First Edition: December 5, 2013

Today's headlines include reports about how President Barack Obama is trying to connect with young adults and urge them to sign up for health coverage.  

Kaiser Health News: Kansas Advocates For Developmentally Disabled Oppose Giving Medicaid Insurers Full Responsibility
Reporting for Kaiser Health News, in collaboration with The Washington Post, Jenni Bergal writes: "Aldona and Pat Carney call their son, Neil, "a 24-7 kid." He's profoundly autistic, severely mentally retarded and attends a special school. He has tried to eat light bulbs and charcoal briquettes and can be aggressive, sometimes scratching people near him. Neil, 18, who walks with a limp and carries around a grey sock that calms him, lives in a beige single-family home with a professional caregiver who's known him for years. The house is equipped with cameras to track his movements and a backyard swing he loves to ride" (Bergal, 12/5). Read the story.

The New York Times: Obama Presses Case For Health Law And Wage Increase
President Obama left the White House on Wednesday for one of the capital's working-class neighborhoods to talk about the economy, not simply to divert attention from the troubles of his Affordable Care Act but also to explain how that law, for all of its flaws, fits into his vision for Americans' economic security and upward mobility (Calmes, 12/4).

The New York Times: Democrats' Latest Campaign For Health Care Law Begins
President Obama and congressional Democrats, seizing on the good news of an improving health care website and rising enrollments, on Wednesday highlighted parts of the law that are popular with the public and reminded Americans, and the law's opponents, of what would be lost if the Affordable Care Act were repealed (Weisman and Shear, 12/5).

NPR: HealthCare.gov Now Allows Window Shopping, And A Do-Over
One thing that's clear about the relaunch of the troubled HealthCare.gov website is that it can accommodate more people. Federal officials said more than 1 million users logged in on Monday, and nearly that many on Tuesday. But less attention has been paid to some other upgrades that are also making the site easier for people to use. That's too bad, says Nancy Metcalf, senior editor of Consumer Reports, who has been chronicling the rollout of the health exchanges. She says some of them are pretty impressive (Rovner, 12/5).

The New York Times: Enrollment Numbers Rise After Website Improves
About 29,000 people successfully navigated HealthCare.gov and selected an insurance plan on Sunday and Monday, more than the entire number of people who were able to enroll through the federal exchange during the month of October, according to a person familiar with the project. Officials are still double-checking the data and said they would not release enrollment numbers for November until later this month. But the person said the website was working much better than in October, when only 26,000 people were able to enroll in a plan. Politico first reported the weekend enrollment numbers (Shear, 12/4).

Los Angeles Times: Healthcare.gov Sees Enrollment Jump After Repairs To Troubled Website
In the clearest sign yet that the federal health insurance website is vastly improved, about 29,000 people enrolled in insurance plans over the first two days of this week, exceeding the number of enrollments on the site in all of October, according to a source familiar with the data. The 29,000 figure tallies the number of people able to select health plans Sunday and Monday, the 48-hour window after the administration's deadline for making major repairs to the HealthCare.gov website  (Hennessey, 12/4).

The Washington Post: 29,000 Americans Enroll Under Healthcare.gov In 2 Days, Officials Say
That total exceeds the total number of Americans who enrolled online between Oct. 1 and Nov. 2, which was 26,794. The government defines enrollment as an individual who has successfully signed up for a plan. The new total, while short of the pace needed to reach the administration's target of 7 million enrollments by March 31, shows the federal health insurance marketplace is working much more smoothly than it was at its Oct. 1 launch (Eilperin, 12/4).

Politico: Source: Enrollment Surge On Healthcare.gov
The preliminary numbers for the two-day period provide the clearest evidence yet that the federal exchange is on the mend. About 26,000 people selected a health plan during October and about 100,000 people did so in November, the official said (Budoff Brown, 12/4).

The Wall Street Journal's Washington Wire: Traffic Strong On HealthCare.gov–Will Enrollment Follow?
Strong traffic on HealthCare.gov and new figures from states suggest that enrollment is likely picking up on the federal health-insurance exchange, although federal officials aren't giving any specific recent enrollment figures. Officials at the Centers for Medicare & Medicaid Services, the agency running the federal health-insurance website, say they're planning on releasing updated enrollment figures in mid-December. "We expect our enrollment numbers to increase given the technology improvements to the site," CMS spokeswoman Julie Bataille told reporters Wednesday in a daily update call (Schatz, 12/4).

Politico: Rush To Find Health Options Before Jan. 1
If people whose health insurance was canceled under Obamacare this year don't line up new coverage this month, the Obama administration could face a political nightmare. More people could have lost coverage than gained it when the health law benefits begin on Jan. 1. That's by no means a certainty; the sign-up website is doing better, some insurance carriers are extending plans instead of canceling them, and there are millions more uninsured people who stand to get covered than there are covered people facing plan cancellations. Medicaid sign-ups are also running strong (Norman, 12/4).

