Daily Health Policy Report

Thursday, November 7, 2013

Last updated: Thu, Nov 7

KHN Original Reporting & Guest Opinion

Administration News

Capitol Hill Watch

Health Reform

Health Care Marketplace

State Watch

Weekend Reading

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Popular Provision Of Obamacare Is Fueling Sticker Shock For Some Consumers

Kaiser Health News staff writer Julie Appleby reports: "When setting premiums for next year, insurers baked in bigger-than-usual adjustments, driven in large part by a game-changing rule: They can no longer reject people with medical problems. Popular in consumer polls, the provision in the health law transforms the market for the estimated 14 million Americans who buy their own policies because they don’t get coverage through their jobs. Barred from denying coverage, insurers also can’t demand higher rates from unhealthy people and those deemed high risks because of conditions including obesity, high blood pressure or a previous cancer diagnosis" (Appleby, 11/6). Read the story.

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Health On The Hill: Democrats' Frustrations With Health Law Grow Amid Website Problems

Kaiser Health News staff writer Mary Agnes Carey and CQ HealthBeat's Rebecca Adams discuss recent Capitol Hill events. For instance, HHS Secretary Kathleen Sebelius said at a Senate hearing Wednesday that officials were advised to keep healthcare.gov open while fixing problems and also fielded criticism of President Obama's promise that if Americans like their old health plans they can keep it (11/6). Read the transcript or listen to the audio.

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Capsules: Humana Exec Predicts Obamacare Open Enrollment Extension; Retail Clinics Boom, But Still Small Part Of Overall Market

Now on Kaiser Health News’ blog, Phil Galewitz writes about Humana’s assumption that the health law’s open enrollment period may be extended: "Humana, one of nation’s largest health insurers, said Wednesday that it expects the Obama administration to extend open enrollment for its troubled online marketplaces beyond March 31.  But a spokeswoman for the Centers for Medicare & Medicaid Services, Julie Bataille, said, 'Consumers still have ample time to enroll in the six-month open enrollment period'" (Galewitz, 11/6).

Also on the blog, Marissa Evans takes a look at retail clinics: "The percent of American families using retail clinics in the previous year nearly tripled between 2007 and 2010, from 1.2 percent of U.S. families to 2.9 percent, the study found. However, despite increased use, the study found overall utilization of the clinics remains modest" (Evans, 11/7). Check out what else is on the blog.

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Political Cartoon: 'Pilot Error?'

Kaiser Health News provides a fresh take on health policy developments with "Pilot Error?" by Bill Schorr.

Here's today's health policy haiku: 


Its name is the RUC.
And it's caused controversy.
What will happen next?

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

Senate Dems Go To White House To Assess Health Law Political Fallout

The group of 16 met with President Barack Obama for about two hours, focusing on the floundering Healthcare.gov website and the possibility of backlash in next year's elections. Some lawmakers also pressed the administration to extend the health law's open enrollment period.

Los Angeles Times: White House Tries To Reassure Democratic Lawmakers About Obamacare
Sixteen Senate Democrats met with President Obama on Wednesday to urge that he right his foundering health care website, warning of a "crisis of confidence" if he doesn't act quickly. The president's team acknowledged struggling with how to present its message to the public, but some senators left the meeting more concerned that there were no immediate fixes forthcoming more than a month after Healthcare.gov went live (Parsons, Mascaro and Memoli, 11/6).

The Wall Street Journal: Worried Senators Press Obama On Health Law
Democratic senators took their complaints about the troubled launch of the federal health law directly to the White House Wednesday, as the surprisingly close governor's race in Virginia prompted some in the party to warn that they would face voter backlash next year if the problems weren't fixed (King and Hughes, 11/6).

Politico: President Obama, Democratic Senators Discuss Health Care At White House Meeting
President Barack Obama, Vice President Joe Biden and other senior administration officials met privately at the White House on Wednesday with frustrated Senate Democrats facing reelection in 2014 to discuss the botched Obamacare rollout. The two-hour meeting comes as the Obama administration and congressional Democrats work to assess the political fallout from the health care overhaul's troubled implementation. Lawmakers passed on the frustration expressed by their constituents and the White House walked through their steps to repair the program (Kim, Epstein and Haberkorn, 11/6).

Bloomberg: Obama Moves To Quell Democratic Dissent Over Health Law
President Barack Obama moved to quell growing dissent among Democratic lawmakers over the troubled rollout of his signature health-care law, summoning senators facing re-election for a two-hour White House meeting.  Fifteen Senate Democrats whose terms are up in 2014, along with Colorado Senator Michael Bennet, who heads the party's Senate campaign arm, aired complaints about the flawed federal website for enrolling in an insurance plan and several pressed to postpone the Affordable Care Act's deadline to obtain coverage, according to several lawmakers present (Dorning and Talev, 11/7).

The Star Tribune: Franken Told Obama He Is Frustrated With The Federal Health Care Website, The Senator Said
U.S. Sen. Al Franken was among the Senate Democrats who met with President Obama and Vice President Biden on Wednesday to talk about the federal health care overhaul and "existing challenges with implementation of the Affordable Care Act," according to the White House. "I also made it clear that, while MNsure.org appears to be running more smoothly than the federal website, I want to make certain that the pieces of the federal system that interface with MNsure are working as well as possible," said Franken, who was among 16 senators who met with Obama (Stassen-Berger, 11/6).

In related news --

The Washington Post: Obama Making Aggressive Effort To Reinvigorate His Base
Nearly a year after President Obama’s reelection, his former campaign manager presented him with a poster-size version of a New York Times Magazine cover from November 2011 bearing the headline, "Is Obama Toast?" The president drew laughs with the story Monday at a dinner for Organizing for Action, an activist group started by his campaign staff. But it also served as a timely reminder for true believers that Obama has a history of defying expectations when he is down (Nakamura, 11/6).

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Obama In Texas: While Defending Health Law, He Went On Offense About Medicaid Expansion

President Barack Obama continued to lament the problems plaguing the federal online insurance marketplace, but he also scolded the Texas government for its resistance to the health law's Medicaid expansion, which, he said, left more than a million of the state's people uninsured.

