Daily Health Policy Report

Tuesday, December 10, 2013

Last updated: Tue, Dec 10

KHN Original Reporting & Guest Opinion

Health Reform

Administration News

Capitol Hill Watch


State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

A Test For The Health Law In Scandal-Plagued Cities Of Southeast Los Angeles

Kaiser Health News staff writer Anna Gorman reports: "The towns of Bell and Cudahy in southeast Los Angeles County are best known for corruption scandals that enraged and mobilized their residents. But to California health officials, the small, working class cities have a much more important distinction: They have the highest number of people that could benefit from the state’s insurance marketplace. More than 60,000 people, or about 60 percent of the residents, in the zip code encompassing Bell, Cudahy and Bell Gardens are eligible for financial help buying policies through the Covered California marketplace, according to the state's projections" (Gorman, 12/10). Read the story.

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Insuring Your Health: Insurers Question Health Benefits Of Some Genetic Tests

Kaiser Health News: consumer columnist Michelle Andrews writes: "The day when a simple blood test or saliva sample can identify your risk for medical conditions ranging from cancer to Alzheimer’s disease seems tantalizingly close. But while advances in genetic testing increasingly give people critical information that may help prevent disease, genetics experts say sometimes the hype around these tests has outstripped the science. Insurers, meanwhile, generally only cover tests if there's strong scientific evidence that it can provide a health benefit to patients" (Andrews, 12/10). Read the column.

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Some California Insurance Plans Narrow Doctor, Hospital Choices

Capital Public Radio’s Pauline Bartolone, working in partnership with Kaiser Health News and NPR, reports: "When Diane Shore got a letter that her health policy would be canceled, the small premium increase for a new plan didn’t bother her that much. What she’s really troubled by is: 'My physicians will no longer be in this network of physicians, or the hospitals won’t be as well.' Sixty-two year old Shore owned an IT consulting business in the San Francisco Bay Area, and retired when she sold her business in 2000. She says she wants to stick with the providers that she’s had for years, including the surgeon who cared for her during a bout of breast cancer in 1998" (Bartolone, 12/9). Read the story.

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Capsules: Report: Most States Do A Poor Job Informing Consumers About Physician Quality

Now on Kaiser Health News' blog, Julie Appleby reports: "When it comes to providing consumers with easily accessible information about physician quality, a report out today gave most states grades of ‘D’ or ‘F,’ often because they compile data only about primary care doctors, not specialists" (Appleby, 12/10). Check out what else is on the blog

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For HIV Patients In Texas, Expanded Coverage Is Elusive

The Texas Tribune's Edgar Walters, working in partnership with Kaiser Health News, reports: "Hughes and her husband, Daniel, also HIV positive, receive some health coverage under the Ryan White Care Act, a federal health care program for HIV and AIDS patients. Community advocates expected the Affordable Care Act to provide nearly universal health coverage for HIV patients, freeing up funding from the Ryan White program to cover services beyond primary care. But many HIV patients in Texas live below the poverty line and are therefore ineligible for subsidies on the exchange. Add Texas’ decision not to expand Medicaid to cover poor adults, and the bulk of low-income HIV patients are missing out on expanded health coverage" (Walters, 12/10). Read the story.  

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Political Cartoon: 'Send In The Clowns?'

Kaiser Health News provides a fresh take on health policy developments with "Send In The Clowns?" by Adam Zyglis. 

Here's today's health policy haiku:  


How much will it snow?
Fewer error messages?
That's the feds' focus.

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

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Health Reform

Healthcare.gov 'Vastly Improved,' But Back-End Problems Persist

A little over a week after the deadline that President Barack Obama gave for fixing the federal health care exchange, the system serving 36 states is far more user friendly, according to consumers and navigators. But it is unclear how many of those who enroll in plans may have had garbled or incomplete information sent to insurers because of continuing back-end problems. Problems with the Spanish-language version of the website are also identified.

