First Edition: October 18, 2013

Today's headlines include stories about how Medicare might fit into the next round of budget talks.

Kaiser Health News: Tough Medicare Decisions Await Bipartisan Budget Panel
Kaiser Health News staff writer Mary Agnes Carey reports: "The deal President Barack Obama, Republican and Democratic lawmakers reached to reopen the federal government and raise the debt ceiling includes a bipartisan panel charged with producing a long-term budget agreement. … Both parties have agreed on some Medicare changes, including asking wealthier beneficiaries to pay more for their coverage. They disagree on others, such as increasing the Medicare eligibility age. Democrats won't agree to any major overhaul of Medicare unless Republicans agree to raise taxes, which they have rejected" (Carey, 10/17). Read the story.

Kaiser Health News: What's The Deadline For Buying Health Insurance In Order To Avoid A Penalty?
Kaiser Health News consumer columnist Michelle Andrews offers this answer to a reader's question: "The simple answer is March 31, but unfortunately it's not that straightforward. Starting in January, most people will need to have health insurance. If they don't, they'll owe a penalty amounting to $95 or 1 percent of the family income, whichever is greater. This fee will be collected when they file their federal income taxes. But the rules allow people to have a short gap in coverage of less than three consecutive months before they get dinged with the penalty" (Andrews, 10/18). Read the answer.

Kaiser Health News: After 63 Tries, Reporter Creates Account On Federal Exchange
Now on Kaiser Health News' blog, Phil Galewitz reports: "After 17 days and 63 attempts, I  finally made it.  I was able to create an account on the federal health insurance exchange at www.healthcare.gov – a task which has frustrated millions of Americans" (Galewitz, 10/17). Check out what else is on the blog.

The New York Times: Two Parties Start Work to Avoid Repeat Crisis
By definition, common ground suggests no grand bargain, which would require a much more difficult trade-off where they fundamentally differ -; higher tax revenues that Republicans oppose, in exchange for reductions in Medicare, Medicaid and Social Security that Democrats vow they will not entertain without curbs on tax breaks for wealthy individuals and corporations (Weisman and Calmes, 10/17).

The Washington Post: President, Congress Leave One Crisis Behind But Face Long Road To Budget Deal
The Democrats' budget would restore funding to federal agencies by replacing deep automatic cuts known as the sequester, in part with a large infusion of new tax revenue from the rich. The Ryan budget would not raise taxes and would balance in 10 years, but only by canceling the benefits of the Affordable Care Act while keeping its tax hikes and Medicare cuts. Ryan would also cut spending by domestic agencies to levels so low that even some House Republicans balked at approving funding bills based on his framework. … Rather than trying to hash out a full budget blueprint, many lawmakers and independent analysts expect the conference committee to focus on the most urgent issue facing Congress: funding federal agencies through fiscal 2014. … To avoid increasing deficits, they proposed adopting a range of proposals from Obama's most recent budget request, such as raising Medicare premiums for high-income seniors and requiring federal workers to contribute more to their retirement (Montgomery and Goldfarb, 10/17).

NPR: How The GOP's Shutdown Over Obamacare Fell Short
Remember how that fight over the budget was all about Obamacare? Seems like ancient history now, but House Republicans ostensibly shut down the government 17 days ago, demanding first a defunding, and, when that failed, a year's delay in the health law. When it became clear that President Obama and Senate Democrats weren't going to yield to demands to stop or slow implementation of the administration's signature legislative achievement, Republicans looked for smaller changes (Rovner, 10/17).

Politico: Mitch McConnell Defends Deal, Slams Obamacare Tactics
Using a football analogy, McConnell said he got the ball on his own two-yard-line with a "shaky" offensive line and had to cut a last-ditch deal with Senate Majority Leader Harry Reid to end the crisis, no matter how unappealing to many in his party. Despite acting as a chief deal-maker in recent years during government crises, it was unclear the role McConnell would play until the final days of the bitter fight (Raju, 10/17).

The Wall Street Journal's Washington Wire: Unions Warn Lawmakers On Budget Cuts
With the federal government back in operation, union officials wasted no time stating their demands for future congressional budget talks: no cuts to Social Security, Medicare or Medicaid benefits and repeal the across-the-board budget cuts known as sequestration (Trottman, 10/17).

The New York Times: From The Right, Despair, Anger And Disillusion
Many conservatives described a dispiriting gap between conservative ideals, which they believe inspire widespread agreement, and conservative tactics, which do not. The failure to stop the health care plan left Republicans like Ms. Naples pessimistic and disillusioned. "I'm just totally blown away by everything," she said. "I don't know what's right and what's wrong anymore." Still, for many Wednesday night's vote had to play out as it did, because there was no other alternative (Robertson, 10/17).

The Washington Post: Conservative Republicans Aren't Done Fighting The New Health-Care Law
Fresh off an unsuccessful attempt to block the president's sweeping Affordable Care Act, several conservative Republicans announced Thursday that they have decided on their next political target: the Affordable Care Act. The temporary resolution of the budget battle is likely to intensify, rather than lessen, public scrutiny of the health-care law, commonly known as Obamacare. Chronic problems with the online enrollment system -; which have diminished but not disappeared since its Oct. 1 launch -; were largely overshadowed by the 16-day fiscal standoff in Washington (Eilperin, 10/17).

