First Edition: October 3, 2013

Today's headlines include reports about how the federal and state health exchanges worked on their second day of operations. In the background, the congressional budget stand off continues. 

Kaiser Health News: On Day 2, Federal Insurance Marketplace Offers Mixed Bag Of Problems, But Also Successes
Kaiser Health News staff writers Jay Hancock, Marissa Evans, Phil Galewitz, Jenny Gold and Ankita Rao report: "The federal online marketplace selling newly available health insurance in 36 states continued to frustrate consumers Wednesday with delays and software failures, although some reported success in signing up" (Hancock, Evans, Galewitz, Gold and Rao, 10/2). Read the story.

Kaiser Health News: Across The Country, Consumers Carefully Weigh Rollout Of Marketplaces
Kaiser Health News compiled this report based on stories provided by reporters at our partner public radio stations detailing some of those experiences. "Across the country, consumers, advocates and officials are carefully watching the rollout of the health law's insurance marketplaces as they try to evaluate what works and what doesn't. Many people have encountered technical glitches, especially in the first hours after the marketplaces opened Tuesday. But for some of those who rushed to see what plans would be available, those snags didn't dampen their initial enthusiasm" (10/2). Read the story.

Kaiser Health News: Back To Work After A Baby -- But Without Insurance This Time
Kaiser Health News staff writer Sarah Varney, working in collaboration with NPR, reports: "Pardit Pri had insurance until she decided to quit her job as a legal administrative assistant and stay home with her newborn son 20 months ago. And she expected to have it again. But it didn't work out that way" (Varney, 10/3). Read the story.

Kaiser Health News: Small Businesses May Find Relief In Health Insurance Exchanges Designed For Them
Southern California Public Radio's Stephanie O'Neill, working in partnership with Kaiser Health News and NPR, reports: "But while about 45 employees work here to make Hollywood magic happen, general manager Sunder Ramani is focused on the less exotic work of paying the bills and figuring out how to provide insurance to about 15 employees who don't have union-provided health coverage" (O'Neill, 10/3). Read the story.

Kaiser Health News: Capsules: R.I. Woman Among First To Enroll In Obamacare Exchange
Now on Kaiser Health News' blog, Phil Galewitz reports: "Uninsured for more than five years, Leslie Peters says she was 'chompin' at the bit' to get coverage to afford regular medical care that she often has gone without. That's why as soon as HealthSource RI, the Rhode Island online health insurance exchange, went live Tuesday, she enrolled. 'I was so excited,' said Peters, who lives in Tiverton, R.I" (Galewitz, 10/2) Check out what else is on the blog.

The New York Times: As Demand Stays High, Officials Try To Address Problems In Exchanges
Federal and state officials moved Wednesday to strengthen the computer underpinnings of the new online health exchanges, which proved inadequate to handle a flood of consumer inquiries that began as soon as the system opened on Tuesday and continued into the next day (Perez-Pena, Goodnough and Pear, 10/2).

The Associated Press/White House: Computer Glitches In Health Insurance Marketplace Signal Strong Demand For Coverage
Overloaded websites and jammed phone lines frustrated consumers for a second day as they tried to sign up for health insurance under the nation's historic health care overhaul. That was putting pressure on the federal government and the states that are running their own insurance exchanges to fix the problems amid strong demand for the private insurance plans (10/3).

The Wall Street Journal: Health Insurance Website Still Sees Delays
Efforts to clear logjams in the federal health law's new online insurance marketplaces met with only modest success Wednesday, with strong traffic exacerbating waits and relatively few consumers able to enroll in policies during the system's second day. Blue Cross & Blue Shield of North Carolina, for one, said it was able to enroll only a single person in a subsidized health plan under the law by Wednesday afternoon (Martin, Weaver and Campo-Flores, 10/2).

Politico: Obamacare Day 2: More Turmoil, Some Progress
Obamacare's second day didn't look much different from its tumultuous first day. The problems that plagued the system on its launch Tuesday remained prevalent one day later, as error messages and indefinite waits stymied online visitors to the federal exchange. There was scant evidence that many people were able to even browse the online insurance offerings, much less actually sign up for a plan. The situation varied widely in the 15 states that opted to build their own Obamacare exchanges, with some tallying large numbers of visitors and applications and others continuing to stumble. Most, though not all, of the state exchanges are in Democratic-led states that support the president's health law (Norman and Millman, 10/3).

Los Angeles Times: Glitches Continue To Plague Health Insurance Marketplaces
Obama administration officials attributed the problems to high traffic at the federal website -; healthcare.gov -; which is the main portal for consumers in 36 states to select a health plan. Residents of the remaining 14 states, including California, Connecticut and Maryland, and the District of Columbia can use state-operated websites, many of which also continued to struggle to keep up with demand. Californians encountered computer problems and call-center hold times of more than 30 minutes. The Department of Health and Human Services reported Wednesday that there were 6.1 million unique visits to the federal website on the first day and a half after the site opened Tuesday (Levey, 10/2).

