First Edition: December 23, 2013

The early morning highlights from the major news organizations examine today's deadline for enrolling for health insurance that would begin Jan. 1, as well as a variety of other health law stories and several articles on mental health issues:

Kaiser Health News: Young Invincibles' Decision: To Get Coverage Or Not
Kaiser Health News' staff writer Jay Hancock, working in collaboration with USA Today, reports: "The success of the Affordable Care Act's online marketplaces may depend on people like [26-year-old] Lizzie Bunnen. If healthy adults her age don't sign up, the risk is that predominantly older and sicker members will drive up costs and threaten the portals' future. With the Dec. 23 deadline approaching for January coverage, and at the end of March for all 2014 enrollment, the clock is ticking on what many believe is one of the health law's biggest challenges. As a result, ACA backers have stepped up efforts to persuade Bunnen and others aged 18 to their mid-30s to give Obamacare a second chance on newly improved websites such as healthcare.gov" (Hancock, 12/20). Read the story.

Kaiser Health News: Health Insurers Scramble Toward Jan. 1 Coverage Deadlines
Kaiser Health News staff writers Jay Hancock and Julie Appleby report: "Insurance companies selling through the health law's troubled online marketplaces are scrambling to provide coverage by Jan. 1 even as swarms of customers are still enrolling and making their first payments. ... Medical plans, with potentially billions in revenue at stake in the health law's expansion of private coverage, have hired extra workers to run phone banks and tangle with paper applications that were supposed to be processed online. They've assigned staff to pore through electronic enrollments that might be inaccurate or incomplete, or to remind customers to pay" (Hancock and Appleby, 12/20). Read the story.

Kaiser Health News: Even In Well-Funded Colorado, Tough To Help People Enroll In Obamacare
Eric Whitney, writing for Kaiser Health News in collaboration with NPR, reports: "There are navigators working at 57 assistance organizations across Colorado – everyone from county health departments to local clinics to the state trucking association. Neighboring states Nebraska and Arizona aren't embracing the health care law like Colorado is. They have just two navigator organizations each and about $2 per uninsured person to spend on assisters. Colorado has almost $24 per person. But all the effort had netted about 23,000 customers for private insurance in the state's marketplace as of Dec. 14 – only about 17 percent of the way to the state's goal of enrolling 136,000 people by the end of March" (Whitney, 12/23). Read the story.

Kaiser Health News: Capsules: Catastrophic Obamacare Policies Prove Hard Sell So Far; Explaining Obama's Move To Allow Some 'Catastrophic' Health Coverage Plans
Now on Kaiser Health News' blog, Phil Galewitz examines catastrophic insurance policies: "The Obama administration's decision this week to allow people to buy catastrophic-level policies if their individual health plans had been canceled comes amid reports that few people have bought these less expensive policies sold in new online insurance marketplaces" (Galewitz, 12/20).

Also on the blog, KHN's Mary Agnes Carey was on PBS NewsHour Friday to talk about the Obama administration's plan to allow people who had their health insurance plans canceled to buy so-called "catastrophic" plans, which that are cheaper than ordinary plans but provide less coverage than others being sold under the Affordable Care Act. Watch the video. (Carey, 12/23). Check out what else is on the blog.

The New York Times: Mixed Messages Add Anxiety As Deadline Nears In Health Act
For most Americans, Monday is the deadline to sign up for health insurance that takes effect on Jan. 1. It was supposed to be a turning point in the troubled history of the new health care law, the moment when the spotlight would shift from the federal government's online marketplace to the insurance companies providing coverage to hundreds of thousands and eventually millions of people. But as the date approaches, a series of decisions by the Obama administration to delay some of the law's most important provisions and to extend some deadlines has caused uncertainty among insurers and confusion among consumers (Pear, 12/21).

The Wall Street Journal: Rule Change On Health Insurance Rattles Industry
Monday is the final day for consumers to get new health coverage that takes effect when the new year arrives, leaving thousands of people racing to sign up in time-;and health insurers trying to figure out whether the federal health law will work in the way they had hoped. The number of Americans enrolling continues to fall short of the goals the Obama administration has laid out, which is a problem for the White House. It also represents a problem for the insurance industry, which calculated that the prospect of millions of new customers brought their way by the Affordable Care Act and its coverage requirements would make up for any disruption that came along with the law (Williamson and Radnofsky, 12/22).

USA Today: Monday Marks Key Health Care Deadline
Monday marks the last day to sign up through the federal and state health exchanges to have insurance coverage beginning Jan. 1. And while government officials said the federal site, HealthCare.gov, can handle a last-minute rush of consumers, there's still fear that the word may not be getting out to the people who most need to enroll (Kennedy, 12/22).

Politico: Countdown For Obamacare Signups
The White House has been on a December dash to get people to sign up for health coverage by Monday, the first critical enrollment deadline for Obamacare -; and the last sign-up opportunity for people who want their new health benefits to kick in on New Year's Day. The White House spent the past three weeks trying to move past the double-barreled disaster of the botched HealthCare.gov website and the millions of canceled health plans. The website now works, although not perfectly. Many of the people who received cancellation notices have found alternatives, though some are still scrambling to get health coverage by Monday (Cheney and Villacorta, 12/22).