NPR: White House Cites Pre-Existing Condition Case From Its Own Ranks
It's Day 4 of the White House's new messaging push for the Affordable Care Act. Today the goal is to tell the stories of people with pre-existing conditions who are now entitled to coverage under the new health care law. One such story comes from within the White House. Michael Robertson, chief of staff in the Cabinet Affairs Office, was diagnosed with stage IV colorectal cancer at age 35. "I went overnight from being completely healthy and exercising and all that to having this catastrophic disease," he said in an interview at the White House on Wednesday. Robertson described the shock of realizing "these things can happen in an instant. They don't just happen to older people" (Shapiro, 12/5).

The Washington Post: Obama Urges On Young Activists; 3-Day Healthcare.gov Enrollment Hits 56,000
President Obama urged a group of young activists Wednesday not to give up on promoting his signature health-care law, as enrollment picked up on HealthCare.gov. Roughly 27,000 Americans signed up for insurance on the federal exchange on Tuesday, according to internal figures, bringing the site's three-day enrollment total to 56,000. That figure is more than double the number who enrolled online in the entire month of October, which was almost 27,000 (Eilperin and Goldstein, 12/4).

Los Angeles Times: Obamacare Happy Hour? Obama Urges Creativity In Touting Health Law
With the federal health insurance exchange now operating more smoothly for most users, President Obama assembled 160 youth leaders at the White House on Wednesday, enlisting them to help sign up their peers for health insurance -; a crucial factor in whether his signature law will succeed. As the student body presidents and youth activists gathered for an afternoon of seminars with White House officials and leaders of allied groups, a new poll showed that the administration and its allies have their work cut out for them (Reston, 12/4).

The Associated Press/Washington Post: Obama Hopes Youth Not Discouraged By Health Woes
President Barack Obama says he hopes young people don't get discouraged by how hard it has been to implement health care reform. Obama spoke Wednesday to an audience of young leaders at a White House youth summit on health care. He told the participants that it has never been easy to make big changes in the United States, citing the civil rights movement and efforts by women to win the right to vote (12/4).

Politico: President Obama Wants A Hard Sell For Young Adults
The millennials hung out with the president at the White House on Wednesday, not to shoot hoops or shoot the breeze but to strategize on how to get young adults to sign up for health care. The Youth Summit drew 160 participants from across the country, all members of the 18-35 age demographic that is seen as critical to the financial stability of Obamacare exchanges. The gathering was shy on celebrities in favor of college student body presidents, DJs, YouTube stars, early-career entrepreneurs and leaders from a diverse spread of organizations that have influence with young people, even if it's typically on subjects other than health care. Teen Vogue, for one, was represented (Villacorta, 12/4).

The New York Times: Poll Finds Young People Souring On Health Law And Obama
A majority of 18- to 29-year-olds – a constituency crucial to the success of President Obama's health overhaul -; disapprove of the law, and fewer than a third of those who are uninsured are likely to sign up for coverage, according to a new poll by Harvard University's Institute of Politics. The survey, released Wednesday, also found a stark drop in Mr. Obama's approval ratings among those so-called millennial voters, who have long been his most ardent supporters (Stolberg, 12/4).

Los Angeles Times: Millennial Generation Sours On Obama, Skeptical Of Healthcare Law
Members of the huge millennial generation, who have strongly supported President Obama in the past, have soured on him and take a skeptical view of his signature healthcare law, according to a new poll from Harvard's Institute of Politics. "Millennials have always been one of two significant parts of the Obama coalition," said John Della Volpe, the institute's polling director. Throughout Obama's national political career, members of the millennial generation gave him a significantly higher approval rating than the rest of the population, he said (Lauter, 12/4).

The Wall Street Journal's Washington Wire: Poll: Millennials No Big Fans Of Obamacare
As President Barack Obama gave remarks Wednesday to a White House Youth Summit on health care, a new poll shows the Affordable Care Act isn't faring well among young adults, who share the largely skeptical views of other Americans. A majority of millennials -; adults aged 18-29 -; in the poll disapprove of Mr. Obama's signature health-care law, and fewer than 30% of uninsured millennials said they will definitely or probably enroll if and when they are eligible, a Harvard Institute of Politics poll found (Ballhaus, 12/4).

The Wall Street Journal: Medicaid Is Latest Health-Site Victim
States are warning that they may not process Medicaid enrollments from people who have signed up for the health program through the troubled HealthCare.gov site, raising the prospect that several hundred thousand low-income people who thought they had obtained insurance actually may not have it (Radnofsky, 12/4).

The Washington Post's Wonkblog: Healthcare.gov Is Having Trouble Signing People Up For Medicaid
Every week, usually on Tuesday, the Centers for Medicare & Medicaid Services sends state Medicaid departments something called a "flat file." These files are sort of similar to the much-discussed 834 transmissions, which the exchange sends to an insurance plan when someone signs up. Except the flat files are for the Medicaid program, and lists people that the exchange thinks -- but hasn't officially determined -- will be eligible for the Medicaid program. And, much like the those 834 transmissions, Medicaid officials say, these flat files are riddled with errors and incomplete information (Kliff, 12/4).

