Daily Health Policy Report

Monday, December 23, 2013

Last updated: Mon, Dec 23

KHN Original Reporting & Guest Opinion

Health Reform

Medicaid

Public Health & Education

Health Care Marketplace

Health Disparities

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Health Insurers Scramble Toward Jan. 1 Coverage Deadlines

Kaiser Health News staff writers Jay Hancock and Julie Appleby report: "Insurance companies selling through the health law’s troubled online marketplaces are scrambling to provide coverage by Jan. 1 even as swarms of customers are still enrolling and making their first payments. ... Medical plans, with potentially billions in revenue at stake in the health law’s expansion of private coverage, have hired extra workers to run phone banks and tangle with paper applications that were supposed to be processed online. They’ve assigned staff to pore through electronic enrollments that might be inaccurate or incomplete, or to remind customers to pay. They’re guiding applicants who were expected to sign up on the federal healthcare.gov site or portals run by the states" (Hancock and Appleby, 12/20). Read the story.

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Young Invincibles' Decision: To Get Coverage Or Not

Kaiser Health News' staff writer Jay Hancock, working in collaboration with USA Today , reports: "The success of the Affordable Care Act's online marketplaces may depend on people like [26-year-old] Lizzie Bunnen. If healthy adults her age don't sign up, the risk is that predominantly older and sicker members will drive up costs and threaten the portals' future. With the Dec. 23 deadline approaching for January coverage, and at the end of March for all 2014 enrollment, the clock is ticking on what many believe is one of the health law's biggest challenges. As a result, ACA backers have stepped up efforts to persuade Bunnen and others aged 18 to their mid-30s to give Obamacare a second chance on newly improved websites such as healthcare.gov" (Hancock, 12/20). Read the story.

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Even In Well-Funded Colorado, Tough To Help People Enroll In Obamacare

Eric Whitney, writing for Kaiser Health News in collaboration with NPR, reports: "There are navigators working at 57 assistance organizations across Colorado – everyone from county health departments to local clinics to the state trucking association. Neighboring states Nebraska and Arizona aren't embracing the health care law like Colorado is. They have just two navigator organizations each and about $2 per uninsured person to spend on assisters. Colorado has almost $24 per person. But all the effort had netted about 23,000 customers for private insurance in the state's marketplace as of Dec. 14 – only about 17 percent of the way to the state's goal of enrolling 136,000 people by the end of March" (Whitney, 12/23). Read the story

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Capsules: Catastrophic Obamacare Policies Prove Hard Sell So Far; Explaining Obama's Move To Allow Some Catastrophic Health Coverage Plans

Now on Kaiser Health News' blog, Phil Galewitz examines catastrophic insurance policies: "The Obama administration’s decision this week to allow people to buy catastrophic-level policies if their individual health plans had been canceled comes amid reports that few people have bought these less expensive policies sold in new online insurance marketplaces" (Galewitz, 12/20).

Also on the blog, KHN’s Mary Agnes Carey was on PBS NewsHour Friday to talk about the Obama administration’s plan to allow people who had their health insurance plans canceled to buy so-called catastrophic plans, which that are cheaper than ordinary plans but provide less coverage than others being sold under the Affordable Care Act. Watch the video. (Carey, 12/23). Check out what else is on the blog.

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Political Cartoon: 'On The Naughty List?'

Kaiser Health News provides a fresh take on health policy developments with 'On The Naughty List?' By Rick McKee, The August Chronicle. 

And here's today's health policy haiku:  

A DECEMBER TO REMEMBER

Is there a deadline
for marketplaces today?
It's hard to keep track.
-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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Health Reform

Monday's Deadline To Buy Coverage Leaves Many Scrambling

People who want policies in place by Jan. 1 face a deadline today, but a series of changes in how the health law is being implemented has complicated the process for consumers and insurers.

Kaiser Health News: Health Insurers Scramble Toward Jan. 1 Coverage Deadlines
Insurance companies selling through the health law’s troubled online marketplaces are scrambling to provide coverage by Jan. 1 even as swarms of customers are still enrolling and making their first payments. ... Medical plans, with potentially billions in revenue at stake in the health law's expansion of private coverage, have hired extra workers to run phone banks and tangle with paper applications that were supposed to be processed online. They've assigned staff to pore through electronic enrollments that might be inaccurate or incomplete, or to remind customers to pay (Hancock and Appleby, 12/20).

The New York Times: Mixed Messages Add Anxiety As Deadline Nears In Health Act
For most Americans, Monday is the deadline to sign up for health insurance that takes effect on Jan. 1. It was supposed to be a turning point in the troubled history of the new health care law, the moment when the spotlight would shift from the federal government's online marketplace to the insurance companies providing coverage to hundreds of thousands and eventually millions of people. But as the date approaches, a series of decisions by the Obama administration to delay some of the law's most important provisions and to extend some deadlines has caused uncertainty among insurers and confusion among consumers (Pear, 12/21).

USA Today: Monday Marks Key Health Care Deadline
Monday marks the last day to sign up through the federal and state health exchanges to have insurance coverage beginning Jan. 1. And while government officials said the federal site, HealthCare.gov, can handle a last-minute rush of consumers, there's still fear that the word may not be getting out to the people who most need to enroll (Kennedy, 12/22).

Politico: Countdown For Obamacare Signups
The White House has been on a December dash to get people to sign up for health coverage by Monday, the first critical enrollment deadline for Obamacare -- and the last sign-up opportunity for people who want their new health benefits to kick in on New Year’s Day. The White House spent the past three weeks trying to move past the double-barreled disaster of the botched healthcare.gov website and the millions of canceled health plans. The website now works, although not perfectly. Many of the people who received cancellation notices have found alternatives, though some are still scrambling to get health coverage by Monday (Cheney and Villacorta, 12/22).

