Daily Health Policy Report

Wednesday, December 11, 2013

Last updated: Wed, Dec 11

KHN Original Reporting & Guest Opinion

Administration News

Health Reform

Capitol Hill Watch

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

More Than 110,000 Signed Up For Coverage Through Healthcare.gov In November

Kaiser Health News staff writer Phil Galewitz reports: "While the website serving people in 36 states is still not perfect – insurers are concerned about getting incomplete or inaccurate consumer information -- navigators and insurance brokers say that since major repairs were done over Thanksgiving weekend, the system is working most of the time. Enrollment figures released Tuesday night show that more than 110,000 people signed up for plans through the federal portal in November, more than four times the number in October. Among states relying on healthcare.gov, Florida has the highest number of people choosing a plan over the two month-period (17,908), followed by Texas (14,038) and Pennsylvania (11,788). The pace is expected to pick up this month as a result both of site improvements and the Dec. 23 deadline to enroll for coverage that begins Jan. 1" (Galewitz, 12/11). Read the story.
 

 

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Obamacare Benefits Elusive For Many Working Poor In Northern Florida

Reporting for Kaiser Health News, in partnership with NPR, Eric Whitney writes: "Getting people to sign up for health insurance under Obamacare is an uphill battle in much of Florida. Politicians have put up roadblocks to the law from the beginning - from joining in the lawsuit to thwart it in 2011 to placing restrictions on what health care navigators can discuss with those they advise. That means many don't know what the law might offer them" (Whitney, 12/10). Read the story.

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Capsules: Iowa To Expand Medicaid After Feds OK Money For Private Plans; People With Medicare Have Good Access To Doctors, Study Finds; West Virginia, Virgin Islands, Work Together On Medicaid

Now on Kaiser Health News' blog, Julie Appleby reports on Iowa's plan to expand Medicaid: "The Obama administration Tuesday granted Iowa much of what it requested to move forward with a Medicaid expansion through the use of private insurance plans but refused to allow the state to charge premiums for those who earn less than the federal poverty level. If the state accepts the terms of the agreement, it would become the second to be allowed to use federal dollars to finance the purchase of private health insurance for the newly Medicaid eligible. Arkansas was earlier granted that permission by the Centers for Medicare & Medicaid Services" (Appleby, 12/10). 

Also on the blog, Mary Agnes Carey reports on issues related to Medicare beneficiaries and their access to care: "As key congressional committees consider legislation to repeal Medicare’s physician payment formula, a new study shows that the program’s beneficiaries have generally good access to doctors. The report, prepared by the Kaiser Family Foundation, found that 96 percent of beneficiaries report having access to a doctor’s office or clinic, and about 90 percent of beneficiaries say they can schedule timely appointments for routine and specialty care" (Carey, 12/10).

In addition, Phil Galewtiz writes about the Virgin Islands and West Virginia on Medicaid: "West Virginia and the U.S. Virgin Islands don’t have much in common. It was 82 degrees and sunny today in St. Thomas, while Charleston, W.Va., saw snow and a high of 32. But when it comes to Medicaid, the state-federal health insurance program for the poor, the Mountain State and Caribbean territory are now joined at the hip" (Galewitz, 12/11).  Check out what else is new on the blog.

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Political Cartoon: 'Agony Of Da Feet?'

Kaiser Health News provides a fresh take on health policy developments with "Agony Of Da Feet?" by Christopher Weyant. 

And just for today, here are two health policy haikus:  

CHECKING THOSE ENROLLMENT NUMBERS

November rates climb.
Will those numbers be enough?
Watch the marketplace
-Anonymous

EYES ON IOWA

Slowly but surely
the Medicaid expansion
keeps on expanding
-Anonymous 

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

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Administration News

Health Law Continues To Take A Toll On Obama's Approval Ratings

New polls indicate that, even as the Obama administration hustles to fix healthcare.gov's troubles, the overhaul appears to be a drag on Americans' confidence in President Barack Obama. 

The New York Times: Obama Sees A Rebound In His Approval Ratings
President Obama’s approval ratings, which hit his all-time low last month, have returned to where they were before the rollout of the health care law’s enrollment process, but Americans still lack confidence in the White House’s management of the Affordable Care Act, according to the latest New York Times/CBS News poll. The public’s opinion of the law itself has improved after repairs to the enrollment website (Stolberg and Kopicki, 12/10).

CBS News: Views Of Obamacare Improve, But Are Still Negative Overall
Ten days after the Obama administration's deadline to fix the glitches with its troubled HealthCare.gov website, most Americans (58 percent) don't think the signup for the new health care exchanges is going well, but more than a third – 36 percent -- think it is improving, according to a new CBS News/New York Times poll. The poll finds some improvement in overall views of the health care law since last month, although more Americans disapprove than approve of it, as they have since the law was passed. Fifty percent now disapprove of the health care law, while 39 percent approve (Dutton, 12/10).

