First Edition: October 17, 2013

Today's headlines include reports and analyses of the Capitol Hill deal to raise the debt limit and reopen the federal government, as well as the latest developments regarding the health law's federal and state health insurance exchanges.

Kaiser Health News: Options For Consumers When COBRA Coverage Runs Out
Kaiser Health News consumer columnist Michelle Andrews answers this reader's question: "Can COBRA health insurance coverage be extended beyond 36 months?" (10/17). Watch the video or read the transcript.

Kaiser Health News: Miami Leads Nation In Medicare Drug Spending
The Miami Herald's Daniel Chang, working in partnership with Kaiser Health News, reports: "Elderly Miami residents on Medicare filled more prescriptions for drugs in 2010 than seniors elsewhere in the country, and they were more than twice as likely as residents in Rochester, Minn., to fill at least one prescription for medications that have been identified as high-risk for patients over age 65, such as skeletal muscle relaxants, long-acting benzodiazepines, and highly sedating antihistamines" (Chang, 10/16). Read the story.

Kaiser Health News: Capsules: Washington Exchange Signups Nearly Triple In Week Two; Shutdown Not Hurting Seniors' Ability To Get Medicare Plan Info; State Medicaid Decisions Cost Community Health Centers
Now on Kaiser Health News' blog, The Seattle Times' Amy Snow Landa, working in partnership with KHN, reports on the Washington state insurance exchange: "About 25,000 Washington state residents have enrolled in health plans through the state's online insurance exchange marketplace during its first two weeks. That figure is nearly triple the 9,500 residents who completed their enrollment during the first week that the exchange, called Washington Healthplanfinder, was open for enrollment" (Landa, 10/16).

In addition, Susan Jaffe reports on Medicare plan information during the government the shutdown: "The government may still be shut down -; for now -; and federal websites still caution visitors that information may not be up to date while the government is closed. But Medicare beneficiaries do not have to worry about getting accurate details from the plan finder website during the current open enrollment season, officials said" (Jaffe, 10/16).

Also on Capsules, Phil Galewitz reports on how state Medicaid decisions impact community health centers: "A new study by George Washington University researchers estimates that 518 health centers in the more than two dozen states not expanding Medicaid will lose out on $555 million next year because their uninsured patients won't get Medicaid or federally subsidized coverage in the new online health insurance marketplaces" (Galewitz, 10/16). Check out what else is on the blog.

The New York Times: Republicans Back Down, Ending Crisis Over Shutdown and Debt Limit
Congressional Republicans conceded defeat on Wednesday in their bitter budget fight with President Obama over the new health care law as the House and Senate approved last-minute legislation ending a disruptive 16-day government shutdown and extending federal borrowing power to avert a financial default with potentially worldwide economic repercussions. … The shutdown sent Republican poll ratings plunging, cost the government billions of dollars and damaged the nation's international credibility. Mr. Obama refused to compromise, leaving Republican leaders to beg him to talk, and to fulminate when he refused. For all that, Republicans got a slight tightening of income verification rules for Americans accessing new health insurance exchanges created by the Affordable Care Act (Weisman and Parker, 10/16).

Los Angeles Times: Government Crisis Is Averted – For Now
Republicans had sought the confrontation in hopes that a shutdown and the threat of default would give them leverage to extract concessions from Obama on his signature healthcare law. In the end, the compromise negotiated by Senate Majority Leader Harry Reid (D-Nev.) and Minority Leader Mitch McConnell (R-Ky.) made no significant changes in the Affordable Care Act. … The bill includes one change in the healthcare law: It requires the government to verify the income of those Americans who receive financial help in buying insurance through the new online healthcare marketplaces. Democrats did not object to the provision; they said it largely repeated language already in the law (Mascaro, Memoli and Bennett, 10/16).

