First Edition: November 18, 2013

Today's headlines include reports about the political implications of the healthcare.gov difficulties as well continued coverage of reaction to President Barack Obama's policy cancellation fix.

Kaiser Health News: California Sends Incorrect Information To 246,000 Low-Income Patients
Kaiser Health News staff writer Anna Gorman, working in collaboration with McClatchy, reports: "California has mistakenly sent letters to 246,000 low-income residents, warning they may need to find new doctors next year under the state's newly expanded Medicaid program. The error frustrated counties and community health centers which have repeatedly assured patients they can keep their providers when the Affordable Care Act takes effect in 2014. The patients are part of the state's 'bridge to reform' program, which was designed to cover uninsured, poor Californians until they became eligible for Medicaid, known as Medi-Cal here" (Gorman, 11/17). Read the story.

Kaiser Health News: Uninsured In Mich. City Can Pay For Dental Care With Volunteer Work
Kaiser Health News staff writer Phil Galewitz, working in collaboration with USA Today, reports: "Kelly Price knows too well the pain of infected teeth and how they become so sensitive it hurts to eat or drink. He has suffered with that in the past and still has several teeth that need to be extracted, but the 51-year-old unemployed machinist can't afford to see a dentist. That's why on a morning last month he was helping out at the Food Bank of South Central Michigan filling bags for weekend meals for needy children with Special K cereal, cans of spaghetti and meatballs, green beans, and a juice drink" (Galewitz, 11/17). Read the story.

Kaiser Health News: Capsules: Florida Regulator, Blues Plan Agree To Insurance Fix Proposed By Obama
Now on Kaiser Health News' blog, Phil Galewitz reports: "Florida Insurance Commissioner Kevin McCarty said he will allow insurers to adopt President Barack Obama's plan to extend current policies facing cancellation so that consumers can keep the coverage they have now. In fact, he was permitting plans to do that months before the president suggested it" (Galewitz, 11/15). Check out what else is new on the blog.

Politico: Obamacare's Threat To Liberalsim
From the moment of his improbable emergence as a presidential contender seven years ago, Barack Obama has always positioned himself as something better than a politician. And he has always presented his goals for progressive change as something bigger than the bare minimum a Democrat might hope for in a country that skews center-right. So the fiasco of the launch of Obama's sweeping health care overhaul has put the reputation of Big Government progressivism at risk for at least this generation. And its future now rests on the president's ability to reverse that debacle and to demonstrate that his approach to covering millions of uninsured Americans is not only an enlightened -; but workable -; policy. He set the bar himself (Purdum, 11/18).

The Wall Street Journal: White House Soul-Searches As Errors Mount
The White House has begun a quiet self-assessment in the wake of the troubled health-law launch, recognizing that administration officials missed warning signs and put too much trust in their management practices in implementing a program that is the centerpiece of President Barack Obama's domestic legacy. White House officials want to learn how the rollout flopped, despite what they believed had been sufficient planning, preparation and attention to the issue. Although not a full-bore "forensic" inquiry into what went wrong, the administration aims to organize itself so that "going forward, we don't have these problems," a senior White House official said in an interview (Nicholas and Lee, 9/17).

The Associated Press: Obama Health Care Woes Becomes Credibility Fight
Throughout President Barack Obama's first four years in office, he prided himself on his ability to bounce back when much of Washington thought his presidency was in peril. ... This time, the president is fighting to regain trust and credibility with the American people. Those are the same qualities that helped keep him afloat during those earlier battles. ... The widespread problems have spurred questions about the normally cool and confident president's management style and his competence (Pace, 11/17).

The Associated Press:  Obama Struggles To Save His Cherished Health Law
President Barack Obama's health care law risks coming unglued because of his administration's bungles and his own inflated promises. To avoid that fate, Obama needs breakthroughs on three fronts: the cancellations mess, technology troubles and a crisis in confidence among his own supporters. Working in his favor are pent-up demands for the program's benefits and an unlikely collaborator in the insurance industry. But even after Obama gets the enrollment website working, count on new controversies. On the horizon is the law's potential impact on job-based insurance. Its mandate that larger employers offer coverage will take effect in 2015 (Alonso-Zaldivar, 11/16).

