Daily Health Policy Report

Wednesday, September 25, 2013

Last updated: Wed, Sep 25

KHN Original Reporting & Guest Opinion

Capitol Hill Watch

Health Reform

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Average Obamacare Premiums Will Be Lower Than Projected

Kaiser Health News staff writers Julie Appleby and Phil Galewitz report: "Just days before new online health insurance markets are set to open, the Obama administration Wednesday released a look at average premiums, saying rates in most states are lower than earlier projected -- and that 95 percent of consumers will have at least two insurers to choose from. The report – released the same day that President Barack Obama and former President Bill Clinton touted the law’s benefits -- comes as part of a stepped-up administration effort to explain and defend the health law as congressional Republicans target it for defunding" (Appleby and Galewitz, 9/25). Read the story.

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Some Say Obamacare's 'Affordable' Coverage Isn't Affordable For Them

Kaiser Health News’ staff writer Julie Appleby, working in collaboration with NBC News, reports: "Michelle La Voie wants health insurance, but as a single mom making $38,000 a year and supporting two teenagers, she's not sure she can afford it -- even with a subsidy through the federal health law known as Obamacare" (Appleby, 9/24). Read the story.

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8 Ways Young Women Benefit From Obamacare

Kaiser Health News staff writer Phil Galewitz, working in partnership with Cosmopolitan, reports: "You've heard people arguing about Obamacare (officially known as The Affordable Care Act or ACA) for months ... but you may have tuned it all out, because it's all so confusing and you don’t even know how -- or if -- it affects you. But starting in 2014, the law will require people who can afford insurance to carry it or risk paying a fine, so now's the time to pay attention. And the fact is, you may discover that there are lots of benefits you'll be able to take advantage of. Here's a quick list of what's great about the ACA, especially for young women" (Galewitz, 9/24) Read the story.

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Capsules: 3 States, 3 Different Obamacare Outreach Plans; Questions And Answers About Obamacare Marketplaces

Now on Kaiser Health News' blog, Jenny Gold reports on the enrollment outreach plans being followed by three states: "How many ads will it take to get the uninsured signed up for the new coverage options launching Oct. 1? States do not know yet. But those running their own marketplaces are rolling out some creative new outreach techniques to get there as quickly as possible" (Gold, 9/24).

Also on the blog, Mary Agnes Carey and Julie Appleby were hosted once again by the Washington Post’s Charity Brown for a live discussion with Post readers about how the new online marketplaces will work under the health law. Read a transcript of the discussion or check out what else is on the blog.

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Political Cartoon: 'Overstretched?'

Kaiser Health News provides a fresh take on health policy developments with "Overstretched?' by Gary Varvel.

Here's today's health policy haiku:


What I really want
Is someone to care for me
When my body fails.
-Janice Lynch Schuster

And a bonus -- just because:


Hey Senator Cruz
In the end, green eggs and ham
tasted delicious.

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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Capitol Hill Watch

Politics And Strategies Complicate GOP Efforts To Derail The Health Law

Democrats see the threat of shutting down the federal government over the health law as potentially bringing electoral gains in 2014. Meanwhile, House Republican leaders are mulling whether to attach new repeal amendments -- including one that would delay the health law's individual mandate -- to the pending bill to fund the government.

McClatchy: Senate Moves Toward Showdown Vote On Obamacare
The Senate is expected to take a key vote Wednesday that would smooth the path for an eventual showdown over President Barack Obama's health care plan, but the midday vote is likely to inflame a raging war within the Republican Party. A group of Republican senators tried to launch an old-fashioned filibuster Tuesday, despite pleas from party leadership to back off (Lightman, 9/24).

The Associated Press: Analysis: Republicans In A Risky Fight With Obama
Under relentless pressure from their right wing, Republicans are in the midst of a risky fight with President Barack Obama they know they will lose, little more than a year before an election that history says they should win. To minimize the damage, the party must redefine victory as something less than a full defunding of Obama’s 3-year-old health care law, yet convince the most conservative GOP supporters that Republican lawmakers succumbed after a principled fight. All without triggering a government shutdown or a default by the Treasury, or otherwise offending independents whose ballots will settle the 2014 elections (Espo, 9/25).

The Washington Post: Democrats See GOP Shutdown Threat As Opening For 2014 Election Gains
The key to the Democratic strategy is a belief that a showdown is likely to play out similarly to the government shutdowns of 1995 and 1996, which turned public opinion sharply against the Republican majority. … As a result, many Democrats welcomed Tuesday's filibuster-style floor speech by conservative Sen. Ted Cruz (R-Tex.), who pledged to talk for as long as he could in an attempt to slow Democratic plans to advance a bill that would keep the government open while also funding President Obama's signature health-care law. House Republicans voted to strip funding from Obamacare last week in exchange for keeping the government running. ... But Republican strategists say Democrats are overstating the potential benefits of the showdown for their side. They say that Democrats have their own problems — particularly support for Obamacare in the face of strong public opposition (Goldfarb, 9/24).

Los Angeles Times: Republican Leaders Considering Plan B To Stop Healthcare Law
With their effort to block money to run the government until President Obama guts the new healthcare law starting to fizzle, Republican leaders are considering Plan B. Senate Republicans are pushing renegade Sen. Ted Cruz (R-Texas) to wrap up his filibuster-like obstruction of the government funding bill sooner rather than later. Top Republicans want to get the legislation back to the House in time to give Speaker John A. Boehner (R-Ohio) an opportunity to attach new healthcare repeal amendments that might have a better chance at achieving GOP policy goals (Mascaro, 9/25).

Politico: House GOP May Attach Obamacare Delay To CR
The House Republican leadership is seriously considering attaching a one-year delay of Obamacare's individual mandate to the Senate bill to avert a government shutdown, according to senior GOP aides. If House Republicans decide to go this route, it would all but provoke a government shutdown, since Senate Democrats might not even schedule a vote on a bill that includes that provision, Senate leadership staffers say. Even if the Senate schedules a vote, there might not be time to move the legislation through the slow-moving chamber (Sherman and Bresnahan, 9/25).

