Daily Health Policy Report

Wednesday, December 4, 2013

Last updated: Wed, Dec 4

KHN Original Reporting & Guest Opinion

Administration News

Health Reform

Health Care Marketplace

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Medicaid Expansion To Cover Many Former Prisoners

Kaiser Health News staff writer Guy Gugliotta, working in collaboration with The Washington Post, reports: "When Medicaid expands next year under the federal health law to include all adults living close to the poverty line, one group of eligible beneficiaries will be several million men and women who have spent time in state and federal prisons and jails. The Department of Justice estimates former inmates and detainees will comprise about 35 percent of the people who will qualify for Medicaid coverage in the states expanding their programs to anyone earning less than 138 percent of the federal poverty level, or about $15,000 for an individual in 2013. The Congressional Budget Office estimated earlier this year  that 9 million people will get that new coverage next year" (Gugliotta, 12/4). Read the story.

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Capsules: Obamacare Outreach Is On Wheels In Mississippi; Video: Problems Remain With Healthcare.gov Website; 1.46 Million Determined To Be Eligible for Medicaid And CHIP In October

Now on Kaiser Health News' blog, Marissa Evans reports on Medicaid and CHIP eligibility numbers: "After two months of media shellacking, healthcare.gov website woes and a series of skeptical congressional grillings, the Centers for Medicare & Medicaid Services (CMS) was accentuating the positive, noting the jump in the number of people eligible for Medicaid under the Affordable Care Act" (Evans, 12/4). 

In addition, Mississippi Public Broadcasting's Jeffrey Hess, working in partnership with KHN and NPR, reports on his state's enrollment outreach efforts: "In Mississippi, as in the 35 other states where healthcare.gov is running the enrollment show, it hasn’t been easy to sign up for the health law’s new insurance options. That’s a political problem for Democrats and a personal problem for the uninsured — but it’s a business problem for the companies that are trying to sell insurance plans in the new marketplace.
One insurance company, Humana, is taking to the road to tackle the problem. Humana launched two specially equipped buses which have Internet access and agents on board who can enroll Mississippians in Affordable Care Act plans" (Hess, 12/4).

Also on the Capsules, you can watch the video of KHN's  Mary Agnes Carey on PBS NewsHour Monday to discuss the bug fixes to the federal health insurance marketplace and the problems that remain to be addressed (12/3). Check out what else is on the blog.

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Some Face Marriage Penalty In Obamacare Subsidies

The Philadelphia Inquirer's Robert Calandra, working in partnership with Kaiser Health News, reports: "As the Affordable Care Act wobbles into its second month, more people are enrolling on the healthcare.gov website and learning if they are eligible to get a subsidy and what their monthly premium payment could be. Not everyone is happy, especially those who happen to be just above the subsidy cutoff. Some single older adults who don't qualify for a subsidy - the cutoff is $45,980 for one person - are pulling out dictionaries (it's a book older people use) and rereading the definition of affordable" (Calandra, 12/4). Read the story.

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Political Cartoon: 'Disappoint & Click?'

Kaiser Health News provides a fresh take on health policy developments with "Disappoint & Click?" by Steve Kelley.

Here's today's health policy haiku:  


The Fighting Irish
want health law to take a hike.
A Hail Mary pass?

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

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Administration News

White House Advances Health Law Defense, Urges People To Sign Up

The goal is to boost enrollment figures and reframe the debate with Republican opponents.

The Washington Post: Obama Embarks On New Health-Care Push After Web Site Fixes, Urges Americans To Sign Up
President Obama on Tuesday embarked on the difficult task of persuading Americans to reconsider his landmark health-care law after its botched launch, imploring people to sign up as part of a major push to publicize the benefits of the Affordable Care Act. Republicans immediately lampooned the effort — coming more than three years after passage of the law and two months after its disastrous rollout — and conservative activists vowed to wage a counterassault publicizing the law’s downsides (Goldfarb and Eilperin, 12/3).

Politico: W.H. Kicks Off Turnaround Campaign On Obamacare
President Barack Obama, confident that HealthCare.gov is finally working, attempted Tuesday to shift the nation’s attention toward Affordable Care Act benefits that he says were overshadowed by website problems at a critical time for the law. The president’s brief speech marked the start of the White House’s latest messaging push, a three-week campaign that aims to boost anemic enrollment figures and put Republicans on the defensive after Obamacare’s embarrassing rollout (Millman and Epstein, 12/4).

Politico: White House Turns To Bully Pulpit For ACA Turnaround
The White House launched three weeks of Affordable Care Act promotion in what it promises will be one of Obama’s most extensive, consistent messaging efforts in office. The first event was low-key — a short, quiet, decidedly non-rally-like appearance in a White House complex auditorium (Dovere and Allen, 12/3).

The New York Times: Obama To Defend Health Law As Economic Benefit
President Obama leaves the White House on Wednesday for one of the capital’s most struggling neighborhoods to talk about the economy, not simply to divert attention from his troubled Affordable Care Act but to explain how that law, for all of its flaws, fits into his vision for Americans’ economic security and upward mobility (Calmes, 12/4).