The Washington Post: Federal Officials Seek More Time For People To Enroll In Health Care
President Obama expressed confidence Friday that "a couple million" Americans will have new health coverage as of New Year’s Day. But behind the scenes, federal health officials have been pressing the insurance industry to give people more time to sign up. According to insurance industry executives, federal officials have been asking health plans to provide insurance starting Jan. 1 even for customers who sign up after a looming deadline on Monday (Goldstein and Eilperin, 12/20).

The New York Times: Weighing Health Plans: The Devilish Details 
Picking a plan and estimating your outlays is a complicated and tedious task. Here are some factors that can influence how quickly you reach your out-of-pocket maximum, as well as specifics on deadlines and other recent changes (Bernard, 12/20).

The Associated Press: Health Law Sign-Up Deadline Arrives
Today is the last day to sign up for federal health exchange insurance if people want their coverage to start in January. Officials have already pushed the deadline back a week and it's still unclear whether everyone who wants to enroll will actually be able to because of lingering problems with the federal website (Kennedy, 12/22).

CBS News: Last-Minute Scramble On Critical Obamacare Deadline Day
Efforts range from the practical – a big message on HealthCare.gov that tells people they should enroll by Monday to ensure their coverage starts on time – to the creative: the District of Columbia government dispatched someone from its health exchange, DC Health Link, to one of the city's gay clubs to sign people up. After the rocky rollout of the Affordable Care Act's federal exchanges, which led to very low enrollment numbers in the first month, the administration has been actively seeking ways to ease the sign-up process ahead of the Dec. 23 deadline (people will be able to enroll in the federal exchanges until March 31 to avoid paying a penalty) (Kaplan, 12/23).

Reuters: Obamacare's Signup Deadline On Monday Has Its Exceptions
For most Americans who don't have health insurance, Monday is the deadline to sign up for coverage starting on January 1 under President Barack Obama's health care law. For others, it's not a deadline (Cornwell and Rampton, 12/23).

Bloomberg: Insurers Balk At Obamacare Concessions As Risk Pool Thins
Americans have more time to pay for their new Obamacare health plans, thanks to the insurance industry. What they don’t have is more time to sign up (Wayne and Nussbaum, 12/23).

McClatchy: Obama Touts Health Insurance Enrollment Spike As Deadline Looms
President Barack Obama said Friday that more than 500,000 Americans had obtained health insurance through the healthcare.gov website in December and "tens of thousands" were enrolling each day as the Monday deadline for selecting insurance that’s effective Jan. 1 fast approaches. The surge in sign-ups on the troubled federal website and continued strong activity on state-run marketplaces have pushed combined enrollment under the Affordable Care Act to more than 1 million people, Obama said at his hourlong final news conference of the year (Pugh, 12/20).

And a CNN poll says only 35 percent of Americans support the health law --

CNN: CNN Poll: Health Care Law Support Drops To All-Time Low 
Support for the country's new health care law has dropped to a record low, according to a new national poll. And a CNN/ORC International survey released Monday also indicates that most Americans predict that the Affordable Care Act will actually result in higher prices for their own medical care. Only 35% of those questioned in the poll say they support the health care law, a 5-point drop in less than a month. Sixty-two percent say they oppose the law, up four points from November (Steinhauser, 12/23).

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States, Feds Struggle To Enroll Consumers In Health Coverage

Officials attempting to enroll people for coverage through the health law's exchanges are facing education challenges, website headaches and a deadline of today to get people signed up for Jan. 1 coverage. News outlets provide snapshots in Colorado, California, the District of Columbia, Oregon, Minnesota, Texas, Connecticut, Pennsylvania and Maryland.

Kaiser Health News: Even In Well-Funded Colorado, Tough To Help People Enroll In Obamacare
There are navigators working at 57 assistance organizations across Colorado -- everyone from county health departments to local clinics to the state trucking association. Neighboring states Nebraska and Arizona aren't embracing the health care law like Colorado is. They have just two navigator organizations each and about $2 per uninsured person to spend on assisters. Colorado has almost $24 per person. But all the effort had netted about 23,000 customers for private insurance in the state's marketplace as of Dec. 14 -- only about 17 percent of the way to the state's goal of enrolling 136,000 people by the end of March (Whitney, 12/23).

Los Angeles Times: Californians Rush To Get Health Insurance As Deadline Nears
Like shoppers racing to buy last-minute holiday gifts, thousands of Californians are going online -- or lining up in person -- to get Obamacare insurance ahead of next week's deadline to have coverage starting next month. And the surge in enrollment is putting pressure on the state's health exchange and insurance companies at a time when they were already struggling to keep pace with a flood of applications (Terhune, 12/20).

The California Health Report: Town Hall Audience Learns About ACA Options
Ben Hall’s situation sounds familiar. Ben, a self-employed musician and music teacher living in the Westwood neighborhood of Los Angeles, pays for his own health insurance -- $185 a month to Anthem. He's also one of the millions of Americans who recently received a letter in the mail from his insurance provider canceling his plan at the end of the year because it doesn't meet the minimum requirements for coverage set forth by the Affordable Care Act. That's what motivated Ben and his wife Hillary to attend a recent town hall and enrollment fair hosted last month by Rep. Karen Bass at West Los Angeles College (Fulton, 12/20). 

The San Jose Mercury News: Californians Scrambling To Make Monday Deadline To Sign Up For Health Insurance
For tens of thousands of Californians still without health insurance, Monday's deadline to enroll under the president's new health law feels like an exercise of hurry up and wait. And across the country, government health exchanges are bracing for an avalanche of applications from people who must sign up by end of day Monday if they want coverage to begin Jan. 1. People in the Bay Area are scrambling to sign up too, and others are anxiously awaiting answers about the policies they already applied for. Yet many worry they may not get what they want in time from Covered California, the state's health care exchange, or from their insurance company (Seipel, 12/22). 

