First Edition: October 14, 2013

Today's headlines include the latest on the budget negotiations as well as examinations of what's happening with the health law's online insurance marketplaces.

Kaiser Health News: Why Some Virginia Health Plans Cost So Much
Kaiser Health News staff writer Julie Appleby, working in collaboration with The Washington Post, reports: "Consumers shopping for coverage in new online marketplaces may scratch their heads when they come to a handful of plans in Virginia: Why do some cost more than $1,800 a month? No, the plans do not include gold-plated hospital beds or guaranteed same-day access to doctors. Instead, those premiums reflect an add-on benefit for a type of costly surgery for obesity which makes them up to six times more expensive than plans without such coverage" (Appleby, 10/13). Read the story.

Kaiser Health News: Geography Is Destiny When It Comes To Enrolling In Health Insurance Exchanges
Kaiser Health News staff writer Jenny Gold, working in collaboration with NPR, reports: "Alexandra Dixon threads her way among the people waiting to see a doctor at the Community Clinic, Inc. in Silver Spring, Maryland. She introduces herself with a bright smile and an outstretched hand: 'I'm one of the new health care navigators. Have you heard of the Affordable Care Act?' While some folks mumble, 'um, no I don't think so,' Dixon is nonetheless booked up with appointments. She's one of 350 people in Maryland who have been hired and certified to help consumers enroll in the new health insurance options that are offered as part of the health law" (Gold, 10/13). Read the story.

Kaiser Health News: FAQ: What's At Stake If Congress Repeals The Medical Device Tax
Kaiser Health News staff writer Mary Agnes Carey reports: "As Republicans and Democrats have battled over reopening the federal government and raising the federal debt ceiling, one idea that keeps coming up is a repeal of the 2010 health law's tax on medical devices" (Carey, 10/11). Read the story.

Kaiser Health News also tracked weekend health policy headlines, including reports about the direction of congressional budget talks (10/13).

The Wall Street Journal: Senate Democrats Press New Front In Budget Battle
Senate Democrats have been strengthened by the sidelining, at least for now, of House conservatives, who dropped nearly all their major policy demands only to see Mr. Obama reject their proposal for ending the stalemate. With Senate leaders now negotiating, the fiscal battle focused for the first time in weeks on the budget itself, not on side issues that had dominated, such as the Republican demand that the 2010 health-care law be delayed or altered. Republicans who had opposed the GOP's "defund Obamacare'' strategy welcomed the return of interest to basic spending issues (Hook, 10/14).

Politico: Senate Remains At An Impasse
Monday will be critical. With financial markets fearful of a prolonged impasse, there is little margin for error before Thursday, when the Treasury Department warns the government will begin to run out of money and could fail to pay its bills for the first time in history. That possibility would intensify a budget crisis that started Oct. 1, when government agencies shuttered for the first time in 17 years because of lawmakers' inability to pass a funding bill on time. It's far from clear how the high-stakes fight will play out this week. Republicans have already dropped their push to gut Obamacare, which prompted the shutdown in the first place. But McConnell has yet to accept Democratic demands for higher spending levels for at least a portion of the current fiscal year (Raju and Kim, 10/13).

The Washington Post: Senate Leaders' Talks On Shutdown, Debt Limit Stall As Sides Await Market's Reaction
What started as a mad dash to strike a deal to lift the federal debt limit slowed to a crawl over the weekend as stalemated Senate leaders waited nervously to see whether financial markets would plunge Monday morning and drive the other side toward compromise. Republicans seemed to think they had more to lose. After talks broke down between President Obama and House leaders, GOP senators quickly cobbled together a plan to end the government shutdown -; now entering its third week -; and raise the $16.7 trillion debt limit. Senate Minority Leader Mitch McConnell (R-Ky.) then asked Majority Leader Harry M. Reid (D-Nev.) to elevate negotiations to the highest level (Montgomery and Helderman, 10/13).

The New York Times: Spending Dispute Leaves A Senate Deal Elusive
With a possible default on government obligations just days away, Senate Democratic leaders -; believing they have a political advantage in the continuing fiscal impasse -; refused Sunday to sign on to any deal that reopens the government but locks in budget cuts for next year. … Republicans once said that they would finance the government only if the president's health care law was gutted. A bipartisan Senate framework drafted by Ms. Collins and Senator Joe Manchin III, Democrat of West Virginia, started with a face-saving move for Republicans of a repeal of a tax on medical devices that helps pay for the Affordable Care Act. When Senate Democratic leaders objected, that was tempered to a two-year delay of the tax (Weisman, 10/13).

