Daily Health Policy Report

Friday, September 27, 2013

Last updated: Fri, Sep 27

KHN Original Reporting & Guest Opinion

Administration News

Capitol Hill Watch

Health Reform


Health Care Marketplace

Health Policy Research

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Lessons From The Obamacare Data Dump

Kaiser Health News staff writer Jay Hancock reports: "This week the Department of Health and Human Services released a ton of information about how insurance sold in 36 states under the Affordable Care Act will work. Most of it came in the form of data showing the number of carriers and their premium prices in hundreds of regions. Until now we've seen information on subsidized policies to be sold through online marketplaces released in trickles by states that are creating their own online portals" (Hancock, 9/27). Read the story.

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Obamacare In Middle Of Countdown To Possible Shutdown On Capitol Hill

Kaiser Health News staff writer Mary Agnes Carey and Politico Pro's Jennifer Haberkorn discuss how the standoff is likely to be resolved. The Affordable Care Act lies at the center of a last minute push to fund the government past Sept. 30 (9/26) Listen to the audio or read the transcript.

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Houston Embraces Obamacare Outreach, Despite Cruz And Perry

KUHF’s Carrie Feibel, working in partnership with Kaiser Health News and NPR, reports: "Two high-profile Texans are fighting the Affordable Care Act. Governor Rick Perry has loudly dismissed the law, and Republican Sen. Ted Cruz took to the Senate floor this week to rail against it at length—21 hours and 19 minutes to be exact. On the other side you have Rosy Mota and her clipboard, standing at the door of a CVS pharmacy in one of Houston’s Latino neighborhoods, stopping shoppers. … Mota works for Enroll America, a national organization that has borrowed its tactics from the Obama re-election campaign. Using data-mining and digital maps, the group is figuring out where the uninsured in Houston live, down to the block and house level" (Feibel, 9/27). Read the story.

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A Reader Asks: What Happens To My Coverage If I Move?

Kaiser Health News consumer columnist Michelle Andrews answers the reader’s question about coverage through the health exchanges after a move (Andrews, 9/27). Read the answer.

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South Florida Insurance Rates Will Be Among Lowest In State, Report Says

The Miami Herald's Evan S. Benn and Patricia Borns, working in partnership with Kaiser Health News, reports: "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" (9/26). Read the story.

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Capsules: Online Obamacare Enrollment In Spanish Delayed; Video: Health Law Changes, Seniors And Medicare

Now on Kaiser Health News' blog, Jenny Gold writes about a delay for online enrollment for Spanish speakers: "The Spanish-language version of healthcare.gov will not be equipped to handle online enrollments on Oct 1., according to an Obama administration official. Instead, Spanish speakers will have to wait until Oct. 21 to sign up online" (Gold, 9/26).

Also on Capsules, watch a video of KHN’s Mary Agnes Carey on PBS Newshour in which she answers questions from seniors uncertain of how the Affordable Care Act will affect older Americans and what changes are coming for Medicare recipients (9/27). Check out what else is new on the blog.

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Political Cartoon: 'Frankly Speaking?'

Kaiser Health News provides a fresh take on health policy developments with "Frankly Speaking?" by Eric Allie.

Here's today's health policy haiku:


Texas, Florida
folks have special joy: sorting
out the exchange rates!

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

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Administration News

In Campaign-Style Speech, Obama Defends The Health Law

In his Thursday appearance at a suburban Maryland community college, President Barack Obama dismissed as "crazy" the arguments being advanced by the overhaul's opponents and accused some GOP lawmakers of attempting "blackmail" to stop its implementation.

The New York Times: Obama Scorns G.O.P. 'Blackmail' On Health Law
President Obama mounted a passionate, campaign-style defense of his health care program on Thursday, just days before its main elements take effect, mocking opponents for "crazy" arguments and accusing them of trying to "blackmail a president" to stop the law (Baker, 9/26).

Bloomberg: Obama Says He Won’t Back Down In Fight Over Health Care Law
President Barack Obama said he won’t back down against Republicans trying to block his health care law and said threats to tie their effort to raising the nation’s debt ceiling amount to "blackmail." With five days until enrollment begins, Obama said the Republicans in Congress are becoming increasingly "irresponsible" in opposing the law (Runnigen, 9/26).

Politico: Obama Accuses GOP Of 'Blackmail'
President Barack Obama accused Republicans of trying to "blackmail a president" by threatening to shut down the government or default on the nation’s debt if he doesn’t agree to block implementation of Obamacare. “We’re not going to submit to this type of total irresponsibility,” Obama said in remarks at a community college just outside Washington. "I will not negotiate on anything when it comes to the full faith and credit of the United States of America" (Allen, 9/26).

The Washington Post: Obama's Line In The Sand Is On The Debt Ceiling
On Thursday, Obama categorically rejected the Republican demand that he roll back the Affordable Care Act in order to keep the government open and also refused to entertain negotiations on raising the debt ceiling. Both positions, a centerpiece of his strategy this fall, are striking for a president who has made his willingness to meet the opposition "more than halfway" a defining characteristic of his political persona. Obama gave in on a key feature of his health-care plan in 2010 — a public insurance option — and engaged in a lengthy negotiation over the debt ceiling in 2011. But in his remarks Thursday, Obama said Republicans were trying "to blackmail" him over the health-care law and pledged that he would have none of it (Goldfarb, 9/26).

Los Angeles Times: Obama: Healthcare As Easy As Online Shopping
President Obama says his Affordable Care Act is about to make health insurance cheaper than the average cellphone bill and as easy to get as "a plane ticket on Kayak." In a pitch to community college students in suburban Maryland on Thursday morning, Obama compared the soon-to-launch healthcare "marketplaces" to Internet travel websites that let users compare prices and details with a few keystrokes (Parsons and Hennessey, 9/26).

The Associated Press: Obama Touts Ease Of Health Care Sites
President Barack Obama says his Affordable Care Act is about to make health insurance cheaper than the average cellphone bill and as easy to get as “a plane ticket on Kayak.” In a pitch to community college students in suburban Maryland on Thursday morning, Obama compared the soon-to-launch online health care marketplaces to Internet travel websites that let users compare prices and details with a few keystrokes (9/26).

The Washington Post: Obama Defends Health-Care Law, Calling Health Insurance 'A Right'
President Obama offered a ringing defense of his signature health-care law Thursday amid what he called increasingly "irresponsible" Republican tactics to undermine it, ruling out changes as long as he is in office. Traveling to Prince George’s Community College just outside the Capital Beltway, Obama made a moral argument, as well as an economic one, for legislation that will help define his domestic record for history. He said health insurance is now a "right" in the United States, not a benefit available only to those who can afford it (Wilson and Wiggins, 9/26).