USA Today: Poll: Can The Economy Rescue Obama From 'Obamacare'
The fate of President Obama's second term is emerging as a battle between improving news about the economy and souring views of his signature health care law. A year-end USA TODAY/Pew Research Center Poll chronicles what a drag the Affordable Care Act has become on Obama's reputation, helping to drive down his standing as a trustworthy leader and one who can get things done to the lowest levels of his presidency. Disapproval of the health care law hits a new high (Page,12/10).

Los Angeles Times: Obama's Approval Ratings Stabilize In Latest Poll
President Obama can’t yet claim to have turned a corner, but he does seem to have stopped a politically damaging slide in public approval for himself and his new healthcare law, new polling data indicate. After seven months of steady decline, public approval of Obama’s job performance has ticked upward, according to a new Pew Research Center survey. The poll finds 45% of Americans approve of Obama’s work and 49% disapprove (Lauter, 12/10).

The Wall Street Journal: Poll: Health Law Hurts President Politically
The federal health-care law is becoming a heavier political burden for President Barack Obama and his party, despite increased confidence in the economy and the public's own generally upbeat sense of well-being, a new Wall Street Journal/NBC News poll suggests. Disapproval of Mr. Obama's job performance hit an all-time high in the poll, at 54%, amid the flawed rollout of the health law. Half of those polled now consider the law a bad idea, also a record high (King Jr., 12/11).

The Washington Post’s The Fix: The Worse May Be Behind Obama. But It Cost Him Dearly.
After weeks filled with nothing but bad news for President Obama, there have been some reasons for optimism in recent days. But even if Obama has moved past the lowest low of his presidency, there is no way around the reality that his image has been badly damaged since he triumphed at the polls last fall. The latest bit of good news for Obama came in a pair of new polls released Tuesday. A Pew Research Center-USA Today poll shows a slight uptick in his job approval rating, from 41 percent last month to 45 percent, which was about where he stood before the troubled health-care rollout. A separate New York Times/CBS News poll shows Obama’s approval rating has jumped from 37 percent last month to 42 percent (Sullivan, 12/11).

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Health Reform

Enrollment In Federal And State Health Marketplaces Rises To 365,000

The figures announced by federal officials show a sharp rise in the number of people signing up for insurance in November.

The Washington Post: Health Insurance Enrollment Up In November
About 365,000 Americans chose health plans during the first two months of the federal and state insurance marketplaces, bringing the total to more than triple the meager enrollment from October, according to new figures issued by the Obama administration. The report shows that the number of people who collectively signed up for coverage in the 14 states running their own insurance exchanges continued to outpace the total enrollment from the three dozen states relying on the federal marketplace (Goldstein and Sun, 12/11).

The Wall Street Journal: Private Health Plan Enrollment Rises With New Exchanges
Enrollment in private health plans sold on new insurance exchanges rose sharply in November, as more uninsured Americans picked plans before a December deadline and some of the HealthCare.gov website's glitches were fixed. Nearly 365,000 people nationwide have selected private health plans so far, the Department of Health and Human Services said Wednesday. An additional 1.9 million have been notified about whether they'll qualify for federal subsidies to lower their monthly insurance cost—the first step toward enrolling in a new insurance plan (Schatz, 12/11). 

The New York Times: Sebelius To Testify As U.S. Cites Rise In Health Plan Signups
The number of people selecting health insurance plans in the federal and state marketplaces increased in November at a brisk pace, bringing the total to date to nearly 365,000, or more than triple the number who signed up in October, the Obama administration said on Wednesday. More than a quarter-million people picked health plans last month, and more than half of them were in state-run exchanges, the administration said (Pear, 12/11).

Politico: 7 Million Obamacare Customers?
Health and Human Services Secretary Kathleen Sebelius once described 7 million new Obamacare customers in the first year as what "success looks like." The White House is now trying to affix another label to the estimate: meaningless. It might be too late. For months, the Obama administration embraced the projection by the nonpartisan Congressional Budget Office as a way to explain enrollment goals, boosting their political significance. But the broken HealthCare.gov website caused the program to lag far behind on signing up customers, and it's a steep climb to register 7 million people by the March deadline. About 365,000 selected a plan through the state and federal insurance exchanges in the first two months, according to figures released Wednesday, only a fraction of what the administration had estimated (Budoff Brown and Milman, 12/11).

