Daily Health Policy Report

Tuesday, December 3, 2013

Last updated: Tue, Dec 3

KHN Original Reporting & Guest Opinion

Health Reform

Administration News

Capitol Hill Watch

Health Care Marketplace

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

When Palliative Care Is The Best Care

Kaiser Health News staff writer Anna Gorman, working in collaboration with The Seattle Times, reports: "Hospitals around the country are increasingly starting palliative care programs, designed to relieve seriously ill patients’ pain, stress and symptoms regardless of how long they have to live. While some patients are close to death, others are still receiving treatment to extend their days. And as they do, the palliative care team, including doctors, social workers, nurses and chaplains, tries to improve their quality of life" (Gorman, 12/3). Read the story.

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Insuring Your Health: Mental Health Parity Rule Clarifies Standards For Treatment Limits, Coverage Of Intermediate Care

Kaiser Health News consumer columnist Michelle Andrews talks with Jennifer Mathis, director of programs at the Judge David L. Bazelon Center for Mental Health Law in Washington, about the parity law and the new regulations (Andrews, 12/3). Read the interview.

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Capsules: California's Small Business Insurance SHOP Opens, A Contrast To Feds; Administration: Bugs Reduced At Healthcare.gov; How Is Healthcare.gov Performing Now?

Now on Kaiser Health News' blog, Anna Gorman reports on California's SHOP exchange: "Just a few days after the federal government delayed online enrollment, California announced better news for small businesses who want to buy health insurance. Businesses with up to 50 employees can begin signing up online for coverage through the state’s new marketplace, officials announced Monday" (Gorman, 12/2).

Also on Capsules, Phil Galewitz reports on how healthcare.gov is doing: "For the first time since its mangled Oct. 1 launch, users can now go to the federal government's insurance enrollment website and get detailed information about the costs and benefits of health plans in their county without first enrolling" (Galewitz, 12/2).

In addition, KHN's Mary Agnes Carey was on NPR's "Tell Me More" Monday morning to give an update on the federal government's troubled website. Listen to audio of Carey speaking with Michel Martin. 

Finally, Galewitz also reports on the experience some consumers are having with the federal marketplace: "Vickie Fleisher-Gann had been trying since Oct. 1 to complete her Obamacare application so she could start shopping for insurance on healthcare.gov, but she kept getting stopped by error messages. With her policy expiring at the end of the year, she feared time was running out. On Sunday morning, the former Harrisburg, Pa., hospital administrator finally was able to complete her application, shop for a plan and enroll — all within about 30 minutes. 'I was shocked when it worked,' said Fleisher-Gann, 61. 'I just couldn't believe it'" (Galewitz, 12/2). Check out what else is on the blog.  

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Many Wash. State Health-Exchange Plans Exclude Top Hospitals From Coverage

The Seattle Times' Amy Snow Landa and Carol M. Ostrom, working in partnership with Kaiser Health News, report: "But it’s no joke: Many insurers offering plans through the Washington Healthplanfinder, the exchange marketplace where shoppers can apply for subsidies, are using narrow provider networks. These networks are not the broad, include-all-providers networks that many big employer plans currently enjoy" (Landa and Ostrom, 12/3). Read the story.

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Political Cartoon: 'Some Assembly Required?'

Kaiser Health News provides a fresh take on health policy developments with "Some Assembly Required?" by Lee Judge.

Here's today's health policy haiku:  


They chose a Sunday
to say how well it's working...
But reviews are mixed.

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

Reviews Mixed For 'Fixed' Health Care Website

Some said the Monday's healthcare.gov relaunch -- marked by heavy traffic -- was "rocky" and "bumpy," but administration officials maintained the user experience was much smoother as a result of fixes.   

Los Angeles Times: Healthcare.gov Has Rocky Relaunch
The Obama administration's overhauled health care website got off to a bumpy relaunch Monday as a rush of consumers caused an uptick in errors and forced the administration to put thousands of shoppers on the HealthCare.gov site on hold. … Bataille said about 375,000 visitors went to the site before noon, about double the normal traffic for a Monday morning. The volume caused pages to load slowly and the rate of errors to spike. About 10 a.m. EST, federal officials turned on a new queuing system that alerts some visitors to the site to come back later (Levey, 12/2).

The Associated Press/Washington Post: Updated Healthcare.gov Gets Mixed Reviews
helping people use the federal government's online health exchange are giving mixed reviews to the updated site, with some zipping through the application process while others are facing the same old sputters and even crashes. The Obama administration had promised a vastly improved shopping experience on healthcare.gov by the end of November, and Monday was the first business day since the date passed (12/3).

