First Edition: Nov. 27, 2013

Note to Readers: In observance of the Thanksgiving Holiday, KHN's First Edition will not be published on Thursday and Friday, Nov. 28 and 29. Look for it again in your inbox Dec. 2.

Today's early morning highlights from the major news organizations:

Kaiser Health News: Even Without Expansion, S.C. Will See 16% Jump In Medicaid Enrollment
Kaiser Health News staff writer Phil Galewitz, in collaboration with McClatchy, reports: "Like half the states, South Carolina chose not to expand Medicaid under the federal health law next year, citing the program's high costs and inefficiency. Yet, state officials still forecast a 16 percent enrollment jump by the end of June, 2015, triple that of a typical year and even higher than the 12 percent average increase expected in states that are expanding eligibility. What's going on? South Carolina officials say publicity for the Affordable Care Act and its requirement that most people get insurance will attract tens of thousands of people who are currently eligible for Medicaid but have not enrolled" (Galewitz, 11/26). Read the story. 

Kaiser Health News: Philadelphia To Launch Health-Insurance Outreach 
The Philadelphia Inquirer's Don Sapatkin, in collaboration with Kaiser Health News, reports: "Come into city offices ranging from the Free Library to the Department of Records over the next few months and you will, in theory, be asked whether you have health insurance and offered information about Obamacare, including the option of getting a call from a specialist trained in enrollment. The outreach, described by Enroll America, a national nonprofit, as its biggest partnership with a city in support of the Affordable Care Act, will be announced Tuesday by Mayor Nutter" (Sapatkin, 11/26). Read the story.

Kaiser Health News: Capsules: 8 Senate Democrats Seek Obamacare Enrollment 'Alternative'
Now on Kaiser Health News' blog, Julie Appleby reports on the latest sign of Democrats' concern about the health law problems: "Eight Senate Democrats -; including key leadership member Charles Schumer of New York – told the Obama administration Monday that they 'continue to be troubled by the ongoing technical difficulties' with  healthcare.gov and want an alternative way for insurers and web-based brokers to enroll subsidy-eligible consumers" (Appleby, 11/26). 

The New York Times: A Plea To Avoid Crush Of Users At Health Site
White House officials, fearful that the federal health care website may again be overwhelmed this weekend, have urged their allies to hold back enrollment efforts so the insurance marketplace does not collapse under a crush of new users. At the same time, administration officials said Tuesday that they had decided not to inaugurate a big health care marketing campaign planned for December out of concern that it might drive too many people to the still-fragile HealthCare.gov (Shear and Pear, 11/26).

The Wall Street Journal: Health Website Deadline Nears
With the clock ticking toward a Saturday deadline, Obama administration officials promise that the HealthCare.gov website will work better. Exactly how much better? That is hard to say. The measure of success, repeated by an array of administration officials, is that the online marketplace intended to be used by millions of Americans to obtain health insurance would be working smoothly for the "vast majority of users" by Saturday, the last day of November (Nelson, 11/26).

The Washington Post: Democrats Eagerly Seeking Signs Of Success With Health-Care Law
The political battle over the future of the national health-care law is about to become a media faceoff between Republican accounts of mishap and failure vs. Democratic stories that hint at eventual success. In a pre-Thanksgiving messaging memo, Democratic senators are being urged to use the holiday break to find success stories and "aggressively publicize them so that people can see the law is delivering on its promise." The memo was prepared and distributed by the Senate Democratic Policy and Communications Committee, the Senate Democrats' political messaging operation (O'Keefe, 11/26).

The Associated Press: Obama's Gatekeeper Now Point Man On Health Care
White House chief of staff Denis McDonough was ready to vent. "I've had too much humble pie," he fumed, striding into a top aide's West Wing office. "That was the last slice. I'm full." McDonough had just finished another hand-holding meeting with health care advocates anxious over the disastrous rollout of the health care law. For weeks, President Barack Obama and White House officials had been apologizing for and promising fixes to a faulty website and an unmet promise to insurance holders that they could keep their policies. McDonough's message: It was time to change tactics, quit lamenting the problems and start emphasizing the benefits of the health care overhaul (Kuhnhenn, 11/27). 

Politico: State Successes Show Health Law Can Work
With all the waves of bad news about the Obamacare website and the canceled policies, it would be easy to conclude that nothing in this law will ever work -; that it's just too big and complicated and messy. But that's not the complete picture of the Affordable Care Act rollout. There are a few bright spots -; just enough to suggest that, for all the early disasters, the law's fate isn't final yet. There are states that are running their own websites and enrolling a lot of people, way more than the amateur-hour federal website that serves most of the states. Medicaid enrollment, another part of the law, is going significantly better than the signups for private insurance -; nearly 400,000 people were determined to be eligible in October (Nather, 11/27).

The New York Times: Justices To Hear Contraception Cases Challenging Health Law
The Supreme Court on Tuesday agreed to hear a pair of cases on whether corporations may refuse to provide insurance coverage for contraception to their workers based on the religious beliefs of the corporations' owners. The cases present a new challenge to President Obama's health care law. The Supreme Court in 2012 upheld another part of the law, one that requires most Americans to obtain health insurance or pay a penalty. The Obama administration has exempted many religious groups from the law's requirements for contraception coverage. But it said that commercial corporations could not rely on religious objections to opt out of compliance with the law (Liptak, 11/26).

The Washington Post: Supreme Court To Review Contraceptive Coverage Mandate In Health-Care Law
The cases accepted by the court offer complex questions about religious freedom and equality for female workers, along with an issue the court has not yet confronted: whether secular, for-profit corporations are excepted by the Constitution or federal statute from complying with a law because of their owners' religious beliefs (Barnes, 11/26).