USA Today: Federal Health Enrollments Quadrupled In November
The number of Americans who selected health insurance through the federal exchange, HealthCare.gov, quadrupled in November over the paltry statistics in October, according to new figures released Wednesday morning. The rise from 26,794 enrollees through Nov. 2 to 137,204 through November came before the government said the site had been repaired on Nov. 30 (Kennedy, 12/11).

Los Angeles Times: Enrollment In Obamacare Insurance Rises Sharply In November
Enrollment through insurance marketplaces created by President Obama’s health law rose sharply in November, as more than 250,000 people selected health plans in the month, according to a new government report. That was more than double the number who signed up in October, when problems with the new HealthCare.gov website made enrollment virtually impossible for long stretches of time (Levey, 12/11).

Reuters: Obamacare Health Enrollment Doubled In November: Report
The new tally brought the cumulative total for October and November to 365,000 people who have selected health plans in new online marketplaces set up in all 50 states and the District of Columbia. Just over 800,000 have been determined eligible for government health coverage including the Medicaid program for the poor. The data reflects continued technical problems in November with the federal enrollment website, HealthCare.gov, which crashed on its October 1 launch and was subjected to weeks of emergency fixes. The site has appeared to work far more smoothly since the beginning of this month (Morgan, 12/11).

Kaiser Health News: More Than 110,000 Signed Up For Coverage Through Healthcare.gov In November
While the website serving people in 36 states is still not perfect – insurers are concerned about getting incomplete or inaccurate consumer information -- navigators and insurance brokers say that since major repairs were done over Thanksgiving weekend, the system is working most of the time. Enrollment figures released Tuesday night show that more than 110,000 people signed up for plans through the federal portal in November, more than four times the number in October, but still lower than what some advocates hoped. Among states relying on healthcare.gov, Florida has the highest number of people choosing a plan over the two month-period (17,908), followed by Texas (14,038) and Pennsylvania (11,788). The pace is expected to pick up this month as a result both of site improvements and the Dec. 23 deadline to enroll for coverage that begins Jan.1 (Galewitz, 12/11).

CNBC: 364,682 Enrolled In Obamacare Exchanges By Nov., Far Shy Of 7 Million Goal
A total of 364,682 people were enrolled in private Obamacare insurance plans nationwide by the end of November, federal officials said. Officials maintained that number combined with other new statistics shows there is a "tremendous demand" for affordable, comprehensive health coverage. Separately, another 803,077 people have been deemed eligible for the government-run Medicaid or Children's Health Insurance Plan programs through the Obamacare marketplaces. That was up from nearly 400,000 in the first month (Mangan, 12/11).

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100K Sign Up For Coverage Through Insurance Exchange In N.Y., But Problems Elsewhere Persist

More than 100,000 people in New York have signed up for coverage on the health insurance exchange -- most in private plans. In the meantime, a Maryland official expresses some doubt that fixes will be done to their exchange by a self-imposed deadline. Also, updates from exchanges in Michigan, Minnesota, Vermont, Oregon, Wisconsin and Colorado.

The New York Times: 100,000 Have Signed Up On New York Health Exchange, Officials Say
More than 100,000 people have signed up for coverage through New York State’s health exchange, with two-thirds of them in private plans, significant developments as the state tries to capture a large pool of uninsured residents, state officials said Tuesday. As of Monday, about 69,500 people had selected a private insurance plan through the exchange, in addition to 31,400 who have signed up for Medicaid, the government insurance for the poor, the state health department said. In mid-November, the Medicaid to private insurance ratio was about 50-50, but began tipping toward the private side after that (Hartocollis, 12/10).

The Associated Press/Washington Post:: Brown Says Md. Health Exchange Still Evolving
Under fire from political rivals in Maryland's governor's race, Lt. Gov. Anthony Brown pledged Tuesday to remain focused on fixing the state's bedeviled health care exchange and conduct a full assessment later on why its website has been troubled with computer problems. Brown, who is running for governor, took the lead on implementing health care reform in Maryland. Now, as the state's health care exchange remains challenged more than two months after its launch, Brown is faced with questions about whether the exchange is a lemon (12/10).

The Baltimore Sun: Uncertainty Surrounds Md. Health Exchange Deadline
Lt. Gov. Anthony G. Brown cast uncertainty Tuesday on the administration's ability to meet a deadline for repairs of the state's online insurance marketplace, which has had one of the country's most troubled rollouts under Obamacare (Walker and Cohn, 12/10).

Politico: Michigan May Join States Banning Abortion In Obamacare Plans
Nearly half the states are banning abortion coverage in the new health insurance exchanges almost four years after battles over the issue nearly derailed passage of the Affordable Care Act. Michigan could become the 24th state to ban most abortions in exchange plans this week, after an unusual citizens’ petition drive that allows state lawmakers to resurrect a bill the governor had vetoed and vote it into law without his signature (Cunningham, 12/11). 

