Daily Health Policy Report

Tuesday, December 24, 2013

Last updated: Tue, Dec 24

KHN Original Reporting & Guest Opinion

Health Reform



Health Care Marketplace

State Watch

Weekend Reading

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Consumers Beware: Not All Health Plans Cover A Doctor's Visit Before The Deductible Is Met

Kaiser Health News staff writer Julie Appleby, working in collaboration with NBC News, reports: "If you buy one of the less expensive insurance plans sold through the health law’s marketplaces, you may be in for a surprise. Some plans will not pay for a doctor visit before you meet your annual deductible, which could be thousands of dollars" (Appleby, 12/23). Read the story.

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Capsules: Alabama Blue Cross Shares Obamacare Tax Woes With Customers

Kaiser Health News staff writer Jay Hancock reports: "Insurance companies aren't crazy about their share of the health law’s taxes, but mostly they’ve complained to politicians and regulators. At least one health plan wants to bring consumers into the loop. 'Affordable Care Act Fees and Taxes' is a separate line item on bills Blue Cross Blue Shield of Alabama is sending to individual customers" (Hancock, 12/23). Check out what else is on the blog.

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Political Cartoon: 'HMO For The Holidays?'

Kaiser Health News provides a fresh take on health policy developments with 'HMO For The Holidays?' By Rex May.

And here's today's health policy haiku:  


We're taking a break
to enjoy the holidays.
We'll see you next year.

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

Administration Extends Enrollment One Day After Crush Of Website Customers

More than a million people signed onto the federal health website Monday as consumers rushed to sign up for coverage to begin Jan. 1.

USA Today: HealthCare.gov Tops 1 Million Visitors; Deadline Extended
Officials pushed back the Dec. 23 deadline by a day, acknowledging the site was still having problems signing people up. Earlier Monday, more than 60,000 people hit the landing page when it was too busy to accommodate them and left an email address so they could be alerted when the site wasn't busy, said Julie Bataille, spokeswoman for the Centers for Medicare and Medicaid Services (O'Donnell and Kennedy, 12/23).

The Washington Post: Obama Administration Quietly Extends Health-Care Enrollment Deadline By A Day
Anyone who finishes enrolling by 11:59 p.m. Tuesday will have insurance on Jan. 1, the first day it becomes available (Goldstein and Eilperin, 12/23).

The New York Times: Day Is Added To Deadline As Rush Hits Health Portal
Officials compared the last-minute decision to the kind often made by election officials to keep a polling place open late into the night to accommodate voters already in line at closing. The grace period was the latest example of the administration’s willingness to fiddle with deadlines that once seemed set in political concrete (Shear and Pear, 12/23).

The Wall Street Journal: Health-Insurance Deadline Extended In Late Push To Boost Numbers
Insurers said they received no warning about the deadline change and hadn't prepared for it (Weaver and Martin, 12/23).

The Washington Post: HealthCare.gov’s Last-Minute Shoppers See Mixed Results Signing Up
Around 11 a.m., the Obama administration deployed the site's queuing system, which kicks in when the site has reached its maximum capacity for visitors. Navigators around the country say they have been deluged with phone calls, and that a lot of people are walking into their offices, hoping to get help signing up for coverage despite the navigators’ packed schedule of appointments (Kliff, 12/23).

Reuters: Obamacare Signup Deadline Pushed Back To Tuesday
Officials said the website received 1.2 million visits over the weekend and had surpassed 1 million additional visits by late afternoon on Monday. They said a call center took 200,000 calls from those seeking insurance under the Affordable Care Act, known as Obamacare (Cornwell and Rampton, 12/23).

The Associated Press: Health Care Shoppers Get Added Hours
Bataille said the grace period – which runs through Tuesday – was being offered to accommodate people from different time zones and to allow for any technical problems that might result from a last-minute rush of applicants (Johnson, 12/24).

Bloomberg: Obamacare Sign-Up Extended As Record 1 Million Use Site
Insurers had agreed to begin coverage at the start of 2014 for people who selected policies by the deadline as long as they send their first payments by Jan. 10. With the enrollment extension, people who buy plans from tomorrow through Jan. 15 will get coverage Feb. 1. The last deadline to sign up for a health plan [to avoid the penalty] in 2014 remains March 31 (Wayne and Nussbaum, 12/24).