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Senator's Marathon Stand Against Health Law May Do Little To Stop Senate Measure

Texas Sen. Ted Cruz's winding, marathon speech on the Senate floor and aimed at bringing attention to efforts to block money for Obamacare's implementation but may have little effect.

The Washington Post: Sen. Cruz Continues Night-Long Attack On Obamacare
To most Americans, it looked like a traditional filibuster, fixed in the popular imagination by Jimmy Stewart's performance in "Mr. Smith Goes to Washington." But parliamentary procedures already in place dictate that Cruz will have to yield the floor by Wednesday afternoon at the latest. With Senate passage all but certain on a bill that will include funding for the health-care law, commonly known as Obamacare, Cruz's strategy will give House Speaker John A. Boehner (R-Ohio) and his colleagues only a few hours to respond with a different version of the legislation (O'Keefe and Kane, 9/25).

The New York Times: Senator Persists Battling Health Law, Irking Even Many In His Own Party
Facing an increasingly likely defeat in his tangled procedural fight over funding the government, Senator Ted Cruz took to the Senate floor on Tuesday and declared he would speak "until I cannot stand" to rally voters against the health care law (Weisman, 9/24).

Los Angeles Times: Sen. Ted Cruz Digs In As Shutdown Looms
Three hours into his Senate speech-a-thon, Sen. Ted Cruz recalled that Sen. Rand Paul's filibuster criticizing U.S. drone policy was seen at first as "curious if not quixotic," but ultimately "transformed the debate." Cruz, a Texas Republican, took control of the Senate floor Tuesday to herald his campaign to eliminate the money needed to implement President Obama's health care law. He hoped for a galvanizing moment similar to the one sparked by his Kentucky colleague in March (Memoli, 9/24).

The Wall Street Journal: Cruz's Defiant Stand Is Also A Lonely One
Wearing black tennis shoes in lieu of his customary boots, the Republican took to the Senate floor Tuesday afternoon in front of a handful of lawmakers and vowed to speak until he was "no longer able to stand" in resistance to President Barack Obama's health care law. It technically was just a long speech that stretched late into the night -- not a filibuster -- and couldn't significantly delay a Senate vote expected Wednesday. But Mr. Cruz's defiant stand exemplified his unyielding brand of conservatism that, less than a year into his Senate career, has fueled speculation that he might run for president (Peterson and Hook, 9/24).

Dallas Morning News: Cruz Wages Lonely, Marathon Talk On Defunding Obamacare
Condemned from all sides, Sen. Ted Cruz launched a talkathon Tuesday intended to cripple Obamacare but aimed -- inconveniently -- at a bill that would deliver exactly what he asked for (Gillman, 9/25).

The New York Times: About New York: A Republican Calls Another a 'Fraud'
[Repubican Rep. Peter] King said precisely what he thought of the Cruz tactic: "It is just a form of governmental terrorism." Strong coffee, which Mr. King began pouring last week, a near-solitary voice against what he saw as a cynical maneuver to delude ordinary Republican voters into thinking that President Obama's health care law could be effectively repealed without winning elections or court cases. Now, other Republicans are beginning to speak against Mr. Cruz and what he has wrought (Dwyer, 9/24).

And in other news about Sen. Cruz's efforts on health care -

Politico: Ted Cruz, David Vitter Clash On Obamacare Exemption
Republicans want members of Congress on the Obamacare exchanges without subsidies, but they're split on who else should be there, too. Sen. Ted Cruz (R-Texas) wants to broaden Sen. David Vitter (R-La.)'s proposal to put lawmakers on the exchanges without a tax subsidy to include all federal employees. But Vitter's camp says such a move would only make it easier for Democrats to defeat it (Haberkorn and Everett, 9/24).

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Lawmakers Weigh Deal Giving FDA Greater Clout After Meningitis Outbreak

House and Senate negotiators appear to be making progress towards stiffer regulations over the type of drugs that caused last year's outbreak. In other Capitol Hill news, the GOP pushes to repeal a tax on medical devices, and rural health care providers ask for more time to meet electronic health record deadlines.

The Baltimore Sun: Lawmakers Seek Deal On Drug-Mixing A Year After Outbreak
Lawmakers on Capitol Hill are closing in on a deal to grant the Food and Drug Administration more authority over the type of drugs that caused a deadly outbreak of meningitis last year, advocates close to the issue said Tuesday. Though details of the proposal remain fluid, House and Senate negotiators have been talking for weeks and appear to be making progress toward stiffer regulations (Fritze, 9/25).

The Hill: GOP Senators Push For Medical Device Tax Repeal Vote
GOP senators said Tuesday that they would try to attach a repeal of a medical device tax to a government spending measure, as they prepare for Democrats to strip language defunding the president's health care law. Republicans on both sides of the Capitol despise the medical device tax, with Sen. Orrin Hatch (Utah) calling it a "stupid dumb-ass thing" on Tuesday (Becker, 9/24).

CQ HealthBeat: Senators Ask HHS For Delay In Electronic Records Program
Health care providers, particularly those in rural areas, need more time to meet an Obama administration deadline for the second stage of a health information technology program that is designed to foster electronic record-keeping, two Republican senators said Tuesday in a letter to agency Secretary Kathleen Sebelius (Bunis, 9/24).

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Health Reform

'Average' Exchange Premiums Come In Lower Than Projected

The Obama administration said Wednesday that average premiums in the health law's online insurance marketplaces will be lower than projected by the Congressional Budget Office - 16 percent lower nationwide. But the rates will vary widely depending on where you live, from significantly higher than average in Wyoming and Alaska to lower than average in Tennessee and Texas.

