Daily Health Policy Report

Monday, December 16, 2013

Last updated: Mon, Dec 16

KHN Original Reporting & Guest Opinion

Health Reform

Capitol Hill Watch

Coverage & Access

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

In Hollywood, Health Coverage Presents Unique Challenges

Kaiser Health News staff writer Anna Gorman, working in collaboration with USA Today, reports: "The Hollywood film and television industry relies heavily on freelancers and independent contractors who are rarely offered health insurance from an employer. Throughout Southern California, producers, writers, actors, editors, camera operators and prop makers move from gig to gig and hold numerous jobs each year. Some get insurance through the industry’s unions – after paying hefty fees and dues and working enough hours on union jobs. Others pay for private policies – or simply go without" (Gorman, 12/15). Read the story.

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Political Cartoon: 'All Ears?'

Kaiser Health News provides a fresh take on health policy developments with "All Ears?" by Milt Priggee. 

And here's today's health policy haiku:  


To avoid campaign
troubles, health regs were delayed.
Trouble came later.

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

Americans Blame Health Law For Rising Costs, Eroding Coverage

Meanwhile, in the background, President Barack Obama's acknowledgement that his promise that people could keep their coverage was inaccurate continues to make news.

The Associated Press: AP-GfK Poll: Health Law Seen As Eroding Coverage
Americans who already have health insurance are blaming President Barack Obama's health care overhaul for their rising premiums and deductibles, and overall 3 in 4 say the rollout of coverage for the uninsured has gone poorly. An Associated Press-GfK poll finds that health care remains politically charged going into next year's congressional elections. ... In the survey, nearly half of those with job-based or other private coverage say their policies will be changing next year — mostly for the worse. Nearly 4 in 5 (77 percent) blame the changes on the Affordable Care Act, even though the trend toward leaner coverage predates the law's passage. Sixty-nine percent say their premiums will be going up, while 59 percent say annual deductibles or copayments are increasing (Alonso-Zaldivar and Agiesta, 12/15).

The Hill: People With Health Insurance Sour On ObamaCare, Poll Finds
People with health insurance are unhappy with the rollout of ObamaCare, and many of them blame the law for changes in their policies, according to a new Associated Press-GfK poll. The online survey of 1,367 adults found political challenges for President Obama and congressional Democrats among the population they said would largely be unaffected by the new healthcare law – the 85 percent of people who already have health insurance (Berman, 12/15).

Des Moines Register: Iowa Poll: Iowans Still Split On Obamacare
Few Iowans believe the Affordable Care Act will make their families or the country better off, though more than half predict it will help people who are uninsured, a new Iowa Poll finds. However, Iowans' views of the overall law have not changed much in the past three months, despite a torrent of negative news stories about it, the poll shows (Leys, 12/15). 

The Associated Press: Obama's Health Care Promise Is 2013 Top Quote
President Barack Obama's acknowledgement that his promise that Americans could keep their health insurance plan turned out to be inaccurate topped this year's list of best quotes, according to a Yale University librarian. Other notable quotations on Fred Shapiro's eighth-annual list included Pope Francis’ urging that the Catholic Church reduce emphasizing hot-button issues like abortion, a Republican governor insisting on changes in his party and a Pakistani teenager who was shot by the Taliban calling for a campaign against illiteracy, poverty and terrorism (Christoffersen, 12/15).

CBS News: Obama's "Keep Your Plan" Promise Labeled "Lie Of The Year"
President Obama’s assurance that "If you like your health plan, you can keep it" was named the "Lie of the Year" on Thursday by PolitiFact, a fact-checking organization spun off of the Tampa Bay Times. Mr. Obama’s promise, repeated ad infinitum during and after the health care bill’s passage through Congress, was a "catchy political pitch and a chance to calm nerves about his dramatic and complicated plan" to overhaul the country’s health care system, PolitiFact argued. "But the promise was impossible to keep" (Miller, 12/13).

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Report: Health Law Regs Were Delayed Ahead Of Obama's Reelection

These rules, along with others related to the environment and worker safety, were delayed to avoid introducing contentious issues into the 2012 campaign, The Washington Post reports.

The Washington Post: White House Delayed Enacting Rules Ahead Of 2012 Election To Avoid Controversy
The White House systematically delayed enacting a series of rules on the environment, worker safety and health care to prevent them from becoming points of contention before the 2012 election, according to documents and interviews with current and former administration officials. ... The stalled regulations included crucial elements of the Affordable Care Act, what bodies of water deserved federal protection, pollution controls for industrial boilers and limits on dangerous silica exposure in the workplace (Eilperin, 12/14).

