Daily Health Policy Report

Thursday, September 26, 2013

Last updated: Thu, Sep 26

KHN Original Reporting & Guest Opinion

Capitol Hill Watch

Health Reform

State Watch

Weekend Reading

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Consumer Groups Criticize Anthem's Narrow Network In Missouri’s Obamacare Marketplace

Kaiser Health News staff writer Jay Hancock reports: "Patient advocates say the exclusion of one of Missouri’s top hospital systems from policies offered by the region’s biggest insurer under the Affordable Care Act could hinder treatment for some patients and force others to switch doctors" (Hancock, 9/26). Read the story.

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Worried About Costs And Unaware of Help, Californians Head Into New Era of Health Coverage

Kaiser Health News staff writer Sarah Varney reports: "As uninsured Californians head into a new era of health coverage, they're worried about costs and unaware of the help they'll get from the government, a new survey finds. The survey, by the Kaiser Family Foundation, found that three out of four Californians who earn modest incomes and could buy government-subsidized private coverage believe, wrongly, that they're not eligible for federal assistance or they simply don't know if they qualify" (Varney, 9/26). Read the story.

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Capsules: Answering Consumer Questions About Obamacare Marketplaces; New Health Care Options For Young Adults In 2014

Now on Kaiser Health News' blog, as part of the Washington Post’s continuing series of online discussions about the health law’s new insurance marketplaces, KHN’s Phil Galewitz and the Post’s Sarah Kliff answered readers’ questions. Read the transcript (9/25).

Also on Capsules, watch the video of KHN’s Mary Agnes Carey appearing on PBS Newshour Tuesday night to answer questions from young adult viewers uncertain of how they will be affected by the health law (9/25). Check out what else is on the blog.

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Political Cartoon: 'Drone Strike?' By John Cole, Scranton Times-Tribune

Kaiser Health News provides a fresh take on health policy developments with "Drone Strike?" By John Cole, Scranton Times-Tribune.

Here's today's health policy haiku:


At long last, we see:
Such variability!
Where you live MATTERS

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

GOP Considers Alternatives To Government Shutdown

Republicans are exploring a possible new strategy: shifting the fight over President Barack Obama’s health-care law to a separate bill that would raise the nation's debt limit. Other media outlets report that the debt limit deadline is Oct. 17 -- about two weeks earlier than had been anticipated.

The Washington Post: House Republicans Explore Strategy To Avoid Federal Government Shutdown
With federal agencies set to close their doors in five days, House Republicans began exploring a potential detour on the path to a shutdown: shifting the fight over President Obama’s health-care law to a separate bill that would raise the nation's debt limit. If it works, the strategy could clear the way for the House to approve a simple measure to keep the government open into the new fiscal year, which will begin Tuesday, without hotly contested provisions to defund the Affordable Care Act (Montgomery and Eilperin, 9/25).

Politico: Republicans Shun Shutdown But Flirt With Default
A large number of Senate and House Republicans are raising the threat of a debt default to curtail, delay or defund President Barack Obama’s signature domestic policy achievement. It’s a major gamble — risking the prospect of a first-ever default on U.S. debt — but it’s one seriously being considered by the same Republicans who have refused to join Cruz’s filibuster attempt of the stopgap spending bill to keep the government running (Raju and Sherman, 9/25).

Bloomberg: Boehner Beset By Obamacare Foes In Race To Stave Off Shutdown
John Boehner helped start the clock running on a government shutdown. It's up to him to stop it. The U.S. House speaker’s choice -- between keeping the government running and continuing to fight the nation’s three-year-old health-care law -- has implications for the 2014 congressional elections and, potentially, his future. The Ohio Republican has a tough decision to make. He can keep up the fight against Obamacare when the Senate sends back a spending bill in coming days, making a shutdown more likely. Or, he can fund the government with the help of Democratic votes, and risk alienating a band of Republican newcomers who’ve already tried once to oust him as speaker (Bender, 9/25).

The Wall Street Journal: U.S. Running Out Of Cash More Quickly
Treasury Secretary Jacob Lew said the government would be left with just $30 billion cash on hand "no later" than Oct. 17, and the Congressional Budget Office predicted these funds would be used up between Oct. 22 and Oct. 31 if legislation isn't enacted to raise the ceiling on government borrowing. That little cash could make it difficult, if not impossible, for the government to pay the roughly $55 billion in Social Security, Medicare and military payments due Nov. 1 (Paletta and Peterson, 9/25).

The Washington Post: New Debt Limit Deadline Is Oct. 17
The Oct. 17 deadline comes about two weeks earlier than some independent analysts had predicted. Nancy Vanden Houten, an analyst at Stone McCarthy, said that while she does not have as much information as Treasury, she sees no reason why Treasury would run out of money before Nov. 1, when large payments are due to Social Security recipients, Medicare providers and active-duty service members (Montgomery, 9/25).

The Wall Street Journal: GOP Eyes A New Fiscal Prize With Health-Law Push
In this fall's fiscal showdowns, the long-held Republican goal of extracting spending cuts and other deficit-reduction measures has been eclipsed by the party's drive to stop the federal health-care law. The result has been to inject more volatility and uncertainty into debate on crucial measures to keep the government open and solvent. Amid the fireworks over the health law, some Republicans worry that any drive to address the long-term debt problem is suffering from neglect (Hook, 9/25).

CQ HealthBeat: Some Republicans Back Changes To Health Care Law, But Differ On Strategy
Although some GOP lawmakers are pushing for complete defunding of the law — as proposed by the House-passed short-term spending bill (H J Res 59) — others have indicated they could accept other modifications and do not want to shut down the government while trying for full defunding. "I hate Obamacare; I’d do anything to get rid of it," said Sen. Orrin G. Hatch, R-Utah. "On the other hand, I do want to see an end result that’s favorable. And that’s the real issue here" (Ethridge, 9/25).

Los Angeles Times: Senate Votes 100-0 To Move Ahead On Debate Over Obamacare
The Senate easily overcame Wednesday’s first hurdle to a fizzling GOP strategy to strip funding for President Obama’s healthcare law in exchange for keeping the government running. Top Republicans are now for a new — more modest — way to chip away at the Affordable Care Act. Time is not on their side after Sen. Ted Cruz (R-Texas) monopolized the floor in his lonely filibuster-like campaign. Money for routine government operations is set to run out Oct. 1, unless Congress acts (Mascaro, 9/25).

The Associated Press/Washington Post: Shutdown Showdown Looms: Unanimous Senate Vote Masks Deep Disagreements Over Health Care Law
The vote came shortly after Texas Sen. Ted Cruz held the Senate in session overnight — and the Twitterverse in his thrall — with a near-22-hour speech that charmed the tea party wing of the GOP, irritated the leadership and was meant to propel fellow Republican lawmakers into an all-out struggle to extinguish the law (9/25).

Bloomberg: Senate Spending Bill Moves Set Up House Obamacare Fight
The Senate is accelerating debate on a bill that would avert a U.S. government shutdown as Senate Republicans sought to buy time for their House counterparts to take another swipe at President Barack Obama’s health care law. Senate Majority Leader Harry Reid's move yesterday to speed up consideration of the spending bill means House Republicans will have it sooner than expected -- minus language stripping Obamacare funds though with more time before a Sept. 30 shutdown deadline to restore a provision limiting the law’s reach (Rubin, Tiron and Hunter, 9/25)

Meanwhile, a new poll shows that half of Americans say Republicans should not hold the budget hostage to their defunding effort -

Bloomberg: Americans Reject Effort To End Obamacare Amid Ad Barrage
Half of Americans say Republicans should stop demanding that President Barack Obama's health-care plan be defunded as part of legislation to keep the government running even as they voice concern about the law’s impact. Three in five people say they think the law will raise medical-care costs, and more say they will be worse off than better off under it, according to a Bloomberg National Poll. At the same time, by a margin of 50 percent to 43 percent, Americans say congressional Republicans should accept that it's the law of the land, according to the Sept. 20-23 poll (Przybyla, 9/25).

