Daily Health Policy Report

Wednesday, November 6, 2013

Last updated: Wed, Nov 6

KHN Original Reporting & Guest Opinion

Administration News

Capitol Hill Watch

Health Reform

Medicare

Health Care Marketplace

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Labor Unions May Get Health Law Tax Relief

Kaiser Health News staff writer Jay Hancock reports: "Weeks after denying labor's request to give union members access to health-law subsidies, the Obama administration is signaling it intends to exempt some union plans from one of the law's substantial taxes. Buried in rules issued last week is the disclosure that the administration will propose exempting 'certain self-insured, self-administered plans' from the law's temporary reinsurance fee in 2015 and 2016" (Hancock, 11/6). Read the story.

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Capsules: Obama Administration Hoping 800K Enroll By End Of November

Now on Kaiser Health News' blog, Phil Galewitz reports: "About 800,000 people are expected to enroll in the new online health insurance marketplaces by the end of November, Centers for Medicare & Medicaid Services Administrator Marilyn Tavenner said Tuesday at a congressional hearing. A CMS official said later that estimate includes people signing up for Medicaid as well as private insurance" (Galewitz, 11/5). Check out what else is on the blog.

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Political Cartoon: 'Once More With Feeling?'

Kaiser Health News provides a fresh take on health policy developments with 'Once More With Feeling?' by John Darkow.

Here's today's health policy haiku: 

DO THE VOTES  TELL A HEALTH LAW STORY?

Election Day's done...
It's an off year? What's it mean?
Just ask the pundits...
-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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Administration News

Obama Resets The 'Keep Your Insurance' Pledge, Heads To Texas

President Barack Obama will be visiting an area -- Dallas County -- that has one of the highest concentrations of uninsured people in the nation. He is expected to urge Texas Gov. Rick Perry, a staunch opponent of the health law, to follow the lead of other Republican state executives and pursue the overhaul's Medicaid expansion.

The Wall Street Journal: Obama Recalibrates 'Keep Your Insurance' Pledge
President Barack Obama has continued to recalibrate his promise that "you'll be able to keep your health-care plan" under the Affordable Care Act, adding new language to those oft-repeated words and arguing that those who are losing their insurance will end up with better coverage. The altered phrasing comes amid criticism that Mr. Obama didn't properly characterize the law since thousands of Americans are receiving notices that their health insurance has been canceled. The administration has worked to explain how events on the ground match Mr. Obama's assurances that the new federal law wouldn't force people out of their health plans (Nelson and Nicholas, 11/5).

Los Angeles Times: Obama Adjusts Pitch For Healthcare Law
While a team of techies tries to reboot the broken federal insurance website, President Obama is trying to retool efforts to promote the flailing healthcare law. The flawed launch of the new online marketplaces has forced Obama to spend time defending the insurance exchanges rather than selling them to a skeptical public, as he had planned. More than a month into the rollout, he has few bright spots to highlight and one big gaping hole to avoid: The website he planned to sell with the zeal of a late-night infomercial pitchman does not work properly (Hennessey and Mascaro, 11/6).

The Associated Press/Washington Post: Obama To Pitch Health Care Law In Texas, Drawing Attention To High Rate Of Uninsured
Beset by hard-to-keep promises and a massive website failure, President Barack Obama is promoting his embattled health care law in the state with the highest rate of uninsured Americans in the nation, but also the state that has been among the most politically hostile to the signature initiative of his presidency (11/6).

USA Today: Obama Heads To Dallas For Health Care PR Blitz
President Obama heads to Dallas on Wednesday to make his case for uninsured Americans to enroll for coverage under the Affordable Care Act — heading to a city in a "red state" that the administration believes is prime to hear the president's pitch. Obama will be visiting an area that has one of the highest concentrations of uninsured people in the USA — with more than 670,000, or 28% of Dallas County's population, uninsured (Madhani, 11/5).

Stateline: Texas First In Residents Eligible For Premium Tax Credit Under Obamacare
Texas leads the nation in the number of residents eligible for tax credits to reduce the cost of buying health insurance on the new exchanges, according to an analysis released Tuesday by the Kaiser Family Foundation. Texas has 2.5 million eligible residents followed by California with 1.9 million and Florida with 1.6 million. Vermont has the fewest number of residents eligible for the tax credits with 27,000 (Ollove, 11/5).