The Washington Post: Heavy Traffic On Healthcare.gov After Fixes; Users Report Mixed Results On Insurance Site
The White House announced early Sunday that, given the recent improvements in the site, most HealthCare.gov shoppers should be able to have an experience like Issa's. By 10 a.m., however, the Web site seemed to be struggling with high traffic. Federal health officials said they saw an increase in error rates and a slowdown in response times and decided to deploy "queueing" software designed to limit the number of users permitted on the site at one time (Kliff and Sun, 12/2).

Kaiser Health News: Capsules: Administration: Bugs Reduced At Healthcare.gov
For the first time since its mangled Oct. 1 launch, users can now go to the federal government's insurance enrollment website and get detailed information about the costs and benefits of health plans in their county without first enrolling (Galewitz, 12/2).

Reuters: Retooled Obamacare Website Traffic Surges But Problems Remain
A surge of visitors clogged the U.S. government's revamped health care insurance shopping website on Monday, signaling that President Barack Obama's administration has a way to go in fixing the portal that showcases his signature domestic policy. Facing its first big test since officials proclaimed over the weekend that they had met their deadline to make HealthCare.gov run smoothly for the "vast majority" of users, the site performed markedly better than it did during its disastrous launch two months ago -- but was still short of the crisply running insurance marketplace Obama once touted (Morgan and Krauskopf, 12/2).

Bloomberg: Health Exchange Insurer Bug Fixed As 800,000 Try Website
More than 800,000 visitors gave the hobbled Obamacare website another chance as the government continued to work on software repairs, including a fix to the system that sends customer data to insurers. The rush yesterday to healthcare.gov followed a Dec. 1 report saying that six weeks of work had improved its use for most consumers (Wayne, 12/3).

McClatchy: HealthCare.Gov Usage Soars In December
The troubled HealthCare.gov website was on pace to double its typical weekday volume of users, logging 375,000 unique visitors by noon Monday with more than 800,000 site visitors expected by day's end, the Obama administration said. Officials expected site usage to soar in December as people scurry to enroll in coverage by Dec. 23 in order to have insurance that begins on January 1, 2014. Monday's early volume proved those projections correct (Pugh, 12/2).

CQ HealthBeat: Healthcare.Gov Showing Strain As Volume Increases
Federal officials started diverting consumers from the federal health marketplace website on Monday after they saw worrisome response times and error rates when about 35,000 people were on healthcare.gov at the same time. Previously, they said they would put consumers in a queueing system when there were 50,000 users at a time (Adams, 12/2).

The Hill: Back-Up System Goes Into Effect For HealthCare.Gov
A back-up system was deployed for HealthCare.gov on Monday at a lower traffic rate than federal officials projected, signaling there could be further trouble with the system. The Centers for Medicare and Medicaid Services (CMS) acknowledged that the site's try-again-later system was initiated as roughly 35,000 users tried to access HealthCare.gov at the same time (Viebeck, 12/2).

Kaiser Health News: Capsules: Many Consumers Report Improvements With Healthcare.gov
Vickie Fleisher-Gann had been trying since Oct. 1 to complete her Obamacare application so she could start shopping for insurance on healthcare.gov, but she kept getting stopped by error messages. With her policy expiring at the end of the year, she feared time was running out. On Sunday morning, the former Harrisburg, Pa., hospital administrator finally was able to complete her application, shop for a plan and enroll -- all within about 30 minutes. "I was shocked when it worked," said Fleisher-Gann, 61. "I just couldn't believe it" (Galewitz, 12/2). 

CBS News: Shoppers, Insurers Still Face HealthCare.Gov Hiccups
Despite promises the website could handle 50,000 users at the same time, the queuing system was turned on Monday at approximately 35,000 users. Officials said they had to "maximize the smooth user experience" for those who applied first. There are also potential problems for the thousands who have signed up for new plans (Andrews, 12/2).

Meanwhile, here's how the website is being viewed in specific states --

Kansas Health Institute: Healthcare.Gov Better In Kansas But Still Slowed By High Traffic
Despite improvements made since its disastrous October launch, the HealthCare.gov website today was still not able to seamlessly handle large numbers of consumers attempting to sign up by a Dec. 23 deadline for coverage that starts Jan. 1. Kansas is one of 36 states that chose to rely on the federal website rather than build one of its own (McLean, 12/2).

Miami Herald: Healthcare.Gov Improved, But South Florida Users Still Stymied
Long waits, error messages, unresponsiveness. Hallmarks of the troubled launch of the Health Insurance Marketplace at healthcare.gov continued to stymie South Florida residents and counselors trying to access the website on Monday -- more than two months after the Oct. 1 launch, and despite the government’s self-imposed deadline of Nov. 30 for the system to function smoothly for the "vast majority of Americans" (Chang and Borns, 12/2).