In related news, the leading Democratic and Republican backers of a bill to repeal the medical device tax say the government funding bill is not the place to wage that fight -

Politico: Amy Klobuchar, Orrin Hatch Warn Against Repealing Medical Device Tax Now
The leading Senate backers of a push to repeal the medical device tax are warning that the government funding bill currently under consideration isn't the right venue for this fight. "Right now, it's not part of the strategy," said Sen. Amy Klobuchar of Minnesota, the leading Democratic sponsor of legislation that would repeal the 2.3 percent levy on device manufacturers (Blade and Snell, 9/25).

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Cruz And His Crusade To Derail The Health Law

According to press reports, just as Sen. Ted Cruz, R-Texas, was stirring up interest among the tea party and other grass roots conservatives, his anti-health law strategy was also causing differences among his GOP colleagues.  

Los Angeles Times: Ted Cruz's Senate Talkathon Is Over, But He's Still Talking
He said he hoped the public would carry his message of opposition to President Obama's health care law and pressure Republicans to support his drive to prevent federal spending on it. "At this point, the debate is in the hands of the American people," said Cruz, who even in the halls of the Capitol sounded as if he were still speaking in the chamber. "At this point, I think I have spoken long enough." But he hadn't. Within the hour, he was on Rush Limbaugh's afternoon radio talk show (Memoli, 9/25).

The New York Times: Cruz, Tea Party Hero, Rankles Senate G.O.P. Colleagues
Ted Cruz’s crusade to dismantle President Obama’s health care law has helped cement his status as an emerging hero of the Tea Party and conservative grass roots. But it is stoking resentment and derision from many other Republicans, including his own Senate colleagues, who see his campaign as impractical, self-interested and potentially damaging to the party’s electoral efforts in 2014 and beyond (Peters, 9/25).

The Associated Press: GOP Definer Or Divider? Either Way, Cruz Puts Forth Conservative Case Against Obamacare
Stunt or principled stand, Sen. Ted Cruz’s talkathon against Obamacare scored 21 hours of cable television time to describe the president’s signature law in the most conservative terms. By noon Wednesday when the Texas freshman finally sat down, tea party groups supporting him were in full fundraising mode (Kellman, 9/25).

The New York Times: A New Senator Stops Talking, And A Vote On Spending Nears
On Sunday he made clear that he opposed cutting off debate — called cloture — unless the majority leader, Harry Reid, agreed that 60 votes be required to strip the bill of language that would gut the health care law. On “Fox News Sunday,” Mr. Cruz, a freshman from Texas, declared his opposition to “any vote for cloture, any vote to allow Harry Reid to add funding for Obamacare with just a 51-vote threshold.” “A vote for cloture is a vote for Obamacare,” Mr. Cruz said. Yet after the vote on Wednesday, Senator Mike Lee, Republican of Utah, said Mr. Cruz had never intended to oppose the motion to take up the bill, an assertion contradicted by Mr. Cruz’s words and procedural motions for days before the tally (Weisman, 9/25).

Texas Tribune: Cruz's Speech Further Propels Him Into National Spotlight
For more than 21 hours, U.S. Sen. Ted Cruz spoke about why the nation should defund the Affordable Care Act, commonly known as "Obamacare." And although his floor speech might not succeed in accomplishing that policy goal, the national spotlight is squarely on the freshman senator from Texas who is considered a possible presidential contender in 2016. ... "He's now going to be the leading national politician fighting Obamacare, and that’s extraordinarily valuable territory to own," said Republican political consultant Matt Mackowiak of Austin. "We have some strong conservatives for 2016, but few of them have fought for something in a meaningful way" (MacLaggan, 9/25).

CBS News: Ted Cruz’s Epic Speech, Fact Checked
Throughout Tuesday night and Wednesday morning, assisted at times by his conservative colleagues, (Sen. Ted) Cruz (R-Texas) bemoaned the impact of the health care law, hailed his efforts to stop it, and to fill time, he rambled on about some of his favorite movies and children's books. Some of his remarks -- including the very insistence the Senate can defund the health care law -- took some liberties with the truth. Here's a look at some of Cruz's questionable statements (Condon, 9/25).

Miami Herald: Sen. Marco Rubio Plays Tag Team With Sen. Ted Cruz In Slamming Obamacare On Senate Floor
And at 6 a.m. Wednesday, just as most people were waking up on the East Coast and just in time for the morning news programs, Rubio took to the Senate floor to relieve Sen. Ted Cruz quasi-filibuster over Obamacare. For nearly an hour, as the semi-filibuster entered its 16th hour, Rubio spoke without notes and gave a standard but impassioned stump speech that hopped from the American Dream to broken schools to free enterprise to Obamacare to debt (Caputo, 9/25).

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House And Senate Negotiators Reaching Agreement On Compounding Pharmacy Legislation

The measure would apply uniform national standards to pharmacy compounding while enacting a track-and-trace system to ensure the safety of drugs throughout the supply chain.

The Hill: Lawmakers Strike Agreement On Compounding Pharmacy Regulation
Health policy leaders in the House and Senate announced an agreement on legislation to strengthen regulation of non-traditional compounding pharmacies, which have been tied to several deadly outbreaks in the last year. Lawmakers said the new bill would apply uniform national standards to pharmacy compounding while enacting a track-and-trace system to ensure drugs are safe throughout the supply chain. Currently, a patchwork of state and federal regulations complicates oversight of drug compounders, who either customize medications on a prescription-by-prescription basis or produce drugs in large quantities like a manufacturer (Viebeck, 9/25).

Reuters: U.S. Congressional Panels Agree On Bill To Regulate Drug Compounding
The bill, called the Drug Quality and Security Act, comes in response to a deadly outbreak last year of fungal meningitis that killed more than 50 people and was traced to a tainted steroid sold by the New England Compounding Center in Framingham, Massachusetts. The legislation is expect to pass smoothly and quickly through the full House and Senate (9/25).

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Health Reform

Obama Campaigns For Health Law In Advance Of Oct. 1 Launch

President Barack Obama is slated to speak about the health law again today, this time at a Maryland community college, in an effort to "cut through all the noise." Meanwhile, the White House stressed that next week’s launch of new online insurance exchanges will include glitches — but that the exchanges will open whether the federal government is shut down or not.

Politico: A Final Pitch For Obamacare
It began earlier this week in a public conversation with former President Bill Clinton at the Clinton Global Initiative’s conference in New York, and Obama promises to borrow a note from Clinton’s lecture style Thursday by delving into a detailed explanation of how the new health exchanges work. In between, Sen. Ted Cruz (R-Texas) seized national attention with a 21-hour Senate floor oratory aimed at calling attention to quixotic GOP demands that Obama hamstring his own health care law in exchange for Republicans voting to keep the government open and pay the nation’s debts. “The president will cut through all the noise coming out of Washington,” a White House official said of the short trip to the Largo, Md., campus, which is a 14-mile car ride from the White House (Allen, 9/26).

CBS News: Obama Continues Touting Health Law As Kickoff Approaches
With just five days to go before the Affordable Care Act hits another major milestone, President Obama is keeping up his efforts to raise awareness about the health law's benefits and counter the ongoing conservative campaign against it. The president will deliver a speech at Prince George's Community College in Largo, Md., on Thursday, according to the White House, "to lay out one of the cornerstones of what it means to be middle class in America: having access to affordable health care that you can count on” (Condon, 9/26).

