First Edition: October 4, 2013

Today's headlines include continued status reports on state and federal health exchanges as well as the ongoing Capitol Hill budget drama.

Kaiser Health News: Experts Suggest Software Problems, Not Just Demand, May Be Behind Marketplace Glitches
Kaiser Health News staff writers Jay Hancock and Phil Galewitz report: "Three insurance companies confirmed Thursday that they have enrolled customers through the federal online marketplace created by the health law, but the numbers were meager and signup frustration continued for many people" (Hancock and Galewitz, 10/4). Read the story.

Kaiser Health News: Insurance Brokers Look For Relevance As Health Exchanges Grow
Reporting for Kaiser Health News, Eric Whitney writes: "When states and the federal government rolled out online marketplaces to help people buy health insurance on Tuesday, you'd think that old-fashioned insurance brokers would be worried. All told about $200 million is being spent on a new army of people to help consumers find their way. These navigators, guides or assisters, as they're called, would seem to threaten the business of traditional brokers" (Whitney, 10/3). Read the story.

Kaiser Health News: A Former 'Young Invincible' Looks Forward to Health Insurance
Kaiser Health News staff writer Sarah Varney, working in collaboration with NPR, reports: "Have you heard of the young invincibles? That’s the name given to young people who think nothing bad can happen to them -- healthy people whose enrollment in Obamacare insurance is key to offsetting the costs of older, less healthy buyers. Brad Stevens is a 54-year-old, not-so-young invincible— recently reformed" (Varney, 10/3). Read the story.

The Washington Post: Government Continues Streamlining New Health Exchanges
Health insurers and individuals began reporting a trickle of enrollments in the new online marketplaces created by the health-care law, as federal and state officials scrambled to try to fix technical problems that have prevented many consumers from buying coverage. The White House has declined to release any national statistics on sign-ups, saying complete information was not yet available (Kliff, Somashekhar and Sun, 10/3).

The Washington Post: 'A Trickle, Not A Wave:' What Insurers Are Seeing In Obamacare Enrollment
Health insurers and individuals began reporting a trickle of enrollments in the new online marketplaces created by the health-care law, as federal and state officials scrambled to try to fix technical problems that have prevented many consumers from buying coverage. The White House has declined to release any national statistics on sign-ups, saying complete information was not yet available (Kliff, Somashekhar and Sun, 10/3).

The Wall Street Journal: Insurers See Enrollment On New Health Exchanges
Insurers said they are now getting enrollees through the health law's new online marketplaces, though some state websites and the federally run exchange continued to be slow amid heavy traffic (Weaver, 10/3).

The Wall Street Journal: Meet One Of The First Obamacare Enrollees
While millions of consumers stared down error messages on the online insurance marketplaces launched this week, some did make it through to shop the slate of coverage choices under the new federal health law. Leslie Foster, a 28-year-old freelance filmmaker in Hollywood, is among the first to sign up for an insurance plan (Weaver, 10/3).

Politico: Rare Health Exchange Enrollee Gets 15 Minutes Of Obamacare Fame
Chad Henderson, a college student who is one of the few people to have signed up for health insurance on a federal exchange, is having his 15 minutes of Obamacare fame. The 21-year-old Georgian and former Obama campaign volunteer hit "send" on his online health insurance when the exchanges opened Tuesday, and was catapulted quickly into the Obamacare spin wars (Cheney, 10/3).

Politico: Obamacare Has Time To Fix Exchanges – But Not Forever
In Week One, Obamacare health insurance exchanges have been so swamped with traffic that they have been groaning under the strain. That could be a good sign for a law that America supposedly hated — if the Obama administration can get the federal website bugs worked out before those potential customers get scared away (Nather, Norman and Millman, 10/3).

The Wall Street Journal's CIO Journal: Health Exchanges Ignore Lessons Of Consumerization
The online state health marketplaces that launched Tuesday to qualify and register applicants for health insurance are difficult to use, say IT experts. They say the sites’ goal of guiding applicants through a complex process is being defeated by poor navigation and pages cluttered with too much information. But a CIO who built one state marketplace says that design decisions were hampered by strict government guidelines on how information could be presented (Boulton, 10/3).