The New York Times: Obama Urges Focus On Health Care Law's Benefits
In brief remarks at the White House, the president began what aides described as a weekslong effort to move on from the negative stories of the botched HealthCare.gov rollout. Mr. Obama again conceded the problems but said critics who contended that the law had failed were wrong (Shear, 12/3).

The Associated Press/Washington Post: Obama Declares Health Care Law Is Working
Seeking to regroup from his health care law’s disastrous rollout, President Barack Obama on Tuesday insisted that the sweeping overhaul is working and warned Republican critics that he would fight any efforts to strip away its protections. “We’re not repealing it as long as I’m president,” Obama said during a health care event at the White House. “If I have to fight another three years to make sure this law works, then that’s what I’ll do” (12/3).

Los Angeles Times: Obama Acts To Defend Obamacare And Democrats From GOP Attacks
Two turbulent months into the launch of the Affordable Care Act's insurance marketplace, President Obama moved to defend the law against Republican attacks Tuesday as the administration tried to deflect attention from the federal website's botched rollout. The White House's renewed effort to tout the law has two aims: to encourage Americans to sign up for coverage and to reassure nervous Democratic lawmakers and other allies who have watched Obama's so-far unsuccessful efforts to contain the political damage (Hennessey and Parsons, 12/3).

Bloomberg: Obama Seeks To Salvage Health Law Support With New Focus
President Barack Obama, seeking to halt the erosion in public support for his health-care law, is using the power of his office to try to change the conversation.  After struggling for two months to fix the federal online insurance exchange at the core of the law, Obama yesterday began what aides say will be a three-week campaign to use his bully pulpit to regain momentum for his signature domestic initiative (Dorning, 12/4).

Reuters: Obama Urges Americans Not Be Discouraged By Rocky Healthcare Rollout
President Barack Obama urged Americans not to be discouraged by the rocky rollout of HealthCare.gov on Tuesday and vowed to fix whatever glitches remain as he sought to restore confidence in his leadership. Obama used a speech at the White House to address criticisms of the law and accuse his Republican opponents of attempting to gain politically from the problems surrounding his central domestic policy achievement (12/3).

NBC News: Obama On Affordable Care Act: 'We're Not Repealing It As Long As I'm President'
President Barack Obama said his signature health care reform law is going nowhere as long as he's in office, and he'll spend the remainder of his presidency fighting to make it work if necessary. "Do not let the initial problems with the website discourage you, because it's working better now, and it's just going to keep on working better over time," Obama said at an event at the White House intended to promote the health law and its benefits. "If I've got to fight another three years to make sure this law works, then that's what I'll do," he defiantly added later (O’Brien, 12/3).

The Washington Post: For Obama, Enrolling Under The Health-Care Law Was Inevitable
Unlike members of Congress, President Obama is not obligated to sign up for a plan under his signature health-care law. But from a political perspective, the president has little choice but to opt for either the federal or state health insurance exchange by the end of the year. The White House had announced in March 2010 that the president would enroll in an exchange in response to a political gambit by Republican Sen. Charles Grassley (Iowa), who proposed an amendment to the law that would have required Obama to buy a plan through the exchanges (Eilperin, 12/3).

The Wall Street Journal: Health-Law Fight Pivots Toward Midterms
The fight between the political parties to shape public opinion of the 2010 health-care law is entering a new phase that looks beyond the problems of the enrollment website, amid signs that the law's rocky rollout has damaged Democratic prospects for the next election. President Barack Obama, who spent weeks shouldering the blame for the troubled rollout, said Tuesday the HealthCare.gov website "is working well for the vast majority of users'' and used the moment to try to hit the reset button on the administration's effort to persuade people to sign up for insurance (Nelson, O’Connor and Hughes, 12/3).

And the GOP's counter-offensive -

McClatchy: GOP House Leaders Rip Obamacare, Pledge ‘Patient-Driven’ System
Republicans tried to get out in front on health care Tuesday, hours before President Barack Obama was to launch a new defense of the program at the White House. House of Representatives Republican leaders ripped the Affordable Care Act, known as Obamacare, and Majority Whip Kevin McCarthy, R-Caif., urged a "patient-driven health care system, not a government-driven health care system." So, House Speaker John Boehner, R-Ohio, was asked at a news conference, what does that mean? (Lightman, 12/3). 

Politico: New Obamacare Weapon For GOP: Doctors
Get ready for the next line of attack from the GOP on Obamacare: good luck keeping your doctor. As other controversies surrounding the law begin to fade, House Republicans are increasingly focused on President Barack Obama’s pledge that “if you like your doctor, you will be able to keep your doctor.” They’re hoping to replicate the uproar over canceled insurance plans, which has caused problems for millions of consumers nationwide and political headaches for Democrats (Kim and Haberkorn, 12/3).

In addition, the New York Times examines who in the administration might be held accountable for the troubles so far -

The New York Times: Considering Which Head Or Heads May Roll For A Troubled Website Rollout
White House officials, asserting that the HealthCare.gov website is largely fixed, are under mounting pressure from Democrats and close allies to hold senior-level people accountable for the botched rollout of President Obama’s signature domestic achievement and to determine who should be fired. For weeks, the president and his aides have said they are not interested in conducting a witch hunt in the middle of the effort to rescue the website. But in the West Wing, the desire for an explanation about how an administration that prides itself on competence bungled so badly remains an urgent mission (Shear, 12/3).

