First Edition: December 2, 2013

Today's early morning highlights from the major news organizations, including reports about healthcare.gov's status, the challenges that lie ahead and the concerns being expressed by consumers and insurers. 

Kaiser Health News: Covered California Faulted For Failing To Reach More Spanish Speakers
Kaiser Health News staff writer Anna Gorman, working in collaboration with McClatchy, reports: "Latino lawmakers and health leaders in California are sounding alarms about the insurance marketplace's preparation and tactics for enrolling Spanish speakers and are urging changes following the recent announcement that fewer than 1,000 signed up in the health law' first month"(Gorman, 12/1). Read the story.

Kaiser Health News: With Three Weeks Left, Consumers Fear They May End Up Without Health Coverage On New Year's Day
Kaiser Health News staff writer Jordan Rau reports: "or people in the states with well-functioning insurance websites, such as California, New York and Kentucky, this appears to leave plenty of time. But making the deadline could be dicier for people in Arizona and the 35 other states where the federal website healthcare.gov is the path to coverage, as well as Oregon and Hawaii, which have struggled to get their sites functioning. On Sunday, the government reported progress in improving healthcare.gov, saying the site now allows more than 800,000 visits a day with the rate of timeouts or crashes reduced to below 1 percent. Officials said repairs continue"(Rau, 12/2). Read the story.

Kaiser Health News: Medicare Seeks To Curb Spending On Post-Hospital Care
Kaiser Health News staff writer Jordan Rau, reporting in collaboration with The Washington Post, reports: "After years of trying to clamp down on hospital spending, the federal government wants to get control over what Medicare spends on nursing homes, home health services and other medical care typically provided to patients after they have left the hospital. Researchers have discovered huge discrepancies in how much is spent on these services in different areas around the country. In Connecticut, Medicare beneficiaries are more than twice as likely to end up in a nursing home as they are in Arizona. Medicare spends $8,800 on each Louisiana patient getting home health care, $5,000 more than it spends on the average New Jersey senior. In Chicago, one out of four Medicare beneficiaries receives additional services after leaving the hospital-;three times the rate in Phoenix" (Rau, 12/1). Read the story and the related chart.

Kaiser Health News: UnitedHealthcare Dropping Hundreds Of Doctors From Medicare Advantage Plans
Reporting for Kaiser Health News, in collaboration with USA Today, Susan Jaffe reports: "The company is the largest Medicare Advantage insurer in the country, with nearly 3 million members.  More than 14 million older or disabled Americans are enrolled in Medicare Advantage plans, an alternative to traditional Medicare that offers medical and usually drug coverage but members have to use the plan's network of providers" (Jaffe, 12/1). Read the story.

Kaiser Health News: Capsules: Breaking Up With Healthcare.gov; The Iowa Insurance Challenge: Rural Outreach; Should Consumers Give Healthcare.gov A Second Chance?; Doctors Groups Share Concerns About Narrow Networks, Confusion With White House
Now on Kaiser Health News' blog, Alaska Public Radio's Annie Feidt, working in partnership with KHN and NPR, reports on difficulties with insurance enrollment: "Enrolling in healthcare.gov is not easy. In Alaska, just 53 people enrolled in the first month. Anchorage hair stylist Lara Imler is one of the few who got through. Now though, after she discovered problems with her application, Imler wants to cancel her enrollment" (Feidt, 12/1).

Also on the blog, Iowa Public Radio's Sarah McCammon, working in partnership with KHN and NPR, reports on Iowa's enrollment efforts: "With more than 200,000 Iowans lacking health insurance, there are lots of questions but not many people equipped to answer them. Iowa Insurance Commissioner Nick Gerhart says the state got about $600,000 in federal funding for pay for navigators, who help people understand their options and sign up for coverage. 'That's not a lot of money to build a statewide campaign," he notes. "You have to hire staff, train staff, hold events. I mean that's expensive" (McCammon, 11/271).

In addition, Phil Galewitz, working in collaboration with Cosmopolitan, offers this status check on the health law: "As you probably know from all of the talking (and screaming) heads on TV, the Affordable Care Act (ACA) stumbled out of the gate with a glitch-ridden enrollment site, cancellation of some insurance policies and other technical glitches that have made Steve Jobs roll over in his grave. But if recent headlines and late-night jokes have left you confused, let us straighten it all out for you and tell you what you need to know" (Galewitz, 11/27). 

Galewitz also reports on a White House meeting with physicians: "The nation's top physician groups told White House officials Tuesday they are worried about what consumers will encounter after Jan. 1, when millions are expected to gain coverage under the Affordable Care Act" (Galewitz, 11/27). Check out what else is new on the blog.

Kaiser Health News also tracked weekend news highlights, including the Obama administration's progress report on website fixes (12/1) and news about last week's Obama administration announcement that the small business health exchange would be delayed for one year (11/27).