CBS News: Report: W.H. Delayed Obamacare, EPA Rules Till After 2012 Election
In an effort to ease President Obama’s reelection bid, the White House delayed the imposition of a series of regulations affecting Obamacare and environmental protection ahead of the 2012 election, according to a new report in the Washington Post. While the administration has said its approach to regulatory review is consistent with that of previous administrations, several former administration officials told the Post that the delays were longer under Mr. Obama than his predecessors, and that the motive behind them was clearly political. The regulations in question governed some of the most politically sensitive aspects of the president’s agenda (Miller, 12/15).

Also in the news, Health and Human Services Secretary Kathleen Sebelius declined to tell lawmakers whether she offered her resignation over the troubled launch of healthcare.gov -

CBS News: Sebelius Dodges Question About Whether She Offered Resignation
Health and Human Services Secretary Kathleen Sebelius on Friday refused to say whether she's offered to resign in the wake of botched rollout of the new Obamacare marketplaces. "I'm not going to discuss what I talk about with the president," Sebelius said from Miami, where she was promoting the new marketplaces. Earlier this week at a congressional hearing, Sebelius acknowledged to lawmakers that the launch of HealthCare.gov, the Obamacare website, was "flawed and failed and frustrating.” She has accepted responsibility for the failed launch, but the White House maintains that President Obama still has confidence in her (Condon, 12/13).

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Individuals Still Getting Errors From Health Website As Notifications To Insurers Lag

The Wall Street Journal looks at some of the inaccurate assignments that many consumers find when they seek insurance on the new marketplaces. Meanwhile, the enrollment records for 15,000 people were not properly transmitted to insurance plans, according to federal officials.

The Wall Street Journal: Errors Continue To Plague Government Health Site
Thousands of insurance applicants from HealthCare.gov—at least one in five at the height of the problems by one estimate—have received inaccurate assignments to Medicaid or to the marketplace for private plans, or have received incorrect denials, people familiar with the matter said. Eligibility determinations are an early step in the application process, before consumers choose plans. In some cases described by a state official with knowledge of the matter, legal immigrants who aren't yet eligible for Medicaid in Illinois—it takes five years of residence to join the state-run programs for low-income people—were nevertheless told they would be enrolled (Weaver, 12/13).

The Washington Post: Exclusive: Thousands Of Healthcare.Gov Sign-Ups Didn't Make It To Insurers
Enrollment records for close to 15,000 HealthCare.gov shoppers were not initially transmitted to the insurance plans they selected, according to a preliminary federal estimate released Saturday. While these cases pose a challenge for the Obama administration, officials say they believe the situation is improving. Since early December, fewer than 1 percent of HealthCare.gov enrollments did not make their way to health insurance plans (Kliff, 12/14).

CBS News: Nearly 15,000 Obamacare Sign-Ups Didn't Reach Insurers
Enrollment paperwork for nearly 15,000 Obamacare customers who signed up via HealthCare.gov never made its way to insurance companies, the Department of Health and Human Services announced Saturday. The disclosure reflects the considerable problems the Obamacare website's "back end" faced in corresponding with insurers throughout October and November, even as administration officials were working around the clock to improve the website's "front end" and enable consumers to shop for insurance. Still, HHS emphasized that enrollment records are now reaching their destination far more successfully, noting that since the beginning of December, the number of missing forms has been "close to zero" (Miller, 12/14).

The New York Times: Enrollment Errors Cut, Officials Say; Fixes Are Overstated, Insurers Report 
The Obama administration said Saturday that it had reduced the error rate in enrollment data sent to insurance companies under the new health care law, even as insurers said that the government's records were still riddled with mistakes. The quality of the data is important; it could affect the ability of people to get medical care and prescription drugs when they go to doctors' offices and pharmacies starting next month (Pear, 12/14).

Bloomberg: U.S. Says 15,000 Health-Care Enrollments Didn't Get To Insurers
The government failed to send data to health insurers for about 15,000 people who enrolled in Obamacare through early December, an error corrected last week before it could jeopardize their coverage, the U.S. said. The percentage of enrollments that aren't transmitted to insurers, a process known as an "834 transaction" is now close to zero, the Centers for Medicare and Medicaid Services said in a report yesterday (Wayne, 12/15).

Fox News: Feds: Thousands Of ObamaCare Web Purchases Not Recorded, Incorrect
The Obama administration acknowledged this weekend that the federal ObamaCare website failed to record insurance-policy purchases for as many as 15,000 Americans. The Centers for Medicare & Medicaid Services on Saturday said the transactions were either not recorded or had errors and attributed the problem to "larger technical system issues." Agency spokeswoman Julie Bataille said the so-called "834 transaction forms" are processed by health insurance companies when consumers choose a policy on the site, which has been plagued by technical glitches since enrollment started in October (12/15).

