First Edition: November 20, 2013

Today's early morning highlights from the major news organizations, including reports that President Barack Obama places some of the blame for the health law's woes with Republicans, and details of comments by an Obama administration tech official that a large portion of the healthcare.gov 'back office' functions are yet to be built.

Kaiser Health News: Doctors Complain They Will Be Paid Less By Exchange Plans
Reporting for Kaiser Health News, Roni Caryn Rabin writes: "Many doctors are disturbed they will be paid less -- often a lot less -- to care for the millions of patients projected to buy coverage through the health law's new insurance marketplaces. Some have complained to medical associations, including those in New York, California, Connecticut, Texas and Georgia, saying the discounted rates could lead to a two-tiered system in which fewer doctors participate, potentially making it harder for consumers to get the care they need" (Rabin, 11/19). Read the story.

Kaiser Health News: 'Motor Voter' Meets The Health Law
Kaiser Health News staff writer Anna Gorman, working in collaboration with The Washington Post, reports: "Twenty years ago, Congress passed a controversial law requiring states to allow people to register to vote when they applied for driver's licenses or social services. Now, that same law is bringing voter registration to the health insurance marketplaces, and again, it is expected to result in legal fights. It also could lead to more partisan debate over the Affordable Care Act as Republicans raise concerns about whether the voter registration effort will produce Democratic voters" (Gorman, 11/20). Read the story.

Kaiser Health News: Does The Insurer Have The Right To Cancel A Grandfathered Plan?
Kaiser Health News consumer columnist Michelle Andrews answers a reader's question on this topic (11/20). Read her response. 

The Washington Post: Obama Says Republicans Share Some Blame For Health-Care Law's Failures
President Obama on Tuesday sought to redirect some of the political blame for the botched rollout of the federal health insurance exchange to Republicans, characterizing GOP lawmakers as rooting for the law's failure. Addressing a gathering of business executives, Obama acknowledged that the health-care rollout "has been rough, to say the least," and he lamented the government's archaic information-technology procurement system (Rucker and Somashekhar, 11/19).

The Associated Press/Washington Post: Health Secretary Says Website Will Improve, But Still Be A Work In Progress Come December
The HealthCare.gov website will still be a work in progress beyond the end of the month, Human Services Secretary Kathleen Sebelius said Tuesday, appearing to soften a promise that the site will be working by then for the vast majority of users. "The 30th of November is not a magic go, no go date. It is a work of constant improvement. We have some very specific things we know we need to complete by the 30th and that punch list is getting knocked out every week," Sebelius told The Associated Press (11/19).

The Washington Post: Carney Says Obama Was Told About Healthcare.gov Review In April
White House press secretary Jay Carney said President Obama was told in April about a review of HealthCare.gov's problems, but Carney declined to specify the details of the briefing. A federally-commissioned review by McKinsey & Co. concluded in late March that the online enrollment system was risky because the design process was flawed, The Washington Post first reported Monday night (Eilperin, 11/19).

The New York Times: Perks Ease Way In Health Plans For Lawmakers
Members of Congress like to boast that they will have the same health care enrollment experience as constituents struggling with the balky federal website, because the law they wrote forced lawmakers to get coverage from the new insurance exchanges (Pear, 11/19).

The Wall Street Journal: For Lawmakers, Staff, on Capitol Hill, Obamacare Rollout Goes Smoothly
Lawmakers and their staff are getting personal experience with the Affordable Care Act-;and it isn't always the same as their constituents'. Members of Congress and their aides are getting coverage through the District of Columbia's small-business exchange. That fulfills a provision in the law requiring them to obtain coverage through new insurance exchanges, not the familiar federal employee benefits program, in which Congress, like many large employers, heavily subsidized their premiums (Radnofsky, 11/19). 

The New York Times: In Stance On Renewal Of Old Health Policies, States Run The Gamut
Of the 13 states that have so far said they will allow consumers to renew canceled plans, all but four are led by Republican governors and have generally been opposed to the new health care law. Of the eight that have said they will not carry out the policy, six are in Democratic-led states, many of which have actively worked to put the law into effect and have argued that allowing such an extension could undermine its success. They include New York, which announced its decision on Tuesday, and Massachusetts. Many other states, including California and New Jersey, are still weighing their options (Thomas, Craig and Yourish, 11/19).