Politico: Mandate Change Adds To Obamacare Confusion
If your health insurance was canceled, you don't have to rush out and buy it right now. But if you don't have insurance, you still have to buy it or face a fine. And if you can't keep what some advocates have derided as a "junk plan," you can get another kind of slimmed-down plan -; for a while. Confused? You're not alone (Haberkorn and Millman, 12/20).

The New York Times: New Health Law Frustrates Many In Middle Class
Ginger Chapman and her husband, Doug, are sitting on the health care cliff. The cheapest insurance plan they can find through the new federal marketplace in New Hampshire will cost their family of four about $1,000 a month, 12 percent of their annual income. ... Even more striking, for the Chapmans, is this fact: If they made just a few thousand dollars less a year -; below $94,200 -; their costs would be cut in half, because a family like theirs could qualify for federal subsidies. ... An analysis by The New York Times shows the cost of premiums for people who just miss qualifying for subsidies varies widely across the country and rises rapidly for people in their 50s and 60s. In some places, prices can quickly approach 20 percent of a person's income (Thomas, Abelson and McGinty, 12/20).

The Washington Post: Federal Officials Seek More Time For People To Enroll In Health Care
President Obama expressed confidence Friday that "a couple million" Americans will have new health coverage as of New Year's Day. But behind the scenes, federal health officials have been pressing the insurance industry to give people more time to sign up. According to insurance industry executives, federal officials have been asking health plans to provide insurance starting Jan. 1 even for customers who sign up after a looming deadline on Monday (Goldstein and Eilperin, 12/20),

The Associated Press: Health Plan Sticker Shock Ahead For Some Buyers
As a key enrollment deadline hits Monday, many people without health insurance have been sizing up policies on the new government health care marketplace and making what seems like a logical choice: They're picking the cheapest one. Increasingly, experts in health insurance are becoming concerned that many of these first-time buyers will be in for a shock when they get medical care next year and discover they're on the hook for most of the initial cost (Johnson, 12/22).

The Washington Post: Healthcare.gov Contract: Politics Not A Factor, But Neither Were Firm's Ties To Failed Projects
CGI Federal, the company responsible for building the problem-plagued Web site for the Affordable Care Act, won the job because of what federal officials deemed a "technically superior" proposal, according to government documents and people familiar with the decision. Not considered in the 2011 selection process was the history of numerous executives at CGI Federal, who had come from another company that had mishandled at least 20 other government ­information technology projects more than a decade ago (Markon and Crites, 12/22).

Los Angeles Times: Californians Rush To Get Health Insurance As Deadline Nears
Like shoppers racing to buy last-minute holiday gifts, thousands of Californians are going online -; or lining up in person -; to get Obamacare insurance ahead of next week's deadline to have coverage starting next month. And the surge in enrollment is putting pressure on the state's health exchange and insurance companies at a time when they were already struggling to keep pace with a flood of applications (Terhune, 12/20).

The Washington Post: District's Online Insurance Marketplace Also Hampered By Glitches, Consumers Say
On the eve of the Monday deadline for District residents to sign up for health insurance that takes effect Jan. 1, the city's new online insurance exchange has run into so many technical problems that its staff is combing through incomplete applications looking for people who were stymied from buying insurance and are now running out of time (Kunkle, 12/21).

The Associated Press: Even In Willing States, Health Law's Rollout Rocky
A bug-ridden website. Endless wait times on a toll-free helpline. Error-laden data sent to insurance companies. These are not problems burdening Republican-led states that had to be dragged kicking and screaming into the federal health insurance overhaul. These are recent complications in the rollout of MNsure, the state-based exchange in Minnesota, a place with a long tradition of activist government and generous social programs (Condon, 12/21).

Dallas Morning News: Obamacare Sign-Ups Picking Up Steam In Texas
After a slow start in Texas, insurance sign-up under the Affordable Care Act seems to be growing this month as an important deadline looms for those needing immediate coverage. "I sense that our numbers are picking up dramatically," Dallas County Judge Clay Jenkins said after a round of meetings with federal officials to review the troubled rollout of the new law. ... "Monday is the last day to sign up for coverage that starts on Jan. 1," said Louis Adams, a spokesman for Blue Cross Blue Shield of Texas. "But open enrollment continues through March 31." A deluge of calls in early December forced the insurance carrier to add 500 customer-assistance representatives to a phone bank covering five states, including Texas, according to its Facebook page (Jacobson, 12/22).

Politico: Obamacare Outreach Hits The Clubs
Like other health exchanges and coverage advocacy groups across the country, DC Health Link is reaching out to people wherever they may be, including bars. President Barack Obama even urged bartenders -; who may themselves be uninsured -; to hold happy hours to talk about health insurance and what it can offer young adults. That strategy has clear challenges, however. In a packed nightclub like Town Danceboutique in Northwest D.C., music smothers conversation, dimmed lights make reading difficult, and health coverage is not what's on people's minds (Villacorta, 12/22).

