First Edition: October 28, 2013

Today's headlines include coverage of the health law's federal online insurance marketplace -- healthcare.gov -- and its continuing challenges, troubles and the plans to get it fixed.

Kaiser Health News: Prevention For Profit: Questions Raised About Some Health Screenings
Kaiser Health News staff writer Jenny Gold, working in collaboration with NPR, reports: "For less than $200, Riggs is getting six different screenings for stroke, heart disease and osteoporosis. Life Line says they've checked 8 million Americans this way at churches and community centers, and up to 10 percent of them are found to have some sort of abnormality. But several of the tests performed by Life Line are on a list of procedures for healthy people to avoid" (Gold, 10/28). Read the story. 

Kaiser Health News: Pennsylvania Governor Talks Up Plan To Expand Medicaid His Way
WHYY's Elana Gordon, working in partnership with Kaiser Health News and NPR, reports: "Pennsylvania Gov. Tom Corbett may have kept an eye this week as his fellow Republican governor in Ohio, John Kasich, bypassed his own Republican legislature to expand the state's Medicaid program. As part of the Affordable Care Act, states have the option to give coverage to low-income adults, with the federal government picking up most of the tab. Only about half the states so far have planned to do that, starting Jan. 1, and Pennsylvania has, so far, not been among them" (Gordon, 10/25). Read the story.

Kaiser Health News: Zients Vows Healthcare.gov Will Work Smoothly By End Of November
Kaiser Health News staff writer Phil Galewitz reports: "The troubled federal health insurance exchange will be fixed by the end of November -- two weeks before the Dec. 15 enrollment deadline for coverage to take effect in January, Obama administration officials said Friday" (Galewitz, 10/25). Read the story.

Kaiser Health News also tracked weekend health policy headlines, including the continuing coverage the troubles with the health website and how they took center stage on the Sunday news shows and in the Saturday weekly addresses from the president and the Republicans (10/27).

The New York Times: Health Site's Woes Could Dissuade Vital Enrollee: The Young And Healthy
The economists and policy wonks behind the Affordable Care Act worry that the technical problems bedeviling the federal portal could become much more than an inconvenience. If applicants like Mr. Jackson decide to put off or give up on buying coverage, rising prices and even a destabilized insurance market could result. The enrollment of people like Mr. Jackson, who is 32, is vital for the health care law -; and, for that matter, the entire health care system -; to work (Lowrey, 10/27).

The New York Times: Health Site Woes Undermine Obama's Vow On Government
The breakdown of the federal HealthCare.gov Web site could emerge as a test of Mr. Obama's philosophy, with potentially serious implications for an agenda that relies heavily on the belief in a can-do bureaucracy. Michael Dimock, the Pew center's director, said that the longer the problems persist, the more they could bolster what he called the "almost American value that government is inefficient" (Shear, 10/26).

The Washington Post: HealthCare.gov Doesn't Help Obama's Argument For Greater Government
President Obama has faced a persistent challenge in office. The advocate of big, bold actions to address large and seemingly intractable problems, he has struggled to convince the public that government is equipped to carry out such transformational changes. The rollout of the Affordable Care Act has highlighted that challenge, and the administration's response has no doubt set the president back. He and Health and Human Services Secretary Kathleen Sebelius were slow to acknowledge the scope of the problems with HealthCare.gov, and overall the administration has hardly lived up to its pledge to be the most transparent in history (Balz, 10/26).

Politico: Obamacare Headaches: More Than The Website
The range of issues and potential issues runs the gamut, from the truly glitchy -; the small and likely solvable -; to much more serious threats to the viability of the health exchanges at the heart of Obamacare (Norman and Allen, 10/28).

The Wall Street Journal: Federal Health Site Stymied By Lack Of Direction
A team of young policy experts energized by President Barack Obama's health law toiled for three years in a Bethesda, Md., office building to draw up specifications for the federally run insurance marketplace. Forty miles away at the Centers for Medicare & Medicaid Services' Baltimore headquarters, longtime agency computer experts with different bosses oversaw building the site's software and hardware components. And in Washington, White House advisers worked to preserve the law through treacherous politics, sometimes stalling final decisions about the site, HealthCare.gov, to avoid controversy ahead of the 2012 presidential election (Weaver and Radnofsky, 10/27).

Bloomberg/The Washington Post: Obamacare Insurance Web Sites Limited By Verizon Data Hub Failure
Computer servers hosting a key piece of Obamacare's insurance enrollment program failed today, leaving federal and independent state exchanges unable to provide most services. The data services hub, a system that supplies tax information and other data to Web sites run by the U.S. and 14 states to sell medical coverage, was unavailable after a malfunction at the data center that hosts it (Wayne, 10/27).

The Wall Street Journal: Data Center Outage Hits Health Care Website
The federal data hub relied on by all 14 state-run health care insurance exchanges and 36 exchanges run by the federal government was not working Sunday because the company hosting the hub lost its network connectivity, the Obama administration said. The outage means people trying to sign up online for health care insurance in all 50 states could not complete the process. Terremark, a unit of Verizon Enterprise Solutions that operates the data center that hosts the federal data hub as well as the HealthCare.gov site, couldn't immediately give the Department of Health and Human Services a timeline for fixing the problem, which was affecting customers other than the federal government, HHS spokeswoman Joanne Peters said (Radnofsky, 10/27).

