KHN Morning Briefing

Summaries of health policy coverage from major news organizations.

First Edition: November 7, 2013

Today's headlines include reports about President Barack Obama's efforts to bolster support for the health law, as well as the tough questions faced by Health and Human Services Secretary Kathleen Sebelius in her appearance before the Senate Finance Committee.

Kaiser Health News: Popular Provision Of Obamacare Is Fueling Sticker Shock For Some Consumers
Kaiser Health News staff writer Julie Appleby reports: "When setting premiums for next year, insurers baked in bigger-than-usual adjustments, driven in large part by a game-changing rule: They can no longer reject people with medical problems. Popular in consumer polls, the provision in the health law transforms the market for the estimated 14 million Americans who buy their own policies because they don’t get coverage through their jobs. Barred from denying coverage, insurers also can’t demand higher rates from unhealthy people and those deemed high risks because of conditions including obesity, high blood pressure or a previous cancer diagnosis" (Appleby, 11/6). Read the story.

Kaiser Health News: Health On The Hill: Democrats' Frustrations With Health Law Grow Amid Website Problems
Kaiser Health News staff writer Mary Agnes Carey and CQ HealthBeat's Rebecca Adams discuss recent Capitol Hill events. For instance, HHS Secretary Kathleen Sebelius said at a Senate hearing Wednesday that officials were advised to keep healthcare.gov open while fixing problems and also fielded criticism of President Obama's promise that if Americans like their old health plans they can keep it (11/6). Read the transcript or listen to the audio.

Kaiser Health News: Capsules: Humana Exec Predicts Obamacare Open Enrollment Extension; Retail Clinics Boom, But Still Small Part Of Overall Market
Now on Kaiser Health News’s blog, Phil Galewitz writes about Humana’s assumption that the health law’s open enrollment period may be extended: "Humana, one of nation’s largest health insurers, said Wednesday that it expects the Obama administration to extend open enrollment for its troubled online marketplaces beyond March 31.  But a spokeswoman for the Centers for Medicare & Medicaid Services, Julie Bataille, said, 'Consumers still have ample time to enroll in the six-month open enrollment period'" (Galewitz, 11/6).

Also on the blog, Marissa Evans takes a look at retail clinics: "The percent of American families using retail clinics in the previous year nearly tripled between 2007 and 2010, from 1.2 percent of U.S. families to 2.9 percent, the study found. However, despite increased use, the study found overall utilization of the clinics remains modest" (Evans, 11/7). Check out what else is on the blog.

The New York Times: Despite Fumbles, Obama Defends Health Care Law
Against a backdrop of closer-than-expected election results in Virginia that some attributed to opposition to the health law, Mr. Obama again expressed regret for the troubles at the federal website that have prevented many people from enrolling for insurance. But he said the Texas government — by refusing to take federal funds and expand Medicaid eligibility — had left more than a million people uninsured. He promised to get problems with the health program fixed (Calmes and Weisman, 11/6).

The Associated Press/Washington Press: Obama Sells Health Care Law In Texas, Draws Attention To State's High Rate Of Uninsured
President Barack Obama is comparing the problem-plagued federal health care website to a store that has a good product for sale and not enough cash registers to ring up the purchases. Speaking to volunteers in Dallas, Obama says “nothing drives me more crazy” than knowing that good insurance plans are for sale under the Affordable Care Act, but people are having trouble getting onto the website to buy it (11/6).

The Wall Street Journal’s Washington Wire: Obama Slams Texas' Health-Law Resistance
President Barack Obama lamented Texas’ resistance to the Affordable Care Act Wednesday, saying that more than a million people there could gain coverage if the state expanded Medicaid. The president traveled to Dallas to make a pitch for the federal health law, quickly skimming past the controversy that has enveloped it and instead pushing Texas to participate in the Affordable Care Act (Nelson, 11/6).

Politico: President Obama Thanks Health Care Volunteers In Dallas
President Obama spent some time Wednesday hearing from Senate Democrats concerned about the implementation of the Affordable Care Act, but by the time he got to Dallas a few hours later, he was on the offensive, as he tried to fire up volunteers helping with the law’s implementation. One target was Texas Gov. Rick Perry, who Obama called on to support the expansion of Medicaid in his state, something that just a few Republican governors have done (Epstein, 11/6).

Los Angeles Times: White House Tries To Reassure Democratic Lawmakers About Obamacare
Sixteen Senate Democrats met with President Obama on Wednesday to urge that he right his foundering healthcare website, warning of a "crisis of confidence" if he doesn't act quickly. The president's team acknowledged struggling with how to present its message to the public, but some senators left the meeting more concerned that there were no immediate fixes forthcoming more than a month after healthcare.gov went live (Parsons, Mascaro and Memoli, 11/6).

