First Edition: October 16, 2013

Today's headlines including stories detailing how certain health law provisions are factoring in to the continuing congressional budget stalemate.

Kaiser Health News: FAQ: The Senate Is Looking At The ACA's 'Reinsurance Tax.' What Is That?
Kaiser Health News staff writer Mary Agnes Carey reports: "One provision of the Senate's emerging deal to reopen the federal government and extend the federal debt ceiling includes a one-year delay of a tax to help provide relief to insurers which cover large numbers of high-cost medical cases. Here are some frequently asked questions about the health law's temporary 'reinsurance tax' and how it would work" (Carey, 10/15). Read the story.

Kaiser Health News: 9 Things Millenials Need To Know About Obamacare (But Likely Don't)
Kaiser Health News staff writers Ankita Rao and Marissa Evans report: "Despite being tapped into social media networks and watching The Daily Show, only 10 percent of young Americans say they are very familiar with the Affordable Care Act. Here's what you need to know" (Rao and Evans, 10/16). Read the story.

Kaiser Health News: Capsules: Report: 5.2 Million Adults Will Fall Into ACA Coverage Gap Next Year; Rocky Opening Leaves Health Law's New Co-Ops Jittery
Now on Kaiser Health News' blog, Phil Galewitz reports on the health law's coverage gap: "About 5.2 million poor, uninsured adults will fall into the 'coverage gap,' created by 26 states choosing not to expand Medicaid under the federal health law next year, according to a study released today by the Kaiser Family Foundation" (Galewitz, 10/16).

Also on the blog, Jay Hancock reports on co-op jitters: "Nothing is more important for a startup burning through cash than winning customers and revenue. So problems with the Affordable Care Act's online marketplaces, also known as exchanges, aren't just an inconvenience for the likes of Evergreen Health Co-op. They're a threat" (Hancock, 10/15). Check out what else is on the blog.

The New York Times: Debt Talks In Disarray As House Balks
A day that was supposed to bring Washington to the edge of resolving the fiscal showdown instead seemed to bring chaos and retrenching. And a bitter fight that had begun over stripping money from the president's signature health care law had essentially descended in the House into one over whether lawmakers and their staff members would pay the full cost of their health insurance premiums, unlike most workers at American companies, and how to restrict the administration from using flexibility to extend the debt limit beyond a fixed deadline. Even so, the House speaker, John A. Boehner, Republican of Ohio, and his leadership team failed in repeated, daylong attempts to bring their troops behind any bill that would reopen the government and extend the Treasury's debt limit on terms significantly reduced from their original push against funding for the health care law (Weisman, 10/15).

The New York Times: With G.O.P. Badly Divided, Boehner Is Left 'Herding Cats'
It was yet another moment of decision for Mr. Boehner, who finally finds himself at the crossroads he has been marching toward for weeks: an imminent financial default on the one hand, and on the other an unyielding conservative rank and file that persists with the futile effort to take down President Obama's health care law even if they also take down the speaker in the process. While his colleagues sang about how what once was lost had now been found, Mr. Boehner did not tell them a more dispiriting truth: With less than 48 hours left before the nation is set to exhaust its authority to borrow money, he and his lieutenants were running out of ideas -; a fact made starkly evident by the mad and fruitless scramble on Tuesday to come up with a measure that could win enough support from his members. Around 7 p.m., he sent the House home and canceled all votes for the day (Parker and Peters, 10/15).

The Wall Street Journal: House GOP Abandons Its Proposal
For all the drama, the House legislation looked much like the Senate plan and, like the Senate proposal, was only a short-term fix. The House bill would have raised the debt limit through Feb. 7 and ended the 15-day government shutdown by funding federal agencies through Dec. 15. Conservatives objected both to the Senate bill and Mr. Boehner's alternative because they gave Republicans too little of what they had been demanding-;major changes in the 2010 health-care law and measures to reduce the deficit (Hook, Cui and Peterson, 10/15).

Los Angeles Times: Boehner's Push For House Budget Compromise Falters
Shortly after House leaders officially called off a vote on their most recent plan, spokesmen for Reid and McConnell said Senate talks were resuming. They had paused for the day to allow Boehner (R-Ohio) a chance to get a bill through the House. … Senate aides said the agreement would extend the Treasury's authority to borrow money through Feb. 7 and end the government shutdown, providing federal agencies with funds through Jan. 15. … The plan would make no significant changes in President Obama's healthcare law. Democrats were expected to drop a proposal to repeal a new tax on insurance plans that is opposed by some unions. The agreement also would direct officials to confirm that people receiving insurance subsidies under the law were eligible for them, something Democrats say the law already requires (Memoli, Mascaro and Bennett, 10/15).

