First Edition: October 1, 2013

Today's headlines detail how the federal government has been shutdown as a result of the ongoing congressional battle over the health law. Still, even as House and Senate lawmakers were unable to overcome this issue to reach a deal to provide funding to continue government operations, Oct. 1 is still the official launch of the overhaul's online insurance marketplaces.

Kaiser Health News: Millions Previously Denied Insurance Coverage Because Of Health Problems Look To Online Marketplaces
Kaiser Health News staff writer Phil Galewitz, working in collaboration with McClatchy, reports: "Denise Marshall of Sonoma, Calif., was diagnosed with non-Hodgkin lymphoma in 2011 and a year later, lost her toy company job along with her health insurance benefits. The good news is that her disease was caught early and she is now in remission. The bad news was her cancer diagnosis made it impossible to buy coverage because insurers thought she was too high a health risk. Marshall, 55, is one of millions of Americans with pre-existing health conditions who have been shut out from buying coverage on the individual insurance market. But under the Affordable Care Act., starting Jan. 1 insurers can no longer reject people, charge them more or restrict their benefits because of their health status" (Galewitz, 9/30). Read the story.

Kaiser Health News: Insuring Your Health: Start Your Exchange Shopping Early, But Don't Rush To Buy
Kaiser Health News consumer columnist Michelle Andrews reports: "In recent months, all eyes have been focused on today, the day health insurance marketplaces open for business. While the date is a milestone in the implementation of the health law, other dates are likely more critical for consumers planning to shop for health insurance on their state marketplace" (Andrews, 9/30). Read the story.

Kaiser Health News: Options For Young Adults: Stay On The Folks' Plan, Move To The Marketplace Or Go Without
Reporting for Kaiser Health News in collaboration with NBC News, Michelle Andrews writes: "In 2014, options for young adults, many of whom either aren't offered health insurance at their jobs or can't afford it, will expand again with the opening of the state health insurance marketplaces and the expansion of the Medicaid program to low-income adults in many states. Here's what to look for" (Andrews, 10/1). Read the story.

Kaiser Health News: Capsules: Marketplace Shoppers Must Pay 1st Premium By Dec. 15; Answers To Your Online Health Insurance Exchanges Questions
Now on Kaiser Health News' blog, Phil Galewitz reports on when the first premium payments will be due for new coverage purchased on the exchange: "When consumers start shopping for coverage through new federally run health insurance exchanges on Tuesday, they will be asked dozens of questions before they are shown what health plans are available and how much they cost. Then, to finalize their enrollment, they must contact the private insurer and pay their first monthly premium. If enrollees don’t pay their insurer by Dec. 15, they will not have coverage that takes effect Jan. 1, federal health officials said Monday.  If they miss that first deadline, however, open enrollment runs through March 2014" (Galewitz, 9/30).

Also on the blog, you can watch Galewitz Monday  on C-SPAN's Washington Journal taking questions about the launch of the health law's online health insurance exchanges (9/30). Check out what else is on the blog.

Kaiser Health News also provides a resource page designed to help you navigate your way around what the new health law will mean for you, your family and what health care -- and insurance -- will cost you.

Los Angeles Times: Government Shutdown: House Seeks Conference With Senate
An hour after the federal government began shutting down, House Republicans approved a last-ditch effort early Tuesday seeking to set up a committee with the Senate to resolve their monumental differences over Obamacare. … Although Democratic leaders said they would be willing to work with the House to resolve the differences, they said they would only agree to form a committee after the House approved a government funding bill that was not linked to stopping the president’s healthcare law (Mascaro and Memoli, 9/30).

The New York Times: Government Shutting Down In Impasse
A flurry of last-minute moves by the House, Senate and White House late Monday failed to break a bitter budget standoff over President Obama’s health care law, setting in motion the first government shutdown in nearly two decades. … In the hours leading up to the deadline, House Republican leaders won approval, in a vote of 228 to 201, of a new plan to tie further government spending to a one-year delay in a requirement that individuals buy health insurance. The House proposal would deny federal subsidies to members of Congress, Capitol Hill staff, executive branch political appointees, White House staff, and the president and vice president, who would be forced to buy their health coverage on the Affordable Care Act’s new insurance exchanges. But 57 minutes later, and with almost no debate, the Senate killed the House health care provisions and sent the stopgap spending bill right back, free of policy prescriptions (Weisman and Peters, 9/30).

Los Angeles Times: With Congress At Impasse, Government Starts Shutting Down
The official word to shut down came from the White House just before midnight Monday. Hours earlier, the Senate, by a 54-46 party-line vote, killed a House measure that would have funded government agencies for six weeks but delayed key parts of Obamacare for a year. It was the second such vote that the Senate took during a day in which the two chambers exchanged volleys of legislation with little expectation that any of it would become law (Mascaro and Memoli, 9/30).