The Hill: ObamaCare Site Sees Traffic Surge On Eve Of Enrollment Deadline
The change was ostensibly aimed only at those who began the enrollment process on Monday, but administration officials did not definitively say whether those who initiate an application for the first time on Tuesday would be locked out, or whether they would still be eligible to enroll for coverage beginning on Jan. 1 (Easley, 12/23).

NBC News: 'Record Day' As Last-Minute Obamacare Shoppers Get A 24-Hour Buffer
Experience shows many Americans will wait until the last possible minute to buy health insurance. There’s nothing like a deadline to focus the mind. And in this case, experience also shows that people who waited may have fared better than people who tried to sign up early, although really last-minute users may have to line up (Fox, 12/23).

Fox News: Revised Obamacare Sign-Up Deadline Tuesday
A Republican National Committee spokesman called the latest delay an "opaque move" from an administration that vowed to be transparent. In Ohio, Republican Lt. Gov. Mary Taylor called the deadline extension "a clear sign Healthcare.gov continues to struggle" (12/24).

Los Angeles Times: Last-Minute Surge Of Health Law Sign-Ups
Even in California and other states where enrollment was running more smoothly, plenty of consumers were experiencing snags. ... California officials said some technical headaches were inevitable, but the state website was working well enough to have enabled more than 400,000 people to enroll in private health plans as of Sunday. Nearly 30,000 people were picking out coverage daily, not counting thousands more Medi-Cal enrollees (Terhune, Lauter and Reston, 12/23).

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In 'Symbolic' Move, President Signs Up For Health Insurance

President Barack Obama selected a plan over the weekend while vacationing in Hawaii.

The Associated Press: Obama Enrolls For Health Coverage, Won't Use It
He won't use it, and he didn't actually sign up for it himself, but President Barack Obama has enrolled for health coverage through the new insurance exchanges. Announcing his enrollment Monday, the White House called it a symbolic show of Obama's support for the fledgling exchanges where millions of Americans must buy insurance or face a penalty (Lederman, 12/23).

The Washington Post: Obama Signs Up For Health Care, Buying Bronze Plan The White House Calls 'Symbolic'
The political maneuver, announced Monday by the White House, was aimed at showing solidarity with hundreds of ­thousands of Americans enrolling in the new federal and state health-care exchanges. The move came after months of prodding from Republicans. ... Obama was enrolled in the D.C. exchange over the weekend, aides said, purchasing a "bronze"-level plan (Rucker and Goldfarb, 12/23).

CBS News: Obama Gets Obamacare
Mr. Obama receives his health care from the military. ... An aide traveling with Mr. Obama on his family vacation in Hawaii said a staffer visited the D.C. exchange office in person to enroll the president, because the nature of his case required an in-person sign up. He was, however, involved in making a decision about which plan he would chose (Kaplan, 12/23).

Politico: W.H.: Obama Has Signed Up For Insurance Under Obamacare
"Like some Americans, the complicated nature of the president's case required an in-person sign-up," the official said. "As you’d expect, the president's personal information is not readily available in the variety of government databases HealthCare.gov uses to verify identities." Obama signed up for coverage only for himself and not for the rest of the first family, and will pay a premium that's under $400 per month, the official said (Epstein, 12/23). 

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In State-Run Exchanges, Last Minute Rush To Enroll In Coverage

States who run their own health insurance exchanges are trying to cope with people attempting to enroll before the deadline to get coverage that would begin Jan. 1.   

Politico: Health Enrollment Deadlines Flexing Again In Several States
New York and Massachusetts are following the federal health exchange’s lead and extending their sign-up deadlines for coverage starting Jan. 1, those programs’ directors announced Monday afternoon. Other state exchanges, including the ones in California, Washington state and the District of Columbia, are offering general flexibility for individuals who started but couldn’t complete their applications by the 11:59 p.m. Monday deadline. Residents there will still be guaranteed coverage starting Jan. 1 (Villacorta, 12/23).