Reuters: Obamacare Website Back Up Ahead Of Schedule After Maintenance
The troubled federal website used by Americans to shop for health insurance as part of President Barack Obama's healthcare overhaul was back up and running on Sunday after planned maintenance overnight took less time than planned, government officials said. Healthcare.gov underwent what officials at the Centers for Medicare & Medicaid Services, the agency running the healthcare overhaul, called "extended maintenance" beginning at midnight Saturday EST (Begley, 12/15).

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States Race To Fix Insurance Exchange Glitches

In Maryland, Vermont and Oregon, state officials are still hammering out technological issues preventing consumers from signing up for coverage. In California, in contrast, the pace of enrollment in December has been nearly three times that of a month earlier as the deadline approaches to sign up for coverage that takes effect Jan. 1.

The Washington Post: O'Malley: Nine 'Major' Problems With Online Health-Insurance Exchange Have Been Fixed
Maryland Gov. Martin O’Malley said Saturday that his administration has met a mid-December deadline he set to fix the biggest technological problems hindering enrollment through the state’s online health insurance exchange. O’Malley (D) said that a list of nine “major fixes” that he demanded last month were made as of Friday morning. Among the big problems was the Web site’s tendency to freeze at a highly inopportune moment — just as users seeking to obtain insurance plans clicked the “Enroll” button (Wagner, 12/14).

The Baltimore Sun: O'Malley Says Major Health Exchange Problems Are Fixed
The state has resolved all "major issues" preventing its glitch-ridden health exchange from working, officials said Saturday, a milestone Gov. Martin O'Malley has framed as key to boosting the low enrollment in insurance plans offered under the Affordable Care Act. While officials cautioned that more repairs are necessary, O'Malley said through a spokeswoman that the site "is now functional for most citizens" (Cox, Fritz and Walker, 12/14). 

Los Angeles Times: Anthem Blue Cross Leads California Exchange Enrollment Two Months In
Amid rising enrollment for healthcare insurance in California, industry giant Anthem Blue Cross has seized the early lead with a 30% share of the state's exchange market. Two major rivals, Blue Shield of California and Kaiser Permanente, aren't far behind in newly released state figures (Terhune, 12/13). 

ProPublica: Turning The Corner? In California, At Least, Obamacare Sign-Ups Zoom
The statistics released yesterday from Covered California could bode well for health insurance exchanges that have their act together. Although the California exchange enrolled 109,000 in October and November combined, the tally from the first seven days in December — 49,708 — is nearly three times the pace from a month earlier (Ornstein, 12/13).

The Fresno Bee: Health Coverage Deadline May Be Hard To Meet In Valley
In the central San Joaquin Valley and statewide, a deadline is fast approaching for people to enroll in health plans so they can have insurance at the beginning of the new year. ... Valley insurance agents and health providers say the state's online system has slowed enrollments, and they suspect the agency will be buried by an expected avalanche of applications between now and Dec. 23 (Anderson, 12/14).

The San Francisco Chronicle: New Insurance Law: Long Hours, Low Commissions For Agents
When a client called with questions about applying for insurance under the new health care law, Bay Area insurance agent Simon Chew tried to help. He used the phone line dedicated for agents to call Covered California, the state's new health insurance marketplace. After a long wait he received a partial answer to a question about calculating income. He eventually got that client's application filed, but in the meantime many more questions from other clients started pouring in, and they haven't stopped (Udesky, 12/15).

The Oregonian: Kitzhaber Responds To Oregon's Health Exchange Fiasco With Information-Technology Reforms
Gov. John Kitzhaber announced a set of reforms Friday, saying he was in the dark as the rest of us about the technical difficulties plaguing Oregon's health care exchange. Kitzhaber was notified by Cover Oregon on Sept. 3 that due to technical challenges the state's vaunted new exchange website would be launched in stages. It wasn't until Sept. 30, the day before the federal deadline for exchanges to be fully operable, that the Governor learned the launch would be scrubbed altogether (Manning, 12/14). 

The Associated Press: Oregon Gives Insurance Applicants More Time
Oregon health officials announced a series of changes late Friday in hopes of giving some people more time to sign up for insurance through the state's health insurance exchange. With its online enrollment system not fully working, Cover Oregon announced that insurance companies have agreed to delay the deadline for people to select their plan, a final piece of the multi-step enrollment process (Wozniacka and Cooper, 12/13).