Politico: Obama To Pressure Perry On Health Care During Texas Visit
President Barack Obama plans to call on Texas Gov. Rick Perry -- one of the most prominent Obamacare foes in the country -- to follow the lead of a handful of other Republican governors and agree to the expansion of Medicaid in the state as he visits Dallas on Wednesday. "This isn't a political issue. This is about making sure people where they live have access to good quality, affordable health care," White House deputy senior adviser for communications and strategy David Simas said Tuesday as he previewed the president's trip (Epstein, 11/5).

Dallas Morning News: As He Touts Health Care Law In Dallas, Obama Will Urge Rick Perry To Expand Medicaid
President Barack Obama will use his Dallas visit Wednesday to take aim at both obstacles to his signature health care law. He will prod uninsured Texans to sign up. And he will pressure Gov. Rick Perry to relent in his refusal to expand Medicaid, a move that alone could lop 1.5 million Texans off the rolls of the uninsured (Gillman, 11/6).

Dallas Morning News: Abbott Suggests State Will Boost Requirements On Obamacare Navigators
Attorney General Greg Abbott hinted strongly Tuesday that Texas may impose additional training and background checks on "navigators" hired under federal grants to help people sign up for insurance through the Affordable Care Act. A day before President Barack Obama was to meet with navigators in Dallas, Abbott said his office and the state Department of Insurance have found weaknesses in federal rules (Garrett, 11/6).

Meanwhile, the Obama administration faces positive and negative signs from recent polls -

The Texas Tribune: UT/TT Poll: Texans Like Parts Of Federal Health Law
Most Texans don’t like the Affordable Care Act, but big majorities like many of its components, according to the University of Texas/Texas Tribune Poll. Overall, only 33 percent said they have a favorable opinion of the law that is widely known as Obamacare, while 54 percent have an unfavorable opinion, including 46 percent who said they have a “very unfavorable” view of it (Ramsey, 11/6).

The Hill: Interest In ObamaCare Rises Despite Problems
Interest in the Affordable Care Act has gone up since before its insurance marketplace launched last month, despite the problems plaguing HealthCare.gov. Forty-four percent of uninsured people in the U.S. view the new health insurance more favorably, according to a Reuters/Ipsos poll released Wednesday (Shabad, 11/6).

Bloomberg: Obama’s 39% Gallup Rating Lowest Amid Health Care Fallout
President Barack Obama’s rating in the daily Gallup poll has fallen to its lowest level since October 2011 as his administration continues to be tarnished by the rocky debut of his health-care program. The Democrat’s approval rating stands at 39 percent in the survey, down since the start of October when the rollout of online health exchanges began (McCormick, 11/5).

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Capitol Hill Watch

Sebelius Faces More Questions -- This Time From A Senate Panel

Health and Human Services Secretary Kathleen Sebelius will face a new round of questioning as she appears before the Senate Finance Committee to face growing concern and criticism about healthcare.gov and about recent news surrounding health plan cancellations.

The Associated Press: Sebelius Faces Lawmakers Anew On Health Care Law
Health and Human Services Secretary Kathleen Sebelius is returning to Capitol Hill for a fresh interrogation on the health care law, this time from senators with growing concerns about President Barack Obama's crowning legislative achievement. Sebelius was due to face questions Wednesday from the Senate Finance Committee, whose chairman, Sen. Max Baucus, D-Mont., was a chief author of the 2010 law and remains a vocal defender (Fram, 11/6).

Politico: Sebelius Returns To Scene Of Senate ‘Train Wreck’ Exchange
The Obama administration’s top health care official goes before the Senate on Wednesday amid growing consternation with the problematic rollout of the Obamacare enrollment website and the firestorm over cancelled health policies. HHS Secretary Kathleen Sebelius will appear before the Finance Committee for the first time since last April when Chairman Max Baucus memorably told her he worried about a "train wreck" if implementation of the health law did not get better. Since then Baucus has stood by those remarks, but stressed that he was talking about the implementation, not the Affordable Care Act itself (Haberkorn, 11/6).

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Tavenner Tells Senate Panel To Expect 800K Enrollees By End Of Nov., Answers Security Questions

Centers for Medicare & Medicaid Services Administrator Marilyn Tavenner said Tuesday that fixes have been made to the federal website to improve users' experiences. She also answered questions about an exchange security breach that she said is fixed. In the meantime, the Obama administration faces growing skepticism from those in its own party on the rollout.