Kaiser Health News: Average Obamacare Premiums Will Be Lower Than Projected
Just days before new online health insurance markets are set to open, the Obama administration Wednesday released a look at average premiums, saying rates in most states are lower than earlier projected -- and that 95 percent of consumers will have at least two insurers to choose from. The report – released the same day that President Barack Obama and former President Bill Clinton touted the law’s benefits -- comes as part of a stepped-up administration effort to explain and defend the health law as congressional Republicans target it for defunding (Appleby and Galewitz, 9/25).

The New York Times: Officials Detail Premium Costs Of Health Plan
Administration officials released the information, central to their campaign to persuade millions of uninsured Americans to sign up for coverage, even as Senator Ted Cruz, Republican of Texas, waged a fierce fight on the Senate floor, risking a government shutdown if necessary to eliminate financing for the expansion of coverage under President Obama’s health care law (Pear, 9/25).

The Wall Street Journal: Prices Set For New Health Care Exchanges
The plans, offered under the health care overhaul to people who don't get insurance through an employer or government program, in many cases provide broader coverage than current policies. Costs will vary widely from state to state and for different types of consumers. Government subsidies will cut costs for some lower-income consumers (Radnofsky 9/25).

NPR: Administration Touts Lower-Than-Expected Obamacare Premiums
Premiums in the health insurance exchanges set to open next week will be lower than anticipated, the Obama administration announced Wednesday. According to a report released by the Department of Health and Human Services, "premiums nationwide will ... be around 16 percent lower than originally expected," and 95 percent of uninsured people live in a state with average premiums that are lower than expected (Rovner, 9/25).

Los Angeles Times: Online Obamacare Marketplaces Offer Ample Options, Report Says
Most Americans who shop for health insurance on new online marketplaces set up under President Obama's health law will have a wide variety of choices, a new report from the Department of Health and Human Services indicates. And many young consumers will be able to select health plans that cost $100 a month or less, according to the report, which is based on a preliminary analysis of premiums that insurers will charge when the insurance becomes available Jan. 1 in 36 states (Levey, 9/24).

The Washington Post's Wonk Blog: How Much Will Obamacare Premiums Cost? Depends On Where You Live. 
A 27-year-old in Austin who earns $25,000 could pay $85 per month for health insurance next year, and a family of four in St. Louis with income of $50,000 might face a $32 monthly premium, according to new federal data on health insurance rates under the Affordable Care Act. The report, released Wednesday by the Department of Health and Human Services, showed significant variation in the insurance premiums that Americans shopping on the individual market could pay under the president’s health-care overhaul. Across the 48 states for which data were available, the unsubsidized monthly premiums could be as low as $70 for an individual and as high as $1,200 for a moderate plan for a family of four (Somashekhar and Kliff, 9/25).

The Associated Press/Washington Post: Obama Administration Unveils Premiums And Choices In 36 States As Health Overhaul Debut Nears
The overview of premiums and plan choices, released Wednesday by Health and Human Services Secretary Kathleen Sebelius, comes as the White House swings into full campaign mode to promote the benefits of the Affordable Care Act to a skeptical public. Congressional Republicans, meanwhile, refuse to abandon their quest to derail "Obamacare" and flirt with a government shutdown to force the issue (9/25).

USA Today: How The Insurance Exchanges Stack Up
Wednesday's report is the latest review of exchanges' rates and policies from HHS and various states. Most have shown lower rates than anticipated, as more insurers have entered the markets and pegged their prices to capture more customers. The Obama administration estimates that 7 million uninsured Americans will use the exchanges to buy insurance in the six-month enrollment period that starts next week and ends March 1 (Kennedy, 9/25).

Politico: HHS Reveals Obamacare Coverage Prices For Federal Exchanges
The administration put the best face on the health insurance premiums, emphasizing that the rates have come in lower than expected in the 36 states where the feds will run part or all of the exchanges. That part of the report gives them a snappy answer to the widespread predictions of "rate shock" by critics of Obamacare (Norman and Millman, 9/25). 

NBC News: $11 A Month? Obamacare Super-Cheap For Some, Feds Find
HHS has analyzed the plans that have been approved to go on offer starting Tuesday and finds that in most states, there's plenty of choice with reasonable prices. That gives the administration ammunition against critics who have been warning that health insurance will cost more in the exchanges than it does now (Fox, 9/25).

McClatchy: Report: Obamacare Health Insurance Will Have Affordable Rates 
With prices all but finalized in most states, a new report by the U.S. Department of Health and Human Services found that monthly premiums in 47 states and the District of Columbia, on average, will be 16 percent lower next year than the Congressional Budget Office projected they would be in 2016 -- when the marketplaces are at full capacity. Roughly 95 percent of uninsured people who are eligible for marketplace coverage live in states where average monthly premiums for individual coverage is lower than expected, the report found. And the states with the lowest premiums have more than twice the number of plans offering coverage than states with the highest premiums (Pugh, 9/25).

The Texas Tribune: Feds Release Premium Rates For Insurance Marketplace
As the nation watched U.S. Sen. Ted Cruz on Tuesday argue for hours to defund Obamacare -- even at the cost of shutting down the federal government -- the Obama administration released preliminary data showing that premium rates in the health insurance marketplace created by the law will be comparatively low for Texans (Aaronson, 9/24).

St. Louis Post-Dispatch: Feds Say New Health Exchanges Will Be Competitive, Affordable
New health insurance marketplaces are fostering competition that will mean lower premiums than initially expected, federal officials said Tuesday. In a new report, the U.S. Department of Health & Human Services provided estimates of average policy rates for consumers in 36 states, including Missouri and Illinois, where the federal government is involved in setting up the marketplaces (Doyle and Kulash, 9/24).

