Health law implementation proceeds -- with fits and starts

Even as the election has altered the landscape for lawmakers who hoped to repeal the 2010 health law, some opponents are pressing on with legal challenges. Specific elements of the law, such as its health exchanges, also present logistical and financial issues for the Obama administration.

Politico: Back To The Drawing Board For Obamacare Foes
[Republican] support for full repeal isn't going anywhere. But they also realize the short-term strategy has to change. The opposition plan is now centered on three main pieces, according to conversations with House and Senate Republicans: Focus on piecemeal repeal where it might be possible to pick up a few Democratic votes; use the House majority to conduct investigations into the implementation of the law; and be ready to act when the law crumbles, as they argue that it will (Haberkorn, 11/26).

Politico: Time's Short, But Obamacare Foes Press On In Court
The window is closing for those who want to bulldoze President Barack Obama's health law in court. "It's going to become increasingly difficult because courts are much less willing to overturn something that's already entrenched," said Randy Barnett, the Georgetown University law professor who helped construct the Supreme Court argument against the law earlier this year. ... But the right-leaning critics of the law aren't waving the white flag yet. And even if they can't get rid of the whole law, they are taking legal aim at parts of it (Cheney, 11/26).

Medpage Today: Exceptions To Birth Control Mandate Grow
An Illinois Christian book publisher is the third organization to get a reprieve from a federal court and be told it doesn't have to comply with the Affordable Care Act's (ACA's) contraception mandate. A federal judge here agreed with Tyndale House Publishers that adhering to the law by supplying coverage for certain contraceptives would infringe on its religious freedom. … Tyndale House Publishers, a self-insured company employing 260 full-time workers here, objected and sued the Department of Health and Human Services (Pittman, 11/23).

The Hill: Obama Faces Huge Challenge In Setting Up Health Insurance Exchanges
The Obama administration faces major logistical and financial challenges in creating health insurance exchanges for states that have declined to set up their own systems. ... Sixteen states -; most of them governed by Republicans -; have said they will not set up their own systems, forcing the federal government to come up with one instead (Viebeck, 11/25).

Meanwhile, state leaders continue to wrestle with health exchange decisions -

Kaiser Health News: Minnesota Facing Bigger Bill For State's Health Insurance Exchange
Minnesota's state health insurance exchange will cost $54 million in 2015 to operate, according to the Gov. Mark Dayton administration. The cost comes in at greater than earlier estimates of $30 to $40 million. The state would not have to find the money until 2015, when the state exchanges are required to be financially self-sustaining (Stawicki, 11/25).

The Associated Press: New Hampshire Could Partner With Feds On Health Exchange
New Hampshire could revisit a state law requiring the federal government to run a health insurance exchange ... State Republicans opposed implementing the federal health care overhaul law. They helped turn back $1 million in federal money to be used for planning and passed a law banning the state from establishing an exchange to serve as a marketplace for consumers to find insurance. That could change with the shift in power after the election. Democrats regained control of the House (Love, 11/26).

In other implementation news, a report measures the reach of ACOs -

Politico Pro: Report: ACOs Already Cover 10 Percent Of The Country
An estimated 25 million to 31 million people are treated by organizations already participating in ACOs of some kind, according to a report to be released Monday by the management consulting group Oliver Wyman. By no means are they all receiving truly "accountable care" yet, authors Richard Weil and Niyum Gandhi write, but the rapid growth of ACOs suggests that success in some of the experiments could spread relatively quickly to change the way health care is delivered and paid for in the country. They don't have high expectations for broad savings immediately (Norman, 11/26).

And, the health law is expected to exacerbate a physician shortage -

The Dallas Morning News: Thinly Spread Primary-Care Doctors Face Surge Of Patients From Health Law
Angie Wang arrived at UT Southwestern Medical School in Dallas after two years of working in a New York laboratory trying to unlock the mysteries of Alzheimer's disease ... By selecting family practice, Wang will join an inadequate number of primary-care doctors, the kind who are supposed to care for the millions of newly insured Americans flowing into the U.S. health care system in 2014. Their ranks include family practitioners, pediatricians, obstetrician-gynecologists and general internists (Jacobson, 11/24).