Pioneer Press: MNsure Helpline Waits Reach An Hour; Health Exchange Increasing Call Center Staff
The MNsure call center is struggling to handle an influx of questions from people trying to finalize health insurance for next year. Callers to the help line for Minnesota's new health insurance exchange were being told Tuesday afternoon they had to wait 60 minutes for assistance (Snowbeck, 12/10).

The Associated Press: Vt. Health Care Groups Says Most Small Biz Covered
About three-quarters of Vermont small business employees are enrolled in a health insurance plan that's part of Vermont Health Connect, and they are set to begin receiving health benefits through the new system next month, the Department of Vermont Health Access announced Monday. Like the federal health care website, Vermont's site has been plagued with problems (Ring, 12/10).

The Oregonian: 30,000 Cover Oregon Enrollment Packets Still Not In The Mail, State Official Says
More than 30,000 individuals who met Cover Oregon's deadline for submitting health insurance applications still don't have enrollment packets in hand, a state official acknowledged Tuesday. The concession by Dr. Bruce Goldberg, interim director of the state's exchange, raises serious concerns about the state's ability to meet Gov. John Kitzhaber's promise to successfully enroll all Oregonians who need individual insurance Jan. 1.  Of particular concern are the more than 20,000 individuals whose high-risk health insurance plans have no chance of being extended past Dec. 31 (Hunsberger, 12/10). 

The Milwaukee Journal Sentinel: Obamacare Sign-Up Hits 7,200 In Wisconsin As System Shows Improvement
About 7,200 Wisconsin residents so far have signed up for health coverage through new online federal insurance marketplaces, a state official said Tuesday. Dan Schwartzer, deputy state insurance commissioner, said there are signs the insurance exchange is working somewhat better after weeks of a troubled rollout for the federal law known as Obamacare. Schwartzer, who spoke at a luncheon organized by Wisconsin Health News, said the state's estimate of sign-up figures isn't exact but that in past weeks it had tracked closely with the official federal statistics (Stein, 12/10).

Health Policy Solutions (a Colo. news service): Enrollments, Wait Times Jump
Enrollments in Colorado’s health exchange jumped in December with an additional 5,094 people signing up for private health insurance during the first eight days of the month, according to exchange officials. But enrollments remain well below Connect for Health Colorado’s lowest projections and managers are now considering revising those projections downward. … In the meantime, wait times to talk with a customer service agent at the exchange’s call center have increased to 30 to 40 minutes (Kerwin McCrimmon, 12/10).

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Iowa Wins Approval To Expand Medicaid Using Private Plans

Federal officials approved much of Iowa's proposal to expand low-income health care, but - like the government's approval of Arkansas' request - set important conditions.

CQ HealthBeat: Iowa Second State To Expand Medicaid Via Exchange Coverage
The Centers for Medicare and Medicaid Services approved on Tuesday Medicaid expansion waiver requests by the state of Iowa. CMS officials made few changes to the state’s plan, although they will not let the state charge monthly premiums to very low-income people (Adams, 12/10). 

Kaiser Health News: Capsules: Iowa Wins Approval To Expand Medicaid By Using Federal Funds To Buy Private Plans
If the state accepts the terms of the agreement, it would become the second to be allowed to use federal dollars to finance the purchase of private health insurance for the newly Medicaid eligible. Arkansas was earlier granted that permission by the Centers for Medicare & Medicaid Services (Appleby, 12/10).

The Associated Press: Feds Back Most Of Iowa’s Medicaid Expansion Plan
The announcement creates a political dilemma for the Republican governor, who has championed the use of premiums as a way to improve health outcomes in the state. Branstad did not immediately indicate Tuesday if he would accept the federal terms. ... The state has 30 days to accept the terms, which would provide the state with full funding for the program in 2014, 2015 and 2016 (Lucey, 12/10). 

Meanwhile, media outlets explore debate about the expansion in Tennessee and Florida --

The Tennessean: Haslam Lays Out Conditions For Tenncare Expansion
Gov. Bill Haslam has written federal officials a letter laying out what he thinks is needed to expand Medicaid in the state, following nearly nine months of talks but no concrete progress. Haslam announced Monday that his office would send a letter to Health and Human Service Secretary Kathleen Sebelius describing the status of his “Tennessee plan” to offer Medicaid to more of the poor in Tennessee. ... TennCare covers about 1.2 million residents in the state, but the program leaves out many working-poor adults. The Affordable Care Act calls on Tennessee to offer Medicaid to about 175,000 more people and includes a guarantee that the federal government will cover 90 percent of the cost or more until at least 2020 (Sisk, 12/10).