The Oregonian: State Officials Give Consumers More Time As Cover Oregon Logjam Persists
State officials, facing an increasingly chaotic insurance market of their own making, announced moves late Friday to give Oregonians more time to get low-cost insurance by year end. Cover Oregon, the state's troubled health insurance exchange, said it would give most consumers until Dec. 27 to pick a health plan that would take effect Jan. 1. The state's initial enrollment deadline was Sunday, but thousands of Oregonians still lack information they need from the exchange to select a plan. The new deadline applies only to those who postmarked their applications by Dec. 4, officials said (Hunsberger, 12/14).

The Associated Press: Vt. Gov. Urges Health Connect Sign Up By Dec. 23
Gov. Peter Shumlin on Thursday encouraged people who are eligible for health insurance through the Vermont Health Connect system to sign up by Dec. 23, the deadline to receive a federal subsidy and have coverage effective Jan. 1. Shumlin said the problems that plagued the state's health care website after its Oct. 1 launch are diminishing and residents are signing up in increasing numbers (Ring, 12/13).

The Hill: Report: House Panel Blasts Navigators
People responsible for helping consumers enroll in ObamaCare, known as navigators, were not required to undergo background checks, according to a House Oversight and Government Reform Committee report obtained by Breitbart News (Shabad, 12/16).

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Latino Enrollment In Healthcare.gov Is Still Low

News outlets examine the problem, especially important in California.

Los Angeles Times: California Health Insurance Exchange Struggling To Enroll Latinos
For all its success enrolling tens of thousands in health insurance, California is struggling to translate Obamacare into Spanish. The state's enrollment so far among Latinos is anemic — even though they represent more than half of California's 7 million uninsured residents. Only 5% of enrollees, or fewer than 4,500 people, in the first two months of enrollment are primarily Spanish speakers, new data show (Terhune and Brown, 12/13).

The Washington Post: Health Insurance Enrollment By Hispanics Is Lagging In California
Hispanics are a linchpin of the health-care law because they constitute more than a third of the estimated 29 million people who are eligible to buy coverage on the online insurance exchanges. The population skews young, making Latinos an important demographic for the Obama administration, which is seeking to keep premiums low by coaxing healthy people to join the insurance pools (Somashekhar, 12/14).

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Politics The Predictor Of Whether States Opt To Expand Medicaid

The Associated Press reports that the decision about whether to pursue the Medicaid expansion has more to do with how states vote in governors' races than with need.

The Associated Press: Politics Color Governors' Decisions On Medicaid
Partisan politics are coloring governors' decisions about whether to expand Medicaid in their states, affecting billions of dollars and thousands of low-income people. The question of whether they receive Medicaid coverage may have little to do with need, and much to do with the way their states vote in governors’ races, including primaries. ... Of the eight Republican governors who will expand Medicaid, six are from states carried by President Barack Obama (Babington, 12/14).

Meanwhile, in news from Wisconsin -

The Associated Press: Wis. To Call, Send Letters About Medicaid Change
Wisconsin health officials plan to call and send letters to all 83,000 childless adults who were originally scheduled to start receiving Medicaid in January but now will have to wait until April under a cost-savings move by Gov. Scott Walker and the Legislature. The calls will be placed not only to those who thought they were about to receive coverage but also another 80,000 childless adults who have been on a waiting list but earn too much under tighter eligibility requirements set by Walker and the Legislature (Bauer, 12/13).

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Small Businesses Wrestle With Higher Insurance Costs, Confusion

Many small businesses are facing significant rate increases under the law and have opted instead to renew existing policies, reports The Milwaukee Journal Sentinel. The law's impact on the Hollywood film and television industry, which relies heavily on freelancers, and the latest extensions granted to those buying coverage in new online exchanges also get coverage.

Milwaukee Journal Sentinel: Obamacare Brings Significant Changes To Small Employers' Insurance
The Affordable Care Act brings significant changes to the health insurance market for small employers, and Karegeannes' experience is common, according to insurance brokers. Many small employers — those with fewer than 50 employees — face significant increases in rates, and many have opted to renew their existing policies early, buying time to see how the law affects the market. "The fortunate group of my clients are staying about par, but I would say that fortunate group is very small," said Jeff Anderson, a small-business account executive with M3, an insurance broker. A few clients, he said, face increases in the range of 50% to 60% (Boulton, 12/14). 

The Star Tribune: Ready Or Not, Small Businesses Face The Affordable Care Act
Amid the confusion and controversy surrounding the rollout of health insurance exchanges, one thing remains clear: For small businesses, navigating the process is not the simple, one-stop shopping experience that some predicted it would be. While the website problems are likely to be smoothed out eventually, changes in how health insurance is regulated and sold suggest that businesses still will need assistance in navigating their health insurance options. Under the Small Business Health Options Program (SHOP), small businesses can offer several different plan options to their employees through the exchanges, including a “defined contribution” approach that gives employees a set amount of money with which to purchase insurance (Ackerman, 12/15).