The New York Times: Despite Fumbles, Obama Defends Health Care Law
Against a backdrop of closer-than-expected election results in Virginia that some attributed to opposition to the health law, Mr. Obama again expressed regret for the troubles at the federal website that have prevented many people from enrolling for insurance. But he said the Texas government -- by refusing to take federal funds and expand Medicaid eligibility -- had left more than a million people uninsured. He promised to get problems with the health program fixed (Calmes and Weisman, 11/6).

The Associated Press/Washington Post: Obama Sells Health Care Law In Texas, Draws Attention To State's High Rate Of Uninsured
President Barack Obama is comparing the problem-plagued federal health care website to a store that has a good product for sale and not enough cash registers to ring up the purchases. Speaking to volunteers in Dallas, Obama says "nothing drives me more crazy" than knowing that good insurance plans are for sale under the Affordable Care Act, but people are having trouble getting onto the website to buy it (11/6).

The Wall Street Journal's Washington Wire: Obama Slams Texas' Health-Law Resistance
President Barack Obama lamented Texas' resistance to the Affordable Care Act Wednesday, saying that more than a million people there could gain coverage if the state expanded Medicaid. The president traveled to Dallas to make a pitch for the federal health law, quickly skimming past the controversy that has enveloped it and instead pushing Texas to participate in the Affordable Care Act (Nelson, 11/6).

Politico: President Obama Thanks Health Care Volunteers In Dallas
President Obama spent some time Wednesday hearing from Senate Democrats concerned about the implementation of the Affordable Care Act, but by the time he got to Dallas a few hours later, he was on the offensive, as he tried to fire up volunteers helping with the law's implementation. One target was Texas Gov. Rick Perry, who Obama called on to support the expansion of Medicaid in his state, something that just a few Republican governors have done (Epstein, 11/6).

The Dallas Morning News: In Dallas, Obama Urges Medicaid Expansion As He Scoops Up Cash
In Dallas to raise cash for Senate candidates, President Barack Obama took a side trip Wednesday to pressure Gov. Rick Perry to expand Medicaid and thank volunteers working to help uninsured Texans. He called it a "no-brainer" that Texas could provide coverage immediately to 1 million working poor for little state investment -- if only Perry would go along (Gillman, 11/6).

The Texas Tribune: In Texas, Obama Calls On Perry To Expand Medicaid
During a visit to Dallas on Wednesday, President Obama called on Gov. Rick Perry to expand Medicaid under the federal Affordable Care Act and commended grassroots advocates for their work to educate uninsured residents on health insurance options under the new law (Aaronson, 11/6).

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Capitol Hill Watch

Sebelius Says Healthcare.gov Fixes Coming, Rejects Calls For Delay

Health and Human Services Secretary Kathleen Sebelius sought to reassure lawmakers in a Senate Finance Committee hearing Wednesday that fixes -- hundreds of them -- are being made to Healthcare.gov, but rejected calls to delay the law or shut the website down. She also said she expected enrollment from October to be "quite low."

The New York Times: Sebelius Rejects Delays To Get Time To Repair Problems At Health Site
Kathleen Sebelius, the secretary of health and human services, said Wednesday that the government needed to fix hundreds of problems with the website for the federal health insurance marketplace, but she categorically rejected bipartisan calls to delay parts of the new health care law (Pear, 11/6).

Los Angeles Times: Sebelius On Offense, Tells Senate Panel She Won't Delay Obamacare
Health and Human Services Secretary Kathleen Sebelius said Wednesday that she had considered shutting down the problematic Obamacare website, but has no intention of delaying implementation of the nation’s new health care law. "Delaying the Affordable Care Act wouldn't delay people's cancer, diabetes or Parkinson's," Sebelius said in testimony before the Senate Finance Committee. "Delay is not an option." In her second appearance on Capitol Hill since the botched Oct. 1 rollout of healthcare.gov, the secretary went on the offense as the administration retools its strategy to preserve President Obama’s signature domestic policy achievement (Mascaro, 11/6).

The Washington Post: Sebelius Assures Fixes Are Being Made To Healthcare.gov
Health and Human Services Secretary Kathleen Sebelius said Wednesday that the government is working to fix a "couple of hundred" problems with the federal health insurance Web site and that once the site is running smoothly, she will "re-invite" people who have been turned off by the technical headaches. Sebelius, appearing before the Senate Finance Committee, rejected calls from politicians in both parties to delay aspects of the health care law, including by extending the initial open enrollment period beyond March 31 for buying insurance on the new online marketplaces. People who don't buy coverage by then risk being fined (Somashekhar and Kliff, 11/7).

The Wall Street Journal: Exchange Site Needs Hundreds Of Fixes
Health and Human Services Secretary Kathleen Sebelius offered a sobering picture Wednesday of the challenges in fixing the government's health-insurance website, saying contractors need to fix a couple of hundred problems and "we're not where we need to be." Ms. Sebelius spoke in Senate testimony hours before new information emerged about the HealthCare.gov site's lack of readiness before its Oct. 1 opening. In an internal bulletin released by House Republican investigators, a contractor testing the site reported that, as of Sept. 30, it could handle up to 1,100 users before response time became too slow (Schatz, 11/6).

The Associated Press/Washington Post: Sebelius: Health Care Website Needed Couple Of Hundred Fixes When Repair Effort Began
Republicans blistered Health and Human Services Secretary Kathleen Sebelius on Wednesday over the nation's controversial health care law, bluntly challenging her honesty, pushing for her resignation and demanding unsuccessfully she concede that President Barack Obama deliberately misled the public about his signature domestic program. … During two hours in the Senate Finance Committee witness chair, Sebelius parried some thrusts and listened impassively to others. Treated more gently by Democrats than Republicans, she said at one point: "Clearly the opposition is still quite ferocious, and I'm just hoping that people understand what their options are, what their benefits could be and what their opportunities are" (11/6).

Politico: Kathleen Sebelius Hearing Takeaway: More Bad News
Kathleen Sebelius got through the latest Obamacare hearing Wednesday, but her message to Senate Democrats was a bit of a downer: Expect more bad news. The Health and Human Services secretary told the Senate Finance Committee that the Obama administration is on track to fix the sputtering federal enrollment website. Well, maybe not on track exactly -- "not where we need to be" (Nather, 11/7).