The Associated Press/Washington Post: Obama Ridicules 'Crazy' Republican Doomsday Predictions Of Health Care Law, Pitches Enrollment
With just five days to go before Americans can begin signing up for health care under his signature law, President Barack Obama on Thursday ridiculed Republican opponents for "crazy" doomsday predictions of the impact and forecast that even those who didn’t vote for him are going to enroll. With polls showing many Americans still skeptical of the law known as "Obamacare," the president went back to the basics of explaining how nearly 50 million uninsured Americans will be able to buy coverage in new government-run exchanges while mocking Republicans for trying to block its implementation. "The closer we get, the more desperate they get," Obama argued (9/26).

Reuters: As Critical Phase Nears, Obama Stumps For Healthcare Law
President Barack Obama visits a local college on Thursday to promote his signature healthcare program as it nears a critical enrollment phase, even as the law faces stiff political opposition and a wary public. In remarks at Prince George's Community College in suburban Maryland, Obama will seek to focus attention on the sign-up period for health insurance under the Affordable Care Act, popularly called "Obamacare." Starting on Tuesday, Americans who lack insurance will have six months to shop online for health coverage (Felsenthal, 9/27).

Fox News: Obama Claims 'No Widespread Evidence' Health Law Hurts Jobs, Amid Cutbacks
President Obama, in a heavily partisan speech defending his signature health care law, claimed Thursday "there's no widespread evidence" it is hurting jobs -- despite widespread reports that businesses are cutting back worker hours in order to avoid extra costs tied to the law. The charge that Obamacare is driving Americans into part-time work is one of the central claims that opponents make in arguing for the law to be defunded or delayed. Sen. Ted Cruz, R-Texas, reiterated the claim during his 21-hour floor speech against ObamaCare this week (9/26).

The Fiscal Times: Obama's Approval Sinks As He Fights For Health Plan
President Obama, suffering his lowest public approval in two years, defended his even more unpopular health care law during a speech Thursday morning in suburban Maryland. Locked in political mortal combat with Republicans over the future of his signature Affordable Care Act and the government’s AAA credit rating, Obama delivered a detailed defense of a program designed to extend insurance coverage to millions of uninsured Americans next year (Planin, 9/26).

Los Angeles Times: Healthcare Law: White House Shifts From Selling To Explaining
In the years since the Affordable Care Act became law, the measure known as Obamacare has been debated, excoriated, legally challenged, upheld and then debated some more. Now, with its centerpiece element opening for business in five days, the White House is focusing on a task that many critics of the administration say is long overdue: explaining it. Explaining was Priority No. 1 for the Obama administration during much of the week, with everyone from the commander in chief to the rank-and-file press staff setting out details for reporters (Parsons and Hennessey, 9/26).

The Wall Street Journal: Health Law Puts Obama Legacy On The Line
With the enrollment date approaching and support for the health law lagging in the polls, the administration is starting a sustained effort to make the case for its benefits, deploying the president, first lady, vice president, cabinet officials and an array of celebrities. On Thursday, Mr. Obama delivered an emphatic defense of the law, delving into the details of insurance exchanges and accusing Republicans in Congress of trying to "blackmail" him with threats of default or shutting down the government (McCain Nelson, 9/26).

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Capitol Hill Watch

Government Shutdown Increasingly Likely; Health Law Continues To Be Flashpoint

The Senate is expected to approve on Friday a continuing resolution that provides funding to keep the federal government operating but strips out language passed by the House that would defund the health law. This move will set up heightened conflict with the House, where some conservative Republicans are standing firm in their pledge to oppose any measure that does not further their goal of dismantling Obamacare. In the background, the countdown to a government shutdown continues.  

The New York Times: Senate Is Expected To Approve Budget Bill
The Senate will conclude one of its more unpredictable — and stranger — weeks on Friday when it is expected to approve a bill to finance the federal government, including the health care law that Republicans have been trying to kill (Peters, 9/27).

Politico: Dems: No Obamacare Concessions
There will be no concessions from the Senate on Obamacare to avoid a government shutdown, Democratic leaders said Thursday afternoon. The Democratic leadership team said time and again Thursday that they will only accept a clean continuing resolution, which is precisely what the Senate is set to send back to the House by Saturday. Senate Majority Leader Harry Reid (D-Nev.) will strip out Obamacare defunding language passed by the House last week and send the bill back to the House no later than Saturday, though senators are seeking to move even more quickly but have yet to break through on an expedited time agreement (Everett, 9/26).

The Wall Street Journal: No Clear Path To Avoid Shutdown As House GOP Stands Firm
The Senate is expected to pass a bill Friday that would fund the government for the first 1½ months of the new fiscal year. But Senate Democrats plan to restore money for the Affordable Care Act that House Republicans had stripped out, leaving the two chambers in conflict (Hook and Peterson, 9/26).

The Washington Post: Shutdown Grows More Likely As House Digs In
Using Senate rules permitting him to change the wording of a spending measure approved by the House last week, Majority Leader Harry M. Reid (D-Nev.) is expected to strip out language that would defund the law, change the expiration date on the funding bill to Nov. 15, and pass the measure with a simple majority achieved entirely with Democratic votes. Once the bill returns to the House, any move to change it would by necessity mean that the fight over funding the government would almost certainly continue at least until the final minutes of the fiscal year late on Monday night since the Senate’s arcane, time-sensitive rules would make swift consideration unlikely (O’Keefe, Helderman and Montgomery, 9/26).

Los Angeles Times: As GOP Infighting Persists, Threat Of Government Shutdown Heightens
Options for keeping the federal government open narrowed Thursday as some of the most conservative Republicans in the House rebuffed proposals from Speaker John A. Boehner, who had aimed to break a stalemate over the federal budget. The opposition from conservatives to any measures that fall short of their goals of cutting federal spending or dismantling President Obama's healthcare law left the Ohio Republican with little room to maneuver as a Monday night deadline approached for providing money to keep federal agencies running (Mascaro and Memoli, 9/26).

The Washington Post: Republican Hard-Liners Block Strategy To Avoid Federal Government Shutdown
Boehner (R-Ohio) and his leadership team revealed the first step of that plan to rank-and-file lawmakers early Thursday, urging conservatives to shift their assault on President Obama’s health care law to the coming fight over the federal debt limit. That would allow lawmakers in the meantime to try to reach an agreement on a plan to fund federal agencies into the new fiscal year, which begins Tuesday, and avoid a shutdown. But about two dozen hard-liners rejected that approach, saying they will not talk about the debt limit until the battle over government funding is resolved (Montgomery and Kane, 9/26).