The Fiscal Times: The Obamacare Delays Just Keep On Coming
Under this new, seemingly desperate approach announced on Thursday by Health and Human Services Secretary Kathleen Sebelius, people who have had problems signing up for insurance through the new federal or state operated exchanges will be allowed to enroll after the deadline and still qualify for coverage effective at the start of the new year. Moreover, consumers who haven’t yet paid their first monthly premiums – essential to activating their new policies -- will have until at least the end of this year and possibly beyond. "There's still ample time for folks to research their options, talk things over with their families and select a plan," Sebelius told reporters (Ehley, 12/16).

Kaiser Health News: In Hollywood, Health Coverage Presents Unique Challenges
The Hollywood film and television industry relies heavily on freelancers and independent contractors who are rarely offered health insurance from an employer. Throughout Southern California, producers, writers, actors, editors, camera operators and prop makers move from gig to gig and hold numerous jobs each year. Some get insurance through the industry’s unions – after paying hefty fees and dues and working enough hours on union jobs. Others pay for private policies – or simply go without (Gorman, 12/15).

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With One Week To Go, Insurers Look For Healthy Enrollees

Supporters and detractors of the health law are focused on so-called "young invincibles," adults in their 20s and 30s who don't rack up large medical bills. Dec. 23rd is the deadline for signing up for insurance starting Jan. 1.

The Wall Street Journal: Health Insurers Crank Up Ad Spending
Welcome to the health-insurance ad wars. A malfunctioning HealthCare.gov website and confusion over canceled policies have kept millions of Americans from choosing new health plans so far this fall. But with website access improving and the initial deadline to sign up for coverage looming Dec. 23, insurers are starting to blanket the airwaves and social media with glitzy ads urging consumers to buy their plans (Martin, 12/15).

Los Angeles Times: California-Funded Effort Pitches Obamacare To College Students
Supporters and detractors of Obamacare are fixating on so-called "young invincibles" like the Cal State students, generally healthy adults in their 20s and 30s who don't rack up large healthcare bills. Only by collecting premiums from many more of those infrequent users of medical services can insurance plans expect to offset the higher costs of treating newly insured older and sicker patients. ... But with critics of the healthcare changes producing ads urging millennials not to sign up, it's unclear whether that prized group will respond to outreach efforts (Brown, 12/14).

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Capitol Hill Watch

Congressional Lawmakers And Political Opponents Stake Out Health Law Positions, Strategies

For some, hitting the right note about the health law is proving to be a challenge.

Politico: Nix, Not Fix: GOP Pushed On Health Law
Republican primary candidates are caught in an Obamacare fix. Even the slightest hint that a GOP contender might support anything besides all-out repeal of the health care law is drawing attacks from the right. So, increasingly, in races across the country, proposals to fix the existing law or retain any of it are being ruled out by Republicans eager to further burnish their conservative credentials (Hohmann and Cheney, 12/15).

The New York Times: G.O.P. Firebrands Tone Down Their Message And Run Again
"My name is Congressman Bob Dold!" said the fleece-clad man making his way through a popular restaurant here. … Mr. Dold is seeking a political resurrection in next November's election, after just one term on Capitol Hill. After riding the Tea Party wave to Washington in 2010, he was swept out of office by the Obama tsunami in Illinois in 2012. Now he is among at least nine Republicans, a mix of former incumbents and previous challengers, who are running again — but with a difference. This time they have shelved their incendiary remarks about President Obama and the national debt in favor of a narrower focus on the Affordable Care Act, which they hope will attract moderate voters from both parties, even in heavily Democratic districts, who are disenchanted with its rollout (Steinhauer, 12/15).

Minnesota Public Radio: Obamacare A Burden For Democrats, For Now
The Republican political machine is trying to capitalize on Americans' opposition of the Affordable Care Act by targeting ads at Democrats, including Minnesota DFL U.S. Reps. Rick Nolan, Tim Walz and Collin Peterson. Even before it became law in 2010, most Republicans opposed the Affordable Care Act, and their complaints about "Obamacare" have resonated with many people. A recent Real Clear Politics compilation of polls shows nearly 53 percent of Americans oppose the law (Zdechlik, 12/15).

CBS News: GOP Senator: I Feel Your Pain On Obamacare
Sen. Pat Toomey, R-Pa., has a message for anyone who has been less than thrilled by their experiences with Obamacare’s online insurance exchanges: I feel your pain. Toomey, in the weekly Republican address on Saturday, recalled his wife Kris’ frustrating experience with Obamacare website HealthCare.gov (Miller, 12/14).