The New York Times: Health Care Exchange Is Vastly Improved, Users Say
After two months of false starts, error messages and pleas for patience from the once-hobbled federal online health care exchange, Karen Egozi, the chief executive of the Epilepsy Foundation of Florida, watched on Monday as counselors navigated the website’s pages with relative ease. Click. Next page. Click. Next page. The website, HealthCare.gov, was working so well that Ms. Egozi, who oversees the 45 navigators in eight locations who help consumers enroll in health plans, said her team gave the system an 8 on a scale of 1 to 10, meaning that most people got as far as selecting a plan or taking home information to select a plan. It felt like a champagne moment (Alvarez and Preston, 2/9).

Bloomberg: Back-End Errors At U.S. Health Website Jeopardize Sign Up
There’s no way to tell how many people who think they enrolled for health insurance through the U.S. Obamacare exchange actually have, after about 1 in 4 files sent to insurers had garbled and incomplete information. The data transmission errors have been reduced to 1 in 10 since Nov. 30, the government said on Dec. 6 (Wayne and Nussbaum, 12/9).

Bloomberg: Hidden Obamacare Website Costs Show Lack Of Transparency
President Barack Obama’s health agency said it has spent $319 million building an online health-insurance marketplace through October. More than three years after the passage of Obama’s signature health-care law in 2010, it’s almost impossible to verify and track that spending through public records (Miller and Wayne, 12/10).

CQ HealthBeat: Spanish Website Launches, But More Tweaks Needed
One of the first things noticed by Latino groups who are testing out the newly-launched Spanish-language health care website is that the window shopping tool to compare coverage options without first setting up an account is still written in English. Federal officials “didn’t mention that was going to be the case or when it’d be fixed,” said Liliana Rañón, director of policy and legislation for the League of United Latin American Citizens. “It’s something I made a note of. I’m going to let them know it needs to be changed” (Adams, 12/9).

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To Bridge Trust Gap, Some Health Law Supporters Take Matters Into Their Own Hands

News outlets report on the new approaches and strategies that are emerging as advocates move on from the troubled launch of healthcare.gov.

The Associated Press/Washington Post: Health Care Debate Has Trust, Politics Themes, Too 
For months, the talk was all about computer code. About response times. About glitches and bugs. People who didn’t know a URL from an http were blithely expounding on software snags and web design, thanks to the clunky launch of healthcare.gov, the insurance marketplace for the government’s big health care overhaul (12/9). 

Los AngelesTimes: Obamacare Backers Not Relying On White House To Meet Law’s Challenges
As supporters of the Affordable Care Act brace for new headaches next year, many have concluded they cannot count on the Obama administration, whose efforts to explain and promote the law are increasingly viewed as poorly planned, unreliable and largely ineffective. Consumer advocates, doctors’ groups and many health industry leaders remain committed to helping the law succeed. Most believe in its goals of expanding health coverage and restructuring the medical system to improve quality and control costs. Few see any viable alternatives (Levey and Hennessey,12/9).

Politico: Generation Opportunity To Campaign On Snapchat
Generation Opportunity is taking the Obamacare messaging wars to Snapchat, using the popular smartphone application to encourage young consumers to opt-out of the health insurance exchanges created by the Affordable Care Act. “Our goal is to be where young people are and to engage them in ways that they’re going to find entertaining and useful,” the group’s president Evan Feinberg told POLITICO. “One of the ways we’re getting that message across is through a first-of-its-kind social media campaign through Snapchat” (Delreal, 12/9).

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Simplicity, Testing: Key To Why Some State-Run Exchanges Work

Stateline explores why some insurance exchanges function well and others -- including the one operated by the federal government -- are struggling. Meanwhile, California Democrats say a lookalike GOP health insurance website is confusing consumers, and Maryland faces a self-imposed mid-December deadline to repair its site.

Stateline: Why Some State-Run Health Exchanges Worked 
Not every state-run exchange has performed well -- Hawaii, Oregon, Maryland and Vermont all have had significant problems. However, even though the 14 exchanges run by states and the District of Columbia serve less than a third of the U.S. population, they accounted for more than half of all Medicaid enrollments and 75 percent of private insurance sign-ups in October, according to the federal government's most recent enrollment report. It's too early to pinpoint exactly why some state-run exchanges did better than others, but two common characteristics stand out: simplicity and an abundance of testing (Vestal and Ollove, 12/10).