The Washington Post: Obama Signs Bill To Raise Debt Limit, Reopen Government
An agreement struck by Senate Majority Leader Harry M. Reid (D-Nev.) and Minority Leader Mitch McConnell (R-Ky.) ended a stalemate created last month, when hard-line conservatives pushed GOP leaders to use the threat of shutdown to block a landmark expansion of federally funded health coverage. … Senate Budget Committee Chairman Patty Murray (D-Wash.) was to have breakfast Thursday morning with her House counterpart, Rep. Paul Ryan (R-Wis.), to start a new round of talks aimed at averting another crisis. Obama repeated his vow to work with Republicans to rein in a national debt that remains at historically high levels (Montgomery and Helderman, 10/17).

The Associated Press/Washington Post: Government Reopens After Congress Ends 16-Day Shutdown And Dodges Defaults On Debts
Obama and his Democratic allies on Capitol Hill were the decisive winners in the fight, which was sparked by tea party Republicans like Sen. Ted Cruz of Texas, who prevailed upon skeptical GOP leaders to use a normally routine short-term funding bill to "defund" the 2010 health care law known as Obamacare (10/17).

The Wall Street Journal: Congress Passes Debt, Budget Deal
The deal was opposed by the conservative political groups Heritage Action and Club for Growth, which both urged Republicans to vote against it because it did nothing significant to roll back the health law. But conservative Republicans let the deal move forward without delay in the Senate, while vowing to fight on in future battles. Sen. Ted Cruz (R., Texas), a leader in the conservative's "defund Obamacare" strategy, blamed the defeat on party leaders. "Once again, it appears the Washington establishment is refusing to listen to the American people," he said outside the Senate chamber, as Senate leaders announced the deal inside. A key question is whether wounds from the fight will change the political and policy dynamics when Congress tries to meet the January deadline for funding the government for the remainder of fiscal 2014 and the February deadline for again raising the debt limit (Hook and Peterson, 10/17).

Politico: ACA Backers OK With Income Verification In Debt Deal
Republicans are getting a single Obamacare crumb in the spending deal -; an income verification measure that Democratic proponents of the law are willing to swallow. It's the only tweak to the Affordable Care Act in the agreement forged by Senate Majority Leader Harry Reid and Minority Leader Mitch McConnell to end the shutdown and lift the debt ceiling. The requirement stipulates that the HHS secretary certify there's a way to check that Americans collecting income-based health insurance subsidies are eligible, essentially that they are earning what they claim (Cunningham, 10/17).

The New York Times: News Analysis: Losing A Lot To Get Little
For the Republicans who despise President Obama's health care law, the last few weeks should have been a singular moment to turn its problem-plagued rollout into an argument against it. Instead, in a futile campaign to strip the law of federal money, the party focused harsh scrutiny on its own divisions, hurt its national standing and undermined its ability to win concessions from Democrats. Then they surrendered almost unconditionally (Peters, 10/16).

Politico: Budget Negotiations Begin
A key element of the deal reached to reopen the government and hike the debt ceiling is that both chambers must go to a budget conference. The conference committee will be tasked with agreeing to budget numbers and crafting a bipartisan deal to address long-term deficit reduction. … The committee will include ten Senate Republicans and twelve Senate Democrats, Murray said. The conference committee has until Dec. 13 to reach an agreement (Gibson, 10/16).

USA Today: Health Care Exchange Still Plagued By Problems
Two weeks into the launch of the federal health insurance exchange, the website is still plagued with problems, leading critics to wonder if the problem is worse than it appears. There are two key issues at the core of the problem, said Dan Schuyler, a director at Leavitt Partners, a health care group. One is the volume, which Health and Human Services estimates at 14.6 million unique visitors, and the second is the platform's design (Kennedy, 10/16).

Politico: Two Weeks In, Obamacare Website Still Broken
The Obamacare enrollment website remains badly broken despite two weeks of intensive round-the-clock efforts at repairs. HHS isn't making any predictions about how long it will take to fix it -; or rebuild it. But advocates, lobbyists and industry officials are talking about it as a months-long repair effort (Chaney, Millman and Haberkorn, 10/16).