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Some Consumers May Not Find Obamacare Premiums Affordable

Even as the Obama administration releases average premiums for insurance policies to be sold in each state exchange, some news outlets explore how affordable those options will be for certain groups of consumers.

Kaiser Health News: Some Say Obamacare's 'Affordable' Coverage Isn't Affordable For Them
Michelle La Voie wants health insurance, but as a single mom making $38,000 a year and supporting two teenagers, she's not sure she can afford it -- even with a subsidy through the federal health law known as Obamacare (Appleby, 9/24).

Bloomberg: Obama’s Health Law Premiums Test Limits Of Affordability
Health insurance under Obamacare will cost individuals at least $2,988 a year on average, a price that Republican opponents may target as out-of-reach for many Americans who don’t qualify for U.S. subsidies. While the $249 monthly payment is intended to be discounted through tax credits, less than half of people now buying insurance on their own may get that help (Wayne and Nussbaum, 9/25).

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Obama, Clinton Make Joint Pitch To Uninsured Americans

White House officials said the rare, hour-long appearance by the two presidents was an attempt to focus attention on next week’s opening of enrollment in health insurance exchanges, which are key to the health law's expansion of coverage.

NPR: Commander In Chief, Explainer-In-Chief Tout Health Care Law
President Obama's health care law has so far survived challenges in Congress and the courts. But its biggest test could begin next week. That's when the online marketplaces offering health care coverage to the uninsured are set to start signing people up. The question is, will they come? (Horsley, 9/25).

The New York Times: Obama And Clintons Share Stage For Health Care Talk
After delivering a much-anticipated speech to the United Nations General Assembly in the morning and meeting with world leaders in the afternoon, President Obama turned to health care on Tuesday evening, sharing center stage with the Clinton family at an event to highlight the rollout of the Affordable Care Act (Shear, 9/24).

Los Angeles Times: With Bill Clinton At His Side, Obama Sells Healthcare Law
President Obama accused foes of his healthcare law of trying to sabotage it for political gain, saying opposition has become a "litmus test" for Republicans. The result, Obama said Tuesday evening, is that the law is mired in partisan politics in state legislatures and Congress. … As he spoke, Sen. Ted Cruz, a tea party Republican from Texas, was staging a filibuster at the Capitol to try to strip funding for the nearly 4-year-old law, an effort that threatened to shut down the federal government. It also divided the GOP over tactics (Hennessey, 9/24).

The Associated Press: Reunited Obama, Bill Clinton Tout Health Care Law
Joining forces under dimmed lights in a hotel ballroom in New York, Obama and Clinton laid out the law’s benefits and its connection to the economy while dispelling what they called disinformation about its downsides. Clinton, acting as host, lobbed the questions; Obama answered with the eagerness of a guest on a daytime TV talk show (Superville, 9/24).

The Washington Post: President Obama Enlists Bill Clinton To Help Pitch New Health Insurance Exchanges
The two men who stand as bookends for the modern Democratic Party made a united sales pitch to millions of uninsured Americans to enroll when new insurance marketplaces open Oct. 1. … Obama has enlisted Clinton again as his "secretary of explaining stuff," a nickname he earned after his well-received speech at the 2012 Democratic National Convention. The aim is for Clinton to help sell the health-care law to skeptics across the country while combating Republican attempts to undermine it (Rucker, 9/24).

Politico: Clintons To The Rescue On Obamacare
President Barack Obama on Tuesday tapped into what is becoming his Obamacare elixir: the Clintons. For the second time in a month, Obama leaned on the former first family to help untangle the complexities of the health care law with less than a week left to go before the open enrollment begins Oct. 1 (Budoff Brown, 9/24).

NBC News: Obamacare Created Insurance Company Competition, Clinton Says
Obama tapped Bill Clinton to demystify his health care law at the Clinton Global Initiative, where they spoke for more than an hour (Todd, 9/24).

ABC News: One Obama And Two Clintons Share A Stage
It all played out at an event in midtown Manhattan this evening, with former President Bill Clinton moderating an unusual and at times wonky one-on-one discussion with President Obama about how the new health care law will work. Former Secretary of State Hillary Clinton introduced both men before they took the stage. Clinton, whom Obama once dubbed the "Secretary of Explaining Things," asked leading questions of the president, who spoke at length about benefits of the law he said Americans will enjoy (Dwyer, 9/24).

Also in the news, a look at the White House campaign to promote enrollment in health exchanges -

Reuters: As Ad War Heats Up, White House Pushes To Enroll Millions In Obamacare
The White House on Tuesday kicked off a six-month campaign to encourage millions of Americans to sign up for health coverage under "Obamacare," an effort in which the president and other political celebrities promote the law's promise of subsidized health coverage. But the massive public education campaign faces a long, difficult slog to persuade nearly 3 million healthy young people with low to moderate incomes to purchase private insurance (Morgan, 9/24).

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Threatened Shutdown May Not Officially Slow Health Law's Implementation But Could Trigger Technical Difficulties

Many aspects of the health law will be mostly untouched by the looming federal government shutdown. But some officials are concerned that it could jam up the exchanges' data hub.

NPR: Would A Federal Shutdown Delay Health Care Exchanges?
When the government has to shut down because Congress fails to provide appropriations, only some parts have to close. And those are the things funded by annual appropriations. But the health law was mostly funded with what's called mandatory spending, which is different from annual appropriations. Mandatory programs — which include things like Medicare and Social Security — aren't affected by a government shutdown like the one we're potentially looking at (Rovner, 9/24).

The Wall Street Journal: Shutdown Unlikely To Hit Health Law's Rollout
Getting a passport or seeing pandas at the National Zoo would be more difficult if the government shuts down, but consumers should still be able to shop for health insurance on new online marketplaces. The marketplaces, the centerpiece of President Barack Obama's health law, are set to open Oct. 1. On the same day, parts of the government would shut down if Congress doesn't pass a bill extending federal agencies' discretionary spending (Schatz, 9/24).