Politico: Republicans Offer Holiday Hope, But Only Without Obamacare
Toomey shared several "common-sense, bipartisan solutions" that he said don't require "Obamacare's wholesale government takeover." He proposed giving individuals the same tax credits that employers receive for offering their employees health insurance, pooling small businesses to lower costs and making it easier for insurance to be carried across state lines (Villacorta, 12/14).

Independent Record (Helena, Mont.): Baucus: Obamacare Better Than What We Had, Here To Stay And Can Be Fixed
U.S. Sen. Max Baucus, who famously worried eight months ago that the rollout of the Affordable Care Act’s major components this year might be a "huge train wreck," looks something like a reluctant prophet now. But in an interview last week, Baucus — one of the law's chief architects — said he still stands strongly behind the law, and that it's not going away. ... "There is no question this law was the right thing to do. … (The law) is here, it's with us. The goal is to make it work. It's not going to be repealed" (Dennison, 12/15).

Politico: Gingrich: Budget Deal Keeps Focus On Obamacare
The bipartisan budget agreement is "brilliant politics" that will allow Republicans to keep the heat on Obamacare and avoid the terrible optics of more government shutdowns, former House Speaker Newt Gingrich said Sunday. Gingrich said Republicans can now unwrap the "gigantic Christmas gift" of Obamacare's bungled implementation -- something the party failed to do in October when a focus on defunding Obamacare led to the first government shutdown in 17 years and a corresponding GOP nosedive in the polls (Everett, 12/15).

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HHS-Issa Tension Over Healthcare.gov Security Continues

Meanwhile, Rep. Waxman says the website is secure. 

Politico: Darrell Issa Says HHS Is Pressuring Contractors Over Subpoenas
In an escalating war over the House’s investigation into Obamacare’s website failures, Rep. Darrell Issa accused the Department of Health and Human Services of illegally pressuring contractors not to comply with congressional subpoenas, even as those companies turned over the documents in question on Friday. ... the administration had instructed the companies not to give Issa documents that government officials fear could be used to help hackers disrupt the website if they are leaked to reporters or otherwise put in the public domain (Allen and Millman, 12/14).

Bloomberg: Obamacare Website Has Never Been Breached, Waxman Says
The Obama administration told Congress two days ago that the federal government’s health insurance enrollment system has never been hacked, countering Republican claims that users’ information might be at risk. There have been 32 “information security incidents” at healthcare.gov as of Dec. 11, U.S. Representative Henry Waxman, a California Democrat, said in a memo today following a briefing with security officials from the U.S. Department of Health and Human Services (Wayne, 12/13). 

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Coverage & Access

New Regulations Could Improve Vets' Access To Care For Some Traumatic Brain Injuries

The New York Times: New Rule Could Aid Veterans’ Access To Health Care For Some Traumatic Injuries
The Department of Veterans Affairs has approved new regulations to make it easier for veterans to receive health care and compensation for certain illnesses, including Parkinsonism, dementia, and depression, which have been linked to traumatic brain injury (Southall, 12/16).

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State Watch

State Roundup: Virginia's New Gov. Wants Medicaid Expansion; Insurance Costs More For N.C. Rural Folks

A selection of health care news from Virginia, Florida, North Carolina and Iowa.

The Washington Post: Virginia's McDonnell To Propose Funding Hike For Education, Mental Health, Water Quality
Gov. Robert F. McDonnell will propose a two-year state budget Monday that calls for boosting K-12 education funding by nearly $600 million and pouring millions more into higher education, mental health services, water-quality improvements and homelessness-prevention programs. ... The [incoming governor, Democrat Terry McAuliffe] hopes to change it profoundly by adding language to expand Medicaid under the Affordable Care Act, which state House Republicans say won’t get by them (Vozzella, 12/15).

Des Moines Register: New Health Care Approach Focuses More On Prevention
Norma Vanderpool probably didn’t realize that the pleasant, inquisitive nurse visiting her hospital room last week represented a big change in health care…Burton, who works as a “transition coach” for Mercy, wanted to make sure the patient had everything she needed to prevent another health crisis once she returned home to Indianola (Leys, 12/14).

Related, earlier story: In Iowa, Accountable Care Begins To Make A Difference (Gold, 11/21)

Miami Herald: Broward Health Commissioner’s Lobbying Gig Raises Some Concerns
When Clarence V. McKee quit his commissioner’s seat on the governing board of Broward Health in January, records show he urged his colleagues to keep an eye on consulting contracts doled out by the tax-supported public healthcare system. But less than a month later and without any public discussion by his former colleagues, McKee upgraded his unpaid position to a lobbying contract worth $65,000 courtesy of Broward Health Chief Executive Frank Nask, whose performance the board oversees (Christensen, 12/15).

