First Edition: November 22, 2013

Today's headlines include reports that the Obama administration will push back 2015 Obamacare enrollment by a month, starting Nov. 15, 2014, instead of Oct. 15, 2014.

Kaiser Health News: For Insurers, Obama's Proposed Cancellation 'Fix' Changes Health Law Calculations
Kaiser Health News staff writer Jay Hancock reports: "Despite numerous problems with the health law rollout, WellPoint CEO Joseph Swedish told analysts last week he was still 'confident' in the company's bet to be the biggest seller of Obamacare insurance. Two days later President Barack Obama changed the rules. Suddenly subscribers who were expected to buy coverage through the health law's marketplaces from WellPoint, the nation's No. 2 medical carrier, may end up keeping the plans they have now" (Hancock, 11/22). Read the story.

Kaiser Health News: Covered California: Older Jump In First, But Officials Buoyed By Number Of Young Enrollees
Kaiser Health News staff writers Anna Gorman and Sarah Varney report: "In a state considered crucial to the success of Obamacare, older people have enrolled in California's new health insurance marketplace in large numbers as expected, but younger people also have showed up in force. About 56 percent of Californians who signed up for coverage in October are over 45 and nearly 23 percent of the enrollees are between 18 and 34 years old, according to data released Thursday at the Covered California board meeting in Sacramento. The older enrollees make up a higher percentage than in the state's total population, while the proportion of younger consumers more or less match their makeup state" (Gorman and Varney, 11/22). Read the story.

Kaiser Health News: A Reader Asks: Will International Students Be Eligible For Health Law's Subsidized Coverage?
Kaiser Health News consumer columnist Michelle Andrews responds to this reader's question (11/22). Read her answer.

Kaiser Health News: In Iowa, Accountable Care Begins To Make A Difference
Kaiser Health News staff writer Jenny Gold, working in collaboration with NPR, reports: "Here's how it works: a group of doctors and hospitals get together to form a network responsible for taking care of a group of Medicare patients-;in this case, about 9,000 Iowans.  If the network can prove it's keeping those patients healthier and spending less money to do so, it gets to keep some of the savings. The ACO can then use that money to do things Medicare doesn't usually cover-;like reaching out more to patients at home. But if the ACO does not succeed, it may face a financial penalty" (Gold, 11/21). Read the story.

Kaiser Health News: Capsules: Troubled Health Law Rollout Damages Public Support; Calif. To Canceled Policy Holders: Buy A New Plan
Now on Kaiser Health News' blog, Jordan Rau reports on new poll findings about the health law: "With its troubled rollout of the new insurance marketplaces, the Obama administration has achieved something Republicans have failed to do: seriously dent the popularity of the health care law, according to poll released Friday. Nearly half of Americans now hold an unfavorable view of the law and only a third like it, according to the poll from the Kaiser Family Foundation. (KHN is an editorially independent part of the foundation.)  The 16-percentage point gap between positive and negative views is almost the largest it has been since the foundation began its monthly tracking poll in April 2010. The only time the gap was bigger was in October 2011, when the Republican presidential candidates, gearing up for the primary season, were taking turns bashing the law" (Rau, 11/22).

Also on the blog, Sarah Varney reports on Covered California's decision about canceled health plans: "California did not take President Obama up on his offer to extend canceled health policies.  The five-member board that oversees California's health insurance marketplace, known as Covered California, voted unanimously Thursday to stay the course and cancel policies that didn't meet the requirements of the Affordable Care Act. The board's decision had been widely anticipated, but at the public hearing in Sacramento there was an audible sigh of relief by consumer advocates and insurance company representatives when the vote became clear" (Varney, 11/21). Check out what else is on the blog.

The Wall Street Journal: Obama Administration To Push Back Health-Insurance Enrollment For 2015
The Obama administration is planning to push back the period during which Americans sign up for coverage under the new health law in its second year of operation, a change that could reassure insurers while also avoiding the 2014 midterm elections. The Department of Health and Human Services will allow Americans to start signing up for coverage starting Nov. 15, 2014, rather than Oct. 15, 2014, a department official said early Friday. People will have until Jan. 15, 2015, rather than Dec. 7, 2014, to complete the process, the official said (Radnofsky, 11/22).

Politico: HHS To Delay 2015 Obamacare Enrollment By A Month
The decision means that sign-ups for the 2015 plan year would begin on Nov. 15, 2014 and end on Jan. 15, 2015 instead of the Oct. 15-Dec. 7 window previously announced. The date change, first reported by Bloomberg, also lengthens the enrollment period by a week. Doing so would give companies more opportunity to account for individuals, particularly young adults, who come in late during the plan's first year, which has gotten off to a rocky start. The goal is premiums that more accurately reflect costs for those insured (Levine, 11/21).