Politico Pro: Shutdown Could Snarl Data Hub, Exchange Directors Fear
Leaders of new Obamacare health insurance marketplaces say they're still unsure whether a government shutdown would hurt immediate efforts to start enrolling millions of people in coverage just seven days from now. The state-run marketplaces say a shutdown after Sept. 30 wouldn't affect their funding since they already have contracts in place. But they are concerned about the fate of the federal data hub, which acts as the life support system of the exchanges by enabling state and federal agencies to share eligibility information when someone applies for coverage under the health law (Millman, 9/24).

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Outreach Efforts, Especially For Young Adults And Minorities, Take Center Stage

The Detroit Free Press looks at the challenges in getting the message about the new insurance programs out to the uninsured, while in Florida, some officials are defying the governor's decision to curb federal outreach efforts.

Detroit Free Press: Outreach For New Health Law May Be Particularly Tough For Minority Populations
Their clipboards and their pitch ready, the volunteers just wanted to hand out information. … It might seem, then, that Michigan’s 1.4 million uninsured and underinsured people would anxiously await the Oct. 1 launch of the marketplace. Not so. On this sunny Saturday in this east Detroit neighborhood, few doors opened, even though blinds moved. A few people who came to the door spoke from behind screen doors only (Erb, 9/24).

Kaiser Health News: Capsules: 3 States, 3 Different Obamacare Outreach Plans
How many ads will it take to get the uninsured signed up for the new coverage options launching Oct. 1? States do not know yet. But those running their own marketplaces are rolling out some creative new outreach techniques to get there as quickly as possible (Gold, 9/24).

Miami Herald: Broward Looks To Defy Gov. Scott On Obamacare
Heavily Democratic Broward County is expected to join Pinellas County in resisting Republican Gov. Rick Scott's decision to bar Obamacare enrollment advisors from state health department facilities. Broward Mayor Kristin Jacobs will offer a resolution at Tuesday's county commission meeting that would allow Affordable Care Act "navigators" and counselors at Florida Department of Health facilities in Broward County. The commission, which is dominated by Democrats, is expected to approve the proposal (Hladky, 9/23).

The Associated Press: Ohio Prepares For Federal Health Insurance Market Under Affordable Care Act
Ohio has yet to certify any navigators -- the professionals who will help people get enrolled [on the new insurance marketplaces]. Lt. Gov. Mary Taylor told reporters Tuesday that her insurance department is processing one entity's application. Three other organizations also have been awarded federal money to be navigators. Ohio created additional regulations for navigators, including required background checks, training and certification. Taylor, a Republican, has been one of the state's most vocal critics of the law (9/24).

Health Policy Solutions (a Colo. news service): Ads Target Young Invincibles For 'CYA' Insurance
Colorado plans to unveil its second round of ads when Connect for Health formally launches next week. This time, Colorado will follow California's lead. The new ads show people around the state with bubbles over their heads, showing that "here," "here" and "here," they can get health insurance. … Tom Leydon of Pilgrim Advertising said the new strategy is to get people to buy. In the first round of advertising, Leydon said the goal was to "raise awareness for something that very few people knew about." "Now our goal is to get people to sign up," he said (Kerwin McCrimmon, 9/24).

In other news about state marketplaces -

ABC News: 9 More Things To Know About Health Insurance Exchanges
On Tuesday we brought you the 10 things you need to know about health insurance exchanges. Some of you asked how the exchanges will affect retirees, while others wondered about religious exemptions. To help clear things up before open enrollment starts Oct. 1, here's the second installment of our health insurance explainer (Moisse, 9/25).

Health Policy Solutions (a Colo. news service): Want Tax Credits? You Won't Get Them Online
Pitched to the public as a Travelocity-style online marketplace for health insurance, Colorado's new health exchange won't allow customers to get online tax credits for at least the first month. Colorado exchange managers revealed Monday during a board meeting that customers who want tax credits to make health insurance more affordable will have to call for help, rather than navigating the multi-million dollar computer system on their own. … That's because the online system for determining eligibility for tax credits is not accurate enough to trust yet (Kerwin McCrimmon, 9/24).

Minnesota Public Radio: MNsure Would Delay Oct. 1 Launch If Security Risks Resurface
Minnesota's online health insurance marketplace would not go live as scheduled next week if any privacy or security risks remain unaddressed, MNsure officials said today. The agency officials offered that assurance during a legislative oversight committee hearing on MNsure's information security. State lawmakers quickly called the hearing a MNsure employee accidentally released Social Security numbers and other personal data of at least 1500 insurance brokers (Stawicki, 9/24).

The Sacramento Bee: California Insurance Chief Warns About Fraudulent Sellers Of Health Care Policies
With sales of the first Affordable Care Act policies just a week away, state officials are warning consumers of rip-off artists using scare tactics and phony websites. "Unfortunately, as with any new program, there are those who will use the new system to take advantage of or rip off consumers," said state Insurance Commissioner Dave Jones in a statement Tuesday. Consumers should purchase the new health care policies only through licensed insurance agents or the Covered California website, he said, "not impostors who seek to prey on those who want to sign up for insurance coverage" (Buck, 9/24).

The Star Tribune: Insurance Exchange May Solve Minnesota Pediatric Dental Woes
Help could be on the way in the form of MNsure, the state online insurance exchange that launches next month. Because federal policy requires the exchange to include pediatric dental benefits, state officials expect that thousands more Minnesotans will buy coverage and seek long overdue care for their children's teeth. But they also caution that this expansion of benefits won't solve all of the state's dental woes: Many of the neediest children already qualify for state-subsidized dental benefits and don't use them (Olson, 9/24).

In addition -

The Texas Tribune: Perry, Obamacare And The Uninsured
As the U.S. Census Bureau released new statistics showing Texas again ranks highest for the percentage of people without health insurance, Gov. Rick Perry quietly laid out the next moves in his ongoing effort to derail Obamacare (Aaronson, 9/24).