The New York Times: Republicans Facing A Test Of Unity
As the Congressional showdown over President Obama’s health care law threatens to shut down the government, conservative advocacy groups have emerged as central players — exerting outsize influence, investing tremendous time and resources, and turning the long-shot budget fight into a do-or-die battle that has pitted Republicans against one another (Parker, 9/26).

Bloomberg: Boehner Beset By Obamacare Foes In Race To Avoid Shutdowm
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 (Bender, 9/26).

The New York Times: House G.O.P. Raises Stakes In Debt-Ceiling Fight
Trying to round up votes from a reluctant rank and file, House Republicans said they would agree to increase the debt limit to avert a mid-October default only if Democrats accepted a list of Republican priorities, including a one-year delay of the health care law, a tax overhaul and a broad rollback of environmental regulations (Weisman, 9/26).

Politico: House GOP Banking On Plan C
At this point, it’s difficult to conclusively determine where all the House GOP’s maneuvering and false starts will end. In one sense, the developments might help Congress avoid a government shutdown. Most House Republicans now seem to recognize that they will likely have to swallow a funding resolution that leaves Obamacare intact. Yet, the ups-and-downs also dramatically increase the stakes in the debt-ceiling fight. The borrowing cap must be raised by Oct. 17, or the nation will default on its debts (Sherman and Bresnahan, 9/26).

Kaiser Health News: Obamacare In Middle Of Countdown To Possible Shutdown On Capitol Hill
Kaiser Health News staff writer Mary Agnes Carey and Politico Pro's Jennifer Haberkorn discuss how the standoff is likely to be resolved. The Affordable Care Act lies at the center of a last-minute push to fund the government past Sept. 30 (9/26).

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Manchin May Buck Democrats On Individual Mandate Delay

News outlets are reporting that Sen. Joe Manchin, a West Virginia Democrat, said Thursday he'd be willing to support a year-long delay in the health law's individual mandate if it came before the Senate -- and then walked those comments back. Some other Democrats support modest tweaks to the law, The Wall Street Journal reports.

Bloomberg: Democrat Manchin Breaks Ranks To Back Mandate Delay
U.S. Senator Joe Manchin of West Virginia broke ranks with fellow Democrats and said he’d support a stopgap spending plan that delays the individual mandate in President Barack Obama's health-care law. ... At the breakfast, Manchin said the individual health-insurance rule should be delayed at least a year. "Don't put the mandate on the American public right now," he said. "If you know you couldn’t bring the corporate sector, you gave them a year, don’t you think it’d be fair?" Manchin also said he’d be willing to negotiate in a debate over raising the nation’s $16.7 trillion debt limit. He said he’d support "efficiencies" in Medicare and Social Security and using most of the savings for debt reduction (Bender, 9/26).

Politico: Manchin OK With Obamacare Individual Mandate Delay
West Virginia Democratic Sen. Joe Manchin said Thursday he would vote for a government funding bill that delays Obamacare’s individual mandate for a year if it came up in the Senate, later backtracking and clarifying he doesn’t believe Obamacare should be part of the government funding showdown (Kopan, 9/26).

Fox News: Sen. Manchin Bucks Dems To Back Obamacare Delay – Then Walks Back Remark
Democrats may have just lost one of their own in the high-stakes fight over ObamaCare -- or maybe not. Sen. Joe Manchin, D-W.Va., a moderate Democrat known at times to buck his party, said Thursday that he'd be willing to support a spending bill that also delays the law's requirement on individuals to buy health insurance. "There's no way I could not vote for it," Manchin said. "It's very reasonable and sensible” (9/26).

The Wall Street Journal: Tweaks To Health Law Attract Some Democrats
Sen. Mary Landrieu, facing the prospect of a tough race next year, is squarely behind the Affordable Care Act—up to a point. "It needs to be fixed, not repealed," she said. Democrats overwhelmingly oppose Republican efforts to defund or delay the law, which the GOP wants to attach to must-pass fiscal measures. At the same time, many are eager to find ways to improve it, opening a small chink in a unified Democratic position that will be tested in coming days (O’Connor and Peterson, 9/26).

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Health Reform

Technical Glitches Delay Online Signups For Small Businesses And Spanish Speakers

The Obama administration acknowledged glitches Thursday that will delay online enrollment for small businesses and Spanish-language speakers in the 34 states that elected to not set up their own insurance marketplaces. The postponements amount to a few weeks in the six-month open enrollment period and will not affect the Jan. 1 start date for coverage.

The Associated Press/Washington Post: Deadline Glitches: Health Overhaul Online Sign-Up Delayed For Small Firms And Spanish Speakers
Administration officials are quietly telling key interest groups to expect initial glitches signing up online for coverage under President Barack Obama’s health care overhaul. Two sources tell The Associated Press that small businesses will not be able to enroll online starting Oct. 1 when new health insurance markets go live. Instead, one of the sources, a person who was briefed on the situation, said business owners will initially have to mail or fax their information so that they can enroll (9/26).

Reuters: New Delays Hit Obamacare Rollout Before Oct. 1 Launch
The U.S. government on Thursday announced new delays in rolling out President Barack Obama's health care reform, saying small business and Spanish-language health insurance enrollment services would not begin on October 1 as planned.The postponements amount to a few weeks out of a months-long enrollment period aimed at signing up millions of uninsured Americans for health benefits (Morgan, 9/26).

The New York Times: Enrollment To Be Delayed For Small-Business Marketplaces
The Obama administration on Thursday announced another minor delay in the implementation of the Affordable Care Act, saying that the insurance marketplaces for small businesses would be fully open for enrollment a month later than it had planned. White House officials played down the development, putting it at the end of a news release announcing that the Department of Health and Human Services was "launching the Small Business Health Option Program Marketplace" (Shear, 9/26).

Los Angeles Times: Glitch Delays Online Tools For U.S. Health Insurance Marketplaces
California is unaffected by the delay. But small businesses in some states that want to sign up their employees for health coverage on new federally run marketplaces created by the Affordable Care Act will have to use paper forms until November, according to administration officials (Levey, 9/26).

The Washington Post: Obamacare Suffers Another Delay, Pushing Back Exchange Enrollment For Small Firms
On the federal exchange, which is scheduled to launch on Tuesday, small business owners will not be able to purchase coverage online until Nov. 1. Instead, for the first month, they will have to mail or fax their information to government officials to enroll on the federal exchange, which will serve individuals and business owners in the 34 states that elected not to set up their own exchanges. Plans purchased through the small-business exchange will still take effect Jan. 1, as planned, HHS spokeswoman Joanne Peters told The Washington Post (Harrison, 9/26).