Los Angeles Times: Senators Grill Obamacare Administrator Over Healthcare.gov
The top Obamacare administrator told a Senate committee that setbacks will not hamper overall enrollment in the Affordable Care Act, which she said was expected to start slowly and then grow before the 2014 deadline to carry insurance coverage. Democrats joined Republicans on Tuesday grilling Marilyn Tavenner, the chief of the Centers for Medicare & Medicaid Services, which is overseeing the website for the Health and Human Services Department (Mascaro, 11/5).

The Washington Post: Medicare Chief Marilyn Tavenner Testifies Before Senate On Healthcare.gov Troubles
An administration official overseeing the federal online health insurance marketplace encouraged Americans to log on to the Web site despite its well-publicized technical problems and try to shop for coverage. Testifying Tuesday on Capitol Hill, Marilyn Tavenner said her agency, the Centers for Medicare and Medicaid Services (CMS), plans to release information next week about who enrolled through the state and federal exchanges. She said the target for the end of November is 800,000 enrollments (Somashekhar and Goldstein, 11/5).

CNN: Obamacare Official: First Website Enrollment Figures Next Week
Go to the Obamacare website today because "it has improved," with more people completing applications after a month of problems that botched the rollout of HealthCare.gov, the official in charge of creating the online program told a Senate committee on Tuesday. Marilyn Tavenner, head of the federal Centers for Medicare and Medicaid Services, assured the Senate Health, Education, Labor and Pensions Committee the website will be fixed by the end of November, as promised (Cohen, 11/5).

Kaiser Health News: Capsules: Obama Administration Hoping 800K Enroll By End Of November
About 800,000 people are expected to enroll in the new online health insurance marketplaces by the end of November, Centers for Medicare & Medicaid Services Administrator Marilyn Tavenner said Tuesday at a congressional hearing. A CMS official said later that estimate includes people signing up for Medicaid as well as private insurance (Galewitz, 11/5).

Bloomberg: Obamacare Site Can Handle 17,000 People An Hour, CMS Says
The U.S. health-insurance exchange is seeing improvement and can now register 17,000 customers per hour "with almost no errors," an Obama administration official said at a Senate hearing where the website's underperformance was targeted by both political parties. Fixes included speeding up the site so insurance plans are displayed "in just seconds," Marilyn Tavenner, head of the Centers for Medicare and Medicaid Services, said in remarks to the Senate Health, Education, Labor and Pensions Committee today (Wayne, 11/5).

Roll Call: Democrats' Anxiety Grows Over Obamacare Problems
When a loyal leader on your own team says there is a "crisis of confidence" surrounding your signature initiative, you've got trouble. That's the phrase Democratic Sen. Barbara A. Mikulski of Maryland used repeatedly Tuesday morning to describe the rollout of the new health care law as she questioned Marilyn Tavenner, the head of the health agency tasked with overseeing the law's implementation (Dennis, 11/5).

Politico: 'Crisis Of Confidence' In Obamacare 
Frustrated Senate Democrats laid into a top Obama administration health official Tuesday for the "crisis of confidence" in Obamacare created by the flawed rollout of HealthCare.gov. Marilyn Tavenner, the administrator of CMS, tried to reassure lawmakers that the administration can meet its goal of having the website running by late November. And she said the administration has campaigns ready to encourage young people as well as people who have had their health plans canceled to give Obamacare a chance (Haberkorn and Millman, 11/5).

McClatchy: HealthCare.Gov Official Questioned About Website Security 
A top Obama administration official on Tuesday tried to assure anxious senators that Americans' personal information was secure on the troubled HealthCare.gov website, which erroneously provided a South Carolina man's personal information to a man in North Carolina last week. In testimony before the Senate Health, Education, Labor and Pensions Committee, Medicare Administrator Marilyn Tavenner said she became aware of the mistake on Monday and told the committee a "software fix" had remedied the problem (Pugh, 11/5).

The Wall Street Journal: Health-Site Security Concerns Raised
The Obama administration official overseeing the troubled federal health-insurance website acknowledged Tuesday that a North Carolina man accidentally received another applicant's personal information, raising concerns among lawmakers about the site's security (Schatz, 11/5).