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Earlier Signs Of Website Problems Weren't Addressed

The Wall Street Journal examines how officials building the federal marketplace failed to alert others to problems they were encountering. Other reports look at the concerns about some functions on the site that still are not working properly.

The Wall Street Journal: Health Website Problems Weren't Flagged In Time
When warning signs emerged earlier this year, the agency running the Healthcare.gov website mostly kept the problems to itself -- a decision that now looms large in explaining how the project went so badly astray. Over the weekend, the White House official leading the repair effort, Jeffrey Zients, described a series of improvements that took just six weeks to carry out under a new general contractor, underscoring how an earlier alert might have led to problems being addressed more urgently before the site's Oct. 1 launch (Nagesh, 12/2).

The Washington Post: Health Care Enrollment On Web Plagued By Bugs
The enrollment records for a significant portion of the Americans who have chosen health plans through the online federal insurance marketplace contain errors -- generated by the computer system -- that mean they might not get the coverage they're expecting next month. The errors cumulatively have affected roughly one-third of the people who have signed up for health plans since Oct. 1, according to two government and health-care industry officials. The White House disputed the figure but declined to provide its own (Goldstein and Eilperin, 12/2).

Marketplace: Healthcare.Gov's Next Hurdle: Fixing The Part You Don't See
By midday Monday,  roughly 375,000 people had logged onto healthcare.gov. But an "Open for Business" sign may still be a long distance from a health insurance policy that works at the doctor's office. There are a lot of steps between signing up for health insurance and actually getting that insurance card. Just think about all the folks -- and computers -- that need to talk to each other (Hill, 12/2).

And NPR looks at the extensive problems Oregon has experienced in building its own marketplace.

NPR: Could A Tech Giant Build A Better Health Exchange? Maybe Not
Oregon has spent more than $40 million to build its own online health care exchange. It gave that money to a Silicon Valley titan, Oracle, but the result has been a disaster of missed deadlines, a nonworking website and a state forced to process thousands of insurance applications on paper. Some Oregon officials were sounding alarms about the tech company's work on the state's online health care exchange as early as last spring. Oracle was behind schedule and, worse, didn't seem able to offer an estimate of what it would take to get the state's online exchange up and running (Henn, 12/2).

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Problem Transferring Medicaid Enrollment Data Could Leave Some Without Coverage

The difficulty with sending the completed Medicaid applications from the federal website to states for final processing could leave some of the newly enrolled without coverage early next year. To circumvent the problem, administration officials agreed to let states enroll people without their full applications. But that poses potential risks for states.

Politico: Medicaid, Insurance Fixes May Be Big Trouble Later
An Obamacare fix quietly announced on Black Friday could put states at risk for higher Medicaid costs and even fraud. Although Medicaid sign-ups through HealthCare.gov have been considered a rare bright spot in the flawed Obamacare rollout, the federal portal has been unable to send those Medicaid applications to the states for final processing. If states can't receive and complete their work on Medicaid applications by the end of the year, people could go without Medicaid coverage in early 2014 despite having an eligibility determination (Cheney, 12/3).

CQ HealthBeat: Medicaid Workaround Bypasses Healthcare.Gov To Transmit Applicant Data
Federal Medicaid officials will allow states to enroll people without receiving the actual applications they complete through healthcare.gov. The move is a tacit acknowledgement that in most cases the transfer of application information between the federal insurance exchange and the 36 states it serves will not be ready right away (Adams, 12/2).

In the meantime, Wyoming says no to the expansion, and California details how many who contacted the state exchange are eligible --

The Washington Post: Wyoming Governor Says No To Medicaid Expansion
Wyoming Gov. Matt Mead (R) said Friday he doesn’t want his state to accept federal funding to expand Medicaid coverage, due to problems with the rollout of the Affordable Care Act so far. Mead, a longtime opponent of the law, said the federal health-care exchanges set up under the ACA have hurt more than they have helped, undercutting his confidence in the federal government’s commitment to cover 90 percent of the costs of Medicaid expansion into the future (Wilson, 12/2).

California Healthline: Medi-Cal A Hidden Enrollment Success
The Department of Health Care Services last week released enrollment numbers for Medi-Cal-eligible Californians who initially contacted the Covered California health benefit exchange. The department said 143,608 people will likely receive Medi-Cal coverage as a result of contacting Covered California. That's about 40% of all applications completed through the exchange, said Anthony Cava, a spokesperson for DHCS (Gorn, 12/1).

