Daily Health Policy Report

Thursday, December 5, 2013

Last updated: Thu, Dec 5

KHN Original Reporting & Guest Opinion

Administration News

Health Reform

Capitol Hill Watch

Health Care Marketplace

Coverage & Access

State Watch

Weekend Reading

Editorials and Opinions

KHN Original Reporting & Guest Opinion

In Kansas, A Fight Over Developmentally Disabled Shifting To Medicaid Managed Care

Reporting for Kaiser Health News, in collaboration with The Washington Post, Jenni Bergal writes: "Aldona and Pat Carney call their son, Neil, 'a 24-7 kid.' He's profoundly autistic, severely mentally retarded and attends a special school. He has tried to eat light bulbs and charcoal briquettes and can be aggressive, sometimes scratching people near him. Neil, 18, who walks with a limp and carries around a grey sock that calms him, lives in a beige single-family home with a professional caregiver who’s known him for years. The house is equipped with cameras to track his movements and a backyard swing he loves to ride" (Bergal, 12/5). Read the story.

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Political Cartoon: 'Seen But Not Herd?'

Kaiser Health News provides a fresh take on health policy developments with "Seen But Not Herd?" by Mike Smith. 

Here's today's health policy haiku:  


 Time for happy hour?
Then it’s time to talk health plans…
Young people love that.

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

The White House's Latest Health Law Campaign Message

The effort highlights popular parts of the overhaul and how it advances President Barack Obama's vision of upward mobility and economic security.

The New York Times: Obama Presses Case For Health Law And Wage Increase
President Obama left the White House on Wednesday for one of the capital’s working-class neighborhoods to talk about the economy, not simply to divert attention from the troubles of his Affordable Care Act but also to explain how that law, for all of its flaws, fits into his vision for Americans’ economic security and upward mobility. ... For decades, he said, health care “was one yawning gap in the safety net that did more than anything else to expose working families” to economic insecurity. “That’s why we fought for the Affordable Care Act,” he said (Calmes, 12/4).

The New York Times: Democrats’ Latest Campaign For Health Care Law Begins
President Obama and congressional Democrats, seizing on the good news of an improving health care website and rising enrollments, on Wednesday highlighted parts of the law that are popular with the public and reminded Americans, and the law’s opponents, of what would be lost if the Affordable Care Act were repealed (Weisman and Shear, 12/5).

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Obama Seeks To Connect With Young Adults, Encourages Them To Sign Up For Coverage

The 18-35-year-old demographic is seen as key to achieving stability in the new online insurance marketplaces. But reaching this group is no easy task -- their interest and support for the health law appears to be waning.

The Washington Post: Obama Urges On Young Activists; 3-Day Healthcare.gov Enrollment Hits 56,000
President Obama urged a group of young activists Wednesday not to give up on promoting his signature health-care law, as enrollment picked up on HealthCare.gov. Roughly 27,000 Americans signed up for insurance on the federal exchange on Tuesday, according to internal figures, bringing the site’s three-day enrollment total to 56,000. That figure is more than double the number who enrolled online in the entire month of October, which was almost 27,000 (Eilperin and Goldstein, 12/4).

Los Angeles Times: Obamacare Happy Hour? Obama Urges Creativity In Touting Health Law
With the federal health insurance exchange now operating more smoothly for most users, President Obama assembled 160 youth leaders at the White House on Wednesday, enlisting them to help sign up their peers for health insurance — a crucial factor in whether his signature law will succeed. As the student body presidents and youth activists gathered for an afternoon of seminars with White House officials and leaders of allied groups, a new poll showed that the administration and its allies have their work cut out for them (Reston, 12/4).

The Associated Press/Washington Post: Obama Hopes Youth Not Discouraged By Health Woes
President Barack Obama says he hopes young people don’t get discouraged by how hard it has been to implement health care reform. Obama spoke Wednesday to an audience of young leaders at a White House youth summit on health care. He told the participants that it has never been easy to make big changes in the United States, citing the civil rights movement and efforts by women to win the right to vote (12/4).

Politico: President Obama Wants A Hard Sell For Young Adults
The millennials hung out with the president at the White House on Wednesday, not to shoot hoops or shoot the breeze but to strategize on how to get young adults to sign up for health care. The Youth Summit drew 160 participants from across the country, all members of the 18-35 age demographic that is seen as critical to the financial stability of Obamacare exchanges. The gathering was shy on celebrities in favor of college student body presidents, DJs, YouTube stars, early-career entrepreneurs and leaders from a diverse spread of organizations that have influence with young people, even if it’s typically on subjects other than health care. Teen Vogue, for one, was represented (Villacorta, 12/4).

CNN: Obama Urges Young Supporters To Talk Up Obamacare
Sounding like a motivational speaker, President Barack Obama asked young supporters on Wednesday to encourage their peers to sign up for health coverage under his embattled reforms known both affectionately and derisively as Obamacare. At a White House Youth Summit, Obama used the opportunity to rally a key demographic for the success of the 2010 Affordable Care Act now that the system's problem-plagued website appeared to working smoothly for most users (Cohen, 12/4).

NPR: White House Cites Pre-Existing Condition Case From Its Own Ranks
It's Day 4 of the White House's new messaging push for the Affordable Care Act. Today the goal is to tell the stories of people with pre-existing conditions who are now entitled to coverage under the new health care law. One such story comes from within the White House. Michael Robertson, chief of staff in the Cabinet Affairs Office, was diagnosed with stage IV colorectal cancer at age 35. "I went overnight from being completely healthy and exercising and all that to having this catastrophic disease," he said in an interview at the White House on Wednesday. Robertson described the shock of realizing "these things can happen in an instant. They don't just happen to older people" (Shapiro, 12/5).