The San Jose Mercury News: Few Latinos Signing Up For California Health Insurance Exchange
By now, (Adan Lopez), the 32-year-old self-employed, uninsured Gilroy resident is familiar with Covered California, the state's health insurance exchange, through Spanish-language television and radio -- it even pops up on Internet sites he visits. He just hasn't gotten around to signing up for it. And he's hardly alone. In a state where two of every five people are Latino, a worrisome trend has surfaced in the rollout of the Affordable Care Act: Few Latinos have enrolled. Of the 109,296 California residents who registered for a health insurance plan by Nov. 30, only 13 percent were Latinos (Seipel, 12/20). 

The Washington Post: District's Online Insurance Marketplace Also Hampered By Glitches, Consumers Say
On the eve of the Monday deadline for District residents to sign up for health insurance that takes effect Jan. 1, the city's new online insurance exchange has run into so many technical problems that its staff is combing through incomplete applications looking for people who were stymied from buying insurance and are now running out of time (Kunkle, 12/21).

Politico: Obamacare Outreach Hits The Clubs
Like other health exchanges and coverage advocacy groups across the country, DC Health Link is reaching out to people wherever they may be, including bars. President Barack Obama even urged bartenders — who may themselves be uninsured — to hold happy hours to talk about health insurance and what it can offer young adults. That strategy has clear challenges, however. In a packed nightclub like Town Danceboutique in Northwest D.C., music smothers conversation, dimmed lights make reading difficult, and health coverage is not what’s on people’s minds (Villacorta, 12/22).

The Associated Press: Oregon Fiasco: Online Health Exchange Yet To Launch
With independent consultants warning that Oregon's health-insurance exchange faced serious risks, the state official in charge of delivering the technology strode into a legislative committee to address questions from nervous lawmakers (Cooper, 12/21).

The Oregonian: Cover Oregon: If You Don’t Hear From Us By Monday, Seek Coverage 
Oregon's troubled health insurance exchange began robocalling applicants Friday, warning them that if they don't receive enrollment confirmation by Monday, they should seek coverage elsewhere for Jan. 1. "If you haven't heard from us by Dec. 23, it is unlikely your application will be processed for Jan. 1 insurance coverage," a woman's voice on the pre-recorded call from Cover Oregon says. "If you want to be sure you have insurance coverage starting Jan. 1, you have other options" (Hunsberger, 12/20).

The Associated Press: Even In Willing States, Health Law's Rollout Rocky
A bug-ridden website. Endless wait times on a toll-free helpline. Error-laden data sent to insurance companies. These are not problems burdening Republican-led states that had to be dragged kicking and screaming into the federal health insurance overhaul. These are recent complications in the rollout of MNsure, the state-based exchange in Minnesota, a place with a long tradition of activist government and generous social programs (Condon, 12/21).

Minnesota Public Radio: Faulty MNsure Software Never Tested Due To Federal Delays
As technical problems with the state's online health insurance exchange pile up, MNsure announced today that it is giving people until the end of the year to enroll in a health plan. But the eight-day extension may not be enough time to solve a series of bugs that have plagued the website for months. MNsure officials said the problems can be traced back to software sold to the state by a single vendor, IBM Curam, which was never tested by the state before officials bought it for millions of dollars (Richert and Stawicki, 12/20).

Dallas Morning News: Obamacare Sign-Ups Picking Up Steam In Texas
After a slow start in Texas, insurance sign-up under the Affordable Care Act seems to be growing this month as an important deadline looms for those needing immediate coverage. "I sense that our numbers are picking up dramatically," Dallas County Judge Clay Jenkins said after a round of meetings with federal officials to review the troubled rollout of the new law. ... "Monday is the last day to sign up for coverage that starts on Jan. 1," said Louis Adams, a spokesman for Blue Cross Blue Shield of Texas. "But open enrollment continues through March 31." A deluge of calls in early December forced the insurance carrier to add 500 customer-assistance representatives to a phone bank covering five states, including Texas, according to its Facebook page (Jacobson, 12/22).

The CT Mirror: Access Health Releases Instructions For Getting A Catastrophic Plan
Access Health CT, the state's health insurance exchange, released instructions Friday evening for people whose health plans are being discontinued and who want to buy a catastrophic policy for 2014. Catastrophic plans have lower premiums and higher deductibles than other policies sold on the exchange. They were intended only for people under 30, but the federal government on Thursday night announced an exception for people whose old health plans are being canceled (Becker, 12/20). 

The CT Mirror: Connecticut's Obamacare Exchange Chief: Expect A 'Clunky' Jan. 1
"January 1 is going to be clunky," Access Health CT CEO Kevin Counihan said Friday during a conference call with reporters. Jan. 1 is the first date that plans sold through state-based exchanges like Access Health take effect. Among the potential problems Counihan cited: One insurer hasn't programed its system to produce bills that reflect what customers receiving discounted rates really owe, rather than the full, unsubsidized cost. Wait times to Access Health's call center are averaging 20 minutes -- an amount that Counihan said [is] too long. The federal government unveiled a new policy Thursday evening that could affect plan purchases by people whose old policies are being discontinued (Becker, 12/20).

The Philadelphia Inquirer: Marketplace Clock Ticking For Jan. 1 Coverage
Nayah Houston, 21, of University City, finally got through.  It took the part-time preschool classroom assistant five tries and help from a certified navigator and a call-center rep to wend her way through the healthcare.gov website. But she hung in and snagged a silver-tier HMO plan with -- are you ready for this? -- a 12-cents-a-month premium (Calandra, 12/22).

Politico: Obamacare Fight Erupts In Deep-Blue Maryland 
Maryland gubernatorial candidate Doug Gansler is incensed over the botched rollout of Affordable Care Act. He’s aghast at chronic problems with Maryland’s online enrollment platform and stunned that a state with "literally the smartest people in the country" would have hired a company from North Dakota, of all places, to help put its exchange in place. The whole spectacle, Gansler fumes, "is almost like a Saturday Night Live skit." The punch line: Gansler, Maryland's current attorney general, is a Democrat (Burns, 12/22). 