Los Angeles Times: California Health Exchange Tops 400,000 Enrolled Prior To Deadline 
California's health insurance exchange said more than 400,000 people have signed up for health plans ahead of Monday's enrollment deadline as part of the Affordable Care Act. The Covered California exchange said the latest figures are based on preliminary data through Sunday (Terhune, 12/23).

The Wall Street Journal: California Health-Insurance Site Sees Rush At Finish Line 
Officials said Monday 77,000 people picked a private insurance plan between Friday and Sunday in California, one of 14 states running its own insurance marketplace. Those three days alone accounted for nearly one-fifth of the roughly 400,000 people who have enrolled in private coverage so far, according to state figures. A similar number have been found eligible for Medicaid (Corbett Dooren, 12/23).

The Denver Post: Colorado Health Exchange Deluged With Last-Minute Insurance Buyers
Connect for Health Colorado was deluged by procrastinators Monday who decided to buy private insurance under the federal Affordable Care Act. ... As of Monday, 35,356 people had enrolled, or more than one-eighth of the uninsured people in Colorado (Olinger, 12/23).

The Baltimore Sun: Enrollments On Md. Health Exchange Jump, Though Site Still Glitchy
Gov. Martin O'Malley said Monday that 42,589 people had signed up for insurance through the state's health exchange as of Dec. 21 — a jump of almost 13,000 people in a week — but the faster clip of sign-ups was temporarily stymied by more troubles with the website (Cohn, 12/23).

The Hill: Nearly 54,000 More New Yorkers Enroll In O-Care
Nearly 54,000 more New Yorkers enrolled in the state’s health insurance exchange in the last week, state officials said Monday, bringing the total to more than 188,000. At least 188,546 people have enrolled in the New York marketplace, and at least 421,949 people completed applications. ... It’s unclear how many New Yorkers enrolled through a qualified health plan versus qualifying for Medicaid (Shabad, 12/24).

The Oregonian: Cover Oregon Says It's Made Progress, But Many Still Face Gap In Insurance Jan. 1
Cover Oregon officials say they've made significant progress reducing their backlog of health-insurance applications, but many Oregonians will go without subsidized coverage Jan. 1 because their applications were deemed incomplete. The state's health insurance exchange, choked by technological breakdowns and processing delays, has determined more than 45,600 individuals eligible for private commercial insurance plans (Hunsberger, 12/23).

Fox News: States Lag Far Behind On Obamacare Enrollment
[Oregon's] insurance website failed spectacularly after the Oct. 1 launch. ... in another sign of the uncertainty, applicants began receiving robocalls warning them they should look elsewhere for coverage if they hadn't heard from the state by Monday, in order to get coverage by Jan. 1 (Doocy, 12/23).

The Boston Globe: State Extends Health Insurance Deadline
Monday had been the deadline to apply for coverage to start Jan. 1. People were scrambling to meet it. The call center was overwhelmed, and the website was working even more slowly than normal because of high volume, Massachusetts Health Connector spokesman Jason Lefferts said Monday (Conaboy, 12/24).

WBUR: State Delays Health Connector Enrollment To Dec. 31
The deadline applies to people applying for a plan for the first time or people with unsubsidized coverage that is expiring Dec. 31, and who need new plans starting Jan. 1 to avoid a gap in coverage. Administration officials noted that enrollments ahead of the 2008 individual mandate were made up until Dec. 31, 2007 (Metzger, 12/23).

The Star Tribune: Sign-Up 'Navigators' Are Helping To Ease Mnsure Headaches
Soothing saxophone tones filled the conference room at Portico Healthnet in St. Paul [Minn.] on a recent morning — not from the PA system, but from the speaker of a mobile phone on hold with MNsure. “Your total wait time may be in excess of 30 minutes,” said the message. “We apologize for any inconvenience …” Chuckles filled the room, but the delay was no laughing matter (Olson, 12/23).

Minnesota Public Radio: MNsure Offers Tips For Frustrated Consumers
Minnesotans this week have been waiting an hour, on average, to get help navigating MNsure, the state's new online insurance marketplace. Hoping to ease that pressure, MNsure officials are offering consumers tips to avoid getting stuck when trying to apply for coverage through the website. The tips, including using an updated web browser or entering a middle initial instead of a full middle name, are based on the most frequent calls to the MNsure help center (Stawicki, 12/23).

