First Edition: October 15, 2013

Today's headlines include reports about how the budget deal taking shape in the Senate would not derail the health law, but would include some tweaks.

Kaiser Health News: Pay For Hospital CEOs Linked More To Technology, Patient Satisfaction Than Quality, Study Finds
Kaiser Health News staff writer Jordan Rau reports: "What do hospital boards value in a chief executive? A new study of CEO pay at nonprofit hospitals finds that executives at institutions that have a lot of fancy medical technology and high patient satisfaction are paid more than their peers. But running a hospital that scores well on keeping more patients alive or providing extensive charity care does not translate into a compensation bump" (Rau, 10/14). Read the story.

Kaiser Health News: Insuring Your Health: Health Insurance Co-Ops Offer New Option For Some Marketplace Shoppers
Kaiser Health News consumer columnist Michelle Andrews writes: "Many consumers who shop for coverage on the state health insurance marketplaces this fall have a new option to consider: a health insurance co-op. The nonprofit, member-run "consumer oriented and operated plans," or co-ops, were created under the federal health law to enhance competition on the marketplaces and give consumers affordable choices that emphasize patient-focused, coordinated care. Whether these plans will offer a markedly different consumer experience compared to traditional insurance coverage or do a better job helping members get and stay healthy remains to be seen. Co-op managers say that, at a minimum, the plans' governance structure ensures that consumers' voices will be heard" (Andrews, 10/15). Read the column.

Kaiser Health News: Seniors Cautioned To Pay Close Attention To Details As Enrollment Begins In Medicare Plans
Reporting for Kaiser Health News, in collaboration with USA Today, Susan Jaffe writes: "The seven-week enrollment period for next year's Medicare prescription drug and managed-care plans begins Tuesday, but seniors shouldn't simply renew their policies and assume the current coverage will stay the same. There's a likely payoff for those who pay close attention to the details" (Jaffe, 10/15). Read the story.

Kaiser Health News: South Floridians' Biggest Question About Marketplace Plans: Will They Be Affordable?
The Miami Herald's Patricia Borns, working in partnership with Kaiser Health News, reports: "One 47-year-old cancer survivor thinks the Affordable Care Act could save her life. But a 28-year-old real estate agent sees the law requiring health insurance for everyone as a safeguard he doesn't need. And for an immigrant nursery worker in southern Miami-Dade County, health insurance is a luxury she never thought she could afford -; and is afraid she still can't" (Borns, 10/14). Read the story.

Kaiser Health News: Capsules: Obamacare Enrollees Become Urban Legend; How Consumers Are Navigating The Marketplaces
Now on Kaiser Health News' blog, The Miami Herald's Patricia Borns and Daniel Chang, working in partnership with KHN, report on the new enrollees: "Will the Floridians who have enrolled for Obamacare please stand up? Nearly two weeks after the federal government launched the online Health Insurance Marketplace at healthcare.gov, individuals who have successfully used the choked-up website to enroll for a subsidized health insurance plan have reached a status akin to urban legend: Everyone has heard of them, but very few people have actually met one" (Borns and Chang, 10/15).

Also on Capsules, watch the video of KHN's Julie Appleby on C-SPAN's Washington Journal Monday discussing consumer issues with the new online insurance marketplaces that launched Oct. 1 (10/14). Check out what else is on the blog.

The New York Times: Senators Near Fiscal Deal, But The House Is Uncertain
But while both Senator Mitch McConnell of Kentucky, the Republican leader, and Senator Harry Reid of Nevada, the Democratic leader, praised the progress that was made in the Senate, it was already clear that the most conservative members of the House were not going to go along quietly with a plan that does not accomplish their goal from the outset of this two-week-old crisis: dismantling the president's health care law. … Senate Republicans had pushed for an agreement that included a provision to delay or repeal a tax on medical devices, but that became a sticking point in the negotiations and will almost certainly be excluded from the final deal, Senate aides said. But the deal is likely to include a one-year delay of another tax associated with the Affordable Care Act known as the reinsurance tax, which employers pay. … Another Republican-backed measure likely to be in the deal would require tighter income verification standards for people who receive subsidies under the new health care law. Under the new guidelines, the Health and Human Services secretary would have to certify that the department can verify income eligibility (Shear and Peters, 10/14).

The Washington Post: Senate Leaders Within Striking Distance Of Deal To End Shutdown, Raise Debt Limit
The emerging agreement would extend the Treasury Department's borrowing authority until Feb. 7, reopen the government and fund federal agencies through mid-January, according to aides and lawmakers familiar with the negotiations. … The framework under consideration includes only minor changes to President Obama's signature health-care law, falling well short of defunding it or delaying major provisions as conservative Republicans initially sought. Instead, Republicans would get only new safeguards to ensure that people who receive federal subsidies to purchase health insurance under the law are eligible to receive them. But talks were hung up over another provision, aides and lawmakers said: a demand by Democrats to delay the law's "belly button tax," a levy on existing policies that is set to add $63 per covered person -; including spouses and dependents -; to the cost of health insurance next year (Montgomery and Helderman, 10/14).