Kaiser Health News: Obamacare Benefits Elusive For Many Working Poor In Northern Florida
Getting people to sign up for health insurance under Obamacare is an uphill battle in much of Florida. Politicians have put up roadblocks to the law from the beginning - from joining in the lawsuit to thwart it in 2011 to placing restrictions on what health care navigators can discuss with those they advise. That means many don't know what the law might offer them (Whitney, 12/10).

 

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Group Says Obamacare Plans Discourage HIV Patients From Enrolling

A coalition of AIDS organizations is asking the Obama administration to investigate whether some insurers are trying to discourage HIV-infected patients from enrolling in their policies by failing to cover some AIDS drugs or through what it called "egregious cost-sharing designs." Other stories explore the law's impact on African-Americans and small businesses.

The Wall Street Journal: Group Says Plans Discourage HIV Patients
A coalition of 31 HIV/AIDS organizations is urging the Obama administration to investigate whether some health insurers are trying to discourage HIV-infected patients from enrolling in new policies being sold under the health-care law, a move the groups say could be illegal. The Affordable Care Act prohibits discrimination against people who are sick; insurers can't deny them coverage or charge them more than healthier peers (Beck, 12/10).

Detroit News: U.S. Touts Benefits Of Health Law For African-Americans
A Detroit family of four with an income of $50,000 a year could buy insurance at healthcare.gov for as little as $126 a month after subsidies, the U.S. government announced Monday as part of a report on how federal health care reform impacts African-Americans. ... Six out of 10 uninsured African-Americans who may be eligible for coverage through the Health Insurance Marketplace might qualify for Medicaid, the Children’s Health Insurance Program (CHIP), or tax credits to help with premium costs, according to the report. “Through the Health Insurance Marketplace, 6.8 million uninsured African-Americans have new options for affordable health coverage that covers a range of benefits, including important preventive services with no out-of-pocket costs,” Kathleen Sebelius, U.S. Secretary of Health and Human Services, said in a press release (Bouffard, 12/10).

National Journal: Republican Opposition Cuts Obamacare’s Benefit To Blacks
More than 2.2 million African-Americans living below the federal poverty line won't have access to Obamacare's insurance benefits due to the slew of states that opted out of the law's Medicaid expansion. Had all 50 states expanded Medicaid, 95 percent of uninsured African-Americans would be eligible for some form of federal assistance through the Affordable Care Act coverage—either via Medicaid or premium subsidies—according to a Health and Human Services report released Monday. Instead, only 60 percent will benefit (Ritger, 12/10).

USA Today: SHOP For Health Care Is Help For Small Business
SHOP marketplaces are operating online in most of the states running their own small business marketplaces. That includes 10 states and the District of Columbia planning to run their own marketplaces for individual care, and two other states creating their own SHOP marketplace but using the federal government's HealthCare.gov site for the individual market. The other states under the federal system are a different story: Though businesses can still buy SHOP plans, they aren't available online and lack some of the major features for which they were originally intended (McGinnis, 12/11).

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Capitol Hill Watch

House And Senate Budget Negotiators Reach A Deal

Some say the agreement brokered by Rep. Paul Ryan, R-Wis., and Sen. Patty Murray, D-Wash., will create breathing room to allow lawmakers to try to address major federal spending drivers, such as health care and entitlement programs like Medicare and Social Security.

USA Today: Leaders In Congress Unveil Two-Year Budget Deal
Budget negotiators announced Tuesday a bipartisan deal to set spending levels for the federal government for two years and partially replace unpopular spending cuts with other savings. ... If approved, the agreement would put the congressional budget process back on track, allowing for passage of the 12 annual bills that cover federal spending other than mandatory programs such as Social Security and Medicare (Davis, 12/10).

The Associated Press: Bipartisan Budget Deal Sets Off Some Grumbling
The measure unveiled by Ryan, R-Wis., and Murray, D-Wash., blends $85 billion in spending cuts and revenue from new and extended fees — but no taxes or cuts to Medicare beneficiaries — to replace a significant amount of the mandated cuts to agency budgets over the coming two years (Taylor, 12/11).

The New York Times: Capitol Leaders Agree To A Deal On The Budget
The deal, while modest in scope, amounts to a cease-fire in the budget wars that have debilitated Washington since 2011 and gives lawmakers breathing room to try to address the real drivers of federal spending — health care and entitlement programs like Medicare and Social Security — and to reshape the tax code (Weisman, 12/10). 