The Wall Street Journal: Government Shuts Down As Congress Misses Deadline
On Capitol Hill, a day of rapid-fire legislative maneuvering between Senate Democrats and House Republicans over the terms of a short-term spending bill collapsed late Monday. House Republicans said they planned to appoint a set of negotiators to work out a budget resolution with a small group with senators. But the GOP move came with no concessions on the party's central demand—that Democrats agree to scale back the new federal health law—and it brought lawmakers no closer to reaching a budget deal (Hook and Peterson, 10/1).

The Associated Press/Washington Post: Long-Running Feud Over Obama Health Care Law Plunges Nation Into Government Shutdown
The health care law itself was unaffected as enrollment opened Tuesday for millions of people shopping for medical insurance (10/1).

Los Angeles Times: Government Shutdown: Obama Calls House GOP Irresponsible
Speaking for several minutes without taking questions, the president outlined the functions that would continue in a shutdown – including Social Security, Medicare, national security and public safety – and those that would be curtailed, including national parks, NASA, federal lending programs and recovery efforts helping victims of Superstorm Sandy. Obama said the impact would be a setback to a recovering economy. … The president also noted that, despite Republican efforts to kill his healthcare law, the online insurance marketplaces will roll out Tuesday as scheduled. "The Affordable Care Act is moving forward. That funding is already in place. You can't shut it down," he said (Hennessey, 9/30).

USA Today: Obama: A Shutdown, A Health Care Law
President Obama spends the first day of a partial government shutdown talking about the issue at the heart of the dispute: The new health care law. At mid-day, Obama will meet with Americans who are signing up for new health care exchanges that are available today. "The President will meet with Americans who will benefit from the opening of Health Insurance Marketplaces and being able to comparison shop for the health plans as a result of the Affordable Care Act," says the White House schedule (Jackson, 10/1).

Los Angeles Times: Full Steam Ahead For Obama Healthcare Law
Three and a half years after President Obama signed his landmark healthcare law, his administration made its final preparations Monday to begin enrolling millions of Americans in health insurance amid persistent anxiety over possible technical problems and intense opposition from Republican critics. Administration officials emphasized that a government shutdown would not prevent the federal website for enrolling in health coverage — http://www.healthcare.gov — from going live at 8 a.m Eastern time Tuesday, allowing consumers to begin signing up for plans (Levey, 9/30).

The Washington Post: As Government Shuts Down, Obamacare Moves Forward
The day has arrived when millions of uninsured Americans have their first chance to sign up for what the administration says will be high-quality, affordable health coverage. That achievement is something presidents of both parties sought unsuccessfully for more than 60 years. The coming months and years will show whether the new health-care law, commonly known as Obama¬care, lives up to its aspirations. Those who sign up now, for instance, will not begin to receive benefits until January (Tumulty, 10/1).

The Wall Street Journal: Health Exchanges Open For Business
New marketplaces meant to steer millions of uninsured Americans to health insurance under President Barack Obama's signature health-care law open for business today. After a weeks long scramble by state and federal officials to iron out technical wrinkles and position thousands of outreach workers, the marketplaces are set to launch, warts and all, giving the public a first taste of the health law's core provisions (Weaver, 10/1).

The Wall Street Journal: Muted Rollout For Much-Changed Health-Care Law
It's Oct. 1 and the Affordable Care Act is finally getting its rollout, but President Barack Obama's health-care law looks a lot different from the one he signed 31/2 years ago. Thanks to a Supreme Court ruling, about half the states aren't participating in a Medicaid expansion that was a core part of the legislation. The federal government is running the bulk of new marketplaces for health insurance, not the states as originally envisioned. And some of the key provisions are delayed, including one that makes larger businesses pay a fine if they don't offer coverage (Radnofsky, 9/30).

Politico: Obama: Expect Months Of 'Glitches'
President Barack Obama on Monday said he "absolutely" expects glitches and problems with Obamacare as enrollment kicks off Tuesday. But even with the inevitable complications and issues that accompany the new health insurance exchanges, the president told NPR News he is "confident" the law will offer "the prospect that any American out there who does not currently have health insurance can get high-quality health insurance" (Weinger, 10/1).

The Wall Street Journal's Washington Wire: Agencies Set To Implement Health Law, Shutdown Or No
A Department of Health and Human Services memo says staffers helping to get the Affordable Care Act off the ground won't be furloughed along with other federal workers. That includes employees who are helping with "coordination between Medicaid and the Marketplace, as well as insurance rate reviews," according to the memo. Although Congress is fighting about funding for the law known as Obamacare, a government shutdown wouldn't actually stop the law from being implemented Tuesday. That's because the principal funding for the Affordable Care Act comes from mandatory spending rather than a short-term extension to discretionary spending that Congress is considering now (Schatz, 9/30).