The Associated Press/Washington Post: Obama To Promote Health Law, Urge Public To Get Insurance Through Exchanges Opening Next Week
President Barack Obama is promoting the benefits of his health care law before new insurance exchanges open for business next week. The White House says Obama will explain Thursday how Americans can comparison shop for insurance that meets their needs. He plans to tell an audience at a community college in Largo, Md., that they’ll have lots of options, including plans that are affordable on a variety of budgets (9/26).

Politico: W.H. Lowers Expectations For Obamacare Launch
Americans probably won’t flock to sign up for Obamacare coverage in October or even in November — and the White House doesn’t expect them to, a top Obama adviser said Wednesday. Enrollment will go through lots of ebbs and flows over the six-month enrollment period rather than remaining steady, communications adviser David Simas told reporters during a 45-minute interview at an event sponsored by Third Way, where he downplayed the Obama administration’s expectations for the law’s rollout starting next week (Cunningham, 9/25).

Dallas Morning News: White House: Health Insurance Enrollment Will Have Glitches, But Won’t Be Stopped
The White House on Wednesday said that next week’s launch of the health insurance exchanges won’t go forward without snafus — but that they will launch whether the federal government is shut down or not. “Newsflash: There will be glitches. When glitches occur, we will fix them,” said David Simas, special assistant to the president. “But the phones will be opened and manned, government shut down or no government shut down” (Lindenberger, 9/25).

The Associated Press/Washington Post: Health Care Rollout Would Proceed If Government Shuts Down, Uninsured Would Still Get Covered
A partial government shutdown next week would leave the major parts of the law in place and rolling along, according to former Democratic and Republican budget officials, as well as the Obama administration itself. Health care markets for the uninsured would open as scheduled on Tuesday. Deleting the money to implement the law, the GOP’s dream scenario, would indeed cripple Obamacare. But that’s much less likely to happen than a government shutdown. Obama wouldn’t allow the ruin of his hard-fought namesake legislation (9/26).

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Low Health Insurance Premiums May Come With High Deductibles

News accounts look at the price data for the new insurance marketplaces released by the administration Wednesday and note that consumers need to consider costs beyond the premiums. That's because some lower-cost policies may have stiffer copayments and deductibles layered on top of their monthly costs.

The Associated Press: Obamacare Trade-Off: Low Premium, High Deductible
You might be pleased with the low monthly premium for one of the new health insurance plans under President Barack Obama's overhaul, but the added expense of copayments and deductibles could burn a hole in your wallet. An independent analysis released Wednesday, on the heels of an administration report emphasizing affordable premiums, is helping to fill out the bottom line for consumers (Alonso-Zaldivar, 9/25).

PBS NewsHour: From Bronze To Platinum Plans, What New Insurance Exchange Premiums Cost?
New details were released about coverage choices for consumers in the new health care exchanges. What will their premiums cost? Ray Suarez is joined by Louise Radnofsky of The Wall Street Journal to answer some of your most frequently asked questions (Suarez, 9/25).

CBS News: Obamacare Premiums Vary Greatly By State, City
The Obama administration is stepping up the pressure on uninsured Americans -- especially young Americans -- to sign up and buy health insurance on the new state exchanges that open next week. On Wednesday, it put out new estimates of the premiums. For instance, a 40-year-old earning $50,000 and choosing the medium-priced "silver" plan would pay, on average, $328 a month. Some will pay a lot more, some a lot less, depending on their location (Dahler, 9/25).

Politico: Exchanges May Have High Out-Of-Pocket Costs
Consumers may have to dig a little deeper into their wallets to pay for health care in the Obamacare insurance exchanges, according to a new analysis by Avalere Health. The study of six states suggests that consumers could face steep cost-sharing requirements — like co-payments, co-insurance and deductibles — layered on top of their monthly premiums (Cheney, 9/26).

Bloomberg: Obama’s $3,000 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. The release of the data by the Obama administration comes just six days before the Affordable Care Act's insurance exchanges open for enrollment, and a day after Ted Cruz, a Texas Republican, took the floor of the U.S. Senate to oppose the law (Wayne and Nussbaum, 9/25).

Stateline: Projected Obamacare Premiums Vary Widely Among States
The cost of health insurance on the Affordable Care Act exchanges shows monthly premiums varying widely from state to state, depending on the kind of plan purchased and whether an individual or family qualifies for government subsidies. In the 36 states in which the federal government will run the exchanges, the Department of Health and Human Services said Wednesday the average cost of the benchmark "silver plan" was lower than expected, at $328 a month. But averages are misleading, since virtually no one will pay that exact price (Povich, 9/25).

Marketplace: Obamacare Premiums: What The Price Leaves Out
The wait is over. The Obama administration has released a kind of price list for policies that will be sold on the 36 federally run health exchanges, when they open for enrollment on Tuesday.  Some of the prices are eye-popping. Although the average premium for an individual is $328 a month, a 27-year old in Dallas who makes about $25,000 a year, could buy a lower level bronze plan for $74 a month. But with insurance, as with many things, the premium is just the beginning (Gorenstein, 9/25).

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For Regional Audiences, The Key Question Is What Will A New Policy Cost Here?

Local news outlets examine data released by the Obama administration to see the average rates that local consumers will pay for insurance on the new health marketplaces.

USA Today: Obama Health Care Report Hits Regional Audiences
When government officials release reports, they often do state-by-state or even city-by-city breakdowns -- often to attract better regional and local media coverage. The Obama administration has a hit with a new health care report, scoring front page stories in newspapers in Miami, Pittsburgh, Detroit, Chicago, and other cities (Jackson, 9/25).

Miami Herald: South Florida Insurance Rates Will Be Among Lowest In State, Report Says
Miami-Dade and Broward County residents who buy health insurance through federally run online marketplaces opening Tuesday will be paying some of the cheapest rates available in Florida, according to federal data released Wednesday. A report from the U.S. Department of Health and Human Services shows how many insurance issuers will be offering plans in each county, what tiers those plans will be on and how much the average resident would pay before tax credits in certain tiers (Benn and Borns, 9/25). 

Tampa Bay Times: Obamacare Marketplace Premiums In Florida Lower Than Expected
Less than a week before the Affordable Care Act insurance marketplaces open for business, the federal government announced that average costs in Florida and other states will be lower than it once projected. The federal government says the national average monthly premium for a single person's midtier "silver" plan is $328 before tax credits. That's 16 percent lower than the Congressional Budget Office had originally estimated (Mitchell and Tillman, 9/25).

Health News Florida: FL Market Boasts 102 Plans
The sticker price for a benchmark health plan in Florida's online Marketplace will average $328 a month, far below the price that had been forecast, according to a federal report released early Wednesday. … While $328 may not sound affordable to a lot of people, most uninsured Floridians who use the exchange won't have to pay that much, HHS officials said. Tax credits will reduce the premiums for a majority of those enrolling, often cutting it by half or more (Gentry, 9/25).

Detroit Free Press: Policies On Michigan's Health Exchange To Cost Less Than Elsewhere
Michiganders shopping for insurance on the Michigan Health Insurance Marketplace beginning next Tuesday will spend less than much of the country, a possible result of competition drawn to the state exchange. In Michigan, the lowest prices for three categories of policies, called bronze, silver and gold, all came in lower than the national average, according to a federal analysis released today (Erb, 9/25). 