The Washington Post: Federal Contractors On Edge As Indian Tribes Wait For Claims
When the federal government reneged on its agreement to fully compensate the Shoshone-Paiute tribes for running a hospital on the Duck Valley reservation, the Washington contracting world barely noticed. But after similar contracts were broken with hundreds of other Native American tribes and the debts they were owed snowballed to an estimated $2 billion, federal contractors joined their court battle, alarmed that the practice might eventually ensnare them as well (Kindy, 12/22).

The Washington Post: Health Q&A: How Is Medicaid Changing?
The Affordable Care Act made some pretty substantial changes to Medicaid. First, it allowed states, starting Jan. 1, to expand the program to include anyone who makes up to 138 percent of the federal poverty level -; about $15,800 for an individual and $32,500 for a family of four. This is a big change, because most states only opened Medicaid to children, pregnant women, some very low-income parents, people with disabilities and the elderly. They excluded childless adults (Somashekhar, 12/21).

The New York Times: Spike In Harm To Liver Is Tied To Dietary Aids
Dietary supplements account for nearly 20 percent of drug-related liver injuries that turn up in hospitals, up from 7 percent a decade ago, according to an analysis by a national network of liver specialists. The research included only the most severe cases of liver damage referred to a representative group of hospitals around the country, and the investigators said they were undercounting the actual number of cases. While many patients recover once they stop taking the supplements and receive treatment, a few require liver transplants or die because of liver failure (O'Connor, 12/21).

The New York Times: Tackling A Racial Gap In Breast Cancer Survival
Like many other African-American women in Memphis and around the country, [Debrah] Reid learned about her breast cancer after it had already reached an advanced stage, making it difficult to treat and reducing her odds of survival. Her story reflects one of the most troubling disparities in American health care. Despite 20 years of pink ribbon awareness campaigns and numerous advances in medical treatment that have sharply improved survival rates for women with breast cancer in the United States, the vast majority of those gains have largely bypassed black women (Parker-Pope, 12/21).

The Wall Street Journal: For The Mentally Ill, Finding Treatment Grows Harder
As hard as it might be to acknowledge having a mental-health illness, finding professional help can be even harder. Last year, according to the U.S. Department of Health and Human Services, almost 91 million adults lived in areas like here where shortages of mental-health professionals made obtaining treatment difficult. A departmental report to Congress earlier this year said 55% of the nation's 3,100 counties have no practicing psychiatrists, psychologists or social workers, a combination of budget cuts and doctors leaving the profession (Fields and Corbett Dooren, 12/20).

The New York Times: When The Right To Bear Arms Includes The Mentally Ill
The Russo case highlights a central, unresolved issue in the debate over balancing public safety and the Second Amendment right to bear arms: just how powerless law enforcement can be when it comes to keeping firearms out of the hands of people who are mentally ill. Connecticut's law giving the police broad leeway to seize and hold guns for up to a year is actually relatively strict. Most states simply adhere to the federal standard, banning gun possession only after someone is involuntarily committed to a psychiatric facility or designated as mentally ill or incompetent after a court proceeding or other formal legal process. Relatively few with mental health issues, even serious ones, reach this point (Luo and McIntire, 12/21).

NPR: Screening Newborns For Disease Can Leave Families In Limbo
For Matthew and Brianne Wojtesta, it all started about a week after the birth of their daughter Vera. Matthew was picking up his son from kindergarten when he got a phone call. It was their pediatrician, with some shocking news. Vera had been flagged by New York's newborn screening program as possibly having a potentially deadly disease, and would need to go see a neurologist the next day. Like every state, New York requires that newborns get a small heel prick so that a few drops of blood can be sent to a lab for testing. The idea is to catch health problems that could cause death or disability without early intervention. But in recent years, patient advocacy groups have been pushing states to adopt mandatory newborn screening for more and more diseases, including ones that have no easy diagnosis or treatment (GreenfieldBoyce, 12/23).

Los Angeles Times: L.A. Fire Department Dramatically Overhauls Response To Shootings
Los Angeles fire officials are dramatically changing how rescuers respond to mass shootings after a gunman with a high-powered rifle mortally wounded a federal security officer in a shooting rampage last month at LAX. The new goal is to have Los Angeles Fire Department paramedics and firefighters, protected by armed law enforcement teams, rapidly enter potentially dangerous areas during active shooting incidents to treat victims and get them en route to hospital trauma centers (Lopez and Welsh, 12/22).

Chicago Tribune: Women Report Complications From Essure Birth Control
A device called Essure has been hailed as the next generation of permanent birth control. Unlike a tubal ligation, which requires surgery, Essure can be inserted by catheter in a doctor's office. But complaints about the product have recently surged. The U.S. Food and Drug Administration has received nearly 1,000 adverse event reports related to the device, with 500 arriving this year (Deardorff, 12/22).