PBS NewsHour: Kathleen Sebelius To Congress Delay Of Health Care Law 'Not An Option'
Lawmakers confronted Health and Human Services Secretary Kathleen Sebelius with skepticism over fixes yet to be made on HealthCare.gov and concerns over cancelled policies. However, Sebelius maintained her stance to not delay the heath care law (Holman, 11/6).

Kaiser Health News: Health On The Hill: Democrats' Frustrations With Health Law Grow Amid Website Problems
Kaiser Health News staff writer Mary Agnes Carey and CQ HealthBeat's Rebecca Adams discuss recent Capitol Hill events. For instance, HHS Secretary Kathleen Sebelius said at a Senate hearing Wednesday that officials were advised to keep healthcare.gov open while fixing problems and also fielded criticism of President Obama's promise that if Americans like their old health plans they can keep them (11/6). Read the transcript or listen to the audio.

ABC News: Sebelius: Obamacare Oct. Sign-Ups Will Be 'Quite Low' 
Health and Human Services Secretary Kathleen Sebelius predicted Wednesday that the October enrollment figures released next week will likely be "quite low" after consumers have struggled to access the online marketplace for Obamacare. "The enrollment numbers which we will release next week, which will be the first month of enrollment, are likely to be quite low given that struggles people have had getting access to the site and getting information," Sebelius said at a Senate Finance Committee hearing Wednesday (Saenz, 11/6. 

McClatchy: Sebelius On The Hot Seat Again Over Health Care Website 
After a longtime family friend repeated his call for her resignation during a Senate hearing on Wednesday, Health and Human Services Secretary Kathleen Sebelius warned of "very low" numbers when enrollment figures for the troubled HealthCare.gov website are released next week "Until the site is fully improved and we really kind of open up the doors wide to a lot of people, we're going to have, I think, a struggle getting significant numbers to sign up," she testified at a hearing of the Senate Finance Committee (Pugh, 11/6).

CQ HealthBeat: Sebelius Offers No Relief For Cancelled Policyholders Beyond Pledge To Fix Website
Hundreds of thousands and perhaps millions of Americans with health insurance policies that will be cancelled as of Jan. 1 face a loss of health benefits eight weeks from now with little certainty that the website that could provide them alternative coverage will be fixed (Reichard, 11/6).

Republicans, and even some Democrats, say the law has been painted by the rollout -

Reuters: Lead Author Of Obamacare Law Criticizes Administration Over Rollout
Senator Max Baucus, chairman of the U.S. Senate Finance Committee, who worried openly in April that the rollout could become "a train wreck" said he has been disappointed to hear administration officials say they didn't see problems with the federal health care website HealthCare.gov coming (Morgan and Cornwell, 11/6).

CNN: GOP Focuses On Overall Obamacare Troubles, Not Just Website 
Republican foes of Obamacare still use words like "disaster" and "epic" failure in describing the problems with HealthCare.gov, the portal for enrolling in President Barack Obama's signature health care reforms. However, they also concede the technology problems will likely get resolved, as promised again Wednesday by Health and Human Services Secretary Kathleen Sebelius at a Senate Finance Committee hearing (Cohen, 11/7).

Elsewhere, the specifics of the website's problems become clearer -

Medpage Today: Docs Lack ACA Plan Contracts, Senator Says
Providers are complaining that they have yet to receive contracts from insurers for participation in health plans being offered through the Affordable Care Act's insurance marketplaces, a senator said Wednesday. The issue was brought up by Sen. Robert Menendez (D-N.J.), who questioned Health and Human Services (HHS) Secretary Kathleen Sebelius during a hearing before the Senate Finance Committee. … Sebelius said only qualified health plans are on the ACA's exchanges or marketplaces, and those qualified plans have networks that are deemed adequate by regulators (Pittman, 11/6).

Bloomberg: U.S. Health Website Handled Only 1,100 In Test At Start
The Obama administration’s health insurance website handled only 1,100 simultaneous users before faltering in a test a day ahead of its opening, according to a contractor’s report.  A Sept. 30 “stress” test on the site, healthcare.gov, found it accommodated 1,100 users “before response time gets too high,” contractors wrote in the “ACA Daily Testing Bulletin,” released yesterday by the House Oversight and Government Reform Committee (Wayne, 11/7).

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Health Reform

Humana Offers Perspective On How Botched Healthcare.gov Rollout Has Affected Insurance Industry

In a Wednesday call with investors, the company's chief operating officer said Humana assumes that, because of the website problems, the government will extend the open enrollment period beyond its current March 31 cutoff. The insurer also scaled back its estimates of how many people will sign up for new coverage options.    

Reuters: Top U.S. Insurer Sees Weak Obamacare Sign-Ups, Prepares For Delay
A top U.S. health insurer gave the first detailed view of how the problem-plagued rollout of President Barack Obama's signature healthcare law is affecting the industry, saying on Wednesday it had cut its enrollment forecasts by at least a half and expected the government to delay the sign-up deadline (Humer and Cornwell, 11/6).

Kaiser Health News: Capsules: Humana Exec Predicts Obamacare Open Enrollment Extension
Humana, one of nation's largest health insurers, said Wednesday that it expects the Obama administration to extend open enrollment for its troubled online marketplaces beyond March 31.  But a spokeswoman for the Centers for Medicare & Medicaid Services, Julie Bataille, said, "Consumers still have ample time to enroll in the six-month open enrollment period" (Galewitz, 11/6).

Modern Healthcare: Humana Execs Assume Enrollment Will Be Extended
As the Obama administration continued to assure lawmakers and consumers that HealthCare.gov will be fixed soon, Humana executives suggested the enrollment period for the exchanges will be extended beyond March 31 because of the glitches that have hobbled online signups since the Oct. 1 launch. James Murray, the insurance company's chief operating officer, expressed that opinion on a call with investors Wednesday to discuss third-quarter earnings (Demko, 11/6).

The Wall Street Journal: Humana Profit Falls On Higher Costs
Humana and its peers next year face shrinking government funding for Medicare Advantage plans, which are private industry's version of the health plan for the elderly and disabled. Humana is more tethered to these plans than any other big insurers, making its ability to digest lower incoming payments while guarding profit margins a key issue. The company -- which is one of the biggest providers of privately run Medicare Advantage health plans for seniors in the U.S. -- also has bought stakes in doctor practices in an effort to push further into providing health services, and not just paying for them (Tadena, 11/6).