Los Angeles Times: Healthcare Industry Vested In Success Of Obamacare
President Obama's healthcare law, struggling to survive its botched rollout, now depends more than ever on insurance companies, doctor groups and hospitals -; major forces in the industry that are committed to the law's success despite persistent tensions with the White House  (Levey, 11/21).

The Wall Street Journal: Insurers Cut Doctors' Fees in New Health-Care Plans
Insurers are slashing payments to medical practices in many of the plans they sell through the new health-law marketplaces-;sparking worries that Americans signing up for coverage will have fewer doctors to choose from if low fees spark an exodus from the plans.  UnitedHealth Group Inc. sent some New York City physicians contract amendments as recently as this month setting rates well below what doctors normally see from private insurance, including less than $40 for a typical office visit and about $20 for reading a mammogram, according to confidential documents reviewed by The Wall Street Journal (Weaver and Beck, 11/21).

USA Today: Sticker Shock Hits Health Exchange Shoppers
Sweeping differences in health care exchange pricing among states and counties is leading to sticker shock for some middle-class consumers and others who aren't eligible for subsidies under the Affordable Care Act (O'Donnell and Overberg, 11/21).

Politico: Older Hill Aides Shocked By Obamacare Prices
Veteran House Democratic aides are sick over the insurance prices they'll pay under Obamacare, and they're scrambling to find a cure. "In a shock to the system, the older staff in my office (folks over 59) have now found out their personal health insurance costs (even with the government contribution) have gone up 3-4 times what they were paying before," Minh Ta, chief of staff to Rep. Gwen Moore (D-Wis.), wrote to fellow Democratic chiefs of staff in an email message obtained by POLITICO. "Simply unacceptable" (Allen and Haberkorn, 11/21).

The New York Times: U.S. Unveils Letters Insurers Must Send About Health Plans
On Thursday, the federal government unveiled sample letters that insurance companies will be required to send to anyone seeking to renew one of those policies. The letters are blunt, declaring that the insurance that is about to be renewed "will NOT provide all of the rights and protections of the health care law." Renewal letters sent by insurance companies will have to list all the deficiencies in the policy (Shear, 11/21).

The Washington Post: Insurance Brokers, Agents Also Caught In Healthcare.gov Technology Woes
and agents say a host of technological problems is blocking their ability to help consumers sign up for coverage through the federal health insurance Web site. They say it is a particular problem for people with major health issues -; those considered high-risk -; because they are least able to weather a gap in coverage (Sun and Kliff, 11/22).

The Washington Post: The Federal Health-Care Exchange's Abysmal Success Rate
Technical issues have plagued the rollout of the Affordable Care Act's online health insurance exchanges -; digital marketplaces where individuals can browse and apply for health insurance coverage. States decided whether they would create their own exchange or, if they preferred, have the federal government do it for them (or create one through a partnership with the federal government). Typically, states that embraced the health-care law, such as California, chose to create exchanges, while states that were resistant to it, such as Florida, defaulted to the federal exchange. However, the states that defaulted to a federal exchange are facing a host of technical issues and are faring, on average, much worse than states with their own exchanges (Elliott, 11/21).

The Associated Press/Washington Post: Experts: Healthcare.gov Fix Needs More Time, Money
Curtis says programmers and systems analysts start fixing troubled websites by addressing the glitches they can see. But based on his analysis of the site, he believes the ongoing repairs are likely to reveal even deeper problems, making it tough to predict when all the site's issues will be resolved. "Will it eventually work? Yes, because they have to make it work," he says. But it'll be very expensive" (11/21).

Politico: Emails Show Little Testing On Healthcare.gov
The minimal testing done four days before the launch of HealthCare.gov failed to handle 500 people applying through the website at one time, according to internal e-mails between the top Obama administration technicians working on the site (Haberkorn, 11/22).

The Wall Street Journal's Washington Wire: Obamacare Advocates Delay Marketing Push Until January
Advocates for the health-overhaul law are significantly pushing back the timing of their big advertising blitz aimed at enrolling millions of uninsured Americans in insurance coverage. Ron Pollack, head of the Families USA consumer group and a board member of the Enroll America coalition, says groups like his are now planning on stepping up their advertising about the law in January, rather than during this year's holiday season (Radnofsky, 11/21).

Los Angeles Times: California Won't Extend Health Plans
Spurning President Obama's call to let insurers extend canceled health policies, California won't allow 1 million policyholders to keep their health plan for another year. The board of the Covered California health exchange voted unanimously to break with the president and keep its requirement that insurers terminate most individual policies Dec. 31 because the policies don't meet all the requirements of the Affordable Care Act (Terhune, 11/21).

