KHN Morning Briefing

Summaries of health policy coverage from major news organizations.

Kaiser Health News Original Stories

Political Cartoon: 'Stupid Is As Stupid Does?'

Kaiser Health News provides a fresh take on health policy developments with "Political Cartoon: 'Stupid Is As Stupid Does?'" by John Cole, The Scranton Times.

Here's today's health policy haiku:


Who else has had it
with Gruber coverage? Umm...
Can we please move on?

If you have a health policy haiku to share, please Contact Us and let us know if you want us to include your name. Keep in mind that we give extra points if you link back to a KHN original story.

Health Law Issues And Implementation

HHS Acknowledges Health Law Enrollment Overcounting Mistake

The Obama administration said Thursday that it incorrectly tallied health law sign-ups by accidentally adding about 380,000 dental-plan customers to its overall enrollment numbers. It reduced the overall number of people who enrolled in new coverage to about 6.7 million.

Bloomberg: Obamacare Dental Plan Error Has Critics Seeking Answers
The U.S. health secretary, Sylvia Mathews Burwell, said her agency made a mistake when it added dental-plan customers to recent figures on Obamacare enrollment. Republicans said she owes them an explanation. The disclosure by Burwell’s department that it accidentally added 380,000 people in dental plans to enrollment figures under the Patient Protection and Affordable Care Act provided a new opening for critics. Representative Darrell Issa, a California Republican and chairman of the House committee that revealed the commingling of dental and health enrollment, said Burwell needs to clarify how the error happened. (Wayne, 11/21)

The Wall Street Journal: U.S. Overstates Health Care Enrollees
The Obama administration said it recently overstated how many people had paid-up health coverage through the Affordable Care Act’s insurance exchanges because of the incorrect inclusion of dental coverage sign-ups, marking an embarrassing disclosure as the health-care markets open for their second year of operation. Some 6.7 million people had paid-up health coverage through the Affordable Care Act’s insurance exchanges as of mid-October, about 400,000 less than the government had reported last week, the Obama administration said Thursday. (Radnofsky, 11/20)

The New York Times: Health Insurance Enrollment For Exchanges Was Overcounted
The Obama administration acknowledged on Thursday that it overcounted the total number of people signed up for health insurance through the Affordable Care Act exchanges. ... The discrepancy was discovered by the House Oversight and Government Reform Committee, which had asked for the enrollment records. (Goodnough, 11/20)

The Associated Press: Officials Admit Health Care Goof
The Obama administration Thursday acknowledged it has been over-reporting the number of people signed up under the health care law, a discrepancy that congressional Republicans seeking to repeal the program say they uncovered. It’s another credibility problem for the administration after video surfaced recently of former White House adviser Jonathan Gruber suggesting that deception was used to pass President Barack Obama’s signature law. Health and Human Services Secretary Sylvia M. Burwell called the lapse “unacceptable.” (Alonso-Zaldivar, 11/20)

Los Angeles Times: Obama Administration Overstated Obamacare Enrollment Tally
Congressional Republicans nonetheless strongly criticized the administration and questioned its explanation. “Instead of offering the public an accurate accounting, the administration offered numbers that obscured and downplayed the number of dropouts,” said House Oversight Committee Chairman Darrell Issa (R-Vista.) “Now they’re saying this was just a ‘mistake.’ The claim that this was only [an] accident stretches credulity.” (Levey, 11/20)

USA Today: More Obamacare Troubles: Enrollment Numbers Inflated
The Department of Health and Human Services said Thursday it made a mistake in how it calculated enrollments under the Affordable Care Act, including 380,000 dental plans in its figures for medical plans. Those stand-alone dental plans allowed the Obama administration to claim more than 7 million paid enrollments — the "magic number" that would allow the new health insurance exchanges to be sustainable. The discrepancy was first reported by Bloomberg News, citing data obtained through the House Oversight and Government Reform Committee. (Korte, 11/20)

Politico: Administration Explains Obamacare Enrollment Numbers Error
The Obama administration has admitted that it inflated Obamacare enrollment numbers twice this year — including in testimony to Congress — thanks to an error in the way health insurance numbers were conflated with dental insurance figures. The exaggeration, which HHS Secretary Sylvia Mathews Burwell said was an “unacceptable” mistake, inflated the reported number enrolled in Obamacare by 400,000. House Republicans first spotted the issue, and say that blaming the bad numbers on mistaken data “strains credulity.” If you take the dental insurance customers out of the latest administration Obamacare report, the enrollment number is closer 6.7 million now. (Norman, Pradhan and Kenen, 11/21)