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Top IT Official For Healthcare.gov Resigns

Tony Trenkle, the federal official responsible for Healthcare.gov's launch and security, is moving to the private sector. CBS News reports that Trenkle was supposed to sign off on the site's security before launch but didn't.

The Washington Post's Federal Eye: Tony Trenkle: The Healthcare.gov Official Who Stepped Down
HealthCare.gov may have claimed its first casualty from the Obama administration: a veteran official who helped oversee development of the federal government's glitch-ridden online insurance exchange. The Centers for Medicare and Medicaid (CMS) said on Wednesday that Tony Trenkle, the agency's top technology executive, will step down on Nov. 15 "to take a position in the private sector." CMS Chief Operating Officer Michelle Snyder delivered the news in an e-mail to employees (Hicks, 11/7).

The Wall Street Journal's Washington Wire: Official Involved With Healthcare.gov To Leave
Tony Trenkle, the chief information officer for the Centers for Medicare and Medicaid Services, will leave the agency on Nov. 15, according to an email written by the agency's chief operating officer, Michelle Snyder, and sent to agency employees on Wednesday. Mr. Trenkle oversaw $2 billion worth of annual spending on information products and services including the development of HealthCare.gov, the federal insurance website (Dooren, 11/6).

CBS News: Departing Obamacare Security Official Didn't Sign Off On Site Launch 
Tony Trenkle, the Obamacare official in charge of HealthCare.gov security efforts announced his resignation Wednesday, effective next week. CBS News has learned that Trenkle, the Chief Information Officer for the Centers for Medicare and Medicaid Services (CMS), was originally supposed to sign off on security for the glitch-ridden website before its Oct. 1 launch, but didn't (Attkisson, 11/6).

The Fiscal Times: Top IT Chief At CMS To Jump Sinking Ship
Trenkle was responsible for overseeing CMS’s $2 billion tech budget, which includes the development of Healthcare.gov. He was also the direct supervisor of Henry Chao, CMS's deputy CIO, who is in charge of the contractors hired to build and now fix the problem plagued website. During a press call with reporters on Wednesday, CMS communications director Julie Bataille declined to say whether Trenkle was asked to resign. He will be replaced by Dave Nelson, director of the agency’s Office of Enterprise Management (Ehley, 11/6).

Politico: Top IT Officer Leaving Obamacare Agency
The federal agency responsible for the disastrous rollout of HealthCare.gov has announced that its information technology chief will retire at the end of next week. In the first staffing change disclosed since the website's Oct. 1 launch, CMS Chief Information Officer Tony Trenkle, who oversaw key agency players in the botched HealthCare.gov development, is leaving to take a position in the private sector, according to an email sent to agency staff (Norman, 11/6).

Modern Healthcare: CMS Technology Leader Trenkle Steps Down
Tony Trenkle, the laconic federal official who was both the CMS' point man on the $16.6 billion electronic health-record incentive payment program and its technology leader during the launch of the troubled HealthCare.gov, will be stepping down as the agency's chief information officer and its director of information services to work in the private sector (Conn, 11/6).

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Some Union Health Plans Could Get Break From Health Law's Reinsurance Fee

Language included in a Health and Human Services regulation released last week indicated that some self-insured, self-administered plans would not have to pay this fee in 2015 or 2016. It is not entirely clear, however, which plans would qualify for this exemption.

The Associated Press/Washington Post: Some Union Insurance Plans Could Get Break From Fees Under New Health Care Law
Critics of the new health care law are claiming some labor unions could get a break from fees imposed on everyone covered by health insurance. The Obama administration’s plan to exempt "certain self-insured, self-administered plans" from paying fees in 2015 and 2016 is not sitting well with Republicans, who say the move smacks of favoritism for a powerful White House ally. Labor officials say many unions won't be affected (11/7).

The Wall Street Journal: Health-Fee Proposal Knocked
The Obama administration is planning to exempt some labor unions and businesses from paying part of a contentious reinsurance fee under the health-overhaul law, but unions and businesses said Wednesday the move wouldn't go far enough. The Department of Health and Human Services signaled in a document published quietly last week that it intends to propose a partial break on the fee. But business officials said the vast majority of their insurance plans wouldn't qualify, and union officials said a large majority of theirs wouldn't either, based on the language from HHS (Radnofsky and Trottman, 11/6).

Earlier, related KHN coverage: Labor Unions May Get Health Law Tax Relief (Hancock, 11/6).  

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Who Gets What Under Obamacare, And Who Is Left Out

News stories look at who wins and who loses under the health law. Elsewhere, Obamacare message sparring gets personal.

CBS News: A Tale Of Two Insureds: One Benefits, One Loses Under Obamacare
About 3.5 million Americans have been told their health insurance will be canceled because their plans don't meet the minimum requirements of Obamacare. We met up with those who stand to benefit from health care reform and those who would not (Andrews, 11/6).

ProPublica: Loyal Obama Supporters, Canceled By Obamacare
San Francisco architect Lee Hammack says he and his wife, JoEllen Brothers, are "cradle Democrats"… The couple -- Lee, 60, and JoEllen, 59 -- have been paying $550 a month for their health coverage -- a plan that offers solid coverage, not one of the skimpy plans Obama has criticized. But recently, Kaiser informed them the plan would be canceled at the end of the year because it did not meet the requirements of the Affordable Care Act (Ornstein, 11/6).

Reuters: In The Messaging War On Obamacare, Both Sides Get Personal
Wayne Dofflemyer is no fan of Obamacare. ... In Washington, Dofflemyer and Sullivan's stories have become part of the messaging war over Obamacare, as Republicans and White House-led Democrats spar over whether the technical problems with the program's web site should lead to a broader reconsideration of the effort to help millions of uninsured and underinsured Americans (Debenedetti, 11/7).

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New Coverage Gaps, Cost Issues Spur Health Law Worries

News outlets look at the nuts and bolts of the health law's implementation, including a worry that coverage gaps will persist for some vulnerable people, as well as how the government pays for insurance subsidies and why some premium costs increase under the health law.

The Associated Press/Washington Post: Health Exchange Problems Could Mean Patients With Serious Illness Run Out Of Time To Sign Up
With federal and state online health care marketplaces experiencing glitches a month into implementation, concern is mounting for a vulnerable group of people who were supposed to be among the health law's earliest beneficiaries. Hundreds of thousands of people across the country with pre-existing chronic conditions such as cancer, heart failure or kidney disease who are covered through high risk-insurance pools will see their coverage dissolve by year's end (11/6).