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Today's Administration Pro-Obamacare Theme To Focus On 18-35 Year Olds

Meanwhile, a new poll looks into how 'young invincibles' feel about buying insurance while a second measures public thoughts on paying the fine instead of getting coverage.

The Hill: Obama To Pitch Health Law To Young Activists
President Obama will address a gathering of 18-35 year old activists Wednesday at the White House Youth Summit, the latest in an intensifying push to sell his signature healthcare law. Obama has placed a particular emphasis on recruiting young, healthy consumers to purchase insurance (Sink, 12/3).

Los Angeles Times: Obama To Urge 'Young Invincibles' To Buy Health Insurance
Wednesday's youth summit at the White House — and the evening Google chat with White House advisors David Simas and Kal Penn to reach a wider audience — will offer Obama a chance to reengage young people, a White House official said, and the president will make brief remarks. ... So far, the picture has been mixed. Polls show demand for health insurance among younger adults is strong, but federal officials have not released demographic data showing what percentage of sign-ups fell within the 18 to 34 age group (Reston, 12/3).

CBS News: 40 Percent Of People Under 30 Would Move For Better Health Insurance
More than 40 percent of Americans under the age of 30 say they would consider relocating if it meant access to better and/or less-expensive health insurance, according to a new study. While teens and 20-somethings are the age group usually most willing to move in general, the survey by Bankrate.com also found that 28 percent of all Americans, no matter the age, would consider moving to a new state or county if it improved their coverage or made it less expensive (Von Hoffman, 12/3).

Politico: Poll: 28% Would Rather Pay Fine
More than a quarter of uninsured Americans say they are more likely to pay the fine than sign up for Obamacare before the deadline, a new poll shows. Twenty-eight percent of those surveyed say they will likely pay the fine, according to a Gallup poll released Tuesday’s number that has remained consistent despite the approaching enrollment deadline in March (McCalmont, 12/4).

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Health Reform

New, Improved Healthcare.gov Gets Praise, But Problems Persist

Administration officials lauded the website fixes and said that 750,000 users logged on Monday, but insurers continued to have concerns about the transfer of inaccurate data and automated subsidy calculations.

Politico: Obamacare Fix Wins Applause, But Troubles Remain
For House Democratic Caucus Chairman Xavier Becerra, the new, improved Obamacare website is better than it was — but the law won’t be a success “until every American who has a chance to qualify for these health insurance policies gets it.” For Jeremy Milarsky, who works for one of the “navigator” groups in Missouri that’s helping people sign up, the website is improved enough to make the job easier, mainly because of a new health plan browser feature that actually works (Nather, 12/4).

McClatchy: HHS Temporarily Scraps Automated Payments For Insurers
With the automated payment system for the federal health insurance marketplace still under construction, the Obama administration will temporarily require insurers to manually submit their payment requests beginning in January. The marketplace was supposed to calculate the amount of premium tax credits and cost-sharing benefits that low- and middle-income enrollees were eligible for after they sign up for marketplace coverage. The financial assistance would then be sent electronically to insurers to help pay for coverage (Pugh, 12/3).

CQ HealthBeat: Insurers Kicking The Tires On Fixes For Healthcare.Gov Enrollment Foul-Ups
Insurance companies are scrambling this week to see if the problems with enrollment data that federal officials say have been fixed actually are working. Centers for Medicare and Medicaid Services officials say they have fixed most — but not all — of the bugs on healthcare.gov that either prevented insurers from getting any information about people that enrolled in their plans or gave them inaccurate data (Adams, 12/3).

The Hill: WH Contests Report On Website Problem
The White House contested a report Tuesday that found that as many as a third of completed applications through the ObamaCare website were incorrectly transmitted to insurers. White House press secretary Jay Carney said the figure “does not reflect at all” circumstances “that are happening today” (Sink, 12/3).

The New York Times: Even With Website Fixes, Troubles Persist In Applying For Insurance
While Obama administration officials were heralding the improvements with the website, saying that 750,000 users logged on Monday, hundreds of people took to the website’s Facebook page and other social media platforms to report mixed results (Preston, 12/3).

USA Today: 1 Million People Visited Health Care Website Monday
One million people accessed HealthCare.gov on Monday, its first weekday of operation since a team of technology experts finished a series of fixes aimed at stabilizing the troubled website, the Centers for Medicare and Medicaid Services said Tuesday (Kennedy, 12/3).

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Report: IRS Ready To Calculate Subsidies, Needs To Boost Fraud Detection

The report concluded that subsidies could be vulnerable to fraud -- marking yet another potential trouble spot for the health law's implementation.

The Associated Press: Audit: Health Care Subsidies Vulnerable To Fraud
Government subsidies to help Americans buy insurance under the health care overhaul may be vulnerable to fraud, a Treasury Department watchdog warned on Tuesday in the latest indication that troubles are far from over for President Barack Obama’s signature legislation. The rollout of the law has been hurt by canceled policies and problems with the federal website used by people to enroll in health plans, causing political headaches for the White House and for Democrats in Congress. The new problems concern subsidies that are available to low- and medium-income people who buy insurance through state-based exchanges that opened in October (Ohlemacher, 12/3).