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Insurers Unnerved By Rule Changes For Consumers With Canceled Policies

The Obama administration's announcement last week that consumers whose policies had been canceled could buy catastrophic health plans and were also exempt from the law's mandate in the first year spurred handwringing in some quarters.

The Wall Street Journal: Rule Change On Health Insurance Rattles Industry
Monday is the final day for consumers to get new health coverage that takes effect when the new year arrives, leaving thousands of people racing to sign up in time—and health insurers trying to figure out whether the federal health law will work in the way they had hoped. The number of Americans enrolling continues to fall short of the goals the Obama administration has laid out, which is a problem for the White House. It also represents a problem for the insurance industry, which calculated that the prospect of millions of new customers brought their way by the Affordable Care Act and its coverage requirements would make up for any disruption that came along with the law (Williamson and Radnofsky, 12/22).

Politico: Mandate Change Adds To Obamacare Confusion
If your health insurance was canceled, you don't have to rush out and buy it right now. But if you don't have insurance, you still have to buy it or face a fine. And if you can’t keep what some advocates have derided as a "junk plan," you can get another kind of slimmed-down plan — for a while. Confused? You're not alone (Haberkorn and Millman, 12/20).

The Fiscal Times: Is Obamacare's Individual Mandate Next To Go?
The administration's latest retreat on Obamacare signals the first tangible sign that the president is moving toward a one-year postponement of the individual mandate, arguably the most controversial provision of the beleaguered Affordable Care Act reform. It also has added a new layer of complexity and problems for the insurance industry, which has been struggling to meet targets for enrolling Americans in new health plans ever since the disastrous launch of the technically flawed government websites Oct. 1 (Pianin and Ehley, 12/20).

Kaiser Health News: Capsules: Catastrophic Obamacare Policies Prove Hard Sell So Far
The Obama administration’s decision this week to allow people to buy catastrophic-level policies if their individual health plans had been canceled comes amid reports that few people have bought these less expensive policies sold in new online insurance marketplaces (Galewitz, 12/20).

Kaiser Health News: Capsules: Explaining Why Obama Let More People Buy Catastrophic Plans
KHN's Mary Agnes Carey was on PBS NewsHour Friday to talk about the administration’s plan to allow people with canceled health insurance plans buy so-called "catastrophic" plans, which are cheaper than ordinary plans but provide less coverage (Carey, 12/23).

Fox News: More Last-Minute Fixes To Obamacare To Avoid Net Loss Of Uninsured Americans By Jan. 1
The Obama administration's announcement this week that Americans with cancelled insurance can enroll in bare-bone ObamaCare coverage reflects its urgency to ensure that by January 1 the total number of people with polices doesn’t decrease and to avoid another black eye in implementing the law. The announcement Thursday was just one of several by administration officials this week that shows they are drawing closer to enrolling enough Americans to offset the estimated 4 million to 5 million who had their insurance cancelled because it failed to meet new standards in the president’s signature health care law (12/21).  

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As Consumers Enroll In Marketplace Plans, Questions Remain For Many

Questions remain about insurance pricing, the cost of reform to taxpayers, and who is and isn't covered by the employer mandate.

CBS News: Continued Obamacare Changes Means An Evolving Price Tag
After President Obama in 2009 promised a health care law that cost less than $1 trillion over 10 years, congressional Democrats drafted one that did just that -- in spite of concerns it could compromise the policy. The promise was in part about fiscal prudence and partly about making the law politically palatable. Since the Affordable Care Act passed, it’s of course undergone several changes, creating an evolving price tag that’s given ammunition to the law’s supporters and opponents. Just in the past year, one administrative change to the health law struck $10 billion in revenue from the budget, while another policy that’s in flux has been dubbed an insurer "bailout" (Condon, 12/23).

The New York Times: New Health Law Frustrates Many In Middle Class
Ginger Chapman and her husband, Doug, are sitting on the health care cliff. The cheapest insurance plan they can find through the new federal marketplace in New Hampshire will cost their family of four about $1,000 a month, 12 percent of their annual income. ... Even more striking, for the Chapmans, is this fact: If they made just a few thousand dollars less a year — below $94,200 — their costs would be cut in half, because a family like theirs could qualify for federal subsidies. ... An analysis by The New York Times shows the cost of premiums for people who just miss qualifying for subsidies varies widely across the country and rises rapidly for people in their 50s and 60s (Thomas, Abelson and McGinty, 12/20).

The Associated Press: Health Plan Sticker Shock Ahead For Some Buyers
As a key enrollment deadline hits Monday, many people without health insurance have been sizing up policies on the new government health care marketplace and making what seems like a logical choice: They're picking the cheapest one. Increasingly, experts in health insurance are becoming concerned that many of these first-time buyers will be in for a shock when they get medical care next year and discover they're on the hook for most of the initial cost (Johnson, 12/22).

Fox News: Fire Departments Voice Concern Over Role Of Volunteers Under Obamacare
Fire departments and other emergency squads say they are still waiting to learn from the IRS whether they will have to pay for volunteers' medical insurance under ObamaCare and that having to cover such costs would really hurt many small-budget operations. President Obama’s signature health-care law requires businesses with more than 50 full-time employees to provide health insurance for them. However, whether the IRS considers volunteers full-time employees remains unclear, in part because some receive a stipend or other financial incentives (12/22).

ABC News: Obamacare Explained (Like You're An Idiot)
Turns out a wonky website and warp-speed policy changes are the least of Obamacare's problems. A big reason Americans have hesitated to sign up for health insurance is they don't understand it (Neporent, 12/23).

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Fears Of Website Instability As Deadline Nears

Also, The Washington Post looked into the company that built healthcare.gov. 

The Washington Post: Healthcare.gov Contract: Politics Not A Factor, But Neither Were Firm’s Ties To Failed Projects
CGI Federal, the company responsible for building the problem-plagued Web site for the Affordable Care Act, won the job because of what federal officials deemed a “technically superior” proposal, according to government documents and people familiar with the decision. Not considered in the 2011 selection process was the history of numerous executives at CGI Federal, who had come from another company that had mishandled at least 20 other government ­information technology projects more than a decade ago (Markon and Crites, 12/22).