North Carolina Health News: Rural Premium Rates Impacted By Politics Locale
In this first of a two-part story, N.C. Health News examines how in rural parts of North Carolina, insurance premiums on the federal exchanges are more expensive in rural areas than originally hoped, leaving many without options. ... Even as some recount stories of extremely low monthly premiums, others living in rural counties who are ineligible for Medicaid or make too much to qualify for subsidies on the exchange are still wondering how to obtain affordable coverage (Porter-Rockwell, 12/16).

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Editorials and Opinions

Viewpoints: Health Law Still Facing Major Challenges; Ky. Gov. Questions McConnell's Assessment Of Overhaul; Pa.'s Medicaid Experiment Is A 'Sham'

The Wall Street Journal: ObamaCare's Troubles Are Only Beginning
The White House is claiming that the Healthcare.gov website is mostly fixed, that the millions of Americans whose health plans were canceled thanks to government rules may be able to keep them for another year, and that in any event these people will get better plans through ObamaCare exchanges. Whatever the truth of these assertions, those who expect better days ahead for the Affordable Care Act are in for a rude awakening. The shocks—economic and political—will get much worse next year and beyond (Michael J. Boskin, 12/15). 

The Wall Street Journal: Backdating ObamaCare
The White House says that ObamaCare is all fixed, but its conduct suggests otherwise. As it has realized that the government-created chaos is exposing patients to nasty and even deadly surprises, the government is now forcing the insurance industry to cover everyone retroactively and also to waive the contractual terms of that coverage—or else (12/13). 

The Washington Post: Two Problems That Could Undermine The Affordable Care Act
For years, critics have charged that President Obama's Affordable Care Act is a government takeover of the health-care system, which accounts for about a sixth of the economy. The criticism is feeble. Actually, as the law rolls out, some of the biggest threats to its success stem from the fact that its architects decided not to be more coercive. Two major issues have cropped up since the phase-in began Oct. 1 that could undermine the law's fundamental logic (12/13). 

The New York Times: Medicaid Outpaces Private Plans
After a botched start, the number of people signing up for health insurance plans under the Affordable Care Act has accelerated greatly, with the most substantial gains occurring in Medicaid programs for the poor (12/15). 

Politico: The Republican Answer To Obamacare
It's been a rough two months for the White House since HealthCare.gov went live on Oct 1. In the weeks that followed, it soon became clear that the problem was not just one of technical incompetence leading to a shoddy website, but of bad policy. Millions of Americans began receiving notices that they couldn’t keep their current health plan, their premium costs would be going up, or both. In the face of this disaster, the White House has pivoted to a new line, which can be summed up as, "Well, yes, Obamacare's rollout has been deeply flawed and the impact it has had on Americans wasn't exactly as advertised, but the Republicans have no alternative proposals for how to fix things and just want to return to the status quo." ... The problem with this new accusation from President Obama and his surrogates is that it is completely, utterly and verifiably false (Grover G. Norquist and Patrick Gleason, 12/15).

The Dallas Morning News: The Importance Of Health Care Navigators To Texas
Millions of Texans don't have the security of health coverage. In fact, Texas has the highest rate of uninsured in the nation. Yet there are some who will seemingly stop at nothing to deter Texans — and those who assist them — from obtaining coverage or even learning about their new options under the Affordable Care Act (Health and Human Services Secretary Kathleen Sebelius, 12/16).

The Dallas Morning News: Who Are These Obamacare Navigators?
To help the American people navigate the onerous and confusing requirements of signing up for Obamacare exchanges, the administration spent millions of taxpayer dollars to create the navigator program. Disturbingly, news reports from the last four weeks have highlighted numerous examples of fraudulent activity related to health navigators in Texas. So — who are these navigators and what is their role in Obamacare? (Rep. Pete Sessions, R-Texas, and Rep. Darrell Issa, R-Calif., 12/15).

Lexington Herald-Leader: McConnell Took Medicaid Comments Out Of Context
Kentucky Sen. Mitch McConnell should be careful not to hurt himself with the contorted stretching he and other critics are continuing to do in their increasingly farcical opposition to the federal Affordable Care Act, or ACA, and its underlying goal of improving access to affordable health care for all Americans. The senator's blanket statement in a recent column in the Herald-Leader that "most Kentuckians oppose" the act must be based on the complaints he hears in the echo chamber he and other critics have created and continue to nurture. Because the reality in Kentucky — many hundreds of miles from the senator's offices and home in Washington — is different (Gov. Steve Beshear, D-Ky., 12/16).