The Washington Post: House, Senate Negotiators Reach Budget Deal
Under the terms of the deal, spending for the Pentagon and other federal agencies would be set at $1.012 trillion for fiscal 2014, midway between the $1.058 trillion sought by Democrats and the $967 billion championed by Republicans. ... On top of sequester replacement, the deal calls for an additional $22 billion in deficit reduction by extending a small part of the sequester into 2022 and 2023. That shift would primarily affect Medicare providers, who would face an additional two years of 2 percent across-the-board cuts (Montgomery, 12/10).

The Wall Street Journal: Deal Brings Stability To U.S. Budget
The plan is modest in scope, compared with past budget deals and to once-grand ambitions in Congress to craft a "grand bargain" to restructure the tax code and federal entitlement programs. But in a year and an institution characterized by gridlock and partisanship, lawmakers were relieved they could reach even a minimal agreement (Hook, 12/10). 

In addition, a bipartisan "doc fix" also appears to be gaining momentum.   

The Associated Press: Bipartisan Fix Advancing For Medicare Doctors' Pay
It’s that time of year again: doctors caring for Medicare patients once more face a steep pay cut. But this time Congress is pursuing a permanent fix to the annual drama that has undermined the medical profession’s confidence in the nation’s premier health program. A fundamental change in the budget equation has handed lawmakers a rare opportunity to repeal Medicare’s broken physician payment policy, while also freeing them from having to waive billions of dollars in impending cuts every year. Slowing health care inflation has slashed the cost of repealing the old formula, bringing it down to $116.5 billion over 10 years, according to the latest estimates (Alonso-Zaldivar, 12/10).

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Special Treatment? Examining Who On Capitol Hill Has To Get Coverage On The Health Law's Exchanges

News outlets take a closer look at the circumstances around how members of Congress and their staffs are navigating getting health coverage on the DC insurance exchange -- and just who is required to do so and by when.

CNN: Is Congress Getting Special Treatment On Obamacare?
Congress' tangled relationship with the Affordable Care Act entered another phase Monday, raising a new question about whether lawmakers are really experiencing the exchanges the way other Americans do. Monday night was the deadline for members of Congress and the thousands of people who work on their staffs to sign up for the Obamacare exchanges, where they must go to get any job-related health benefits. But with technical problems popping up in the past few days, House administrators gave employees (including elected members) a safety net. If they were blocked by technical problems, staff members will still be able to sign up for another week (Desjardins, 12/10).

The Washington Post's Fact Checker: Harry Reid's Explanation For Why Not All Of His Staff Is Going On 'Obamacare'
If there is anything that illustrates the complexity of the Affordable Care Act, aka Obamacare, it’s the tiny section concerning members of Congress and their staff. The Fact Checker has spent some time digging into this issue, and it's headache-inducing. The law requires members of Congress and at least some of their staff to leave the Federal Employees Health Benefit Program and join the health-care exchanges. That was easier said than done, in large part because congressional employees previously had received a stipend to help pay for premiums, whereas they generally make too much to qualify for subsidies in the exchanges. So a system has be gerry-rigged, using the DC small-business exchange (SHOP), to allow for continued health-care stipends from the federal government. See, it is headache-inducing (Kessler, 12/11). 

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Sebelius Orders Probe Of Botched Website Rollout

As Health and Human Services Secretary Kathleen Sebelius headed to Capitol Hill to testify, she announced several steps to address the healthcare.gov issues, including asking the department's inspector general to review the management decisions behind the rollout and pledging to implement his recommendations. Meanwhile, the president's choice to lead the Internal Revenue Service, John Koskinen, appears headed for confirmation.

The Associated Press: Sebelius Asks For Investigation Of Healthcare.gov
President Barack Obama's top health official is asking for an investigation into the administration's botched rollout of healthcare.gov. The website was supposed to have been the online portal to insurance coverage under the new health care law, but technical problems turned it into a frustrating bottleneck for millions of consumers. It's working better now after two months of repairs. … The announcement comes as Sebelius heads to Capitol Hill for another round of grilling Wednesday before the House Energy and Commerce Committee. Lawmakers want explanations for dozens of questions about the website's design, workability and security. They also want to know why Sebelius and other top officials repeatedly assured them everything was on track (Alonso-Zaldivar, 12/11).

Politico: Kathleen Sebelius Asks For Investigation Of Flawed Obamacare Website
Health and Human Services Secretary Kathleen Sebelius announced several steps Wednesday to address the healthcare.gov disaster and pledged to improve accountability in an agency that spends billions every year on IT contracting. Sebelius, who testifies before the House Energy and Commerce Committee later this morning, asked HHS Inspector General Dan Levinson to do a review of the management decisions behind the Obamacare enrollment website, including how contractors perform and are paid. She pledged to act on his findings (Kenen, 12/11).

