First Edition: December 9, 2013

Today's headlines include reports about new sticker-shock concerns over costs for coverage purchased through the health law's new online insurance marketplaces.  

Kaiser Health News: Judge's Medicare Advantage Order Could Have National Impact
Reporting for Kaiser Health News, Susan Jaffe writes: "In a decision that could have national implications, a federal judge in Connecticut temporarily blocked UnitedHealthcare late Thursday from dropping an estimated 2,200 physicians from its Medicare Advantage plan in that state. While the judge's decision affects only the physicians in Fairfield and Hartford Counties who brought suit, several other medical groups are considering filing similar actions" (Jaffe, 12/6). Read the story.

Kaiser Health News: Minnesotans Who Think They Signed Up For Health Insurance May Not Be Enrolled
MPR's Catharine Richert, working in partnership with Kaiser Health News and NPR, reports: "In the most vivid detail yet, Minnesota's top insurers have laid out a list of technological problems that they say may keep people who've enrolled in a health plan from being covered on Jan. 1. Insurance carriers selling plans on the state's insurance marketplace say enrollment information they're getting from MNsure, is inaccurate and incomplete - and that time is running out to fix these problems" (Richert, 12/8). Read the story.

Kaiser Health News: Capsules: Does Knowing Medical Prices Save Money? CalPERS Experiment Says Yes
No on Kaiser Health News' blog, Ankita Rao reports on CalPERS' pricing experiment: "In an effort to raise awareness and rein in what can seem like the Wild West of health care, the California Public Employees' Retirement System (CalPERS), the second largest benefits program in the country, and Anthem Blue Cross started a 'reference pricing' initiative in 2011. The initiative involved a system to guide their enrollees to choose facilities where routine hip and knee replacement procedures cost less than $30,000" (Rao, 12/6). Check out what else is on the blog.

Kaiser Health News also tracked weekend health policy headlines, including coverage about error rates among people who tried to sign up for coverage during October and November (12/7), as well as the problems that have plagued the insurance exchanges in D.C. and Maryland (12/7).

The New York Times: Amid The Uproar Over The Health Law, Voices Of Quiet Optimism And Relief
The rollout of the health care law has been plagued with problems so deep that even some of its strongest supporters have soured on its potential. The bottlenecks in the federal online insurance exchange, which serves 36 states; the cancellation of hundreds of thousands of policies that did not comply with the minimum requirements of the new law; and the high price of some plans sold through both federal and state-run exchanges have all cast a pall over President Obama's efforts to win support for the law (Goodnough, Thomas and Abelson, 12/8).

The New York Times: On Health Exchanges, Premiums May Be Low, But Other Costs Can Be High
For months, the Obama administration has heralded the low premiums of medical insurance policies on sale in the insurance exchanges created by the new health law. But as consumers dig into the details, they are finding that the deductibles and other out-of-pocket costs are often much higher than what is typical in employer-sponsored health plans (Pear, 12/9).

The Wall Street Journal: High Deductibles Fuel New Worries Of Health-Law Sticker Shock
As enrollment picks up on the HealthCare.gov website, many people with modest incomes are encountering a troubling element of the federal health law: deductibles so steep they may not be able to afford the portion of medical expenses that insurance doesn't cover. The average individual deductible for what is called a bronze plan on the exchange-;the lowest-priced coverage-;is $5,081 a year, according to a new report on insurance offerings in 34 of the 36 states that rely on the federally run online marketplace (Scism and Martin, 12/8).

USA Today: Federal Exchange Sends Unqualified People To Medicaid
The federal health care exchange is incorrectly determining that some people are eligible for Medicaid when they clearly are not, leaving them with little chance to get the subsidized insurance they are entitled to as the Dec. 23 deadline for enrollment approaches. State and industry officials haven't quantified the problem yet, but the National Association of State Medicaid Directors may release information next week after following up on reports from around the country, says Executive Director Matt Salo (O'Donnell, 12/8).

The Associated Press/Washington Post: Insurance Agents Feeling Left Out Of 'Obamacare'
When insurance agent Kelly Fristoe recently spent 30 minutes helping a client pick a mid-level health plan and the federal marketplace website froze, he called the government's hotline and tried to finish the application. But the operator refused to credit Fristoe as an agent on the application, meaning he wouldn't get the commission or be listed as the follow-up contact if his client needed help again later (12/8).

Politico: Nevada's Republican Governor Is 'All In'
In a Republican party that's gone all out against Obamacare, Nevada Gov. Brian Sandoval went all in. Sandoval is the only Republican governor whose state is both running its own health insurance exchange this year and expanding its Medicaid program under the health law. ... in fully implementing Obamacare, Sandoval faces a double-edged sword: He's helping bring health care coverage to a state with the second highest uninsured rate in the country, while he may be hurting his national ambitions because he's not actively blocking the president's law (Haberkorn, 12/7).