The Fiscal Times: Oops: Obama Administration Inflated Obamacare Enrollment Numbers
In September, federal health officials announced that 7.3 million people had signed up for health insurance on the state or federal exchanges. This was big news—as it meant Obamacare had beaten the White House’s goal of enrolling 7 million people in the first year of the program. However, it turns out, the real number of people who signed up for medical coverage is actually about 6.97 million. (Ehley, 11/20)

Meanwhile, the Los Angeles Time reports on California's enrollment numbers so far this open season -

Los Angeles Times: California Enrolls 11,357 In First 4 Days Of Obamacare Open Enrollment
California's insurance exchange said 11,357 new people signed up for Obamacare coverage in the first four days of open enrollment. The second year of sign-ups under the Affordable Care Act began Saturday, and the Covered California exchange said it was ahead of last year's pace. Enrollment runs through Feb. 15. Last year, it took 15 days for the state to reach 11,000 enrollees when the health-law expansion first launched in October 2013. (Terhune, 11/20)

Parsing Claims About The Cost Of Obamacare Plans examines competing claims about the cost of Obamacare plans while The Fiscal Times reports on an analysis examining the cost of deductibles in 2015 plans sold through the health law's insurance exchanges. Today: Fact Check: The Great Health Care Premium Debate Continues
In the latest round of what's-happening-to-health-care-premiums, Republican Rep. Michele Bachmann wrongly claims that we're seeing "huge increases" in employer-sponsored plans, while President Obama touts historically low health care inflation, which experts say is mainly due to the slow economy, not the health care law. Both Bachmann and Obama were making competing arguments about the success of the Affordable Care Act, specifically on costs to consumers. (Robertson, 11/20)

The Fiscal Times: Obamacare Deductibles, Already High, Climb in 2015
Now that Obamacare’s health exchanges have been open for nearly a week, consumers have had time to shop around and get a better look at their options. While much attention is focused on the price of Obamacare’s premiums, a new analysis by HealthPocket takes a look at how deductibles on these policies compare to last year—as well as how they stack up against other types of coverage –like employer-based plans. (Ehley, 11/21)

In related news, Reuters offers consumer tips for comparing plans in both the health law's online insurance marketplaces as well as for Medicare  -

Reuters: Medicare, ACA Care And How To Navigate During Enrollment
This is enrollment season for two huge public health insurance programs: Medicare and the Affordable Care Act health insurance exchanges. For older Americans, the overlapping sign-up periods can lead to confusion and enrollment errors. Insurers offering Medicare and ACA policies have big money at stake, and consumers are subject to a blizzard of marketing messages. Annual enrollment for Medicare prescription drug (Part D) and Advantage (Part C) plans began Oct. 15 and runs until Dec. 7; shopping for healthcare policies in the marketplace exchanges created under the ACA began Nov. 15 and ends Feb. 15. (Miller, 11/20)

Oklahoma Asks Supreme Court To Hear Its Health Law Challenge, Too

Oklahoma's attorney general said Thursday he has asked the high court to hear his arguments that parts of the health law don't apply to his state, at the same time they consider the subsidy challenge in King v. Burwell. Meanwhile, thousands of Missouri and Illinois residents would lose more than $2 billion in health insurance subsidies if the court were to rule in favor of the plaintiffs.

CQ Healthbeat: Oklahoma Asks Supreme Court to Hear Its Health Law Challenge
Oklahoma’s attorney general said Thursday that he is asking the Supreme Court to consider his state's challenge to health law insurance subsidies at the same time justices hear arguments in a similar case they agreed to take up earlier this month. In the petition, Attorney General Scott Pruitt said the Oklahoma challenge should be added to the briefing schedule that is already in place for King v. Burwell, and that the two cases should be heard together. (Attias, 11/20)

The St. Louis Post-Dispatch: Missouri, Illinois Health Insurance Subsidies In Jeopardy
Thousands of people in Missouri and Illinois would lose a total of more than $2 billion in annual health insurance subsidies if the Supreme Court rules against President Barack Obama’s administration in a case next year. The case has garnered national attention since the high court agreed to hear it earlier this month. At issue is whether the government can award subsidies to consumers who purchase health plans in a marketplace operated by the federal government. (Shapiro, 11/21)

Immigrants Here Illegally Will Not Get Access To Health Law But May Get Other Coverage

Politico reports that once these immigrants don't face deportation threats, they may be able to take regular jobs with health insurance. Also in the news, some anti-abortion activists are charging that states are not complying with the health law's provisions to offer one plan that does not cover abortion and a former administration officials talks about making narrow provider networks smarter.