The Wall Street Journal: Most Insurance Regulators Back New Obama Plan
Insurance regulators in about half of U.S. states have now declared where they stand in response to President Barack Obama's plan to allow a one-year extension of policies canceled because they don't comply with the health law. So far, most support the initiative-;or at least aren't blocking insurers who want to take advantage of it (Scism and Martin, 11/19).

The Associated Press/Washington Post: Md. Insurance Commissioner Says Canceled Policies Can Be Renewed, But Only Through 2014
Maryland's insurance commissioner says individual policies that don't comply with the federal health care overhaul can be extended through the end of next year. Insurance Commissioner Therese Goldsmith said in a memo to insurers Tuesday that they can renew such policies for 2014 as long as the renewals take effect before Jan. 1 (11/19).

Politico: CMS Sees Progress With Direct Plan Enrollment
Obama administration tech officials announced Tuesday that consumers can now enroll directly with insurers and avoid HealthCare.gov altogether, and their Obamacare subsidies will go with them. But insurance industry sources remained skeptical, citing a cumbersome repair effort over the past several weeks that has yet to prove itself. And officials from the Centers for Medicare & Medicaid Services said insurers have to try out the new system "in coming days" to see whether the federal portal can hold up  (Norman, 11/20).

The Washington Post: Up To 40 Percent Of Obamacare's 'Back Office' Functions Yet To Be Built, Tech Chief Says
Henry Chao, the Obama administration official who oversaw the technical development of the federal health insurance marketplace, said Tuesday that his team has yet to complete 30 to 40 percent of the overall project. Speaking before a subcommittee of the House Energy and Oversight Committee, Chao said the Centers for Medicare and Medicaid Services is still working on a number of "back office" aspects of the project, including a system to send payments to insurance companies (Somashekhar, 11/19).

The New York Times: Health Insurance Marketplace Is Still About 40 Percent Incomplete, Official Says
The official, Henry Chao, made the assessment in testimony before a panel of the House Energy and Commerce Committee. Lawmakers expressed surprise that so much work remained to be done seven weeks after the federal website opened to the public (Pear, 11/19).

The Wall Street Journal: New Tech Worries Loom For Health Law
A top government technology official told Congress on Tuesday that about 30% of the federal health-insurance marketplace "is still being developed," suggesting more tough hurdles await the administration even after the consumer portion, HealthCare.gov, is mostly fixed (Dooren, 11/19).

Politico: Tech Chief: Up To 40% Of Obamacare Work Left
A key player in the Obamacare website's creation acknowledged Tuesday that up to 40 percent of IT systems supporting the exchange still need to be built. The revelation from Deputy Chief Information Officer Henry Chao of the Centers for Medicare & Medicaid Services occurs as the administration works at its Nov. 30 deadline to shore up the website (Meyers, 11/20).

The Washington Post: Maryland Struggling With Technological Problems With Online Insurance Exchange
Maryland is wrestling with stubborn technological problems with its online insurance exchange, posting weak enrollment even as other states have signed up thousands of consumers for plans under President Obama's new health-care law. In October, the exchange's first full month of operation, 1,278 people signed up for the private plans, and 465 signed up in the first week of November. Those low numbers raise questions about whether Maryland will achieve its enrollment target of 150,000 by the end of March. The state has about 800,000 uninsured residents (Sun, 11/19).

The Washington Post: Brown Accused Of 'Dropping The Ball' On Health Care In Md. As He Appears With Football Players
The two leading Democratic candidates for governor of Maryland engaged in some trash talk Tuesday over the implementation of health-care reform in the state. The campaign of Attorney General Douglas F. Gansler (D) accused Lt. Gov. Anthony G. Brown (D) of "dropping the ball" on the rollout of the Maryland Health Exchange on a day when Brown appeared alongside past and present Washington Redskins players to promote enrollment in insurance programs (Wagner, 11/19).