The Star Tribune: MNsure Is Counting On The Young Signing Up, But Typical Enrollee Is 50
As the deadline nears for Minnesotans to purchase health insurance for 2014 on MNsure, an unsettling question remains: Will young, healthy people sign up on the online exchange and infuse plans with the premium revenues they need to pay for all the older, sicker people? Through November, half of the enrollees who bought private health plans on MNsure were between the ages of 51 to 64, even though that age group makes up only 21 percent of the state’s non-elderly population (Olson, 12/23).

The CT Mirror: Enrollment Brisk, Demand High At First Connecticut Obamacare Enrollment Deadline
"We're just exploding here today," Kevin Counihan, CEO of Access Health CT, the state’s health insurance exchange, said Monday. As of 5 p.m. Monday, just over 59,100 people had signed up for health care coverage offered by the exchange, up from close to 56,000 Sunday night, Counihan said. The enrollment figures include people buying private insurance and those who will receive Medicaid (Levin Becker, 12/23).

And in two states with federally run exchanges:

The Associated Press: Deadlines Loom For Texans Seeking Health Care
In Dallas and Houston, hundreds of people trained to assist with enrollment worked the day before Christmas Eve, forgoing a vacation day that many others enjoyed. ... About 25 percent of Texas residents, or some 6 million people, lack health insurance. It is the highest rate in the nation. ... Many people who turned out in recent days were eager to enroll for coverage that would begin Jan. 1, said Mario Castillo, who is leading outreach and enrollment efforts in a 13-county region surrounding Houston for Enroll America (12/23).

The Associated Press: Ohio Groups See Steady Flow Of Health Care Signups
Groups helping to enroll Ohioans in health insurance plans say they are seeing a steady flow of people ... Counselors at one consumer advocacy group were stacked with appointments on Monday to help people find a health plan. Cathy Levine, executive director of the Universal Health Care Action Network of Ohio said interest in coverage has picked up. But she said reaching prospective enrollees has been difficult without a big marketing campaign 1 (Sanner, 12/23).

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GOP Steadies Aim On Dems, Even Those Without Obamacare Ties

One North Carolina Democrat who never voted for the health law finds he still has a tough fight from Republicans. In the meantime, new polls show support for the health law at a new low, but some still see the law as Obama's biggest achievement.

The Associated Press: House Foe Of Health Overhaul Still Top GOP Target
Listen carefully when Republicans say they can blame almost every House Democrat for the flaws of the health care overhaul. Rep. Mike McIntyre, D-N.C., is the exception. He's never voted in favor of President Barack Obama's signature health care law. It's a key reason the nine-term Democrat is still in Congress. It might be enough in 2014, although he barely won last year. In a district redrawn by Republicans for Republicans, McIntyre is the GOP's top Democratic target in the battle for control of the House (Kellman, 12/23).

Time: 3 House Races Obamacare Will Decide In 2014 
Even after House Republicans led the government to a shutdown in October, Democrats have little to no chance of retaking the lower chamber. Among other factors, the botched rollout of the Affordable Care Act has caused potential candidates to drop out or wait for a better climate, and thrown up in the air the safety of Democratic incumbents across the country. In his most recent forecast, David Wasserman of the Cook Political Report writes that Democrats would now need to win 42 of 43 the competitive races in 2014 to capture the House. Here are three House races where Obamacare could strengthen John Boehner’s grip on the Speaker's gavel (Rogers, 12/23).  

CBS News: Americans See Health Law As Obama's Biggest Achievement And Failure, Poll Suggests
A new Gallup poll shows that Americans would name the Affordable Care Act as President Obama's greatest achievement and his greatest failure, though a larger percentage hold a negative view. Obamacare dominates almost every other response on both the success and failure lists. The next two greatest achievements that survey respondents named were getting the troops home/ending wars and capturing al Qaeda leader Osama bin Laden/anti-terrorism efforts, both of which were named by 7 percent of people as the top achievement. The only other category that matches Obamacare is "none," which is a result of 40 percent of people who self-identify or lean Republican who said they could not name something they consider his greatest achievement (Kaplan, 12/23).