Politico: Undocumented Immigrants Won't Get Obamacare - But Latino Coverage Could Rise
President Barack Obama’s immigration order won’t suddenly swell the rolls of Obamacare with undocumented immigrants, but it will open the door to many more Latinos getting health insurance. Freed from deportation threats, more of the undocumented may be able to take regular jobs with health insurance for themselves and their families, instead of operating in shadow jobs without health insurance. They will not be covered by Obamacare, however. (Wheaton, 11/20)

The Hill: Activists Say States Keep Abortion Coverage In Health Plans
Anti-abortion activists are claiming that the Obama administration is still ignoring its promise to allow healthcare customers to opt out of plans that cover abortions. Under ObamaCare, every state is required to offer at least one plan that does not cover abortion. But research from the Family Research Council and the Charlotte Lozier Institute has found that at least three states — with more than 100 plans altogether — are still not complying. (Ferris, 11/20)

Kaiser Health News: Former HHS Official Calls For ‘Smarter’ Networks That Deliver Cost-Effective Care
Many consumers who signed up for health coverage through online insurance exchanges discovered their doctors were not in their plans’ networks. While narrow networks aren’t new, they have emerged as one of insurers’ major levers for keeping costs down under the Affordable Care Act. Lawsuits in California allege that some insurers duped customers into thinking their networks were larger by posting inaccurate provider lists. But such plans can be designed right, says Gary Cohen, a former Obama administration official who helped oversee the launch of the federal health website. Cohen sat down recently with Kaiser Health News’ Julie Appleby (Appleby, 11/21).

Poll: Almost Quarter Of Uninsured Say They Can't Afford Coverage

Nearly a quarter of those without insurance said they expected to stay that way because of the cost of coverage, according to a Kaiser Family Foundation poll done just before the health law's insurance exchanges opened.

Kaiser Health News: A Quarter Of Uninsured Say They Can’t Afford To Buy Coverage
Just days before the health law’s marketplaces reopened, nearly a quarter of uninsured said they expect to remain without coverage because they did not think it would be affordable, according to a poll released Friday. That was by far the most common reason given by people who expect to stay uninsured next year, according to the latest tracking poll by the Kaiser Family Foundation. (Carey, 11/21)

Politico Pro: Poll: Americans Don’t Expect ACA Drama To Die Down
Many Americans expect debate over the Affordable Care Act to reignite given the outcome of the midterm elections and Republicans' upcoming control of the Senate, according to a poll released Friday. Yet the public’s opinion of the law isn’t heating or cooling: It remains just as unfavorable as in recent months. (Villacorta, 11/21)

Who Uncovered The Gruber Videos?

Fox News reports on the person who found the politically damaging videos of Jonathan Gruber. It turns out he wasn't an operative, but a normal person who feels like he lost his coverage as a result of the health law.

Fox News: He Found The Jonathan Gruber Videos — And No Media Outlet Would Call Him Back
The man who changed the ObamaCare debate was at a gas station when I reached him, and he wasn’t dying to talk. “I really want to stay out of the limelight,” said Rich Weinstein, a Philadelphia investment adviser. “This is not about me.” But it is about him in the sense that if not for one slightly obsessed citizen, we wouldn’t have the videos of Jonathan Gruber saying the health care law was deceptively designed and its passage depended on the stupidity of the American public. And it is about his frustrating struggle to get that information out to the media. (Kurtz, 11/20)

Politico: Gruber Video Sleuth: 'This Is Not About Me'
The person who unearthed the Jonathan Gruber videos isn’t a political operative or professional opposition researcher — he is just an angry guy from Philly who says he lost his health insurance because of Obamacare. (McCalmont, 11/20)

Capitol Hill Watch

Senate Panel Examines Soaring Generic Drug Prices

In other Capitol Hill news, lawmakers continue to meet about -- but report no agreements on -- the Labor-HHS appropriations bill, as well as other spending measures, for fiscal year 2015.