The Associated Press/Washington Post: Health Insurance Marketplaces Open For Coverage, But Their Success Remains Far From Assured
Millions of Americans will be able to shop for the first time Tuesday on the insurance marketplaces that are at the heart of President Barack Obama's health care reforms, entering a world that is supposed to simplify the mysteries of health coverage but could end up making it even more confusing, at least initially. Whether consumers will be pleased with the experience, the premiums and the out-of-pocket costs of the plans offered to them will finally start to become clear. Tuesday's rollout comes after months of buildup in which the marketplaces, also known as exchanges, have been both praised and vilified (10/1).

The Washington Post: White House Shows Off Web Site to Buy Health Insurance Under Obamacare
The Obama administration on Monday showed off the federal Web site, Healthcare.gov, where millions of Americans starting Tuesday will be able to buy coverage under President Obama's health-care law, promising it will be open for business despite congressional battling and widespread reports of computer problems. People seeking to buy health insurance on the federal marketplace will be able to enter personal information, including their incomes and Social Security numbers; learn how much government assistance they might qualify for, if any; search for plans by price and coverage level; and then purchase a plan directly from the insurance company (Somashekhar and Sun, 9/30).

USA Today: HHS Puts Final Touches On Exchange Sites Before Launch
Starting at 8 a.m., visitors to healthcare.gov, the federal government's health care website, will be able to navigate how to shop for and buy health insurance as part of the law, Sebelius said. … The stakes for the health exchanges are high, and there have been some stumbles on the way. In July, the administration acceded to the wishes of business groups and delayed the requirement that employers with more than 50 workers provide health insurance to their employee or pay a fine. Businesses had complained the tax and insurance requirements were too complicated and difficult to implement in time for the Jan. 1. Deadline (Kennedy, 10/1).

The Associated Press/Washington Post: Consumers Will Need Personal Details, Financial Info, Basic Insurance Knowledge To Get Covered
Getting covered under President Barack Obama’s health care law might take you more than one sitting. In a media preview, it felt like a cross between doing your taxes and making an important purchase that requires research. "Nothing like this has ever existed before," said Health and Human Services Secretary Kathleen Sebelius (10/1).

Politico: Poll: Most Will Get Health Insurance
Asked whether they plan to get insurance when the requirement takes effect or pay the fine for not doing so, 65 percent of uninsured Americans said they would get health insurance, according to a Gallup poll out Monday. Twenty-five percent said they would pay the fine. Gallup also asked about the whether those individuals planned to use the exchange markets that launch Tuesday to buy their insurance. Almost half, 48 percent, said they planned to use the exchanges, 36 said they did not and 17 percent weren’t sure (Kopan, 9/30).

The New York Times: House To Add Measure Cutting Health Subsidy For Congress
Conservative activists have framed the language as ensuring that Congress and the White House live under the same strictures as ordinary Americans under the health care law. In fact, the language would put poorly paid junior staff members at a disadvantage. Most people purchasing coverage on the exchanges will be subsidized by generous tax credits. Most Americans will still get their insurance from their employers who will remain subsidized by a tax deduction for the cost of that care (Weisman, 9/30).

The Associated Press/Washington Post: House GOP Conditioned Keeping Government Open To Making Lawmakers Pay More For Health Care
About 18,000 people — including members of Congress, all their aides, presidential appointees and even the president and vice president — would lose the employer-provided health insurance under a condition that Republicans proposed for averting a government shutdown. The Democratic-controlled Senate rejected the measure Monday night, an hour after the House passed it (10/1).

The Wall Street Journal: One GOP Demand On Health Law Hits Lawmakers' Coverage
The latest Republican demand for keeping the government running doesn't dismantle the president's health-care law. Instead, it exposes lawmakers, their aides and White House staff to the law in a way designed to maximize the pain. The proposal, similar to one backed in the Senate by Sen. David Vitter of Louisiana, would limit federal health-care contributions to lawmakers, staff and to some White House officials, making their coverage more expensive (Peterson, 9/30).

The Washington Post: Administration Moves To Limit, But Not  End, Health Insurance Subsidy For Congress
Members of Congress and their staff who will have to get their health insurance through the Affordable Care Act would continue to receive a government contribution toward premiums next year but only if they enroll in a specific ACA plan, under a revised Obama administration policy unveiled Monday. The policy was issued as House Republican leaders floated a plan, as part of the maneuvering over the budgetary deadlock, to end that contribution for Congress and certain employees who will be forced out of their current health program (Yoder, 9/30).

NPR: How A Tax On Medical Devices United Political Rivals
As the federal government lurches toward a shutdown, there's one thing a lot of people in Congress actually agree on. A 2.3 percent excise tax on medical devices that took effect at the beginning of 2013 should be undone, they say. House Republicans included a provision to do that in a funding bill passed over the weekend that also sought a one-year delay in the implementation of the Affordable Care Act (Hensley, 9/30).