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Supreme Court Turns Down Liberty University's Challenge To The Health Law's Employer Mandate

The Christian college, located in Virginia, argued that the mandate is unconstitutional, but the high court rejected the petition, marking the second time in two years that it has declined to review the constitutionality of the overhaul's requirements for most large employers regarding health coverage for workers.

Los Angeles Times: Supreme Court Declines To Hear Case On Obamacare's 'Employer Mandate'
The Supreme Court will not reconsider the part of President Obama’s healthcare law that requires employers to provide basic health insurance for their workers or pay a tax penalty. The justices on Monday dismissed an appeal brought by a conservative Christian college in Virginia that contended the "employer mandate" is unconstitutional (Savage, 12/2).

The Associated Press/Washington Post: High Court Ends Liberty U. Lawsuit Over Health Law
The Supreme Court has turned away a Christian university’s attempt to overturn a key part of the Obama administration’s health care law. The justices did not comment Monday in leaving in place a federal appeals court ruling dismissing Liberty University’s lawsuit (12/2).

Politico: Supreme Court Rejects Liberty University Employer Mandate Challenge To Health Law
The Supreme Court on Monday declined to wade into the constitutionality of Obamacare’s employer mandate. The high court rejected a petition from Liberty University, which challenged the law’s employer coverage requirements, individual mandate and contraception coverage requirements. A lower court upheld the law in Liberty’s case. Last week, the justices agreed to review two other cases, brought by the Hobby Lobby craft-store chain and Conestoga Wood Specialties, that focus specifically on the law’s contraception coverage requirement and these for-profit companies’ claim of religious exemption (Haberkorn, 12/2).

CNN: Supreme Court Won’t Hear Broader Legal Challenge To Obamacare
A broader legal challenge to Obamacare's so-called "employer mandate" was turned aside by the Supreme Court on Monday. The justices, without comment, again refused to intervene in Liberty University's long-running appeal of the Affordable Care Act. It marked the second time in two years the court has declined to review the constitutionality of requirements for most large employers to offer a range of health insurance coverage for their workers (Mears, 12/2).

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Feds May Help Offset Insurers' Losses On Canceled Policies; If Website Falters Again, Some Consumers Face Increased Risks

Also, a new poll examines how much people know about the law.

The New York Times: Insurers Are Offered Assistance For Losses
The White House is offering more money to insurance companies as an incentive for them to let people keep insurance policies that were to have been canceled next year. The administration floated several proposals on Monday to "help offset the loss in premium revenue and profit" that it said might occur if insurers went along with President Obama's request to reinstate canceled policies (Pear, 12/2).

The Associated Press: Year-End Signups Crucial Test For Health Care Site
President Barack Obama's new and improved health care website faces yet another test in just a couple of weeks, its biggest yet. If HealthCare.gov becomes overwhelmed by an expected year-end crunch, many Americans will be left facing a break in their insurance coverage. ... Some of those at risk are among the more than 4 million consumers whose individual policies have been canceled because the coverage didn’t comply with requirements of the new health care law. A smaller number, several hundred thousand, are in federal and state programs for people whose health problems already were a barrier to getting private insurance before the overhaul (Alonso-Zaldivar, 12/2).

The New York Times: Cost Of Health Care Law Is Seen As Decreasing
The rollout of President Obama’s health care law may have deeply disappointed its supporters, but on at least one front, the Affordable Care Act is beating expectations: its cost. Over the next few years, the government is expected to spend billions of dollars less than originally projected on the law, analysts said, with both the Medicaid expansion and the subsidies for private insurance plans ending up less expensive than anticipated (Lowrey, 12/2).

CNN: Younger Americans Least Familiar With Obamacare, Polls Show
Americans 18 to 29 are the least familiar with the Affordable Care Act, a new Gallup poll has found. ... Gallup found that 63% of those 18-29 respondents say they are "very familiar "or "somewhat familiar" with the law, while 37% say they are "not too familiar" or "not familiar at all." The age group that reports the most familiarity with Obamacare is the 50-64 age range, with 77% of those respondents describing their knowledge of the law as "very familiar" or "somewhat familiar" (12/2).

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California's Small Business Insurance Exchange Opens For Business

Even though the federal government announced last week that it would delay the federal small business online marketplace, California's began operating on Monday for businesses with as many as 50 employees.  

Los Angeles Times: State Health Insurance Exchange Aims To Enroll 7,000 Small Firms
Trying to stem a steady erosion in employer health coverage, California's insurance exchange said it's looking to enroll 7,000 small businesses next year as part of the federal healthcare law. At an event in Los Angeles on Monday, officials with Covered California said their online marketplace for small firms is fully operational and that more than 1,500 businesses had already created shopping accounts on the state website (Terhune, 12/2).