The Associated Press: Soaring Prices In Generic Drug Raises Ire, Draw Senate Scrutiny
Some low-cost generic drugs that have helped restrain health care costs for decades are seeing unexpected price spikes of up to 8,000 percent, prompting a backlash from patients, pharmacists and now Washington lawmakers. A Senate panel met Thursday to scrutinize the recent, unexpected trend among generic medicines, which usually cost 30 to 80 percent less than their branded counterparts. Experts said there are multiple, often unrelated, forces behind the price hikes, including drug-ingredient shortages, industry consolidation and production slowdowns due to manufacturing problems. But the lawmakers convening Thursday's hearing said the federal government needs to play a bigger role in restraining prices. (11/21)

CQ Healthbeat: With Clock Ticking, Labor-HHS Spending Bill Remains In Limbo
The top four appropriators on the Labor-Health and Human Services-Education spending bill that funds many federal health programs met Wednesday but reported no agreement on a fiscal 2015 blueprint. The group faces pressure to reach quick consensus on a roughly $157 billion bill. Leaders of the Appropriations committees want to finish their dozen overdue bills with a single omnibus measure, but the current fiscal 2015 continuing resolution expires on Dec. 11. (Young and Lesniewski, 11/20)

State Watch

State Spending Swells -- Mostly Driven By Medicaid Expansion Fund Infusion

According to a report from the National Association of State Budget Officers, state spending has not increased at a rate this fast since before the recession.

The Washington Post: State-Level Spending Grew Last Year, Thanks Largely To Obamacare
State spending last year grew at its fastest pace since before the recession, thanks mostly to an infusion of spending through Obamacare. Overall, spending was up 5.7 percent in fiscal 2014, according to a new report from the National Association of State Budget Officers. That’s up from 2.2 percent the year before and 1.1 percent before that. (Chokshi, 11/20)

The Hill: State Medicaid Spending Soars Under Obamacare
Federal dollars given to states for Medicaid swelled nearly 18 percent this year to cover millions of newly eligible people, helping to reverse a years-long trend of shrinking state budgets. Medicaid now makes up one-quarter of all state spending, with about $41.8 billion coming from the federal government over the last year, according to a report from the National Association of State Budget Officers. All other spending dropped $3.4 billion. (Ferris, 11/20)

State Highlights: Health Disparities Viewed Through Various Policies; Insurance Commissioners And Narrow Networks

A selection of health policy stories from Minnesota, Georgia, Washington state, Nebraska, North Carolina, New York and Virginia.

Stateline: To Attack Health Disparities, States Take a Broader View
For years, proposals to raise the minimum wage in Minnesota bogged down over economic concerns: Would a raise impel businesses to leave the state? Would it decrease employment? Would it touch off inflation? The supporters’ main argument, that raising the minimum wage would put more money into the pockets of low-wage workers and their families, fell short. This year, proponents seized on a new strategy: They convinced the legislature to ask the Minnesota Department of Health to analyze the health impact of the state’s minimum wage of $6.15 an hour, which is among the lowest in the country. (Ollove, 11/21)

Modern Healthcare: Providers, Advocates Seek Tougher Rules On Network Adequacy
Many health care stakeholders want more muscle from state insurance commissioners' efforts to help states police how health plans assemble and manage their provider networks. The National Association of Insurance Commissioners is circulating a draft model state law addressing increasingly fractious practices. Providers and consumer advocates have generally applauded the effort but plan to press for the document to propose more stringent standards regarding provider directories, out-of-network billing and what constitutes an adequate provider network. (Demko, 11/20)

Georgia Health News: State Panel Meets Over Ailing Rural Hospitals
Struggling to stay afloat financially, a northwest Georgia rural hospital has opted to file for bankruptcy protection from its creditors. Officials at Hutcheson Medical Center in Fort Oglethorpe said Wednesday evening that the filing would allow it to continue operations, restructure debt, and help protect it from a Chattanooga system’s effort to foreclose on the hospital’s property. (Miller, 11/20)

