First Edition: November 25, 2013

Today's headlines include reports about how political concerns and strategies are taking shape as a result of healthcare.gov's difficulties.

Kaiser Health News: Administration Tests Fixes That Would Allow Insurers, Brokers To Enroll More Consumers
Kaiser Health News staff writer Julie Appleby reports: "Insurers and the Obama administration are testing fixes to healthcare.gov designed to allow insurers and web-based brokers to directly enroll consumers who qualify for subsidies under the health law. Allowing insurers and online brokers to directly enroll customers in subsidized coverage could be key to signing up the millions of people the government had projected would gain coverage this year. …. But so far, some of those same technical difficulties have prevented most insurers and brokers from being able to do that. Late Friday afternoon, the administration said it had made progress in tweaking the website's design, and was launching a pilot test of the fixes with insurers in Texas, Ohio and Florida" (Appleby, 11/24). Read the story.

Kaiser Health News: Health Law Enrollment Efforts For Asian Americans Face Challenges Of Language Diversity, Cultural Differences
Kaiser Health News staff writer Ankita Rao, working in collaboration with USA Today, reports: "But there is no easy prescription for reaching such a diverse group. Health care workers and advocates must consider dozens of languages and dialects -; from Bengali to Tagalog -; when communicating with the approximately 3 million Asian Americans who have trouble speaking and understanding English. In addition, their religions, cultures and socioeconomic status add complexity to the challenge of developing educational campaigns" (Rao, 11/24). Read the story.

Kaiser Health News: Capsules: Obamacare Deadline For Jan. 1 Coverage Extended One Week; Sex Sells … Health Insurance?
Now on Kaiser Health News' blog, Mary Agnes Carey reports on the deadline extension: "Consumers will have an extra week -; until Dec. 23 – to enroll in health insurance coverage that begins Jan. 1, Obama administration officials said Friday. … While the administration has said the site will work smoothly for most customers by Nov. 30, some advocates had been concerned that consumers still might not have enough time to sign up for coverage that would take effect Jan. 1. The previous deadline was Dec. 15" (Carey, 11/22).

Also on Capsules, Eric Whitney reports on a provocative health insurance advertising campaign in Colorado: "The Affordable Care Act is good for young adults because it'll save them money on health care, leaving them more to spend on liquor and birth control. That's one way to interpret the message from a provocative new ad campaign in Colorado. Not everyone is thrilled with it. In a federal hearing in October, Rep. Cory Gardner, R-Colo., showed Health and Human Services Secretary Kathleen Sebelius one of the ads" (Whitney, 11/24). Check out what else is on the blog.

Kaiser Health News also tracked weekend health policy headlines, including what happened on the Sunday morning talk shows. 

The Washington Post: For Beleaguered IRS, A Crucial Test Still Awaits After Troubled Rollout Of Health-Care Law
The success of the Affordable Care Act could ultimately turn on the performance of an agency that has so far eluded the public spotlight amid the program's tumultuous rollout. Whether the new law can be enforced will be up to the Internal Revenue Service, an already beleaguered agency charged under the act with carrying out nearly four dozen new tasks in what represents the biggest increase in its responsibilities in decades. None is more crucial than enforcing the requirement that all citizens secure health insurance or pay a penalty (Hamburger and Kliff, 11/24).

The New York Times: Medicaid Expansion Faces Major Logistical Challenges Among the Homeless
Today, most state Medicaid programs cover only disabled adults or those with dependents, so Mr. Cannon and millions of other deeply impoverished Americans are left without access to the program. But starting Jan. 1, President Obama's health care law will expand Medicaid coverage to adults with incomes under 138 percent of the federal poverty line, and enrollment is expected to increase by about nine million next year. Thousands of homeless people will be among the newly covered (Lowry, 11/24).

Politico: As Deadline Nears, Ticking Clock On Democratic Patience
Some Capitol Hill Democrats are preparing to launch broadsides against President Barack Obama if the Affordable Care Act website isn't fixed by the end of the month. That will come in the form of more aggressive scrutiny in Republican-led oversight hearings, open advocacy for further delay in the enrollment deadline and individual coverage mandate, and more calls for a staff shake-up in the White House (Allen, 11/25).