NPR: How The Affordable Care Act Pays For Insurance Subsidies
But the authors of the Affordable Care Act didn't want the subsidies to become a drain on the Treasury and add to the deficits. So they included provisions designed to offset the cost of the subsidies. MIT economist Jonathan Gruber, who helped develop the law, says about half the costs are offset by projected savings in Medicare payments to insurers and hospitals. Another quarter is offset by added taxes on medical-device makers and drug companies (Ydstie, 11/7).

Kaiser Health News: Popular Provision Of Obamacare Is Fueling Sticker Shock For Some Consumers
Kaiser Health News staff writer Julie Appleby reports: "When setting premiums for next year, insurers baked in bigger-than-usual adjustments, driven in large part by a game-changing rule: They can no longer reject people with medical problems. Popular in consumer polls, the provision in the health law transforms the market for the estimated 14 million Americans who buy their own policies because they don’t get coverage through their jobs. Barred from denying coverage, insurers also can’t demand higher rates from unhealthy people and those deemed high risks because of conditions including obesity, high blood pressure or a previous cancer diagnosis" (Appleby, 11/6).

USA Today: Mental Health Bills May Limit Young American's Clout
High mental health costs for young adults threaten to undermine a key assumption of the Affordable Care Act: that insuring more young people will lower costs because they are healthier and require less expensive care (Kennedy, 11/6).

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Reports Of Insurance Policy Cancellations Spread

News organizations in California, Georgia, Colorado and Virginia examine the issue.

California Healthline: How Many People Are Losing Their Plans Under Obamacare, Really?
At least half of the 14 million people who shop in the individual insurance market can expect to receive a cancellation letter ahead of next year. A review by "Road to Reform" found that hundreds of thousands of cancellation letters had already been sent in states like Oregon, Florida and Georgia. And about 1 million of consumers affected are in California. One key PR challenge: The cancellation letters are piling up at a much faster rate than Americans are able to sign up for new coverage (Diamond, 11/6).

Georgia Health News: Canceled Policy? It May Be Extendable
Thousands of Georgians are getting notices that their health insurance policies are being terminated because they're not compliant with the Affordable Care Act. The cancellation notices have created an uproar in political circles and in households across the country. Some people are facing higher premiums, and others say they had been led to believe that that their policies could not be canceled under the ACA without their consent. But many Georgia consumers have an option if they are unhappy about losing their current policy: They can renew it before Jan. 1 (Miller, 11/6). 

The San Francisco Chronicle: Clarifying State Settlement With 1 Blue Shield Firm
Blue Shield will let some California policyholders extend their coverage for an additional 90 days -- until March 31 -- under a settlement with the California Department of Insurance announced Tuesday. The settlement applies only to Blue Shield of California Life and Health Insurance Co. -- one of two Blue Shield health insurers in the state. It does not presage a widespread delay in health policy cancellations that are a result of the Affordable Care Act, although several bills in Congress would halt or postpone those terminations (Pender, 11/6).

Fox News: Almost 250,000 Colo. Residents Lose Health Plans Under ObamaCare
Almost 250,000 Colorado residents have or will have their health insurance plans cancelled under Obamacare, the state's Division of Insurance said Wednesday. A spokesman for the agency said in a press release that the plans are being cancelled for numerous reasons, one being that some of the plans do not meet the new requirements for patient care under the Affordable Care Act (11/6).

The Denver Post: Nearly 250,000 Colorado Health Policies Canceled, Many From Obamacare
Insurance companies are canceling health policies for nearly 250,000 Coloradans, many because of Affordable Care Act rules, a tally likely to inflame consumers upset with controversial reforms. The Colorado Division of Insurance said policies for 2013 that do not meet new minimum benefits under Obamacare are being canceled. Other cancellations are the result of business decisions by the insurers as part of normal operations (Booth, 11/6).

The Richmond Times-Dispatch: Some Health Plans For Virginians Being Canceled
While some states let insurance companies amend existing health policies to meet Affordable Care Act standards, Virginia regulators required companies to build new policies from scratch. Either way, the net effect is the same -- thousands of people in Virginia and elsewhere are getting notices that their existing plans will no longer be offered after Jan. 1 or the next time they are up for renewal (Smith, 11/7).

The Washington Post's The Fact Checker: The White House Effort To Blame Insurance Companies For Lost Plans
In defending President Obama's now-discredited pledge that "if you like your health-care plan, you'll be able to keep it," the White House has repeatedly tried to blame insurance companies. White House spokesman Jay Carney's statement above, accusing insurance companies of stripping away benefits, is typical. Columnists supportive of the White House have piled on, arguing that insurance companies should be blamed. … But there's an interesting wrinkle to this story that few appeared to have understood. The main culprit is not whether or not the insurance industry has changed a plan that ran afoul of the administration’s regulations -- but the law's effective date. Let's explain (Kessler, 11/7).

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For Health Exchange Navigators, Enrollment Frustrations Continue

Workers helping people enroll in policies through the health law's new online insurance marketplaces are still finding website problems and it's causing concerns. 

Bloomberg: Obamacare Website Frustrations Persist As Deadline Looms
In Palm Beach, Florida, a legal aid group charged with helping enroll people in health insurance through the Obamacare website celebrated after their first signup at the end of last week. … Even as top federal officials testify in Senate hearings that healthcare.gov is improving weekly, workers on the front lines in the drive to enroll people say the website remains inconsistent, balky and crash-prone (Pettypiece and Wayne, 11/7).

Marketplace: Obamacare Limbo Land For Health Care Navigators
In Camden, navigators are resorting to paper applications. It's straightforward, says [navigator Toni] Cohen. But she's worried. "The biggest concern I have of the last five weeks, is that the people who have filled out applications have not heard anything back yet," says Cohen. One reason: paper applications must be run through the same web portal as the online ones (Gorenstein, 11/6).