The Associated Press/New York Times: Wisconsin: Medicaid Delay Bill Advances
The State Assembly passed a bill on Wednesday that would give those losing their Medicaid coverage three more months to sign up for private plans through the new federal online marketplace. Assembly Republicans said that the Obama administration's health care failures forced them to take quick action on a bill that Gov. Scott Walker proposed and called the Legislature into special session for this month (12/4).

The Associated Press/Washington Post: House, Senate Still At Odds On Medicaid Expansion
The chairman of a joint legislative commission looking at possible Medicaid expansion in Virginia indicated Wednesday that members remain "at a bit of an impasse" over the issue. Sen. Emmett Hanger, R-Augusta and chairman of the state's Medicaid Innovation and Reform Commission, said that House and Senate contingents on the commission are still looking for "a grand bargain that will allow us politically to go forward" (12/4).

The Wall Street Journal: Drug-Cost Surprises Lurk Inside New Health Plans
Americans with chronic illnesses-;who are expected to be among the biggest beneficiaries of the health law-;face widely varying out-of-pocket drug costs that could be obscured on the new insurance exchanges. Under the law, patients can't be denied coverage due to existing conditions or charged higher rates than healthier peers. The law also sets an annual out-of-pocket maximum of up to $6,350 for individuals and $12,700 for families, after which insurers pay the full tab (Beck, 12/4).

The Wall Street Journal's Washington Wire: Small Businesses Say ACA's Aggregation Rules Unfair
Donna Baker of Adrian, Mich., owns an accounting firm, payroll company and retail store. Her husband, Kim, is the sixth generation owner of a dairy farm. While the four businesses are separate entities, they count as one employer under the health-care law due to a technicality -; Mrs. Baker is a minority stakeholder in the 1,800-acre property that her husband's farm sits on, plus she helps out with some of the farm's bookkeeping (Needleman, 12/4).

The Associated Press/Washington Post: Abortion Covered In Most Health Plans For Congress
More than 90 percent of health insurance plans offered to lawmakers and congressional staff cover abortion, an unforeseen consequence of a Republican amendment to President Barack Obama's health law. The disclosure Wednesday by abortion opponent Rep. Chris Smith, R-N.J., also highlights an emerging issue nationally: It may be hard for individual consumers to determine whether abortion is a covered benefit in plans offered through the new online insurance markets (12/4).

Los Angeles Times: Rep. Janice Hahn Calls On State GOP To Take Down 'Fake' Obamacare Site
A website run by California Assembly Republicans has come under fire this week, with critics alleging it misleads visitors about the Affordable Care Act and one Democratic congresswoman calling for it to be taken down. The Assembly GOP Caucus says the website, coveringhealthcareca.com, is meant to be a resource for Californians looking for more information on the new healthcare law and insurance exchange (Mason, 12/4).

Politico: Permanent 'Doc Fix' Unlikely This Year
Lawmakers have all but given up on efforts to permanently replace the Medicare physician payment formula this year and have refocused their effort on getting it done in 2014. Both the Senate Finance and the House Ways and Means committees are expected to vote next week on a proposal that would permanently repeal the Sustainable Growth Rate and establish a new formula for paying doctors and hospitals that treat Medicare patients. It's a rare bipartisan, bicameral approach that would forever eliminate the need for the universally hated annual "doc fix" (Haberkorn and Cunningham, 12/5).

Politico: Darrell Issa: Health Site May Top $1 Billion
Rep. Darrel Issa (R-Calif.) on Wednesday said he believes the troubled HealthCare.gov website will cost taxpayers more than $1 billion before it is fully operational. "The fact is, eventually they'll get this website working, at the cost of probably over a billion dollars," Issa, chair of the House Oversight Committee, told Fox News' Bill Hemmer. "They're probably closer to $700 million now and they're going to spend a lot more doing the hard parts on the back end" (Delreal, 12/4).

The New York Times: Think The E.R. Is Expensive? Look At How Much It Costs To Get There
Thirty years ago ambulance rides were generally provided free of charge, underwritten by taxpayers as a municipal service or provided by volunteers. Today, like the rest of the health care system in the United States, most ambulance services operate as businesses and contribute to America's escalating medical bills. Often, they are a high-cost prequel to expensive emergency room visits. Although ambulances are often requested by a bystander or summoned by 911 dispatchers, they are almost always billed to the patient involved (Rosenthal, 12/4).

The Associated Press/Washington Post: Railroads To Offer Health Care To Same-Sex Spouses
A day after being sued by legally married, gay engineers, the nation's largest freight rail carriers announced they will provide health care benefits to the same-sex spouses of their employees. Gus Melonas, a spokesman for BNSF Railway Co., read the statement Wednesday from the National Railway Labor Conference to The Associated Press. The conference represents the railroad companies in dealings with labor groups, lawmakers and courts (12/5). 

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