The Associated Press: Health Worker, Head Of Firm Indicted On Medical Equipment Fraud
The owner of an Omaha medical equipment company and a southeastern Nebraska mental health professional have been indicted on federal counts of Medicaid fraud. Federal court records show that Clement Akara of Omaha fraudulently billed Medicaid 76 times, illegally receiving nearly $66,000. Court records say Akara, 60, filed claims for nebulizers and other equipment and services never provided. (11/21)

Modern Healthcare: Kaiser Expands Clinic Services To Target Stores
Kaiser Permanente is moving into the retail clinic business, teaming up with big-box retailer Target Corp. to open four store-based locations in California that will use telemedicine to go beyond traditional in-store clinic services. Three Kaiser clinics opened this month in San Diego, Vista and Fontana, Calif., and a fourth will open in West Fullerton in December, serving both Kaiser health plan members and non-members. With the addition of the four clinics, Minneapolis-based Target will have 84 clinics in eight states, but the Kaiser-staffed clinics will have expanded capabilities compared to other locations. (Rubenfire, 11/20)

The Associated Press: N.Y. Medicaid Inspector General Leaving Post
New York's inspector general for Medicaid, the state's largest annual expenditure, says he's leaving. In a message to staff, James Cox says they've done the job he set out to do, establishing 22 audit protocols that led to record recoveries, establishing solid standards and a productive relationship with medical providers. (11/20)

The Washington Post: For Arlington’s Poor, Medical Care Is The Prize In A Free Clinic’s Lottery
One by one, the winning lottery numbers were called, 20 Arlingtonians who suddenly had a shot at medical care they could not afford anywhere else. More than 90 patients-in-waiting had lined up outside the Arlington Free Clinic for the drawing — whites, blacks, Hispanics and Asians, many with children in tow. All had little money and big medical worries. All waited to see if this was their day. (Sullivan, 11/20)

Health Policy Research

Research Roundup: Mastectomies; Hospital Drug Discounts; Homeless Coverage

Each week, KHN compiles a selection of recently released health policy studies and briefs.

JAMA Surgery: Nationwide Trends In Mastectomy For Early-Stage Breast Cancer
Accredited breast centers in the United States are measured on performance of breast conservation surgery (BCS) in the majority of women with early-stage breast cancer. Prior research in regional and limited national cohorts suggests a recent shift toward increasing performance of mastectomy in patients eligible for BCS. ... We performed a retrospective cohort study of ... more than 1.2 million adult women treated at centers accredited by the American Cancer Society and the American College of Surgeons Commission on Cancer ... In the past decade, there have been marked trends toward higher proportions of BCS-eligible patients undergoing mastectomy, breast reconstruction, and bilateral mastectomy. The greatest increases are seen in women with node-negative and in situ disease. (Kummerow et al., 11/19)

Health Affairs/Robert Wood Johnson Foundation: Health Policy Brief: The 340B Drug Discount Program
The 340B program is a federal program established in 1992 that allows safety-net health care organizations serving vulnerable populations to buy outpatient prescription drugs at a discount. ... Since 2010, 340B has become a higher-profile issue as a result of growth of the program via two actions: the Affordable Care Act's (ACA's) addition of more eligible hospitals and new Health Resources and Services Administration (HRSA) guidance allowing covered entities to contract with multiple pharmacies. Government reports documenting deficiencies in oversight and management of 340B have also brought attention to the program. ... the debates regarding the program are not particularly unique. Among the most persistent questions are: Is the scope of the program justified considering the current health care system? Is there sufficient, and sufficiently-funded, government oversight? (Stencel, 11/17)

The Kaiser Family Foundation: Early Impacts Of The Medicaid Expansion For The Homeless Population
This analysis provides an early look at the impact of the expansion for homeless providers and the patients they serve .... Medicaid expansion has already contributed to key benefits for individuals and providers within the homeless community. Sites in states that expanded Medicaid have experienced significant gains in coverage among their homeless patients. Participants report that these coverage gains have led to improved access to care and other broader benefits, including improved ability to work and maintain housing. Providers feel they have a wider array of treatment options available and that they are better able to provide care based on the best courses of treatment rather than on the availability of charity or discounted services. (DiPietro, Artiga and Gates, 11/13)