But a new poll shows the president and the health law are losing favor with this population -

Bloomberg: Youth Break With President On Obamacare Support In Poll
The nation’s youth, a group that twice rallied behind President Barack Obama at the ballot box, is failing to support his signature domestic achievement and increasingly disillusioned with his presidency. More than half of those 18 to 29 years old say they disapprove of Obamacare and half expect it will increase their health-care costs, a survey by Harvard University’s Institute of Politics shows. Four in 10 say they anticipate the quality of their coverage will get worse because of the law (McCormick, 12/4

The New York Times: Poll Finds Young People Souring On Health Law And Obama
A majority of 18- to 29-year-olds – a constituency crucial to the success of President Obama’s health overhaul — disapprove of the law, and fewer than a third of those who are uninsured are likely to sign up for coverage, according to a new poll by Harvard University’s Institute of Politics. The survey, released Wednesday, also found a stark drop in Mr. Obama’s approval ratings among those so-called millennial voters, who have long been his most ardent supporters (Stolberg, 12/4).

Los Angeles Times: Millennial Generation Sours On Obama, Skeptical Of Healthcare Law
Members of the huge millennial generation, who have strongly supported President Obama in the past, have soured on him and take a skeptical view of his signature healthcare law, according to a new poll from Harvard’s Institute of Politics. “Millennials have always been one of two significant parts of the Obama coalition,” said John Della Volpe, the institute’s polling director. Throughout Obama’s national political career, members of the millennial generation gave him a significantly higher approval rating than the rest of the population, he said (Lauter, 12/4).

The Wall Street Journal’s Washington Wire: Poll: Millennials No Big Fans Of Obamacare
As President Barack Obama gave remarks Wednesday to a White House Youth Summit on health care, a new poll shows the Affordable Care Act isn’t faring well among young adults, who share the largely skeptical views of other Americans. A majority of millennials — adults aged 18-29 — in the poll disapprove of Mr. Obama’s signature health-care law, and fewer than 30% of uninsured millennials said they will definitely or probably enroll if and when they are eligible, a Harvard Institute of Politics poll found (Ballhaus, 12/4).

PBS NewsHour: Presidential Approval Ratings Wane As Millennials Grow Wary Of ACA
A new poll of Americans aged 18-29 revealed a "solid majority" of young people disapprove of the Affordable Care Act. Of those without health care coverage, only 29 percent said they were likely to enroll in the insurance exchanges. Judy Woodruff talks to John Della Volpe of the Institute of Politics at Harvard University (Woodruff, 12/4).

Fox News: ‘Sea Change’: Poll Shows Young People Skeptical Of Obamacare, Amid Obama Outreach
As the president hosts a White House youth summit, a new poll from his alma mater shows a majority of young people aren't interested in signing up for his signature health care plan. The Harvard "Millennials" poll found only 22 percent of young Americans -- defined in the survey as between 18 and 29 years old -- plan to sign up for ObamaCare. Even more troubling for the administration, fewer than a third -- only 29 percent -- of people who currently do not have health insurance plan to enroll (Roberts, 12/4).

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Health Reform

29,000 Americans Enroll Through Healthcare.gov In 2 Days, Says Source

That total exceeds the number who enrolled during the entire month of October, demonstrating that recent fixes have made the website easier to use.

The New York Times: Enrollment Numbers Rise After Website Improves
About 29,000 people successfully navigated HealthCare.gov and selected an insurance plan on Sunday and Monday, more than the entire number of people who were able to enroll through the federal exchange during the month of October, according to a person familiar with the project. Officials are still double-checking the data and said they would not release enrollment numbers for November until later this month. But the person said the website was working much better than in October, when only 26,000 people were able to enroll in a plan. Politico first reported the weekend enrollment numbers (Shear, 12/4).

Los Angeles Times: Healthcare.gov Sees Enrollment Jump After Repairs To Troubled Website
In the clearest sign yet that the federal health insurance website is vastly improved, about 29,000 people enrolled in insurance plans over the first two days of this week, exceeding the number of enrollments on the site in all of October, according to a source familiar with the data. The 29,000 figure tallies the number of people able to select health plans Sunday and Monday, the 48-hour window after the administration’s deadline for making major repairs to the HealthCare.gov website  (Hennessey, 12/4).

The Washington Post: 29,000 Americans Enroll Under Healthcare.gov In 2 Days, Officials Say
That total exceeds the total number of Americans who enrolled online between Oct. 1 and Nov. 2, which was 26,794. The government defines enrollment as an individual who has successfully signed up for a plan. The new total, while short of the pace needed to reach the administration's target of 7 million enrollments by March 31, shows the federal health insurance marketplace is working much more smoothly than it was at its Oct. 1 launch (Eilperin, 12/4).

Politico: Source: Enrollment Surge On Healthcare.gov
The preliminary numbers for the two-day period provide the clearest evidence yet that the federal exchange is on the mend. About 26,000 people selected a health plan during October and about 100,000 people did so in November, the official said (Budoff Brown, 12/4).

The Wall Street Journal's Washington Wire: Traffic Strong On HealthCare.gov–Will Enrollment Follow?
Strong traffic on HealthCare.gov and new figures from states suggest that enrollment is likely picking up on the federal health-insurance exchange, although federal officials aren’t giving any specific recent enrollment figures. Officials at the Centers for Medicare & Medicaid Services, the agency running the federal health-insurance website, say they’re planning on releasing updated enrollment figures in mid-December. "We expect our enrollment numbers to increase given the technology improvements to the site," CMS spokeswoman Julie Bataille told reporters Wednesday in a daily update call (Schatz, 12/4).