The Wall Street Journal's Washington Wire: Connecticut's Early Health Enrollees Skew Older
Are older Americans enrolling in health insurance plans in greater numbers than young adults? Early enrollment figures released by two states suggest that could be the case. Data released Tuesday by Connecticut officials show that more people over the age of 55 enrolled in private insurance (40%) than people under the age of 35 (26%). The figures represented enrollment in private health plans as of Nov. 15 (Schatz, 11/19).

Los Angeles Times: Drew Altman, Obamacare's Ref
He might have become a doctor like his father, but a grad school (Harvard) summer job researching health policy changed all that. Now as the head of the Kaiser Family Foundation, Drew Altman deals not with lab numbers for a few patients but with healthcare data for millions. For years he headed up state and federal programs on welfare reform, homelessness and Medicaid. Since 1991, he's shaped the Menlo Park-based foundation as "a trusted source of information in a healthcare world dominated by vested interests." With Obamacare stumbling out of the gate, the foundation has been marshaling its data on behalf of consumers and providers to clear the fog of policy (Morrison, 11/19).

The New York Times' The Caucus: Koch Brothers' Group Uses Health Care Law To Attack Democrats
Americans for Prosperity, the political group backed by the billionaire brothers Charles and David Koch, is targeting three of the most vulnerable Senate Democrats who are up for re-election next year. The group's efforts are part of a new $3.5 million attack advertising campaign that hammers lawmakers for supporting President Obama's health care law. The senators -; Mark Begich of Alaska, Kay Hagan of North Carolina and Mary L. Landrieu of Louisiana -; are all from conservative-leaning states that voted to elect Mitt Romney in 2012. The ads will start running in those states on Wednesday (Peters, 11/19).

Politico: Harry Reid Between Affordable Care Act And Vulnerable Democrats
Reid and his leadership team are assessing how Obama's proposed administrative fix to allow individuals to keep canceled insurance plans for one year plays in GOP-friendly states like Louisiana, Arkansas and North Carolina -; where key Democratic incumbents are up for reelection next year, leadership aides said. The hope is that the fix may blunt a recent nose dive in public approval of Obamacare (Everett and Kim, 11/19).

The Associated Press/Washington Post: Prescription Drug Sales Will Continue To Slow Due To Expiring Patents And Austerity Measures
Growth in global prescription drug spending will slow to the lowest rate in decades as low-cost generic drugs continue replacing former blockbusters in the U.S. and Europe, where governments face new pressure to reduce health care spending, according to a new forecast. The projection from data firm IMS Health shows the global prescription drug market growing by 3 to 6 percent over the next four years to $1.2 trillion by 2017. That compares to a growth rate of 5.4 percent in the last four-year period (11/19).

The New York Times: Justices Reject Bid To Block Texas Law On Abortions
The Supreme Court on Tuesday turned away an emergency application asking it to block a Texas law that requires doctors performing abortions to have admitting privileges at a nearby hospital (Liptak, 11/19).

Los Angeles Times: Supreme Court Vote Upholds Texas Abortion Law
The Supreme Court cleared the way Tuesday for Texas to enforce a strict new abortion regulation that opponents say prevents a third of the state's clinics from performing the procedure. The court, in a 5-4 vote, split along ideological lines in turning down an appeal to block the law that abortion rights advocates challenged as unconstitutional (Savage, 11/19).

Los Angeles Times: O.C. Nursing Home Pays $48 Million To Settle Medicare Fraud Case
Ensign Group Inc., a Mission Viejo company that operates nursing homes in several states, has agreed to pay $48 million to resolve allegations that it billed Medicare for unnecessary procedures performed on its patients. Two former Ensign Group therapists had accused the company in whistle-blower lawsuits of performing the unnecessary rehabilitation therapy at six skilled-nursing facilities in California. Although the lawsuits were filed in 2006, the government contended that the fraud lasted from 1999 to 2011 (Pfeifer, 11/19).

Los Angeles Times: Healthcare Regulator's Move To Kaiser Under Investigation
California authorities are investigating whether laws were broken when a government regulator went to work for healthcare giant Kaiser Permanente, a company she spent years investigating for the state. Marcy Gallagher was a supervising attorney at the California Department of Managed Health Care, where she participated in several investigations of Kaiser. Last year, she left state employment and joined the company, where she works in a unit that responds to California regulators (Megerian, 11/19).