Los Angeles Times: Pennsylvania Isn't Serious About Expanding Medicaid. How Do We Know?
Pennsylvania Gov. Tom Corbett has lately been getting credit in the political press for being one of those Republican governors coming around on the expansion of Medicaid under the Affordable Care Act. Advocates for the underprivileged can't understand why. They're right to wonder. Corbett's "Healthy Pennsylvania" plan, which was released for public comment this week, is a sham. It would reduce health benefits for many of his neediest citizens and impose punitive conditions on their coverage (Michael Hiltzik, 12/14). 

Tampa Bay Times: Failure At The Top On Medicaid
Florida is stuck with a tea party governor who won't talk and a tea party House speaker who won't listen. Gov. Rick Scott refuses to repeat his earlier support for Medicaid expansion, and House Speaker Will Weatherford refuses to hear the economic and moral arguments for accepting billions of federal dollars to cover the poor. Congress is finally rejecting such ideological rigidness in embracing a budget compromise, and the Legislature should do the same on health care (12/13).

Detroit Free Press: Affordable Care Act Won't Solve All Our Health Care Problems
Michigan is one of the 25 states where the legislature voted for Medicaid expansion, albeit reluctantly. Statewide, it is estimated that more than 400,000 of Michigan’s 1.3 million uninsured will people become eligible for Medicaid. I was hopeful that about 80% of the uninsured patients we see at Cabrini Clinic would be among them. However, the Michigan Legislature asked the U.S. Department of Health and Human Services for waivers on the program that it is calling Healthy Michigan. ... For the uninsured poor, these waivers will pose barriers (Mary Ellen Howard, 12/14). 

USA Today: Obamacare Hurts My Small Business
When it comes to the Affordable Care Act, politicians are governing by sound bite rather than by reason. Nowhere is this more evident than with some of the promises regarding how the law will affect both individuals and businesses. Everyone is now familiar with the administration's debunked promise that "if you like your plan, you can keep it." Over 5 million Americans lost their health insurance in recent months. But many small businesses, like mine, have also been notified that the plans we offer our employees will be canceled and replaced with more expensive alternatives (Susan Gabay, 12/14).

Des Moines Register: Health Care Comes With Responsibility
Iowa, a purple state, has reached an agreement with the federal administration on a form of Medicaid expansion that doubtless will be spun in different political ways. ... Described in partisan terms, Democrats wanted to expand a comprehensive set of health benefits to those who, because of lack of resources or private health coverage, did not have access to health services. Republicans wanted those receiving coverage to exercise personal responsibility for their health. Iowa lawmakers found a way to do both. Probably imperfect, it nonetheless represents a substantial (Charles Bruner, 12/15).

And on other issues -

Los Angeles Times: Budget Deal Is Just A Start
The budget agreement reached by the House and Senate this week is a small step forward in restoring some sanity and order to the process. ... But the agreement also represents another missed opportunity to address our long-term fiscal problems. ... The small reforms in this agreement do not address the real long-term drivers of our debt, including the growth of healthcare entitlement programs and Social Security's funding shortfall (Erskine Bowles and Alan Simpson, 12/13). 

The New York Times: Skip The Supplements
Doctors always ask parents if their children are taking any medicines. Unfortunately, because most parents don't consider dietary supplements to be drugs, we often never knew about their use, let alone whether they might react dangerously with the child’s other treatments. The F.D.A. has the mandate, but not the manpower, to oversee the labeling and manufacture of these supplements. In the meantime, doctors — and consumers — are on their own (Paul A. Offit and Sarah Erush, 12/14).

The New York Times: Solving The Shortage In Primary Care Doctors
Again and again, we hear that the country has too few doctors, particularly for primary care. And Obamacare is supposed to make the shortage much worse in the coming years as more Americans become insured and try to shoehorn themselves into already crowded medical offices. But why, exactly, are doctors in such short supply? ... It turns out that the real bottleneck is at the post-med-school step: residencies, those supervised, intensive, hazing-like, on-the-job training programs that doctors are required to go through before they can practice on their own (Catherine Rampell, 12/14). 

NPR: Before The Prescription, Ask About Your Doctor's Finances
When my mother discovered that her oncologist was being paid tens of thousands of dollars to speak about a cancer drug — the same one that he had put her on — she became upset, confused and scared. Every time he recommended a medication or a procedure, she wondered whether he was picking a treatment because it was right for her, or because he got paid to do it. At the dawn of managed care, worried patients wanted to know whether their doctor was getting paid more to do less. Now, as many doctors' salaries depend on how many procedures they perform, patients want to know whether their doctor is paid more to do more. ... A few doctors, and I'm one of them, are beginning to post information about how we earn our money on a public website and to discuss the financial issues with our patients (Dr. Leana Wen, 12/14).

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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.