Reuters: More Obamacare Enrollees In Two Days Than All Of October: Sources
More people signed up on the government's new health insurance website on the first two days of December than in the entire first month of the launch of President Barack Obama's healthcare reform, sources familiar with the numbers said on Wednesday. The sources said about 29,000 people enrolled on Sunday and Monday, surpassing nearly 27,000 for all of October when the opening of the HealthCare.gov website was beset by glitches that led to a public apology by the president and a retooling of the portal (Holland, 12/4).

NPR: HealthCare.gov Now Allows Window Shopping, And A Do-Over
One thing that's clear about the relaunch of the troubled HealthCare.gov website is that it can accommodate more people. Federal officials said more than 1 million users logged in on Monday, and nearly that many on Tuesday. But less attention has been paid to some other upgrades that are also making the site easier for people to use. That's too bad, says Nancy Metcalf, senior editor of Consumer Reports, who has been chronicling the rollout of the health exchanges. She says some of them are pretty impressive (Rovner, 12/5).

Some news outlets examine issues behind these numbers - 

Politico: Rush To Find Health Options Before Jan. 1
If people whose health insurance was canceled under Obamacare this year don’t line up new coverage this month, the Obama administration could face a political nightmare. More people could have lost coverage than gained it when the health law benefits begin on Jan. 1. That’s by no means a certainty; the sign-up website is doing better, some insurance carriers are extending plans instead of canceling them, and there are millions more uninsured people who stand to get covered than there are covered people facing plan cancellations. Medicaid sign-ups are also running strong (Norman, 12/4).

Modern Healthcare: CMS Works With Insurers On Inaccurate Enrollment Data
The CMS is working to calm the nerves of insurers still rattled by inaccuracies in enrollment information from HealthCare.gov, which the companies say could prevent consumers from getting coverage they're counting on having Jan. 1. The agency formed a team with QSSI, the contractor assigned to lead the federal website rescue effort, to work directly with insurance companies on the problems with so-called 834 files, which are necessary to transfer enrollment data from the federal insurance marketplace to the plan issuers (Blesch, 12/4).

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Medicaid Signups May Be Affected By Website Glitches

The federal government has been unable to transfer full Medicaid applications to the 36 states participating in healthcare.gov, potentially leaving some who sign up for Medicaid without coverage. The administration says it will send states partial files for processing, but some state officials are balking. Other Medicaid developments in Wisconsin, Virginia, Georgia, Florida and Texas are also covered.

The Wall Street Journal: Medicaid Is Latest Health-Site Victim
States are warning that they may not process Medicaid enrollments from people who have signed up for the health program through the troubled HealthCare.gov site, raising the prospect that several hundred thousand low-income people who thought they had obtained insurance actually may not have it (Radnofsky, 12/4).

The Washington Post’s Wonkblog: Healthcare.gov Is Having Trouble Signing People Up For Medicaid
Every week, usually on Tuesday, the Centers for Medicare & Medicaid Services sends state Medicaid departments something called a "flat file." These files are sort of similar to the much-discussed 834 transmissions, which the exchange sends to an insurance plan when someone signs up. Except the flat files are for the Medicaid program, and lists people that the exchange thinks -- but hasn't officially determined -- will be eligible for the Medicaid program. And, much like the those 834 transmissions, Medicaid officials say, these flat files are riddled with errors and incomplete information (Kliff, 12/4).

The Associated Press/New York Times: Wisconsin: Medicaid Delay Bill Advances
The State Assembly passed a bill on Wednesday that would give those losing their Medicaid coverage three more months to sign up for private plans through the new federal online marketplace. Assembly Republicans said that the Obama administration’s health care failures forced them to take quick action on a bill that Gov. Scott Walker proposed and called the Legislature into special session for this month (12/4).

The Milwaukee Journal Sentinel: Gov. Scott Walker Gaining Support For Plan To Sidestep Obamacare
Gov. Scott Walker wants consumers to be able to sidestep Obamacare's online insurance market and still get subsidized coverage — and at least one of his requests to do that might get traction. The GOP governor's push comes as the Assembly voted, 64-32, Wednesday to approve Walker's separate proposal to respond to the troubled rollout of the federal health law by waiting to drop patients off state BadgerCare Plus health care coverage (Stein, 12/4).  

The Associated Press/Washington Post: [Virginia] House, Senate Still At Odds On Medicaid Expansion
The chairman of a joint legislative commission looking at possible Medicaid expansion in Virginia indicated Wednesday that members remain “at a bit of an impasse” over the issue. Sen. Emmett Hanger, R-Augusta and chairman of the state’s Medicaid Innovation and Reform Commission, said that House and Senate contingents on the commission are still looking for “a grand bargain that will allow us politically to go forward” (12/4).

The Dallas Morning News: Study: Refusal To Expand Medicaid Is Costing Texas Billions
If Texas keeps refusing to enlarge Medicaid under the Affordable Care Act, the state will pass up a heap of money, a new study has found. In 2022, the state would pass up federal money for Medicaid expansion equal to more than twice its haul that year in federal highway aid, according to researchers Sherry Glied and Stephanie Ma of New York University. Texas would forfeit $9.6 billion of federal Medicaid matching funds in 2022. That’s one-fourth of what the federal government expects to spend on defense contracts in the state that year, the study said (Garrett, 12/4).

Georgia Health News: Study Calculates Cost Of Expansion Decision
Only Texas and Florida would have net losses higher than Georgia among 20 states that have opted not to expand Medicaid, said the study, conducted by Sherry Glied and Stephanie Ma of New York University. Georgia would see a net loss of $2.86 billion in 2022 if it were the only state remaining that did not increase its Medicaid program to cover more low-income adults, said the study, which takes into account the federal taxes paid by state residents for other states’ expansions (Miller, 12/5).