Los Angeles Times: White House Optimistic Obama Will Bounce Back From Healthcare Glitches
He's vented, attacked, apologized and adjusted. Now, President Obama has one move left in his attempt to salvage the rollout of his healthcare law: hope the website works soon. The White House, knowing a functional website is needed to calm its panicky allies, has now entered the wait-and-see period of its triage after the turmoil that has followed the Oct. 1 rollout. With the latest fix to the law unveiled, a bruising House vote behind them and experts working feverishly on the broken website, administration officials believe they may have weathered the worst (Hennessey and Parsons, 11/16).

The Wall Street Journal: Health-Law Fracas Leaves Congress In Limbo
Furor over the botched implementation of President Barack Obama's health-care law has allowed Congress to engage in a familiar activity: procrastination. Prospects already were dim for substantial legislation in the dwindling days of 2013, but the headline-grabbing fights over the federal health exchange and canceled insurance policies have given House Republicans no incentive to change the subject. The issue has drowned out talk of an immigration overhaul, taken the focus off high-stakes budget talks and stalled efforts to rewrite the tax code (Peterson and McKinnon, 11/17).

The New York Times' Congressional Memo: Lesson Is Seen In Failure Of 1989 Law On Medicare
Angry Americans voice outrage at being asked to pay more for health coverage. Lawmakers and the White House say the public just doesn't appreciate the benefits of the new health law. Opponents clamor for repeal before the program fully kicks in. The year was 1989, and the law was the Medicare Catastrophic Coverage Act, which was supposed to protect older Americans from bankruptcy due to medical bills. Instead it became a catastrophe for Democratic and Republican lawmakers, who learned the hard way that many older Americans did not want to be helped in that particular way (Hulse, 11/17).

The Wall Street Journal: High-Risk Patients Fuel More Health-Law Worry
So-called high-risk pools for people rejected by commercial health-insurance companies were supposed to be largely phased out when President Barack Obama's health law kicked in. Instead, they are gaining a brief second life in some states due to the problems with the federal health-insurance exchange created by the law (Radnofsky, 11/17).

Politico: States Divided Over Complying With Obamacare 'Fix'
State regulators aren't rushing to President Barack Obama's rescue after the White House's attempt to fix the rising wave of canceled health insurance policies. The president's decision to extend the renewal window for existing health plans won't work for the millions losing their coverage unless insurers and state insurance regulators give their blessing (Millman and Cheney, 11/18).

Politico: Insurance Lobby: ACA Fix No Panacea
Two top insurance industry executives bent over backwards on Sunday not to pick a fight with the Obama administration, even as they said the president's latest Obamacare fix will be a real pain for them. Former Sen. Ben Nelson (D-Neb.), the namesake of the infamous and discarded Cornhusker Kickback in the Affordable Care Act who is now the chief executive of the National Association of Insurance Commissioners, said President Barack Obama's fix to allow insurance companies to continue offering substandard plans through 2014 has no teeth (Epstein, 11/17).

USA Today: After Obamacare Fix, Consumers Remain Uncertain
Cathy Pedersen is in what amounts to health insurance limbo. When President Obama announced a rule change last week to his Affordable Care Act that potentially would allow hundreds of thousands of Americans to keep their old insurance plans, Pedersen saw a glimmer of hope that the inexpensive, high-deductible plan she's been purchasing for nearly 20 years wouldn't be canceled after all (Madhani and Barnett, 11/17).

The Wall Street Journal: Wal-Mart Says Insurance Costs May Hurt Customer Spending
Wal-Mart Stores Inc.  has a long list of reasons why its customers aren't spending as much as hoped: the expiration of the payroll tax cut in January, the November rollback of food-stamp benefits and continued uncertainty in Washington. Now, the world's largest retailer is hinting at a new one: the looming individual mandate to buy health insurance under the Affordable Care Act (Banjo, 11/17).