The Associated Press: Health Website's Security Prompts Worries
But a short while later, Tavenner acknowledged the Carolinas security breach. "We actually were made aware of that" Monday, she said in response to a question from Sen. Johnny Isakson, R-Ga. "We implemented a software fix." It was not immediately clear how the North Carolina man was able to view the personal information of the man in South Carolina. However, a vulnerability that has afflicted websites for years is known as "horizontal privilege escalation," in which a legitimate user of a website slightly alters the string of random-looking characters in the website's address or inside downloaded data files known as "cookies," causing the system to display information about the accounts of other users. It can be protected against by a well-designed website (Alonso-Zaldivar, 11/6).

Politico: Security Experts Fear ACA Vulnerabilities
Early stumbles on the hobbled Obamacare website -- password glitches, incomplete testing and fractured development -- underscore considerable safety risks and hint at deeper vulnerabilities, data security experts warn. Lawmakers seized on those concerns Tuesday and will most likely do so again Wednesday, reverting attention to a process that has astounded IT specialists (Meyers, 11/5).

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'War Room' Notes Offer View Of Chaos That Surrounded Healthcare.gov Launch

Rep. Darrell Issa, R-Calif., who chairs the House Oversight and Government Reform Committee, released more than 100 pages of documents showing how the difficulties and glitches were chronicled.    

The New York Times: Notes Reveal Chaotic White House Talks On Health Care Site
More than 100 pages of "war room notes" released by congressional investigators on Tuesday offer a window into the chaos that overwhelmed the Obama administration as the federal health insurance marketplace started up last month and officials realized that its problems could not be fixed quickly (Pear, 11/5).

Politico: Darrell Issa Releases 175 Pages Of Obamacare 'War Room' Notes
A slew of newly released notes documenting Obamacare's first month fill in more of the blanks of how the troubled launch unfolded but don't reveal any enrollment numbers. During the first few days following the federal exchange site’s Oct. 1 launch, the Obama administration publicly blamed the HealthCare.gov glitches on high website traffic. But the 175 pages of notes from the Obamacare "war room" — released Tuesday by the House Oversight and Government Reform Committee — contain little to no mention of higher-than-expected volume (Cunningham, 11/5).

CNN: Documents Show First Days Of Obamacare Rollout Worse Than Initially Realized
A stack of daily updates written by Obamacare contractors shows the October rollout hit more walls than previously known: In the first days, half of the calls to the phone center had problems, paper applications could not be processed and up to 40,000 people at a time were sitting in the waiting room of http://www.HealthCare.gov. The 175 pages of internal updates during the sign-up chronicle the growing ailments and efforts to heal the system during October. The House Oversight and Government Reform Committee, led by Republican Darrell Issa, obtained the documents from contractors involved and released them Wednesday (Desjardins, 11/6).

In other oversight news -

The Hill: GOP Lawmaker Subpoenaes ObamaCare Enrollment Data
House Ways and Means Committee Chairman Dave Camp (R-Mich.) on Tuesday issued a subpoena to the agency responsible for implementing ObamaCare, requiring it to turn over all the data the agency has about how many people have enrolled in the healthcare exchanges. Camp previously requested the data from Centers for Medicare & Medicaid Services administrator Marilyn Tavenner at a hearing last month, but says the agency has refused to provide it (Easley, 11/5).

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Sens. Landrieu, Manchin Seek Support For Bills To Amend Health Law

The Democrats are offering legislation that would seek to stop the cancellations of individual market policies and delay fines set up by the health law for people who don't secure coverage.

Bloomberg: Democrats Seek Support For Bills To Offset Obamacare Woes
Two Senate Democrats are rallying support for measures to delay Obamacare penalties or let people keep their health plans as Health and Human Services Secretary Kathleen Sebelius testifies again on the flawed rollout. Senate Democratic leaders aren't saying whether they will allow votes on the proposals by Mary Landrieu of Louisiana on existing policies or Joe Manchin of West Virginia to delay fines for a year (Hunter, 11/6).

Fox News: White House Sidesteps On Legislative Efforts Formalize ObamaCare
The White House on Tuesday refused to state its position on legislative proposals aimed at formalizing President Obama's promise that people who like their existing coverage should be allowed to keep it under the new health care law. Rep. Fred Upton, R-Mich., and Sen. Mary Landrieu, D-La., introduced bills permitting insurers to reinstate plans that fall short of the coverage requirement under ObamaCare after insurance companies began sending out millions of cancellation letters, often citing the new health care law as the reason (11/6).