The Wall Street Journal: Worried Senators Press Obama On Health Law
Democratic senators took their complaints about the troubled launch of the federal health law directly to the White House Wednesday, as the surprisingly close governor's race in Virginia prompted some in the party to warn that they would face voter backlash next year if the problems weren't fixed (King and Hughes, 11/6).

Politico: President Obama, Democratic Senators Discuss Health Care At White House Meeting
President Barack Obama, Vice President Joe Biden and other senior administration officials met privately at the White House on Wednesday with frustrated Senate Democrats facing reelection in 2014 to discuss the botched Obamacare rollout. The two-hour meeting comes as the Obama administration and congressional Democrats work to assess the political fallout from the health care overhaul’s troubled implementation. Lawmakers passed on the frustration expressed by their constituents and the White House walked through their steps to repair the program (Kim, Epstein and Haberkorn, 11/6).

The Washington Post: Obama Making Aggressive Effort To Reinvigorate His Base
Nearly a year after President Obama’s reelection, his former campaign manager presented him with a poster-size version of a New York Times Magazine cover from November 2011 bearing the headline, “Is Obama Toast?” The president drew laughs with the story Monday at a dinner for Organizing for Action, an activist group started by his campaign staff. But it also served as a timely reminder for true believers that Obama has a history of defying expectations when he is down (Nakamura, 11/6).

The New York Times: Sebelius Rejects Delays To Get Time To Repair Problems At Health Site
Kathleen Sebelius, the secretary of health and human services, said Wednesday that the government needed to fix hundreds of problems with the website for the federal health insurance marketplace, but she categorically rejected bipartisan calls to delay parts of the new health care law (Pear, 11/6).

Los Angeles Times: Sebelius On Offense, Tells Senate Panel She Won't Delay Obamacare
Health and Human Services Secretary Kathleen Sebelius said Wednesday that she had considered shutting down the problematic Obamacare website, but has no intention of delaying implementation of the nation’s new healthcare law. “Delaying the Affordable Care Act wouldn’t delay people’s cancer, diabetes or Parkinson’s,” Sebelius said in testimony before the Senate Finance Committee. “Delay is not an option.” In her second appearance on Capitol Hill since the botched Oct. 1 rollout of healthcare.gov, the secretary went on the offense as the administration retools its strategy to preserve President Obama’s signature domestic policy achievement (Mascaro, 11/6).

The Washington Post: Sebelius Assures Fixes Are Being Made To Healthcare.gov
Health and Human Services Secretary Kathleen Sebelius said Wednesday that the government is working to fix a “couple of hundred” problems with the federal health insurance Web site and that once the site is running smoothly, she will “re-invite” people who have been turned off by the technical headaches. Sebelius, appearing before the Senate Finance Committee, rejected calls from politicians in both parties to delay aspects of the health-care law, including by extending the initial open enrollment period beyond March 31 for buying insurance on the new online marketplaces. People who don’t buy coverage by then risk being fined (Somashekhar and Kliff, 11/7).

The Wall Street Journal: Exchange Site Needs Hundreds Of Fixes
Health and Human Services Secretary Kathleen Sebelius offered a sobering picture Wednesday of the challenges in fixing the government's health-insurance website, saying contractors need to fix a couple of hundred problems and "we're not where we need to be." Ms. Sebelius spoke in Senate testimony hours before new information emerged about the HealthCare.gov site's lack of readiness before its Oct. 1 opening. In an internal bulletin released by House Republican investigators, a contractor testing the site reported that, as of Sept. 30, it could handle up to 1,100 users before response time became too slow (Schatz, 11/6).

The Associated Press/Washington Post: Sebelius: Health Care Website Needed Couple Of Hundred Fixes When Repair Effort Began
Republicans blistered Health and Human Services Secretary Kathleen Sebelius on Wednesday over the nation’s controversial health care law, bluntly challenging her honesty, pushing for her resignation and demanding unsuccessfully she concede that President Barack Obama deliberately misled the public about his signature domestic program. … During two hours in the Senate Finance Committee witness chair, Sebelius parried some thrusts and listened impassively to others. Treated more gently by Democrats than Republicans, she said at one point: “Clearly the opposition is still quite ferocious, and I’m just hoping that people understand what their options are, what their benefits could be and what their opportunities are” (11/6).

Politico: Kathleen Sebelius Hearing Takeaway: More Bad News
Kathleen Sebelius got through the latest Obamacare hearing Wednesday, but her message to Senate Democrats was a bit of a downer: Expect more bad news. The Health and Human Services secretary told the Senate Finance Committee that the Obama administration is on track to fix the sputtering federal enrollment website. Well, maybe not on track exactly — “not where we need to be” (Nather, 11/7).