The Washington Post’s The Fix: How Does Your County Stack Up On Health Insurance? Consult This Interactive Map.
The battle between advocates and opponents of the federal health-care law is often chock-full of macroscopic statistics and data points. But what about looking at health care on a smaller scale? Thanks to an interactive infographic below from the consumer finance Web site ValuePenguin, you can take a look at how your own county measures up when it comes to what percentage of the population is insured, how many companies are offering plans on the exchange, and how it all compares to every other county in the country. Data for the tool come from the Census, HealthCare.gov and state insurance exchanges (Sullivan, 12/9).

The New York Times: Parties In California Squabble Over Another Website
California has enjoyed one of the smoothest rollouts of a health care exchange in the country. But the state’s Democrats are accusing Republicans of trying to sabotage the state-run exchange by putting up their own health care website (Lovett, 12/9). 

Kaiser Health News: A Test For The Health Law In Scandal-Plagued Cities Of Southeast Los Angeles
The towns of Bell and Cudahy in southeast Los Angeles County are best known for corruption scandals that enraged and mobilized their residents. But to California health officials, the small, working class cities have a much more important distinction: They have the highest number of people that could benefit from the state’s insurance marketplace. More than 60,000 people, or about 60 percent of the residents, in the zip code encompassing Bell, Cudahy and Bell Gardens are eligible for financial help buying policies through the Covered California marketplace, according to the state’s projections (Gorman, 12/10).

The Baltimore Sun: Health Exchange Officials Face Deadline For Repairs
Even as [Maryland] state officials are racing to meet a self-imposed deadline to fix major glitches with the state's online insurance marketplace, some consumers continued to have problems buying health coverage through the exchange. Gov. Martin O'Malley pledged to correct the problems by mid-December, and two new state officials have been tapped to lead the exchange after weeks of technical problems and the resignation of its executive director (Cohn and Walker, 11/9).

Narrow networks of doctors and navigator availability also make news in California and Maine --

Kaiser Health News: Some California Insurance Plans Narrow Doctor, Hospital Choices
When Diane Shore got a letter that her health policy would be canceled, the small premium increase for a new plan didn’t bother her that much. What she’s really troubled by is: ‘My physicians will no longer be in this network of physicians, or the hospitals won’t be as well.’ Sixty-two year old Shore owned an IT consulting business in the San Francisco Bay Area, and retired when she sold her business in 2000. She says she wants to stick with the providers that she’s had for years, including the surgeon who cared for her during a bout of breast cancer in 1998 (Bartolone, 12/9).

The Associated Press: Several Maine Towns Far From Health Care Help
Nearly a dozen of Maine's largest communities are more than 15 miles from the nearest navigator or counselor who can help residents sign up for coverage on the health insurance marketplace, according to an analysis presented to lawmakers Monday. Of the 77 Maine towns where most people work and shop and where most hospitals and colleges are located, 11 don't have navigators and certified application counselors within 15 miles, the Maine Health Access Foundation found (Durkin, 12/9).

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Democrats Press N.C. To Expand Medicaid; Ohio Launches Medicaid Signup Site

The White House asks two top North Carolina Democrats to urge Gov. Pat McCrory and state lawmakers to reconsider a health law provision to cover more low income people. Meanwhile, Ohio reports that more than 1,100 residents signed up for Medicaid on the first day a signup site went live.

McClatchy/Raleigh News & Observer: White House, NC Democrats Press State To Expand Medicaid
The White House enlisted two top North Carolina Democrats on Monday to urge Gov. Pat McCrory and the legislature to reconsider their opposition to Medicaid expansion under Obamacare. "Medicaid expansion is a smart choice for states," White House Spokesman Josh Earnest said during a telephone news conference along with Durham Democrats, Mayor Bill Bell and state Sen. Floyd McKissick (Schoof, 12/9).

Columbus Dispatch: Ohio's Medicaid-Enrollment Website Works Smoothly On First Day
Online enrollment began yesterday for Ohio's newly expanded Medicaid program, allowing more than 1,100 low-income residents to sign up for tax-funded health insurance by the end of the day. State officials said it's likely the largest number ever to sign up for benefits in a single day. ... It also was without the technical failures and glitches that plagued the Oct. 1 launch of HealthCare.gov's online enrollment system (Candisky, 12/10). 