The Wall Street Journal: Online Health Exchanges For Small Businesses Hit Snag
The Obama administration acknowledged for the first time Thursday that a technological problem is forcing it to delay part of the rollout of the new health care law, saying insurance exchanges won't be ready to accept online applications from small businesses when the program launches Tuesday. With less than five days left to debug the sprawling new computer system, there are other signs of trouble: People close to the situation are also skeptical the online marketplaces for individual customers will be fully ready. The administration said it was confident they would open on time (Radnofsky, Weaver and Needleman, 9/26).

Politico: Another Obamacare Delay
The one-month delay is not a major blow to the health care law -- the exchanges for individuals are still expected to open on time. But it's yet another PR headache for the White House as it ramps up a major Obamacare sales pitch just five days before open enrollment is scheduled to begin (Millman and Haberkorn, 9/26).

Kaiser Health News: Capsules: Online Obamacare Enrollment In Spanish Delayed
The Spanish-language version of healthcare.gov will not be equipped to handle online enrollments on Oct 1., according to an Obama administration official. Instead, Spanish speakers will have to wait until Oct. 21 to sign up online (Gold, 9/26).

Marketplace: Obamacare Faces Another Delay: En Espanol
Here's one job we can all be glad isn't ours this week: Tech support for Obamacare. There are reports of two more glitches today. Small businesses who want to sign up for health insurance online will have to wait until Nov. 1 to complete the process, although they will still be able to enroll by fax. That's the small glitch. A bigger deal is that the Spanish version of the main website for the federal exchanges -- the entry point to buy coverage -- won't be working for at least a few weeks (Gorenstein, 9/26).

CBS News: Obamacare’s Counselors Caught In Partisan Battle
Five days before those new state health insurance exchanges open for business, President Obama was out encouraging folks to sign up for Obamacare. But while he was doing that, his administration revealed a couple of new glitches. A Spanish-language enrollment Web site won't be up and running for a few more weeks, and there will be a one-month delay for small businesses to sign up. Counselors known as "navigators" are to help folks with the enrollment process, but they've become targets in the partisan battle over Obamacare (Strassmann, 9/26).

The Hill: White House Delays Obamacare Enrollment For Small Businesses
The Obama administration is delaying ObamaCare enrollment for small businesses and Spanish speakers. Small businesses will not be able to buy health insurance through new online marketplaces when they launch next week, the Health and Human Services Department said. Republicans seized on the delay to argue that the health care law is destined to fail (Baker, 9/26).

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Conn. Marketplace CEO Acknowledges Problems Could Lie Ahead; Fla. Health Advocates Looking For More Consumer Help

Concerns about the roll-out of the marketplaces are examined in several states.

The CT Mirror: Computer Snags, Other Problems May Dog Health Exchanges
Less than a week before the opening of state insurance exchanges nationwide, no one is sure how this key element of the Affordable Care Act is going to roll out. The Obama administration is hoping for a seamless debut. But even Obamacare's biggest boosters predict there will be problems, though there's debate as to how serious those problems will be. "I am confident there will be glitches," said Kevin Counihan, CEO of Access Health CT, Connecticut’s health exchange (Radelat, 9/26).

Health News Florida: FL Navigator Law Has Gap
There will be only about 150 licensed "navigators" in the state to act as health plan enrollment advisors for millions of uninsured Floridians over the next six months -- not nearly enough, everyone agrees. So hospitals and other health-care businesses and non-profits are busy getting employees trained for the role of  "Certified Application Counselors," or CAC's (Gentry, 9/27).

Georgia Health News: A Geographic Sore Spot For Exchange Premiums
About 95 percent of American consumers will have a choice of two or more health insurance issuers, and often many more, the U.S. Department of Health and Human Services said Wednesday in announcing premiums for federally run insurance exchanges in 36 states, including Georgia. But in two regions of southwest Georgia, there's only one insurer offering coverage -- Blue Cross and Blue Shield of Georgia. And the premiums in that corner of the state are much higher than in the rest of Georgia (Miller, 9/26).

Minnesota Public Radio: MNsure Roll-Out A Ripe Opportunity For Scammers
The roll-out of the Affordable Care Act, a confusing process for many people, is a dream come true for rip-off artists. The Federal Trade Commission has already investigated nearly 300 consumer complaints nationwide related to insurance scams, including one from Minnesota. Other people in the state also say they have received false information in the mail, questionable phone pitches and email spam (Volpe, 9/26).

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In State Politics, Anti-Obamacare Attacks Continue As Outreach Ramps Up

Some state officials tout their anti-Obamacare credentials as enrollment efforts pick up on the eve of the Oct. 1 opening of new online marketplaces.

The Washington Post: Ken Cuccinelli Launches First Campaign Ad To Focus On Obama Health-Reform Law
With portions of the Affordable Care Act set to kick in next week, Attorney General Ken Cuccinelli II’s campaign for Virginia governor is airing its first ad explicitly aimed at the health-reform measure. The ad, titled "Obamacare,” focuses on Cuccinelli’s (R) long-standing opposition to President Obama's signature legislation while blaming foe Terry McAuliffe (D) for the measure's perceived faults (Pershing, 9/26).

The Wall Street Journal’s Washington Wire: Michigan GOP Governor To Washington: Work It Out
Michigan Gov. Rick Snyder may be a Republican, but he blames both sides for the bitter partisan fight underway in Washington over federal spending and borrowing, and the shape of the president’s health-care overhaul. "I hold all sides equally accountable. I see no value in 'Who did what to whom?'" he said in an interview after a speech at the conservative American Enterprise Institute (King, 9/26).

Kaiser Health News: Houston Embraces Obamacare Outreach, Despite Cruz And Perry
Two high-profile Texans are fighting the Affordable Care Act. Governor Rick Perry has loudly dismissed the law, and Republican Sen. Ted Cruz took to the Senate floor this week to rail against it at length -- 21 hours and 19 minutes to be exact. On the other side you have Rosy Mota and her clipboard, standing at the door of a CVS pharmacy in one of Houston’s Latino neighborhoods, stopping shoppers. … Mota works for Enroll America, a national organization that has borrowed its tactics from the Obama re-election campaign. Using data-mining and digital maps, the group is figuring out where the uninsured in Houston live, down to the block and house level (Feibel, 9/27).

The Associated Press: HHS Secretary Talks Health Care Overhaul In Dallas
U.S. Health and Human Services Secretary Kathleen Sebelius says she's hoping Texas lawmakers will change their minds about accepting funding for the health care overhaul once its provisions kick in (Merchant, 9/26).

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GE Uses Clout To Change How Hospitals, Doctors Work

The New York Times looks at the impact one big employer can have on the medical system in a community. Also, The Wall Street Journal examines the health law's efforts to set up accountable care organizations and the impact on hospitals.