Kaiser Health News: Capsules: California's Small Business Insurance SHOP Opens, A Contrast To Feds
Many companies will be able to receive a tax credit, meaning the federal government will help cover their portion of the employee premiums. To be eligible for tax credits, businesses must have fewer than 25 full-time employees, pay employees less than $50,000 a year and cover at least half of the full-time employees’ premiums (Gorman, 12/2).

And, in related news -

Los Angeles Times: California's Health Insurance Exchange: 5 Things To Watch In December
Like many retailers, California's health insurance exchange is banking on a rush of December shoppers. California has already signed up nearly 80,000 people in private health plans and 135,000 more in Medi-Cal, the state's Medicaid program. But crunch time starts now as deadlines approach. People have until Dec. 23 to sign up for coverage that takes effect Jan. 1. Open enrollment runs through March (Terhune, 12/2).

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Administration News

White House Readies New Health Law Push After Website Woes

President Barack Obama and the White House will launch a new three-week health law offensive to re-sell the law to Americans after woes with the federal online website to buy health coverage hurt public perception of the law. Obama himself plans on buying coverage on the federal exchange website.

The Associated Press/Washington Post: Obama Tries To Move Past Health Care Website Woes
President Barack Obama will focus on those benefits at a White House event Tuesday. Flanked by Americans who the White House says have benefited from the overhaul, the president will try to remind Americans that his health law is preventing insurance discrimination against those with pre-existing conditions and is allowing young people to stay on their parents’ coverage until age 26. He’ll also take aim at Republicans, arguing that the GOP is trying to strip away those benefits without presenting an alternative (12/3).

Politico: White House Returns To Obamacare Sales Mode
President Barack Obama will launch a coordinated campaign Tuesday by the White House, congressional Democrats and their outside allies to return attention to why the Affordable Care Act passed in the first place. After two months of intense coverage of the botched HealthCare.gov rollout, the president will host a White House event kicking off a three-week drive to refocus the public on the law’s benefits, senior administration officials told Politico (Budoff Brown and Allen, 12/2).

The Wall Street Journal’s Washington Wire: Obama Speech To Kick Off Health Push
President Barack Obama on Tuesday will launch a new effort aimed at highlighting the benefits of the Affordable Care Act, as the White House works to shift the conversation away from the botched rollout of HealthCare.gov. A White House official said that while work continues on the website, the administration wants to renew its focus on aspects of the law that it says are already helping consumers. Mr. Obama will speak Tuesday at 2:30 p.m. at the White House, kicking off a three-week, coordinated campaign that will feature a benefit of the federal-health law each day (Nelson, 12/3).

Reuters: With Website Improved, Obama To Pitch Health Plan
President Barack Obama will try to sell the American people on the relaunch of his troubled healthcare program on Tuesday in a bid to restore confidence in his signature domestic policy initiative and, more broadly, in his presidency. Obama will speak on the health care program, formally called the Affordable Care Act, at 2:30 p.m. Tuesday, the White House said (Felsenthal, 12/3).

Bloomberg: Obama To Tout Health Law’s Benefits To Rebuild Support
President Barack Obama plans to highlight the 2010 health-care law’s benefits at a White House event today, kicking off a three-week campaign to regain support for a program marred by a troubled implementation. Obama will emphasize the importance of using the newly-repaired federal online insurance exchange to enroll Americans in health plans, the White House said in a statement (Dorning, 12/3).

CNN: Official: White House To Push Benefits Of Obamacare, PR Offensive On The Way 
Battered by two months of bad publicity over the Obamacare website, the White House is going on the offensive to tout what it sees as the benefits of the President's signature healthcare plan, a White House official told CNN. The offensive is a sign the White House no longer feels weighed down by the problem-plagued HealthCare.gov. Over the weekend, officials announced they had met their self-imposed November 30 deadline for getting the site working for the "vast majority" of users, saying response times and error rates had been slashed while capacity increased (Acosta and Payne, 12/3).

The Wall Street Journal: West Wing Set For New Blood
President Barack Obama will likely soon have three top staff positions to fill, at a time when he is under mounting pressure from the public and Democratic lawmakers to prove he can manage more adeptly and restore confidence in his signature health care program. The White House said over the weekend that it would create a new, permanent position overseeing HealthCare.gov, the troubled website that has threatened the success of the 2010 health law and been one of the most serious challenges facing the Obama presidency. Jeffrey Zients, who leads the online effort on a temporary basis, leaves early next year to become director of the president's National Economic Council (Nicholas and Lee, 12/2).