The New York Times: Search Tools Wanting On Many Exchanges
Since the new health insurance exchanges opened for business on Oct. 1, millions of people who have visited the online sites have been unable to enroll because of technical problems and software glitches. But many people who are getting through the log-in process are encountering a different set of problems when they try to determine whether policies sold through the exchanges will provide the doctors, hospitals or drugs they need. Most of the 15 exchanges run by states and the District of Columbia do not have provider directories or search tools on their Web sites -; at least not yet -; so customers cannot easily check which doctors and hospitals are included in a particular plan's network. Most allow customers to search for providers by linking to the insurers' Web sites, but the information is not always accurate or easy to navigate, health care experts say (Goodnough, 10/16).

The New York Times: States Report Health Insurance Application Numbers
Minnesota's state-run health insurance exchange reported Wednesday that 5,569 households had completed applications for coverage in the first two weeks of operation, representing 11,684 people. The exchange portal has run relatively smoothly after struggling with technology problems for a few days after it opened on Oct. 1, said April Todd-Malmlov, the executive director. … Separately, California said Tuesday that about 94,500 applications for health insurance had been started through its exchange between Oct. 1 and Oct. 12. But exchange officials would not say how many applications had been completed in that period (Goodnough, 10/16).

The Associated Press/Washington Post: Small Businesses Give Health Exchanges Mixed Reviews, But More than Expected Are Signing Up
More small businesses than expected are signing up for health insurance on state exchanges that opened this month. The insurance markets began operating Oct. 1 under the health care law. They were designed to offer low-cost insurance for individuals and small businesses. Many business owners have been pleasantly surprised by the rates and coverage, according to accounts from owners and state officials. But some owners are disappointed and plan to buy insurance privately (10/16).

Los Angeles Times: Covered California Removes Glitchy Online Directory Of Doctors
Checking up on a doctor is becoming a major snag for Obamacare shoppers in California. Three weeks into open enrollment, the state's insurance exchange, Covered California, has pulled its online directory of medical providers after acknowledging there are serious problems with the information. The California Medical Assn. says it found mistakes such as obstetricians labeled as ophthalmologists and the wrong doctors described as fluent in Russian and Farsi (Terhune, 10/16).

NPR: If A Tech Company Had Built The Federal Health Care Website
HealthCare.gov was meant to create a simple, easy way for millions of Americans to shop for subsidized health care. Instead, in a little two more than weeks, it has become the poster child for the federal government's technical ineptitude. A dysfunctional contracting system clearly bears some of the blame. But entrepreneurs in Silicon Valley likely would have approached the project differently from the start (Henn, 10/17).

Politico: Shutdown Over, Congress Turns To Obamacare 'Train Wreck'
With the shutdown over and a default averted, Washington has another train wreck to sift through: the Obamacare rollout. Republican critics have plenty to investigate, starting with the $400 million website that doesn't work and the federal contractor that built it, while asking a more fundamental question: Will it be fixed in time for people to get health coverage early next year (Norman, 10/17).

The Washington Post: New Hampshire Will Hold Special Session On Medicaid Expansion
New Hampshire legislators will meet next month to hammer out what leaders hope will be a bipartisan agreement to expand Medicaid after the state's Executive Council voted Wednesday to allow Gov. Maggie Hassan (D) to call a special session (Wilson, 10/17).

The New York Times: Sebelius Stands Firm Despite Calls To Resign
Kathleen Sebelius, the secretary of health and human services, has no intention of bowing to Republican demands that she resign after the troubled rollout of President Obama's health care law, people close to her said Wednesday. And the White House expressed "full confidence" in her (Pear, 10/16).

The Associated Press/Washington Post: UnitedHealth's 3rd-Quarter Profits Rise 1 Percent, Health Insurer Narrows 2013 Forecast
UnitedHealth Group says its third-quarter earnings inched up 1 percent, as enrollment gains helped the nation's largest health insurer counter rising medical costs (10/17).

NPR: To Reduce Patient Falls, Hospitals Try Alarms, More Nurses
A bad fall in the hospital can turn a short visit into a long stay. Such falls featured in congressional discussions about patient safety, and in a new study in the Journal of Patient Safety about medical errors. Falls are one part of a multistate clash between nurses and hospitals over how to improve the safety of hospitalized patients. In Washington state, hospitals are required to report falls that happen on their watch to the state health department (Ryan, 10/16).