The New York Times: As Some Companies Turn To Health Exchanges, G.E. Seeks A New Path
Although the new federal health care law is designed to help people buying individual policies, even people with employer-provided policies are beginning to see changes in their coverage as companies rethink health care for their workers, discontinuing it in a few cases and redesigning it in many others. ... But here in Cincinnati, General Electric is taking the opposite approach. One of the largest employers in the nation, it spends more than $2 billion a year offering coverage to 500,000 employees and retirees and their families. And it is using its considerable clout in places like this -- where its giant aviation business gives it a major presence -- to work directly with doctors and hospitals to improve care and reduce costs (Abelson, 9/26).

The Wall Street Journal: Hospitals Give Health Law Real-World Test
In an ACO, hospitals or groups of doctors contract with insurers to provide care for an assigned patient population. The aim: better care at lower cost. ACOs have incentives to keep patients healthy and incurring lower costs because they get to share the savings. Commercial insurers have created more than 200 ACOs with health-care systems in recent years. Now, the Affordable Care Act is giving the concept a government-funded test by authorizing Medicare to set up pilot ACOs. More than 250 health systems have signed on since 2011, creating ACOs covering more than four million Medicare beneficiaries (Beck, 9/26).

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Parsing The Premiums In New Obamacare Exchanges

Media outlets analyze the data on premiums for 36 states released this week by the Obama administration -- looking at the impact of competition on prices and assessing which regions -- and which consumers -- might be winners or losers in the new online marketplaces.

Kaiser Health News: Lessons From The Obamacare Data Dump
This week the Department of Health and Human Services released a ton of information about how insurance sold in 36 states under the Affordable Care Act will work. Most of it came in the form of data showing the number of carriers and their premium prices in hundreds of regions. Until now we've seen information on subsidized policies to be sold through online marketplaces released in trickles by states that are creating their own online portals (Hancock, 9/27).

North Carolina Health News: North Carolina Insurance Rates A Mixed Bag
As the enrollment period for health insurance being offered under the Affordable Care Act, the rates for plans purchased through the health insurance marketplaces in North Carolina are finally emerging. Rates for the plans vary widely across the state, and in many areas are higher than the national average, in part because few insurers have jumped into the market in North Carolina (Hoban, 9/27).

MinnPost: Minnesota's Top Health Insurance Ranking Didn’t Include All Factors
The federal analysis that proclaimed Minnesota’s health insurance premiums the lowest in the nation didn't take into account factors that could have upped the cost. National data released Wednesday found other states much higher than the average $144 monthly price for the cheapest low-tier plan on the MNsure health exchange. Similar coverage in Wyoming, for example, listed for $425 (Nord, 9/26).

Meanwhile, two media outlets report on a study by the right-leaning Manhattan Institute noting that some people, among them young men, will pay comparatively more in the new marketplaces --

CBS News: Study: Insurance Costs To Soar Under Obamacare
New research from the Manhattan Institute estimates that insurance rates for young men will rise by 99 percent. Rates for younger women will rise between 55 percent to 62 percent, according to the right-leaning New York think tank. The precise impact of the new health law is likely to vary markedly from state-to-state, however. That's largely because different states have had different requirements for what had to be included in health insurance policies in the past. The Affordable Care Act, commonly known as Obamacare, overrides these rules and sets a federal overlay that demands a wide array of mandatory coverages. The Manhattan Institute has drawn up an interactive map that may help forecast the rise in cost for individuals (Kristof, 9/26).

Fox News: Despite Gov't Assurances, Some Could See Insurance Costs Soar Under Obamacare
On Wednesday, Health and Human Services Secretary Kathleen Sebelius released an overview of premiums and plan choices, saying "For millions of Americans, these new options will finally make health insurance work within their budgets." The administration also said premiums would generally be lower than what congressional budget experts had estimated during debate on the legislation. But former Congressional Budget Office Director Doug Holtz-Eakin said Thursday, “unfortunately you can go all through that HHS report and not be able to answer the most important question: will my insurance rates go up in 2014?” (Angle, 9/27).

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Health Law Confusion, Division Among American Public Persists

USA Today examines how the health law is viewed in Colorado as a case study of the confusion that surrounds it. As further evidence of that confusion, one new poll finds that people without insurance are divided on how much the overhaul will impact them just as another concludes that half of Americans say Republicans should stop their effort to derail the measure as part of the current budget battle.

USA Today: Colorado: Microcosm Of Confusion On Health Law
In Colorado and across the country, the insurance marketplaces known as exchanges are scheduled to open Tuesday, and the success or failure of Obama's signature legislative achievement is at stake. Passing the health care overhaul defined much of his first term in the White House, and defending it from Republican assault has defined much of his second -- including in the current budget showdown (Page, 9/27).

The New York Times: Uninsured Americans Divided On Impact Of Health Care Law
Less than a week before the health insurance marketplaces established by the 2010 health care law begin accepting customers, a New York Times/CBS News poll has found that there is some support among uninsured Americans for President Obama and his law, but also a wariness and a lack of understanding about what the law will mean for them (Kopicki, 9/26).

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.

California Healthline: Survey: Reform Support Holding Steady
According to a survey released today, Californians approve of the Affordable Care Act's health care reform by a small margin, with 53 percent of those polled supporting the effort. The numbers haven't changed much since the last survey -- which is a little surprising, said PPIC president and CEO Marc Baldassare. "These numbers are pretty consistent with previous surveys. Really, there is no change over time in the approval numbers," Baldassare said. And that's a bit of a surprise, given the publicity around next week's launch of open enrollment season for the Covered California health benefit exchange (Gorn, 9/26).

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Notices About Medicare Advantage Changes Coming

Medicare Advantage plans are informing seniors of changes to their plans by mail this week. Meanwhile, KHN's Mary Agnes Carey talks about what Obamacare changes older Americans can expect.

The Oregonian: Medicare Advantage Plan Changes Arriving In The Mail 
Seniors: keep an eye on your mailboxes this week. Medicare Advantage plans will be mailing required notices of how their benefits and costs will change in 2014. Seniors can join, switch or drop health and drug plans for the coming year between Oct. 15 and Dec. 7. Before all that, plans must provide letters detailing any changes in coverage or cost by Sept. 30. If you get one, be sure to review it and understand the changes made (Hunsberger, 9/26).

PBS NewsHour: What Kinds Of Changes Can Older Americans Expect Under Health Reform? 
How does the Affordable Care Act alter Medicare or other insurance coverage for older Americans? Mary Agnes Carey of Kaiser Health News joins Ray Suarez to answer some of your most frequently asked questions (Suarez, 9/26).