Politico: Redone Healthcare.gov Faces New Test
The test will start on what's expected to be heavier Web traffic on Monday. And it will last through Dec. 23, the deadline for millions of people -; including those who have had their policies canceled -; who want to log on and get coverage that starts on Jan. 1. The soft relaunch on Sunday also resets the effort by the administration and its health care allies to have 7 million people sign up in Obamacare insurance exchanges in the next four months. If people can sign on and get covered, the White House hopes, it could start rebuilding support for President Barack Obama's signature health law and confidence in the president himself (Haberkorn, 12/1).

The Washington Post: Healthcare.gov Meets Deadline For Fixes, Obama Administration Says
After a series of technical fixes and capacity upgrades, many of which were made over the past week, HealthCare.gov is now working more than 90 percent of the time -; a big improvement over October, when the site was operating only about 43 percent of the time and frequently crashed, said Jeffrey Zients, the administration official overseeing the improvements. … Even with the improved performance, some people are likely to encounter problems on the site. And there is another worry -; reports sent to insurance companies about who has enrolled in health plans include errors that could cause problems when people try to use their new insurance plans next year (Somashekhar and Sun, 12/1).

The Associated Press/Washington Post: Gov't Diagnosis: Healthcare.gov On The Mend
Yet officials acknowledged more work remains on the website, which made its national debut two months ago with hundreds of software flaws, inadequate equipment and inefficient management. Federal workers and private contractors have undertaken an intense reworking of the system, but some users might still encounter trouble. How many problems are left? That's the question consumers and lawmakers alike will be eying before the next crucial deadline: Dec. 23 (12/2).

Los Angeles Times: Major Health Website Bugs Fixed, Officials Say, But More Work Needed
The Obama administration said Sunday it had met its deadline to fix the major problems that have hobbled the federal healthcare website since its disastrous debut two months ago, but officials acknowledged that further repairs were necessary. … Administration officials concede that the site still may not be able to handle the crush of people expected to seek insurance this month. Consumers need to select health plans by Dec. 23 if they want coverage to begin Jan. 1. During peak times, some consumers may be put into a queue to gain access, officials said (Levey and Mascaro, 12/1).

NPR: A New Worry Looms Online For The Affordable Care Act
As the Obama administration scrambles to fix the glitch-plagued site, experts are beginning to worry about another problem that may further impair the rollout of the Affordable Care Act. Health insurance companies say they're seeing numerous errors in a form that plays a vital part in the enrollment process. The problems are manageable so far, but many worry about what will happen if enrollment surges in the weeks to come (Zarroli, 11/30).

The New York Times: Insurers Claim Health Website Is Still Flawed
The problem is that so-called back end systems, which are supposed to deliver consumer information to insurers, still have not been fixed. And with coverage for many people scheduled to begin in just 30 days, insurers are worried the repairs may not be completed in time (Pear, 12/1).

The Wall Street Journal: Insurers Seek To Bypass Health Site
Insurers and some states are continuing to look for ways to bypass the balky technology underpinning the health-care law despite the Obama administration's claim Sunday that it had made "dramatic progress" in fixing the federal insurance website. Federal officials said they had largely succeeded in repairing parts of the site that had most snarled users in the two months since its troubled launch, but acknowledged they only had begun to make headway on the biggest underlying problems: the system's ability to verify users' identities and accurately transmit enrollment data to insurers (Radnofsky, Schatz and Ante, 12/1).

The Wall Street Journal's CIO Report: White House Tracking HealthCare.gov Performance With Real-time Analytics
Administrators of HealthCare.gov used Web analytics software to track the insurance exchange's performance in real-time in order to identify and fix issues hampering users of the website. The software, from startup New Relic Inc., was a key tool that led to several fixes, including a new feature that alerts consumers via email when the exchange is available to process their requests. However, it's not clear whether these improvements are enough to ensure that connections between the federal exchange and databases managed by health insurers necessary for completing insurance transactions will work properly (Boulton, 12/1).

The Washington Post: Consumer Tips For Healthcare.gov Show Administration's Cautious Optimism
The Obama administration on Sunday reported vast improvement with the HealthCare.gov health-insurance portal that opened with extensive glitches in October, while acknowledging that the site still needs more work. One sign of ongoing problems came in the form of a blog entry and infographic that Health and Human Services Secretary Kathleen Sebelius published on Huffington Post. Both items provide tips for consumers visiting the site, most notably by encouraging them to use it during off-peak hours -; mornings, nights and weekends (Hicks, 12/2).

The Washington Post: New Health-Care Law Pushing Employers To Make Tough Decisions About Coverage
For years, Ron Peppe spent much of his time poring over contracts that his company, Canam Steel, won to build steel infrastructure in highways, stadiums and hotels, such as the underground steel foundation it just completed for the new Marriott Marquis in downtown Washington. These days, Peppe, the head of legal and human resources at Canam, whose U.S. headquarters are in Point of Rocks, Md., still reads plenty of contracts. But he is also spending much more time reading the ongoing deluge of rules and regulations coming out of federal agencies that are meant to help guide employers as they adjust their companies' health benefits under President Obama's signature health-care law, the Affordable Care Act (Ho, 12/1).

