First Edition: October 23, 2013

Today's headlines include continuing coverage about the problems with the healthcare.gov website, how Health and Human Services Secretary Kathleen Sebelius is in the hot seat and how the White House has called in reinforcements -- a glitch czar.

Kaiser Health News: Online Insurance Brokers Stymied Selling Obamacare Policies
Reporting for Kaiser Health News, in partnership with NPR, Eric Whitney reports: "Consumers aren't the only ones frustrated by problems with the online health insurance exchanges being run by the feds. Private companies that sell health insurance on the Internet are also in a bind. Websites like eHealthInsurance.com that were planning to start selling new, subsidized Obamacare policies on Oct. 1 still can't offer them to customers" (Whitney, 10/22). Read the story.

Kaiser Health News: Oregon Experiment Puts Therapists On Primary Care Teams
Oregon Public Broadcasting’s Kristian Foden-Vencil, working in partnership with Kaiser Health News and NPR, reports: "The state of Oregon is trying some experiments to bring different kinds of medical professionals under the same roof. Medicaid patients can see different kind of doctors in one visit, and the hope is it will provide better patient care, eventually at less cost to the state. This can make sense in a primary care setting, where doctors often have to deal with stomach aches and migraines that end up stemming from mental, rather than physical, problems" (Foden-Vencil, 10/22). Read the story.

Kaiser Health News: Capsules: In Some States, Most Early Marketplace Enrollees Qualify For Medicaid
Now on Kaiser Health News’ blog, Phil Galewitz reports: "Many of the uninsured are poor, and applicants don’t have to pay anything to sign up for Medicaid. Shoppers applying for private health coverage through the marketplace have to pay their first monthly premium before they are fully enrolled. Their first payment must be made by Dec. 15 for coverage to take effect Jan. 1. Most are expected to be eligible for some tax credits, up front, to help pay the monthly premiums" (Galewitz, 10/22). Check out what else is on the blog.

The New York Times: Sebelius Thrust Into Firestorm On Exchanges
Republicans insist the buck stops with the secretary. But although Ms. Sebelius runs the Department of Health and Human Services, the agency directly responsible for the health care law, there are questions about how deeply she was involved in the development of the troubled Web site (Stolberg, 10/22).

Politico: Upton Previews Sebelius 'Grilling'
The chairman of the House committee that plans to take testimony from Obamacare tech contractors Thursday previewed his questions today in an interview with a local radio station. "When did they know that it was going to be so poorly run? What answers do they have? Did they alert the administration that there were troubles early on?” said House Energy and Commerce Committee Chairman Fred Upton (R-Mich.) on Detroit’s WJR Radio. “There’s going to be a ton of questions for them, and we’ll see how they respond" (Cheney, 10/22).

Politico: Marilyn Tavenner To Testify On Hill Next Week
The Obamacare grilling on Capitol Hill will continue. Marilyn Tavenner, administrator of the Centers for Medicare & Medicaid Services, will testify in front of the House Ways and Means Committee on Tuesday, Oct. 29, on implementation of the health law, POLITICO has learned (Haberkorn, 10/22).

Politico: Kathleen Sebelius: ACA Delay Wasn't An Option
Health and Human Services Secretary Kathleen Sebelius said delaying the launch of the insurance exchanges was "not really an option" — even though those building the federal website knew about major problems days in advance. "There are people in this country who have waited decades for affordable health coverage, people who are so eager for this to happen," Sebelius told CNN’s Sanjay Gupta on Tuesday night. "Waiting is not really an option" (Cunningham, 10/22).

The Wall Street Journal's Washington Wire: Sebelius: 'We Didn't Have Five Years' to Keep Testing Site
Health and Human Services Secretary Kathleen Sebelius said Tuesday that under ideal circumstances, the administration would have had more time to develop and test the online health-insurance marketplace that has been tripped up by technical troubles (Nelson, 10/22).

Politico: Why Kathleen Sebelius Is Safe
Kathleen Sebelius may be irreplaceable — in that she cannot be replaced. Not because President Barack Obama wouldn’t be able to find someone else to do the job, or that anyone’s too pleased with the launch of the Obamacare website. But the White House and Democrats on the Hill know a potential confirmation fight would be so torturous and difficult that they’re better off sticking with the Health and Human Services secretary they’ve got, despite all that’s gone wrong on her watch (Dovere, 10/23).