The Associated Press: White House Sidesteps On Letting People Keep Current Health Coverage
Senate Democrats spoke dismissively of the proposals, signaling they have no intention of permitting a vote on the issue that marks the latest challenge confronting supporters of "Obamacare." ... At the White House, press secretary Jay Carney refused repeatedly to state a position on the proposals, saying he hadn't "reviewed or seen an examination internally" on any of them (Espo, 11/6).

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Health Reform

Officials Stepping Up Pressure On Insurers To Stop Cancellations, Or Explain Them

Insurance industry officials meet with White House officials, and California convinces one company to delay cancellations for three months.

The Wall Street Journal: Health Insurers Urged To Extend Policies Beyond Year-End
Federal lawmakers and state officials are stepping up pressure on insurers to allow consumers whose coverage has been canceled in response to the health overhaul to keep their policies beyond the end of the year. On Tuesday, one of the largest regional health plans in the nation, Blue Shield of California, said it would relax its stance on terminated policies for about 115,000 people after state regulators demanded it do so. Customers now will have until March to decide which plan to choose for 2014, a three-month extension. Because the newer plans generally cost more, the extension could save residents as much as $28.6 million on premiums, said Dave Jones, California's insurance commissioner  (Martin and Radnofsky, 11/5).

Los Angeles Times: State Insurance Chief Faults Health Exchange For Cancellations
Stepping into the national backlash over health policy cancellations, California Insurance Commissioner Dave Jones faulted the state's health exchange for requiring insurers to terminate coverage Dec. 31, but acknowledged that he has little power to stop it. Jones reiterated his support for President Obama's healthcare law Tuesday, but he said these cancellation notices and the resulting avalanche of consumer complaints were an unnecessary blunder (Terhune, 11/5).

The San Jose Mercury News: Blue Shield Forced To Delay Canceling 80,000 Health Insurance Policies
The clock is ticking on 1 million Californians forced to buy new health insurance because their plans don't comply with the federal health care law, but on Tuesday one of the state's biggest health insurers was forced to give its customers a three-month reprieve. Blue Shield of California must delay canceling health insurance policies that cover 119,000 people, many of whom are scrambling to buy new policies on the state's new health insurance exchange -- and consumer advocates are urging other insurance companies in California and the rest of the nation to follow suit (Seipel, 11/5).

Politico: California Blue Shield Extension Unlikely To Affect Other Health Plans
Blue Cross of California has agreed to allow 115,000 customers to stay on their current policies until the end of Obamacare's open enrollment period March 31, under threat of a lawsuit by the state insurance department. But the move is unlikely to be a broader answer to the millions of cancellation notices being sent out nationwide, which have caused a political crisis for the White House on top of the rocky launch of the Obamacare website. California Insurance Commissioner Dave Jones said Tuesday a quirk in California law made it possible for him to require the extension from Blue Shield, but that it’s unlikely to apply to anyone else, even in his state (Cheney and Norman, 11/5).

ProPublica: Why Health Insurance Cancellations Shouldn't Be A Surprise
To get behind the headlines, we reached out to a leading expert on the law: Kip Piper, who advises large health care organizations on Medicare, Medicaid, and health reform policy, finance and business strategy. ... "The fact that ACA would effectively nuke most of the existing commercial individual health insurance market was never in question," Piper told us. In the interview below, which was edited for length and clarity, Piper discusses cancellations, the apparent surge in Medicaid enrollments under Obamacare and whether more transparency would have helped the rollout (Ornstein, 11/5).

The Associated Press/Washington Post: Obama's Chief Of Staff Asks Largest Health Insurers To Help Explain Cancellations To Americans
The White House is asking insurance companies to explain to Americans the cancellation letters they're receiving in the mail. President Barack Obama’s chief of staff, Denis McDonough, met Tuesday with CEOs from some of the largest health insurers. The White House says McDonough updated the CEOs on fixes to healthcare.gov and problems with enrollment data sent electronically to insurers. McDonough also solicited input on whether the system is getting better (11/5).

The Baltimore Sun: Obama, Some Marylanders Grapple With Dropped Insurance Plans
Raymond Liu remembers President Barack Obama's promise that people would be able to keep their insurance if they liked it. He liked his, but he won't be able to keep it. As Obama continues his campaign to win over Americans skeptical of the Affordable Care Act, the ranks of critics are growing, swollen by people such as Liu who are losing their existing health insurance because it does not comply with the law (Cohn, 11/6).