The Fiscal Times: Obamacare Poll Numbers Hit New Low
The headline number from the CNN/ORC International poll released this morning is 62 percent – that's the share of Americans who reported that they opposed Obamacare, and it's the highest figure ever. Only 35 percent of respondents said they were in favor of the law. A deeper dive into the new poll numbers, however, reveals a somewhat more nuanced view of the law among Americans. Of those who said they were opposed to the law, a significant percentage – equal to 15 percent of the population overall – said  their opposition stemmed from a belief that the law is "not liberal enough" (Garver, 12/23). 

And Politico looks at one group that has come out in favor of the law --

Politico: Taking A Different Path, Hispanic Evangelicals Support Obamacare
Under the big evangelical tent where tens of millions of Americans worship, Hispanic churches are embracing Obamacare despite the concerns about religious freedom that have tarnished the law for many of their fellow believers. Pastors have encouraged support since enrollment for health coverage began in October. Their take is that the law's positives outweigh its negatives, especially for the one in three Hispanics without insurance, the highest uninsured rate of any racial or ethnic group. Many of the uninsured are eligible for major new health benefits plus subsidies to help them afford coverage (Cunningham, 12/22).

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Parsing Obamacare's Impact On Business, Insurers And Parolees

Media outlets explore how the law might affect those buying less expensive policies, businesses anxious about new investments and those recently released from prison.

Kaiser Health News: Consumers Beware: Not All Health Plans Cover A Doctor's Visit Before The Deductible Is Met
If you buy one of the less expensive insurance plans sold through the health law's marketplaces, you may be in for a surprise. Some plans will not pay for a doctor visit before you meet your annual deductible, which could be thousands of dollars (Appleby, 12/23).

Appleton (Wis.) Post Crescent/Gannett Wisconsin Media: Health Care Changes Worry Some Employers
The Affordable Care Act is having a chilling effect on some Wisconsin employers, as soaring health care costs and uncertainty over new fees and requirements have caused some businesses to put a hold on hiring and expansion, business leaders say. Reed Hall, CEO and secretary of the Wisconsin Economic Development Corp., said profit margins remain small as the nation recovers from the Great Recession, and many Wisconsin businesses view President Obama’s trademark legislation as yet another reason to avoid adding expenses (Litke, 12/22).

Kaiser Health News: Capsules: Alabama Blue Cross Shares Obamacare Tax Woes With Customers
Insurance companies aren't crazy about their share of the health law's taxes, but mostly they've complained to politicians and regulators. At least one health plan wants to bring consumers into the loop. "Affordable Care Act Fees and Taxes" is a separate line item on bills Blue Cross Blue Shield of Alabama is sending to individual customers (Hancock, 12/23).

The California Health Report: Parolees, Corrections To Benefit From ACA
Recent parolees, a population in dire in need of improved medical care, could be among those poised to benefit most from the Affordable Care Act come Jan. 1. The full implications of how the law will affect this population are still hazy, as officials across all fields of corrections prepare for the changes. It is clear, however, that parolees are among those with a high rate of health concerns and are likely to fall into the categories qualifying for assistance under the new law (Wyman, 12/24).

Meanwhile, security concerns persist -

Roll Call: Issa’s Quest Continues To Expose HealthCare.gov Security Gaps
Oversight and Government Reform Chairman Darrell Issa is on a quest to prove there are vast security gaps on HealthCare.gov, and he and his staff think they may have just hit a gold mine. On Dec. 20, the California Republican’s office released selected portions of a Dec. 17 interview between the committee and Teresa Fryer, the chief information security officer at the Centers for Medicare and Medicaid Service (Dumain, 12/23).

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3 States Take Divergent Paths On Health Care For Poor

Media outlets look back at the decisions made by Minnesota, Wisconsin and Texas leaders about expanding coverage to the poor under the health law and what that will mean for residents living just above the poverty line.

MinnPost: Minnesota, Wisconsin Diverge On Health Care Coverage For Those Barely Above Poverty Line
People in Wisconsin and Minnesota living just barely above the poverty line are about to see their health care fortunes change — in opposite directions. In Wisconsin, about 77,500 people are expected to lose Medicaid and will have to obtain coverage through the private exchanges. These include 38,067 people between 100 percent and 133 percent of the federal poverty level, and 35,781 people between 133 percent and 200 percent (Hertel and Nord, 12/23).