Los Angeles Times: Obama To Use Federal Health Insurance Exchange To Find A New Plan
The president plans to buy new health insurance through the online marketplace created by his signature health care law, a spokesman said Monday, confirming a promise the White House made nearly three years ago as it fought to push the legislation through Congress. White House spokesman Jay Carney told reporters that he did "not have any update" on the president's plans to enroll but suggested Obama was among the many Americans who are taking their time signing up for a new insurance plan. Open enrollment ends March 31 (Hennessey, 12/2).

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Capitol Hill Watch

Health Law Complicates Democratic Senators' Reelection Efforts In The South

The Wall Street Journal reports that three of the four most vulnerable Senate Democrats are from southern states. The paper also looks at how members of Congress will fare on the new online insurance marketplace.

The Wall Street Journal: Democrats Face Battles In South To Hold The Senate
[Sen. Mark] Pryor and Sens. Kay Hagan of North Carolina and Mary Landrieu of Louisiana—as well as Democratic candidates in Kentucky and Georgia—must contend with the dismal approval ratings of President Barack Obama in their home states. They face increased political pressure from the problem-ridden rollout of the health-care law (Hook, 12/2).

The Wall Street Journal’s Washington Wire: What Obamacare Coverage Costs Congressmen
Some members of Congress are about to get their own kind of sticker shock when they head to the new insurance exchanges. A few will get a price cut.  As the Journal has reported, a provision in the health law requires lawmakers to get their benefits alongside small-business employees for the first time, and that means lawmakers' premiums will suddenly be tied to their age. ... Here’s what’s happening to a selection of senators and representatives, with a look at the plans available to them (Ballhaus and Radnofsky, 12/2).

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Health Care Marketplace

Hospital Prices -- Biggest Driver Of Medical Inflation -- Remain Opaque

Nothing is more convoluted than hospital charges, which represent about a third of the nation's $2.7 trillion annual health care bill, reports The New York Times. Reuters finds that hospitals may quote prices for parking but not for procedures. Meanwhile, Kaiser Health News describes the trend in palliative care programs, designed to relieve pain and distress, regardless of how long a patient has to live.

The New York Times: As Hospital Prices Soar, A Single Stitch Tops $500
In a medical system notorious for opaque finances and inflated bills, nothing is more convoluted than hospital pricing, economists say. Hospital charges represent about a third of the $2.7 trillion annual United States health care bill, the biggest single segment, according to government statistics, and are the largest driver of medical inflation, a new study in The Journal of the American Medical Association found (Rosenthal, 12/2).

Reuters: Hospitals Will Quote Prices For Parking, Not Procedures
People usually don't know what their medical procedures cost until after they leave the hospital, and a new study suggests they would have a hard time finding out in advance. Inspired by an earlier study looking at hip replacement surgery costs, researchers tried to see if consumers could get price quotes for a much simpler diagnostic test from Philadelphia area hospitals (Jegtvig, 12/2).

Los Angeles Times: Cedars-Sinai And UCLA Health Teaming Up To Open Rehab Hospital
Two longtime rivals, Cedars-Sinai Medical Center and UCLA Health System, are teaming up to open a 138-bed rehabilitation hospital in Century City, reflecting both the growing need for this specialty care and the pressure on hospitals to control costs (Terhune, 12/2).

Kaiser Health News: When Palliative Care Is The Best Care
Hospitals around the country are increasingly starting palliative care programs, designed to relieve seriously ill patients’ pain, stress and symptoms regardless of how long they have to live. While some patients are close to death, others are still receiving treatment to extend their days. And as they do, the palliative care team, including doctors, social workers, nurses and chaplains, tries to improve their quality of life (Gorman, 12/3).

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State Watch

State Highlights: Okla. Gov. Looks For Cuts To Cover $60M More In Health Care Costs; Miss. Gov. Wants To Offer Hospitals Money To Offset Health Law

A selection of health policy stories from Oklahoma, Mississippi, Wisconsin, Delaware, Texas, Colorado, Massachusetts, Georgia and California.

The Associated Press: Fallin Warns Of $60M Spike In Health Care Costs
[Oklahoma] Gov. Mary Fallin said Monday that state agency heads should be looking for ways to save money in next year's budget, given reports of lackluster tax collections to Oklahoma's general revenue fund and the more than $60 million increase in mandatory health care spending the state will bear next year (Murphy, 12, 2).

The Associated Press: Bryant Wants To Give Hospitals Funds To Offset Health Care Reform
[Mississippi] Gov. Phil Bryant is proposing the state give Mississippi hospitals $4.4 million to offset an expected loss of federal funds due to the Affordable Care Act. Under the federal health care law, over a period of years the reimbursement to hospitals for treating people with no health care coverage will be reduced (12/2).