Philadelphia Inquirer: U.S. Officials Share Specifics On Health Plans
The average monthly premium for the lowest-cost "bronze" individual plans will be $229 in Pennsylvania (among the lowest in the nation) and $333 in New Jersey (among the highest), according to the U.S. Department of Health and Human Services. Tax credits that are expected to apply to most purchasers would substantially lower rates in both states (Brubaker and Sapatkin, 9/25).

The Associated Press: Pa. Exchange To Offer Among Lowest-Cost Premiums
Pennsylvania residents who buy health insurance in the federally run online marketplace that opens next week will pay below the national average, and the state ranks 10th-lowest out of 47 for which data were available, according to figures released by the Obama administration Wednesday. The state average is $286 a month for a mid-range plan, not including out-of-pocket costs or tax credits that benefit lower-income families, the figures showed. That's below the $328 national average (Levy, 9/25). 

Arizona Republic: Arizonans' Costs Low Under New Health Law
For Arizona's lowest-cost middle-range "silver" plan, which pays 70 percent of medical costs, average premiums will cost $248 per month, compared with the national average of $310. Only four of 48 states had less-expensive average premiums for that plan. Arizona's second-least-expensive silver plan will cost $252, compared with a national average of $328. The least-expensive bronze plan in Arizona will charge an average premium of $214, compared with the national average of $249. Those average rates are before federal tax-credit subsidies are calculated (Alltucker, 9/25).

Chicago Tribune: Illinois Insurance Exchange Rates Lower Than U.S. Average
Illinois residents will pay slightly less than the national average for health insurance offered under President Barack Obama's health care law, according to rates released Tuesday by state and federal officials.The snapshot provides an early yet incomplete look at how much consumers might pay in premiums and comes a week before the launch of new insurance exchanges, the online marketplaces in which individuals, families and small businesses can compare and buy coverage, often with the help of federal tax credits (Frost, 9/25).

Milwaukee Journal Sentinel: Obamacare Plan Premiums Unveiled For Wisconsin
The Obama administration released figures Wednesday suggesting that average premiums for health plans sold on the Wisconsin marketplace set up under the Affordable Care Act may increase less than previously feared. The report from the U.S. Department of Health and Human Services provided the first information on premiums for the marketplace, or exchange, being set up by the federal government in Wisconsin (Boulton and Stein, 9/25).

The Oregonian: Oregon Health Coverage Hikes Show Two Sides Of New Law
It feels like rate shock for Oregonians whose health insurance plans don't meet new standards for minimum benefits. Instead, many are learning in the mail they'll be shifted to beefed-up plans that cost more (Budnick, 9/25).

St. Louis Beacon: Federal Officials Project Lower Premiums Under Health Insurance Marketplace In Missouri
Health policy analysts differ sharply on the conclusions of Wednesday's federal report, which says premiums in Missouri will be about 16 percent lower than previously projected for consumers eligible to buy their health insurance through the government-run marketplace or exchange on Oct. 1 (Joiner, 9/25). 

Georgia Health News: Feds Unveil Low Premiums On State Exchange
The average premium for the lowest-cost silver plan will be $304, and for the cheapest bronze plan it will be $265 in Georgia, lower than the national average. Those prices don't take into account the subsidies. On Wednesday, the U.S. Department of Health and Human Services released the prices of health insurance in the exchanges in Georgia and 35 other states where the exchanges are being run by the federal government. The exchanges are a key component of the Affordable Care Act in the Obama administration’s drive to have more uninsured gain coverage. Nineteen percent of Georgians currently have no health insurance (Miller, 9/25).

San Jose Mercury News: Obamacare: Californians Will Pay 10th Highest Rates In Country Under Health Exchange
The price of health insurance under Obamacare came sharply into focus Thursday, as Californians learned that they will pay the 10th-highest rates in the country for a mid-range policy. With less than a week to go until open enrollment begins on the new health-insurance exchanges created by the Affordable Care Act, the Obama administration published insurance premiums and plan choices for 26 states where the federal government is taking the lead to cover uninsured residents (Seipel, 9/26). 

St. Paul Pioneer Press: Minnesota's Health Exchange Premiums Lowest In Nation, Feds Say
Are premiums on Minnesota's new health insurance exchange the lowest of any rates that will be offered across the country? Yes, according to a new federal study. Maybe, according to health care experts. Absolutely! DFLers say. That's the wrong question! Republicans counter (Snowbeck, 9/25).

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New Details Emerge On Health Law Spending, Effects On Business

News outlets examine how some businesses are dropping their cheapest health plans and steering employees to the new health insurance online exchanges. Others explore how insurers are responding to new rules and the cost of the Obamacare exchanges.

The Wall Street Journal: Firms Drop, Rather Than Upgrade, Cheapest Health Plans
The nation's largest provider of security guards plans to discontinue its lowest-cost health plans and steer roughly 55,000 workers to new government-sponsored insurance exchanges for coverage next year, in the latest sign of the fraying ties between employment and health care (Thurm, 9/25).

The Denver Post/Associated Press: Small Business Nearing Deadline On Employee Health Insurance
A critical date is approaching for small business owners: Starting Oct. 1, they must make decisions about employee health insurance under the Affordable Care Act. All companies have obligations under the ACA, no matter how many workers they have or whether they plan to provide insurance. They must provide information about insurance to employees. They need to think about what kind of insurance to provide, and whether to get it through a broker or to use the state or federal exchanges known as SHOP, or the Small Business Health Insurance Options Program (Rosenberg, 9/26).

CNN: Fact Check: Obamacare Forcing Small Businesses Overseas
Sen. Ted Cruz, R-Texas, during September 24 speech on Senate floor: "I would ask you to take each of those small business owners and multiply it by the millions of small business owners across this country. The millions of small business owners who aren't growing, the millions of small business owners who are forcing their employees, forcibly reducing their hours to 29 hours a week, the millions of small business owners who are considering moving operations overseas or have already because of Obamacare."  Verdict: False. There is no doubt that Obamacare has had some impact on small business hiring. But Cruz wildly overstates the case (9/25).

CNN: Fact Check: UPS Dropping Coverage For Spouses
Several employers – including UPS, Delta, Univ of Virginia, Trader Joes, Home Depot – have recently announced changes to their employee benefits and cited Obamacare as the reason for the pullback. While it is true that Obamacare is raising costs on employers, there are other factors increasing costs, such as the improving economy. Verdict: Misleading. Obamacare is contributing to the benefit cuts, but is not the sole reason (9/25).

Healthy Cal: Agriculture Businesses Struggle To Comply With Affordable Care Act
Agricultural businesses and the insurance companies that serve them are scrambling to prepare for the changes that health care reform will bring over the next few years. Many smaller farmers struggle with the details of the Affordable Care Act, such as how to count seasonal farmworkers to determine who they must insure. Employers of more than 50 will face fines if they don’t insure eligible workers. Meanwhile, three of California’s agricultural-focused health insurance providers required waivers from ACA rules to continue operation. Those waivers expire next year (Griffy, 9/26).

In the meantime, an audit of IRS spending on the health law calls on the Obama administration to keep closer watch of the money it spends on the rollout --

Fox News: IRS Failed To Account for $67M In Obamacare Costs, Report Says 
The Internal Revenue Service is unable to account for $67 million in spending related to the implementation of ObamaCare, according to an IRS watchdog report released Wednesday. The report by the Treasury Inspector General for Tax Administration said the money was part of a $488 million fund established to cover implementation costs between 2010 through 2012 (9/26).

Reuters: IRS Struggles To Track Its 'Obamacare' Spending: Watchdog
With Congress debating whether to take funding away from the Affordable Care Act, or Obamacare, the Treasury Inspector General for Tax Administration said in an audit that the IRS failed to account for some of the agency's spending to implement the law. Federal agencies must report their spending so there is an accurate measure of the full cost of government programs. The IRS did not report $67 million in costs the agency incurred for employees who were working on the healthcare law for fiscal 2010 through 2012, the report said (Temple-West, 9/25).