USA Today: High Volume Spurs Health Exchange System Crash
A high number of visitors to the new federal health insurance exchange site Wednesday caused the system to crash or cause prospective insurance customers to endure long waits. The Department of Health and Human Services has tried to limit the problems by changing how site visitors enter the site and reach details on how to shop for and buy insurance (Kennedy, 10/2).

The New York Times: Problems At Health Care Web Site Not From Online Attack, Experts Say
As the federal government struggled on Wednesday to explain the technical problems experienced by would-be users of the health exchange Web site, www.healthcare.gov, computer security specialists say they had ruled out a cyberattack known as a denial of service, or DDoS, attack. Those occur when attackers fire huge amounts of traffic at a Web site until it collapses under the load. Such attacks typically entail hundreds of millions of data requests to a site per second. The federal health care site experienced 4.7 million unique visitors in the first 24 hours. New York State's site experienced 30 million Web requests, which could have been fueled at least in part by a New York advertising blitz on sites like CNN.com, media coverage, and links from news sharing sites like Reddit (Perlroth, 10/2).

The Associated Press/Washington Post: Md. Explores Alternative Ways To Create Accounts To Use Online Health Insurance Marketplace
As Maryland's new online marketplace for health insurance continues to have trouble handling a deluge of requests to set up accounts, state health officials are exploring alternative ways to create those accounts, the state's health secretary said Wednesday. Dr. Joshua Sharfstein said tens of thousands have visited the site but fewer than 100 people so far have actually enrolled in a health plan through Maryland Health Connection. Sharfstein estimated that hundreds have been able to create accounts online (10/2).

The Associated Press/Washington Post: NY Health Care Website Slammed By 30 Million Hits; State Monitoring For Any Attack, Protest
State Department of Health Executive Director Donna Frescatore said the agency doubled the website's capacity after users experienced delays and other difficulties entering. New York is constantly monitoring the website for "robots" which could inundate the system as a protest or as a way to disrupt the health care program. But no evidence has been found. The department said evidence of an attack or protest could be seen immediately (10/2).

The Wall Street Journal: New York Health Insurance Exchange Launches
Thousands of New Yorkers struggled Tuesday as they sought to use a balky new website that hosts the state's new health-insurance exchange, but officials pledged to fix the bugs and took heart that the site received unexpectedly high traffic on its first day. … The state's online marketplace, which opened for business as enrollment for insurance under the federal Affordable Care Act began around the U.S., was receiving upgrades to handle more traffic late Tuesday, Ms. Frescatore said. The website recorded more than 10 million hits, while about 9,000 people were able to shop. The site counts every hit, regardless of whether someone was able to get onto the site, a spokesman said (Dawsey, 10/2).

The Wall Street Journal's Washington Wire: Why Kentucky's Health Exchange Worked Better Than Many Others
While Kentucky's health-insurance exchange experienced some glitches when it launched Tuesday, it seemed to perform better than many of its peers. State officials and outside experts attribute the smoother rollout to a variety of factors, including intensive testing of the system, a less-flashy but more-efficient website and strong coordination among state agencies involved in the effort. As a result, Kentucky's exchange, dubbed Kynect, logged solid results in the first day and a half of operation. As of 4:00 p.m. Wednesday, 10,766 applications for health coverage had been initiated, 6,909 had been completed and 2,989 individuals or families had enrolled in new coverage (Campo-Flores, 10/2).

The New York Times: Millions Of Poor Are Left Uncovered By Health Law
A sweeping national effort to extend health coverage to millions of Americans will leave out two-thirds of the poor blacks and single mothers and more than half of the low-wage workers who do not have insurance, the very kinds of people that the program was intended to help, according to an analysis of census data by The New York Times (Tavernise and Gebeloff, 10/2).

The New York Times: Despite Criticisms, Health Care Law's Impact On Jobs Is Still Unclear
To Speaker John A. Boehner, it is "job-killing." To Senator Ted Cruz, it is "hurting the American people." To Senator Mitch McConnell, it is a "big reason we are turning into a nation of part-time workers." But to many independent economic analysts, it remains too early to tell how the sweeping Affordable Care Act will affect the jobs market (Lowrey and Harwood, 10/2).

The Wall Street Journal's Washington Wire: U.S. Citizens Abroad Avoid Health-Law Mandate
The Affordable Care Act requires most Americans to carry health insurance or pay a tax penalty–and there's a reason we say "most" rather than "all." Americans who live abroad at least 330 days of the year will be treated as if they have qualifying insurance coverage and won't owe any tax penalty, according to the Internal Revenue Service. That's true regardless of whether the U.S. citizen actually has health insurance in the country where he or she lives (Schatz, 10/2).