The Washington Post: HealthCare.gov Fixes Won't Be Done Until End Of November, Adviser Says
The Obama administration announced Friday that it was putting a private firm in charge of fixing its faulty health insurance Web site and set the end of November as a target date for working out all the bugs, the first indication of how long repairs may take. One day after contractors on the project publicly suggested that the federal government inadequately tested the site before its Oct. 1 launch, administration officials said that one of those contractors -; Columbia-based Quality Software Services Inc., or QSSI -; would take over management of HealthCare.gov (Somashekhar and Sun, 10/25).

The Associated Press/Washington Post: Republicans Ready To Question Sebelius About Troubled Rollout Of Obama's Health Care Law
Republicans plan to seek answers from Health and Human Services Secretary Kathleen Sebelius on the Obama administration's troubled start for its health care website to buy insurance, and are raising concerns about the privacy of information that applicants submit under the new system. GOP lawmakers said Sunday that the Obama administration will face intense scrutiny this week to be more forthcoming about how many people have actually succeeded in enrolling for coverage in the new insurance markets (10/28).

The Associated Press/Washington Post: In A Twist, Republican Senators Fight To Keep Tax Increase As Part Of New Health Law
Republicans in Congress don't usually fight for tax increases, especially ones that are part of President Barack Obama's health care law. But GOP senators balked when Democrats proposed delaying a new temporary fee on everyone covered by health insurance. So employers, insurance companies and other health plan sponsors are in line to pay $63 a person next year for everyone who has coverage. The temporary fee covers all workers, spouses and dependents covered by health insurance (10/28).

The Washington Post: White House Tries to Rally Congressional Democrats In Support Of Obamacare
By the time President Obama acknowledged on Monday that his signature health-care program had serious problems, it was clear that the political stakes had escalated for the White House. And so that evening, Obama gathered some of the top political advisers from his first term for a strategy session on a range of topics. The president himself spent little time on how to handle the political fallout, arguing that fixing the problems of HealthCare.gov, the Web site at the heart of the troubles, would take care of that challenge (Eilperin, 10/26).

Los Angeles Times: U.S. Hires Contractor To Fix Healthcare Website
Jeffrey Zients, the management consultant enlisted to assess the situation, acknowledged that dozens of unresolved problems remained, including software flaws -; contradicting administration officials' early claims that unexpected traffic volume was the main cause of the frequent error messages, frozen screens and other problems. Still, Zients said the site would be running smoothly for the "vast majority" of users by the end of next month (Hennessey and Clemons, 10/25).

The New York Times: Promised Fix For Health Site Could Squeeze Some Users
Such a condensed time frame raises the question of how hundreds of thousands of people whose current policies do not comply with the health law will obtain new coverage in time, and how millions who may qualify for subsidies will enroll. Some experts predicted a groundswell of demands from Congress and elsewhere to delay the deadlines (Pear and LaFraniere, 10/25).

Politico: Healthcare.gov Smiling Face Vanishes
The website for the problem-plagued health care exchanges has a new look, and gone is the smiling face of an unidentified woman from the homepage. Since its roll out, the website had featured a smiling young woman, who became known as the "Obamacare girl," and whose identity people tried unsuccessfully to uncover (Kopan, 10/28).

Los Angeles Times: Some Health Insurance Gets Pricier As Obamacare Rolls Out
Thousands of Californians are discovering what Obamacare will cost them -; and many don't like what they see. These middle-class consumers are staring at hefty increases on their insurance bills as the overhaul remakes the healthcare market. Their rates are rising in large part to help offset the higher costs of covering sicker, poorer people who have been shut out of the system for years. Although recent criticism of the healthcare law has focused on website glitches and early enrollment snags, experts say sharp price increases for individual policies have the greatest potential to erode public support for President Obama's signature legislation (Terhune, 10/27).

The Washington Post: QSSI, Contractor Chosen To Fix HealthCare.gov, Faced Questions From Lawmakers Last Year
The company chosen by the Obama administration to oversee the repair of the new federal health insurance Web site faced questions from lawmakers a year ago about whether it was an appropriate choice for earlier work on the site, given that it is owned by the country's largest health insurance company. ... Republican lawmakers including Sen. Orrin G. Hatch (Utah), Sen. Charles E. Grassley (Iowa), Rep. Darrell Issa (Calif.) and Rep. Fred Upton (Mich.) sent letters to UnitedHealth Group and HHS asking how QSSI had been chosen, given what they viewed as a potential conflict of interest. The lawmakers were concerned that QSSI might have access to information or would build the technology in a way that would give -United¬Health's insurance business an advantage (Yang, 10/25).