Politico: Kentucky's Unlikely Health Care Heartthrob
As the only governor of a Southern state who has both set up a state insurance exchange and green-lighted an expansion of the Medicaid program, [Steve] Beshear represents a painfully rare bright spot in the landscape of Obamacare implementation. The state exchange, dubbed Kynect, has been a model of smooth enrollment compared with the federal government's version, and has absorbed 550,000 Web visitors and 180,000 phone inquiries so far. The final verdict on the program -; nationally and on the state level -; is far from decided, but Beshear says his mind is entirely made up on both the merits and the politics of health care (Burns, 12/7).

Los Angeles Times: Covered California Gave Consumers' Contact Information To Agents
Raising concerns about consumer privacy, California's health exchange has given insurance agents the names and contact information for tens of thousands of people who went online to check out coverage but didn't ask to be contacted. The Covered California exchange said it started handing out this consumer information this week as part of a pilot program to help people enroll ahead of a Dec. 23 deadline to have health insurance in place by Jan. 1 (Terhune, 12/6).

The Associated Press/Washington Post: Calif. Health Exchange Shares Data Without Consent
Peter Lee, executive director of Covered California, says the information was shared to ease the process for consumers. The exchange was set up in response to the federal Affordable Care Act. It has been struggling with a surge in applications ahead of a Dec. 23 deadline to have insurance in place by Jan. 1 (12/7).

The Associated Press/Washington Post: Iowa Insurer Pokes Fun At Federal Website In Ads
The television ads show a series of medical mishaps: a man kicking the wrong leg in a reflex check, a urine sample bottle that won't open for a frustrated patient and a blood pressure cuff letting out a strange noise when the doctor presses the plastic bulb. After each scene, a narrator says: "Things don't always work like they're supposed to. Good thing the government exchange website isn't the only place to buy health insurance" (12/8).

The Wall Street Journal: Health-Site Snafus Plague Maryland
Maryland is struggling to fix its troubled health-insurance website more than two months after it opened, showing how technology woes are affecting more than just the federal system. The official in charge of Maryland's insurance marketplace, Rebecca Pearce, resigned late Friday after criticism of her decision to take a vacation in the Cayman Islands during Thanksgiving week. New statistics released Friday showed just a trickle of customers signing up for private coverage in the state (Dooren, 12/8).

The Washington Post: Rebecca Pearce, Director Of Maryland's Health Insurance Exchange, Resigns
The Maryland official who directly oversaw the rollout of Maryland's health insurance exchange resigned Friday amid continuing technical problems that have hampered the state's online enrollment efforts. After an emergency session Friday night, the board of the Maryland Health Benefit Exchange accepted the resignation of Rebecca Pearce, its executive director, and thanked her in a statement for working "tirelessly and with tremendous dedication" for more than two years (Wagner and Sun, 12/6).

The New York Times: Obama Recalls An Aide To Guide Health Care Law
As the Obama administration continues the aggressive public defense of the Affordable Care Act it began this week, the president will get some help from his former chief congressional lobbyist, Phil Schiliro, who is returning temporarily to the White House almost exactly two years after he left. Mr. Schiliro's job, which is expected to last a few months, is to help protect the health care law from legislative attacks by repeal-minded Republicans in Congress, and to quiet dissent from politically vulnerable Democrats seeking to distance themselves from the law and the president ahead of the midterm congressional elections (Calmes, 12/6).

Politico: Ex-Obama Aide Phil Schiliro Returns To White House As Obamacare Strategist
Schiliro's assignment, which will last several months, is Obama's first personnel move at the White House since the disastrous rollout of HealthCare.gov.  ... Schiliro left the White House in December 2011 after serving as an architect of Obama's top legislative achievements of his first term, including Obamacare, the economic stimulus program and the Dodd-Frank financial overhaul law (Budoff Brown, 12/6).

USA Today: Sibling Rivalry? Zeke Vs. Rahm Emanuel On Obamacare
When Rahm Emanuel was White House chief of staff and Ezekiel Emanuel was helping draft the Affordable Care Act, the famously combative brothers clashed over the health care law. … But now, the prominent health policy analyst says the technical problems that have dogged the website are being solved and "will soon be forgotten" (Page, 12/9).