Politico: Obamacare's Next Big Test
The Monday night deadline for getting Obamacare insurance starting Jan. 1 will test the American public's interest in coverage under the president's health law -- and the capacity of the recently refurbished website to accommodate a last-minute enrollment surge. Dec. 23 is the first hard deadline for the Affordable Care Act since the disastrous Oct. 1 debut of healthcare.gov, and the most significant stress test for the website itself since Nov. 30, the date the administration promised to have it working smoothly for the "vast majority" of Americans. By Dec. 1, it had largely met that goal (Haberkorn, 12/23).

The Wall Street Journal: Health-Site Outage Recalls Flawed Launch
For the past few weeks, U.S. officials and government contractors have been pleased with the performance of the HealthCare.gov website. But Friday brought a reminder of the site's disastrous rollout when it suffered an unexpected outage just days before a crucial enrollment deadline. The outage, which was resolved after three hours, underscored the challenges as President Barack Obama's health law reaches a key coverage deadline (Ante and Radnofsky, 12/20).

The Associated Press: Obama Says 1 Million Signed Up For Health Care
Largely hidden from consumers, another set of technical problems is frustrating insurers, who say the government continues to send them inaccurate data on some enrolled individuals. Insurers call some of those jumbled enrollment files "orphans" and others "ghosts." They could turn into gremlins after Jan. 1 for some patients trying to use their new coverage. Consumers might show up at the pharmacy counter or doctor's office only to be told they're not in the system (Alonso-Zaldivar and Pace, 12/20).

 

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Two Different Rulings On Health Law's Contraceptive Rule

A judge in Oklahoma ruled against the insurance coverage requirement, while a Washington judge ruled against a Catholic Church challenge. 

The Associated Press: Injunction Granted In Okla. Birth Control Lawsuit
A federal judge granted an injunction Friday that prohibits the government from enforcing the federal health care law's requirement that insurance coverage include access to the morning-after pill and similar contraceptives on almost 200 religious organizations that have filed a class-action lawsuit to block the mandate (Talley, 12/21).

Fox News: Federal Judge Deals Another Blow To Obamacare Contraceptive Mandate
Judge Timothy DeGiusti said the ministries have the right to challenge the health care law's contraceptive mandate and that an injunction is needed to prevent the federal government from enforcing it on them. The lawsuit is similar to one filed in Oklahoma City last year by Hobby Lobby Stores, Inc., which calls itself a "biblically founded business" (12/21).

Bloomberg: Archdiocese Obamacare Contraception Challenge Is Rejected
The Catholic Church isn’t harmed by the U.S. Affordable Care Act’s requirement for providing employees with insurance coverage for contraceptives, a judge ruled, throwing out most of a lawsuit challenging the provision. U.S. District Judge Amy Jackson in Washington yesterday rejected arguments by the Roman Catholic Archbishop of Washington and the archdiocese’s schools that the requirement to provide cost-free coverage for contraceptive services violates religious freedom (Rosenblatt and Zajac, 12/21).

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Young Adults Remain A Focus Of Insurance Marketplace Outreach

This key demographic is needed to help keep insurance costs lower.

Kaiser Health News: Young Invincibles' Decision: To Get Coverage Or Not
The success of the Affordable Care Act's online marketplaces may depend on people like [26-year-old] Lizzie Bunnen. If healthy adults her age don't sign up, the risk is that predominantly older and sicker members will drive up costs and threaten the portals' future. With the Dec. 23 deadline approaching for January coverage, and at the end of March for all 2014 enrollment, the clock is ticking on what many believe is one of the health law's biggest challenges. As a result, ACA backers have stepped up efforts to persuade Bunnen and others aged 18 to their mid-30s to give Obamacare a second chance on newly improved websites such as healthcare.gov (Hancock, 12/20).

Reuters: Analysis: How The White House Is Rebranding Obamacare For 'Young Invincibles'
Last summer, White House officials planning a nationwide push to urge young adults to enroll in new health insurance plans had a big problem: Polls showed that many young, healthy people who could be key to the success of the Affordable Care Act knew little about it or its October 1 rollout. So the administration, scrambling to create a publicity "buzz" that would ripple across social media, turned to Hollywood (Bohan, 12/21).

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Medicaid

Court Gives Ohio Gov. Kasich Gets Green Light For Medicaid Expansion

Elsewhere, Wisconsin Gov. Scott Walker signs bill to postpone changes to BadgerCare, and Pennsylvania officials seek support for Gov. Tom Corbett's "Healthy Pennsylvania" plan.

Columbus Dispatch: Ohio Supreme Court Upholds Kasich's Expansion Of Medicaid 
The Ohio Supreme Court yesterday cleared the way for Gov. John Kasich’s expansion of Medicaid to an estimated 275,000 poor, uninsured Ohioans. In a 4-3 ruling released late in the afternoon, the court found a legislative panel that oversees government spending acted within state law when it accepted federal aid to fund the expansion (Candisky, 12/21).

Cleveland Plain Dealer: Ohio Supreme Court Rejects Efforts To Halt Expansion Of Medicaid To Cover Working Poor 
The Ohio Supreme Court on Friday rejected efforts by six conservative Republican legislators and two right-to-life organizations to thwart the expansion of Medicaid in Ohio. The court’s ruling was 4-3, but the three who dissented did not side with the plaintiffs. Rather, they thought the case should not have been heard (Higgs, 12/20).

The Milwaukee Journal Sentinel: Walker Signs Bill Delaying Badgercare Changes Because Of Obamacare Problems 
About 83,000 of the state's poorest residents would wait three months to join the BadgerCare Plus health plan and a slightly smaller low-income group would keep existing coverage in the program for three months longer, under a bill signed by Gov. Scott Walker on Friday. The legislation passed the Senate Thursday by an 18-12 vote, with all Republicans in favor, all Democrats in attendance opposing it and three Democrats absent. The Assembly voted 64-32 for the bill on Dec. 4. "This bill gives the federal government more time to fix major issues with the (federal) Affordable Care Act and it gives Wisconsinites more time to make a logical health care transition," Walker said in a statement (Stein, 12/20).