Politico: 'Glitches' Hit Obamacare Paper, Phone Applications Too
With the supposedly state-of-the-art $600 million HealthCare.gov portal malfunctioning, President Barack Obama is urging Americans to go ahead and try to get health coverage by mailing in a paper application, calling the helpline or seeking help from one of the trained "assisters." But the truth is those applications -; on paper or by phone -; have to get entered into the same lousy website that is causing the problems in the first place. And the people processing the paper and calls don't have any cyber secret passage to duck around that. They too have to deal with all the frustrations of HealthCare.gov -; full-time (Winfield Cunningham, 10/26).

Politico: Delay Obamacare? Not As Easy As You Think
More and more Democrats worried about the 2014 election are beginning to join the Republican call to delay the Obamacare enrollment season. But it's not as easy as bumping things back a few days on the calendar. Insurance companies would raise a ruckus because they set their prices based on customers enrolling before April. The Obama administration doesn't want to push the successful enrollment stories until any later than they have to. And neither want to give procrastinators another reason to wait to sign up (Haberkorn, 10/25).

The Washington Post: IRS Offers Hint At How Many Americans Have Been Able To Use Healthcare.Gov Successfully
Despite the technical problems plaguing many of the new health insurance Web sites, the federal government has delivered 330,000 premium subsidy calculations to people who have gotten deep enough into the system to find out whether they qualify for financial help, the Internal Revenue Service said Saturday. The disclosure offers a hint of how many people might be successful in using the online marketplaces, which opened Oct. 1 amid widespread technical difficulties that prevented many people from accessing them (Kliff and Somashekhar, 10/26).

The Wall Street Journal: States Report Medicaid Surge After Health-Law Rollout
Some states are signing up tens of thousands of new Medicaid enrollees in the initial weeks of the health law's rollout, while placing far fewer in private health insurance-;a divergence that suggests Medicaid expansion may be a larger part of the law than expected. In one sense, the Medicaid figures are good news for the Affordable Care Act's advocates, who hoped the law would reduce the number of Americans without health insurance (Schatz and Dooren, 10/27).

The New York Times: Insurers' Stocks, Unhurt By The Dawn Of The Health Care Law
Yet from the financial perspective of the health care industry, Obamacare, as the law is often known, doesn't seem much of a hindrance. In fact, it may even turn out to be positive. Consider the situation of health insurance providers. Because they face new regulations intended to broaden coverage and limit profit-taking, some analysts have been concerned that profits will suffer. But in the run-up to the Affordable Care Act, stock market prices have told a different story. Over the last 12 months, shares of the top five publicly traded health insurance companies -; Aetna, WellPoint, UnitedHealth Group, Humana and Cigna -; have increased by an average of 32 percent, while the Standard & Poor's 500-stock index has risen by just 24 percent (Bernasek, 10/26).

The New York Times: Health Insurance Options Aren't Limited To Government Exchanges
Of course, the main attraction of the exchange is that plans sold there may come with subsidies that can substantially lower your monthly premiums. (Premium credits are for people making up to $46,000 for an individual and up to $94,000 for a family of four.) Web-based brokers, like eHealth, are supposed to be able to help consumers enroll in subsidy-eligible plans by connecting to the federal marketplace to verify the consumer's income, under government guidelines issued last spring. But that isn't happening yet at eHealth, in part because the company is still testing its system, said a spokesman, Nate Purpura (Carrns, 10/25).

The Associated Press: As Health Marketplaces Open, Vt. Eyes Bigger Goal
As states open insurance marketplaces amid uncertainty about whether they're a solution for health care, Vermont is eyeing a bigger goal, one that more fully embraces a government-funded model. The state has a planned 2017 launch of the nation's first universal health care system, a sort of modified Medicare-for-all that has long been a dream for many liberals (Gram, 10/26).

The Associated Press/Washington Post: Obama's Troubled Health Rollout May Be Problem With Kind Of Staying Power That GOP Has Sought
For nearly five years, Republicans have struggled to make a scandal stick to President Barack Obama's White House. One by one, the controversies -; with shorthand names such as Solyndra, Benghazi, and Fast and Furious -; hit a fever pitch, then faded away. But some Republicans see the disastrous rollout of Obama's health law as a problem with the kind of staying power they have sought (10/27).

The Washington Post: Spinal Fusions Serve As Case Study For Debate Over When Certain Surgeries Are Necessary
By some measures, Federico C. Vinas was a star surgeon. He performed three or four surgeries on a typical weekday at the Daytona Beach, Fla., hospital that employed him, and a review showed him to be nearly five times as busy as other neurosurgeons. The hospital paid him hundreds of thousands in incentive pay. In all, he earned as much as $1.9 million a year. Yet given his productivity, some hospital auditors wondered: Was all of the surgery really necessary? (Whoriskey and Keating, 10/27).

The New York Times: FDA Shift On Painkillers Was Years In The Making
When Heather Dougherty heard the news last week that the Food and Drug Administration had recommended tightening how doctors prescribed the most commonly used narcotic painkillers, she was overjoyed. Fourteen years earlier, her father, Dr. Ronald J. Dougherty, had filed a formal petition urging federal officials to crack down on the drugs (Meier and Lipton, 10/27).