The Wall Street Journal: Senate Leaders In Striking Distance Of A Deal
The proposed agreement's framework included no major alterations to the 2010 health-care law that Mr. Obama championed and congressional Republicans have tried to curtail. However, lawmakers appeared to be weighing some minor changes, including new procedures to verify the incomes of some people receiving government subsidies for health-insurance costs. Lawmakers also appeared to be considering delaying for a year a fee of $63 per insured person levied on those who offer policies, including employers, unions and insurance carriers. The likely beneficiaries of the fee would be traditional insurance carriers, which are required to sell policies to everyone, regardless of medical history, and so could see customers incur major bills. Large employers and unions that provide coverage say the levy is unfair and they can't afford it, and have fought for an exemption (Peterson and Hook, 10/15).

Los Angeles Times: Senate Leaders Close In On Deal To End Budget Standoff
The proposal would not make significant changes in President Obama's healthcare law. But it could include a pair of tweaks: the delay of a new tax opposed by labor unions and an income verification requirement for customers who buy insurance through the new online marketplaces (Mascaro, Memoli and Bennett, 10/14).

The Associated Press/Washington Post: Senate Leaders Nearing Agreement To Fully Reopen Government, Avoid Threat Of Default
The plan is a far cry from the assault on "Obamacare" that tea party Republicans originally demanded as a condition for a short-term funding bill to keep the government fully operational. It lacks the budget cuts demanded by Republicans in exchange for increasing the government's $16.7 trillion borrowing cap. Nor does the framework contain any of a secondary set of House GOP demands, like a one-year delay in the health law's mandate that individuals buy insurance. Instead, it appeared likely to tighten income verification requirements for individuals who qualify for Obamacare subsidies and may repeal a $63 fee that companies must pay for each person they cover under the big health care overhaul beginning in 2014 (10/15).

Politico: Tea Party Groups Still Want Obamacare  Gutted
You go through a whole government shutdown so you can kill Obamacare dead, and all you get is a little more due diligence before people can get their subsidies? Tea party groups are furious over the prospect that Congress is drifting toward a government funding-debt ceiling deal that might just take the usual one or two tepid dings out of President Barack Obama's signature health care law, just like Congress has in previous fights (Nather, 10/15).

The Wall Street Journal's Washington Wire: Belly-Button Tax: In Or Out Of Budget Deal?
The $63 levy on each person covered in a health plan goes into a fund to compensate insurance carriers who end up paying big medical bills for new customers who buy on the government exchanges. The levy is applied to spouses and dependents as well as policy holders, earning it the nickname "the belly-button tax." It's paid by every company that provides insurance -; big businesses, organized labor, and insurance carriers. The likely beneficiaries of the compensation fund, though, are just the traditional insurance carriers, who will become required to sell coverage to everyone, regardless of their medical history (Radnofsky, 10/14).

Politico: Medical Device Makers Flex Muscle, Arm Way Into Debt Limit Fight
Several key lawmakers advocating a medical device tax repeal deal to end the current fiscal standoff could be rewarded by more than just a peacemaker reputation. The olive branch they're offering could boost their campaign coffers (Blade, 10/14).

The Wall Street Journal: State-Run Health Exchanges Gain Some Traction
At least 38,000 people have signed up for new health plans in the state-run insurance exchanges that opened Oct. 1, while more than 100,000 have completed applications and are close to finishing the process, according to state data (Schatz, 10/14).

The Associated Press/Washington Post: Regulators Say Some Insurance Brokers Mislead Those Seeking Subsidized Health Policies
This month's glitch-filled rollout of the health insurance marketplaces created by federal law is a business opportunity for brokers and agents, but regulators warn that it also opened the door for those who would seek to line their pockets by misleading consumers. New Hampshire's insurance commissioner sent a cease-and-desist letter last week to an Arizona company he accused of building a website to mislead health care shoppers into thinking it was the official marketplace. The site was taken down Friday (10/14).

Politico: Exemptions Pose Another Big Hurdle For Obamacare
Think you're exempt from Obamacare's individual mandate? Good luck proving it. The health law's least popular component -; the requirement to obtain insurance or face a tax penalty -; also features a lengthy list of exceptions for people facing certain hardships like foreclosure, domestic violence or homelessness. Members of certain religious sects or Native American tribes also are exempt (Chaney, 10/15).

Los Angeles Times: Online Firms To Help Enroll People In Obamacare, But Not In California
The nation's biggest online seller of health insurance has joined forces with the federal government to enroll people across the country in Obamacare, but EHealth Inc. won't be signing up any Californians (Terhune, 10/14).

The Wall Street Journal: Health Law Stirs Up Lending
Small businesses are griping that the new U.S. health-care law is difficult to understand. Now some may have another complaint: If they don't have a handle on the law's cost and impact, they may have a harder time getting a loan. To qualify for some loans, especially for growth capital, more companies are being required to provide assurances that they will be in compliance with the Affordable Care Act by 2015. The law will require businesses with 50 or more full-time employees to offer health insurance to their full-timers or face penalties (Murphy, 10/14).

The New York Times: Beneficiaries of Medicare Left Confused By Exchanges
Medicare beneficiaries can sign up for private health plans starting Tuesday, but federal officials fear that many of them, out of confusion, might go to the new federal insurance exchange (Pear, 10/14).

The Associated Press/Wall Street Journal: Excellus Dropping Out Of Medicaid Managed Care
Excellus BlueCross BlueShield says it's dropping out of public health insurance programs for the poor and disabled. The insurer has notified doctors and other providers it's withdrawing from the Medicaid managed care and Family Health Plus programs because it expects to lose about $100 million on those programs this year. The move will affect more than 22,000 central New Yorkers (10/15).