Cleveland Plain Dealer: Ohio Launches Website To Help Enroll Applicants For Newly Expanded Medicaid Program
The state "flipped the switch," [Sam Rossi, a spokesman for the Ohio Department of Medicaid,] said, at 6 a.m. Monday. By 11 a.m. about 450 people had enrolled. By later in the afternoon, about 3:30 p.m., the number had risen to 1,165. The computer system itself is new, replacing one that was 32 years old, Rossi said. By 2015, the state intends to integrate the Supplemental Nutrition Assistance Program, formerly called food stamps, and Temporary Assistance for Needy Families into the same computer system (Higgs, 12/10). 

The Associated Press: Ohioans Can Sign Up Online For Medicaid Program
Many low-income state residents can now sign up for the Medicaid health program through a new website, though it's unclear how soon their applications will get finalized. The online enrollment option became available Monday to children, pregnant women and adults who are newly eligible under an expansion of the federal-state program for the poor and disabled (12/9).

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Administration News

John Podesta Reportedly Ready To Join White House Team

A former aide to President Bill Clinton is expected to help President Barack Obama as he seeks to recover public support on the health law.

The New York Times: Ex-Clinton Aide Expected To Join Obama
President Obama, after a rocky year that leaves him at the lowest ebb of his presidency, is bringing into his White House circle the longtime Democratic strategist John D. Podesta, a former chief of staff for President Bill Clinton. … Word that Mr. Podesta would for the first time join Mr. Obama’s official staff, from people familiar with the discussions, comes as the president is seeking to recover public support and credibility after the flawed introduction in October of the insurance marketplaces that are a key part of his signature Affordable Care Act. This week he brought back his former chief congressional lobbyist, Phil Schiliro, who had moved to New Mexico, to help on the health care issues (Calmes, 12/9).

Politico: Podesta To Advise Obama
Podesta will return to the White House as Obama struggles to regain his credibility after the troubled rollout of HealthCare.gov. The president has already recalled Phil Schiliro, a former legislative affairs director, to serve as the White House’s point person on Obamacare policy. Podesta is viewed as a hand so trusted and widely perceived as an honest broker in Democratic circles that he would have run the presidential transition of either Barack Obama or Hillary Clinton in 2008 (Budoff Brown, 12/9).

Meanwhile, another Obama administration nominee will be questioned by a Senate panel about the health law.

The Associated Press/Washington Post: IRS Nominee To Face Questions On Health Law
President Barack Obama’s choice to head the Internal Revenue Service goes before a Senate committee Tuesday to face tough questions about the agency’s targeting of tea party groups and its ability to administer parts of the president’s health law. Obama nominated John Koskinen, a retired corporate and government official with experience managing numerous organizations in crisis, to take over the IRS in August. If confirmed by the Senate, the 74-year-old turnaround specialist would sign on to a five-year term, which would last beyond Obama’s stay in office (12/10).

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Capitol Hill Watch

Senate Finance Committee Scheduled To Vote Thursday On 'Doc Fix' Legislation

The measure would permanently change how Medicare pays providers for their services. In addition, the Congressional Budget Office has reduced the price tag associated with repealing the current Medicare payment formula.

The Wall Street Journal: Permanent Fix for Medicare Fees Seen
An annual push by doctors to delay cuts to Medicare patient fees is afoot, but this time the prognosis is better for a permanent solution to the long-festering problem. The Senate Finance Committee is scheduled to vote Thursday on "doc fix" legislation that would permanently change how Medicare providers are paid by the government for their services. Similar legislation was unanimously passed by the House Energy and Commerce Committee in July (Schatz, 12/9).

Medpage Today: CBO Cuts Cost Of SGR Repeal Yet Again
The Congressional Budget Office (CBO) has again lowered the price tag for repealing Medicare's much-derided sustainable growth rate (SGR) physician payment formula, dropping it by nearly $23 billion. The 10-year cost estimate for doing away with the SGR is now $116.5 billion, the CBO said late Friday. The previous estimate, made this past February, was $139 billion, which was much less than the $271 billion price tag that CBO had given the idea in August 2012. Lawmakers said the lower price tag could make it easier it finally repeal the SGR, which has been a major focus of Congress this year (Pittman, 12/9).