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Fed, State Work On Medicaid Applications In The Marketplaces Face Delays

Meanwhile, in New Hampshire, the panel tasked with deciding if the state will expand its program faces an Oct. 15 deadline to provide recommendations to the legislature.

The Wall Street Journal: Medicaid Applications Face Delay In Health Exchanges
The federal government's insurance exchanges won't be able to transfer Medicaid applications to states when the exchanges open Oct. 1, another sign of the technical hurdles the Obama administration is facing in preparing for the health-overhaul law (Radnofsky, 9/24).

CQ HealthBeat: State Medicaid Programs Working Quickly To Be Ready On Oct. 1
A sampling of states that are gearing up for the health care law's changes to the Medicaid system shows that officials have made progress, but that some states will not be completely ready by Oct. 1, when enrollment in an expanded program is scheduled to start along with the opening of the insurance exchanges (Adams, 9/24).

The Associated Press: N.H. Panel To Decide On Medicaid
A special panel that will recommend whether New Hampshire should expand its Medicaid program to poor adults will start discussing a specific plan next week. The panel faces an Oct. 15 deadline to make recommendations to the Legislature (Ramer, 9/25).

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Federal Appeals Court Mulls Whether Businesses Can Be Exempt From Birth Control Mandate

The court is considering a case in which two brothers who own businesses in Ohio say the requirement to cover the cost of contraceptives to their employees would violate their Roman Catholic beliefs.

The Associated Press/Washington Post: Judges Weigh Whether Businesses Can Be Exempt From Health Care Law’s Contraception Mandate
A federal appeals court is considering whether for-profit businesses can be exempted from a contraceptive mandate in the health care law because of the owners’ religious views. The law already exempts houses of worship from the requirement, but two brothers who own businesses in Ohio argue they shouldn’t have to comply. The brothers, Francis and Philip M. Gilardi, say the requirement would force them to violate their Roman Catholic religious beliefs and moral values by providing contraceptives such as the Plan B pill for their employees (9/24).

Politico: D.C. Court Skeptical Of Contraception Rule
The D.C. Circuit Court of Appeals on Tuesday expressed skepticism over the Obama administration’s claims that it can require nearly all employers to provide access to contraceptives in their employee health plans. The appeals court on Tuesday heard arguments on whether to allow an injunction blocking the policy — one of the most controversial provisions of Obamacare — for Francis and Philip Gilardi and their Freshway Foods produce company. It’s the latest in a series of lawsuits against the requirement that are now working their way through the court system and are expected to reach the Supreme Court (Haberkorn, 9/24).

In related news, nuns become the latest plaintiffs challenging the contraception rule -

The Wall Street Journal's Washington Wire: Nuns Challenge Obamacare's Contraception Rule
A public-interest law firm challenging the federal health law’s requirement that employers cover contraception in workers’ insurance plans has a new plaintiff: nuns. The Becket Fund for Religious Liberty filed a lawsuit Tuesday in federal district court in Denver on behalf of the Little Sisters of the Poor, a Catholic religious order that operates homes with 13,000 poor elderly people (Radnofsky, 9/24).

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Popular Or Unpopular, Health Law Rollout Fires Up Backers, Detractors

The popularity, or unpopularity, of the health law in different parts of America remains a flashpoint issue in determining how the law rolls out, as lawmakers and health officials share their points of view with a skeptical public.

The New York Times: In Corner Of Arkansas, Frustration But No Panic Over Possible Shutdown
People do have strong feelings about some of the issues, most significantly an almost universal suspicion of the Affordable Care Act. But in a conservative district that has sent Republicans to Congress every year since 1967, people seem to see the current turmoil as the new normal of Washington rather than a seminal political moment likely to affect their own lives. And if Republican legislators could be overplaying their hand by pushing their case against Obamacare to the outer limits, there is not much sign of that in the reactions here. Their second-term congressman, Steve Womack, voted with House Republicans to defund Obamacare, and no one can imagine anything so dire that voters could elect a Democrat here. Still, that does not mean people are happy about what they see (Fernandez, 9/24).

Politico: At Kentucky State Fair, Fear And Confusion Over ACA 
Somewhere between the cart hawking hamburgers stuffed between Krispy Kreme doughnuts and a display of world championship horses, Kentucky state employees were trying to sell Obamacare at the state fair. "If you know anyone without insurance or problems with pre-existing conditions, they can't deny you and can’t charge you more," employees of the state's new health insurance exchange told fair-goers passing by the booth (Haberkorn, 9/24).

The Washington Post’s The Fact Checker: How Unpopular Or Popular Is Obamacare? 
In the fight over President Obama’s health care law, politicians love to toss around statistics that show either how popular it is -- or is not. But this pair of statements is truly head-spinning. How can the most unpopular law ever passed in the history of this country be supported by 59 percent of the American people? And can a government shutdown really be "the worst idea that came along"? Let's take a look (Kessler, 9/25).

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Businesses, Other Stakeholders Confront Health Law's Nitty-Gritty Details

From renewing health policies early and pushing marketing efforts to creating new patient-care programs and seeking new workplace wellness rules, stakeholders are busying themselves wading through a deep pool of health law changes.

The New York Times: Rules Sought for Workplace Wellness Questionnaires
A federal lawmaker is asking the Equal Employment Opportunity Commission to investigate employer wellness programs that seek intimate health information from employees, and to issue guidelines preventing employers from using such programs to discriminate against workers (Singer, 9/24).

The Associated Press: Small Businesses Temporarily Sidestep Health Law
Many small businesses have found a way to temporarily sidestep some of the headaches brought on by the new health care law.  One of them is Huber Capital Management. The asset management firm in El Segundo, Calif., is renewing its health insurance policy early, in 2013 instead of 2014 (Rosenberg, 9/24).