The New York Times: After Obama Meeting, Insurers Question Plan's Workability
A day after they were caught off guard by President Obama's proposal to prevent cancellation of insurance policies for millions of Americans, top executives of some of the biggest insurance companies emerged from a meeting at the White House on Friday, expressing mixed feelings about whether the idea could work in every state.  The hastily called meeting was an attempt by the White House to address the growing frustration of the nation's insurers over the administration's fumbling of the health care law. It came just a day after the president announced on television that insurers could now continue coverage for people whose policies were being canceled because they did not meet the new law's standards (Abelson and Craig, 11/15).

The Associated Press: GOP Sees Health Care Law As Big 2014 Opportunity
In his West Virginia district, the TV ads attacking Democratic Rep. Nick Rahall over the calamitous startup of President Barack Obama's health care law have already begun. The 19-term veteran, a perennial target in a GOP-shifting state, is among many in the president's party who have recited to constituents Obama's assurance that they could keep insurance coverage they liked under the 2010 overhaul.  ... Rahall was among 39 Democrats who, despite an Obama veto threat, voted Friday for a GOP measure that would let insurers continue selling policies to individuals that fall short of the health care law's requirements. ... Republicans are emboldened by Obama's reversal and the Democrats' scramble for cover (Fram, 11/16).

The Washington Post: Health-Care Law Has Changed Game For Democrats Looking To 2014 Election
Few places may better explain how the bungled launch of President Obama's health-care law has scrambled the political landscape for Democrats than this hamlet north of Philadelphia. Democrats have been hoping to capitalize on the political fallout for the GOP from the recent government shutdown. If they can do so anywhere, it should be in the suburbs north and west of the city where three adjoining congressional districts represent a confluence of Democratic Party ambitions for the 2014 midterm elections. ... The recent debacle over HealthCare.gov's rollout may have narrowed whatever perceived advantages Democratic candidates may have had over Republican opponents. In some minds, the health-care law's flubs have merged with the government shutdown to render an unfavorable verdict on all of Washington (O'Keefe and Kane, 11/16).

Politico: Obamacare: So, What Could Go Wrong Next?
The stumble-filled debut of President Barack Obama's health care law is drawing new attention to the other risks that have been on the radar screen of health care wonks for months. Think health insurance plans sinking under the weight of sick customers, newly insured people being stunned that they still have to spend on health care, and possibly another wave of canceled policies -; right before the 2014 elections (Nather, 11/18).

The Washington Post: HealthCare.gov Goal Is For 80% Of Users To Be Able To Enroll For Insurance
The Obama administration will consider the new federal insurance marketplace a success if 80 percent of users can buy health-care plans online, according to government and industry officials familiar with the project. The goal for how many people should be able to make it through the insurance exchange is an internal target that administration officials have not made public. It acknowledges that as many as one in five Americans who try to use the Web site to buy insurance will be unable to do so (Goldstein and Eilperin, 11/16).

Los Angeles Times: Healthcare Coverage Counselor Stymied By Website Problems
Passport and tax records in hand, Nela Barboza fiddled nervously with a plastic folding fan as she approached Jessie Orozco's desk. "Buenas tardes," she said cordially. "I'm here to sign up for Obamacare." Orozco, a benefits counselor at St. John's Well Child & Family Center in South Los Angeles, was thrilled. ... The sense of anticipation quickly dissipated. Orozco encountered problems with the state website created for counselors like her. She couldn't find forms in Spanish, the language Barboza best understands. She had trouble estimating the costs Barboza would pay and confirming details of what would be covered (Brown, 11/16).

Los Angeles Times: Emails Show Officials Alarmed By Healthcare.gov Months Before Debut
As work on healthcare.gov -; the federal online portal to sign up for new health insurance plans -; backed up during the summer, employees of the agency responsible for it started to raise alarms. In emails, they listed problems that included "seriously substandard staffing," shoddy work and a lack of coordination between contractors (Tanfani, 11/15).

The Washington Post's The Fact Checker: False Claims About A Health-Care Memo Persist Even After Testimony
The committee's news release asserted that a Sept. 3, 2013, memo outlined "serious security vulnerabilities" in the exchange and quoted Chao, who had not seen it before being shown it by committee staff, as saying it "presented a significant risk to the system."  But it turned out that, upon close examination of the memo, it had nothing to do with the parts of the Web site that launched on Oct. 1. Instead, the memo dealt with modules of the Web site that would not be operational until spring of 2014 -; and  even when these modules go online, they will not submit or share personally identifiable information (Kessler, 11/18).