UCLA Center for Health Policy Research: More Than Half A Million Older Californians Fell Repeatedly In The Past Year
Falls are the leading injury-related cause of death and of medical care use among Californians ages 65 and over. In 2012, there were 1,819 deaths due to falls among older Californians. More than 72,000 hospitalizations were caused by fall injuries among older adults during that year, along with more than 185,000 emergency department (ED) visits. ... Fewer than half of those experiencing multiple falls discussed how to reduce their risk with a health professional. This policy brief details the characteristics of older Californians who have repeated falls, their health care use, and the actions they can take to reduce the risk of future falls. It also provides policy suggestions for reducing the risk of falls. (Wallace, 11/20)

JAMA Internal Medicine: Use Of Cardiac Biomarker Testing In The Emergency Department
Cardiac biomarker testing is not routinely indicated in the emergency department (ED) because of low utility and potential downstream harms from false-positive results. ... Retrospective study of ED visits by adults ... selected from the 2009 and 2010 National Hospital Ambulatory Medical Care Survey, ... Cardiac biomarker testing in the ED is common even among those without symptoms suggestive of [acute coronary syndrome]. Cardiac biomarker testing is also frequently used during visits with a high volume of other tests or services independent of the clinical presentation. More attention is needed to develop strategies for appropriate use of cardiac biomarkers. (Makam and Nguyen, 11/17)

Urban Institute: Immigrant Access To Health And Human Services Final Report
Eligibility policies limit immigrants’ access to some parts of the safety net supporting low-income and poor families in the United States. The ACA opens public health insurance and affordable private health insurance to some immigrant families who were previously uninsured, but not all. And even immigrants who are eligible for safety-net programs face a number of administrative, logistical, and cultural barriers to accessing benefits. Our research found that complicated eligibility criteria combined with existing data systems and eligibility screening forms and processes made enrollment difficult for both agency staff and immigrant families. ... Our research in California, Maryland, Massachusetts, North Carolina, and Texas uncovered a number of promising practices that can help bridge the gap between available public supports and immigrants’ needs. (Gelatt and Koball, 11/12)

Heritage Foundation: Medicare’s SGR: Fixing It The Right Way, Not In A Lame Duck Session
Congress needs to junk the sustainable growth rate (SGR) formula that governs Medicare physician payment. Under the formula, if Medicare physicians’ payments in any given year increase by more than the economy’s growth, an automatic and proportionate reduction in their reimbursements is imposed the following year. ... Congress routinely circumvents the SGR—its own handiwork—by making a series of temporary adjustments preventing the SGR’s reductions from taking effect, a practice known as the “doc fix.” ... Congress must also make sure that it does not impose hundreds of billions of costs on already overburdened American taxpayers by ignoring the accumulation of the costs of the fix outside the CBO’s normal 10-year budget window. ... Any permanent Medicare “doc fix” must be financed with permanent Medicare savings. (Robert Moffitt, 11/20)

Here is a selection of news coverage of other recent research:

Medscape: Low-Dose Aspirin Fails In Primary Prevention
A new trial shows no benefit of low-dose, once-daily aspirin in the primary prevention of cardiovascular events in patients with multiple risk factors, including hypertension, diabetes, and dyslipidemia. ... There were significant reductions in MI and in transient ischemic attack (TIA), but a significant increase in serious extracranial hemorrhage meant the net benefit was questionable. ... The results of the Japanese Primary Prevention Project (JPPP) were published online November 17 in JAMA . (Jeffrey, 11/18)

Editorials And Opinions

Viewpoints: Effects Of A 'Market-Driven' Health System; Administration's Poor Accounting

A selection of opinions on health care from around the country.

The Washington Post: People Who Wanted Market-Driven Health Care Now Have It In The Affordable Care Act
As the Affordable Care Act moved into its second open enrollment period on Nov. 15, critics seized on the fact that some beneficiaries are in for unpleasant surprises. Some of those who enrolled last time will face higher premiums if they stay with their current plans. They will have to shop around on the exchange to find a plan with a lower price. When they return to the Web site, they are likely to find more plans to choose from than they did last year. More choices — how confusing! ... Oh, dear! That all sounds complicated, inconvenient and unfair. What have these “socialist Democrats” done to us? But wait a minute: Isn’t that how markets are supposed to work? (Alice M. Rivlin, 11/20)