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The Health Law's Impact On Food Stamp Eligibility; Will Unions Get The Tax Relief They Are Seeking?

News outlets offer the latest news on a range of health law implementation issues.

Politico: Obamacare Could Increase Food Stamp Rolls
Republicans have another reason to hate Obamacare: It could grow the number of people on food stamps. The Obama administration has ordered a study to determine whether the Affordable Care Act, by increasing the number of people eligible for Medicaid, will also increase the number of people enrolled in the Supplemental Nutrition Assistance Program based on how states enroll people (Parti, 11/5).

Kaiser Health News: Labor Unions May Get Health Law Tax Relief
Weeks after denying labor's request to give union members access to health-law subsidies, the Obama administration is signaling it intends to exempt some union plans from one of the law's substantial taxes. Buried in rules issued last week is the disclosure that the administration will propose exempting 'certain self-insured, self-administered plans' from the law's temporary reinsurance fee in 2015 and 2016 (Hancock, 11/6).

Politico: Werfel: IRS On Track With ACA Tax Credits
The Internal Revenue Service is successfully verifying income eligibility for tax credits under Obamacare, acting IRS Commissioner Daniel Werfel said on Tuesday. The agency has received more than 1.3 million requests from the state and federal insurance marketplaces and has acted on more than 300,000 requests to determine eligibility for the premium tax credits included in the Affordable Care Act to subsidize insurance coverage. "Our ACA tools are working as planned," said Werfel, speaking at a tax meeting of the national CPA group, AICPA (French, 11/5).

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Study: Premiums In Red States After Health Law Rose More Than In Blue States

The Heritage Foundation reports that premiums for people who live in "red" states -- those with more Republicans -- are seeing their health coverage premiums rise more on average than those in "blue" states. In the meantime, an analysis shows how many people will be eligible for health law coverage subsidies in Georgia and Oregon.

Fox News: Obamacare Price Hikes Hit Red States Hardest
Experiencing sticker-shock at the price of insurance on Obamacare exchanges? That's more likely if you live in a "red state" that didn't vote for Obama, according to price data compiled by the Heritage Foundation. In red states, premiums for 27-year-olds rose an average of 78 percent on ObamaCare exchanges, whereas in "blue states" that voted for Obama, premiums rose a smaller 50 percent. Senate critics of Obamacare say the difference is one way in which the bill is unfair (Lott, 11/5).

Georgia Health News: 654,000 Eligible For Subsidies On Exchange 
More than 650,000 Georgians will be eligible for subsidies in the health insurance exchange, the seventh-highest total in the nation, a new report said Tuesday. A total of 17 million people who are uninsured or who buy their own coverage will be eligible for the discounts, according to the Kaiser Family Foundation analysis (Miller, 11/5).

The Oregonian: Cover Oregon: Study's Estimates On Enrollment, Tax Credits Raise Stakes For Health Exchange 
Nearly 190,000 Oregonians could qualify next year for federal tax credits to bring down health insurance costs by using the state's health exchange. That's less than half the state's previous estimate. But in an odd twist, that's actually good news because it reflects lower premiums in Oregon than in most other states (Budnick, 11/5).

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What's Behind The Medicaid Enrollment Jump?

Stateline examines the reasons why Medicaid enrollment is soaring in the 25 expansion states. Meanwhile, in Missouri, Gov. Jay Nixon may be attempting to resurrect his state's conversation.

Stateline: Why New Medicaid Enrollment Is Soaring
A Stateline survey of the 25 expansion states and the District of Columbia provides clear explanations for the strong Medicaid rollout so far. The biggest reason for the initial jump in Medicaid enrollment is that hundreds of thousands of people in the expansion states have been pre-qualified for expanded Medicaid because they are already enrolled in low-income state health care. Illinois, for example, will roll over 100,000 Cook County residents who have received expanded Medicaid benefits since 2011 Vestal, 11/6).

St. Louis Beacon: Nixon Calls Meeting Of Legislative Panels To Discuss Medicaid
After months of lying low on the topic of Medicaid expansion, Missouri Gov. Jay Nixon appears to be resurrecting the issue with Tuesday's invitation to General Assembly leaders to join him “for a discussion about reforming our state’s health-care system to provide better outcomes for patients and better returns for taxpayers” (Mannies, 11/5).