Meanwhile, Minnesota exchange officials provide their first-month tallies -  

Minnesota Public Radio: MNsure Signups Reach 11,000 In First Month
Nearly 11,000 people have signed up for health coverage through the online health insurance marketplace since it opened Oct. 1, MNsure officials said today. Of the 10,940 who are in the process of enrolling in coverage, most will wind up in government plans, either MinnesotaCare or Medical Assistance. About 1,800 are in the process of enrolling in commercial health plans (Stawicki, 11/6).

Pioneer Press: MNsure's Low Premiums Mean Many Minnesotans Won't Qualify For Tax Credits
Health insurance premiums for 2014 are so low in many parts of Minnesota that some consumers aren't qualifying for tax credits through the state's new health insurance exchange (Snowbeck, 11/6).

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For Some Republicans, Support For Medicaid Expansion Draws New Adversaries

The Los Angeles Times examines the political backlash in Ohio to GOP lawmakers who supported the Medicaid expansion. Meanwhile, CQ HealthBeat reports on efforts to phase-in the electronic data system that will send states information about people who appear to be eligible for Medicaid who have tried to sign up for coverage through healthcare.gov.  

Los Angeles Times: GOP Lawmakers In Ohio Under Fire For Supporting Medicaid Expansion
State Rep. Barbara Sears is the kind of Republican the party would want to highlight these days: a woman and former business owner, fluent in health insurance issues. … But this year, the popular legislator with a strong conservative voting record has found her photo on door hangers throughout her district, pictured as the conductor of the Obamacare train to disaster. … The reason: Sears has championed a key element of Obamacare. Her support for the expansion of Medicaid to cover more of the state's poor is also backed by Ohio's Republican Gov. John Kasich and nearly three-quarters of Ohioans, according to an AARP poll (Reston, 11/6).

CQ HealthBeat: State Officials Get Update On Electronic Transfer Of Medicaid Application Data
Federal officials are preparing to phase in, state by state, a function that will electronically send states information about people who have tried to sign up for health coverage through healthcare.gov and appear to qualify for Medicaid (Adams, 11/6).

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Health Care Marketplace

AMA Panel Involved In Physician Rate Setting Moves Toward More Transparency

The Washington Post: AMA Panel Takes Steps Toward More Transparency
The American Medical Association panel that plays a key role in setting payment rates for physicians has voted to make public more of its deliberations and is revamping some of the methods it uses for determining the values of services. The panel has come under criticism in recent years because, despite its importance in the economy of U.S. health care, its meetings have not been freely accessible to the public. The panel advises the federal government on the value of physicians’ services and its estimates are widely used by insurance companies (Whoriskey, 11/6).

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State Watch

State Highlights: Officials Seek Public Watchdog For Health System Money

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

Bloomberg: Obamacare Impact On Virginia Vote Steers Strategy In 2014
Republicans cite their 2.5-point defeat in the Virginia governor's race as proof that Ken Cuccinelli would have reversed his fortunes if he'd hammered earlier and longer on Obamacare, an issue the attorney general said tightened the contest in its final days (Davis and McCormick, 11/7).

Politico: GOP: Virginia Results Boost 2014 Obamacare Attacks 
At a time when not much is going right politically for the Republican Party, one thing certainly is: Obamacare. And the Virginia governor's race this week, party hands say, is the best evidence yet. "Virginia validates Republican hopes that Obamacare will not only be the defining issue but also the most potent issue," said Brock McCleary, a GOP pollster. "What really moved numbers at the end [of the Virginia governor's race] was that Obamacare drove headlines, particularly in the Washington, D.C., media market" (Isenstadt, 11/6).

Miami Herald: Watchdog Wanted For Public Funds To Aid Jackson Health System
One day after Miami-Dade voters approved $830 million in public funds for upgrades and new equipment and facilities for Jackson Health System, local elected officials and leaders of the county's public hospital network vowed Wednesday to keep a campaign promise that the money will be spent as intended and monitored closely by a yet-to-be-established oversight board (Chang, 11/6).

Miami Herald: Miami-Dade Community Health Centers Win Government Grants
More than a dozen Florida community health centers -- including seven in Miami-Dade County -- were awarded $8.3 million in grants Thursday to expand their practices and hire more physicians, nurses, dentists, psychologists and other providers in an effort to increase Americans' access to health care under the Affordable Care Act, federal officials announced (Chang, 11/7).

California Healthline: Seniors Seek Strategic Plan On Aging
The Assembly health committee of the Senior Legislature voted last week during its annual four-day meeting in Sacramento to push a bill to adopt a state strategic plan on aging. The state developed an aging plan in 2009, complete with 28 specific action-item recommendations, but the Legislature never codified it, according to Jim Levy, a senator in the Senior Legislature. … This time around, Levy said, the provision for state money will be withdrawn, and the $4,000 to implement the proposals will either come from federal funds or private donations (Gorn, 11/6).

The Lund Report: Oregon Health Authority Moves To Limit Coverage For Self-Monitoring Diabetics
For years most of the diabetes care community shared a simple mantra: when it comes to blood sugar levels, diabetics should test, test, test. It’s not so simple anymore. Now the Health Evidence Review Commission, the body charged with reviewing costs for the Medicaid-funded Oregon Health Plan, wants to reduce the number of diabetes testing strips given to some diabetics from several per day to one per week (Bryan, 11/4).

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Weekend Reading

Longer Looks: Bad Behavior Treatment; End Of Life Decisions

Every week reporter Ankita Rao selects interesting reading from around the Web.

Los Angeles Times: Bad Behavior Isn't An Illness
When the 1980 edition of the Diagnostic and Statistical Manual of Mental Disorders (commonly known as the DSM-3) was being prepared, psychiatrist Allen Frances lobbied for the inclusion of a new diagnosis: masochistic personality disorder. His push failed, and by the time the fourth edition came out in 1994 (edited by Frances), he was glad it had. He no longer believed such a condition existed. ... Yet the new DSM-5 does agree with abused women that their male abusers are suffering from a psychiatric condition: intermittent explosive disorder. The diagnostic criteria include having had three violent and unpremeditated outbursts in a 12-month period in which people or animals were hurt. Leaving aside the question of why the diagnosis should require three rather than two or four behavioral outbursts in 12 months (or, for that matter, in six or 18 months), a question must be asked: Is the habit of losing one's temper and destroying things or hurting people really a medical condition? Doesn't the diagnosis empty the act both of meaning and moral content, all in the service of a spurious objectivity?  (Theodore Dalyrymple, 11/5).

