First Edition: August 30, 2013

Today's headlines include the latest news on congressional efforts to avert a financial crisis as well as coverage of the news from the Internal Revenue Service, Treasury Department and Department of Health and Human Services about how same-sex marriage will be recognized.

Kaiser health News: A Reader Asks: I Get Coverage Through My Estranged Husband. Can I Choose To Go To The Marketplace?
Kaiser Health News consumer columnist Michelle Andrews offers caution about the financial implications of that switch (8/30). Read the question and answer.

Kaiser Health News: Florida Is No. 2 In Nation For Rate Of Uninsured
The Miami Herald's Daniel Chang, working in partnership with Kaiser Health News, reports: "Florida has the nation's second-highest rate of uninsured residents younger than 65 -; a total of about 3.8 million people, or about 25 percent of the state's population, including more than 500,000 younger than 19, according to U.S. Census data released Thursday" (Change, 8/30). Read the story.

Kaiser Health News: Group Health Omits Abortion Coverage From Plans Sold On State Exchange
The Seattle Times' Carol M. Ostrom, working in partnership with Kaiser Health News, reports: "Group Health Cooperative will not cover abortion in its individual health-insurance plans being offered through the Washington state marketplace put in place by the Affordable Care Act, but says women who buy them will be able to access the service without paying more. Group Health said it made the decision not to include the coverage because of murky regulations about how it would have to account for federal money in plans that offered abortion" (Ostrom, 8/30). Read the story.

Kaiser Health News: Capsules: IRS Ruling On Same-Sex Couples Has Implications For Health Law; Survey: HHS Will Allow 'Unbanked' People To Use Prepaid Debit Cards On Exchanges; Americans Have Low Health Insurance Literacy
Now on Kaiser Health News' blog, Mary Agnes Carey reports on the IRS ruling: "The decision from the Treasury Department and the Internal Revenue Service means that the income of legally married same-sex couples will be considered in determining eligibility for enrollment in the health law's Medicaid expansion and for subsidies to purchase coverage in the law's online marketplaces, or exchanges" (Carey, 8/30).

Sarah Varney reports on the Department of Health and Human Services decision to let "unbanked" people used prepaid debit cards to pay for insurance: "At the urging of advocates for low-income consumers, the Obama administration said Wednesday that it is moving ahead with a rule requiring health plans accommodate households that do not have traditional bank accounts. One in four of the uninsured eligible for federal insurance subsidies does not have a bank account, according to a report released earlier this year by the tax preparation firm Jackson Hewitt" (Varney, 8/29).

Also on the blog, Marissa Evans reports on a survey examining public understanding ofhealth coverage buzz words: "Premium, deductible, copay, all basic health insurance terms many Americans don't understand, according to a recent poll. More than half could not correctly define at least one of these common financial terms related to health insurance, according to poll results released by the American Institute of CPAs" (Evans, 8/29). Check out what else is on the blog.

The New York Times: Talks To Avert A Fiscal Crisis In The Fall End With No Result
Over the past weeks, the Senate group -; which called itself the "sounding board" -; had moved away from the kind of "grand bargain" Mr. Obama had sought, which would combine higher tax revenues and changes to social programs like Medicare to produce trillions of dollars in deficit reduction. Instead, they aimed simply to replace the automatic across-the-board cuts known as the sequester over the next eight years with other budget changes. Mr. Obama, in his most recent budget plan, had accepted $200 billion in sequester savings over eight years, and both sides appeared ready to leave in place small cuts to entitlement programs in the sequester legislation (Weisman, 8/29).

The Washington Post: White House, Republican Senators Give Up On Budget Talks
The end of the talks comes just over a week before Congress is to return from its summer break to confront a series of imminent deadlines, including the risk of a government shutdown Oct. 1 and potential default on the national debt a few weeks after that. … Through multiple meetings with White House Chief of Staff Denis McDonough, Deputy Chief of Staff Rob Nabors and Budget Director Sylvia Mathews Burwell, the group discussed a range of options, including a "grand bargain" that would involve a complete restructuring of Medicare, according to people familiar with the meetings, who spoke on the condition of anonymity to describe the private talks. The group also discussed a smaller deal that would replace much of the remaining sequester savings -; about $500 billion over the next eight years -; with narrower reforms to Medicare, Social Security and other ­mandatory-spending programs, such as farm subsidies (Montgomery, 8/29).