Los Angeles Times: California Health Insurance Exchange Still Lacks Doctor Search Tool
Several days into enrollment, California's insurance exchange still has no answers for people wanting to know if their doctors are included in health plans being sold on the state-run market. Covered California, the state's new insurance marketplace, said Thursday that its online search tool for doctors and hospitals won't be ready until Monday at the earliest (Terhune, 10/3).

The Associated Press/Washington Post: Maryland Health Care Website Improves After Technicians Find Cause Of Online Bottleneck
Maryland's online marketplace for health insurance is working better after technicians found the cause of a bottleneck that hampered efforts to create accounts online, the executive director of the Maryland Health Benefit Exchange said Thursday, but visitors to the website were still running into delays (10/3).

Los Angeles Times: Obamacare Meets Extra Resistance In Oklahoma
The nation's healthcare law was written with the residents of rural counties like Choctaw in mind. A quarter of the Oklahomans who live in the ranch country near the southeastern corner of the state are uninsured, one of many reasons their health ranks near the bottom of Oklahoma's 77 counties. But that does not mean people here want Obamacare (Reston, 10/3).

The Associated Press/Washington Post: Legislative Budget Writers In Delaware Discuss Medicaid Spending, Other Big Expenditures
Budget writers from Delaware's legislature met Thursday to consider how to curb spending on the state’s Medicaid program, which is costing state taxpayers about $700 million a year. State Medicaid director Stephen Groff briefed members of the Joint Finance Committee on how the subsidized health care program for the poor and disabled operates and outlined some of the biggest cost drivers, including a 40 percent increase in enrollment over the past five years (10/3).

The Washington Post: Virginia Medicaid Panel Member Calls 'Obamacare' Expansion Unlikely In Near Term
The vice chairman of a panel exploring Medicaid reform and expansion in Virginia told fellow House Republicans this week that the program is unlikely to be broadened anytime soon. It could take months, if not years, to determine if the federal-state health-care program has been sufficiently reformed to merit expansion, Del. Steve Landes (R-Augusta) said in a confidential memo to his caucus. A copy of the memo was obtained by The Washington Post (Vozzella, 10/3).

The New York Times: Majority Disapprove Of Shutting Down Government Over Health Law
A wide majority of Americans disapprove of shutting down the federal government over differences about the 2010 health care law, including a majority of those who oppose the law, according to the latest CBS News poll. Americans are also overwhelmingly dissatisfied, and increasingly angry, with the way things are going in Washington. More than 4 in 10 now say they are angry, up 13 percentage points since March (Sussman, 10/3).

The Wall Street Journal: GOP Group Urges Detente On Health Law
A small but increasingly vocal coalition of Republican lawmakers is urging the party's top brass to stop trying to dismantle the entire health-care law, believing the fight is a losing one for their party. On Thursday the group proposed a narrower approach: repeal the health law's medical-device tax and restore funding for federal agencies for the next six months (Peterson, 10/3).

The Associated Press/Washington Post: Analysis: In Quest To Scuttle Obama's Health Care Overhaul, GOP Gets Unintended Result
Republicans insisted they wanted to shut down the nation's 3-year-old health care overhaul, not the government. They got the opposite, and now struggle to convince the public that responsibility for partial closure of the federal establishment lies with President Barack Obama and the Democrats. There's ample evidence otherwise, beginning with Speaker John Boehner's refusal to permit the House to vote on Senate-passed legislation devoted solely to reopening the government (10/3).

Los Angeles Times: As Government Shutdown Persists, Focus Shifts To Debt Limit
With the federal government shutdown in its third day, both sides of the dispute that started with a Republican drive to end Obamacare shifted their focus Thursday to the next fiscal deadline: the need to raise the debt limit by mid-October to avoid a default (Mascaro and Memoli, 10/3).