Pittsburgh Post-Gazette: Corbett's Medicaid Proposal Gets Cheered And Jeered Here 
[Pennsylvania's Secretary of Public Welfare Beverly] Mackereth visited Downtown for the second stop of a journey across the state to collect public comments on Mr. Corbett's "Healthy Pennsylvania" plan, which the Republican governor is pushing in lieu of a Medicaid expansion offered by the federal Affordable Care Act. From the courthouse lobby, she was serenaded by a few dozen protesters from the Cover the Commonwealth Coalition, who say the governor's plan slashes Medicaid benefits and makes it harder to apply for help. In a musical twist on "Jingle Bells," they asked Mr. Corbett to "do the right thing" (McGill, 12/21).

The Washington Post: Health Q&A: How Is Medicaid Changing?
The Affordable Care Act made some pretty substantial changes to Medicaid. First, it allowed states, starting Jan. 1, to expand the program to include anyone who makes up to 138 percent of the federal poverty level — about $15,800 for an individual and $32,500 for a family of four. This is a big change, because most states only opened Medicaid to children, pregnant women, some very low-income parents, people with disabilities and the elderly. They excluded childless adults (Somashekhar, 12/21).

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Public Health & Education

Keeping Firearms Out Of The Hands Of The Mentally Ill

The New York Times reports on the challenge of keeping firearms out of the hands of the mentally ill, while The Wall Street Journal explores the difficulty finding treatment for many people because of a lack of providers in many places.

The New York Times: When The Right To Bear Arms Includes The Mentally Ill
The Russo case highlights a central, unresolved issue in the debate over balancing public safety and the Second Amendment right to bear arms: just how powerless law enforcement can be when it comes to keeping firearms out of the hands of people who are mentally ill. Connecticut’s law giving the police broad leeway to seize and hold guns for up to a year is actually relatively strict. Most states simply adhere to the federal standard, banning gun possession only after someone is involuntarily committed to a psychiatric facility or designated as mentally ill or incompetent after a court proceeding or other formal legal process. Relatively few with mental health issues, even serious ones, reach this point (Luo and McIntire, 12/21).

The Wall Street Journal: For The Mentally Ill, Finding Treatment Grows Harder
As hard as it might be to acknowledge having a mental-health illness, finding professional help can be even harder. Last year, according to the U.S. Department of Health and Human Services, almost 91 million adults lived in areas like here where shortages of mental-health professionals made obtaining treatment difficult. A departmental report to Congress earlier this year said 55% of the nation's 3,100 counties have no practicing psychiatrists, psychologists or social workers, [a result of] a combination of budget cuts and doctors leaving the profession (Fields and Corbett Dooren, 12/20).

The Star Tribune: Two Senators Block Franken's Mental Health Bill
Legislation that would strengthen mental health ­programs across the country is being blocked by two senators who believe that states should govern how mentally ill people are treated, said Sen. Al Franken, D-Minn., a chief co-sponsor of the bill. Franken, who has made mental health legislation a centerpiece of his Senate work, declined to identify the reluctant senators, saying that the lawmakers are being heavily lobbied behind the scenes to move aside so the bill with bipartisan support can get a floor vote. “There is pressure from law enforcement groups and attorneys from within his state for him to not block the bill,” Franken said of one of the ­senators during an interview earlier this week. “I think we’ll get there, but right now there is a hold on the bill” (McEnroe, 12/23).

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Hazards of Dietary Supplements, New Birth Control Device Explored

Dietary supplements account for nearly 20 percent of drug-related liver injuries reported by hospitals, according to The New York Times, while a surge in adverse event reports about Essure, a device hailed as next generation birth control, is explored by the Chicago Tribune. NPR looks at the increase in newborn screening tests.

The New York Times: Spike In Harm To Liver Is Tied To Dietary Aids
Dietary supplements account for nearly 20 percent of drug-related liver injuries that turn up in hospitals, up from 7 percent a decade ago, according to an analysis by a national network of liver specialists. The research included only the most severe cases of liver damage referred to a representative group of hospitals around the country, and the investigators said they were undercounting the actual number of cases. While many patients recover once they stop taking the supplements and receive treatment, a few require liver transplants or die because of liver failure (O'Connor, 12/21).

Chicago Tribune: Women Report Complications From Essure Birth Control
A device called Essure has been hailed as the next generation of permanent birth control. Unlike a tubal ligation, which requires surgery, Essure can be inserted by catheter in a doctor’s office. But complaints about the product have recently surged. The U.S. Food and Drug Administration has received nearly 1,000 adverse event reports related to the device, with 500 arriving this year (Deardorff, 12/22). 

NPR: Screening Newborns For Disease Can Leave Families In Limbo
For Matthew and Brianne Wojtesta, it all started about a week after the birth of their daughter Vera. Matthew was picking up his son from kindergarten when he got a phone call. It was their pediatrician, with some shocking news. Vera had been flagged by New York's newborn screening program as possibly having a potentially deadly disease, and would need to go see a neurologist the next day. Like every state, New York requires that newborns get a small heel prick so that a few drops of blood can be sent to a lab for testing. The idea is to catch health problems that could cause death or disability without early intervention. But in recent years, patient advocacy groups have been pushing states to adopt mandatory newborn screening for more and more diseases, including ones that have no easy diagnosis or treatment (GreenfieldBoyce, 12/23).

 

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Health Care Marketplace

Whom Do Americans Want Care From? Doctors Or Other Practitioners?

Doctors who provide personalized care get organized into a new group, while a new survey seems to suggest Americans prefer getting their care from a doctor instead of nurse practitioners or physician assistants.