Health News Florida: Medicaid Grows Without ‘Expansion’ Money
Even though Florida’s Legislature turned down federal funds to expand Medicaid under the Affordable Care Act, leaving billions of federal dollars on the table, the state's health insurance program for the poor continues to grow. Florida’s Medicaid program added about 165,000 people in October, according to a report from the Centers for Medicare & Medicaid Services (Gentry, 12/4).

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Pace Of Health Insurance Applications Picks Up

News outlets in Wisconsin and Minnesota report increases in applications for coverage through new online marketplaces. But baby boomers, as opposed to so-called "young invincibles," dominate sign-ups in Colorado, while in California, Democratic lawmakers worry a lookalike website set up by Republican lawmakers will lead some applicants astray.

The Milwaukee Journal Sentinel: Health Insurance Applications Picking Up In Wisconsin
Over the Thanksgiving holiday, 136 people completed applications for a health insurance plan sold by Common Ground Healthcare Cooperative. The number of completed applications — almost as many as the health insurer received in all of October — is a sign that the Obama administration has made headway in fixing the problems with the healthcare.gov website. But the number of completed applications — 878 as of Monday compared with 742 on Nov. 27 — indicates the challenges ahead in enrolling people for coverage under the Affordable Care Act (Boulton, 12/4).  

Minnesota Public Radio: MNsure Applicants In Last Stage Double In November
The number of people who are in the final stages of applying for health insurance through the state's new online insurance marketplace, has more than doubled since the beginning of November according to figures released today by MNsure. Roughly 24,600 people are in the process of paying for a plan. That's up from nearly 11,000 in early November (Richert and Stawicki, 12/4).

The Star Tribune: MNsure Applications Double As State Works To Fix Glitches
More than 71,000 people applied for insurance on MNsure as of Nov. 30 — up from more than 31,000 at the end of October. Some 48,724 sought coverage from private insurers, and the rest were applying for the state’s public programs, MinnesotaCare and Medical Assistance. Fewer have taken the next step — completing enrollment and selecting a payment method. That tally is now 24,586 — with the great majority eligible for public programs; only 4,478 people have enrolled in private individual plans (Olson, 12/5).

Health Policy Solutions (a Colo. news service): Boomers Dominate Health Sign-Ups
Baby boomers are signing up for Colorado’s health exchange at much higher numbers than the so-called “young invincibles” who are critical to the success of health reform. Colorado’s health exchange, Connect for Health Colorado, this week released basic demographic data for the first time since the exchange opened on Oct. 1. Of the 9,980 people who signed up for health insurance in the first two months, 6 percent are ages 18 to 25. Another 11 percent are 26 to 34 years old. Most health analysts define “young invincibles” as people younger than 30. But even including young people through age 34, only 17 percent of sign-ups so far are coming from people ages 18 to 34. Meanwhile, older adults ages 55 to 64 accounted for 43 percent of people who bought plans in October and November (Kerwin McCrimmon, 12/4).

Los Angeles Times: Rep. Janice Hahn Calls On State GOP To Take Down ‘Fake’ Obamacare Site
A website run by California Assembly Republicans has come under fire this week, with critics alleging it misleads visitors about the Affordable Care Act and one Democratic congresswoman calling for it to be taken down. The Assembly GOP Caucus says the website, coveringhealthcareca.com, is meant to be a resource for Californians looking for more information on the new healthcare law and insurance exchange (Mason, 12/4).

The Sacramento Bee: California Lawmaker Seeks Investigation Of Republican Health Care Website
Assemblyman Jimmy Gomez, D-Los Angeles, became the latest California Democrat to assail a website he says Assembly Republicans created to amplify critiques of the law, rather than help Californians enroll in insurance via Covered California, the state's newly operational exchange. Gomez has sent the Assembly Rules Committee a letter asking them to investigate. In a statement released earlier Wednesday, California Democratic Party Chair John Burton said the website demonstrated "Republicans in California have no qualms about following their national Party's lead when it comes to spreading misinformation about the Affordable Care Act” (White, 12/4).

California Healthline: 96% Of Californians Picked Just Four Health Plans Through Covered California. Are Small Plans Getting Squeezed Out?
That data point's taken from a Covered California release that offers some of the first insight into the makeup of early enrollees through the exchange and which plans they're picking. And while it's hardly fair to directly compare the two issuers -- Anthem has a presence in all 19 of Covered California's regions, whereas Valley is only offering plans in Santa Clara County -- the contrast is eye-catching. It's also telling. The biggest players, so far, are getting enormous market share from Covered California's customers. The smaller plans are seeing a trickle (Diamond, 12/4).

Health Policy Solutions (a Colo. news service): PR Tab Of $118,000 Included Push To Control Board
Colorado’s health exchange has paid nearly $120,000 this year for outside PR advice that included discouraging members of the oversight board from talking about the exchange as it launched. So far this year, Connect for Health Colorado has paid about $118,100 to the Denver firm, OnSight Public Affairs. A contract between the exchange and the firm calls for $15,000 per month in payments from September through November, $13,000 a month from April through August and $9,000 per month for January through March. The contract called for about 60 hours of work per month in exchange for the monthly retainers (Kerwin McCrimmon, 12/4).

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Widely Varying Drug Costs In New Health Plans

The Wall Street Journal explores out-of-pocket drug costs in plans offered on the health law's exchanges. Other stories probe so called "aggregation rules" that could affect some small businesses and the law's potential impact on safety-net hospitals and clinics.

The Wall Street Journal: Drug-Cost Surprises Lurk Inside New Health Plans
Americans with chronic illnesses—who are expected to be among the biggest beneficiaries of the health law—face widely varying out-of-pocket drug costs that could be obscured on the new insurance exchanges. Under the law, patients can't be denied coverage due to existing conditions or charged higher rates than healthier peers. The law also sets an annual out-of-pocket maximum of up to $6,350 for individuals and $12,700 for families, after which insurers pay the full tab (Beck, 12/4).