Meanwhile, in the background --

Politico: Why The Timing Is Right For A Budget Deal
John Boehner and Barack Obama failed. Harry Reid, Boehner and Mitch McConnell didn’t fare much better. Eric Cantor and Joe Biden barely got started. But with the year winding to a close, Sen. Patty Murray (D-Wash.) and Rep. Paul Ryan (R-Wis.) are nearing a modest, yet important, budget deal that senior aides say could be rolled out as soon as Tuesday and voted on later this week (Sherman and Bresnahan, 12/10).

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Tax Employer Health Care Plans? GOP Rethinks Proposal, Continues Health Law Barrage

A GOP proposal to begin taxing employer-based health care benefits is worrying some Republicans that such a move could hurt the party politically ahead of 2014's elections. In the meantime, Republicans are continuing their attack on Democrats over the health law, using phrases like "broken promise" and "extraordinary disruption" to describe the law.

The Wall Street Journal: Republicans Shy Away From Their Own Health Plan
Democrats' politically bruising experience over the Obama health law has prompted leading Republican policy experts to rethink one of the party's own long-standing ideas about remaking the health-care system. President Barack Obama and his party have suffered in public-opinion polls amid the health site's troubled rollout and as some five million people lost existing coverage that didn't meet new standards, even as the law seeks to expand coverage to many more Americans. Some Republicans are now worried that a GOP proposal to begin taxing health-care benefits offered through employers—which would affect some 160 million Americans—would cause market disruptions far more severe and expose the party to its own political peril (Meckler, 12/9).

Politico: GOP Ads Tie Dems To ACA ‘Broken Promise’
Republicans are using House Democrats’ own words against them in a new set of radio ads that tie the lawmakers to the bungled Obamacare rollout. Specifically, the National Republican Congressional Committee’s ads, which launch Tuesday, focus on President Barack Obama’s “broken promise” that people could keep their old insurance plans under the new health law. Republicans spent weeks digging through old clips and statements from Democrats in hopes of catching them making the same pledge (Isenstadt, 12/10). 

The Washington Post’s The Fact Checker: McConnell’s Claim Of Obamacare ‘Extraordinary Disruption’ For Americans With Health Insurance
Sen. McConnell, the Republican leader, has long been a critic of the Affordable Care Act, a.k.a. Obamacare. But his recent comments on Fox News appeared overheated: Are the 85 percent of Americans who have health insurance facing “extraordinary disruption”? McConnell’s comments in some ways are the flip side of President Obama’s claim earlier this year that “the 85 and 90 percent who already have health insurance” will not notice anything but better health care. He argued that impact will be felt instead by “that small group of people — 10 to 15 percent of Americans; now, it’s still 30 million Americans, but relatively a narrow group — who don’t have health insurance right now or are on the individual market and are paying exorbitant amounts for coverage that isn’t that great” (Kessler, 12/10).

And Republican Sen. Lindsey Graham has enrolled in coverage under the law but declined to take a federal subsidy --

The Washington Post: Lindsey Graham Enrolls Under Obamacare, Declines Federal Subsidy
Sen. Lindsey Graham (R-S.C.) became the latest U.S. lawmaker to enroll in a federal health insurance exchange but forego the federal subsidy he would normally receive for his premium. Graham announced Monday he would enroll in his home state's exchange, which is being run by the federal government, even though he opposes the Affordable Care Act. The congressional open enrollment period ends Monday. Senators are allowed to receive a federal subsidy covering roughly 75 percent of their health care premiums under the law by enrolling in the D.C. Health Link exchange. But at least 12 senators have waived their employer contribution and joined either a state-run exchange or the federal exchange (Eilperin, 12/9). 

Politico: Lindsey Graham Declines Health Care Contribution
Graham, who is 58 and single,said he will pay $400 more per month under Obamacare than under his current plan. But that significant increase is also likely due to the fact that he is turning down his employer contribution — which can cover as much as 75 percent of the costs of health care plans (Kim,12/9).