The Atlantic: My Mother Deserved To Die Comfortably
"Can you look at this for me?" Feng, my grandparents' neighbor, handed me a doctor's report written in Chinese along with a box of his mother's new chemotherapy drug. Everyone in my grandparents' little town in China knew me as the hotshot granddaughter getting her Ph.D. in the U.S., but I had to confess that my medical knowledge was limited to English, and I wasn't a professional. I handed the report to my father. "Don't tell your mother that her cancer might recur," he advised. "She needs to have hope that she'll get better." While he isn’t a medical professional either, my father had supported my mother through most of her four-year battle with lung cancer and was familiar with much of the jargon. … I had watched my mother die in pain in a hospital because my father didn't allow us to discuss the possibility of death, and she never filled out an advance directive. I tried to refuse further medical intervention, and my father told me I was killing her. I didn't want Feng's family to go through that (Jenny Qi, 11/6).

Stanford Medicine: Almost Without Hope
In the emergency room of the Rosebud Indian Health Service Hospital, suicide attempts by drug overdose are seen nearly nightly. Alcohol-related car accident injuries fill many of the small hospital's beds, competing for space with tuberculosis, pneumonia and liver and kidney failure. Diabetes is common, leading to loss of life and limb. The physical complications of poverty, joblessness and epidemic rates of alcoholism, diabetes and depression spill over into the wards here at the only hospital on the Rosebud Reservation, which has a population of 13,000 and stretches across 1,970 square miles of South Dakota prairie. Life is short, violence high and health care lacking in Todd County, the second poorest county in the nation (Tracie White, 11/2013).

The Baltimore Sun: Linda's Journey
Linda Hershey lost her nose to squamous cell cancer in 2007. She chose nose reconstruction surgery at Johns Hopkins, the beginning of a years-long journey marked by medical and emotional challenges. This four-part series explores Hershey's long campaign to have her nose rebuilt (Algerina Perna, 11/5).

Center for Investigative Reporting: Rehab Clinics Cut Off For Questionable Billing Still Reaped Federal Funds
Days after a Los Angeles County inspector identified possible forgery in the files of a small drug rehabilitation center, she received a hand-delivered letter expressing the clinic’s “profound gratitude.” Inside was $1,000. The county labeled it a bribe and dropped its contract with Goretti Health Services in 2008, records show. ... But with its Drug Medi-Cal contract canceled, the Lawndale clinic kept itself afloat with a second taxpayer-funded program, receiving $380,000 in federal Access to Recovery grants. The government funds are controlled by two different divisions of the same state department – housed in the same Sacramento building. One division is on the third floor; the other is on the fourth (Christina Jewett and Will Evans, 11/6).

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Editorials and Opinions

Viewpoints: The Battle Over One Woman's Medical Story; Why Mass. Didn't See A Wave Of Cancellations; Politicians' Love Of Anecdotes

The Wall Street Journal: Edie Sundby’s Choice
Edie Littlefield Sundby may not have thought she'd ignite a national debate when the stage-4 cancer survivor asked us to publish her Monday op-ed on losing her oncologist due to the Affordable Care Act. But she certainly has, and it's important to understand why. Mrs. Sundby and millions like her must be denied their medical choices if ObamaCare is going to work as its liberal planners intend (11/6).

Los Angeles Times: A Closer Look At The WSJ's Newest Obamacare Horror Story
The most prominent example of Obamacare victimization being offered at the moment comes from Edie Littlefield Sundby of San Diego, a businesswoman who related in a Wall Street Journal op-ed earlier this week how Obamacare is threatening her life by depriving her of access to her cancer doctors. … There's no reason to doubt Sundby's dilemma in trying to continue her current treatment, or her conviction that her survival is the product of her particular lineup of doctors and hospitals. (Though her earlier interviews certainly suggest that her spirit, her tenacity, and the support of her husband may have had a lot to do with her survival.) But what Sundby, 62, addresses in her op-ed is the question of whether Obamacare places her health at risk. There the evidence doesn't look so clear. In fact, there are signs that the Affordable Care Act might help save her (Michael Hiltzik, 11/6).

CNN: Bloomberg Could Fix Obamacare
Liberals and conservatives don't agree on much these days, but many agree on this: The Department of Health and Human Services' HealthCare.gov rollout has been a debacle. That's reason enough for President Obama to replace agency Secretary Kathleen Sebelius, and he should go with an unconventional choice: New York Mayor Michael Bloomberg. ... The ongoing fiasco has not only dealt a body blow to the Affordable Care Act, it has set back the entire progressive project of good, smart government by failing so ridiculously on one of its most visible public initiatives (Michael Zuckerman, 11/5).

The Boston Globe: Why Obamacare Can’t Replicate Mass.
If the Affordable Care Act was modeled on the Massachusetts health reform, why was the rollout of the Commonwealth’s program in 2006 smooth while the launch of Obamacare is so buggy? The answers speak volumes about what prevents Americans from getting efficient health care reform (Robert Kuttner, 11/6).

The Washington Post: At Obamacare Hearings, Governing By Anecdote
It did not sound good for Sen. Pat Toomey. "I'm a two-time breast cancer survivor and I’m facing the loss of insurance," the Pennsylvania Republican declared Wednesday at a Senate Finance Committee hearing on the health-care law. "Three years ago, I was diagnosed with multiple sclerosis," he added. ... Happily for Toomey, he was not describing his own maladies. He was reading e-mails sent by his constituents. But the senator has contracted a dangerous condition that can cause people to have impaired judgment. It's called governing by anecdote — and it's spreading (Dana Milbank, 11/6).

The Washington Post's The Plum Line: Ignore The Spin War About Obamacare. It's Irrelevant. Rinse, Repeat.
So you thought Republicans had finally given up on "repeal and replace" as their slogan about the Affordable Care Act? It seemed to be dead and buried more than a year ago. But this is one that just can't stay buried. In a new op ed piece, Paul Ryan claims that, yes, Republicans still intend to use the "republican remedy" of winning elections so that they can, yes, "repeal and replace Obamacare." It’s back! (Jonathan Bernstein, 11/6). 