Politico: Kathleen Sebelius Back To The Hill For More Drubbings
Kathleen Sebelius isn't going anywhere -- but the White House isn't exactly pulling out all the stops to defend her work. That's the reality of Sebelius's uncomfortable status as she returns to the Hill on Wednesday to catch more arrows over Obamacare. The Health and Human Services secretary seems to have largely escaped the early GOP calls for her resignation over the website fiasco, and by most accounts she still has a good personal relationship with President Barack Obama (Nather, 12/11).

The Washington Post: IRS Nominee On Track For Approval Despite Acrimony
President Barack Obama's choice to head the Internal Revenue Service told senators Tuesday he will work to restore public trust in the agency in the wake of the tea party scandal even as the IRS takes on new responsibilities administering the president's health care law. At the same time, John Koskinen warned that budget cuts are threatening the agency's ability to collect revenue effectively and enforce the nation's tax laws (12/10).

CQ HealthBeat: Fix-It Man Praised As IRS Choice, But Confirmation Hearing Stalls
The nominee to lead the Internal Revenue Service appears to be heading for Senate confirmation, but seemingly unrelated political controversies will further delay John Koskinen from starting in the job. Koskinen, an affable veteran of management turnaround work both at Freddie Mac and in the private sector, spoke to the Senate Finance Committee on the importance of the IRS in implementing the 2010 health care law before his confirmation hearing was brought to an abrupt halt (Young, 12/10).

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State Watch

State Highlights: Kaiser Permanente Says Some Patient Data Lost

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

Los Angeles Times: Kaiser Permanente Reports Privacy Breach to 49,000 Patients
Health care giant Kaiser Permanente has notified about 49,000 patients of a privacy breach at its Anaheim Medical Center. Kaiser said a computer flash drive was reported missing Sept. 25 inside the hospital's nuclear medicine department. The storage drive included patient names, date of birth, their medical record number and the type and amount of a specific medication (Terhune, 12/10). 

The Milwaukee Journal Sentinel: Sargent Offers Bill Allowing Counties To Take Obamacare Funds 
Assembly Democrats want counties to be able to capture federal money the state has rejected in an effort to get more low-income people on the BadgerCare Plus health care program.  Gov. Scott Walker and his fellow Republicans who control the Legislature declined additional federal money to expand BadgerCare under the Affordable Care Act, or Obamacare. They said they feared the federal government would not keep its commitment to pay the costs of the expansion (Marley, 12/10). 

The Richmond-Times Dispatch: McDonnell Urges $38 Million For Mental Health System 
Gov. Bob McDonnell will use his final budget to pump money into the state's mental health system following the attack on state Sen. R. Creigh Deeds, and is urging changes to the system, including extending the amount of time someone can be held in an emergency. In addition to action in the two-year budget he will present to lawmakers Monday, McDonnell created a task force to study improvements in mental health services and crisis response. His package of reforms and funding boosts for mental health and substance-abuse disorder programs totals $38.3 million over the next two years (Meola and Martz,12/11).

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Editorials and Opinions

Viewpoints: 'Small-Bore' Budget Deal Better Than Shutdown; Calif. Battle on Medical Malpractice; Obama Should Turn To Health Quality

USA Today: Minimalist Budget Deal Beats Another Shutdown: Our View
The bipartisan spending deal announced Tuesday night by Senate Budget Chairman Patty Murray, D-Wash., and House Budget Chairman Paul Ryan, R-Wis., barely qualifies as a tweak. It would not make meaningful progress on reducing projected deficits, ... BY any measure it is a small-bore deal, but it as at least  something — a toehold that prevents a serious fall and might, optimistically, enable a climb to safety. ... It would also partially undo the inflexible across-the-board spending cuts known as sequestration. Longer term, the accord could signal the beginning of a more constructive relationship in Congress (12/10).

USA Today: Budget Deal A Step Backward: Opposing View
While imperfect, the sequester has proved to be an effective tool in reducing base discretionary spending. Nonetheless, conservatives have expressed a willingness to alter the budget caps established by the 2011 debt ceiling deal in exchange for immediate and substantive structural reforms that significantly reduce spending and address the real drivers of our debt. Unfortunately, the budget agreement struck by Rep. Paul Ryan and Sen. Patty Murray is a step backward (Michael A. Needham, 12/10). 

The Wall Street Journal: A Least Bad Budget Deal
All of this doesn't begin to match the magnitude of America's fiscal challenges, but it is probably the best that the GOP could get considering Washington's current array of political forces. ... The question for Republicans is what happens if this fails? It means more turmoil, more evidence that the GOP can't govern, and the risk of another shutdown. By contrast this deal pushes the budget debate past next November and lets Republicans focus on ObamaCare and its many ills. ... The deal means overall federal spending will not decline in 2014 as it has the last two years (12/10). 