The New York Times: An Obamacare Do-Over
Many political analysts were surprised by how close I came to winning the Virginia Senate race earlier this month. I received more than a million votes running on a five-point plan for economic growth, and the first point was a specific proposal to replace the Affordable Care Act. In a purple state like Virginia, I could not have gotten so close to defeating Mark R. Warner, a popular incumbent, by talking only about “repeal.” But while I wasn’t elected to the Senate, those who were might find these reforms worthy of their support, in part because they were well received in a swing state of considerable importance in the Electoral College. (Ed Gillespie, 11/20)

Forbes: Post-Obamacare Health Reform: Will Health Insurers Be Redeemed?
Just as Ronald Reagan’s 1981 tax reforms did not drop out of the sky when he took office, but had been developed in Congress for years by Jack Kemp and William V. Roth, the newly elected Congress has the opportunity and responsibility to pursue a consensus on post-Obamacare health reform that puts patients’ needs in front of politicians’ delusions, so the next president has something with which to replace Obamacare. Will health insurers resist, focused on consolidating their Obamacare gains, or will they accept the need for real reform? Although not immediately apparent, there is hope that health insurers will be ready to move beyond Obamacare. (John R. Graham, 11/19)

The New York Times' The Upshot: Health Enrollment Counting Error Shows Where System Is Still Broken
The Obama administration’s overcounting of the number of people enrolled in Affordable Care Act health plans reveals how all the glitches in the government’s computer system have yet to be worked out. Instead of the 7.3 million people that the government reported were enrolled in health insurance plans in September, congressional investigators discovered that the number was 6.97 million. A more recent estimate of 7.1 million should have been 6.7 million, Sylvia Mathews Burwell, Secretary of Health and Human Services, acknowledged Thursday. (Margot Sanger-Katz, 11/20)

The New Republic: The Government Overstated Obamacare Enrollment By 400,000 People. That's Inexcusable.
Yikes. Enrollment in Obamacare insurance plans this fall was lower than the Department of Health and Human Services reported at the time. The difference was about 400,000 people, or about 6 percent of the total. Conservative critics say it’s proof that Obama is “cooking the books,” just as they have claimed all along. Senior Administration officials swear they made an honest mistake. They've offered what sounds (at least to me) like a plausible explanation. But even if that explanation is accurate, the error would still be inexcusable. (Jonathan Cohn, 11/20)

Bloomberg: Obamacare Inflates Its Numbers. I Feel Sick.
Health and Human Services Secretary Sylvia Mathews Burwell seems to be saying that this was some sort of mistake. And it’s possible that this is all it is. But I would be more inclined to give the benefit of the doubt if the administration hadn’t otherwise been managing enrollment data so aggressively, releasing good figures as soon as it had them but sitting on bad data as long as possible, and ceasing to issue regular reports as soon as open enrollment stopped and the numbers began to decline rather than rise. (Megan McArdle, 11/20)

The New York Times' Well: That Medical Test Costs $50, Or Is It $500?
When I was growing up in Lexington, Ky., in the late 1970s, we used to go to an all-you-can-eat buffet called Duff’s. It was the cheapest restaurant in town. My father and mother ate for $2 apiece, my brother and I were charged $1, and my little sister, who was 3, ate free. After my father paid the cashier, we’d sprint over to the smorgasbord and fill our plates. We’d fill them again and again. If the fried chicken got cold, my father would tell us to throw it out and get more. We gorged; we took advantage; we were wasteful — because we perceived it as free. We’d eat so much that one of us would invariably get sick on the way home. In many ways, Duff’s is like our health care system. Someone else appears to be paying for it, so who cares how much it costs? (Dr. Sandeep Jauhar, 11/20)

Los Angeles Times: For Many People Living Under Threat Of Deportation, Obama Offers Relief
Under Obama's plan, the government will defer for three years the deportation of parents of children who are U.S. citizens or legal permanent residents, if the parents pass a background check and have been in the country for five years. He will also expand the pool of so-called Dreamers — those who came to this country illegally as children — who are eligible for deferrals. He will not offer deferrals to their parents. ... People receiving deferrals will not be eligible for health coverage under the Affordable Care Act, nor will they qualify for other federal programs, such as food stamps, that support low-income citizens, permanent residents and others here legally. (11/20)