The Wall Street Journal: Republicans Insistent About Tweaking Health-Care Law
Some of the changes in the health-care law Republicans have sought in budget negotiations affect provisions so obscure few have heard of them, while others would hit more high-profile parts of the legislation. What the changes all have in common is that they are relatively small, particularly when compared with opponents' original hopes: to use the budget debate as a lever to strip funds from implementation of the law, or delay for a year its signature provision that most individuals carry insurance or pay a penalty. Those efforts have fallen short (Radnofsky, 10/15).

The New York Times: A Closer Look At The Reinsurance Fee
Though a tax on medical devices has been a point of contention in the negotiations over the fiscal standoff, the Senate proposal that would end the government shutdown and raise the debt limit is likely to include instead a one-year delay of another tax associated with the Affordable Care Act -; the so-called reinsurance tax, which employers pay (Pear, 10/15).

Politico: Obscure Obamacare 'Reinsurance' Fee Takes On Big Role In Spending Deal Talks
The Senate's proposal to end the shutdown and debt stalemate would delay private sector payments to the health care law's temporary reinsurance program, which is meant to stabilize the new health insurance marketplaces that opened for enrollment Oct. 1. The House counter-proposal doesn't have it, so its inclusion in any final deal is looking less likely (Millman, 10/15).

The New York Times: Conservatives Look to End Health Contributions for Congress Members and Staff
A group of House Republican conservatives met midday on Tuesday to discuss an acceptable alternative to a House proposal to reopen the government that was abandoned earlier in the day for lack of support. What many seek is a provision that would eliminate government contributions to the health plans for members of Congress and their staff members -; as well as for the president, vice president and members of the cabinet -; who would obtain their insurance through the exchanges established by the Affordable Care Act (Steinhauer, 10/15).

USA Today: Congressional Health Care Bogs Down Shutdown Talks
Congress' own health insurance could be one of the last obstacles to reaching a deal to reopen the government and avoid default. House Republicans floated a bill Tuesday that would have ended the 16-day federal government shutdown and raised the debt limit, but it also would have eliminated the employer contribution for health care for all members of Congress, their staffs, the president, the vice president, and all their political appointees (Korte, 10/15).

Politico: Obama Vows Veto Over Vitter Measure
President Barack Obama told House Democratic leaders Tuesday that he would veto debt-ceiling legislation if it includes a provision pushed by Sen. David Vitter (R-La.) and House GOP leaders that would cut health subsidies for congressional and senior executive branch officials, according to sources familiar with the discussion at a private White House meeting (Allen, 10/15).

The Washington Post's Fact Checker: Did Obama Exempt 1,200 Groups, Including Congress, From Obamacare?
The waivers were granted to companies (such as McDonald's or other fast food chains) that provided inexpensive bare-bones health plans known as "mini-meds," in what the administration called "a bridge" to 2014, when the law would be fully implemented. That's because the law says that annual coverage limits can't be lower than $750,000 in 2013 -; and there are no annual dollar limits starting in 2014. So without those waivers, employees in those companies might have been left in the lurch until the law fully went into effect (Kessler, 10/16).

Politico: Talking About The Medical Device Tax
The tax has been in and out and in and out of several offers from both Republicans and Democrats to smooth a deal to re-open government and lift the debt ceiling. As of late on Tuesday, it was cut from the latest House Republican offer. It also fell out of a Senate offer from earlier this week. But the repeal's staying power in the debate highlights a typical Washington confluence of money and local politics (Bade and Dixon, 10/15).

Los Angeles Times: Medical Device Makers See An Opening In budget Impasse
Leaders from the medical device industry listened when President Obama vowed in 2009 that there would be shared sacrifice and "no sacred cows" to help pay for his healthcare law. But unlike the pharmaceutical industry, insurers and others at that healthcare summit, the device makers never shook hands on a deal. Instead, after a 2.3% tax on their revenue was included in the 2010 Affordable Care Act, they started a drive to repeal it. Now, with Washington paralyzed in a government shutdown and a fight over the debt limit, the device makers have seized on the impasse as a chance for victory (Tanfani, 10/16).

The Washington Post: Health-Care Law's Fate Could Hinge On Political Climate In Individual States
The greatest threats to the ultimate success of the new health-care law come not from the technical problems that have plagued its rollout, but from a hostile political climate in many individual states and from potentially serious weaknesses in its design. Those are the conclusions of a cautionary report just published by the Brookings Institution's new Center for Effective Public Management (Tumulty, 10/15).