NPR: Lessons For The Obamacare Rollout, Courtesy Of Massachusetts
Today marks a milestone on the nation's long march toward universal health coverage – the launch of online marketplaces, called exchanges, designed to help people find health insurance they can afford (Knox, 10/1).

The New York Times: Federal Official at Center Of The Health Care Tumult Has Gone Against The Grain
The federal official in charge of health insurance shopping malls, which open Tuesday under President Obama’s health care law, has been challenging conventional wisdom since he came to Washington from California three and a half years ago. The official, Gary M. Cohen, is at the center of the furor over the health care law. As director of the Center for Consumer Information and Insurance Oversight, he enforces the provisions of the Affordable Care Act that affect insurance companies. He supervises the new insurance marketplaces, or exchanges, including more than 30 that will be run by the federal government (Pear, 9/30).

The Wall Street Journal: Government Shutdown Is Defining Moment For Boehner
Since January, Mr. Boehner has strained to steer clear of either a shutdown or a debt-ceiling crisis for which his party might be blamed, from reshuffling the legislative calendar to scheduling more than 40 votes to repeal or rework the health law, a move designed to give his members ample opportunity to voice their displeasure with the law. In the end, the impasse resulted as much from the internal dynamics of Mr. Boehner's GOP caucus as it did from the partisan divisions in the country as a whole and the chasm between Democrats and Republicans about basic tax-and-spending policies. After months of jockeying, Mr. Boehner heeded the calls from his most conservative colleagues by refusing to give in on requesting health-law changes (O’Connor, 10/1).

NPR: A Doctor's 9 Predictions About The 'Obamacare Era'
Debate is raging about Obamacare, and not just in Washington. Out here in Oklahoma we're grappling with implementation of the Affordable Care Act. Patients. Employers. Hospitals. Doctors. Insurers. All of us. Here then are one doctor's predictions about what we will see in the short and medium term for what I see as the unfolding Obamacare era — the biggest domestic health expansion since the enactment of Medicare in 1965 (Schumann, 9/30).

The Wall Street Journal: Health-Care Overhaul Pushes Small Firms To Lock In Lower Rates
With major provisions of the federal health overhaul set to take effect Jan. 1, many U.S. insurers are prodding small-business customers to renew their current coverage early, to lock in lower rates. "With all of the changes coming up in 2014, we want to provide you with options that allow you to make the right decision for you and your employees," said a recent letter from one major insurer, Blue Shield of California, which has made the pitch to all of its small-business customers, who can keep their 2013 rates if they act to renew existing plans by Oct. 14 (Simon, 9/30).

Politico: Stakeholders Will Be Spending Big On 2014 ACA Ads
If you think you’re seeing a lot of Obamacare ads right now, just wait until 2014. No other piece of legislation has engendered such massive ad efforts as the Affordable Care Act, say marketing experts. They expect television ad spending to double in the next year and a half as people start to enroll for coverage and the health law remains a top political issue in House, Senate and gubernatorial races in 2014 (Cunningham, 10/1).

The New York Times: Online Map Helps New Yorkers Understand Federal Health Law Benefits
More than one million New Yorkers are expected to gain coverage under the federal health care law, according to estimates from the New York State Health Foundation. On Monday, the foundation unveiled an online map, where people will be able to view estimates by region of how many people are expected to be covered under Medicaid and how many will get private insurance – as well as how many are likely to remain uninsured (Abelson, 9/30).

The Associated Press/Wall Street Journal: NYC's Plan To Get Health Insurance Bids On Hold
New York City's plan to solicit bids for health insurance for hundreds of thousands of workers has been put on hold. A Manhattan judge on Monday granted a preliminary injunction preventing the City from issuing the bids. A group of unions sued the city Aug. 10, shortly after Mayor Michael Bloomberg said the city was planning to seek bids within days. Bloomberg said the request for proposals will look to save up to $400 million a year (10/1).

Los Angeles Times: L.A. Sues To Block Vote That Could Force Separate Health Departments
The city of Los Angeles filed a lawsuit Monday to halt a ballot measure that would require the city to start its own health department separate from the county's. AIDS Healthcare Foundation, a major provider of HIV testing and treatment services for Los Angeles County's health department that also frequently butts heads with county leadership, led the charge to get the city measure on the June 2014 ballot (Sewell and Mehta, 9/30).

The Associated Press/Wall Street Journal: Dartmouth-Founded Health Collaborative Grows
Four more health systems have joined a data-sharing project at improving health care and lowering costs that was started by New Hampshire's Dartmouth-Hitchcock health system and other partners three years ago (9/30).  

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