CNN: GOP Sen. Graham Latest To Sign Up For Obamacare, Refuse Subsidy
Republican Sen. Lindsey Graham has decided to sign up for federal health care coverage in the South Carolina exchange, rather than through the Washington, D.C., exchange where he would qualify for a federal subsidy offered to both lawmakers and congressional aides. "I don't think members of Congress should get a special deal," Graham said in a press release. "Obamacare is being pushed on the American people and we should live under it just like everyone else," he added (Sommers, 12/9).

ABC News: Colin Powell Pitches Single-Payer Health Care In US
Former Secretary of State Colin Powell has waded into the health care debate with a broad endorsement of the kind of universal health plan found in Europe, Canada and South Korea. "I am not an expert in health care, or Obamacare, or the Affordable Care Act, or however you choose to describe it, but I do know this: I have benefited from that kind of universal health care in my 55 years of public life," Powell said, according to the Puget Sound Business Journal, last week at an annual "survivors celebration breakfast" in Seattle for those who, like Powell, have battled prostate cancer (Lazar, 12/9).

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Cost And Quality: Consumers Continue To Face Obstacles

A new report finds that states generally do a poor job in communicating physician quality ratings to consumers, while a Gallup poll finds that cost issues continue to be a reason some people delay care.

Kaiser Health News: Capsules: Report: Most States Do A Poor Job Informing Consumers About Physician Quality
Now on Kaiser Health News’ blog, Julie Appleby reports: “When it comes to providing consumers with easily accessible information about physician quality, a report out today gave most states grades of ‘D’ or ‘F,’ often because they compile data only about primary care doctors, not specialists” (Appleby, 12/10).

The Hill: Poll: 30 Percent Delay Costly Medical Treatment
Thirty percent of adults say they or a family member had to put off medical treatment in the last year because it was too expensive, according to a Gallup poll released Monday. Breaking down those numbers more, nearly 60 percent of uninsured people, the poll indicates, say they have put off medical treatment (Shabad, 12/9).

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State Watch

Oregon Gov. Kitzhaber To Seek 4th Term; Health Care Will Likely Be A Campaign Issue

John Kitzhaber announced he intends to seek an unprecedented fourth term. In the background, his state continues to experience difficulties with Cover Oregon, the state's online insurance marketplace.

Los Angeles Times: Oregon Governor Opens Bid For 4th Term Despite Rocky Obamacare Rollout
When Oregon Gov. John Kitzhaber announced his bid for a fourth term Monday, it was no surprise that he did so at an elementary school – a long way from the headquarters of Cover Oregon where software engineers are still trying to fix problems with the state’s healthcare exchange and get it online (Reston, 12/9).

The Washington Post: Oregon’s Kitzhaber Will Run For Fourth Term
Oregon Gov. John Kitzhaber (D) will seek a fourth four-year term in office, he said Monday, kicking off a campaign likely to be dominated by health care and tax reform. Kitzhaber, already the longest-serving governor in Oregon’s history, kicked off his campaign for another four-year term at Portland’s Earl Boyles Elementary School. He starts his campaign with $239,000 in the bank, the Oregonian reported (Wilson, 12/9).

USA Today: Oregon Gov Expects ‘Slings And Arrows’ On Health Care
Could the rocky rollout of an online health care exchange be a factor in a 2014 election? We're not talking about a race for Congress, but the race for governor in Oregon — where Democratic incumbent John Kitzhaber announced Monday he will seek an unprecedented fourth term. Kitzhaber, who has already made Oregon history with his third term in office, said he expects to take "a few slings and arrows about the rocky rollout" of the Cover Oregon online insurance exchange. Like the federal HealthCare.gov site, whose problems have dominated headlines for weeks, the Oregon website was scheduled to launch Oct. 1 (Camia, 12/9). 

Meanwhile, the Wall Street Journal looks at the Oregon website's problems.