The Associated Press/Washington Post: Republican Senator Says Budget Talks With White House Officials Yield 'No Common Ground'
But the budget talks have always split over Obama's insistence that any reduction in programs such as Social Security or Medicare be accompanied by tax increases or closed loopholes for the rich that would generate more revenue. Obama did win more than $600 billion in tax increases over 10 years on wealthier taxpayers earlier this year and Republicans have said they would not cede more (8/29).

The Wall Street Journal: Budget Talks Fail To Bridge Divide
Republicans have offered to replace the bulk of the sequester cuts-;$518 billion over eight years-;with other, more targeted cuts to Medicare, Medicaid and other entitlement programs, according to a GOP official familiar with the discussions. They offered to raise revenues to reduce the deficit, the official said, but not, as the White House wanted, to replace the sequester (Hook, 8/29).

NPR: Study: Price Shocks On Health Exchanges Appear Unlikely
With new health insurance exchanges set to launch in just over a month, there's been a lot of chatter about how shocking the rates might be. One possibility is that adding sick people to a more comprehensive benefits package will cause premiums to soar. Last spring, the Society of Actuaries predicted an average increase of 32 percent because of to the law, which prompted an outcry from opponents of the law (Rovner, 8/29).

Los Angeles Times: California Unveils Ads For New Health Insurance Market
The state faces the daunting challenge of trying to reach more than 5 million people who are uninsured or don't receive health insurance at work. Now officials are preparing to advertise on television and radio, in print and online -; much of it in Spanish -; to persuade consumers unfamiliar with the federal health law to sign up. The state is purposefully avoiding Hollywood stars in its opening sales pitch. Instead, the state's ads revolve around people worrying about getting care and paying their medical bills in hopes that those stories will counter persistent political attacks and widespread confusion about the Affordable Care Act (Terhune and Gorman, 8/29).

The Wall Street Journal: Subsidies for Older Buyers Give Health Insurers a Headache
But the federal subsidies that make this possible for older people are causing headaches that insurers are struggling to understand. The programs reverse a long-standing tenet of the insurance business: That riskier customers pay more. The subsidies can be far more generous to older people than younger ones, the analysis of Ohio's marketplace shows (Weaver and Radnofsky, 8/29).

The Wall Street Journal: A New Kind Of Insurance Head-Scratcher: Estimating Future Income
Under the health law, millions of Americans will face a new test of their fortunetelling skills: precisely predicting their next year's income. The federal health-care overhaul creates a potentially rich new class of benefits for people-;namely, federal subsidies they can use to buy insurance on the new marketplaces created in each state. Eligibility for subsidies is based on income (Radnofsky and Weaver, 8/29).

The Washington Post: Obamacare Affects Executive And Legislative Employees Differently
Executive-branch employees won't automatically lose their existing health coverage when they become eligible soon for the insurance exchanges forming under President Obama's healthcare law, according to the federal personnel office. Agency officials began driving that point home this week amid continued confusion and concerns about how the so-called Obamacare legislation will affect health-benefits for federal employees (Hicks, 8/30).

The Washington Post: Adults In The Northeast And Midwest Are Relatively Well-Insured. The Rest Of The Country Not So Much.
More than one in four Texans under the age of 65 lacks health insurance, more than any other state in the nation. Florida is next, followed by Nevada, New Mexico and Oklahoma. Those results are from a new Census Bureau report released Thursday morning detailing health insurance rates at the state and county level. The report is a fascinating read if you're into health policy and demographics, but we found one map-;the first-;especially interesting (Chokshi, 8/29).

Politico: President Gearing Up For Major New Obamacare Push
Three years after signing Obamacare into law, President Barack Obama finally looks eager to talk about it. The White House is mapping out a strategy to deploy the president, First Lady Michelle Obama, Vice President Joe Biden and Jill Biden in what will be their most coordinated effort yet to sell Obamacare, senior administration officials said (Budoff Brown, 8/30).

Politico: The Obama-Clinton Health Care Bond
Bill Clinton will attempt again next week to do for Obamacare what has long eluded its namesake: Cut through the political noise and change the perception of a law much of the public doesn't like or understand. His speech at Clinton's presidential library in Arkansas Wednesday is a continuation of the relationship that benefited the former and current president in the 2012 campaign. It's a role Clinton has played before on behalf of the Affordable Care Act, which is rooted in the failed effort by he and his wife, Hillary Clinton, to pass comprehensive health care reform two decades ago (Haberman and Millman, 8/30).