The Wall Street Journal’s Washington Wire: IG Report: IRS Must Be Vigilant On Health-Care Fraud
The Internal Revenue Service has developed accurate systems for calculating health-care tax credits under the Affordable Care Act, but it needs to strengthen fraud detection and other systems, the inspector general for the IRS said in a report. Starting in January, eligible taxpayers who buy insurance through government-run exchanges can qualify for the credits under the health law to help them pay their premiums (McKinnon, 12/3).

Politico: Report: IRS Ready On ACA Tax Credits But Not For Fraud
The Internal Revenue Service has successfully finished testing systems to accurately calculate tax credits under Obamacare but needs to improve its controls to avoid problems with fraud as the agency begins doling out the credits in 2014, an inspector general report said Tuesday. The Treasury inspector general for tax administration said in a report that IRS software has a system to verify tax credit calculations before it issues them to health insurers, but it said the agency may not yet have a system in place to stop tax cheats seeking to underestimate their incomes and fraudulently cash in on health subsidies (Bade and French, 12/4).

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States Lead In Health Law Insurance Sign-Up Race

States operating their own insurance websites are leading the federal government in signing up people for health coverage. Though healthcare.gov, the federal website which serves the residents of 36 states, is working better for some, complicated cases still bewilder "navigators" -- and Texas has proposed new rules and background checks for the workers.

CBS News: How Some States Are Pulling Off Stealth Obamacare Sign-Ups
Despite the failings of the buggy federal healthcare.gov site, there’s a stealth march on enrolling people in Obamacare.  That's coming from the 14 states and the District of Columbia that have created their own websites to sign people up for private health insurance. In October, these sites signed up almost 80,000 people for health-care plans, compared with fewer than 27,000 enrollees for the federal site that serves 36 states, Bloomberg notes (Picchi, 12/3).

The Associated Press: Health Care Website OK, Cases Can Be Complicated
The federal health care website worked just fine Tuesday for Texans seeking insurance coverage, but trained helpers are finding some individual cases are not so simple and those delays have nothing to do with technology. On the same day President Barack Obama vigorously defended his program to make sure the vast majority of Americans have health insurance, counselors across Texas dealt with an influx of applicants hoping to get insured after months of delays due of shoddy technology (12/4).

The Texas Tribune: TDI Proposes New Rules For Health Navigators
To address privacy concerns raised by state leaders, the Texas Department of Insurance on Tuesday proposed additional rules for the so-called navigators directed to help Texans find health insurance under the federal Affordable Care Act (Aaronson, 12/3).

The Dallas Morning News: Texas Insurance Chief Says Obamacare 'Navigators' Need Background Checks, Training 
The Texas Department of Insurance on Tuesday proposed background checks and 40 hours of additional training for the federally paid "navigators" who help consumers sign up for coverage under the federal health law. The department called for state testing and registration of navigators. The tentative rules would make organizations that hire navigators post sureties or carry malpractice insurance to pay out tens of thousands of dollars for their potential "wrongful acts" (Garrett, 12/3).

NPR: Nonprofits Challenge Missouri Licensing Law For Insurance Guides
In the first lawsuit of its kind, several nonprofit groups that received federal grants to help people sign up for insurance under the Affordable Care Act are suing the state of Missouri. The Missouri law requires health insurance helpers called navigators to be licensed by the state, which involves passing an exam and paying a fee (Rovner, 12/3).

In the meantime, there are updates from how exchanges are doing in Washington state, Colorado, California and Maryland --

The Seattle Times: Healthplanfinder Enrollment Tops 175,000 -- Mostly In Medicaid
More than 175,000 Washington residents have signed up for health insurance through Washington Healthplanfinder, the state's online insurance marketplace, according to the latest enrollment figures released Tuesday by the Washington Health Benefit Exchange. The vast majority of enrollees qualified for the state's Medicaid program, Apple Health, which is expanding eligibility in 2014 to include adults with incomes up to 138 percent of the federal poverty level, which is about $16,000 for an individual (Landa, 12/3).

The Denver Post: Enrollments At Colorado Health Insurance Exchange Rise To 9,980
Enrollment in the state health exchange and expanded Medicaid programs ramped up steeply in the last half of November, with private policies climbing by two-thirds in two weeks. Colorado's state-run exchange now has 9,980 members buying private policies, many subsidized by federal credits, since the Oct. 1 rollout of new Affordable Care Act reforms. That was up from 6,001 when the exchange last reported on Nov. 18 (Booth, 12/2).

The Denver Post: Colorado's Congressional Delegation Still Shopping For Health Care
The very people casting the votes and doing the most thinking and talking about the virtues and vices of the Affordable Care Act face a personal decision with a looming deadline: What to do for their own health care next year (Sherry, 12/3).

California Healthline: California Small Business Exchange Up & Running, Unlike Delayed Federal Exchange
Covered California officials yesterday said the state's small business exchange has 1,500 applications in progress and is successfully online, as well -- unlike the recently delayed federal small-business exchange site. "We are up and running and open for business," Covered California executive director Peter Lee said. About 1,500 employers have set up accounts with the Small-Business Health Options Program -- or SHOP -- since enrollment opened Oct. 1, Lee said (Gorn, 12/3).