The Washington Post: Visits To Federal Health-Care Web Site Off 88%
The number of visitors to the federal government's HealthCare.gov Web site dropped 88 percent between Oct. 1 and Oct. 13, according to a new analysis of America's online use, while less than half of 1 percent of the site's visitors successfully enrolled for health insurance the first week (Eilperin, 10/15).

The Associated Press/Washington Post: Before Glitches Arose, Internal Admin. Projections Called For Robust Health Care Signups
The Obama administration's internal projections called for strong enrollment in the states in the first year of new health insurance markets, according to unpublished estimates obtained by The Associated Press. Whether those expectations will bear out is unclear. Technology glitches have frustrated many consumers trying to sign up for coverage online, and efforts to upgrade and repair healthcare.gov are ongoing (10/15).

Politico: Web Brokers On Standby, Waiting To Sell Obamacare Plans
The Obama administration has enlisted a small army of online brokers to help sell new Obamacare health plans, but those sites have been sidelined in the health care law's first two weeks as the feds struggle to sort out their own glitch-filled website. The federal agency in charge of the exchanges signed agreements this summer with several e-brokers to sell health plans in the 36 states where the feds are running the new individual marketplaces. But the online brokers, eager to tap a new market of people who'll qualify for federal subsidies, learned shortly before the Oct. 1 launch that they wouldn't be able to offer exchange plans right away (Millman, 10/16).

Los Angeles Times: California Insurance Exchange Reports 94,500 Application Starts
After two weeks of open enrollment, Californians have started nearly 95,000 applications for health insurance through the state's new exchange. Covered California, the state marketplace, announced the latest figures Tuesday and it said consumer interest in the federal healthcare law remains strong (Terhune, 10/15).

Politico: Obama Has 'Full Confidence' In Sebelius
President Obama has "full confidence" in Health and Human Services Secretary Kathleen Sebelius despite the bumpy rollout of HealthCare.gov, the White House said Tuesday. "The secretary does have the full confidence of the president," press secretary Jay Carney told reporters, responding to a question about the "Fire Sebelius" movement that's cropped up among Republicans (Epstein, 10/15).

NPR: Medicare Begins Open Enrollment, With An Online Caveat
The open enrollment for Medicare programs that began Tuesday will run into December. While the Medicare website doesn't have the problems found in the new federal health system's sites, the government shutdown means that information "may not be up to date," the site warns its users (Chappell, 10/15).

The Associated Press/Washington Post: Study: Where Seniors Live Affects What Medications Prescribed, Whether They're The Best Kind
Where seniors live makes a difference not only in how much health care they receive but also the medications they're prescribed -; as some miss out on key treatments while others get risky ones, new research shows. More than 1 in 4 patients on Medicare's prescription drug plan filled at least one prescription for medications long deemed high-risk for seniors, according to the study released Tuesday by the Dartmouth Atlas Project (10/15).

USA Today: Thefts From Nursing Home Trust Funds Target The Elderly
Thousands of residents in U.S. nursing homes and other long-term care institutions for the aged and disabled have had their personal savings raided or mismanaged after relying on the facilities to safeguard the money in special trust fund accounts, a USA TODAY investigation shows. These trust funds, which most long-term care providers are required to maintain for residents who request that the facility handle their money, are supposed to work like conventional bank accounts, with accrued interest, regular statements and reliable oversight. But USA TODAY found more than 1,500 recent cases in which nursing homes have been cited by state and federal regulators for mishandling the funds (Eisler, 10/16).

Los Angeles Times: LA County Health Workers Required To Get A Flu Shot Or Wear A Mask
Effective this influenza season, healthcare workers in Los Angeles County will be required to receive immunizations against influenza or wear a protective mask while in contact with patients. In an order issued by Public Health director Dr. Jonathan Fielding, the county mandated that all workers in hospitals, nursing facilities and intermediate care facilities who work in patient areas or have direct contact with patients receive an annual flu vaccination (Brown, 10/15).

Los Angeles Times: Doctor Arrested In Illegal Prescription Of Narcotics
A Southern California pain doctor who was featured in a 2012 Times investigative article on patient overdose deaths was arrested Tuesday on seven counts of illegally prescribing narcotics and other widely abused drugs. Dr. John Dimowo is charged with prescribing Vicodin, Norco, Adderall and Xanax to undercover agents who pretended to be patients but had no legitimate need for the drugs (Glover and Girion, 10/15).