Los Angeles Times: Assemblyman Wants Lawmakers To Enroll In Health Insurance Exchange
Assemblyman Brian Nestande is no fan of Obamacare, but he's pushing a proposal to require all state lawmakers to get their benefits through the newly launched healthcare exchanges. The Palm Desert Republican said he'll be introducing a bill that would require lawmakers who want to get health benefits offered by the Legislature to enroll through Covered California, the state's healthcare exchange (Mason, 10/2).

The Washington Post: Fairfax Utility: Obamacare Will Likely Lead To Dropped Coverage
The Fairfax County Water Authority said that it will likely drop insurance coverage for its nearly 400 employees if taxes on generous health-care plans take effect as planned in 2018 under the federal Affordable Care Act. The public utility, a quasi-governmental entity that provides water to 1.7 million Northern Virginians, said that the tax would eventually cost it millions of dollars a year (Vozzella, 10/2).

USA Today: Is Health Law Really To Blame For Plan Changes?
A handful of big-name firms and many small ones are making major changes to their health care plans this fall, and while some big companies are blaming the Affordable Care Act, insurance and economic experts call those claims an exaggeration. Making health insurance changes, including big premium and deductible hikes when the rate of increase in health care costs has slowed, creates a "messaging issue," says University of Michigan business economics professor Thomas Buchmueller (O'Donnell and McGinnis, 10/2).

The New York Times: Conversations: The Landscape Of Small-Business Health Insurance
Five years ago, a start-up called Liazon began offering businesses a new way to provide health insurance to employees. On Liazon's Bright Choices, an online marketplace, a company can specify how much money it wants to spend on each employee's benefits, and employees can use that contribution to buy the plan of their choice (Mandelbaum, 10/2).

Politico: ACA's Foot Soldiers Help Families Deal With System
Forget the technical glitches. Navigators and other enrollment assisters are trying to prepare for the hundreds of different scenarios families are going to bring to Obamacare. A single mother with expiring unemployment benefits? A mom who is undocumented and a father who has papers? A family that earns too much money for Medicaid but not enough to get subsidies? (Haberkorn, 10/3).

The Wall Street Journal: Micro Businesses Find Health-Care Rollout Is Slow
Porche Lovely of Denver attempted to enroll in a health-care plan through her state's new insurance exchange Tuesday because her employer doesn't offer health benefits. Her employer? Porche Lovely. Among the 22 million Americans expected to sign up for health insurance through the new state exchanges over the next two years are owners of micro businesses-;companies with just a few or no employees (Needleman, 10/2).

The Wall Street Journal's Venture Capital Dispatch: Psilos Partner Sees Opportunity in ObamaCare Exchanges
The state and federal health-insurance exchanges central to ObamaCare have been getting a bad rap this week, as millions of consumers flocking to websites have caused crashes and delays. But when the dust settles, the exchanges will present opportunities for businesses to save money, for entrepreneurs to develop new technologies and for investors to reap returns, said venture capitalist Lisa Suennen, whose firm Psilos Group has made a number of investments over the years in startups that do business with or alongside the insurance industry (Hay, 10/2).

USA Today: Some Physicians Still Charge Co-Payments Banned By Law
Some doctors' offices are still charging patients co-payments for preventive exams, such as annual physicals and well-baby checkups, even though the Affordable Care Act prohibits the practice (Kennedy, 10/3).

The Wall Street Journal: No Movement In Shutdown Standoff
House Speaker John Boehner (R., Ohio) said after the meeting that Republicans continue to want changes to the new federal health law, the Affordable Care Act. Democrats have said they won't agree to changes to the law as a condition of reopening the government. … Mr. Obama has said he is willing to compromise on a wide-ranging budget deal-;but only after Republicans take two steps: reopening the government without changing the health law, and raising the nation's borrowing limit. After the White House meeting, Senate Majority Leader Harry Reid (D., Nev.) repeated that Democrats stood firm against changing the health law (Hook, Lee and Peterson, 10/2).

The New York Times: Obama Says He Won't Negotiate Until Government Reopens
President Obama told Republican leaders on Wednesday that he would negotiate with them only after they agreed to the financing needed to reopen the government and also to an essential increase in the nation's debt limit, without add-ons. … The meeting was the first time that the president linked the two actions that he and a divided Congress are fighting over this month: a budget for the fiscal year that began on Tuesday, and an increase in the debt ceiling by Oct. 17, when the Treasury Department will otherwise breach its authority to borrow the money necessary to cover the nation's existing obligations to citizens, contractors and creditors. Only when those actions are taken, Mr. Obama said, would he agree to revive bipartisan talks toward a long-term budget deal addressing the growing costs of Medicare and Medicaid and the inadequacy of federal tax revenues. … Yet the refusal of the Republican-led House earlier this week to approve government funding until Mr. Obama agrees to delay his signature health-care law …  raised fears from Washington to Wall Street that Republicans likewise would carry out their threat to withhold approval for an increase in the debt ceiling (Calmes and Weisman, 10/2).