Politico: GOP Returns To Obamacare In Weekly Adddress
Rep. Renee Ellmers (R-NC) focused on how she said the Affordable Care Act is hurting families whose existing insurance plans have been canceled because they didn't meet the health law's coverage requirements. "The Obama administration is essentially saying it knows what's best for you and your family," Ellmers said, charging that many people also will lose longtime, trusted doctors because of Obamacare (Villacorta, 12/7).

The New York Times: Three Senators Try To Hold Off G.O.P. In South
Next year, Democrats will face not only a general hostility to the national party among Southern white voters, but also a keen dislike of President Obama's Affordable Care Act. Representative Bill Cassidy, one of the Republicans opposing Ms. Landrieu, has an attack ad that calls her "Barack Obama's rubber stamp." She and her two Southern colleagues in the Senate voted for the health plan and have reiterated their support, though they have also rushed to criticize the administration's handling of the rollout and pushed for modifications. Republicans are trying to exploit the opening, insisting that each of the incumbents muttered the decisive "aye" that allowed the law to pass, which was approved 60 to 39 (Robertson and Peters, 12/8).

Politico: Website Woes, PR Firms Boon
It may be have been a debacle, but there is one upside to the glitch-plagued rollout of the health care website: It's become a powerful case study for crisis management consultants and their clients of what not to do. … Far from the world of government and politics, the botched launch of Healthcare.gov has become an instant classic. It has replaced such notorious bungles as New Coke and the BP oil spill as a real time example in the crisis management world of how not to respond when everything goes wrong. Experts are eagerly cashing in on the administration's missteps, offering critiques in private interactions with clients, as well as publishing blog posts and op-eds on the basic rules of crisis management that were not followed (Gold, 12/8).

Politico: Members' Obamacare Sign-Up Headaches
Staring down a deadline to sign up for Obamacare, some lawmakers are getting hit by technical glitches or sticker shock. Others are breezing through the website, elated by lower premiums and better health services. And at least one won't sign up at all -; opting to pay a penalty instead. In short, the Obamacare experience is the same mixed bag on Capitol Hill as it is across the nation (Kim and Haberkorn, 12/9).

The Washington Post: Budget Deal Expected This Week Amounts To A Cease-fire As Sides Move To Avert A Standoff
House and Senate negotiators were putting the finishing touches Sunday on what would be the first successful budget accord since 2011, when the battle over a soaring national debt first paralyzed Washington. The deal expected to be sealed this week on Capitol Hill would not significantly reduce the debt, now $17.3 trillion and rising. It would not close corporate tax loopholes or reform expensive health-care and retirement programs. It would not even fully replace sharp spending cuts known as the sequester, the negotiators' primary target (Montgomery, 12/8).

The Wall Street Journal: Congress Readies A Year-End Dash
Because Republicans have refused to raise taxes and Democrats have declined to consider major cuts to Medicare or other entitlement programs, any deal is likely to mitigate only a modest chunk of the sequester. To permit spending to rise above levels set in 2011, lawmakers would need to agree on ways to trim the federal budget deficit elsewhere, potentially by increasing fees for airport security and federal guarantees of private pensions. An agreement would mark a rare moment of bipartisan accord brokered without the specter of a government shutdown or financial chaos. However, even a deal reached by two lawmakers popular within their own parties would still have to secure the support of a GOP caucus unafraid to buck its leadership and a Democratic caucus concerned about other expiring programs. In recent weeks, Democrats have pushed to extend emergency benefits for the long-term unemployed past their Dec. 28 expiration, but Mr. Durbin said Sunday he didn't expect it would become a make-or-break issue in the budget talks (Peterson and Crittenden, 12/8).

The Washington Post: An Effective Eye Drug Is Available For $50. But Many Doctors Choose a $2,000 Alternative.
The two drugs have been declared equivalently miraculous. Tested side by side in six major trials, both prevent blindness in a common old-age affliction. Biologically, they are cousins. They're even made by the same company. Avastin costs about $50 per injection. Lucentis costs about $2,000 per injection. Doctors choose the more expensive drug more than half a million times every year, a choice that costs the Medicare program, the largest single customer, an extra $1 billion or more annually (Whoriskey and Keating, 12/7).

Los Angeles Times: Healthcare Union Abusing Initiative Process, Critics Say
Duane Dauner, president of the California Hospital Assn., emailed the group's board in September with a warning: The leader of the state's largest healthcare workers' union had told him that if hospitals did not pave the way for the organizing of 20,000 workers, the union would launch ballot measures taking aim at hospital pricing and executive pay. But negotiations on organizing agreements between the two sides stalled. In November, the union, SEIU-United Healthcare Workers West, filed two initiatives for the 2014 ballot that would limit hospital prices and cap executive compensation at nonprofit hospitals (Mason, 12/6).