The Wall Street Journal’s Washington Wire: Small Businesses Say ACA’s Aggregation Rules Unfair
Donna Baker of Adrian, Mich., owns an accounting firm, payroll company and retail store. Her husband, Kim, is the sixth generation owner of a dairy farm. While the four businesses are separate entities, they count as one employer under the health-care law due to a technicality ... which means they would be required to offer health-insurance benefits to their combined full-time staff — if it reaches 50 employees — starting in 2015, or pay a penalty (Needleman, 12/4).

Marketplace: How Post-ACA Health Care Is Like The Airline Business
Cooper University Hospital is expecting a huge wave of patients starting next month, as millions of consumers get health insurance, some for the first time. The question for hospital executives in Camden, and around the country, is how to manage this new population. For one, there is a chance this new patient population will exacerbate existing problems at Cooper (Gorenstein, 12/5).


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Capitol Hill Watch

Senate Leader Reid Exempting Some Staff From Buying Health Insurance On Exchanges

Senate Majority Leader Harry Reid is exempting some of his staff from buying health care coverage on the health law's exchanges, a move the law allows but one that few if any top congressional leadership figures have made. Elsewhere, Rep. Darrel Issa says healthcare.gov could cost $1 billion when the site is finally fully operational.

CNN: Some Reid Staffers Exempt From Obamacare Exchanges 
Democratic Senate Majority Leader Harry Reid, one of Obamacare's architects and staunchest supporters, is also the only top congressional leader to exempt some of his staff from having to buy insurance through the law's new exchanges. Reid and his personal staff will buy insurance through the exchange. But it's also true that the law lets lawmakers decide if their committee and leadership staffers hold on to their federal employee insurance plans, an option Reid has exercised (Frates, 12/4).

Fox News: Reid Exempts Some Staff From Having To Buy Insurance On Obamacare Exchange 
Senate Majority Leader Harry Reid is allowing some staffers to keep their health insurance instead of making them buy it through an Obamacare exchange, although he was one of the strongest Capitol Hill supporters of the 2010 law. The Nevada Democrat is exercising his discretion under the president's signature law to designate which staffers can keep their federal insurance plan and which must now purchase a policy through the District of Columbia's health care exchange (12/4).

Politico: Darrell Issa: Health Site May Top $1 Billion 
Rep. Darrel Issa (R-Calif.) on Wednesday said he believes the troubled healthcare.gov website will cost taxpayers more than $1 billion before it is fully operational. "The fact is, eventually they'll get this website working, at the cost of probably over a billion dollars," Issa, chair of the House Oversight Committee, told Fox News’' Bill Hemmer. "They're probably closer to $700 million now and they're going to spend a lot more doing the hard parts on the back end" (Delreal, 12/4).

And top Democrats discuss how Obamacare will play in next year's elections -

The Hill: WH-DSCC Obamacare Powwow
White House chief of staff Denis McDonough held an unpublicized meeting with Sen. Michael Bennet (Colo.), chairman of the Senate Democrats' campaign arm, amid anger and anxiety that Obamacare's botched rollout could cost the party its majority next year. In the meeting, requested by the Democratic Senatorial Campaign Committee (DSCC), McDonough and Bennet discussed what the White House could do to help vulnerable Senate Democrats and "talked about developing a stronger relationship with the White House," according to one senior Democratic aide familiar with the conversation (Parnes, 12/5).

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Hopes Dim For Medicare Doctor Payment Fix This Year, Short-Term Patch Is Likely

Lawmakers are proposing another patch to temporarily fix the Sustainable Growth Rate, while a permanent fix is being readied in Senate and House committees.

CQ HealthBeat: Ways And Means Aims For Doc Fix Markup Next Week, But Offsets In Question
The House Ways and Means Committee is working towards marking up bipartisan legislation next week to replace how Medicare reimburses physicians, giving hope that lawmakers are that much closer to a permanent solution (Ethridge and Attias, 12/4).

Politico: Permanent 'Doc Fix' Unlikely This Year
Lawmakers have all but given up on efforts to permanently replace the Medicare physician payment formula this year and have refocused their effort on getting it done in 2014. Both the Senate Finance and the House Ways and Means committees are expected to vote next week on a proposal that would permanently repeal the Sustainable Growth Rate and establish a new formula for paying doctors and hospitals that treat Medicare patients. It's a rare bipartisan, bicameral approach that would forever eliminate the need for the universally hated annual "doc fix" (Haberkorn and Cunningham, 12/5).

MedPage Today: SGR: Once More Kicked Down The Road?
Meanwhile, Congress is considering a short-term SGR patch to stave off for up to 3 months the roughly 24 percent Medicare pay cuts scheduled to start in 2014 in order to give lawmakers time to address a permanent SGR repeal. Wednesday's update -- which was not released by the Senate Finance and House Ways and Means committees as of press time -- provides a more fleshed out SGR-repeal proposal than the version lawmakers released in October (Pittman, 12/4).

In other Capitol Hill news --

CQ HealthBeat: Former CBO Chief Argues For Reversal Of Cuts To Insurer-Run Medicare Plans
A former Congressional Budget Office chief argued for an end to cuts to insurer-run Medicare Advantage at a House hearing Wednesday, while Democrats contended that these reductions merely ended a pattern of paying private companies more to coordinate health services than the federal agency would have spent on its own (Young, 12/4).

The Associated Press: Abortion Covered In Most Health Plans For Congress
More than 90 percent of health insurance plans offered to lawmakers and congressional staff cover abortion, an unforeseen consequence of a Republican amendment to President Barack Obama’s health law. The disclosure Wednesday by abortion opponent Rep. Chris Smith, R-N.J., also highlights an emerging issue nationally: It may be hard for individual consumers to determine whether abortion is a covered benefit in plans offered through the new online insurance markets (Alonso-Zaldivar, 12/4).