The Washington Post: Senior HHS Official To Brief Democratic Lawmakers Wednesday On Obamacare
Mike Hash, who directs the Office of Health reform at the Department of Health and Human Services, will brief House Democrats Wednesday about implementation of the Affordable Care Act. The closed-door session, which will start at 8:50 a.m., marks the first time the administration will have briefed members of Congress on the online enrollment system since its troubled rollout on Oct. 1 (Eilperin, 10/22).

Politico: House GOP Want Obamacare Briefing
House Democrats are set to be briefed on Obamacare implementation on Wednesday morning, but Republicans say they haven't been offered the same opportunity and are asking for a similar meeting in the days to come (Epstein, 10/22).

The New York Times: Sebelius Names Administration Veteran To Lead Tech Repair Efforts
The Obama administration did not look far for someone to lead the so-called tech surge to fix its troubled health insurance Web site: Jeffrey D. Zients, a management trouble-shooter already in line to take over as the chief White House economic adviser on Jan. 1, until then will manage the effort to resolve the technical failures (Calmes, 10/22).

Los Angeles Times: White House Brings In Help To Fix Healthcare Website
A familiar troubleshooter has been enlisted to try to fix the government's health insurance website, administration officials said Tuesday, as political pressure piled up over the centerpiece of President Obama's healthcare law. Jeffrey Zients, a former acting director at the Office of Management and Budget, will assist the Department of Health and Human Services with "short-term advice, assessments and recommendations," White House spokesman Jay Carney said. Zients has served as the chief performance officer at OMB, a job aimed at improving government technology and efficiency (Hennessey, 10/22).

The Associated Press/Washington Post: Who Ya Gonna Call? Obama Calls Trusted Fixer To Work On Health Care Site’s Embarrassing Woes
When a federal program that promised cash rebates to people who traded in their clunkers for more fuel-efficient vehicles was overrun by demand, President Barack Obama assigned Jeffrey Zients, his deputy budget director, to help eliminate the backlog. When the same thing happened with sign-ups for an updated version of the GI Bill, one designed to help the 9/11 generation of veterans get a college education, Obama again turned to Zients for help (10/22).

The Wall Street Journal: Obama Turns To Fix-It Aide For Health Site
The move—the first shakeup of top personnel since the troubled rollout Oct. 1 of the federal government's HealthCare.gov website—comes a day after President Barack Obama acknowledged the site's poor functioning and said "nobody's madder than me" about it. Mr. Zients, who previously served as acting director of the Office of Management and Budget, will face a steep challenge in fixing the federally run marketplace, which is designed to offer health-insurance choices to those who can't get coverage from their employer or a government program in 36 states that have declined to run their own exchanges. The government has addressed some problems, including a technical flaw that had blocked most people from viewing their options, but others have emerged (Nelson and Radnofsky, 10/22).

USA Today: Health Care Website Problems Jeopardize Obama's Legacy
As his administration scrambles to fix the online enrollment process under the Affordable Care Act, President Obama is facing a challenge that threatens to undercut the most significant legislative victory of his presidency. The difficulty of the situation, and the pressing need to find a solution, was underscored on Tuesday when the White House announced that Obama has tapped Jeffrey Zients, a former deputy White House budget director who has helped the president fix other troubled government programs, to lead the embattled Department of Health and Human Services' effort to repair the online exchange (Madhani, 10/22).

The Washington Post: Two Key Parts Of Online Health Insurance Exchange Will Take Longer To Fix Than Expected
The Obama administration acknowledged Tuesday that two key parts of its online health insurance marketplace will take longer than expected to fix, even as it brought back a former senior White House official to help diagnose and correct the Web site’s flaws. A senior health official said that the insurance exchange, HealthCare.gov, is still unable to perform one of its basic functions: making it easy for low-income Americans to enroll in Medicaid electronically. Days before the exchange opened three weeks ago, the administration said that feature was not ready but would be available by Nov. 1, at the latest (Eilperin and Goldstein, 10/22).

Politico: Poll: 12% Say Obamacare Rollout 'Going Well'
Following the troubled rollout of the website behind Obamacare, very few Americans said the launch is going well, according to a new poll out Tuesday. Only 12 percent said the enrollment process on Healthcare.gov is going well, the CBS survey shows. Almost half of Americans say it isn’t and 38 percent say they can’t evaluate (McCalmont, 10/22).

Los Angeles Times: Lack Of Quality Ratings On Covered California Site Is Criticized
California's insurance exchange came under fire for its plan to withhold quality ratings of health plans until late 2015 while thousands of consumers shop for coverage under the federal healthcare law. The state exchange, Covered California, said Tuesday that it had reliable ratings on only four of the 12 participating health insurers primarily because their networks of doctors and hospitals have changed so much for new policies available next year (Terhune, 10/22).