Bloomberg: Wisconsin Tries To Follow Texas In Reviving An Abortion Law
One month after Texas Attorney General Greg Abbott won a U.S. appeals court ruling overriding a decision to block abortion restrictions in his state, Wisconsin's top lawyer is aiming for a similar result. Both states have laws requiring doctors who perform abortions to obtain admitting privileges at a hospital within 30 miles (48 kilometers) of their clinic (Harris, 12/3).

The Associated Press/Washington Post: Delaware Mental Health Task Force Continues Work
A task force studying Delaware's civil mental health laws is finishing up its work in advance of a Jan. 1 deadline for submitting a report with its full findings to the General Assembly and the governor. Among the issues that have been examined by the task force, which meets Tuesday, are immunity provisions regarding involuntary mental health commitments. The immunity provision were the subject of a task force report that was due earlier this year and which was followed with legislation signed by Gov. Jack Markell in March (12/3).

The Texas Tribune: In Texas, Uncertainty After Health Plan Cancellation Uproar
Many Texans in individual health care plans that don't comply with the Affordable Care Act have been spared cancellation notices. But for the Texans whose plans have been dropped, health care experts are encouraging them to proceed carefully (Zaragovia, 12/3).

The Texas Tribune: Despite Changes, Nurses Push For More Independence
As an advanced practice nurse specializing in family medicine, Holly Jeffreys operates the only medical clinics in two rural Texas Panhandle counties. The state requires that she have a contract with a physician to supervise both clinics, but she operates the facilities almost independently (Aaronson, 12/2).

I-News/Health Policy Solutions (a Colo. news service): Delays To Implementing Mental Health Initiative ‘An Embarrassment’
Susan Beckman wants you to know that "a lot of sloppy work" -- and not a conspiracy -- were behind the state's botched job of finding someone to run a network of walk-in mental health crisis centers. Beckman heads the administrative branch of the Colorado Department of Human Services, the office responsible for the failed solicitation process. The department has been accused of colluding with local actors -- that is, local providers of mental health services -- to elbow out a newcomer, but Beckman says a slew of mistakes were just human error (Jones, 12/2).

WBUR: Coming To Mass. Ballots? Nurse Staffing And Hospital 'Claw Back'
Two measures that the nurses’ union supports look like they've gathered enough signatures to move forward toward appearing on state ballots next year. One, titled The Patient Safety Act, would set a limit on how many patients a registered nurse can be assigned. The nurses' association says the measures have both gathered more than 100,000 signatures. Secretary of State William Galvin tells us on his website that for the 2014 election, "the initiative petition must be signed by a minimum of 68,911 certified voters. No more than one-quarter of the certified signatures may come from any one county" (Goldberg, 12/2).

Georgia Health News: Progress Being Made Against Costly Readmissions
Georgia's nursing homes and hospitals are collaborating more than ever to reduce readmissions, say officials with Georgia's Quality Improvement Organization (QIO), a state-based group funded by Medicare to review medical care. A big driver in this change has been the readmission penalties that hospitals now face. These penalties were created by the 2010 Affordable Care Act (Miller, 12/2). 

California Healthline: Health Information Exchange Taking Root In Northern California
Northern California health information organizations are helping lay the groundwork for the next steps in expanding health information exchange throughout the state. Their participation in pilot programs for secure messaging, rural health information exchange and personal health records puts Northern California communities in the forefront of the campaign to increase the use of health information technology. There are 16 community HIOs in California, half of which are operational. A new map shows health technology has reached 35 counties -- more than half of California's 58 counties (Edlin, 12/2).

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Editorials and Opinions

Viewpoints: Despite 'Fast Recovery,' Website Faces Challenges; Calif. GOP's 'Underhanded' Tactic; Obama's Work On Website Disappoints

The New York Times: Fast Recovery For Health Care Website
The Obama administration says it has made enormous improvements in its website for enrolling consumers in new health insurance plans. There are still major hurdles to surmount, but the strides made raise the prospects that the website will be able to help millions of Americans buy policies from private insurers on new insurance exchanges. ... That dire situation at the front end of the process has been largely corrected through a frantic repair effort over the past five weeks, but it won't be enough unless the final back-end stage of enrollment is fixed as well (12/2). 

Los Angeles Times: An Underhanded Anti-Obamacare Stunt By The California GOP
Opponents of the Affordable Care Act never stop producing new tricks to undermine the reform's effectiveness. But leave it to California Republicans to reach for the bottom. Their goal appears to be to discredit the act by highlighting its costs and penalties rather than its potential benefits. The device chosen by the Assembly's GOP caucus is a website at the address coveringcaliforniahealthcareca.com. If that sounds suspiciously like coveredca.com, which is the real website for the California insurance exchange, it may not be a coincidence. Bogus insurance websites have sprung up all over, aiming to steer consumers away from legitimate enrollment services (Michael Hiltzik, 12/2).