The Washington Post: GOP Aides: Boehner Tells Colleagues He Will Avoid A Default On Federal Debt
With the government shuttered and a deadline for raising the debt limit just two weeks off, anxious Republicans began steering the party away from a dead-end debate about the health-care law and toward discussion of a broader deal to reduce the nation's debt. … In meetings with small groups of rank-and-file lawmakers, House Speaker John A. Boehner (R-Ohio) has emphasized that he will not permit the country to default for the first time on its debt. Given that a bloc of hard-line conservatives is unlikely to vote to increase the limit under any circumstances, Boehner has told fellow Republicans that they must craft an agreement that can attract significant Democratic support (Montgomery and O'Keefe, 10/3).

The Wall Street Journal: GOP Begins Search For Broad Deal On Budget
Senior Republicans in Congress, frustrated over their inability to strike a deal to reopen the government, began shifting from their drive to undercut the 2010 health-care law, which has been the central element of the dispute, toward a broader budget deal. Unlike the summer 2011 debt-ceiling debacle, President Obama and his administration appear to be pushing for market unrest, with the hope that it will spur Republicans to end the current budget standoff. The new focus comes as Congress is beginning to confront the need to raise the U.S. debt ceiling, which the Treasury said must be done this month in order to pay the nation's obligations (Hook and O'Conner, 10/3).

Politico: Government Shutdown: Democrats Preempt Entitlement Change Talk
Liberal Democrats are already railing against the notion that entitlement programs could be scaled back as part of any grand bargain to end the government shutdown and hike the debt ceiling. At a press conference of the Congressional Progressive Caucus led by Rep. Keith Ellison (D-Minn.), the group said they aren’t waiting to see if the murmurs that it’s a possibility become reality (Gibson, 10/3).

The New York Times: G.O.P. Elders See Liabilities In Shutdown
The hard-line stance of Republican House members on the government shutdown is generating increasing anger among senior Republican officials, who say the small bloc of conservatives is undermining the party and helping President Obama just as the American people appeared to be losing confidence in him. From statehouses to Capitol Hill, frustration is building and spilling out during closed-door meetings as Republicans press leaders of the effort to block funding for the health care law to explain where their strategy is ultimately leading (Martin, 10/3).

The New York Times: Rattled Congress Seeks Way Out Of Its Standoff
Representative Paul D. Ryan of Wisconsin, chairman of the House Budget Committee, has initiated conversations with senior House Republicans on a broad deficit reduction deal that would allow some increases to federal programs squeezed by the automatic cuts known as sequestration in exchange for long-term changes to programs like Medicare and Social Security. The package would most likely include instructions to try to move along efforts to simplify the tax code as well. Aides described those talks as "conversations about conversations," not true negotiations, and they favored the term “down payment” on the deficit over "grand bargain" (Weisman, 10/3).

The Associated Press/Washington Post: Cuccinelli Finally Urges Congress To Restart Government, Then Strangle Health Law Separately
After days of equivocation, Republican gubernatorial nominee Ken Cuccinelli on Thursday called on Congress to reopen the federal government, then fight over whether to starve the new health care law of funding. Cuccinelli told reporters after a Thursday-morning event that shuttering the government is not the right way for opponents of the 2010 Affordable Care Act to gain leverage to defeat the law he wants to see repealed (10/3).

The Washington Post: Shutdown Will Halt D.C. Medicaid Payments
The federal shutdown will mean another setback for a beleaguered group: D.C. medical providers, particularly those serving low-income residents. The federal government shutdown means payments related to publicly funded health programs will cease until further notice, city health care finance officials said Thursday. That includes payments made directly to health providers, as well as the massive "capitated" payments made to the managed-care organizations that handle most city Medicaid enrollees (DeBonis, 10/3).

The Wall Street Journal's Washington Wire: Shutdown To Stop D.C. Medicaid Payments
The District of Columbia's Medicaid program, which covers around 220,000 low-income and disabled city residents, said Thursday it is stopping paying health providers until the federal government shutdown is resolved. Many D.C. government services such as trash pick-up have continued to run because the city is drawing on a $144 million contingency fund to pay for them in the absence of being able to use its 2014 budget, hamstrung by the budget showdown (Radnofsky, 10/3).

Politico: Wendy Davis Launches Bid For Texas Governor
Wendy Davis, the Democratic state senator whose abortion filibuster catapulted her to national fame, announced Thursday that she will run for Texas governor, a race that looks to be a banner 2014 contest (Glueck, 10/4).

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