The Associated Press/Washington Post: Government Shutdown In 3rd Day After White House Meeting Leaves Obama, Hill Leaders At Odds
House Speaker John Boehner, R-Ohio, complained to reporters that Obama had said anew that "he will not negotiate." Boehner made clear that curbing the health care overhaul that Obama pushed into law three years ago remains part of the price for returning 800,000 furloughed federal workers to their jobs and resuscitating programs ranging from feeding pregnant women to staffing Internal Revenue Service call centers (10/3).

Los Angeles Times: House Republicans Turn Toward Seeking A Deal On The Debt Ceiling
Knowing that a delay of Obamacare remains unlikely to be accepted by the president, Republicans are expected to revisit the components of past budget battles: cuts to Medicare, Social Security and other entitlement programs, as well as reforming the tax code, a long-standing interest (Memoli and Mascaro, 10/2).

The Washington Post: Focus Shifts To Looming Debt-Ceiling Deadline As Shutdown Talks At White House Go Nowhere
On Capitol Hill, senior Republicans began to suggest that a broad agreement to overhaul entitlements and the tax code could be used as a resolution to both the shutdown and debt limit clash. But Democrats view that approach as hostage taking, and say Congress must reopen the government and authorize additional borrowing before serious negotiations can occur (Goldfarb, 10/2).

Politico: Poll: Most Against Default Over Obamacare
As the likelihood grows that the fight over the government shutdown will merge with a fight to raise the debt ceiling, a new poll shows Americans are against defaulting on the nation's debt over Obamacare. Asked what is more important for Congress to do, 51 percent said it was more important for Congress to raise the debt ceiling, compared with 43 percent that said it was more important to delay Obamacare, in a CNN/ORC International poll out Wednesday (Kopan, 10/2).

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).

The Washington Post: John Boehner, Between A Rock And A Hard Place On Shutdown And Debt Limit
Within the increasingly right-leaning GOP caucus, Boehner might survive one big vote that relied heavily on Democratic support. But two important votes -; on the government funding and the debt ceiling -; with mostly Democratic backing would leave the already embattled speaker on political life support. The result is that Boehner has thrown in with the most conservative Republican lawmakers. A few dozen of them have urged holding up the government funding legislation to extract concessions from Democrats on President Obama's Affordable Care Act (Kane, 10/2).

The Wall Street Journal: Reid Sets Tone For Democrats In Shutdown Fight
Mr. Reid has emerged as the GOP's new public enemy No. 1 because he is the man driving his party's hard bargain against Republican leaders in the legislative back-and-forth over funding the government. Democrats have refused to negotiate with Republicans as long as they insist on delaying or defunding the 2010 health-care law. More than any other Democrat, Mr. Reid seems to be setting the tone of his party in the showdown over the shutdown. The impasse marks a shift this year by Democrats in Congress and the White House, who are no longer willing to barter with GOP leaders demanding major concessions in exchange for short-term government-funding bills or extending the nation's borrowing limit (O'Connor and Hook, 10/2).

NPR: From Therapy Dogs To New Patients, Federal Shutdown Hits NIH
The National Institutes of Health is the biggest source of funding for medical research in the world. An the partial federal government shutdown has put it in a precarious position. Universities and hospitals across the country are grappling with what the NIH shutdown will mean for them. The NIH also has its own hospital at its main campus in Maryland called the NIH Clinical Center and is dedicated solely to medical research. Patients often go there to receive experimental treatments. The shutdown has affected the NIH hospital in ways both large and small (Greenfieldboyce, 10/3).

Los Angeles Times: UC Irvine And MemorialCare Health System Agree to Partner, Not Merge
Amid growing healthcare consolidation as Obamacare rolls out, UC Irvine and MemorialCare Health System have agreed to a partnership deal. The UC Board of Regents said Wednesday it has approved an affiliation between UC Irvine Health and MemorialCare, two major hospital systems in Southern California. It's not a merger and both will remain independent (Terhune, 10/2).

Politico: Texas Anti-Abortion Ad To Hit Wendy Davis
Wendy Davis, the Texas state senator who is poised to announce a Democratic bid for governor on Thursday, is an "abortion zealot" out-of-step with the rest of the state, according to a new ad going up in Texas this weekend (Glueck, 10/3).