The Texas Tribune: Year In Review: [Texas] Health And Human Services
The medical community, local government leaders and health care advocates pushed lawmakers to expand Medicaid under the federal Affordable Care Act, or to propose an alternative "Texas Solution" to reform Medicaid. They hoped to find a way to draw down billions in federal dollars to expand health coverage for the poor. But Gov. Rick Perry and legislative Republicans refused to expand a "broken" program, and instead approved a measure to block the Health and Human Services Commission from expanding Medicaid eligibility without legislative approval (Aaronson, 12/24).

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Medicare Drug Program Gets Senator's Scrutiny After Vulnerability Report

ProPublica: Senators Press Medicare For Answers On Drug Program
A Senate committee chairman said he is concerned about the "serious vulnerabilities" detailed in a ProPublica report about scams that target Medicare's popular prescription drug program. Sen. Tom Carper, D-Del., who chairs the Homeland Security and Governmental Affairs Committee, said in a statement that he plans to ask Medicare officials and the inspector general of the U.S. Department of Health and Human Services "to look into the specifics of these cases, as well as determine the extent of any program-wide vulnerabilities that may have allowed them to occur." The committee monitors fraud in government programs (Ornstein and Weber, 12/24).

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Health Care Marketplace

Retirement Of Baby Boomers To Spur Surge In Health Sector

As baby boomers retire, employment opportunities in the health care sector could be substantial. Meanwhile, doctors disagree over whether gynecologists should be able to treat men.

USA Today: Health Care Workers Will Lead U.S. Job Gains To 2022
The retirement of aging Baby Boomers will reshape the job market over the next decade, leading to the smallest portion of Americans employed or looking for work since the mid-1970s, barely six in 10, a new Labor Department forecast predicts. The result: slower economic growth but new employment opportunities in health care, where millions of new jobs are likely to be created (Davidson, 12/23).

The New York Times: Gynecology's Gender Question 
Should gynecologists be allowed to treat men? A medical specialty board stirred up a hornet’s nest in September when it said no and warned gynecologists that if they accepted male patients, they could lose their certification -- something doctors need in order to work. Protests erupted from patients and doctors who said the policy, set by the American Board of Obstetrics and Gynecology, interfered with medical care and research. Since then, the board, based in Dallas, has backed off twice (Grady, 12/23). 

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State Watch

State Highlights: Mass. Pharmacy Agrees To $100M Settlement; Texas Grand Jury Clears Abortion Provider

The Wall Street Journal: Massachusetts Pharmacy In Settlement Over Tainted Injections
The Massachusetts pharmacy whose tainted steroid injections were blamed for a deadly outbreak of fungal meningitis has agreed to pay more than $100 million to victims and their families, according to lawyers involved in a tentative settlement. The tentative deal is part of an effort to compensate victims and their families for injuries they suffered after receiving the injections for back pain (Rockoff, 12/23).

The New York Times: Texas: Grand Jury Clears Abortion Provider 
A grand jury in Harris County found no evidence of criminal behavior by a Houston doctor who performs late-term abortions and was accused by anti-abortion groups of killing live-born babies (Eckholm, 12/23).

The Star Tribune: Fast-Growing Health Insurer Ucare Moves Into New Markets
CEO Nancy Feldman still slides on the tiara when there’s a milestone to celebrate at UCare, the health insurance company she has run since 1995. The tradition began not long after Feldman arrived, when she donned the crown and handed out 40,000 M&Ms to employees, with each chocolate morsel representing one of the enrollees in the still-young insurer’s health plans. But the biggest tiara party could come in the year ahead. UCare expects to see enrollment expand beyond the 400,000 mark, extending an unrivaled growth spurt that sets it apart from its peers among the Star Tribune’s 100 largest nonprofit companies, where it ranks No. 7 on our list (Crosby and Kennedy, 12/23).