How insurers respond to new requirements also gets scrutiny --

Baltimore Sun: Maryland Insurance Administration Issues Warning About Renewing Policies Early
According to the Maryland Insurance Administration, consumers who buy health insurance directly from an insurer or an HMO may get a letter telling them to renew earlier than their regular renewal date. The reason, the regulator said, is that policies renewed before January don’t have to have new consumer protections required under the health care law, such as coverage for pre-existing conditions. … Another reason not to renew early: You might have to start all over again to meet the deductible before insurance starts paying for your care, the insurance administration said. And insurance companies wonder why they get such a bad rap (Ambrose, 9/26).

Kaiser Health News: Consumer Groups Criticize Anthem's Narrow Network In Missouri’s Obamacare Marketplace
Patient advocates say the exclusion of one of Missouri's top hospital systems from policies offered by the region's biggest insurer under the Affordable Care Act could hinder treatment for some patients and force others to switch doctors (Hancock, 9/26).

The law's costs and problems are also examined --

Fox News: Report: Obamacare Exchanges Costing $558M 
A new report on the economic and regulatory burden of ObamaCare shows the health care law’s so-called insurance “exchanges” has resulted in the federal government spending an additional $558 million and 16.6 million more hours on paperwork. “These results should not be surprising,” American Action Forum, a conservative advocacy group, said in its report released on Wednesday. The Patient Protection and Affordable Care Act is a “massive piece of legislation … . It is clear that this ‘fundamental reform’ has produced more red tape, additional complexity and higher costs” (9/25).

The Fiscal Times: 5 Obamacare Problems That Should Have Been Fixed 
While some unanticipated malfunctions and technical errors are par for the course when creating such a vast system, fault lines that health care advocates have been warning about for months or years still show no sign of being corrected before open enrollment launches next week, although federal and state employees are said to be troubleshooting. Here are the top five Obamacare mistakes that should have been fixed by now (Braverman, 9/25).

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Health Law's Success Or Failure To Unfold In Individual Stories

How people judge the health law will depend on whether they get insurance that proves affordable and adequate through the new exchanges, The Washington Post reports. In the meantime, a Kaiser Family Foundation survey finds that three out of four California residents of modest income believe wrongly that they're not eligible for government help to buy insurance.

The Washington Post: Individuals Will Define Obamacare's Fate
Having passed a test of its constitutionality before the Supreme Court, the law now faces an even more critical judgment -- one that will be written in millions upon millions of individual stories. Among the winners will be the uninsured, assuming the coverage they get proves to be affordable and adequate. Businesses facing a new requirement to provide insurance say they could be losers. Some people who buy their own insurance may pay more, while others may pay less. Hospitals and doctors welcome the fact that more patients will be able to pay their bills but worry the government will demand more say in what kind of care they provide (Kliff, Somashekhar, Sun and Tumulty, 9/25).

The Washington Post: How Eight Lives Would Be Affected By The Health Law
When President Obama signed the Affordable Care Act in 2010, he declared that "health-care reform is no longer an unmet promise. It is the law of the land." Now, we get to see whether it works. Starting Oct. 1, millions of Americans who lack medical insurance or buy their own coverage will have their first chance to sign up for health insurance under Obamacare. Read related article or see how much you would pay for insurance (Kliff, Somashekhar, Sun and Tumulty, 9/26).

Kaiser Health News: Worried About Costs And Unaware of Help, Californians Head Into New Era of Health Coverage
As uninsured Californians head into a new era of health coverage, they're worried about costs and unaware of the help they'll get from the government, a new survey finds. The survey, by the Kaiser Family Foundation, found that three out of four Californians who earn modest incomes and could buy government-subsidized private coverage believe wrongly that they're not eligible for federal assistance or they simply don't know if they qualify" (Varney, 9/26).

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D.C.'s Obamacare Insurance Exchange Hits Technology Snag

The District of Columbia's online health exchange will not be able to immediately calculate a person's subsidy to help them buy coverage or sign up for Medicaid when the health law exchange opens Oct. 1. Instead, such determinations will be done offline as officials try to fix the problems. D.C.'s online health exchange technology problems follow similar ones in Colorado and Oregon. 

The Washington Post: Navigating The Affordable Care Act, Whose Health Insurance Exchanges Open Tuesday
The plan is for millions of Americans to go online to compare health plans, find out if they’re eligible for federal help with premiums and buy coverage. But problems -- which include the District’s announcement on Wednesday that a major part of its online marketplace will not be ready Tuesday -- could impede the program’s debut (Sun, 9/25).

The Washington Post: District’s Health Exchange Hits Major Snag, Will Still Open Oct. 1
District officials announced Wednesday that a major part of a new health insurance system it is building under President Obama’s health-care overhaul will not be ready on Tuesday because of "a high error rate" discovered during recent testing. The online marketplace, in which uninsured people are supposed to be able to sign up under the Affordable Care Act, will open as scheduled. But it will not be able to immediately determine online whether people are eligible for Medicaid, the state-federal program for the poor, or for government subsidies to afford premiums (Sun and Somashekhar, 9/25).

The Washington Post's Wonk Blog: D.C.'s Obamacare Fail: Prices Won’t Work Until November
While the D.C. Health Link will launch a Web site on October 1, shoppers will not have access to the their premium prices until mid-November. The delay comes after the District marketplace discovered "a high error rate" in calculating the tax credits that low- and middle-income people will use to purchase insurance on the marketplace. The insurance marketplaces, if working as plan, are supposed to spit out an estimate for a tax credit after a shopper enters in some basic information about where she lives and how much she earns. In the District, that won't happen next month. Instead, the eligibility determination will be made "off-line by experts" by early November (Kliff, 9/25).

Reuters: Computer Snags Delay Parts Of Obamacare In Some U.S. States
The District of Columbia's online health insurance exchange -- one of 51 set up under President Barack Obama's health care reform law -- will be unable to perform two key functions when it opens on October 1, exchange officials announced on Wednesday. The District joins Colorado and Oregon on the list of "Obamacare" exchanges hobbled by problems with information technology (IT), contributing to expectations that Obama's signature domestic achievement will get off to a slow start when the exchanges go live next Tuesday (Begley, 9/25).

The Wall Street Journal: Key Functions Of D.C. Health Exchange Delayed
The system is supposed to calculate the amount of tax credits lower earners can receive to help them pay for coverage, and it is also designed to determine whether people are newly eligible for Medicaid. But a spokesman for the exchange, known as DC Health Link, said those two functions won't be ready until about Nov. 1 (Dooren, 9/25).

McClatchy: Computer Glitch Delays Obamacare Insurance Exchange In D.C. 
In an unexpected setback, officials at the District of Columbia’s health insurance marketplace announced Wednesday that a computer glitch won’t allow consumers to get their federal tax credits that are key to helping them buy health coverage on Oct. 1 when the marketplace officially opens for business. The same problem will keep residents in the nation’s capital from enrolling electronically in the Medicaid program, said D.C. marketplace spokesman Richard Soriano. Workers will instead enroll Medicaid applicants manually on Oct. 1 without delay (Pugh, 9/25).

CQ HealthBeat: Online Subsidy Determinations Delayed in D.C., Colorado -- Elsewhere Too?
In recent days, the Centers for Medicare and Medicaid Services has been downplaying concerns that computer systems involved in federally run marketplaces would not be able to reliably calculate premium costs taking subsidies into account. The agency said in response to a Wall Street Journal story reporting the problem that accurate premium calculations would be made when the marketplaces open on Oct. 1 (Reichard and Adams, 9/25).