California Health Report: Knocking On Doors For Obamacare 
Hundreds of paid canvassers and volunteers fanned out across the state over the last two weeks to tell residents such as Ordaz about the new health-care law and encourage the uninsured to sign up for coverage. The canvassing, which stretched across 12 counties from San Diego to the Bay Area, was organized by California Calls, a nonprofit that aims to change the state’s voting electorate. In a twist on health-care advocacy, the group is using the new law as leverage for its activism. After telling registered voters about Obamacare, the community organizers asked residents for their contact information and whether they’d like to participate in community forums (Guzik, 12/4).

The Baltimore Sun: Despite Troubles, State Keeps Goal For Health Exchange
Despite continuing technical glitches, the director of Maryland's troubled health exchange said Tuesday that she believes the state can reach its goal of enrolling roughly a fifth of its uninsured residents by the end of March. Rebecca Pearce, executive director of the Maryland Health Benefit Exchange, acknowledged that only about 3,000 people have signed up for private health plans so far (Cox, 12/3).

Some are having better luck enrolling at healthcare.gov --

The Associated Press: Federal Health Care Website Working Better In Utah
When she first tried several weeks ago to sign up for health insurance on the federal government's online marketplace, Pam Sheridan was repeatedly kicked off by the glitch-plagued website. Her second attempt Friday went much smoother: she was able to enroll without any hitches in less than an hour (McCombs, 12/3).

The Associated Press: Pa. Residents See Some Upgrades On Health Website
The federal government's beleaguered health insurance website is better than it was, but still far from flawless, according to Pennsylvanians who are trying to help other residents use it to obtain health coverage. In Harrisburg, Roberta Vann, a certified application counselor at the Hamilton Health Center, reported a noticeable improvement in the operation of Healthcare.gov Monday morning (Jackson, 12/3).

ProPublica: For Uninsured Missouri Reporter, Obamacare Is A Real-Life Story
For Missouri public radio reporter Harum Helmy, the Affordable Care Act is more than just a story she covers. It is also a story she’s living (Ornstein, 12/3).

In other state news related to the health law's implementation -

Reuters: Wisconsin Lawmakers Consider Delay In State Medicaid Changes
Wisconsin lawmakers on Wednesday are expected to consider delaying by three months a plan to shift thousands of people from a state Medicaid program onto the federal health insurance marketplace that has been plagued by technical problems. Under the proposal backed by Republican Governor Scott Walker, about 72,000 people now due to be shifted from Wisconsin's BadgerCare Medicaid program on January 1 would be allowed to stay on until the end of March (O’Brien, 12/4).

The Wall Street Journal: States Divided On Letting Insurers Extend Old Plans
Insurance commissioners in most Republican-led states have agreed to a request from President Barack Obama to allow carriers to extend many insurance plans slated for cancellation, while regulators in Democratic states remain divided, The Wall Street Journal has found. At least 21 of 30 states with GOP governors have said they are willing to let insurers extend policies through 2014 that otherwise would be canceled because they don't comply with the new federal health law. Many of the Republican-led states are allowing renewals that would extend coverage well into 2015 (Scism and Radnofsky, 12/3).

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1.46 Million Enroll In Medicaid Through Health Law Exchanges

The Obama administration said Tuesday that more than 1.46 million people have been found eligible and signed up for Medicaid or the Children's Health Insurance Program in October. Meanwhile, South Dakota's governor won't rule out expanding Medicaid in the future and Ohio lawmakers are poised to give themselves greater oversight of the program after the governor bypassed them to expand it.

The New York Times: October Medicaid Applications Far Outpace Enrollment Through Exchanges
The Obama administration said Tuesday that 1.46 million people had applied and been found eligible for Medicaid or the Children's Health Insurance Program in October, far more than had selected a private health plan in the new insurance marketplaces (Pear, 12/3).

Kaiser Health News: 1.46 Million Determined To Be Eligible for Medicaid And CHIP In October
After two months of media shellacking, healthcare.gov website woes and a series of skeptical congressional grillings, the Centers for Medicare & Medicaid Services (CMS) was accentuating the positive, noting the jump in the number of people eligible for Medicaid under the Affordable Care Act (Evans, 12/4).

The Washington Post: South Dakota Governor Daugaard Won't Rule Out Future Medicaid Expansion
South Dakota Gov. Dennis Daugaard (R) doesn't favor expanding Medicaid coverage to include more low-income residents, but it appears he won't rule out the possibility of expanding the program in the future. Daugaard, who plans to address the state's budget in a speech to the legislature Tuesday, is expected to tell legislators he will pursue coverage for tens of thousands of uninsured South Dakota residents through other means (Wilson, 12/3).

Columbus Dispatch: GOP Bill Would Expand Medicaid Oversight
Less than two months after Gov. John Kasich bypassed the General Assembly to expand Medicaid eligibility, legislators are poised to enact a bill to give themselves more oversight and input on the tax-funded health-care program for Ohio's poor and disabled. Yesterday, a House subcommittee recommended -- on a party-line vote -- passage of legislation that Republicans say will reduce costs and help those who rely on Medicaid to find jobs and move off government assistance (Candisky, 12/4).