The Washington Post's The Fact Checker: Ted Cruz's Claims On Obamacare Focus On Losers, Not Winners
In the wake of the defeat of his effort to derail the Affordable Care Act, a.k.a. Obamacare, Sen. Ted Cruz (R-Tex.) continues to make assertions about the law that have puzzled and concerned readers. But it's hard to know where to begin, as he repeatedly uses language that sketches the law in apocalyptic terms, even though the law has barely begun to be implemented. So we will focus on a few key items (Kessler, 10/18).

The Wall Street Journal: Health Website Woes Widen As Insurers Get Wrong Data
Insurers say the federal health-care marketplace is generating flawed data that is straining their ability to handle even the trickle of enrollees who have gotten through so far, in a sign that technological problems extend further than the website traffic and software issues already identified (Weaver and Radnofsky, 10/17).

USA Today: Tech Experts: Health Exchange Site Needs Total Overhaul
The federal health care exchange was built using 10-year-old technology that may require constant fixes and updates for the next six months and the eventual overhaul of the entire system, technology experts told USA TODAY (Kennedy, 10/17).

The Washington Post's Wonk Blog: The Obama Administration Projected 500,000 Obamacare Sign-Ups This Month. Can That Still Happen?
We don't know, at this point, how many people have signed up for health insurance through HealthCare.gov. Because the site has been very difficult to use, the assumption is not many. One outside estimate pegs the number around 36,000. That's for 34 states that tend to have the highest uninsured rates. That's not so great. But that's not the story in Washington, where more than 25,000 applications for private insurance have been completed, and another 20,000 or so for Medicaid. And it's not the case in New York, which has had 40,000 such applications come in. In Kentucky, Washington, Minnesota and a handful of other states running their own marketplaces, they've seen thousands signing up this month (Kliff, 10/17).

The Wall Street Journal: Attention Likely To Shift To Health Law
The end of Washington's budget showdown is likely to shift attention back to President Barack Obama's health law and its rocky rollout, news of which was sometimes submerged in the past 16 days of struggle. Both the government shutdown and the opening of new online health-insurance exchanges happened on the same day, Oct. 1. Republicans tried to defund Mr. Obama's law as part of a deal to reopen the government, but the law emerged virtually unscathed. The greater damage to the law, it turns out, has been self-inflicted: Officials and contractors charged with getting the federally run exchange up and running instead produced a problem-plagued website that has blocked many people from shopping for coverage. Even when people do sign up, private insurers have warned that the information they are getting about the enrollees may be flawed (Radnofsky and Weaver, 10/17).

The Washington Post: Gansler's New Running Mate Knocks Brown For Problems With Maryland's Health Exchange
Health care is among the issues on which Brown has played a leading role in the administration of Gov. Martin O'Malley (D). Until recently, Maryland had been held up as a model for its implementation of the Affordable Care Act. But the Web site for Maryland's health exchange was plagued by glitches when it debuted this month, hindering the ability of people to sign up for coverage as part of Obama's signature initiative (Wagner, 10/17).

The Wall Street Journal's Risk & Compliance Journal: HIPAA Impedes the Sharing of Medical Information
The Health Insurance Portability and Accountability Act was a well-intentioned law designed to protect patients from having their health information disseminated without their approval, but it also impedes the sharing of information among those with the same health afflictions (DiPietro, 10/17).

Los Angeles Times: UnitedHealth's Shares  Dip On Small Increase In Quarterly Profits
The Minnetonka, Minn., company said government funding cuts to Medicare Advantage plans were one drag during the quarter, but it said overall medical costs remained in check (Terhune, 10/17).

The Wall Street Journal: Tough Prognosis For Health Insurers
Health insurers got a first taste Thursday of the challenges awaiting them under the new federal health law, with UnitedHealth Group Inc. issuing a cautious outlook for 2014 due to funding cuts tied to the law. Under the health law, insurers like UnitedHealth and Humana Inc. will reap lower payments for additional services beyond the basic fee-for-service Medicare program (Martin, 10/17).

Reuters/The New York Times: UnitedHealth Posts Higher Profit On New Enrollments
UnitedHealth said it had 45.3 million people enrolled in health plans as of Sept. 30, helped by increases in individuals in government-paid programs such as Medicaid for the poor and Medicare Advantage for older people. Its international large-group business also expanded (10/17).

Los Angeles Times: A Journey From Mental Illness To Music And A Standing Ovation
With help from San Francisco's Behavioral Health Court two years ago, Knoble found herself not in prison -- where she was headed after committing a violent crime while off her medications -- but instead surrounded by a team of treatment specialists who have helped her thrive. The poised young woman, whose story was recently featured in The Times, told it in her own words Wednesday to an audience gathered at the St. Francis Yacht Club to celebrate the court's 10-year anniversary (Romney, 10/17).