The Wall Street Journal: Spanish-Language Health Site Delayed
It isn't just the English-language federal website that is weighing on the success of the health-care law. Consumers still can't enroll for insurance on CuidadoDeSalud.gov, the U.S. government's Spanish-language health website. The site was supposed to be fully operational by mid-October, but a Centers for Medicare & Medicaid Services spokeswoman said it won't be ready until the end of this month (Schatz, 11/24).

The New York Times: Tension And Flaws Before Health Website Crash
Interviews with current and former Obama administration officials and specialists involved in the project, as well as a review of hundreds of pages of government and contractor documents, offer new details into how tensions between the government and its contractors, questionable decisions and weak leadership within the Medicare agency turned the rollout of the president's signature program into a major humiliation. The online exchange was crippled, people involved with building it said in recent interviews, because of a huge gap between the administration's grand hopes and the practicalities of building a website that could function on opening day. Vital components were never secured, including sufficient access to a data center to prevent the website from crashing. A backup system that could go live if it did crash was not created, a weakness the administration has never disclosed. And the architecture of the system that interacts with the data center where information is stored is so poorly configured that it must be redesigned, a process that experts said typically takes months (Lipton, Austen and LaFranier, 11/22).

The Washington Post: HealthCare.gov Contractor Had High Confidence But Low Success
At 9 a.m. on Aug. 22, a team of federal health officials sat down in a Baltimore conference room with at least a dozen employees of CGI Federal, the company with the main contract to build the online federal health insurance marketplace. For six weeks, the federal officials overseeing the project had become increasingly worried that CGI was missing deadlines, understaffing the work and overstating its progress. ... A final "pre-flight checklist" before the Web site's Oct. 1 opening, compiled a week before by CMS, shows that 41 of 91 separate functions that CGI was responsible for finishing by the launch were still not working (Goldstein and Eilperin, 11/23).

The Associated Press/Washington Post: Obama Officials Upbeat About Health Site Fixes
There won't be a magic moment, but the Obama administration's much-maligned health insurance website should be able to weather an expected year-end crush of customers, officials asserted Friday. A combination of software fixes, design changes, added hardware and newly announced wiggle room should provide the right combination to finally deliver a workable website, White House troubleshooter Jeffrey Zients said in an upbeat assessment. Zients is a management consultant parachuted in by the White House to extricate President Barack Obama from a technology debacle that has sent his poll ratings into a nose dive (11/22).

The Washington Post: State-Run Health Insurance Exchanges Report November 'Enrollment Surge'
After anemic enrollment in the federal health insurance marketplace, several states running their own online exchanges are reporting a rapid increase in the number of people signing up for coverage, a trend officials say is encouraging for President Obama's health-care law. By mid-November, the 14 state-based marketplaces reported data showing enrollment has nearly doubled from last month, jumping to about 150,000 from 79,000, according to state and federal statistics. The nonprofit Commonwealth Fund, which has been tracking the data, called the most recent numbers "a November enrollment surge" (Sun and Kliff, 11/22).

NPR: White House Pushes Next Year's Health Plan Sign-Ups Later
Another day brings another delay for the federal health law known as the Affordable Care Act. On Friday, the Obama administration announced that, starting next year, it is pushing back the start of the sign-up period for those buying individual and small business insurance until mid-November, rather than mid-October. That will give insurance companies some extra time to set their premiums, given this year's difficulties (Rovner, 11/22).

The Wall Street Journal: Health-Law Sign-Up Period Extended For A Week
Officials cited difficulties with the federal HealthCare.gov website in pushing back the deadline to Dec. 23 from Dec. 15 for coverage that takes effect Jan. 1. That is the earliest day that coverage under President Barack Obama's health-care law can begin. The move highlights the time pressure to get the law's new health-insurance exchanges running (Radnofsky and Martin, 11/22). 