The State: SC Medicaid Program Growing Despite Rejection Of Obamacare
 S.C. lawmakers -- led by Republican Gov. Nikki Haley -- refused to expand the state's Medicaid program under the federal Affordable Care Act, saying the state could not afford it. But the enrollment and costs of the state's health insurance program for the poor are growing rapidly even without that expansion (Beam, 12/3).

Meanwhile, another group is expected to benefit --

Kaiser Health News: Medicaid Expansion Expected To Offer Coverage To Many Former Prisoners
When Medicaid expands next year under the federal health law to include all adults living close to the poverty line, one group of eligible beneficiaries will be several million men and women who have spent time in state and federal prisons and jails. The Department of Justice estimates former inmates and detainees will comprise about 35 percent of the people who will qualify for Medicaid coverage in the states expanding their programs to anyone earning less than 138 percent of the federal poverty level, or about $15,000 for an individual in 2013. The Congressional Budget Office estimated earlier this year that 9 million people will get that new coverage next year (Gugliotta, 12/4).

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Federal Judge Hears Arguments On Health Law Subsidies

Millions of people in 34 states could be denied government subsidies to help them pay for insurance if the latest lawsuit brought by the opponents of the health law is successful. Meanwhile, Notre Dame joined the groups challenging the law's mandate that most large employers offer birth control coverage without a co-pay.

The Washington Post: Health-Care Law's Critics See Court Case Over Subsidies As Their Last Shot
Opponents of the health-care law took their latest legal challenge to a federal courtroom in the District on Tuesday in a case that many critics of the law view as their last and best chance to gut it before key provisions kick in Jan. 1. Though some legal scholars view the case as a long shot, it could have significant consequences if it is successful. Millions of people in 34 states could be denied the government subsidies established by the law to help low- and middle-income people pay their health-insurance premiums starting next year. Even those who think the case has no merit are closely watching it unfold (Somashekhar, 12/3).

The Wall Street Journal: Federal Judge Hears Arguments On Health-Law Subsidies
A federal judge in Washington offered few hints Tuesday of how he plans to rule during arguments in a case challenging the legality of federal subsidies available to some consumers who purchase health insurance through federally run online exchanges. At issue is the implementation of a key part of the 2010 Affordable Care Act, which requires most Americans to carry health insurance or pay a tax penalty. To make coverage more affordable, the law calls for the government to subsidize coverage for qualifying low- and middle-income individuals (Kendall, 12/3).

Fox News: ObamaCare Faces Another Challenge In Federal Court
The Affordable Care Act faced another legal challenge Tuesday in federal court, as a group of business owners and individuals pushed back against an IRS regulation they say is both unlawful and potentially crippling. The regulation, which stems from the ACA, defines which applicants are eligible for subsidies in connection with obtaining health care coverage. It's a significant distinction, because those subsidies trigger massive employer and individual obligations in the states where they are awarded (Bream, 12/4).

The Associated Press: Notre Dame Sues Over Birth Control Mandate
The University of Notre Dame on Tuesday filed another lawsuit opposing portions of the federal health care overhaul that forces it to provide health insurance for students and employees that includes birth control, saying it contravenes the teachings of the Roman Catholic Church. The lawsuit filed in U.S. District Court in South Bend claims the Affordable Health Care Act violates Notre Dame’s freedom to practice religion without government interference. Under the law, employers must provide insurance that covers a range of preventive care, free of charge, including contraception. The Catholic Church prohibits the use of contraceptives (Coyne, 12/3).

The Wall Street Journal: Notre Dame Suit Says Compromise On Birth-Control Rule Is Inadequate
Notre Dame says in its complaint, filed Tuesday in U.S. District Court for the Northern District of Indiana, that the compromise offered by the administration still leaves the school complicit in something it considers immoral. The university says the health-care law has created a situation in which its sponsorship of an insurance plan is tantamount to condoning birth control and its acquisition. Notre Dame cited a recent advertising campaign aimed at young people that described contraception access as one of the key benefits to getting coverage (Radnofsky, 12/3).

Bloomberg: Obamacare Suits Mount As Notre Dame Joins Scrum Of Cases
Hours after the University of Notre Dame filed a religious challenge to the U.S. health-care overhaul in Indiana federal court, a judge in Washington heard arguments in a lawsuit assailing tax provisions of the statute.  The cases underscore the persistent and diverse nature of legal attacks on the Affordable Care and Patient Protection Act even as the Obama administration struggles to fix bugs in healthcare.gov, the online marketplace for health insurance created by the measure (Zajac and Harris, 12/4).

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Health Care Marketplace

United Health Details Expected 2014 Health Law Hits

The Associated Press/Washington Post: UnitedHealth Details Expected 2014 Overhaul Hits
UnitedHealth Group is the latest company to detail the hit its business will absorb from the health care overhaul. The nation’s largest health insurer said Tuesday that it expects to pay as much as $1.9 billion in taxes and fees imposed by the law next year and absorb a funding cut for a key product, Medicare Advantage plans, which are privately run versions of the government’s Medicare program for the elderly and disabled people. All told, it expects the overhaul to take a $1.1 billion bite out of its after-tax operating earnings in 2014 (12/3).

