health System's Age-Old Woes
The angst over the Obamacare rollout has obscured two truths: First, the computer glitches -- while deeply embarrassing -- are a tech problem that is fixable. Second, the cancellation of some Americans' insurance policies and premium hikes for others reflect longstanding problems in the health care system that weren’t suddenly caused by the Affordable Care Act. The great advancement in Obamacare is that it finally provides a framework to address these flaws (11/5).

USA Today: An Empty Pledge Comes Back To Haunt Obama
It was a disingenuous promise that has come back to haunt the Obama administration. Time after time, before and after the law went into effect, President Obama and his aides have promised that people who liked their current health insurance would be able to keep it under the Affordable Care Act. ... What makes the situation even worse is this was not simply some careless slip of the tongue, but rather a cold-blooded political calculation. The Wall Street Journal reports that way back when the law was being drafted, some White House policy advisers warned that this ironclad guarantee was a stretch. But, the Journal reported, they were overruled by political operatives (Rem Rieder, 11/4). 

The Washington Post: A Dishonest Presidency 
He said, "If you like your health care plan, you'll be able to keep your health care plan. Period. No one will take it away. No matter what." That statement was clear, unequivocal and wrong -- and Obama and his advisers knew it. The president's defenders are twisting around for ways to explain away his 16 words (Marc A. Thiessen, 11/4).

The Wall Street Journal: How Low Can They Go?
To misspeak means to express oneself imperfectly or incorrectly. It implies either a careless choice of words or an unintended candor (as in a "Freudian slip"). Obama did not misspeak. As The Wall Street Journal reported over the weekend, the slogan was the result of careful deliberation. Whereas "some White House policy advisers objected to the breadth of Mr. Obama's 'keep your plan' promise," "political aides" insisted upon it. The latter prevailed. In an interview with the Journal, one unidentified former official "added that in the midst of a hard-fought political debate 'if you like your plan, you can probably keep it' isn't a salable point" (James Taranto, 11/4).

Mother Jones: If the GOP Repeals Obamacare, 137 Million Americans Could Get Cancellation Notices
The GOP has gleefully jumped on media reports about Americans having their health insurance plans nixed because of Obamacare. "Obama lied. My health plan died," conservative blogger Michelle Malkin wrote in September, referring to President Barack Obama's promise that people who liked their health insurance plans could keep them. But how many Americans' health plans would receive some form of cancellation notice if GOP hard-liners got their wish and repealed Obamacare? Probably at least 150 million. Let's do the math (Erika Eichelberger, 11/5).

The New Republic: A Mixed Blessing From Obamacare
To simplify things a bit, some advocates and experts believe it’s important to insulate people even from more modest medical costs. They argue that the burden of paying even a few thousand dollars a year can cause serious hardship and discourage people from getting care they really need. ... Other advocates and experts believe that insurance should exist primarily for protecting people from catastrophic expenses -- and that leaving people directly responsible for other costs will encourage them to be smarter consumers of medical care. ... But the political debate over this issue lately has been mystifying -- and occasionally maddening. Conservatives tend to be ones who oppose making coverage more generous. They are the ones who hold up catastrophic policies as the ideal. But you never hear them applauding Obamacare for making such policies available and financially attractive. On the contrary, they say Obamacare fails to encourage catastrophic-only insurance -- when, in fact, the law seems to do just that (Jonathan Cohn, 11/4).

The Wall Street Journal: The ObamaCare Website Failure Was Inevitable
While the Obamacare website fiasco is disturbing, it is no isolated event. Dysfunctional information systems are endemic in the federal government. Officials' incessant talk about living in a 21st-century information society that can generate "big data" to help solve our problems diverts attention from the stubborn truth: Many government agencies and programs operate in an informational stone age (Peter Schuck, 11/4).

Bloomberg: The Primary Care Technician Will See You Now
One obvious way to address the shortage of primary medical care in the U.S. is to train more people who can provide it. Even if this could somehow happen overnight, though, it wouldn't necessarily solve the problem: Only 1 in 4 medical-school graduates goes into primary care (the least lucrative area of medicine), and no more than half of nurses and physician assistants do. Just as important, those who do practice general medicine are rarely drawn to work in the rural and inner-city areas where people most lack access to medical treatment (11/4).

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EDITOR:
Stephanie Stapleton

ASSOCIATE EDITOR:
Andrew Villegas

WRITERS:
Marissa Evans
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.