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Health Care Marketplace

Looming Caregiver Shortage For Aging America

An aging America means more demand for caregivers who help care for the elderly, but a looming shortage could endanger that care. In the meantime, California stakeholders debate how that state should shape home care in the future.

Bloomberg: Boomers Face Caregive Shortage As U.S. Offers New Rules: Jobs
Carolyn Gay, a certified nursing assistant of 20 years, says she wants to inspire teens to become caregivers to the elderly. … Well-prepared helpers for seniors and disabled Americans soon could be harder (Smialek, 9/26).

California Healthline: How Should State Shape Care At Home?
We've all seen the demographic predictions: California's numerous baby boomers will swamp the health care industry with aging bodies -- almost all of them wanting to stay healthy, active and living at home. That last part -- living at home -- may become a recurring, resounding policy issue in the coming years. A new report from the UCLA Center for Health Policy Research suggests California policymakers need to pay more attention to health care delivered in the home. … We asked legislators and stakeholders how California can best shape state policy regarding home health care givers to get ready for major changes ahead (9/26).

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Health Policy Research

Research Roundup: Managed Care For Dementia Patients

Each week, KHN compiles a selection of recently released health policy studies and briefs.

JAMA Internal Medicine: Health Insurance Status And The Care Of Nursing Home Residents With Advanced Dementia
Dementia is a leading cause of death in the United States; however, patients dying with this disease may not receive optimal end-of-life care. ... many of these [nursing home] residents commonly experience burdensome and costly interventions, such as hospital transfers, tube-feeding, and intravenous antibiotics. ... Nursing home reimbursement policies are among the factors that incentivize more aggressive care. ... This study linked unique prospective clinical data with Medicare claims to describe and compare patterns of care between nursing home residents with advanced dementia enrolled in a Medicare managed-care insurance plan and those with fee-for-service Medicare. Residents enrolled in Medicare managed care received more primary care visits (principally from NPs), were more likely to have a DNH order, and had fewer hospital transfers for acute illness compared with those who had traditional Medicare coverage. Our findings also suggest that managed-care residents may have been more likely to enter hospice and that family members may have been more satisfied with the level of care (Goldfield, Grabowski, Caudry, Mitchell, 9/23).

JAMA Internal Medicine: Growth In Medicare Expenditures for Patients With Acute Myocardial Infarction
We studied the cost to Medicare during 365 days of a well-defined cohort of beneficiaries hospitalized for [acute myocardial infarction or heart attacks]. Increased expenditures were not largely the result of price increases (DRG reimbursement stayed constant or even declined in real terms) or changes in the use of technology during the index admission. Instead, expenditures 31 to 365 days after the index admission rose by 28.0 percent because of increased use of home health agencies, hospices, durable medical equipment, skilled nursing facilities, and inpatient services. Although the first 30 days after admission are the focus of many bundled payment initiatives, care after the initial admission is still very much "fee for service." ... our findings suggest that although Medicare's current bundled payments may include expenditures for patients with AMI within 30 days of the event, they do not contain spending beyond 30 days, which accounted for most of the expenditure growth for such patients from 1998 through 1999 and 2008 (Likosky et al., 9/23).

Employee Benefit Research Institute: Sources of Health Insurance and Characteristics of the Uninsured: Analysis of the March 2013 Current Population Survey
The percentage of the nonelderly population (under age 65) with health insurance coverage increased to 82.3 percent in 2012, notable because increases in health insurance coverage have been recorded in only six years since 1994. The percentage of nonelderly individuals with health insurance coverage was 81.5 percent in 2010, the lowest level of that population with such coverage during the 1994–2012 period. ... Employment-based health benefits remain the most common form of health coverage in the United States. In 2012, 58.5 percent of the nonelderly population had employment-based health benefits, down from the peak of 69.3 percent in 2000, during the 1994–2012 period. However, the 2012 level was essentially the same as in 2011 (58.4 percent), meaning that the decline in the percentage of the nonelderly population with employment-based coverage that has occurred each year since 2000 ceased in 2012 (Fronstin, 9/26).

The Kaiser Family Foundation: Wide Disparities In The Income And Assets Of People On Medicare By Race And Ethnicity: Now And In The Future
This report provides insight into preparations in Maryland, Nevada, and Oregon -- three states that have established a State-based Marketplace, are moving forward with the Medicaid expansion, and are among the states leading the way in preparing for outreach and enrollment. ... Across the three states, the most significant challenge they have faced in preparing for the expansions has been developing the new integrated eligibility and enrollment systems. In all three states, time constraints have limited the capabilities they will be able to build into their systems by October 1st. ... All three states benefit from supportive political leadership and close, collaborative working relationships among key state agencies. Moreover, they have a strong network of community partners that are working closely with the states. Lastly, stakeholders in all three states have been creative and adaptable as they prepare for implementation (Artigua et al., 9/24). 

Congressional Budget Office: Medicare And Social Security Payroll Taxes And Benefits For People In Different Birth Cohorts
Different generations will pay different amounts of Medicare and Social Security payroll taxes and receive different amounts of Medicare and Social Security benefits during their lifetime -- as discussed in The 2013 Long-Term Budget Outlook released this week. Medicare benefits are expected to be higher for later generations primarily because of the growth of health care spending per person but also because increases in life expectancy will cause later generations to receive benefits for longer periods, on average. Social Security benefits are expected to be higher for later cohorts because of increased life expectancy and because real earnings generally grow over time. Payroll taxes will be higher for later cohorts because of that growth in real earnings (Meyerson and Topoleski, 9/20).

Here is a selection of news coverage of other recent research:

Reuters: Vets May Not Get Speedy Cancer Care
Adults diagnosed with colon or rectal cancer are experiencing longer wait times before receiving cancer treatment in Veterans Affairs (VA) Medical Centers across the U.S., according to a recent report. The growing treatment delays may not be specific to VA centers alone, and whether the delays are tied to worse outcomes, as previous studies have found for breast and other cancers, is unknown, researchers said (Huggins, 9/20).

MedPage Today: Docs' Role In ACO Leadership Remains Strong
Physicians have had a strong leadership role in the development and operation of the early accountable care organizations (ACOs) -- and that's a good omen for the future, a health reform expert said Monday. Physician-led ACOs outnumber their hospital-led counterparts, Elliott Fisher, MD, MPH, director of the Dartmouth Institute for Health Policy and Clinical Practice, noted at an Alliance for Health Reform briefing on the topic. He pointed to evidence from the health consulting firm Leavitt Partners of Salt Lake City (Pittman, 9/24).