Medpage Today: AAFP Throws PAs Under The Bus?
The AAFP survey in question polled more than 1,000 adults on who they would like to receive their medical care from. Not surprisingly, 72 percent said they would like to receive care from a physician, compared with 7 percent who said they want it to be from an NP. Roughly a fifth (21 percent) had no preference and 16 percent don't know. It's the premise of the survey -- conducted by Ipsos but commissioned by AAFP -- and not the findings that irked PA groups. They said asking the question inherently assumes that PAs and NPs are inferior to physicians, their work isn't valued, and makes them seem less of a team (Pittman, 12/22).

Medpage Today: Concierge Docs Get Organized
Several medical societies and groups are developing around the practice of concierge medicine as the rapidly growing field tries to sort itself out. One group of doctors is working to start the American College of Private Physicians (ACPP) to help the fiercely independent doctors coalesce around each other, network, foster research, and share best practices to help grow concierge medicine even more. Organizers have applied for 501(c)3 tax exempt status, are collecting money, and are about to launch a website. They hope to send a letter next month announcing their plans to physicians known to be working in this type of practice (Pittman, 12/20). 

And one hospital reduces how many alarms it uses to cut "alarm fatigue" --

The Boston Globe: Boston Medical Center Reduces Monitor Alarms
Boston Medical Center has dramatically cut down on unneeded alarms from patient monitors, providing a national model for other hospitals as new safety rules on "alarm fatigue" take effect Jan. 1. Nurses’ desensitization to incessantly beeping alarms -- hundreds of alerts a day, many false -- is a national problem. It is blamed for dozens of deaths each year, as overwhelmed staff fail to respond with urgency, or at all (Kowalczyk, 12/23).

Finally, the L.A. fire department overhauls how its first-responders are protected at mass shooting events --

Los Angeles Times: L.A. Fire Department Dramatically Overhauls Response To Shootings
Los Angeles fire officials are dramatically changing how rescuers respond to mass shootings after a gunman with a high-powered rifle mortally wounded a federal security officer in a shooting rampage last month at LAX. The new goal is to have Los Angeles Fire Department paramedics and firefighters, protected by armed law enforcement teams, rapidly enter potentially dangerous areas during active shooting incidents to treat victims and get them en route to hospital trauma centers (Lopez and Welsh, 12/22).

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Native Americans Fight Government Over Hospital Compensation

The Washington Post: Federal Contractors On Edge As Indian Tribes Wait For Claims
When the federal government reneged on its agreement to fully compensate the Shoshone-Paiute tribes for running a hospital on the Duck Valley reservation, the Washington contracting world barely noticed. But after similar contracts were broken with hundreds of other Native American tribes and the debts they were owed snowballed to an estimated $2 billion, federal contractors joined their court battle, alarmed that the practice might eventually ensnare them as well (Kindy, 12/22).

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Health Disparities

Racial Divide For Breast Cancer Survival Widens

Despite numerous advances in the screening and treatment of breast cancer, black women are still far more likely to die of the disease than white women.

The New York Times: Tackling A Racial Gap In Breast Cancer Survival
Like many other African-American women in Memphis and around the country, [Debrah] Reid learned about her breast cancer after it had already reached an advanced stage, making it difficult to treat and reducing her odds of survival. Her story reflects one of the most troubling disparities in American health care. Despite 20 years of pink ribbon awareness campaigns and numerous advances in medical treatment that have sharply improved survival rates for women with breast cancer in the United States, the vast majority of those gains have largely bypassed black women (Parker-Pope, 12/21).

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State Watch

State Highlights: Minn. To Cut Elderly Medicaid Benefits; Calif.'s Insurance Commissioner Seeks Re-Election

Minneapolis Star Tribune: State To Cut Medicaid Benefits For The Elderly
Starting in January, thousands of low-income elderly Minnesotans could lose government benefits intended to help them stay in their homes and out of nursing care. In an effort to constrain runaway Medicaid spending, Minnesota is implementing stricter rules that will make it harder for senior citizens to qualify for home-based services, potentially leaving them with reduced care or no care at all (Serres, 12/21).

The Sacramento Bee: California's Insurance Commissioner Seeks Re-Election, More Power
He was an early supporter, but that hasn’t prevented Insurance Commissioner Dave Jones from finding plenty of fault with President Barack Obama’s new health care program and its rollout in California. Jones wasn’t happy the state’s health insurance exchange told insurers not to include pediatric dental care as a standard benefit in their plans. He criticized the exchange, Covered California, for rejecting Obama’s offer to let insurers grant extensions to more than 1 million customers with policies set to terminate at year’s end. But perhaps his biggest issue with the program has been that, as the state’s elected insurance regulator, he is unable to reject health insurance premium increases (Cadelago, 12/22).

The Wall Street Journal: Fight Over California Girl Points To Confusion About Brain Death 
A rare public battle has erupted between the family of a 13-year-old California girl who was declared brain dead and the hospital that would like to take her off life support. Beyond a family's tragedy, the dispute points to continuing confusion in society over the concept of brain death, especially when other parts of the body are functioning, said experts not involved with the case (Winslow, 12/20).

The Associated Press: Bloomberg Leaves Rich Public Health Legacy In NYC 
Michael Bloomberg steered New York City through economic recession, a catastrophic hurricane and the aftermath of 9/11, but he may always be remembered, accurately or not, as the mayor who wanted to ban the Big Gulp. After 12 years, Bloomberg leaves office Dec. 31 with a unique record as a public health crusader who attacked cigarettes, artery-clogging fats and big sugary drinks with as much zeal as most mayors go after crack dens and graffiti (Caruso, 12/21).

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Editorials and Opinions

Viewpoints: Impact Of 'Meddling With' Health Law; Antibiotics On Farms; 'Let Thritysomethings' Join Medicare

The Washington Post: Meddling With Obamacare Could Undermine The Whole Thing
[A]ll of these last-minute policy shifts confuse people who were already struggling to understand a complex new system, ... The cumulative effect is that at least some people — we hope not many — will misunderstand their responsibilities under the law or be deterred from seeking coverage. The biggest danger is that the Obama administration is encouraging politicians to meddle in the health-care system every time a few vocal constituents get upset about its requirements (12/21).