The Wall Street Journal: Justices To Decide On Companies' Religious Rights
The Supreme Court said it would decide whether businesses, like people, have a right to religious expression, in cases challenging the federal health law's mandate that employers provide contraceptive coverage to female employees. The high court upheld most of President Barack Obama's Affordable Care Act in a June 2012 decision. But lower courts have split since then on whether contraceptive coverage must be included in minimum benefits packages (Bravin, 11/26).

Politico: Supreme Court Agrees To Hear Cases On Contraceptive Mandate
The case could also rekindle the same clash that unfolded during the 2012 presidential campaign, when Republicans attempted to make the contraception rule an important issue. A ruling against the contraception coverage rule wouldn't knock down the whole health law, but it would give more fuel to its opponents (Haberkorn, 11/26).

NPR: Supreme Court Takes Challenge To Obamacare Contraceptive Rule
In enacting the ACA, Congress required large employers who offer health care services to provide a range of preventive care, including no-copay contraceptive services. Religious nonprofits were exempted from this requirement, but not for-profit corporations. Some three dozen of these corporate entities challenged this requirement in court, contending the contraception mandate violates their religious rights. On Tuesday, the Supreme Court agreed to examine the issue, after lawyers on both sides asked for high court review (Totenberg, 11/26).

Los Angeles Times: Supreme Court To Hear Cases On Obamacare And Birth Control 
The Supreme Court agreed Tuesday to jump into a growing legal dispute between the Obama administration and businesses run by conservative Christians over whether a company must pay for birth control drugs that conflict with its owner's religious beliefs (Savage, 11/26).

The New York Times: New Birth Control Label Counters Lawsuit Claim
European health authorities have made two significant changes to the label of an emergency contraception pill that is equivalent to Plan B One-Step. One of the changes could be relevant to two cases that the Supreme Court added to its docket on Tuesday. The new label of the drug, Norlevo, says it "cannot stop a fertilized egg from attaching to the womb," contradicting a claim by some abortion opponents that has fueled their objections to the Affordable Care Act (Belluck, 11/26).

The Wall Street Journal: Doctors: New Health Care Plans Raise Red Flags
Physicians groups told Obama administration officials Tuesday that they are worried that new insurance plans under the Affordable Care Act offer only limited networks of providers and low reimbursement rates for doctors, and that could make it difficult for millions of those enrolled to actually get health care (Radnofsky, 11/26).

The Wall Street Journal: State Exchanges Started Late, Clashed With Vendors
It was on a cold, sunny day in Baltimore last January that Curt Kwak, chief information officer of the Washington Health Benefit Exchange, first realized that the signature feature of President Obama's Affordable Care Act could be in trouble. That day, at a status review meeting of CIOs of state health exchanges, he learned that many of his peers were far behind where they should have been. According to Mr. Kwak, several of his peers hadn't yet selected a systems integrator –  tech vendors who play crucial roles in fitting together the multiple components of health insurance exchanges that allow consumers to select and enroll in health plans. In contrast, Mr. Kwak had had a systems integrator in place since the previous January (Boulton, 11/26).

USA Today: Sebelius: Health Site Experience 'Improved Every Day'
State and local elected officials should "not hesitate" to tell their constituents to go to HealthCare.gov and sign up, Health and Human Services Secretary Kathleen Sebelius said Tuesday. "We are definitely on track to have a significantly different user experience by the end of this month," Sebelius said. "But this isn't a magic turn-on switch. The experience is improved every day" (Kennedy, 11/26).

Politico: Group To Hit Mike Enzi On Obamacare
A conservative nonprofit group is set to launch a TV attack ad Monday intimating that Republican Sen. Mike Enzi is less than pure in his opposition to Obamacare. Americans for Job Security highlights the incumbent's support for exchanges during the 2010 debate over Obamacare (Hohmann, 11/26).

NPR: 3 Ways Obamacare Is Changing How A Hospital Cares For Patients
The Affordable Care Act is transforming more than health insurance. In hospitals around the country, the legislation could transform the way doctors and nurses actually care for patients. Part of the law is designed to rein in the nation's exploding health care costs by creating hundreds of little experiments that test new ways for hospitals to save money (Chow, 11/26).

NPR: To Changing Landscape, Add Private Health Care Exchanges
We've been reporting a lot lately on the troubled rollout of President Obama's signature health care law. But at the same time, there are rumblings of a major shift in the way companies offer private health insurance to workers. It involves what are called "private health care exchanges." These are similar to -; but completely separate from -; the public exchanges you've heard so much about (Arnold, 11/27).

USA Today: Children's Hospital Reaches Out To Parents, Too
Amber Bailey used to travel up to an hour to see her baby's pediatrician. That was when things were looking brighter and she was living in a house with her child's father. She's homeless now with two small children, but their doctor is only five minutes away, and medical care even comes to her shelter [in Philadelphia]. Health care may dominate the news these days, but it's typically not on the minds of the homeless. But one children's hospital and a generous donor here are making sure the most vulnerable members of this city's struggling population remember the importance of their children's and their own health care and coverage. And the thanks they receive from the families adds to the satisfaction they get from meeting some of the goals of the health care overhaul (O'Donnell, 11/26).

Los Angeles Times: Healthcare Costs At Big L.A. Firms Up 4.5% This Year, Survey Shows
Healthcare costs for Los Angeles employers climbed 4.5% this year to $11,625 per employee, a new survey shows, and firms expect a bigger increase in 2014. Nationwide, health-benefit costs in the workplace rose just 2.1% in 2013 to $10,779 per worker, which includes employer and employee contributions for medical, dental and other health coverage. The figures come from a survey of employer health plans by Mercer, a benefits consulting firm (Terhune, 11/26).