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Weekend Reading

Holiday Reads: Squabbling Families, The Psychology Of Santa, Holiday Stress And Chocolate Chip Cookies

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

The Atlantic: Why Families Fight During Holidays      
[T]his time of year the Internet is ripe with lists on how to avoid or mitigate family conflicts. At big gatherings, familiarity may not always breed contempt, but it sure can breed festering emotional wounds. Leonard Felder, a Los Angeles psychologist, has found that about three-quarters of us have at least one family member who annoys us. But why is it that the same minor jabs and annoying tics that are harmless coming from friends prompt epic screaming matches when uttered by relatives? ... Here are four theories as to why our families drive us nuts, and it would be nice of you to pay attention for once in your life (Olga Khazan, 12/23).

Pacific Standard: The Psychology Of Santa Claus
Polls show that 84 percent of American adults believed in Santa when they were children—children who, when prompted, say with a straight face that Santa is just as real as Michael Jordan. Santa was much realer to me than Michael Jordan, who never once gave me a present. Santa was the coolest guy on the planet. ... Parents continue with the Claus con, according to professor at Illinois State University, in order to ensure their children's parental dependency and to preserve their innocence. However, studies show that parents are often much sadder than their children when the truth comes out (Sarah Sloat, 12/19).

The Washington Post: For Women, It's The Most Stressful Time Of The Year
Family therapist B. Janet Hibbs, the author of "Try to See It My Way: Being Fair in Love and Marriage ," says her office is full of stressed-out, angry couples who feel unhappy and misunderstood during the holiday season. "I hear women say: 'You don't understand, I don't really have a choice. I have to do this,'" Hibbs said. They're overwhelmed not only doing too much but trying to keep mental track of it all. And men are defensive that they're blamed for not doing enough or doing it poorly. ... Feeling that I’m no longer the only one responsible for making Christmas magic — and that we can decide for ourselves what’s good enough — has freed up space in my head and my day (Brigid Schulte, 12/20).

Time: Why The Holidays Don’t Make Everyone So Jolly
People who suffer from anxiety and depression, for example, can have their already fragile emotions strained to the breaking point from all the stress of meeting holidays obligations. And if there has been a sorrowful event during the year, the end of the year can revive the trauma. … But the challenges do not, as many believe, lead to a spike in suicides over the holidays. According to a 2012 study from the University of Pennsylvania's Annenberg Public Policy Center, the average highest suicide days actually occur in the spring and summer. And, according to some experts, the stressful season does not lead to more new diagnoses for depression or other mood disorders (Alexandra Sifferlin, 12/18). 

The Wall Street Journal: A Gift To Last A Lifetime
Jerry Sullivan gave his wife, Lorraine, a kidney for Christmas. ... Mr. Sullivan, a 59-year-old utility executive, wasn't a match for his wife, a retired 59-year-old educator, who was born with polycystic kidney disease and has been on dialysis since both her kidneys were removed in 2012. However, he agreed to give his kidney to a stranger, Claudette Parnell, a 52-year-old U.S. Department of Housing and Urban Development employee who suffers from chronic kidney disease and has been on a deceased donor list for five years. His donation made Lorraine eligible to receive a kidney from an anonymous living donor as part of a national kidney exchange. Essentially a swap (Ralph Gardner Jr., 12/23).

The New Yorker: Sweet Morsels: A History Of The Chocolate-Chip Cookie
The chocolate-chip cookie celebrated its seventy-fifth birthday this year. ... The beauty of the chocolate-chip cookie—and no small part of its enduring popularity—is its fungibility. You can make it with shortening, margarine, or butter; you can make big cookies or small cookies; you can use pecans or walnuts or M. & M.’s or peanut butter; you can use more brown sugar or less; ... It doesn’t matter. What comes out will still be recognizable as a chocolate-chip cookie and, most likely, it will taste good. ... It seems that the only thing you can't do to a cookie, as Malcolm Gladwell discovered in 2005, is make it healthy (Jon Michaud, 12/22).

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Editorials and Opinions

Viewpoints: 'Parade Of Delays' On Health Law; McConnell On White House 'Stunts;' Update On SHOP Exchange

The New York Times: Weak-Kneed On The Health Care Mandate
If the website malfunctions in October and November were infuriating to supporters of health care reform, the continuing parade of delays that followed it have simply been depressing. They have contributed to the impression that the Obama administration is desperately trying to keep the new system from spinning out of control, countering the good news that 1.2 million people have signed up for insurance through the federal and state exchanges. ... Having cracked once on this subject, the White House will be pushed to do so more forcefully by the law’s critics when the policies take effect next month. This should be the last concession (David Firestone, 12/23).