Bloomberg: Obamacare Keeps Patients At Home Slowing Hospital Use
Obamacare has already transformed Esther Redd’s health, like that of thousands of other Americans…Then Redd, like more than 600 other Mount Sinai patients over the past three years, was singled out as a high-risk patient and assigned to one of 27 social workers focused on keeping patients out of the hospital. Mount Sinai created the program after the Affordable Care Act set up an incentive system to provide hospitals extra money for keeping people healthy, and penalize them for having too many patients readmitted too soon (Pettypiece, 9/25).

The CT Mirror: Amid Obamacare Marketing Push, Confusion About Medicare 
There’s a major marketing campaign under way for Access Health CT, the new insurance marketplace opening Oct. 1 as part of the federal health reform law. But some officials and others who work with seniors are trying to get out a separate message: If you’re on Medicare, the new marketplace is not for you (Becker, 9/24).

PBS NewsHour: How Does Health Reform Change Options For Young Adults?
Under the new health care reform law, young adults can stay on their parents' insurance until they are 26. What options are available for young adults with limited income? Gwen Ifill looks to Mary Agnes Carey of Kaiser Health News to answer some of your most frequently asked questions (Ifill, 9/24).

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State Watch

State Highlights: N.M. Officials Seek Less Medicaid Money Next Year

A selection of health policy stories from Virginia, New Mexico, Florida, Missouri and California.

The Associated Press: Medicaid Agency Seeks Less Money In NM Next Year
The agency managing New Mexico's largest health care program is asking for less -- not more -- state money to operate in the upcoming budget year. It's the first time in more than a decade the Human Services Department isn't seeking an increase in state aid for Medicaid, which provides health care for a fourth of New Mexico's population (Massey, 9/24).

The Washington Post: Inova's Contract With Kaiser Permanente To Expire
Two of the largest players in Northern Virginia's health industry are parting ways. Inova Health System said Tuesday that its contract with Kaiser Permanente will not be renewed when it expires Oct. 1, a break that could be a sign of what is to come as pressure to contain medical costs forces companies to rethink their relationships (Halzack, 9/24).

Health News Florida: 2 Public Co.'s Win In FL Medicaid
Sunshine State Health Plan, a subsidiary of Centene Corp., won more contracts than any other company in the bidding for a slice of the Florida Medicaid program as it shifts its entire enrollee population into managed-care plans. Sunshine State won the right to compete in nine of 11 districts in the state. Tampa-based WellCare Health Plans scored in seven (Gentry, 9/24).

St. Louis Beacon: County Health Department Official Set Up Bogus Firm, Performed Services And Paid Himself
A spokeswoman for St. Louis County Executive Charlie Dooley said the county will pursue every avenue -- including the courts -- to recover county money that may have been embezzled by a top official in the county Health Department. As the investigation came close to him, he killed himself (Mannies, 9/24).

California Healthline: How California's Dual-Eligibles Project Compares With Five Other States' Plans
Officials in six states designing programs to coordinate benefits and services for people who qualify for both Medicare and Medicaid are finding one of the most difficult issues to resolve is creating an integrated appeals process. That's the summary finding of a new analysis released last week by the National Senior Citizens Law Center, a not-for-profit senior advocacy and research group (Gorn, 9/24).

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Editorials and Opinions

Viewpoints: Health Law Premium Rates Reveal 'Mostly Good News' But Renew Critics Arguments; 'Cruz-ing For A Bruising;'

The New Republic: What Obamacare Will Cost You: Now We Know
President Obama, President Clinton, and Senator Ted Cruz all spent a lot of time talking about Obamacare on Tuesday. But the real news came just as the day was ending, right at midnight, when the Department of Health and Human Services released data on insurance premiums available through the new Obamacare marketplaces. Several states had already released their data. With this report, HHS provided premium information for most of the rest. Overall, the numbers are pretty consistent with previous reports, albeit with some new and interesting wrinkles. It seems like mostly good news, though the law's critics would argue it vindicates some of their arguments, as well (Jonathan Cohn, 9/25).

Forbes: Double Down: Obamacare Will Increase Avg. Individual-Market Insurance Premiums By 99% For Men, 62% For Women
For months now, we've been waiting to hear how much Obamacare will drive up the cost of health insurance for people who purchase coverage on their own. Last night, the U.S. Department of Health and Human Services finally began to provide some data on how Americans will fare on Obamacare's federally-sponsored insurance exchanges. HHS' press release is full of happy talk about how premiums will be "lower than originally expected." But the reality is starkly different. Based on a Manhattan Institute analysis of the HHS numbers, Obamacare will increase underlying insurance rates for younger men by an average of 97 to 99 percent, and for younger women by an average of 55 to 62 percent. Worst off is North Carolina, which will see individual-market rates triple for women and quadruple for men (Avik Roy, 9/25). 

The New York Times: The Embarrassment Of Senator Ted Cruz
Like hard-liners in the far right corner of the House, Mr. Cruz has grabbed for every possible lever in his campaign against President Obama's health law, fully aware that he will not succeed but eager for the accolades and donations that will inevitably follow from the Tea Party's misguided faithful. In the process, he has demonstrated how little he understands Senate rules and, more important, how little he appreciates the public's desire for a collaborative Congress (9/24).

The Washington Post: Ted Cruz's Futile And Counterproductive Battle Against Obamacare
A Congressional Research Service analysis, provided at the request of Sen. Tom Coburn (R-Okla.), has demonstrated that most of the health law would still be implemented even if Congress excluded funds for it from a temporary spending bill. Meanwhile, that bill, whose ultimate passage Mr. Cruz is obstructing, would peg the overall budget at the truncated level set in the sequester — a limitation that we regard as indiscriminate and ill-advised but that the GOP could trumpet to its grass roots as a victory for small government, if not for Mr. Cruz's noisy crusade (9/24).