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State Watch

State Highlights: Caremark To Pay MassHealth $2.6M After Not Reimbursing Claims

A selection of health policy stories from Massachusetts, Oregon, Kansas and North Carolina.

WBUR: AG: Caremark To Pay MassHealth $2.6M For Not Reimbursing Pharmacy Claims 
This just in from Massachusetts Attorney General Martha Coakley: Caremark, the national pharmacy benefits manager that also operates mail-order pharmacies, will pay $2.6 million to MassHealth -- and $4.25 million in a multistate settlement -- for failing to reimburse claims. "This settlement is the result of an investigation into allegations that Caremark failed to properly handle and reimburse pharmacy claims for certain customers in the Commonwealth, leaving MassHealth to foot the bill," AG Coakley said. "Our office will continue to safeguard the taxpayers' investment in programs designed to provide care and treatment to our most vulnerable citizens" (Zimmerman, 12/3).

The Oregonian: Oregon Bill Would Force Lawmakers To Get Health Insurance Through Cover Oregon
An Oregon lawmaker wants to make sure legislators and statewide elected officials in Oregon know firsthand what enrolling for benefits through the state’s insurance exchange is like. Rep. Julie Parrish, R-West Linn, plans to introduce legislation next year that would boot her and her colleagues from the state-provided health plan they have now and send them to Cover Oregon. Under current law, legislators have access to the same health care coverage other state employees are provided through the Public Employees Benefit Board. All but one lawmaker is enrolled in at least one part of the state insurance package (Gaston, 12/3).

Kansas Health Institute: KC-Area School Districts Hoping New Wellness Center Pays Many Dividends
Four Kansas City-area school districts are partnering on a wellness clinic with the goal of making treatment more accessible to their employees while reducing worker absenteeism and health insurance costs. The wellness center is at the Blue Springs School District's Paul J. Consiglio Education Center (Sherry, 12/3).

North Carolina Health News: A Health-Monitoring Program Charts Success, Seeks Funding
Nurse Rhonda Cotton worked face to face with patients for 23 years at Vidant Roanoke Chowan Hospital, plus 10 years in a surgeon's office and a few more in hemodialysis and home health. But two years ago, she gave up bedside nursing to take a job with Roanoke Chowan Community Health Center (RCCHC) in Ahoskie. Her new position put her on the phone and in computer contact with patients in remote towns (Ellis, 12/4).

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Editorials and Opinions

Viewpoints: Why Can't Health Website Be Like Amazon?; Debunking GOP's Resistance To Medicaid

The Wall Street Journal: Obama And The 'Amazon Experience'
For an "Amazon-like" experience, it isn't enough to have a website that functions on the front end, the back end and in between. ... You also need an Amazon-like culture, which is the product of other Amazon-like realities. Such as: Jeff Bezos as the boss, demanding results and innovation from his employees, providing results and satisfaction for his customers and shareholders. So how does Barack Obama's management style measure up to Mr. Bezos's? Let's compare (Bret Stephens, 12/2).

The New York Times: The Conscience Of A Liberal: Unacceptable Realities
On both the healthcare and inflation fronts, what you have to conclude is that there are a large number of people who find reality — the reality that governments are actually pretty good at providing health insurance, that fiat money can be a useful tool of economic management rather than the road to socialist disaster — just unacceptable. I think that in both cases it has to do with the underlying desire to see market outcomes as moral imperatives (Paul Krugman, 12/3).

The Wall Street Journal: Low-Information Leadership
Everyone understands in their own rough way that ObamaCare is a big mess. And that it's not the website, it's the law itself. ... It's a leader's job to be skeptical of grand schemes. Sorry, that's a conservative leader's job. It is a liberal leader's job to be skeptical that grand schemes will work as intended. You have to guide and goad and be careful. And this president wasn't (Peggy Noonan, 12/3).

The New York Times: The Real Health Care Distraction?
In the last few weeks it's been trendy, in Republican circles, to claim that anything Democrats do or say unrelated to the Affordable Care Act is a ploy to "distract" attention away from the problematic HealthCare.gov rollout. (Really, anything: filibuster reform or a diplomatic breakthrough with Iran.) In his speech today defending the law, President Obama seemed to try to take back that narrative, suggesting that all the attention paid to the glitchy rollout is the real distraction — from the fact that the law’s working, the status quo ante was terrible, and that his political opponents have never offered a viable alternative (Juliet Lapidos, 12/3).

Los Angeles Times: Debunking The Anti-Obamacare Camp's Attack On Medicaid
If Congress were really concerned about the "indignity" of Americans on Medicaid, nothing's stopping lawmakers from upgrading the reimbursement rate or even shifting all those people to the subsidies available to other lower-income Americans on the ACA. ... It's also worth noting that of the 25 state governments that have refused to expand Medicaid to cover more of their citizens (all Republicans), not a single one has claimed to be doing so because they don't think Medicaid is good enough -- their chosen alternative is no health insurance at all for people living at 138% of the poverty line or below (Michael Hiltzik, 12/3).

Los Angeles Times: For Obama, It's All About Obamacare
President Obama's speech Tuesday announced the relaunch of his healthcare program's website. But he was also aiming to relaunch his entire second term, which has careened from high ambition to near-catastrophe in less than 11 months. Until his signature healthcare program is running smoothly, Obama stands little chance of focusing Congress on any of the other goals of his once-ambitious second-term agenda, including immigration reform and addressing the nation's infrastructure needs (Doyle McManus, 12/4).