The Washington Post: In Rural Kentucky, Health-Care Debate Takes Back Seat As The Long-Uninsured Line Up
On the campaign trail, Senate Minority Leader Mitch McConnell was still blasting the new health-care law as unsalvageable. At the White House, President Obama was still apologizing for the botched federal Web site. But in a state where the rollout has gone smoothly, and in a county that is one of the poorest and unhealthiest in the country, Courtney Lively has been busy signing people up: cashiers from the IGA grocery, clerks from the dollar store, workers from the lock factory, call-center agents, laid-off coal miners, KFC cooks, Chinese green-card holders in town to teach Appalachian students (McCrummen, 11/23).

USA Today: Analysis Of Huge Data Sets Will Reshape Health Care
Insurers will soon reassess how they predict costs; patients will let doctors know what medications won't work with their particular genomes; and researchers will look at hospital records in real time to determine the cheapest, most effective ways to treat patients -; all because of developments in what is known as big data. Driven by industry trends and the Affordable Care Act, the analysis of large sets of data, such as medication usage or hospital readmissions, has enabled health care providers and policymakers to make smarter decisions and predict future trends (Kennedy, 11/24).

The Associated Press: NYC Medical Providers Negotiate Insurance Deals
With deadlines looming, medical providers and insurers in New York are negotiating deals that may determine which doctors you can see if you buy a health plan through the state's new insurance marketplace. One of the world's most respected cancer hospitals, Memorial Sloan-Kettering Cancer Center, announced Friday that it had signed agreements to join the networks of three plans being sold through the exchange: Health Republic Insurance, Oscar Insurance and Oxford Health Plans. Oxford will only be available to small businesses (11/22).

Los Angeles Times: Molina Healthcare Poised For Healthy Growth
Molina Healthcare Inc. of Long Beach was looking after the medical needs of low-income people long before Obamacare debuted. Molina Healthcare began 33 years ago after emergency room physician C. David Molina had seen too many poor people with easily treatable and preventable illnesses. He opened three small clinics in Long Beach to serve them (White, 11/24).

The New York Times: In The Health Law, An Open Door For Entrepreneurs
In the weeks since the health insurance marketplaces of the Affordable Care Act went online, a well-publicized ripple of alarm and confusion has permeated the ranks of small-business owners. But less well known is the response of another contingent: newcomers to entrepreneurship who see the legislation as a solution to the often insurmountable expense of getting health insurance. Some even view the Affordable Care Act itself as a business opportunity (Martin, 11/23).

The Wall Street Journal: Companies Prepare To Pass More Health Costs To Workers
Companies are bracing for an influx of participants in their insurance plans due to the health-care overhaul, adding to pressure to shift more of the cost of coverage to employees. Many employers are betting that the Affordable Care Act's requirement that all Americans have health insurance starting in 2014 will bring more people into their plans who have previously opted out (Francis, 11/24).

The Washington Post's The Fact Checker: Ted Cruz's Fuzzy Math About The 'Trade-Off At The Heart Of Obamacare'
Cruz's math in this interview was quite unlike any figures The Fact Checker had heard or seen before, so let's explore how the senator came up with his numbers. Under Cruz's calculations, 200 million people are at risk of losing their insurance in order to benefit just 15 to 20 million people-;while leaving 30 million uninsured (Kessler, 11/25).

The New York Times: Don't Dare Call The Health Law 'Redistribution'
"Redistribution is a loaded word that conjures up all sorts of unfairness in people's minds," said William M. Daley, who was Mr. Obama's chief of staff at the time. Republicans wield it "as a hammer" against Democrats, he said, adding, "It's a word that, in the political world, you just don't use." These days the word is particularly toxic at the White House, where it has been hidden away to make the Affordable Care Act more palatable to the public and less a target for Republicans, who have long accused Democrats of seeking "socialized medicine." But the redistribution of wealth has always been a central feature of the law and lies at the heart of the insurance market disruptions driving political attacks this fall (Harwood, 11/23).