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Health Care Marketplace

The Ambulance Biz Adds To Health Costs, Do Hospital Observation Services Lower Them?

News outlets examine hospital costs issues.  

The New York Times: Think The E.R. Is Expensive? Look At How Much It Costs To Get There
Kira Milas has no idea who called 911, summoning an ambulance filled with emergency medical technicians. Ms. Milas, 23, was working as a swim instructor for the summer and had swum into the side of the pool, breaking three teeth. A week later she received a bill for the 15-minute trip: $1,772.42. ... Thirty years ago ambulance rides were generally provided free of charge, underwritten by taxpayers as a municipal service or provided by volunteers. Today, like the rest of the health care system in the United States, most ambulance services operate as businesses and contribute to America’s escalating medical bills (Rosenthal, 12/4).

PBS NewsHour: Why Eliminating 'Hospital Purgatories' Would Save Billions of Dollars
Few Americans understand [hospital observation services] or even know they exist. Which is why -- as health care costs continue to climb by the year -- it might come as a shock that these are the very services that could end up saving hospitals billions each year. Put simply, observation services are designed to determine which patients can be safely discharged from the hospital and which should remain for a longer stay (Corapi, 12/4).

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Coverage & Access

Nation's Largest Freight Carriers To Offer Health Benefits To Same-Sex Spouses

The Associated Press/Washington Post: Railroads To Offer Health Care To Same-Sex Spouses
A day after being sued by legally married, gay engineers, the nation’s largest freight rail carriers announced they will provide health care benefits to the same-sex spouses of their employees. Gus Melonas, a spokesman for BNSF Railway Co., read the statement Wednesday from the National Railway Labor Conference to The Associated Press. The conference represents the railroad companies in dealings with labor groups, lawmakers and courts (12/5). 

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State Watch

Poll: Only 44 Percent Of Californians Support Health Law

Californians are split on support for the health law. In the meantime, other polls show 66 percent of the uninsured are planning on getting coverage and that the young are more likely to get insured, despite the popular notion that they would shun coverage.

The Associated Press: Poll: Californians Split On Federal Health Reforms
Californians twice voted overwhelmingly for President Barack Obama, but they are split on his most important domestic policy achievement -- health care reform. A Public Policy Institute of California survey released Wednesday finds that just 44 percent of Californians favor Obama's Affordable Care Act, while the same percentage has an unfavorable opinion (10/4).

The San Francisco Chronicle: Poll: 66% Of Uninsured Plan To Get Health Coverage 
Most Californians have at least heard about the state's new health insurance marketplace, and the majority of the uninsured who participated in a survey released Wednesday said they plan to get covered next year as required by the federal health law. About 68 percent of the 1,701 Californians surveyed Nov. 12-19 -- more than a month after the national launch on Oct. 1 -- said they were aware a health care exchange is available to people in the state to buy medical insurance. But the survey, conducted by the nonpartisan Public Policy Institute of California, doesn't make clear whether Californians understand the difference between the state-run marketplace, called Covered California, and the glitch-plagued federal website (Colliver, 12/4).

The San Jose Mercury News: California Poll Shows Young And Healthy More Likely To Seek Medical Insurance 
They've been dubbed the "young invincibles," people in their 20s and 30s who must sign up for medical insurance in droves to ensure the success of the new health care law. But a new California poll indicates that perhaps they should be called the "young convincibles." The startling finding by the Public Policy Institute of California says that young and healthy people are overwhelmingly more likely to seek health insurance than older and sicker people (Seipel, 12/4).

Meanwhile, some other news from Colorado --

Health Policy Solutions (a Colo. news service): Canceled Plans Won't Get Resurrected In Colorado
Colorado is joining about a dozen other states that are not requiring health insurance companies to revive canceled health plans. Those states include California, Washington, Vermont and New York, according to the lobbying group, America's Health Insurance Plans. Colorado Insurance Commissioner Marguerite Salazar on Tuesday said that more than 95 percent of the 250,000 people in Colorado who received cancellation notices have had the option to renew their old plans and continue them into 2014 if they chose to do so (Kerwin McCrimmon, 12/4).

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State Highlights: La. Targets Docs Who Steer Patients Into Some Managed Care Plans

A selection of health policy stories from South Carolina, Louisiana, Texas, Kansas, Missouri, Colorado and California.

The Associated Press: Director: Medicaid Spending In S.C. Less Than Projected
South Carolina's Medicaid director says his agency is on track to spend about $250 million less this fiscal year than allotted in the state budget. Director Tony Keck told a Senate panel on Wednesday the Department of Health and Human Services is projected to spend $6.2 billion in state and federal money (Adcox, 12/4).

Modern Healthcare: La. Rule Targets Docs Steering Patients Into Certain Managed-Care Plans
Regulators in Louisiana are attempting to crack down on a perceived pattern of physicians inappropriately steering patients into particular Medicaid managed-care plans. Doctors caught exerting such influence could be booted from the program or asked to return payments for services they provided, and they face up to $5,000 in fines, according to an emergency rule effective Dec. 1 (Dickson, 12/4).

The Texas Tribune: State Gets Federal OK To Boost Medicaid Payments
A year after Texas was slated to increase Medicaid payments to primary care physicians under the Affordable Care Act, the state has received federal approval to implement the change. Although the ACA required states to increase payments to primary care physicians in 2013, the federal government did not approve the state's plan to implement the rate increases until recently (Aaronson and Luthra, 12/4).