Los Angeles Times: Selling Healthcare: Colorado Uses Beer Kegs, Golf Clubs And Bros
Most of the sales pitches being made for the new national healthcare plan have been along the lines of California’s earnest effort, using pictures of cherubic children in toy cars with taglines like "Preexisting conditions won’t stop your kids anymore." Not so everywhere (Decker, 10/22).

NPR: States' Refusal To Expand Medicaid May Leave Millions Uninsured
President Obama Tuesday appointed one of his top management gurus, Jeffrey Zeints, to head the team working to fix what ails Healthcare.gov, the troubled website that's supposed to allow residents of 36 states enroll in coverage under the Affordable Care Act. But even if the team gets the website working as it should, millions of Americans may still log on to discover that they aren't eligible for any health coverage at all. And that won't be due to any technical glitch. It's because their state has decided not to expand its Medicaid program (Rovner, 10/23).

The New York Times: Judge Allows Legal Challenge Of Law To Continue
A federal judge cleared the way on Tuesday for consumers to challenge President Obama’s health care law on the grounds that the federal government cannot legally provide subsidies to people who buy insurance through the exchange run by it. The judge, Paul L. Friedman, of Federal District Court here, said that four individuals could pursue their lawsuit challenging the Obama administration’s interpretation of a provision of the law that defines who is eligible for subsidies (Pear, 10/22).

The Wall Street Journal: Judge Allows Suit Challenging Health-Law Subsidies
The mixed ruling means the Obama administration will have to mount a full defense of the law's subsidy provisions in a Washington, D.C., federal court. Challengers had sought a preliminary injunction to block subsidies immediately for those who buy health insurance through federally run online exchanges. Such an injunction could have dealt a considerable blow to the administration at a sensitive time, as U.S. officials continue to fight technical difficulties with a federally run website (Kendall, 10/22).

Politico: Challenge To Affordable Care Act Subsidies Advances
D.C. District Judge Paul Friedman has allowed a case challenging the federal government’s authority to give out premium subsidies on the federal exchanges to go ahead but has denied a request for a preliminary injunction to block the subsidies from flowing. Friedman denied on standing grounds the government’s motion to dismiss the case, saying that four individual plaintiffs in Halbig v. Sebelius have standing to sue over the IRS rule allowing insurance subsidies to be awarded (Cunningham, 10/23).

Politico: Obamacare Site could Mean Legal Fights
If the Obamacare enrollment website seems like a tangled mess, just wait for the lawsuits. The potential for a morass of litigation over who’s responsible for the problems that have plagued the rollout of President Barack Obama’s signature health care law is significant, government procurement experts say (Gerstein, 10/23).

The Associated Press/Washington Post: Rubio Introducing Bill To Delay Health Care Penalty Amid Sign-Up Difficulties
Sen. Marco Rubio says he'll introduce legislation to delay the penalty that can be assessed on individuals who don’t buy insurance under the government’s new health care law. The Florida Republican says people should not be punished for not buying the insurance when major technical problems have plagued the online sign-up process. Uninsured Americans have until about mid-February to sign up for coverage if they are to meet the law’s requirement that they be insured by the end of March. If they don’t, they will face a penalty (10/22).

Politico: Marco Rubio Bill Would Delay Obamacare
Rubio also hit the Obama administration for a lack of transparency on Obamacare, saying the White House is withholding information so people won't see the "ugly things" of the law (McCalmont, 10/22).

The Wall Street Journal's Washington Wire: Democratic Senator Suggests Extending Health Deadlines
Sen. Jeanne Shaheen, a Democrat from New Hampshire, on Tuesday told the White House that individuals shouldn't face penalties for failing to buy health insurance if technical problems with the new federal health-care website prevent them from signing up for an insurance plan (Hughes, 10/22).

Politico: Hill Staffers A Potential Boon For DC Exchange
District of Columbia insurance officials who have long worried about how many people would sign up for health coverage get a surprise bonus next month: a slew of Congress members and staffers. Three weeks from now, about 15,000 Hill aides and their bosses will be eligible to sign up through the small-business or SHOP exchange offered by the D.C. Health Link. Not all will enroll — some are on a spouse's plan or have Medicare. But those who do will most likely be disproportionately young and healthy, reflecting the Capitol Hill workforce — exactly the kind of customers the insurance pool wants and needs (Cunningham, 10/23).