The Associated Press/Washington Post: Analysis: To GOP, All Roads Lead To 'Obamacare'
Republican leader Mitch McConnell, with his eyes on the political road ahead and a GOP-damaging partial government shutdown in the rearview mirror, chalked the Senate shift up to "broken promises, double standards and raw power -; the same playbook that got us Obamacare." The calculation seems to be that there will be time for Republicans to retaliate for the Democratic maneuver that swept away generations of precedent in the tradition-bound Senate. The change didn't eliminate filibusters, and a spirit of revenge actually may give the GOP an incentive to launch them in greater numbers (11/22).

Politico: Dems Worry Leaders In Denial On Obamacare
Democratic leaders claim the bungled launch of Obamacare is just the latest news sensation -; a media-stirred tempest that looks in the heat of the moment like it could upend the midterm election, but ends up fizzling well before voters head to the polls. Some party strategists say they're in denial (Isenstadt, 11/25).

Los Angeles Times: Biden Keeps A High Profile – Except On Healthcare
The week of his 71st birthday, in a two-day trip to Houston and Panama City, Biden was hardly hiding. He toured the Houston port, walked a stretch of the Panama Canal, met with Panama's president and squeezed in meetings with opposition candidates and elected officials when he wasn't making calls to foreign leaders from Air Force 2. But at the same time, he was conspicuously avoiding the healthcare spotlight that has been glaring on the president, Health and Human Services Secretary Kathleen Sebelius and other senior officials. Biden did discuss healthcare at some events. In Houston, he talked with volunteers seeking to sign people up for coverage, meeting with them for more than an hour and reassuring them that healthcare.gov would get back on track (Parsons, 11/22).

Politico: Politics Shadow Senators' Health Exchange Choices
Some of the Senate's most vulnerable members in the 2014 elections are giving up government contributions toward their own health insurance under Obamacare next year as voter sentiment turns against the president's signature program. Several are signing up for their home state exchanges instead of Washington's, allowing them to say they're in the same boat as constituents (Villacorta and Haberkorn, 11/25).

Politico: John Boehner's Premiums Spike Under Obamacare
Don't expect to hear the Ohio Republican complain about his personal price spike, but he's one of many older lawmakers and aides who are just finding out how much more they will have to pay as they move from the old Federal Employees Health Benefits system to coverage in the District of Columbia's new health insurance exchange, as required by a provision in the Affordable Care Act and subsequent federal regulations. That will be true, too, for some consumers across the country who are transitioning into the exchanges (Allen, 11/24).

The New York Times: Court Confronts Religious Rights Of Corporations
Hobby Lobby, a corporation, says that forcing it to provide the coverage would violate its religious beliefs. A federal appeals court agreed, and the Supreme Court is set to decide on Tuesday whether it will hear the Obama administration's appeal from that decision or appeals from one of several related cases (Liptak, 11/24).

The Wall Street Journal: Medicare To Cut Dialysis Payments Much Less Than Expected
The Centers for Medicare and Medicaid Services said it would reduce payments to kidney dialysis providers by less than 1% over the next two years in a reversal of the much-larger cuts it had proposed this summer (Walker, 11/22).

The Wall Street Journal: New Strategies For Long-Term Care
As long-term-care insurance becomes more expensive and harder to get, what are families who want it left to do? Fewer carriers are offering the coverage, which helps pay for future nursing-home, assisted-living and home care. Those that still do are raising premiums on new and longtime policyholders (Greene, 11/22).

The Washington Post: What Are Gov.-Elect Terry McAuliffe's Plans For Virginia's Mental Health System?
In the wake of the Creigh Deeds family tragedy, it seems instructive to look ahead to how Gov.-elect Terry McAuliffe plans to deal with Virginia's mental health system. I wrote a story last month about the views of both gubernatorial candidates on the state system, based in part on their platforms and in part on questions I asked about key issues. McAuliffe fully favors Virginia expanding its Medicaid coverage through the Affordable Care Act, saying it would provide new health care coverage for about 400,000 Virginians and would increase money for mental health treatment (Jackman, 11/25).