Los Angeles Times: Republicans Cannot Rely On Ire At Obama To Last
For the GOP, continuing glitches in the online delivery system for the new national healthcare market reinforce the argument that the Obama administration has tried to do too much, too fast without really understanding the enormity of the job. That is the upside for Republicans. The downside is that there is obviously a demand for the product Obamacare is trying to deliver and, by the time the election rolls around, millions of voters may have forgotten the website bugs. Instead, they may be pleased that healthcare coverage is no longer out of reach for them and they will not want to see it taken away by a Republican Congress (David Horsey, 12/3).

The Washington Post: The GOP's Toxic Messaging
As the government health-care Web site chugs along, the Obama administration has begun a counter-initiative to combat Republican naysaying — and its weapons are of superior grade. The bunker buster is positive messaging and a return to hope and change (Kathleen Parker, 12/3).

The Washington Post’s The Plum Line: Medicaid Expansion Becomes Weapon Against GOP Governors
It's widely accepted as an article of faith that Obamacare will be uniformly bad politics for Dems in 2014. After all, the rollout is a disaster and majorities disapprove of the law, so how could it possibly be any other way, right? Here's something that counter-programs that narrative a bit: Democrats are currently using a major pillar of the health law — the Medicaid expansion — as a weapon against Republican Governors in multiple 2014 races (Greg Sargent, 12/3).

The Washington Post’s Post Partisan: Health Care Reemerges As A Normal Issue
For years now, we’ve thought about Obamacare in terms of whether it would pass, and then whether or not it would actually be implemented. That fight is over. ... That doesn’t mean that health care won’t be an issue. Expect, for example, Republicans to eventually fight over subsidy levels (and, perhaps, both parties to try to refashion subsidies to avoid perverse incentives on earnings). Expect, too, Republicans to eventually try to reduce ACA-connected taxes (Jonathan Bernstein, 12/3).

Bloomberg: Nobody Should Get Rich Off Obamacare
For an industry that's supposed to be burdened by the launch of Obamacare, the health-care business is doing pretty well. Stocks of health-care companies are up almost 40 percent this year, the strongest performance of any sector in the S&P 500. This is despite, for insurers, new regulations on the "medical loss ratio" which require them to spend at least 80 percent of premiums on health care -- in practice, capping their profits and administrative expenses such as advertising at 20 percent (Evan Soltas, 12/3).

And on other issues --

Los Angeles Times: ACLU Sues Catholic Bishops Over View That Abortion Is Evil
Everyone knows that Catholic hospitals don't perform elective abortions. Incomprehensibly, Catholic hospitals even fall afoul of the church if they perform an abortion to save a mother's life. But are they negligent if they fail to merely inform a pregnant woman that abortion is the safest option when her health is in danger and her fetus faces certain death? And that if she wants an abortion, she should seek help elsewhere? (Robin Abcarian, 12/3).

The Washington Post: Eradicating AIDS
On March 24, 1987, the activist group AIDS Coalition to Unleash Power (ACT UP) gathered in front of Trinity Church on Wall Street in New York City for its first ever demonstration. ... When ACT UP took to the streets three decades ago, AIDS was a death sentence. ... Today, that is no longer the case. We have cutting-edge drugs that keep people alive. We have evidence-based models for prevention. We have global awareness of the epidemic. What we lack is the political will and compassion to reach out to the most marginalized among us and make sure that they have equal access to prevention and care. Ending AIDS is no longer a matter of science — it’s a matter of justice (Katrina vanden Heuvel, 12/3).

USA Today: Obama's Disappointing Surgeon General
In all the talk about the relaunch of HealthCare.gov, Americans might have missed President Obama's nomination of Vivek Hallegere Murthy to be our next surgeon general. With the nomination of the self-described "passionate entrepreneur" — a 36-year-old part-time physician and full-time businessman — to be "America's Doctor," Obama has upendeded the tradition of promoting those who have focused their careers on healing, teaching and research (Dr. Bruce L. Davidson, 12/3).

Bloomberg: Cloudy, With a Chance of Flu 
Researchers, at last, have come up with a flu-forecasting system that works like the weather report. If used well, the information could mobilize health measures when and where they are needed. Many lives are at stake: Flu kills from 3,000 to 49,000 people in the U.S. every year. ... The next step is for public health authorities to use the information. Ensuring sufficient stocks of vaccines and anti-flu treatments would prevent the kind of shortages that hit some communities last year (12/3). 

Bloomberg: The Failed Promise of 23andMe
Genetics is more complex than scientists imagined. ... This hasn’t prevented companies such as 23andMe Inc. from selling direct-to-consumer genetic testing, with claims that it offers beneficial health information. Debates about the information these companies are providing boiled over last week after the Food and Drug Administration, which is responsible for ensuring that medications, medical devices and tests are safe and effective, sent a letter to 23andMe, demanding that the company stop selling its $99 genetic test kit.... Given the stakes involved, the FDA should take stronger action to protect consumers from the risks associated with direct-to-consumer testing (Robert Klitzman, 12/3). 


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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.