Kaiser Health News: Kansas Advocates For Developmentally Disabled Oppose Giving Medicaid Insurers Full Responsibility
Aldona and Pat Carney call their son, Neil, "a 24-7 kid." He's profoundly autistic, severely mentally retarded and attends a special school. He has tried to eat light bulbs and charcoal briquettes and can be aggressive, sometimes scratching people near him. Neil, 18, who walks with a limp and carries around a grey sock that calms him, lives in a beige single-family home with a professional caregiver who's known him for years. The house is equipped with cameras to track his movements and a backyard swing he loves to ride (Bergal, 12/5).

St. Louis Beacon: Many Concerns -- And Some Hope -- In Health Data On Blacks In The Region
Sherrill Jackson is a 21-year breast cancer survivor. Shermane Winters-Wofford is a two-time stroke victim. Isadore Wayne and Mellve Shahid are coping successfully with prostate cancer. All four are known less for their adverse health experiences than for sending uplifting messages to black communities, dispelling myths about their illnesses and encouraging people to take advantage of medical screenings and other programs that can save lives (Joiner, 12/4).

Health Policy Solutions (a Colo. news service): Health Detectives Use House Calls, 'Hotspotting' To Cut Costs
Bridges to Care is an experiment that’s part of the trend in health care called "hotspotting." Dr. Jeffrey Brenner, a family physician working in one of the poorest communities in the U.S., Camden, N.J., pioneered the concept when he found that 1 percent of people there were racking up 30 percent of health costs. … Brenner looked for "hotspots" or outliers in vast amounts of data -- the sickest people who were costing the most. Then he did the unthinkable. Instead of trying to cut off these complex patients, Brenner gave them more, better-tailored care (Kerwin McCrimmon, 12/4).

California Healthline: State, Stakeholders Work To Renew Community-Based Adult Services
California health officials and stakeholders yesterday gathered in Sacramento to lay out a path to renew the Community-Based Adult Services program, which must be renewed by May 2014 or it will expire in August 2014. The wide-ranging meeting touched on dozens of facets of care for the frail population but also managed to skip over one of the central issues of the waiver renewal -- the state requirement that all CBAS centers shift to not-for-profit status. "That's one of the standards of participation, and will be included in the next meeting," said Denise Peach, chief of the CBAS branch of the state Department of Aging (Gorn, 12/4).

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Weekend Reading

Longer Reads: Millenials' Mental Health and Sleeping Pills Without Side Effects

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

ProPublica: Sex, Lies And HIV: When What You Don't Tell Your Partner Is A Crime       
Nick Rhoades was clerking at a Family Video store in Waverly, Iowa, one summer afternoon in 2008 when three armed detectives appeared, escorted him to a local hospital and ordered nurses to draw his blood. …His crime: having sex without first disclosing he had HIV. ... The man Rhoades had sex with, 22-year-old Adam Plendl, had not contracted the virus. That’s not a surprise, because Rhoades used a condom (Sergio Hernandez, 12/1).

The Atlantic: The Secret Life Of Grief        
My mom died on July 18, 2013, of pancreatic cancer, a subtle blade that slips into the host so imperceptibly that by the time a presence is felt, it is almost always too late. Living about 16 months after her diagnosis, she was "lucky," at least by the new standards of the parallel universe of cancer world. We were all lucky and unlucky in this way. Having time to watch a loved one die is a gift that takes more than it gives. ... For some, grief is a dull and unrelenting ache that fades—or doesn't. But for many of us, grief is something else. Grief is resilience (Derek Thompson, 12/3).

Slate: Why Millenials Can't Grow Up       
Amy (not her real name) sat in my office and wiped her streaming tears on her sleeve, refusing the scratchy tissues I’d offered. "I’m thinking about just applying for a Ph.D. program after I graduate because I have no idea what I want to do." Amy had mild depression growing up, and it worsened during freshman year of college when she moved from her parents’ house to her dorm. … Her case is becoming the norm for twenty- to thirtysomethings I see in my office as a psychotherapist. I’ve had at least 100 college and grad students like Amy crying on my couch because breaching adulthood is too overwhelming. ... Rates of depression are soaring among millennials in college (Brooke Donatone, 12/5).

The New Yorker: The Big Sleep                                                                               
One evening in late May, four senior employees of Merck, the pharmaceutical company, sat in the bar of a Hilton Hotel in Rockville, Maryland, wearing metal lapel pins stamped with the word "team." They were in a state of exhausted overpreparedness. The next morning, they were to drive a few miles to the headquarters of the Food and Drug Administration and attend a meeting that would decide the future of suvorexant, a new sleeping pill that the company had been developing for a decade. Merck’s team hoped to persuade a committee of seventeen, composed largely of neurologists, that suvorexant was safe and effective (Ian Parker, 12/9).

Indianapolis Monthly: Susan Cox Is No Longer Here                                                                            
She was 52, homeless, and cancer-stricken. A group of devoted strangers vowed that she would not die alone. And then something miraculous happened. One woman's beautiful, strange, and troubling final days. ... It all began in the middle of August, with a phone call from Wishard Memorial Hospital, the city hospital of Indianapolis, informing me that I needed to hurry to meet a woman who was dying. She didn’t have much time left. A few weeks before, I had inquired about visiting a patient in the hospital’s months-old No One Dies Alone program, NODA for short, essentially a bedside vigil to provide a loving environment for people who otherwise have no one else (Justin Heckert, 12/2).

Quartz: Sick Iranians Are Struggling To Get Life-Saving Meds. US Legislators Plan To Make It Even Harder
Not a month after a breakthrough in nuclear negotiations with Iran, US legislators are pushing for a fresh round of sanctions. The bill will punish Iran should it flout the nuclear agreement’s six-month deadline for curbing uranium enrichment and allowing more inspections. ... Six years of sanctions have throttled Iran’s supply of essential drugs, causing an acute shortage of things like antibiotics and vaccines, as well more advanced drugs (Gwynn Guilford, 12/3).