The Washington Post: Launch Of Healthcare.gov Has Been A Rough Passage For Program 'Navigators'
McCarron's group is one of about 100 organizations across the country that received government grants to help people sign up for coverage. These groups of "navigators" have been stymied by the same technical problems that have thwarted individual consumers, and many say they have become worn down and discouraged. Now they are hoping that this weekend will mark a turnaround for the program, which they once promoted with enthusiasm and more recently have had trouble defending (Somashekhar, 11/30).

Los Angeles Times: Oregon May Be In Over Its High-Tech Head In Obamacare Rollout
In Oregon, a state envied for its high tech, sign-ups under the new federal healthcare law have been anything but. About 400 newly hired workers in Salem are processing paper applications by the thousands for health insurance under President Obama's law. They review each 19-page application, calculate eligibility for tax subsidies, and then mail back a packet of each consumer's options -; which the customers must mail back to complete the sign-up process (Reston, 11/28).

Los Angeles Times: Kentucky Governor Sees Health Law As Chance To Heal An Ailing State
But leading one of the nation's poorest, sickest states, [Kentucky Gov. Steve] Beshear has improbably overseen one of the most successful rollouts of Obama's troubled healthcare overhaul and become, deep in his long public career, a hero to Democrats grasping to find a redeeming figure amid the political wreckage. He's an unlikely champion, not least because Kentucky's two U.S. senators are both implacable opponents of the program (Barabak, 11/28).

Los Angeles Times: Stores Selling Obamacare Policies Popping Up Across California
As shoppers hunt for holiday bargains this season, they may find something unusual for sale at the mall: Obamacare. With enrollment deadlines looming, California officials, insurance companies and agents are staking out retail space to sign up thousands of people as part of the Affordable Care Act. These sales tactics reflect how dramatically the healthcare law is changing the insurance industry (Terhune, 11/27).

USA Today/The Jackson Clarion-Ledger: Two States, Different Experiences Under Health Care Law
For a 50-year-old nonsmoker in Mississippi's most populous county, the least expensive health plan in the federal insurance marketplace costs $385 a month, nearly 40% higher than its equivalent in Kentucky. There, the same person can find a mid-range, or Silver plan, for as little as $278 a month. The annual savings between those two plans could purchase a new Apple MacBook Pro laptop, for example, or six weeks of groceries for the average family of four. And Kentucky's median household income last year was already nearly $4,500 higher than Mississippi's: $41,086 vs. $36,641 (Le Coz, 12/1).

The New York Times: Medicaid Growth Could Aggravate Doctor Shortage
Dr. Ted Mazer is one of the few ear, nose and throat specialists in [the San Diego] region who treat low-income people on Medicaid, so many of his patients travel long distances to see him. But now, as California's Medicaid program is preparing for a major expansion under President Obama's health care law, Dr. Mazer says he cannot accept additional patients under the government insurance program for a simple reason: It does not pay enough (Goodnough, 11/28).

Los Angeles Times: For Congress, Healthcare Plans Remain A Notch Above
Trying to align lawmakers with the people they represent, Congress three years ago decided that when the new healthcare plan took effect, members would give up their platinum health benefits and enroll in the online marketplaces created for millions of other Americans. In typical congressional fashion, however, things have not worked out exactly as advertised (Memoli, 12/1).

USA Today: Long-Shot Legal Challenges To Health Care Law Abound
President Obama's signature health care law could get nicked by the Supreme Court next year when the justices take up the mandate that most businesses provide free coverage for contraception. But that's not the only legal hurdle it faces. In courtrooms across the country, Republican state attorneys general and conservative groups are challenging the way the law was passed, the way it was worded and the bureaucracy it created (Wolf, 11/29).

Politico: Contraceptive Cases  Raise Religious Liberty Issues
The Supreme Court in early spring will hear two legal challenges to Obamacare's contraception coverage requirement, a case that addresses a complex question that has never come squarely before the court: Can a for-profit company engaged in commercial activities declare religious beliefs? Under the women's preventive health benefit in the Affordable Care Act most employers must provide all Food and Drug Administration-approved forms of contraception with no co-pays. There are exemptions for religious organizations and ways for religious-affiliated institutions to try to work around the requirement. But owners of nonreligious businesses who oppose some or all contraceptives say the government shouldn't be able to require them to break with their religious beliefs (Haberkorn, 12/2).

Politico: Sandy Hook Spurs States' Mental Health Push
At least 37 states have increased spending on mental health in the year since Adam Lanza shot dead 20 children, six school employees and his mother in Newtown, Conn. It's not just about money, either. States are experimenting with new -; and sometimes controversial -; ways to raise awareness about psychological distress, to make treatment more accessible for children and adults and to keep firearms away from those struggling with mental illness (Simon, 12/2).