The Wall Street Journal: Obama Repeals ObamaCare
It seems Nancy Pelosi was wrong when she said "we have to pass" ObamaCare to "find out what's in it." No one may ever know because the White House keeps treating the Affordable Care Act's text as a mere suggestion subject to day-to-day revision. Its latest political retrofit is the most brazen: President Obama is partly suspending the individual mandate. ... Mr. Obama is doing through executive fiat what Republicans shut down the government to get him to do. (12/21).

Bloomberg: Premature Panic Over Obamacare
For a law as complicated and controversial as the Affordable Care Act, the line between sensible tinkering and panicked retreat is hard to find. After months of trying, though, the administration of President Barack Obama seems to have crossed it. ... The law can still work to get more Americans decent and affordable health insurance, if it’s allowed to work the way it was designed to. This is no time for the administration to lose its nerve (12/20).

Los Angeles Times: Another Day, Another Leak From Issa, Another Credulous News Report
The sun has risen in the East, so there must be a news report somewhere quoting a partial transcript leaked by Rep. Darrell Issa (R-Vista) purporting to show the shortcomings of Obamacare. Bingo! We have not one but two "investigative" news reports, from CBS and ABC, based on the same partial transcript. And both, consequently, have the same level of credibility: none (Michael Hiltzik, 12/20).

The Kansas City Star: More Minefields In The ‘Battle Of Obamacare’
Obamacare doesn’t allow insurance rejections or higher premiums for pre-existing conditions. Powers’ wife found a plan that will be cheaper than what he can get her through his job. ... Powers said he shared his good news with [Sen. Jerry Moran, R-Kan.] office on Wednesday. I asked Moran’s press secretary Thursday if the senator would discuss Powers’ experience on the Senate floor, as he had the case from Wichita. As of Friday afternoon, I had not received a response (Alan Bavley, 12/22).

The Fiscal Times: The Hidden Impact of Obamacare And The Economy
Obamacare has delivered another sucker punch to the middle class. This time it’s sticker shock. Now that a few people can get past the tech problems of HealthCare.gov and actually see the real cost of insurance plans available, they are finding that Affordable Care is big hit to the family budget. And when the family budget gets hit in the solar plexus, guess what happens to consumer spending and the economy (Jacqueline Leo, 12/22).

USA Today: Ask A Veteran About Government Health Insurance
Charles Skipper is an American hero. ... two Purple Hearts, a Bronze Star, and a lifelong battle with post traumatic stress disorder. But you wouldn't know that he's a hero by the way he's been treated by the Department of Veterans Affairs. Six years after filing a disability claim, he's still waiting for resolution. ... Washington should take note. Whereas VA's problems simply need to be fixed, larger attempts to impose government-run healthcare system on the entire country are a fool's errand. Veterans know this all too well (Pete Hegseth, 12/21).

The New York Times: Santacare Is Coming To Town
To my American constituents, of both the naughty and nice parties, I’m pleased to announce the rollout of the Affordable Gift Act, referred to by the name of its sponsor — yours truly — as Santacare. While Santacare is not a single-giver system, as with sleigh insurance, you must sign up for it, or else incur a penalty of talking on the phone with Uncle Harold in Cleveland about his sleep apnea (Teddy Wayne, 12/21).

Los Angeles Times: A Real Obamacare Fix: Let Thirtysomethings Sign Up For Medicare
As long as we’re unveiling plans willy-nilly, how about letting thirtysomethings like me buy into Medicare? Information on the coverage is readily available, and I like what I see. Virtually every health provider in the country takes Medicare, so I won’t have to find a new doctor. Co-pays are reasonable. Count me in. I’m exactly the type of young, healthy person the health exchanges want. So surely adding me to the Medicare pool could only help the system (Matthew Fleischer, 12/20).

The New York Times: Health Care’s Road To Ruin
There are plenty of interesting ideas being floated to help repair the system, many of which are being used in other countries, where health care spending is often about half of that in the United States. ...  But the nation is fundamentally handicapped in its quest for cheaper health care: All other developed countries rely on a large degree of direct government intervention, negotiation or rate-setting to achieve lower-priced medical treatment for all citizens. That is not politically acceptable here (Elisabeth Rosenthal, 12/21). 

The New York Times: The Peril Of Antibiotic Use On Farms
After years of inaction, the Food and Drug Administration has finally taken an important step to reduce the use of medically important antibiotics in animal feed. The goal is to curb the rise of bacteria that become resistant to antibiotics used in both human and veterinary medicine. ... [but the move] does not go far enough. (12/21). 

Bloomberg: A Law to Fix Mental-Health Care
In the wake of gun violence such as occurred at Sandy Hook Elementary School and Virginia Tech, commissions are organized and institutional reviews are conducted. Rarely, however, are meaningful reforms proposed. The legislation recently introduced in the House of Representatives by Tim Murphy, a Pennsylvania Republican, is a refreshing change. The Helping Families in Mental Health Crisis Act of 2013 addresses a long list of inadequacies in services for people who suffer from schizophrenia, bipolar illness, major depression and other severe conditions (Dr. Sally Satel, 12/22).

The New York Times: For Mothers-to-Be, Finding Health Care In A Group
Recently in a nondescript conference room near Union Square in Manhattan, eight very pregnant women, husbands, boyfriends and a sister sat in a circle around a small patchwork quilt for two hours and talked about managing the discomforts of pregnancy. ... It did not look like what it was: a doctor’s appointment (Tina Rosenburg, 12/21). 

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EDITOR:
Stephanie Stapleton

ASSOCIATE EDITOR:
Andrew Villegas

WRITERS:
Lisa Gillespie
Marissa Evans

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.