First Edition: September 26, 2013

Today's headlines include details regarding the ongoing congressional battle over the future of the health law in the context of avoiding a government shutdown, as well as the developments on the ground as the Oct. 1 launch of the health law's insurance marketplace nears. 

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

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

Kaiser Health News: Capsules: Answering Consumer Questions About Obamacare Marketplaces; New Health Care Options For Young Adults In 2014
Now on Kaiser Health News’ blog, as part of the Washington Post’s continuing series of online discussions about the health law’s new insurance marketplaces, KHN’s Phil Galewitz and the Post’s Sarah Kliff answered readers’ questions. Read the transcript (9/25).

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

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

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

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

Los Angeles Times: Time Is Short For GOP To Stop Obamacare, Avoid Government Shutdown
The collapse of a GOP strategy to halt President Obama's healthcare law has Republican leaders scrambling to find other ways to dismantle it as part of legislation needed to fund the government in a few days or trigger a shutdown. Time is not on their side: Sen. Ted Cruz (R-Texas) has monopolized the floor in his lonely filibuster-like campaign to kill the Affordable Care Act. Patience among Republicans for the renegade senator's go-it-alone strategy is waning as money for routine government operations is set to run out by Oct. 1 (Mascaro, 9/25).

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

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

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

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

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

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

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

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

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

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

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

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

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

The Associated Press/Washington Post: Health Law Policies That Offer Low Premiums Come With High Deductibles And Copayments
You might be pleased with the low monthly premium for one of the new health insurance plans under President Barack Obama’s overhaul, but the added expense of copayments and deductibles could burn a hole in your wallet. An independent analysis released Wednesday, on the heels of an administration report emphasizing affordable premiums, is helping to fill out the bottom line for consumers (9/25).

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

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

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

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

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

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

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

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

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

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

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