Reuters: Kids' Race May Play A Role In ER Treatment For Pain
Black children who are brought to the emergency room for stomach pain and cramps are less likely than white children to be given painkillers, a new study suggests. Using records from more than 2,000 ER visits, researchers found that white children and teenagers more often received painkillers available over the counter, such as ibuprofen and acetaminophen (Tylenol), or more powerful opioids, including oxycodone. The difference remained after the severity of children's conditions and various hospital-related factors were taken into account (Pittman, 9/23).

Time: Overdoing Bone Density Testing
Among the many tests that doctors recommend as people get older is monitoring for bone mineral density (BMD) to keep track of how quickly bone is being broken down to make sure that the skeleton is strong enough to prevent fractures and other bone failures. People with low BMD readings could benefit from medications that shore up bone and lower the risk of hip and other fractures. So doctors recommend that people over age WHAT TK repeat BMD screening every two years. But the latest research suggests that all that testing may not be necessary (Sifferlin, 9/25).

Reuters: Drug Subsidy Failed To Close Racial Gap In Statin Use
Among older Americans with heart disease or diabetes, blacks are still less likely to be on cholesterol medication than whites, despite federal prescription drug subsidies that lowered costs, according to a new study. Older blacks are also less likely than whites to have their cholesterol under control, researchers found. Because black patients are more likely to skip doses or to not take expensive medications at all for cost reasons, the Medicare Part D program that started in 2006 was expected to close a racial gap in the number of Americans with heart disease taking statins (Doyle, 9/25).

Medpage Today: Team-Based Care Doesn't Defuse Burnout
Practicing in a team-based delivery model did not improve burnout rates for physicians after a year, a small study found. Doctors who meet the criteria of "burned out" were higher (35 percent) for physicians a year after practicing in a team model compared with those practicing a more traditional model (30 percent, P=0.331), William Spinelli, MD, MPA, and colleagues reported here at the American Academy of Family Physicians Scientific Assembly. Burnout rates were lower for clinical assistants and other office staff in a team model -- although those results weren't statistically significant, Spinelli, of Allina Health in Minneapolis, told MedPage Today during a poster presentation (Pittman, 9/26).

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Editorials and Opinions

Viewpoints: Gerson Says No Compromises Makes For 'Bad Politics;' Democrats Are Getting A Pass; Manchin Signals A Break In Democratic Ranks

The Washington Post: A Compromised Reputation Among The GOP
We are seeing that an anti-compromise ideology can make for bad politics. In our system, Obamacare will not be overturned by one house of Congress. A tea-party shutdown strategy — if implemented — would make securing the other house and the presidency less likely for Republicans. And the political energy consumed by Cruz and crew has not been available to promote incremental limits on Obamacare that might have aided GOP political prospects (Michael Gerson, 9/26).

The Wall Street Journal: Defunders Give Democrats A Pass
As Mr. McConnell said Tuesday on the Senate floor: Majority Leader Harry Reid "can only afford to lose four Democrats if he wants to restore funding for Obamacare. So, if five Senate Democrats vote against the majority leader, Obamacare will be defunded . . . The spotlight should be on them." If only it were. The tragic reality is that this vote isn't shaping up to be all that perilous for the owners of the law. Nobody is even talking about Democrats. Nobody has put an iota of pressure on them for months (Kimberley A. Strassel, 9/26).

Bloomberg: Ted Cruz Republicans Listen Only To Themselves
A recent CNBC poll asked whether the Patient Protection and Affordable Care Act should be defunded. By 44 percent to 38 percent, Americans said no. Then the pollsters asked specifically about Cruz’s plan: forcing a shutdown to defund Obamacare. The public rejected that idea 59 percent to 19 percent. But Cruz isn’t listening. Public opinion on Obamacare is complicated but generally consistent. The law is unpopular. But a solid majority wants the Republican sabotage to end (Ezra Klein, 9/26).

USA Today: House GOP Rants Its Way Past Fiscal Problem: Our View
Defunding Obamacare — for all the Tea Party hyperventilating — would not yield much savings. Next year, according to the Congressional Budget Office, it will amount to about 1.3% of federal spending. As it ramps up fully, it will grow to about 3.3%. That's a pretty small sliver of government to justify sacrificing the financial credibility of the United States. What's more, because defunding Obamacare would also defund the offices that collect the taxes that more than pay for it, the action would actually increase the deficit (9/26).

USA Today: Obamacare Is Fiscally Irresponsible: Opposing View
By Washington standards, the entitlements within Obamacare start slowly. Next year, the Medicaid expansion and exchange subsidies will cost taxpayers $48 billion. Over the next decade, however, the cost of these entitlements will balloon to $1.8 trillion. Simply put, Obamacare is incompatible with fiscal responsibility. Left in place, Americans should expect these costs to grow (Michael A. Needham, 9/26).

The Wall Street Journal: The Obamacare Phalanx Breaks
One reason Obamacare has held together despite its unpopularity is the phalanx of support from Democrats. They passed it on a partisan basis without a single Republican vote, and they're sticking to it. So it was news on Thursday when West Virginia Senator Joe Manchin became the first Democrat of note to break with one of Obamacare's core tenets. The Senator told a media breakfast that he'd vote to support a bill to fund the government that included a one-year delay in the Affordable Care Act's mandate to buy individual health insurance (9/26).

The Wall Street Journal: Manchin Breaks Ranks
Senators like Ted Cruz of Texas have been trying to repeal ObamaCare in one fell swoop. ... But other GOP lawmakers, who share the freshman senator's goal, think that his strategy is unrealistic given that Republicans control only the House and that the president is unlikely to undo his signature achievement. The better tactic is to go after portions of the law, such as the individual mandate, that are less popular and hard for Democrats to defend. In other words, pick fights that you stand a chance of winning. Mr. Manchin's change of heart suggests that this strategy even has some bipartisan support (Jason L. Riley, 9/26).

The Wall Street Journal: The Beltway Stalemate
Any clear-eyed thinking would show that Obamacare needs to be, at the least, delayed. The law has always suffered from its usurpation of the physician-patient relationship, its infringement on First Amendment freedoms of Christian businesses and entities, and its stifling of the innovation and flexibility our health-care system needs. We now see the Obama administration unilaterally delaying parts of the law, Congress working to ensure members and their staffs are not burdened by the new rules, and concerns that Obamacare computer systems will be unready for the enrollment that starts in a few days. We continue to find "glitches," price shocks and other surprises throughout the legislation and its related rules (Pete Du Pont, 9/26). 

The New York Times: Could a Republican Health Care Reform Ever Happen?
But the first moment when a Republican Congress might actually be able to pass a health care overhaul won’t arrive until February of 2017, at which point Obamacare will have been the baseline for two years — the new taxes, the subsidies, the mandates, the higher premiums, the Medicare cuts, the Medicaid expansion, all of it. And at that point, the plausible right-of-center alternatives to Obamacare will no longer look risky and disruptive relative to the status quo, because that status quo will no longer be one that Republican interests and voters are deeply invested in defending. Instead, those interests and voters will be looking for ways to limit the health care law’s impact (Ross Douthat, 9/26). 