The New York Times: Tennessee Governor Hesitates on Medicaid Expansion, Frustrating Many
Gov. Bill Haslam of Tennessee describes it as "trying to thread a needle from 80 yards." Mr. Haslam is only the latest Republican tailor trying to figure out whether to expand the state's Medicaid rolls as prescribed by President Obama's Affordable Care Act. In his case, it involves trying -; so far unsuccessfully -; to balance some sharply conflicting concerns: struggling hospitals, local business groups, dwindling state resources and fierce conservative opposition to the new health care law. And it has left him hanging out there, with no resolution in sight (Lyman, 11/16).

The Washington Post: Fired DC Insurance Commissioner Tried To Apologize For Criticizing Obamacare Fix
A fuller accounting of D.C. Mayor Vincent C. Gray's (D) firing of the city's insurance commissioner is coming into view. Documents and interviews show that criticism of William P. White was immediate and fierce inside Gray's office last week when White issued a statement critical of President Obama's proposed fix to part of the botched rollout of the Affordable Care Act (Davis, 11/18).

Politico: D.C. Names Insurance Commissioner
The D.C. city government has named Chester A. McPherson as the new acting insurance commissioner, days after the former commissioner was fired following his statement against the White House's administrative fix on cancelled insurance plans. McPherson, the acting commissioner, had been the deputy commissioner of market operations at the Department of Insurance, Securities and Banking since August 2011 (Haberkorn, 11/17).

The Washington Post: D.C. Insurance Commissioner Fired A Day After Questioning Obamacare Fix
A day after he questioned President Obama's decision to unwind a major tenet of the health-care law and said the nation's capital might not go along, D.C. insurance commissioner William P. White was fired. White was called into a meeting Friday afternoon with one of Mayor Vincent C. Gray's (D) top deputies and told that the mayor "wants to go in a different direction," White told The Washington Post on Saturday. White said the mayoral deputy never said that he was being asked to leave because of his Thursday statement on health care. But he said the timing was hard to ignore. Roughly 24 hours later, White said, he was "basically being told, 'Thanks, but no thanks' " (Blake, 11/16).

The New York Times: Washington Insurance Official Is Ousted
The insurance commissioner for the District of Columbia was dismissed from his job just a day after he publicly questioned a decision by President Obama to reverse a provision of the Affordable Care Act, a person with knowledge of the events said on Sunday (Craig and Shear, 11/17).

The Wall Street Journal's Washington Wire: Sacked DC Insurance Chief Admits 'Misstep'
The District of Columbia's insurance commissioner lost his job after he publicly criticized President Barack Obama's decision to allow an extension of health policies that don't comply with new federal law, making his comments without approval from the mayor's office on a politically sensitive topic. William P. White, who had been the district's top insurance watchdog since 2011, was replaced over the weekend by a deputy commissioner in the department, who will serve as acting commissioner "effective immediately," according to a statement released Sunday by the Department of Insurance, Securities and B (Scism, 11/17).

The Wall Street Journal: UnitedHealth Culls Doctors From Medicare Advantage Plans
UnitedHealth Group Inc., the nation's largest provider of privately managed Medicare Advantage plans, has dropped thousands of doctors from its networks in recent weeks-;spurring protest from lawmakers and physician groups and leaving many elderly patients unsure about whether they need to switch plans to keep seeing their doctors. Doctors in at least 10 states have received termination letters, some citing "significant changes and pressures in the health-care environment" (Beck, 11/16).

Los Angeles Times: Health Measures To Dominate 2014 Voter Ballot
Obamacare's troubled rollout -; and its more successful California start -; may be dominating the news now. But wait till next year. An election year ballot full of health issues awaits California voters next November. And the lineup could spur a campaign free-for-all that may prompt hundreds of millions of dollars in campaign spending (Lifsher, 11/17).