The Wall Street Journal: Labor Official Sees Progress On Health-Law Concerns
Unions are making some progress in getting the Obama administration to address their concerns about the new health law, and Labor Secretary Tom Perez is playing a central role, AFL-CIO President Richard Trumka said Thursday. "We've been working with the administration to find solutions to what I think are inadvertent holes in the act. I'm hopeful that we'll get something done in the very near future," Mr. Trumka said at a breakfast with reporters sponsored by the Christian Science Monitor (Trottman, 8/29).

The New York Times: Gay Marriages Get Recognition From the I.R.S.
Separately, the Health and Human Services Department said Thursday that Medicare would extend certain key benefits to same-sex spouses, "clarifying that all beneficiaries in private Medicare plans have access to equal coverage when it comes to care in a nursing home where their spouse lives."  But federal agencies are not moving in lock step. Instead, they are creating a patchwork of regulations affecting gay and lesbian couples -; and may be raising questions about discrimination and fairness in the way that federal benefits are distributed. Medicare and Treasury officials have said they would use a "place of celebration" standard for determining whether gay couples are eligible for benefits. That means same-sex couples would receive benefits as long as they are legally married, regardless of where they live (Lowrey, 8/29).

Los Angeles Times: IRS, Treasury Will Recognize Same-Sex Marriage Across State Lines
The change in policy follows the Supreme Court's decision in June overturning a key provision of the Defense of Marriage Act that barred the federal government from recognizing same-sex marriages for purposes such as insurance benefits, immigration and tax filings. … Beneficiaries of a private Medicare plan will also be able to enter the same nursing home as their same-sex spouses, the Department of Health and Human Services said. "Today's announcement is the first of many steps that we will be taking over the coming months to clarify the effects of the Supreme Court's decision and to ensure that gay and lesbian married couples are treated equally under the law," Health and Human Services Secretary Kathleen Sebelius said. The Supreme Court's ruling on the Defense of Marriage Act has wide-reaching implications for federal benefits, but individual policies are being clarified by the agencies that administer them (Koseff, 8/29).

The Washington Post's Wonk Blog: The IRS And Medicare Will Now Recognize Same-Sex Marriages. All Of Them.
This is a big first step to general federal recognition of same-sex marriages. And the government took a second step, too. The Department of Health and Human Services ruled Thursday that legally wedded same-sex couples, wherever they live, are eligible for certain Medicare benefits reserved for married couples. In its memo, HHS "specifically clarifies that this guarantee of coverage applies equally to couples who are in a legally recognized same-sex marriage, regardless of where they live." … It's still not all federal government roses for these couples. Social Security uses a place of residence rule, and has issued instructions to personnel to deny claims for spousal benefits from same-sex couples living in states where such marriages are not recognized. But the overall trend is toward a federal government that offers benefits to as expansive a set of same-sex married couples as possible (Matthews, 8/29).

NPR: Money May Be Motivating Doctors To Do More C-Sections
Obstetricians perform more cesarean sections when there are financial incentives to do so, according to a new study that explores links between economic incentives and medical decision-making during childbirth. About 1 in 3 babies born today is delivered via C-section, compared to 1 in 5 babies delivered via the surgical procedure in 1996. During the same time period, the annual medical costs of childbirth in the U.S. have grown by $3 billion annually (Vedantam, 8/30).

The Texas Tribune/New York Times: With Youth Tanning Law, Texas Aims to Lower Melanoma Risk
Soon, Texas will join a number of states that bar minors from tanning indoors, which experts say greatly increases the risk of melanoma in those under 18. Senate Bill 329, written by State Senators Joan Huffman, Republican of Southside Place, and Sylvia R. Garcia, Democrat of Houston, automatically became law in June without the governor's signature and will take effect on Sunday (Serrano, 8/29).

The New York Times: N.F.L. Agrees To Settle Concussion Suit For $765 Million
The National Football League has agreed to pay $765 million to settle a lawsuit brought by more than 4,500 players and their families, largely closing the legal front in the league's battle against accusations that it concealed what it knew about the dangers of repeated hits to the head (Belson, 8/29).