The Wall Street Journal: How ObamaCare Rips Off The 'Young Healthies'
When ObamaCare is under attack, its defenders retreat to several well-worn claims. Among them is a provision that compels insurance companies to allow parents to keep their "children" ages of 21 to 26 on their family policies. Yet this part of the Affordable Care Act was not engineered in response to any noticeable interest group. Instead, political considerations are responsible for the provision—which is an unnecessary and a deceptive ripoff of the "young healthies" (Carl Schramm, 11/6). 

The Wall Street Journal: ObamaCare Goes Hollywood For Hispanics
With a disastrous ObamaCare website rollout and millions of Americans being kicked off their health-insurance plans, it's clear things aren't going well for the president's signature legislation. This week saw fresh evidence of how worried ObamaCare supporters are: news of an effort to use Hollywood story lines to send a message to Hispanics that they should sign up. It's not the first time promoters of government programs have used TV and radio programming to win over the country's largest minority group (Mike Gonzalez, 11/6). 

Bloomberg: Obamacare’s Defects Are The Price Of Bad Politics
The rollout of Obamacare could hardly have gone worse. To understand what happened and judge whether things might improve, notice that the problems fall into three fairly distinct categories: defects in the plan, defects in its initial execution and defects in the way it was sold. In the end, only the first will matter (Clive Crook, 11/6).

Bloomberg: Was Obamacare The Big Election Issue?
Bloomberg View columnists Margaret Carlson and Ramesh Ponnuru met online to chat about the elections in Virginia, New Jersey and Alabama and the continuing mishaps of the Patient Protection and Affordable Care Act. Below is a lightly edited transcript (Margaret Carlson and Ramesh Ponnuru, 11/6).

USA Today: Health Care Needs A Steve Jobs
At some point, a freewheeling United States gave birth to the most innovative health care system in human history. American doctors have continuously introduced medical miracles. But today, every young health care professional ought to ask, "Can we keep it up?" Anyone who has witnessed the Obamacare meltdown can be forgiven for wondering, too (Robert Graboyes, 11/6). 

The New York Times: Getting Government Technology Right
The problems with the federal health insurance website have highlighted the need for broad reform in how the government uses technology to deliver public services (11/6).

The Washington Post: Clunker Progressivism
Barack Obama's presidency has become a feast of failures whose proliferation protects their author from close scrutiny of any one of them. Now, however, we can revisit one of the first and see it as a harbinger of progressivism's downward stumble to HealthCare.gov (George F. Will, 11/6). 

The San Francisco Chronicle:  Out With The Old, In With Obamacare
The math for the Affordable Care Act in California is stark: Kick 1 million Californians off the private health care plans they already have at the end of the year so that a million Californians can enroll in subsidized Obamacare plans. Another million or so can stay in their old plans, and the state will sign up an additional 1.1 million for Medi-Cal. The losers are Californians, many of them Obama voters, who run their own shops and did the right thing by buying private health care, probably after Obamacare passed. If they are among the two-thirds of private policyholders expected not to qualify for federal subsidies, they face an ugly case of rate shock (Debra J. Saunders, 11/6).

Virginian-Pilot: 47,000 Reasons To Expand Medicaid
The financial cost of refusing to expand Medicaid is overshadowed by the human toll. As The Pilot's Amy Jeter recently reported, Virginia's intransigence ensures that about 47,000 people here in South Hampton Roads will continue to be denied coverage. They earn less than 138 percent of the federal poverty level - about $15,415 for one person, and $31,809 for a family of four -- making them ineligible to receive the subsidies better-paid people can receive to buy insurance (11/7).

And on other issues -

Los Angeles Times: The Lyme Disease Battle
There is a subculture in America you may know little about. Its members are haunted by a slender, twisting, tick-borne germ known as Borrelia burgdorferi, the microbe responsible for Lyme disease, and they are trying desperately to warn us that we are all at risk of contracting a debilitating, chronic illness characterized by joint pain, fatigue, mood disorders and a long list of other symptoms. Arrayed against these true believers are most of the mainstream scientists who study B. burgdorferi. Although they acknowledge that Lyme disease is a genuine illness that humans can get from being bitten by infected ticks, and that those who are not treated promptly can develop worse symptoms, they don't believe that infection leads to a chronic condition (Wendy Orent, 11/7).

The New York Times’ Opinionator: Treating The Village To Cure The Disease
In communities across Africa, health workers are going house to house with medicine to combat lymphatic filariasis, or L.F., which is the world's second-largest cause of chronic disability. They make sure the children are old enough, the women aren't pregnant and no one is seriously ill. Then people take two pills while the health worker watches. She writes down their names in her ledger (Jason Silverstein, 11/6).

The New England Journal of Medicine: Grading A Physician's Value — The Misapplication Of Performance Measurement
Perhaps the only health policy issue on which Republicans and Democrats agree is the need to move from volume-based to value-based payment for health care providers. Rather than paying for activity, the aspirational goal is to pay for outcomes that take into account quality and costs. In keeping with this notion of paying for value rather than volume, the Affordable Care Act (ACA) created the "value-based payment modifier," or "value modifier," a pay-for-performance approach for physicians who actively participate in Medicare. By 2017, physicians will be rewarded or penalized on the basis of the relative calculated value of the care they provide to Medicare beneficiaries. Although we agree that value-based payment is appropriate as a concept, the practical reality is that the Centers for Medicare and Medicaid Services (CMS), despite heroic efforts, cannot accurately measure any physician's overall value, now or in the foreseeable future (Drs. Robert A. Berenson and Deborah R. Kaye, 11/6).

The New England Journal of Medicine: Medicare's Physician Value-Based Payment Modifier — Will The Tectonic Shift Create Waves?
Given the challenges entailed by a much-needed tectonic shift toward value-oriented physician payment, it made sense for the ACA to require CMS to introduce an incentive program with familiar design elements, quality measures, and attribution methods. But the [Physician Value-Based Payment Modifier] cannot be effective until a broader base of physicians is fully engaged, potentially controversial issues related to accountability and attribution are addressed, and stakeholders gain the necessary experience in improving care quality and cost in real-world settings (Dr. Alyna T. Chien and Meredith B. Rosenthal, 11/6).

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Stephanie Stapleton

Andrew Villegas

Lisa Gillespie
Shefali Luthra

The Kaiser Daily Health Policy Report is published by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation. (c) 2014 Kaiser Health News. All rights reserved.