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Editorials and Opinions

Viewpoints: Coping With Physician Shortage; 'Righteous' Hobby Lobby Cause; Enrolling Millenials

The New York Times: No, There Won't Be A Doctor Shortage
In just over a decade the United States will need 130,000 more doctors than medical schools are producing. So says the Association of American Medical Colleges, which warns of a doctor shortage that will drive up wait times, shorten office visits and make it harder for Americans to access the care they need (Scott Gottlieb and Ezekiel J. Emanuel, 12/4). 

Los Angeles Times: The Righteousness In Hobby Lobby's Cause
A little more than 20 years ago, Congress did something that, today, is hard to imagine. Lawmakers from both parties and across the political spectrum found common ground and passed, by a near-unanimous vote, the Religious Freedom Restoration Act, which firmly commits the federal government to protecting and promoting our "inalienable right" to freely exercise religion. As President Clinton remarked when he signed the legislation into law, "the power of God is such that even in the legislative process, miracles can happen" (Richard W. Garrett, 12/5). 

Los Angeles Times: What Obama Should Do If He Wants Young People To Sign Up For Obamacare
Will young, healthy people sign up for Obamacare? That may be the single most important question for the success of the new insurance program. If young people sign up, the pool of customers will be relatively healthy and rates may stay reasonable. If they don't, the pool could include a disproportionate number of sick people running up big bills, leading to potentially crippling rate increases (Doyle McManus, 12/4).

The Fiscal Times: Millenials Jump Ship Over Obamacare Bait And Switch
It took long enough for the demographic that will pay the most for Obamacare to finally figure it out. Now that the wealth transfer from younger and healthier adults to older sicker ones through Obama's mandating of unneeded comprehensive insurance for the latter has become clear, millennials have not just steered clear of the health care exchanges -- they're steering clear of Barack Obama and the Democratic Party now, too (Edward Morrissey, 12/5).

JAMA: Lessons From The ACA Crash
The Affordable Care Act (ACA) had a rough October and November. First, the federal health insurance exchange website did not work as intended, making it virtually impossible for people who wanted coverage to sign up. ... The failure of the ACA rollout has many ramifications, its effect on national politics being an obvious one. But there are substantive implications well beyond politics (David Cutler, 12/4).

The Washington Post's Right Turn: Fix Your Own Mess, Democrats
Liberal pundits and Democratic lawmakers (easily confused with one another) have taken to arguing that the GOP is rooting for Obamacare to fail. And, moreover, they complain they aren't helping to fix it. To the first I plead guilty and the second, I must ask: Are they mad? (Jennifer Rubin, 12/4).

The Washington Post's Post Partisan: Why 29,000 Obamacare Sign Ups Are Nothing To Celebrate
Obamacare supporters are celebrating the news that 29,000 people signed up for Obamacare on Sunday and Monday -- the first days since the re-launch of the healthcare.gov website. Calling it an "enrollment surge," Obama officials gushed to Politico that this figure "surpasses the total for the whole month of October" and "provide the clearest evidence yet that the federal exchange is on the mend." High fives all around! (Marc. A. Thiessen, 12/4). 

The Washington Post: NIH Research Is Ailing From The Budget Squeeze 
Francis S. Collins, director of the National Institutes of Health (NIH), has been distributing a chart that shows the success rate of grant applications to NIH for scientific research. While the rate was about 30 percent as recently as a decade ago, it has plunged to about 15 percent, which Dr. Collins says is the lowest in history. One reason for this is that more applicants are seeking funds, but the budget squeeze also is to blame. Dr. Collins is worried that the low success rate will cause young scientists and researchers to abandon the laboratory for other careers or to take their talents and ideas to other countries (12/4).

The Wall Street Journal's Wonder Land: Obama's Red-Line Presidency
What would you rather be: an American lost inside an Obamacare exchange or a Syrian rebel? No matter who gets touched by the helping hand of Barack Obama, the problem is not merely the broken promise but the chaos that follows the break. Start with Obamacare. When Mr. Obama addressed the nonperformance of healthcare.gov, here's one of the things he said: "What we're also discovering is that insurance is complicated to buy." Come again? You're discovering this? It sounds as if Obamacare was sprung over beer-and-pretzels by a bunch of guys watching hoops at the White House. The one group of people in the world who would believe this is how Obamacare came to life would be the Syrian rebels. They also got hit by a glitch (Daniel Henninger, 12/4).

The Fiscal Times: Will Obamacare Actually Make You Healthier?
According to a recent survey by the Commonwealth Fund, a health care think tank, "U.S. adults are significantly more likely than their counterparts to forgo health care because of the cost, to have difficulty paying for care even when they have insurance, and to deal with time-consuming insurance issues." This may not be good news for policymakers and proponents of Obamacare. There's little to suggest that the exchanges will reduce overall health care costs, trim paperwork or make insurance claim processing any easier (John F. Wasik, 12/4).

The New York Times: Opinionator: To Make Hospitals Less Deadly, A Dose Of Data 
Going to the hospital is supposed to be good for you. But in an alarming number of cases, it isn't. And often it's fatal. In fact it is the most dangerous thing most people will do. Until very recently, health care experts believed that preventable hospital error caused some 98,000 deaths a year in the United States -- a figure based on 1984 data (Rosenberg, 12/4).

St. Louis Beacon: Democracy In A World Without Facts: A Look At Health Care And Guns
Some years ago at a scientific meeting in Sweden, a conversation with a local resident veered toward gun policy in the United States. You have tens of thousands of gun deaths annually, my companion intoned, and the trend is to make guns easier to access so more people can have them! This was not a casual assertion that U.S. gun policy is imperfect. It was not an invitation to explore alternatives (Ken Schechtman, 12/4).

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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.