The Washington Post: Texas Senator Is Cruz-ing For A Bruising
They called him to the Strom Thurmond Room off the Senate floor, named after the late lawmaker who was famous for his filibusters against civil rights. They pleaded with their junior colleague to reconsider his plan to block a vote on legislation that would keep the government open. The filibuster, ostensibly in opposition to Obamacare, would do nothing to halt the hated health-care reforms, they said. It would make Republicans look foolish. It would leave House Republicans with too little time to avoid a shutdown. And it could cause Republicans to be blamed for that shutdown (Dana Milbank, 9/24).

The Wall Street Journal: The Obamacare Wars Are Just Starting
The Obamacare fight is turning hot and heavy. House Republicans have made an implausible threat to shut down the government to defund Obamacare, but a plausible motive is to create fear, uncertainty and doubt (which already exists in abundance regarding Obamacare) during the crucial sign-up period that begins next month. On the flip side, the administration's last-minute decision not to require income documentation in the first year can only do wonders for enrollment. A handy Kaiser Family Foundation calculator shows how: A single person who estimates his 2014 income as $33,000 would get a measly $6. Change the estimate to $30,000 and, hey, get $507 (Holman W. Jenkins Jr., 9/24).

The New York Times' Economix: Medicare's Lessons For The Affordable Care Act
Next week will not be the first time that the federal government has introduced a new, subsidized health insurance program for millions of people. The introduction of the Medicare program a half-century ago provides some indicators of how the Affordable Care Act's new health insurance marketplaces might evolve after they open on Tuesday (Casey B. Mulligan, 9/25). 

The New York Times' Economix: How To Gut Obamacare
If House Republicans want to fray the Affordable Care Act on the eve of its implementation, defunding it won't work. They'd be better off stripping or delaying the individual mandate. That's the conclusion of two recent studies that speak to one of the many moving pieces in this fall's vicious budget debate (Anne Lowrey, 9/24). 

Los Angeles Times: Contraception Coverage: A Hobby Shop Is Not A Church
A federal appeals court has thrown enforcement of one of the Affordable Care Act's mandates into confusion by accepting a bizarre argument: that businesses can refuse on religious grounds to include birth control in employee health plans (9/24).

The Washington Post: The Color Of Money: Michelle Singletary On Health Insurance Marketplaces
If you haven't already, you will probably be getting a notice from your employer about the new health insurance marketplaces through the Affordable Care Act. The notices, which are required by the health care reform law but carry no penalty if employers fail to provide them, are seen as just one more way for the government to get the word out about the marketplaces, which open Oct. 1 (Michelle Singletary, 9/24).

Des Moines Register: Why Critics Truly Fear Obamacare Might Succeed
The irony in this is hard to beat. So is the lie. An internet-based ad features a young woman on an examining table with her legs up in stirrups waiting to be examined. But instead of her doctor, a sinister looking Uncle Sam pops up holding a speculum and peering between her legs, as the screaming woman tries to back away. … Far from forcing actions on people against their wills, replacing trusted doctors with government bureaucrats or taking away women's choices, the new law expands them and gives consumers more power. It requires insurance companies to cover preventive services including drugs, contraception and sterilization (Rekha Basu, 9/24).

Bloomberg: Don't Be Alarmed By Obamacare's Failures
House Republicans trying their damnedest to stop Obamacare in its tracks aren’t the only ones who foresee chaos when state health-insurance exchanges open one week from today. President Barack Obama himself has told Americans to expect "glitches" and "hiccups." That's an understatement. It's the surest bet since the 1936 presidential election: Things won't work perfectly when the gears begin turning on the giant new public health-insurance sales machine, the likes of which the U.S. has never seen. ... If things don't run smoothly from the get-go, it won't mean that this piece of the Patient Protection and Affordable Care Act has failed (9/24).

Bloomberg: Economy Can't Be All That's Slowing Health Costs
A new set of projections released last week by Medicare's actuaries has drawn much attention, in part because it suggests the deceleration in the growth of health costs we’ve seen over the past few years is ephemeral. The actuaries attribute the slowdown to the "lingering effects of the economic downturn and sluggish recovery" and to increases in cost sharing. Both of these explanations have serious shortcomings -- and that, in turn, suggests something larger is in fact at work (Peter Orszag, 9/24).

Politico: Securing The Health Exchange Network
It's ironic this year that National Cybersecurity Awareness Month falls in October, because come Oct. 1, the new health insurance exchanges established under the Affordable Care Act go "live" — and they will unleash a host of new cyberactivity and cybersecurity threats that our health care system is not yet equipped to handle (Cindy Gillespie and Elizabeth Ferrell, 9/24).

JAMA Internal Medicine: Going After The Money
The Patient Protection and Affordable Care Act initiated a variety of experiments primarily focused on reducing spending on acute care, including rewarding hospitals for efficiency (part of its mix of metrics in value-based purchasing), penalizing "excessive" readmissions, having greater transparency through public reporting of provider charges, extending bundled payments around episodes of hospital care, and, ultimately, encouraging the growth of accountable care organizations. However, it is less clear if hospital care is a major source of cost growth—and if it is not, then we may not be looking for savings in the right place (Dr. Ashish K. Jha, 9/23).

Health Policy Solutions (a Colo. news service): Obesity, Lack Of Preventive Care A Threat To Hispanics, Latinos
A closer look at the health and health care experiences of Hispanic and Latino Coloradans reveals troubling inequities. One in four (26 percent) Hispanic and Latino Coloradans report that they are in fair or poor health, compared to 14 percent of all Coloradans. In addition, Hispanic and Latino Coloradans are twice as likely to live in poverty, twice as likely to be uninsured and 3.5 times as likely not to graduate from high school compared to all Coloradans (Gretchen Hammer, 9/24).

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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.