Health law impact: Some consumers likely to run into penalties; Va. marketplace pricing reflects unusual add-on; American Indians' tough choice

News outlets look at a variety of policy issues surrounding the health overhaul, including what might lead people to not sign up and face a fine, how Virginia insurers priced their plans based on bariatric surgery costs and the campaign to sign up Native Americans.

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).

Kaiser Health News: Why Some Virginia Health Plans Cost So Much
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).

The Associated Press: Ind. Sees Subsidy Loophole In Health Care Suit
The lawsuit Attorney General Greg Zoeller and 15 Indiana school districts have filed against the IRS could also block federal subsidies for state residents enrolling in the health exchange that's part of the federal health overhaul. The lawsuit, filed earlier this week, says the federal government lacks standing to require health benefits for any employee who works more than 30 hours in a week (LoBianco, 10/11).

Bloomberg: More Republican Districts Have Low Health-Coverage Rates
Republicans represent more U.S. congressional districts with below-average health-insurance coverage than Democrats, an irony ensnared in a government shutdown triggered by a law designed to expand access to care.  Districts with less coverage are especially common in Texas, where each of the 36 House seats represents an area with a rate lower than the national average, according to U.S. Census Bureau data compiled by Bloomberg (McCormick and Giroux, 10/14).

The Philadelphia Inquirer: Don't Base Your Selection Only On Premium Price
Everyone was asking about premiums in the months before the rollout of the Affordable Care Act. But many people are mistaken if they think the premium represents the bottom-line cost of health insurance. It doesn't (Calandra, 10/13).

Stateline: ACA – A Hard Sell For Native Americans
Longstanding treaties with the federal government guarantee all Native Americans free health care. As a result, the Affordable Care Act exempts them from paying a penalty if they choose not to purchase insurance. More than 2 million Native Americans receive free health care at federally supported Indian health facilities. Many others receive care from tribal facilities and urban Indian organizations. So why would an American Indian or Alaska Native sign up for reduced-rate insurance on the exchanges? Indian health advocates said the benefits are many. "It's an unprecedented opportunity," said Roxane Spruce Bly, who is working with New Mexico's health insurance exchange to provide outreach to Native Americans. "It's the biggest thing to happen in Indian health in my lifetime. It solves so many problems for Indian people" (Vestal, 10/14).