Bloomberg: Now Obama Can Target Health-Care Quality
Indeed, over the past few years, the Congressional Budget Office has lowered by more than $1 trillion its projected estimates of Medicare and Medicaid spending over the next decade. But we are only at the beginning of what is possible. Now, President Obama should step forward with bold national goals. One would be a dollar-and-date target for total health-care savings, based on the above projections for improvements in the quality and coordination of care. Or, to make the goal easily measurable, the president could declare that, starting in 2020, health-care spending per person should rise no faster than general inflation (Dr. Ezekiel Emanuel, Sen. Sheldon Whitehouse, D-R.I., and Peter Orszag, 12/10). 

Los Angeles Times: The Battle Between Doctors And Trial Lawyers Grows More Infantile
California initiative campaigns have a way of reducing all important public policy issues to their lowest intellectual denominators -- and highest financial numerators. The coming battle over the state's medical malpractice limits looks certain to set records in both categories. We've written before about the necessity of modernizing MICRA, the Medical Injury Compensation Reform Act of 1975. Even its drafter acknowledges that it was botched at birth; because its limit of $250,000 on pain-and-suffering recoveries isn't indexed to inflation, it serves merely to shut the courthouse door to the victims of medical malpractice (Michael Hiltzik, 12/10). 

The New York Times' Economix: Conflicting Pressures On Demand For Doctors
But the new law limits payments to physicians and other medical providers. If patients are lucky, the demand for doctors will be low enough that the limits will not matter. But if the new law results in a significant net increase in physician demand, the payment limits will help remind us of Soviet-era limits on the price of bread, with queues and black markets to follow  (Casey B. Mulligan, 12/11). 

The Washington Post's Right Turn: The Deck Is Stacked Against Obamacare
Democrats and their media allies are giving us a bad case of whiplash. Obamacare will work! Obamacare won't matter! Obamacare is going to give millions of people affordable health-care coverage! Of course it's more expensive — look what you are getting! Yes, these are contradictory spiels, an inevitable consequence of a White House is disarray, if not on the verge of panic. Depending on the spin of the moment (HealthCare.gov is fixed! It doesn't matter if it's fixed!), the left-leaning blogosphere twists this way and that, trying to follow the White House's logic (Jennifer Rubin, 12/10). 

The Washington Post's The Plum Line: Another Potential Boost For Obamacare
Opponents of the Affordable Care Act tend to suggest expanded coverage resulting from the law's Medicaid expansion somehow doesn't really count as success. But the law's goal is to expand coverage, and the Medicaid expansion is one of the tools it utilizes to accomplish that. And here's another way the Medicaid expansion could succeed — continuing to grow the built-in constituencies that will benefit from the Affordable Care Act (Greg Sargent, 12/10).

The Fiscal Times: HealthCare.Gov: Better, But Not Ready For Prime Time
While the White House has insisted that most of the problems with the site are fixed, there are still plenty of bugs that prevent it from doing its intended mission: Linking Americans with affordable private insurance policies. The latest chapter in my two-month-long quest involved trying to bypass the buggy system. Although I was finally able to log on recently after a short respite in the HealthCare.gov "waiting room," I got bounced to an error page that stated my "identity wasn't verified" (John F. Wasik, 12/11).

Fox News: Dr. Manny: Specialty Doctors Will Be Hard To Find Under ObamaCare
Patients covered by Medicaid often have no choice but to hope their problems are being addressed at these clinics in an adequate manner. So imagine what's going to happen once ObamaCare expands Medicaid enrollment, or better yet, when some basic health plans pick up more patients who are looking for more affordable insurance premiums.  Are you going to be able to easily find a dermatologist, ophthalmologist or orthopedic surgeon – especially during a limited timeframe in which your problems need addressing? I don't think so (Dr. Manny Alvarez, 12/10). 

Georgia Health News: A Win-Win Plan: Protecting Providers, Reducing Costs
In 2010, Congress adopted President Obama's Affordable Care Act (ACA) with the goal of providing access to high-quality, affordable health care. One of the many flaws in the ACA is that it fails to address our broken medical malpractice system. By placing physicians and hospitals at financial and professional risk when an error occurs, our medical tort system increases the cost of health care, because it encourages the practice of defensive medicine. The system also decreases access to compensation for those with minor medical injuries, and interferes with quality improvement measures (Henry N. Goodwin Jr., 12/10).

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EDITOR:
Stephanie Stapleton

ASSOCIATE EDITOR:
Andrew Villegas

WRITERS:
Ankita Rao
Marissa Evans

The Kaiser Daily Health Policy Report is published by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation. (c) 2012 Kaiser Health News. All rights reserved.