Elsewhere, other states deal with online exchange issues of their own, including with outreach -- 

The Wall Street Journal: Insurance Push Nears Liftoff
Tuesday marks the debut of New York state's health-insurance exchange, an online marketplace that will allow consumers to choose between more than a dozen coverage plans. Albany wants to enroll 1.1 million people over the next three years, a mix of individuals and employees of small businesses. The state has made a special push in New York City, home to 1.5 million of the state's 2.7 million uninsured. A range of challenges loom. Many people are so poor they won't be able to afford the insurance; others don't speak English and are still others are leery of revealing personal medical information to the government. Then there is the simple lack of awareness (Dawsey, 9/25).

The Associated Press/St. Louis Post-Dispatch: Marketplace To Be Called 'Get Covered Illinois' 
The brand name of Illinois' new health insurance marketplace does something that other states' names don't. "Get Covered Illinois" tells the 1.8 million uninsured residents what they need to do. Gov. Pat Quinn's administration unveiled the name Wednesday, less than a week ahead of the launch of the online marketplace where people can comparison-shop for the coverage required under President Barack Obama's health care law (Johnson, 9/25). 

Detroit Free Press: 13 Insurers To Offer Plans On The State's Exchange
Michigan consumers will have13 insurers to choose from on the state’s health insurance exchange. Priority Health offers plans under two licenses. It won’t be clear until Oct. 1 how much their plans will cost (9/25).

Milwaukee Journal Sentinel: County Would Spend Up To $729,000 On Obamacare Outreach, Under Compromise 
A plan to spend up to $729,000 in Milwaukee County taxpayer funds to help with outreach for the rollout of the Affordable Care Act won the endorsement of a County Board panel Wednesday. The plan would give $379,000 to four agencies to help reach low-income people who might not otherwise understand they could be losing coverage they now have under BadgerCare or might want to purchase health insurance through a new online insurance exchange created by the health law, commonly known as Obamacare (Schultze, 9/25).

California Healthline: Exchange Officials Field Readiness Queries
The Assembly Committee on Health this week held a hearing to determine readiness of the Covered California health benefit exchange -- just a week before open enrollment season starts. Covered California begins enrolling Californians for health coverage Oct. 1. The enrollment period for subsidy-eligible Californians will last six months.   "We don't need everyone to sign up on Oct. 1 itself, but we do want people to be signing up between Oct. 1 and Mar. 31," said Assembly member Richard Pan (D-Sacramento), chair of Assembly Health (Gorn, 9/25).

In other news --

Miami Herald: Miami-Dade Weighs Gov. Rick Scott’s Obamacare 'Navigators' Ban 
Miami-Dade, Florida’s largest county and the one with the largest number of uninsured, is making plans to join Broward and defy Gov. Rick Scott’s decision banning Obamacare coordinators from operating at local health departments. Miami-Dade’s mayor and commissioners began weighing the decision Tuesday as Broward County voted overwhelmingly to allow the so-called "navigators" at health departments to spread the word about, and sign people up for, new Affordable Healthcare Act plans that could come online Oct. 1 (Caputo, Mazzei and Rabin, 9/24).

NPR: A Medicaid Expansion In Pennsylvania May Take Time
In Pennsylvania, more than a half-million people who don't have insurance are waiting to hear whether the state will take advantage of a Medicaid expansion that's part of the Affordable Care Act. The federal law would allow people earning up to 138 percent of federal poverty guidelines to sign up for Medicaid. But a Supreme Court ruling that largely upheld the law gave states the choice whether to expand their Medicaid programs (Brady, 9/26).

KUT/The Texas Tribune: Exchanges May Provide Relief To Families Seeking Coverage For Kids (AUDIO)
The new federal health care exchanges opening Oct. 1 could provide a safety net for the families who earn too much money to qualify for state and federally subsidized health care plans like Medicaid and CHIP (Zaragovia, 9/26).

California Healthline: California Raced To 'Set The Pace' On Obamacare Implementation. Did It Pay Off?
Every expert suggested that the ACA's rapid implementation in California could be traced back to [former Calif. Gov. Arnold] Schwarzenegger's efforts in 2007 and 2008 to enact universal health care. … Although the Schwarzenegger plan ultimately failed, many of its components -- from big elements like the exchanges to smaller pieces like guaranteed issue -- ended up in the ACA. And because state leaders had already done much of the foundational work, they were better positioned to speedily roll out the national law (Diamond, 9/25).

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State Watch

State Highlights: Jails Treat Huge Number Of Mentally Ill; Class Action Bid Denied In Fla. Lawsuit Over Disabled Children In Nursing Homes

A selection of health policy stories from Florida, Illinois, California, New York, Pennsylvania, Missouri and Washington.

The Wall Street Journal: The New Asylums: Jails Swell With Mentally Ill
America's lockups are its new asylums. After scores of state mental institutions were closed beginning in the 1970s, few alternatives materialized. … The country's three biggest jail systems -- Cook County, in Illinois; Los Angeles County; and New York City -- are on the front lines. With more than 11,000 prisoners under treatment on any given day, they represent by far the largest mental-health treatment facilities in the country. By comparison, the three largest state-run mental hospitals have a combined 4,000 beds. Put another way, the number of mentally ill prisoners the three facilities handle daily is equal to 28 percent of all beds in the nation's 213 state psychiatric hospitals, according to the National Association of State Mental Health Program Directors Research Institute Inc. (Fields and Phillips, 9/26).

News Service Of Florida/Miami Herald: Class Action Denied In Lawsuit For Kids Placed In Nursing Homes 
A federal judge Wednesday rejected arguments that a lawsuit challenging Florida's placement of severely disabled children in nursing homes should be a class action -- but left open the possibility that it could become a class action in the future. The lawsuit, filed last year on behalf of several plaintiffs, contends that Florida has violated the Americans with Disabilities Act by placing children with complex medical needs in nursing homes instead of providing services in the children’s homes and communities (9/25).

Miami Herald: Clinic Program Brings Health Care To Schools 
A student suffering from a mild asthma attack stops by North Miami High's medical clinic. After receiving a breathing treatment, he heads back to class in 30 minutes. At John F. Kennedy Middle, a student stops by the dental trailer and gets a sealant painted onto her teeth to prevent cavities. The services are the results of the Dr. John T. Macdonald School Health Initiative, a network of school-based health clinics that operate out of nine Miami-Dade public schools, mostly in North Miami and North Miami Beach (Green, 9/22).

Philadelphia Inquirer: Three With Local Ties Named Macarthur Fellows 
One local winner is Jeffrey Brenner, 44, a Camden primary care physician who turned to advocacy and organizing to create a health care delivery model designed to meet the medical and social service needs of some of Camden's most vulnerable residents. ... Through his own research, Brenner was able to establish that half of Camden's residents used emergency rooms each year, often for minor health problems, and that 13 percent of the patients were generating 80 percent of the costs. One patient alone racked up nearly $5 million in charges over five years. ... Brenner founded the Camden Coalition of Health Care Providers, a broad network of private practices, hospital staff, and social workers attempting to deliver strategic preventive and primary care (Giordano, 9/25). 

St. Louis Post-Dispatch: Booming Sales Of E-Cigarettes Attract Big-Time Marketing And More Calls For Regulation
Harry and Donna Kholer sell e-cigarette kits with devices they import from China and liquids they mix for the faux-smoke sensation. Their Move2Vapor is a mom-and-pop business in a wide-open, burgeoning and unregulated market that is attracting the big tobacco companies, which are launching advertising campaigns and pushing slick display cases in convenience stores. Anti-smoking organizations are pressing the federal government to at least regulate the devices, if not restrict them pending lengthy studies. Last week, 16 organizations, including the American Lung Association and the American Academy of Family Physicians, urged President Barack Obama to press the Food and Drug Administration to quickly approve regulations (O'Neil, 9/26). 