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Medicare

UnitedHealthcare CEO: Medicare Advantage Benefit Cuts Are 'The New Frontier'

Tampa Bay Times: AARP Medicare Plan Cuts Signal Major Changes, Says UnitedHealthcare CEO
AARP Medicare plans, administered by insurance giant UnitedHealthCare, have been under scrutiny lately for belt tightening, ranging from dropping Silver Sneakers to dropping thousands of physicians from their networks. Major providers like Moffitt Cancer Center and St. Luke's Cataract and Laser Institute are out for 2014. ... But this trend is neither temporary nor confined to AARP plans, said Jack Larsen, CEO of UnitedHealthcare, in an interview with the Tampa Bay Times (Nohlgren, 11/2).

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Health Care Marketplace

HCA Profits Up, CVS Forecasts The Same On Filling More Prescriptions

HCA reports greater profits over higher admissions to their hospitals, while CVS Caremark forecasts higher profit on filling more prescriptions.

The Wall Street Journal: HCA 3rd-Quarter Profit Up 1.4% Amid Modest Growth in Admissions, Revenue
The company said it now expects adjusted earnings before interest, taxes, depreciation and amortization for the year near the upper end of its previously guidance for $6.25 billion to $6.5 billion (Stynes, 11/5).

Reuters: CVS Caremark Raises Outlook Sees Exchanges Helping In 2014
CVS Caremark Corp raised its profit forecast for the year on Tuesday, as sales grew at its drugstore chain and it processed more prescriptions from new clients. The company also said it expects private health insurance exchanges to help business next year (Wahba, 11/5).

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State Watch

State Highlights: New Va. Governor-Elect Pledges To Expand Medicaid

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

The Associated Press/Washington Post: McAuliffe Elected Governor, Defeats Cuccinelli After Pledging To Expand State's Medicaid Rolls
In his emotional concession speech, Cuccinelli also noted the lopsided spending and vowed he would not give up on his fight against Democrats' national health care law. … From the outset, the campaign shaped up as a barometer of voters' moods and a test of whether a swing-voting state like Virginia would elect a tea party-style governor. Republicans bet a deeply conservative candidate would be their best shot at holding onto the governor's office, passing over a lieutenant governor for Cuccinelli, a crusader against the federal health care law (11/6).

The Milwaukee Journal Sentinel: Health Plan Cost Increases Below 7% For Large Area Employers
Employers and employees in the Milwaukee area overall saw larger increases in the cost of health benefits this year than in 2012, with the smallest employers seeing the sharpest increases, according to an annual survey done by HCTrends. The online survey, in which more than 200 employers participated, found that health plan costs increased on average by 8 percent to 10 percent this year compared with an average increases of 5 percent to 7 percent last year (Boulton, 11/5). 

Miami Herald: Miami-Dade Voters Approve $830 Million For Jackson Health System
Four months of campaign messages about the long-deferred needs of Jackson Health System and the urgency for the aging public hospital system to more effectively compete against South Florida’s private and not-for-profit hospitals paid off Tuesday (Chang,11/5).

The California Health Report: Doctors To Check For Domestic Abuse During Regular Exams
Studies show that the majority of Californians -- as many as two-thirds -- don't know where to turn for help if they, or someone they care about, is a victim of domestic violence. Meanwhile, research shows that 44 percent of adult women suffer domestic abuse at some point in their lives, according to figures from Kaiser Permanente. But a new provision of the Affordable Care Act could change those estimates, and soon. As of Jan. 1, health care providers will begin screening all women during regular checkups for signs of domestic abuse (Bookwalter, 11/6).

California Healthline: New Map Shows Health Technology Reach
California Health eQuality yesterday released a map of health information organizations across the state. It shows a marked increase from last year's tally of counties that have some kind of health information exchange network. "It shows progress," said Rayna Caplan, senior program officer at the UC-Davis Institute for Population and Health Improvement, which oversees the CHeQ program. … The map highlights 35 counties which either have operational or emerging community HIO initiatives. That's well over half of California's 58 counties, and it's a big difference from last year's progress, Caplan said (Gorn, 11/5).

Health Policy Solutions (a Colo. news service): Tepid Recovery Leaves One In Seven Uninsured
The number of uninsured people declined slightly in Colorado over the last two years as the economy began to rebound. But more than 741,000 people -- or one in seven Coloradans -- has remained uninsured while another 720,000 are underinsured, meaning that their out-of-pocket health costs exceed 10 percent of their income. Nearly half of the uninsured said they've gone without health coverage for more than five years and one in 10 have never had it (Kerwin McCrimmon, 11/5).