The Wall Street Journal’s CIO Journal: Cover Oregon CIO: Integrating Oracle Software is ‘Daunting’
More than two months after the Obamacare online health exchanges launched, Oregon has yet to enroll a single person online through its state exchange. The site’s tech leader cited the challenges integrating primary contractor Oracle Corp.'s software as well as missed deadlines by the software maker and the state’s own failure to hire a systems integrator as key reasons for Cover Oregon’s continued dysfunction. These challenges, which persist today, mean the exchange won’t be fully operational until after Jan. 1, 2014 (Boulton, 12/9).

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State Highlights: Health Care Price Data And Transparency In N.Y. And Calif.; States Shift Tobacco Settlement Funds Away From Prevention

A selection of health policy stories from New York, California and North Carolina.

The New York Times: New York State Hospital Data Exposes Big Markups, and Odd Bargains
Just how expensive is your hospital? In New York, the answer may lie in a trove of hospital cost data newly posted online by the State Health Department. As part of an effort to make health care pricing more transparent, the state is naming hospitals and listing their median charges and costs for 1,400 conditions and procedures from 2009 to 2011. In 2011, prices ranged from the $8 bill at Benedictine Hospital in Kingston, N.Y., for treating a case of gastritis (cost: $2), to a $2.8 million charge for a blood disorder case at University Hospital of Brooklyn that cost it $918,462 (Bernstein, 12/9).

California Healthline: Forum Examines Price Transparency
Experts discussed the thorny issue of price transparency in health care -- including the possibility of seeking legislation to align hospital prices in California -- at a forum yesterday in Sacramento. … In 2011, the California Public Employees' Retirement System, the second largest buyer of health care in the country after the federal government, started a reference-pricing program that set standard prices for medical procedures, such as knee replacements, as well as some medications and services. According to a report last week from the Center for Studying Health System Change, CalPERS saved about $3 million over the past two years (Gorn, 12/9).

The New York Times: States Found To Shift Funds From Antismoking Efforts
Despite billions of dollars nationwide from tobacco taxes and settlements with manufacturers more than a decade ago, only two states are poised to meet federal recommendations for tobacco prevention spending during the 2014 fiscal year, an alliance of advocacy groups said in a report issued on Monday (Binder, 12/9).

Raleigh News & Observer: NC Auditor Says Medicaid Claims System Had More Than 3,200 Defects 
The state audit released Monday put a number to all the problems with a new Medicaid claims system that has frustrated hospitals, doctors and other health care providers for months. NC Tracks has had more than 3,200 defects since the state started using it July 1, according to the report, and more than 600 had not been fixed by Nov. 5 (Bonner, 12/9).

The Day (New London, Conn.): Self-Insured L+M Does Not Have To Notify Workers Of Coverage Loss 
Locked-out nurses and technicians at Lawrence + Memorial Hospital learned Monday that state law does not protect them from the immediate loss of their health care coverage. ... [Matt O'Connor, a spokesman for two AFT Connecticut union locals] said he wants to find out what kind of federal relief might be available to help union workers, many of whom are single parents, navigate the difficulty of being out of work and having to pay for their own medical insurance. The union previously announced a $20,000 defense fund to help members undergoing economic hardships (Howard, 12/10). 

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Editorials and Opinions

Viewpoints: Health Law Problems Plague Calif., Too; Obamacare Redistribution Is From Lucky To Unlucky; FDA Crackdown On Genetic Testing

The Wall Street Journal: Californians Souring On ObamaCare
While politicians in Washington are hailing California's exchange as proof of the law's success, voters in California don't seem to agree—and it's not hard to understand why. Policies for about 900,000 Californians are being cancelled because they don't meet the law's benefit mandates. And about two-thirds of these individuals won't be eligible for subsidies on the exchange and will likely see their premiums rise. And while the California exchange may be less glitch-prone than the one set up by the feds, it's been nothing short of an embarrassment for a state that considers itself the tech capital of the world (Allysia Finley, 12/9).

The San Francisco Chronicle: Obamacare Prescription: Fair Share Of Less Care
Lately I've been hearing from readers who are among the million Californians who had private health care plans, received cancellation notices and now have to buy new coverage. Some figured that if they signed up with their old providers -- Blue Shield or Anthem -- they'd have access to the same doctors and hospitals. Not quite (Debra J. Saunders, 12/9).