Los Angeles Times: Obama Calls On His Supporters To Join 'Team Obamacare'
Could the activists of the 2012 presidential campaign come to Obamacare's rescue? With the website for the nation’s new healthcare program mired in structural problems that could take weeks — if not months — to fix, President Obama appealed to his supporters in a video Tuesday to join "Team Obamacare" and help counter the law's critics (Reston, 10/22).

The Associated Press/Washington Post: Beset By Website Woes, Obama Administration Appeals To Allies to Stick With Health Care Law
The Obama administration is appealing to its allies in Congress, on Wall Street and across the country to stick with President Barack Obama’s health care law even as embarrassing problems with the flagship website continue to mount. The website’s troubled debut was overshadowed by the partial government shutdown that started the same day the website went live. Last week, Obama and Democrats walked away from a no-holds-barred fight with Republicans over debt and spending with a remarkable degree of unity, made all the more prominent by the deep GOP divisions the standoff revealed (10/23).

Politico: White House Works To Flip Obamacare Narrative
The president himself appeared Tuesday in an Organizing for Action You Tube video, asking supporters to spread the word about what Obamacare means to ordinary people — and promising to get the broken website fixed. “I’m asking you to be a part of Team Obamacare,” he said. “We won’t be able to reach everyone who deserves the safety and security of affordable health insurance without you” (Haberkorn and Meyers, 10/23).

The Washington Post: Health Co-Ops, Created To Foster Competition And Lower Insurance Costs, Are In Danger
When the new health-care law was being cobbled together, Congress decided to establish a network of nonprofit insurance companies aimed at bringing competition to the marketplace, long dominated by major insurers. But these co-ops, started as a great hope for lowering insurance costs, are already in danger (Merkon, 10/22).

The Wall Street Journal: Part-Time Work Still Up, But Health Law Isn't The Cause
Millions of Americans remained stuck in part-time jobs in September, but there's little evidence to support claims that the federal health-care law is to blame. Part-time employment rose during the recession and remains far above historical norms. Critics of the 2010 Affordable Care Act have suggested the trend could be due to its provision that requires many companies to offer health insurance to full-time employees beginning in 2015. That rule, critics argue, provides companies with an incentive to hire part-timers—and some employers have said they are already shifting to part-timers (Casselman, 10/22).

The New York Times: As Drug Costs Rise, Bending the Law Is One Remedy
The high price of many prescription drugs in the United States has left millions of Americans telling white lies and committing fraud and other crimes to get their medicines. In response to a New York Times article about the costs, hundreds of readers shared their strategies, like having a physician prescribe twice the needed dose and cutting pills in half, or “borrowing” medicines from a friend or relative with better insurance coverage. But an increasingly popular — though generally illegal — route is buying the drugs from overseas (Rosenthal, 10/22).

The Washington Post: Cuccinelli Teams With Paul Ryan To Rip New Health-Care Law
Virginia’s Republican candidate for governor, Ken Cuccinelli II, sought to make up lost ground in his campaign on Tuesday by again spotlighting the bug-filled launch of Obamacare and teaming with a nationally known conservative. This time it was Rep. Paul Ryan (R-Wis.), who shared a telephone press conference with Cuccinelli to bash the Affordable Care Act and warn that Terry McAuliffe (D) has bet his agenda on expanding Medicaid in Virginia under the federal health-care law (Kunkle, 10/23).

The Associated Press/Wall Street Journal: Poll: NY Residents Divided Over Health Care Law
A new poll has found more New York state residents who favor moving ahead with the new health care law than those who want to repeal it. A Siena poll released Tuesday found 43 percent of respondents saying they want to see the law go forward. Another 32 percent say the law should be put on hold until it's workable and affordable and 22 percent want it repealed (10/23).

Los Angeles Times: L.A. Leaders Fight Ballot Measure To Create City Health Agency
City Hall and Los Angeles County elected leaders are warning that if voters pass a June ballot measure that forces the city to create its own health department, it will increase costs and erode essential services now provided by the county. But the officials find themselves in a quandary: Although they vehemently oppose the measure, state law blocks them from publicly financing an opposition campaign (Mehta, 10/22).

Check out all of Kaiser Health News' e-mail options including First Edition and Breaking News alerts on our Subscriptions page.

This is part of Kaiser Health News' Daily Report - a summary of health policy coverage from more than 300 news organizations. The full summary of the day's news can be found here and you can sign up for e-mail subscriptions to the Daily Report here. In addition, our staff of reporters and correspondents file original stories each day, which you can find on our home page.