Los Angeles Times: Dr. Seuss Goes To Washington
Sen. Ted Cruz has egg on his face. Green egg. On Tuesday, during his 21-hour marathon "filibuster" against Obamacare, he read aloud to his daughters back home the Dr. Seuss book "Green Eggs and Ham." But he clearly missed its message. In the Seuss tale, Sam-I-Am, a lover of green eggs and ham, tries to persuade a friend to try them. But the man resists. He resists so persistently and so adamantly that he ends up sounding a lot like the Republicans on Capitol Hill who are determined to defund President Obama's healthcare law. But in the Seuss story, the man is finally persuaded to try the offending eggs and ham, and, much to his surprise, he loves them. If only the GOP would take a page from that book (Peter Dreier, 9/26).

Los Angeles Times: Debt Ceiling Baloney From Republicans
The GOP's price for raising the limit is major concessions by Democrats on spending, entitlements and the 2010 healthcare law. No matter what you think about those demands, it's irresponsible to take the debt ceiling hostage, especially when the automatic across-the-board sequester spending cuts enacted in 2011 are motivating both sides to seek a broad fiscal deal (9/25).

The New York Times: A Republican Ransom Note
We’ll refrain from deliberately sabotaging the global economy, Speaker John Boehner and the other leaders said, if President Obama allows more oil drilling on federal lands. And drops regulations on greenhouse gases. And builds the Keystone XL oil pipeline. And stops paying for the Consumer Financial Protection Bureau. And makes it harder to sue for medical malpractice. And, of course, halts health care reform for a year (9/26). 

The New York Times: Is Obamacare Working?
The Obama administration this week provided the first detailed look at premiums to be charged to consumers in federally run health insurance markets, established under the Affordable Care Act. With some states already rolling out the new exchanges, are we seeing that the law is worthwhile or a problem? (9/26).

Kansas City Star: Lieutenant Governors In Missouri, Kansas Agitated Over Obamacare
The rollout of the new insurance marketplaces, courtesy of Obamacare, has rattled Republican politicians like a disturbance in the jungle. The agitation seen in Washington is just the beginning (Barbara Shelly, 9/26).

Kansas City Star: Transform Medicaid To Help More Low-Income Missourians
A hearing in Jefferson City Thursday stood out as an encouraging show of pragmatism amidst all the last-gasp frenzy about repealing Obamacare. While Republican politicians in Washington blustered about getting rid of the law — which won’t happen — legislators and experts were seeking a way to make it work better in Missouri (9/26).

Philadelphia Inquirer: Obamacare Deserves Chance
Cruz maintains that he only wants to protect Americans from Obamacare, which he says is "hurting almost every sector of the economy." That's quite an accomplishment for a program that has yet to be implemented -- and which can be revised as needed after it's been cranked up. The dangerous steps toward a shutdown that Cruz and his cabal are willing to take, either now or when the debate turns to raising the debt ceiling, have more to do with enhancing their status among the tea-party faithful than with making health care affordable and accessible (9/25).

St. Paul Pioneer Press: Patient Incentives Needed To Bring Down Health Costs
The Affordable Care Act is going into operation, at least if conservative Republicans in the House fail to repeal it. Yet regardless of that or other changes in health financing, we will continue to struggle with rising costs of care itself. The act may boost some incentives for providers to do things at less expense. … But there still will be few incentives on the patient side. Until that changes, evermore high-tech treatments and an aging population are likely to drive spending upward at a faster rate than growth of the overall economy (Edward Lotterman, 9/25).

And on other issues -

Politico: Abortion Is A Winning Issue For Wendy Davis
Along with guns and gays, abortion has long been part of the Republican red-state arsenal. But as Texas Republicans abandon suburban women to court Tea Party voters, they create opportunities for Democrats whose abortion positions appear increasingly moderate. If [State Sen. Wendy] Davis can frame [Lt. Gov. Greg] Abbott’s extreme position as restricting abortion access, then Gov. Wendy Davis might not be such a crazy idea after all (Jason Stanford, 9/26).

Tampa Bay Times: For Mentally Ill, There Must Be A Better Way
An investigation will ultimately determine whether St. Petersburg Officer Damien Schmidt acted appropriately Monday night when he shot and killed an ax-wielding young man on a downtown sidewalk. But the death of Kenneth Robert Sprankle and three other mentally ill people recently killed in confrontations with St. Petersburg police should force a serious discussion in Tallahassee about spending more on mental health services. More treatment on the front end could save lives and taxpayer money (9/25).

The Wall Street Journal: Medical Education Needs Major Surgery
The U.S. medical education system is the finest in the world, yet it is very expensive and inefficient. ... The uncomfortable truth is that medical schools today provide a preclinical education that their students neither want nor need. Students hate live classroom lectures, especially for basic content, and they know they learn better [online] on their own time at their own pace. Yet schools still rely on these educational relics. A more individualized system of self-study using the latest in digital technology, along with small study groups to integrate knowledge, would provide more effective learning. It seems wasteful to pay 170 anatomy professors to design 170 separate courses and then bill students for this privilege (Jonathan David, 9/26).

Miami Herald: Fee Changes Take A Toll On Lab Testing Industry
As the head of a clinical laboratory specializing in cancer testing for more than 20,000 patients in south and central Florida, recently proposed efforts to reduce payments for critical diagnostic lab testing that Medicare cancer patients rely on to receive life-saving treatment are deeply troubling. ... proposed cuts to payments for vital cancer tests are so severe — nearly 75 percent in some cases — it would reduce payment to below the cost of laboratories to buy necessary materials to provide these services (Dan Vanoort, 9/25).

Journal of the American Medical Association: The Future of the Medicare Home Health Program
Most older Americans want to age in place. The Medicare home health benefit is a prominent national policy supporting older Americans at home and provides for visiting nurse and therapist services from home health agencies (HHAs). In 2012, Medicare spent $18.2 billion on HHAs; 3.5 million beneficiaries received care. Home health can help struggling patients get support in the community and can enable successful transitions home from institutional care. However, numerous concerns have been raised about the home health benefit, including fraud, geographic variation in utilization, and poor coordination with primary medical care. This uncertainty is untimely, as more than 70 million adults will join Medicare between 2011 and 2030 with the hope of receiving care at home. It is time to develop a stronger home health option (Dr. Steven Landers, 9/26).

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Stephanie Stapleton

Andrew Villegas

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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.