The Wall Street Journal: Split Over Health-Law Change
California officials rebuffed President Barack Obama Thursday and voted against letting insurers in the state reinstate canceled health policies, in a move that highlighted internal tensions among Democrats about the health law's direction. Mr. Obama proposed last week that insurers be allowed to restore the canceled policies, hoping to quiet a furor that broke out when it became clear that millions of Americans who bought individual coverage were losing it (Radnofsky, Lazo and Scism, 11/21).

The New York Times: California Encouraged by Health Plan Enrollment
Especially encouraging, officials said, was the enrollment of young people, who are considered essential to the success of the Obama administration's health care law (Thomas and Pollack, 11/21).

The Wall Street Journal's Washington Wire: California's Health Exchange Gains Momentum
While the federal health-insurance exchange continues to be bogged down by problems, California's state health exchange is gaining momentum, according to new figures released by the state Thursday. As of Nov. 19, nearly 80,000 Californians had selected a private health plan, as enrollments more than doubled since the beginning of the month. Enrollment rates rose to about 2,700 per day in the second week of November from 700 per day in the initial week after the Covered California exchange opened Oct. 1, the state said (Ante, 11/21).

The Washington Post: Expanding Medicaid Could Cloud Some Republicans' 2016 Hopes
Christie is one of just eight Republican governors to accept the expansion. He and Gov. John Kasich (R), of Ohio, are the only two who have both expanded Medicaid and who are said to harbor White House ambitions. Expanding Medicaid will make most adults who earn up to 138 percent of the federal poverty limit eligible for coverage. The federal government will cover 100 percent of the costs of the expansion for the first few years of the program, and 90 percent of the costs going forward (Wilson, 11/21).

The New York Times: Health Law Is Dividing Republican Governors
At the annual meeting here of the nation's Republican governors, the ones who are eyeing presidential runs in 2016 say they oppose the health care law. But there is sharp disagreement among those who have helped carry out the law and those who remain entrenched in their opposition (Martin, 11/21).

The Wall Street Journal's Washington Wire: Some GOP Governors Embrace Medicaid Expansion
The health-care fight consuming Washington looks a little different at the state level where a handful of Republican governors have embraced a central tenet of the new law: expanding Medicaid to cover the poor. Prominent Republican governors have pegged their political fortunes to the expansion, including New Jersey Gov. Chris Christie, who is often mentioned as a White House hopeful in 2016, and others who have potentially difficult re-elections next year, such as Ohio Gov. John Kasich and Michigan Gov. Rick Snyder (O'Connor and Radnofsky, 11/21).

The New York Times: Maine Hires Firm To Study Medicaid System, To Democrats' Ire
Officials in Maine have hired a consulting firm to study the state's Medicaid system, to include evaluating the cost of expanding the program under President Obama's Affordable Care Act, a move Gov. Paul R. LePage has in the past rejected (Bidgood, 11/21).

The Washington Post: A Montana Group Wants Voters To Decide On The Obamacare Medicaid Expansion
There's no shortage of controversy surrounding the president's landmark health-care law, but one battle has been fought in each and every state: whether to expand Medicaid under the law. The nation is evenly split -; half the states are moving forward with the expansion and half aren't. In some states, the decision came down from the governor and in others, the legislature. In Montana, the governor was for it, but a mistaken vote -; yes one man's mistake -; killed its chances in the state House. But now, a coalition of groups under the banner Healthy Montana Initiative wants to put the question to voters next fall (Chokshi, 11/22).

The Washington Post's The Fact Checker: Did Mary Landrieu Cast The 'Deciding Vote' For Obamacare?
Americans for Prosperity, a conservative advocacy group backed by the Koch brothers, is launching ads targeting Democrats for having voted for the Affordable Care Act. As the 2014 midterm elections loom, readers should get ready for a flood of ads showing President Obama repeating his Four-Pinocchio statement that Americans could keep their health plan if they liked it. In this case, the Fact Checker was curious about the claim that Sen. Mary Landrieu (D-La.), who likely will have a tight race, cast the "deciding vote" for the law. AFP is clearly trying to undercut the publicity surrounding her effort to pass a fix to the law that would allow individual policyholders to keep their plans (Kessler, 11/22).

The Associated Press/Washington Post: Boehner Signs On To 'Obamacare' After Delay, Tweet
At one point Thursday, Boehner tweeted his frustration -; "Guess I'll just have to keep trying" -; along with photos of himself at a computer and the error message he says he received. The House speaker has 583,000 followers on Twitter (11/21).

Politico: John Boehner Now Enrolled In Obamacare
About an hour after Speaker John Boehner's office said he couldn't sign up for Obamacare coverage on the District of Columbia's exchange, his office said he's now officially enrolled. "Kept at it, and called the DC Health Link help line. They called back a few hours later, and after restarting the process on the website two more times, I just heard from DC Health Link that I have been successfully enrolled," Boehner's office wrote (Millman and Cunningham, 11/21).