Los Angeles Times: Government Shutdown Talks Hit Snag In Senate
The protracted stalemate has left Congress facing twin crises: Thursday's deadline to raise the nation's borrowing limit or risk a potentially catastrophic debt default, and a federal government shutdown that will enter its third week Tuesday. Republicans had hoped they could use the standoff to gain leverage in their fight with Democrats over the budget and President Obama's healthcare law, but find themselves in a dramatically weakened position. They have failed to unify around a common negotiating position and face polls showing that the public by large margins blames them for the stalemate (Mascaro, 10/13).

The New York Times: Stuck On Usual Quarrel: Raising New Revenue
But even if the current talks soon resolve the immediate impasse, which did not look likely on Saturday, any renewal of negotiations for a long-term fiscal plan will run into the same underlying problem that has doomed efforts for the past three years. Republicans refuse to raise additional tax revenue, and until they do, Mr. Obama will not support even his own tentative proposals for reducing spending on fast-growing social benefit programs, chiefly Medicare. During a White House meeting with Senate Republicans on Friday, he reiterated that the two go hand in hand, according to people who were there (Calmes, 10/12).

The Washington Post: Federal Health Exchange Sending Confusing Enrollment Information To Insurers
The federal health-care exchange that opened a dozen days ago is marred by snags beyond the widely publicized computer gridlock that has thwarted Americans trying to buy a health plan. Even when consumers have been able to sign up, insurers sometimes can't tell who their new customers are because of a separate set of computer defects (Goldstein and Cha, 10/11).

Politico: Obamacare: Who Will Ignore Law's Requirements?
Millions of Americans may be wrestling with computer glitches to try to sign up for Obamacare -; but many people eligible just won't bother and will pay a price for it. Some will flout the mandate to buy coverage on ideological grounds, a health insurance version of civil disobedience (Bade and Norman, 10/14).

The New York Times: From the Start, Signs Of Trouble At Health Portal
For the past 12 days, a system costing more than $400 million and billed as a one-stop click-and-go hub for citizens seeking health insurance has thwarted the efforts of millions to simply log in. The growing national outcry has deeply embarrassed the White House, which has refused to say how many people have enrolled through the federal exchange. Even some supporters of the Affordable Care Act worry that the flaws in the system, if not quickly fixed, could threaten the fiscal health of the insurance initiative, which depends on throngs of customers to spread the risk and keep prices low (Pear, LaFraniere and Austin, 10/12).

Politico: Tech Experts Wary Of More Obamacare Glitches
The glitch-plagued Obamacare rollout might be just the beginning: A series of potential technology problems could thwart the Obama administration's goal of getting 7 million people enrolled in the new exchanges by the end of March. Millions of people have already encountered error messages, delays, crashes and stuck accounts. Technology experts and Obamacare backers worry that each step ahead in the process -; filling out applications, checking on subsidies and selecting a health insurance plan -; creates a potential technology choke point. And that doesn't even count any additional chaos when people try to use their new health insurance come January (Norman and Millman, 10/12).

The Washington Post: Glitches On Health-Care Sites Prompt Increased Interest In Paper Applications
The dead-tree version of health insurance enrollment is turning out to be surprisingly popular. Unable to use new government insurance Web sites that have been plagued by technological problems, those tasked with helping the uninsured sign up for health coverage are bypassing the sites altogether, relying instead on old-fashioned paper applications (Sun and Somashekhar, 10/12).

The Associated Press/Washington Post: Obamacare A Success So Far? Lack Of Enrollment Numbers From Many States Makes It Hard To Say
After more than a week in action, is a key feature of President Barack Obama's health care overhaul a success or a bust? Judging by the dearth of data, it's virtually impossible to say. The federal government has released no comprehensive data on how many people have enrolled for health insurance using federally run exchanges, the online marketplaces being used in 36 states for residents to compare and buy insurance. In the 14 states running their own exchanges, the situation isn't much better (10/11).