The New Republic: Yes, Obamacare Is Redistribution—But Republicans Are Wrong About Who Pays
Republicans aren't wrong when they say Obamacare amounts to redistribution. But they seem to have a distorted view of how that redistribution works. ... one obvious takeaway is that the majority of funding in the law is money paid by—or given up by—either the wealthy or parts of the health care industry. It's higher taxes on families making more than $250,000 a year, or new fees for the device industry, or cuts for health insurers serving Medicare patients. ... But one thing to remember is that, fundamentally, health care reform has always been about a vulnerability that the poor and the middle class share. In the old days, before Obamacare, just about anybody could end up without health insurance, which meant just about anybody could end up ruined because of medical bills. The simplest way to describe Obamacare is as a transfer from the lucky to the unlucky. And when it comes to health, you don't have to be poor to be unlucky (Jonathan Cohn, 12/10).

Reuters: Healthcare.gov: Private Shame, Public Blame
Obamacare's troubled birth is cited as irrefutable evidence that the public sector is particularly ill-fitted to deal with something as important as healthcare. Had the process been left to the private sector, they argue, the website would have worked and Americans been better served. But hold on. Obamacare may be a government-run enterprise, but the profound errors in building the site were overwhelmingly due to the incompetence of the private sector (Nicholas Wapshott, 12/10).

Fayetteville (N.C.) Observer: State Changes Course On Medicaid. Good
It appears that Gov. Pat McCrory and some of his top managers are rethinking their plan to mend a "broken" Medicaid system. That's good, because the system that administers the health-insurance program for low-income residents isn't all that broken. Part of the Medicaid administration, the nonprofit Community Care of North Carolina, is widely considered one of the most successful in the country. Other states routinely send their health-and-human-services managers here to check it out and try to copy it. Community Care includes medical-provider networks that work to manage Medicaid patients' medical conditions and keep them healthier. Studies show that the system has saved hundreds of millions of dollars in the past few years (12/10).

The Atlanta Journal Constitution: Finally, Something Obamacare Actually Does
What's one thing Obamacare does? It gives people an awfully big incentive to cheat on their taxes. The subsidy cutoffs are the same in Georgia -- the subsidies are only for those earning less than four times the federal poverty level -- although the premiums and thus the potential savings for tax cheats are different. But the point remains: There's an awfully strong incentive for self-employed people, whose earnings aren't reported by others on a W2 form, to understate their income (Kyle Wingfield, 12/9).

Forbes: No, You Can't Keep Your Drugs Either Under Obamacare
The President famously promised that you could keep your health plan and doctor. For many people, both of those pledges are turning out to be false. And now, you might not be able to keep your medicine, either. There are two reasons why. The first has to do with the higher out of pocket costs patients will face. The second issue may be even more significant. Simply put, many drugs may not be covered at all, and the costs patients incur by buying them with cash won’t count against out of pocket caps (Scott Gottlieb, 12/9).

Health Policy Solutions (a Colo. news service): Repeal And Replace? What Would That Mean, Exactly?
Supporters of the ACA say that the opposition does not have an alternative plan. In fact, congressional opponents have offered alternatives, going all the way back to 2009. At least four pieces of legislation could be categorized as serious alternatives: Patient’s Choice Act of 2009, Empowering Patients First Act of 2009 and 2013 and, finally, American Health Care Reform Act of 2013. None of the bills was analyzed and scored by the Congressional Budget Office, however, so we do not have a long-term, non-partisan analysis of how much the proposals would cost, how much they would reduce or add to the deficit or how many uninsured Americans would be covered under them (Bob Semro, 12/10).

USA Today: Your DNA And Your First Amendment
Did you know that you cannot be trusted with knowledge of your own genetic background? That's what the Food and Drug Administration decreed late last month when it ordered 23andMe to stop marketing its "Personal Genome Service." ... The FDA does not claim that 23andMe is a scam or could cause direct injury. Instead, its concern is that people using the genome service "may begin to self-manage their treatments." Essentially, the agency wants to "protect" patients from knowing about their own health (David Rivkin Jr. and Andrew Grossman, 12/9).

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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.