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Editorials and Opinions

Viewpoints: Obama's 'Sin Of Omission;' Dems' Panic Grows Over Health Law Woes; Men Should Pay For Maternity Care

The Washington Post: The Sin Of Omission In Obamacare 
"The big lie," as the president’s broken Obamacare promise is now known, was that everyone could keep his or her doctor and insurance policy under the ACA. No one, Americans were justified in inferring, would be remotely inconvenienced by Obamacare. Instead, the reality is well-known: Millions are expected to lose their insurance policies, while others will see their premiums skyrocket. It is still jarring to my adult psyche to impugn another, especially the president of the United States, as a liar, so I won't. But it is not possible to pretend that the American people have been told the truth. Nor is it possible to pretend that Barack Obama has been completely honest (Kathleen Parker, 11/5). 

Politico: Democrats Now See Why Tea Party Wants To Delay Obamacare
Obamacare is unworkable, and Democrats are finally beginning to acknowledge that the Tea Party Patriots were right all along. The catastrophic failure of the Obamacare website looms like a metaphor for the destructive nature of the law itself. Not being able to log on to HealthCare.gov is one thing. Horrified Americans discovering that their health insurance is being canceled is another thing entirely — it put a lie to the promise of Obamacare itself (Jenny Beth Martin, 11/5).

USA Today: Obama Health Lie Freaks Dems
Many of the president's supporters are in barely concealed panic over the fact that he didn't tell the truth when he was selling the Affordable Care Act. In an oft-repeated vow, he told the country that "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." This was, by any common-sense measure, a lie. It was a lie because President Obama understood that one of the central aims of the Affordable Care Act was to squeeze out the individual insurance market (and the small business market), forcing those Americans on to the HealthCare.gov exchanges. You can't force people out of one insurance product and into another while simultaneously letting them keep their plan (Jonah Goldberg, 11/5).

Los Angeles Times: Obama Should Just Say 'I Was Wrong' On Health Insurance Pledge
Denis Healey, a former Labor Party leader and high-ranking official in Britain, famously said on the floor of Parliament in 1983, "The first law of holes is that when one is in a hole, one should stop digging." Too bad no one in the Obama administration seems to have taken that piece of advice to heart (Jon Healey, 11/5).

The Washington Post: In Maryland Speech, Obama Promised No Changes To Individual Health Plans
As the news of insurance cancellation notices continues to grab headlines, the White House and supporters have tried to pretend that President Obama never promised that Americans could keep their existing health plans. The president himself has suddenly claimed that he told people there would be exceptions to his promise — too bad that he didn't tell people there would be exceptions. And the president kept making that promise even after his own Department of Health and Human Services published predictions in the Federal Register acknowledging that as many as 10 million Americans will have their existing coverage cancelled (Todd Eberly, 11/5).

The New Republic: Obamacare Makes Men Pay For Maternity Care. Good!
Stories of real-life Obamacare “rate shock” have revived an old debate. Previously, health insurers could charge women higher premiums than they charged men. Insurers could also exclude maternity benefits. Obamacare prohibits those practices and conservatives are angry. Why should men have to pay higher insurance prices for services they will never use directly? ... here, for the men unhappy about this change, are four reasons all policies should cover maternity care and other women's health services—even if it makes those policies more expensive (Jonathan Cohn, 11/5).

The New York Times' Economix: In The Death Spiral We Trust
The insurance-market death spiral makes sense in theory, but economists do not really know if, and how often, it is a practical consideration in real-world health insurance markets (Casey B. Mulligan, 11/6).

And on other issues -

Bloomberg: There's A Better Way To Pay Doctors
Congress may soon vote on a bill changing how, and how much, Medicare pays doctors. That's a good idea -- so long as taxpayers benefit, too. ... the measure would help Medicare catch up with a shift that private health insurers have already started: changing the way doctors are paid, by emphasizing the quality and cost of care over quantity of services. This makes sense (11/5).

The New York Times: Approving, And Suspending, A Dangerous Drug
The Food and Drug Administration made the appropriate call last week when it suspended sales of a promising leukemia drug for desperately ill patients that turned out to be unexpectedly dangerous. About 2,000 people have taken the drug to treat a relatively uncommon form of leukemia that kills about 600 Americans each year (11/5).

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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.