The Seattle Times: Most Seattle Firms Comply With Sick-Leave Law But Startup Flawed, Study Says 
A year after city's new mandatory paid sick-leave law went into effect, a majority of businesses are providing benefits to their employees, but the initial implementation was often confusing and time-consuming. Those are the results of a small study conducted for the Seattle City Council by University of Washington researchers as part of a larger, ongoing follow-up survey of 550 companies to determine how well the law is working (Thompson, 9/25). 

The Seattle Times: Shaken By School HIV Lessons, A Mom Shakes Up What's Taught 
When her daughter was going into the fifth grade two years ago, Jodie Howerton reviewed the HIV/AIDS educational materials that would be used in her child's class -- and was appalled by what she saw. The opening clip of a video, circa early 1990s, featured this headline: "Thousands die of AIDS." In it, the human immunodeficiency virus (HIV) was dressed as a growling, red monster and there was a cameo appearance by the Grim Reaper. The outdated images and statistics about AIDS (acquired immunodeficiency syndrome) and the virus that causes it, were particularly troublesome to the Woodinville mother of three, who had adopted a son born with HIV and who worried the video would perpetuate existing stereotypes (Turnbull, 9/25). 

The Associated Press/Miami Herald: Fla. Legislators Will Soon Pay More For Insurance
House Speaker Will Weatherford, who has come under fire for rejecting calls to expand the state's safety-net health care program to cover more Floridians, is going to require House members to pay more for their own insurance starting in January. Weatherford decided to have House legislators pay the same rate as career service workers: $50 a month in premiums for individual coverage and $180 a month for family coverage. Senators already started paying the same rate as career service workers at the start of 2013. House members — as well as Gov. Rick Scott and other top state officials — have been paying $8.34 a month for individual coverage and $30 a month for family coverage (Fineout, 9/25).

Philadelphia Inquirer: Fitzpatrick: Obamacare Hurting Sesame Place Employees
In a letter sent last week to President Obama, U.S. Rep. Mike Fitzpatrick contended that the Affordable Care Act had caused Sesame Place, one of Bucks County's biggest tourist attractions, to terminate health benefits for its part-time employees. ... A spokesman for SeaWorld, the amusement park's parent company, confirmed Wednesday that the company was cutting the weekly work limit for part-time employees from 32 to 28 hours. Under the Affordable Care Act, companies can face fines if they do not provide insurance for staffers who work at least 30 hours per week (Zauzmer, 9/25).

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Weekend Reading

Longer Looks: Dangers Of Too Much Tylenol; Death Dinners

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

ProPublica: Use Only As Directed
During the last decade, more than 1,500 Americans died after accidentally taking too much of a drug renowned for its safety: acetaminophen, one of the nation's most popular pain relievers. Acetaminophen – the active ingredient in Tylenol – is considered safe when taken at recommended doses. Tens of millions of people use it weekly with no ill effect. But in larger amounts, especially in combination with alcohol, the drug can damage or even destroy the liver (Jeff Gerth and T. Christian Miller, 9/20).

Al Jazeera: In Indian Country, Uneven Access To Plan B
A slender woman with long, dark hair stands silently flipping through a series of handwritten cards. "Afraid? Worried?" the first says. The questions go on. "Unprotected sex?" "Missed your pills?" "Condom broke?" "Raped?" … Access to emergency contraception is especially vital in Native American communities because of the exceptionally high rate of sexual assault (more than one in three Native women is raped in her lifetime versus fewer than one in five for American women overall), (Rachel Friedman, 9/24).

Bloomberg: Death Dinners At Baby Boomers' Tables Take On Dying Taboo
At a Manhattan dinner party, former Citigroup Inc. executive Steffen Landauer gathered an eclectic mix of guests at his apartment off Fifth Avenue to sip pinot noir, dine on seared salmon -- and talk about death. … Not to be confused with a macabre parlor game, the evening was conceived to confront real-life issues wrapped up in death and dying that few people like to acknowledge, let alone talk about at a dinner party. Would I want a feeding tube? Does dad want to die at home? What happens to my kids if I die in an accident along with my spouse? Those questions are getting asked more frequently. Over the past month, hundreds of Americans across the country have organized so-called death dinners, designed to lift the taboo around talking about death in hopes of heading off conflicts over finances and medical care -- and avoiding unnecessary suffering at the end of life (Shannon Pettypiece 9/24).

The New York Times: The Simple Test That Saved My Baby
On July 10, my wife gave birth to a seemingly healthy baby boy with slate-blue eyes and peach-fuzz hair. The pregnancy was without complications. The delivery itself lasted all of 12 minutes. After a couple of days at Greenwich Hospital in Connecticut, we were packing up when a pediatric cardiologist came into the room. We would not be going home, she told us. Our son had a narrowing of the aorta. … It turned out that our son was among the first in Connecticut whose lives may have been saved by a new state law that requires all newborns to be screened for congenital heart defects (Michael Grabell, 9/21).

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Editorials and Opinions

Opinions On Cruz: GOP Fight Obscures Harms From Sequester; Dramatic Stand Reaffirms Republican Resolve; Fundraising Bonanza For Both Parties

The New York Times: Lasting Damage From The Budget Fight
The budget crisis manufactured by Congressional Republicans will never succeed at halting health care reform, but it has already caused long-lasting harm. It will preserve the deeply damaging spending cuts, known as the sequester, that are costing jobs and hurting the lives of millions (9/25).

The New York Times: Suffocating Echo Chamber
When Senator Ted Cruz of La Mancha jumped on his trusty steed and charged the windmills, he explained: "Everyone in America knows Obamacare is destroying the economy." He added that accepting the Affordable Care Act would be like appeasing the Nazis. Cruz is a smart man, and maybe this is just disingenuous demagoguery. But there’s a scarier possibility: After spending too much time in the Republican echo chamber, he may believe what he says (Nicholas D. Kristof , 9/25). 

Politico: After Talking The Talk, Ted Cruz Wins
The Cruz all-nighter wasn't a legislative tactic so much as it was what 19th-century anarchists called "the propaganda of the deed." It made a point. It dramatically reaffirmed Republican resolve to repeal Obamacare. It drove more debate about the health care law. It perhaps opened up space for more realistic immediate Republican goals, such as a delay in the individual mandate, in the impending fiscal fights. It also saved Cruz's reputation among the tea party conservatives he cares about most (Rich Lowry, 9/26).

The New York Times: John McCain Versus Ted Cruz
It's no secret that Senator John McCain doesn't much like Senator Ted Cruz, whom he once called a "wacko bird." His main grievance is that Mr. Cruz isn’t interested in the business of governing, which requires compromise. If Mr. Cruz can't get what he anything and everything he wants, he'd rather grandstand and muck up the Senate than give in (Juliet Lapidos, 9/25). 

The Wall Street Journal: Cynical Obamacare Fundraising
Republicans and Democrats don't agree on much about health-care policy these days, but leaders in both parties see the Obamacare debate as an opportunity to raise money (Jason L. Riley, 9/25).