The New York Times' Letter From Washington: Mileposts Remain For Health Care Law
The drama surrounding the government shutdown and potential debt default almost obscured the rollout of President Obama's Affordable Care Act. Both champions and critics of the measure should be grateful. More than eight million Americans tried to log on to federal or state exchanges, despite concerted efforts by conservatives to dissuade them. Software glitches foiled many of these inquiries and undermined supporters' claims that the program was ready for prime time (Hunt, 10/13).

The Associated Press/Washington Post: O'Malley Says Work On Maryland's Health Care Website Could Take Another Month And A Half
Fixing glitches on Maryland's online marketplace could continue for as long as another month and a half, Gov. Martin O'Malley said Friday, comparing the effort to dealing with a hurricane or a snowstorm. Still, he said improvements are being made every day. Maryland Health Connection, the online portal where people can shop for health plans and enroll in them, also updated the numbers of people who have visited the website and created accounts since it opened on Oct. 1, when it ran into problems almost immediately (10/11).

The Texas Tribune/New York Times: For Aid Insuring Latinos, Groups Look Close to Home
Though they make up roughly a third of the state's population, Latinos account for nearly two-thirds of the more than six million Texans without health insurance. But in the 13 days since a federal insurance marketplace aimed at helping the uninsured find coverage opened, health care advocates across the state have encountered common obstacles in getting Latinos registered, including limited access to computers and the lack of an e-mail address (Aaronson, 10/12).

USA Today: Pushing Health Care In USA's Poorest City
Today's door-to-door insurance salesmen may seem worlds apart from the residents of these often-tattered row houses, but they share one big thing in common. They haven't been able to afford insurance either. They face the daunting task of helping to convince the nearly 200,000 uninsured residents of Philadelphia County that they can -; and should -; buy it now. The new exchange's success, the cornerstone of the Affordable Care Act, will hinge on whether it can meet the federal goal of 7 million enrollees, but also on whether it can sign up enough healthy younger people like these canvassers to make up for all the ailing older ones. Rather than set up and market its own health insurance exchange, Pennsylvania joined 30 other states in defaulting to the federal marketplace. The state is doing some limited marketing -; through e-mails and on its own health insurance website -; but hasn't heard back on its request for funds to do its own outreach about the exchange and doesn't know when it will because of the government shutdown, says Rosanne Placey, spokeswoman for the state insurance commissioner (O'Donnell, 10/12).

The Wall Street Journal: It's Time For Medicare Open Enrollment
Medicare's annual open-enrollment period starts Tuesday, and this year beneficiaries need to take a particularly close look at their options, many of which have been tweaked. ... Overall, premiums for Advantage plans, the private-insurer version of Medicare coverage, are projected to go up next year-;by 5%, or $1.64, on average, to $32.60 a month, according to the Centers for Medicare and Medicaid Services, the agency that runs Medicare. For drug plans, the average basic-plan premium will be $31, which it said was about the same as this year. But analysts say that the steady average masks a lot of tweaks that insurers are making to Advantage plans in response to cutbacks in payments from the federal government-;including that at least a few plans' premiums will go up sharply (Mathews, 10/13).

The New York Times: Patients Mired In Costly Credit From Doctors
In dentists' and doctors' offices, hearing aid centers and pain clinics, American health care is forging a lucrative alliance with American finance. A growing number of health care professionals are urging patients to pay for treatment not covered by their insurance plans with credit cards and lines of credit that can be arranged quickly in the provider's office. The cards and loans, which were first marketed about a decade ago for cosmetic surgery and other elective procedures, are now proliferating among older Americans, who often face large out-of-pocket expenses for basic care that is not covered by Medicare or private insurance (Silver-Greenberg, 10/13).

The New York Times: Gov. Brown Of California Vetoes Biotech Drug Bill
The first year of skirmishes in state legislatures over bills that would govern the use of cheaper versions of expensive biotechnology drugs is nearly over. Health insurers and generic drug companies have prevailed in most states over brand-name pharmaceutical companies (Pollack, 10/13).

Los Angeles Times: Mental Health Court Helps Save A Troubled Talent From The Street
Kim Knoble's past tracks an arc of promise, mental illness and descent into what her parents call "living hell." But Knoble is not homeless, in prison or dead -; outcomes common with stories like hers. Instead, on Wednesday, the woman with a head of wild red curls plans to walk into the St. Francis Yacht Club, tell her tale of recovery and lift the instrument she did not touch for a decade to play Massenet's "Meditation From Thais" (Romney, 10/13).