The New York Times: The Legitimacy Problem 
Governing in an age of distrust is different than governing in an age of trust. Government now lacks the legitimacy to impose costs on losers, so politicians face unprecedented pressure to create situations in which everybody looks like winners. ... People like Social Security, but I bet you that Congress could not pass a Social Security law today. ... The erosion of the [individual] mandate won’t kill Obamacare over all. It’ll just make it much more expensive for the government. But the larger lesson is that to sustain a program in this culture, you probably have to rely on policy mechanisms that maximize consumer-style choice, not mandates (David Brooks, 12/23).

Reuters: Obamacare's Endless Exemptions
All the delays, waivers and exemptions in the world aren’t going to solve a problem like this. They only create more confusion for a public that’s looking for results, not spin. And many of the administration’s exemptions could force premiums even higher. Moreover, the White House’s stunts ignore what is fundamentally wrong with Obamacare: The "we know best" attitude that led to it in the first place (Sen. Mitch McConnell, R-Ky., 12/20).

The Fiscal Times: Another Big Flaw In Obamacare – Tort Reform
With all the delays and "fixes," the misnamed Affordable Care Act looks like downtown Aleppo – a mere shell of its former self. ... If cost control were really the ambition, some ideas favored by Republicans, such as limiting the awards available to patients who sue their doctors – i.e., tort reform – would have been adopted. The Obama White House stood in the way of limiting excessive payments to plaintiffs (Liz Peek, 12/23).

The Washington Post: Wonkbook: Obamacare's Newly Uninsured
Pennsylvania's insurance commissioner, Michael Consedine, estimates that about 250,000 people in his state have seen their insurance policies cancelled this year — many of them because of Obamacare. ... Many of the people whose plans were cancelled have gone and bought new insurance through brokers or directly from insurance companies. So the gap between plan cancellations and new plan sign-ups is considerably smaller than these numbers suggest. But it's not at all likely that it's been closed (Ezra Klein and Evan Soltas, 12/23).

The New York Times: Small Businesses Showing Little Interest in State SHOP Exchanges
While the travails of the federally run SHOP exchanges have been widely reported, many of the state-run exchanges — which together could serve about two-fifths of the nation’s small businesses — have faced their own problems in attempting to field a small-business health insurance exchange. ... To be sure, businesses in any state that want to offer health insurance to employees — and no company with fewer than 50 full-time equivalent employees is obliged to provide the coverage — can do so (Robb Mandelbaum, 12/23).

The Washington Post: Obama Has Begun Repealing Obamacare
Obamacare as written is already gone, dismantled by its namesake. Obamacare itself has not, strictly speaking, collapsed of its own weight. Rather, it has been changed from its original, unworkable form first by Chief Justice John Roberts and then by the president into some new, unworkable mishmash. ... The question remains whether the law in some form will remain or whether the 2016 contest will be about what sort of plan replaces Obamacare (Jennifer Rubin, 12/23). 

The Washington Post: How Did Maryland's Health Site Malfunction?
If people's health weren't on the line, it would be darkly funny: For weeks, uninsured Marylanders trying to get coverage through the state’s health exchange have slogged through online forms and technical glitches, only for the system to freeze just before they hit the "enroll" button. The Web site is supposed to facilitate the enrollment of 150,000 Marylanders in private health insurance. As of the middle of the month, it had signed up only 7,435 — and that is after notching its highest-volume days since its Oct. 1 launch (12/23).

Health Policy Solutions (a Colo. news service): Simple Solution – Single Payer
Our fiscally prudent cohorts should want a system of private care or whatever the provider fancies with a low overhead to administer, and one that covers everyone — namely single payer. After all, let’s remember that Medicare was implemented within six months of passage using one’s Social Security number and all the relevant information documented on index cards. No fancy computer system was required with exorbitant expenditures to make it work. Now seniors love their Medicare (Dr. Rochelle Dworet, 12/23).

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Stephanie Stapleton

Andrew Villegas

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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.