The Washington Post: On Obamacare, Republicans Get In Their Own Way
If the ACA is, as conservatives believe, as unpleasant in potential effects as it is impossible to implement, conservatives should allow what Lincoln called "the silent artillery of time" to destroy it. ... House Republicans can attach to the continuing resolution that funds the government, and then to the increase in the debt ceiling, two provisions: Preservation of the ACA requirement — lawlessly disregarded by the administration — that members of Congress and their staffs must experience the full enjoyment of the ACA without special, ameliorating subsidies. And a one-year delay of the ACA's individual mandate (George F. Will, 9/25).

The Wall Street Journal: Let Obamacare Collapse
What the GOP's Defund-Obamacare Caucus is failing to see is that Obamacare is no longer just Obamacare. It is about something that is beyond the reach of a congressional vote. As its Oct. 1 implementation date arrives, Obamacare is the biggest bet that American liberalism has made in 80 years on its foundational beliefs. This thing called "Obamacare" carries on its back all the justifications, hopes and dreams of the entitlement state. The chance is at hand to let its political underpinnings collapse, perhaps permanently (Daniel Henninger, 9/25).

Bloomberg: Lots Of Words And Few Facts From Ted Cruz
Exactly what Ted Cruz accomplished with his 21-hour stemwinder from the Senate floor yesterday and today is unclear. What’s not debatable is his central argument against President Barack Obama’s health-care-reform law -- that it is "the single biggest job-killer in America." It’s flat wrong (9/25).

Miami Herald: Scare Tactics On Obamacare
It wasn’t the longest speech on the Senate floor, and not quite a filibuster, but Sen. Ted Cruz, R-Texas, made his points during his talkathon about the Affordable Care Act: Socialism! A jobs killer! Americans don’t want it! A red herring to impose a single-payer system! ... Here's the reality check: Obamacare passed muster in the conservative-leaning U.S. Supreme Court. It is not a socialist plot — just ask insurance companies that will be selling policies. It is not a jobs killer — just ask hospitals and healthcare professionals who are poised to hire more workers as insurance options expand this year for millions of Americans. And it won't usher in a single-payer system like those in European countries because Americans don’t want that (9/25).

Politico: How Obamacare May Be Holding Down Costs
The historic slowdown in health-care costs is continuing. Earlier this month, the government's actuaries found that total national health spending continues to grow at the lowest rate we've ever seen. And our annual employer health benefits survey released in August found premiums up just 4 percent on average for family policies this year, while overall health spending is growing at the slowest rate in 50 years (dating back to when the government first started tabulating health expenditures). Experts debate how much of the slowdown is due to the weak economy, which causes people to use less health care, and how much is due to changes in health insurance and the health-care system, such as higher cost-sharing or new efforts to limit avoidable tests or hospital days. But the consensus – including the actuaries – is that both factors are playing some role (Drew Altman, 9/26).

Detroit Free Press: While Affordable Care Act Prepares To Save Lives, The GOP Recites Dr. Seuss
What to do when the false narrative you’ve been pushing for five years withers in the light of fact and reality? If you’re Texas Sen. Ted Cruz, the obvious answer is the foot-stamping losers’ refuge of the filibuster, apparently (Stephen Henderson, 9/25).

Los Angeles Times: Obamacare As Political Theater
Each week seems to bring new claims that the Affordable Care Act (a.k.a. Obamacare) — which begins enrollment for coverage on health insurance exchanges on Oct. 1 — will bring calamity. In many ways, this furor is reminiscent of Medicare's beginnings in 1966. That law, passed in 1965, had just a year before it went live. There were plenty of naysayers and fears of potentially calamitous roadblocks (Marilyn Moon, 9/26).

The Fiscal Times: Why Obamacare May Not Put A Dent In Health Spending
The Department of Health and Humans Services released a report on Wednesday that, for the first time, provided details on the premium rates in 36 states where the federal government will run or support insurance exchanges. The report found that average premiums across 48 states, not including tax credits for those eligible to receive them, would be about 16 percent lower than projected. Yet that data doesn’t fully describe the costs for all Americans once the exchanges launch on Oct. 1. The report looks at premiums for 27-year-old nonsmokers and families of four making $50,000. The actual rates you get might be different from those listed (John Wasik, 9/26).  

The Fiscal Times: Rising Premiums Expose Obamacare 'Bait And Switch'
With the rollout of the Affordable Care Act individual exchanges less than a week away, the Department of Health and Human Services finally got around to announcing what consumers will have to pay.   Their press release  put a positive spin on the data, heralding the "significant choice" that consumers will find in these exchanges – and at "lower than expected premiums."  This, however, is nothing but what Forbes analyst Avik Roy calls "happy talk" (Edward Morrissey, 9/26).

Miami Herald: Gov's Privacy Concerns Are A Sham
Let's conduct a poll. By hand signal. Anyone who discerns even an inkling of sincerity in the governor's decision to bar Affordable Health Care "navigators" from county health department premises, slap yourself in the head. Pasco County Health Director Dr. Marc Yacht, for one, wouldn't poll in favor of the gov. He called Rick Scott’s policy, ostensibly to protect patient confidentiality, "cruel and irresponsible," charging that it will "significantly compromise a multitude of needy Floridians from getting critical health care" (Fred Grimm, 9/25).

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Viewpoints: The Debate On Locking Up People With Mental Illness; Michael J. Fox's New Role

USA Today: Should 11 Million Mentally Ill Be Locked Up? Our View
The awful mass killings this month by a delusional shooter at Washington's Navy Yard provoked familiar demands to fix the nation's mental health system. ... There's no question that the nation's mental health system needs improvement. Ask almost any parent who has tried to get help for a severely troubled child. The number of psychiatric beds today is less than one-tenth the 500,000 available in the 1950s, and the overburdened, underfunded system fails to treat millions of people with severe mental illness. They and their advocates have long lacked the clout that gets funding for other diseases. If concern over mass shootings helps propel a fix, good. But the idea that this will end mass shootings is extremely naive — or politically convenient (9/25).

USA Today: NRA: Navy Yard Shooter Should Have Been Committed
Four miles from the White House. The Washington Navy Yard. Tragedy that didn't have to happen. Victims that didn't have to be victims. He never should have been at the Navy Yard. Discharged from the military, he had several run-ins with law enforcement — including firearms offenses — and told authorities he was under microwave attack and hearing voices. At that point, he should have been committed (Wayne LaPierre, 9/25).

Texas Tribune: Close Dangerous State Disabled Centers
[The state’s 13 institutions for people with developmental disabilities] have been avoiding accountability for years. Since 2009, when the U.S. Department of Justice ordered the state to improve conditions at all 13 locations, federal investigators have threatened to cut funding to the centers more than 50 times, most recently in May of this year. Reform has been excruciatingly slow. After six rounds of DOJ reviews since 2009, only one center has achieved more than 30 percent compliance across 161 categories the federal and state governments agreed are in need of improvement — things like reducing incidents of abuse, neglect and exploitation (Arlene Wohlgemuth and Dennis Borel, 9/24).

The Wall Street Journal: A Big Step In The Fight Against Superbugs
In the U.S. and abroad, humans are at risk of increasingly weak antibiotics and increasingly strong superbugs. Before the discovery of penicillin in the early 20th century, a significant portion of people unlucky enough to contract a bacterial infection died. With increasing antibiotic resistance, we risk a post-antibiotic era every bit as frightening (Jonathan B. Perlin and Richard Platt, 9/25).

USA Today: Michael J. Fox A Role Model For Disabled
But with the premiere of the Michael J. Fox Show Thursday night, Fox's role as an actor could transition him into a major civil rights leader for people living with disabilities. Television has the power to change lives. From our favorite sitcoms to the evening news, polls show that television is the lens through which Americans form opinions. Indeed, TV can have a stronger impact on both viewers and this country's laws than even education or our own families (Jennifer Laszlo Mizrahi, 9/25).

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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.