Los Angeles Times: Not A Good Enough Obamacare Fix
Success! The Obama administration announced over the weekend that it had hit its deadline of Nov. 30 for HealthCare.gov. Of course, there were caveats. The site will still probably get buggy when there's a lot of traffic, which is why Health and Human Services Secretary Kathleen Sebelius advised people to use it at off-peak hours. But that simply means peak hours will be moved to after midnight. After all, you don't alleviate crowding if you tell everyone to try a different door (Jonah Goldberg, 12/3).

Los Angeles Times: By Fumbling The Healthcare Website, Obama Disappoints
He's supposed to be the technology president, propelled into office by his team's expertise in social media, Internet tracking and online fundraising. Today, he looks like the fumbler-in-chief, clueless and groveling. It's hard to miss the irony as President Obama's grand idea hobbles out of the starting gate, tripped up by technological blunders and bureaucratic bumbling (Sandy Banks, 12/2).

The Washington Post: Obamacare Is Here To Stay
Winds were calm in the capital on Monday, except in the immediate vicinity of the White House, where gale-force exhalations were blowing out of the West Wing. After the administration's claim Sunday that star-crossed HealthCare.gov had been repaired with "private sector velocity," and the site's relatively smooth functioning on Monday, Obama administration officials moved with aerospace-sector velocity to celebrate meeting their self-imposed deadline (Dana Milbank, 12/2).

USA Today: Obamacare Isn't Perfect, But It's A Decent Fix
As the problems with HealthCare.gov, the website marketplace for individual health insurance for people in states which opted not to run their own health care exchanges, begin to fade, we will have more of an opportunity to examine the deeper flaws in the Affordable Care Act, commonly known as Obamacare (Duncan Black, 12/3). 

Bloomberg: HealthCare.Gov Is 'Fixed.' What Will Go Wrong Next?
The quick improvements may be impressive, but they also cast the failure to prepare the site for its Oct. 1 debut in an even harsher light. President Barack Obama can no longer claim that the three years since the Patient Protection and Affordable Care Act became law wasn't enough time to build a functioning website. But the software repair measurements miss the crucial metric: the number of people who sign up for health insurance on the federal exchange. The test of the HealthCare.gov fixes will be the extent to which they accelerate those sign-ups, which reportedly reached 100,000 in November (12/2).

Bloomberg: Does Obamacare Put Too Much Faith In Markets?
The idea of Obamacare was to harness the power of the market to deliver better health care. Perhaps the resulting monstrosity is our punishment for being so slow to see that markets aren't the solution to everything (Mark Buchanan, 12/2).

Fox News: It's A Clark Kent Moment For Republicans – How GOP Can Take Back Middle Class After Democrats' ObamaCare Mess
Each week offers new cause for alarm: whether a dysfunctional website rife with opportunity for security breaches, health care cancellation notices, or sharp increases in health care premiums, ObamaCare has quickly devolved into a political third rail for the Democratic party. Out of the ashes of ObamaCare, however, rises a golden opportunity for the Republican party – so long as the GOP's leadership has the presence of mind to grasp the full implications of this historic moment (John Jordan, 12/2).

The Chicago Sun-Times: Obamacare's Lesson: Government Does Stuff Badly
We conservatives are always on about the "unintended consequences" of government programs, but we didn't expect the Obama administration and congressional Democrats to provide such a vivid object lesson. If the tipsy, teetering debut of Obamacare invites a new skepticism about the capacity of government to run things, it will be the most welcome unintended consequence since Alexander Fleming left his staphylococci samples on a workbench over summer vacation. Government programs, after all, fail frequently but are almost never held to account, far less held up to ridicule (Mona Charen, 12/2).

On another issue -

The Wall Street Journal: Don't Get Your Operation On A Thursday
New York, five other states and the District of Columbia are considering legislation that would mandate minimum hospital-nurse staffing levels. The Massachusetts Nurses Association is planning an initiative for the November 2014 state ballot asking voters to approve a law setting minimum staffing levels for all hospitals, a change they say would alleviate the dangerous strain on overworked nurses and result in improved patient care. The nursing associations in the six states (including Texas, Iowa, Mass., N.J. and Minn.) fervently support such legislation. In turn, hospitals vehemently oppose staffing mandates (Eugene Litvak, 12/2).

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Stephanie Stapleton

Andrew Villegas

Lisa Gillespie
Shefali Luthra

The Kaiser Daily Health Policy Report is published by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation. (c) 2014 Kaiser Health News. All rights reserved.