The Associated Press/Washington Post: Health Exchange Problems Could Mean Patients With Serious Illness Run Out Of Time To Sign Up
With federal and state online health care marketplaces experiencing glitches a month into implementation, concern is mounting for a vulnerable group of people who were supposed to be among the health law’s earliest beneficiaries. Hundreds of thousands of people across the country with pre-existing chronic conditions such as cancer, heart failure or kidney disease who are covered through high risk-insurance pools will see their coverage dissolve by year’s end (11/6).

The Washington Post’s Federal Eye: Tony Trenkle: The Healthcare.gov Official Who Stepped Down
HealthCare.gov may have claimed its first casualty from the Obama administration: a veteran official who helped oversee development of the federal government’s glitch-ridden online insurance exchange. The Centers for Medicare and Medicaid (CMS) said on Wednesday that Tony Trenkle, the agency’s top technology executive, will step down on Nov. 15 “to take a position in the private sector.” CMS Chief Operating Officer Michelle Snyder delivered the news in an e-mail to employees (Hicks, 11/7).

The Wall Street Journal's Washington Wire: Official Involved With Healthcare.gov To Leave
Tony Trenkle, the chief information officer for the Centers for Medicare and Medicaid Services, will leave the agency on Nov. 15, according to an email written by the agency’s chief operating officer, Michelle Snyder, and sent to agency employees on Wednesday. Mr. Trenkle oversaw $2 billion worth of annual spending on information products and services including the development of HealthCare.gov, the federal insurance website (Dooren, 11/6).

Los Angeles Times: GOP Lawmakers In Ohio Under Fire For Supporting Medicaid Expansion
State Rep. Barbara Sears is the kind of Republican the party would want to highlight these days: a woman and former business owner, fluent in health insurance issues. … But this year, the popular legislator with a strong conservative voting record has found her photo on door hangers throughout her district, pictured as the conductor of the Obamacare train to disaster. … It's all part of a campaign against her by Americans for Prosperity. … The reason: Sears has championed a key element of Obamacare. Her support for the expansion of Medicaid to cover more of the state's poor is also backed by Ohio's Republican Gov. John Kasich and nearly three-quarters of Ohioans, according to an AARP poll (Reston, 11/6).

The Associated Press/Washington Post: Some Union Insurance Plans Could Get Break From Fees Under New Health Care Law
Critics of the new health care law are claiming some labor unions could get a break from fees imposed on everyone covered by health insurance. The Obama administration’s plan to exempt “certain self-insured, self-administered plans” from paying fees in 2015 and 2016 is not sitting well with Republicans, who say the move smacks of favoritism for a powerful White House ally. Labor officials say many unions won’t be affected (11/7).

The Wall Street Journal: Health-Fee Proposal Knocked
The Obama administration is planning to exempt some labor unions and businesses from paying part of a contentious reinsurance fee under the health-overhaul law, but unions and businesses said Wednesday the move wouldn't go far enough. The Department of Health and Human Services signaled in a document published quietly last week that it intends to propose a partial break on the fee. But business officials said the vast majority of their insurance plans wouldn't qualify, and union officials said a large majority of theirs wouldn't either, based on the language from HHS (Radnofsky and Trottman, 11/6).

The Washington Post’s The Fact Checker: The White House Effort To Blame Insurance Companies For Lost Plans
In defending President Obama’s now-discredited pledge that “if you like your health-care plan, you’ll be able to keep it,” the White House has repeatedly tried to blame insurance companies. White House spokesman Jay Carney’s statement above, accusing insurance companies of stripping away benefits, is typical.  Columnists supportive of the White House have piled on, arguing that insurance companies should be blamed. … But there’s an interesting wrinkle to this story that few appeared to have understood. The main culprit is not whether or not the insurance industry has changed a plan that ran afoul of the administration’s regulations — but the law’s effective date. Let’s explain (Kessler, 11/7).

NPR: How The Affordable Care Act Pays For Insurance Subsidies
But the authors of the Affordable Care Act didn't want the subsidies to become a drain on the Treasury and add to the deficits. So they included provisions designed to offset the cost of the subsidies. MIT economist Jonathan Gruber, who helped develop the law, says about half the costs are offset by projected savings in Medicare payments to insurers and hospitals. Another quarter is offset by added taxes on medical-device makers and drug companies (Ydstie, 11/7).

USA Today: Mental Health Bills May Limit Young American’s Clout
High mental health costs for young adults threaten to undermine a key assumption of the Affordable Care Act: that insuring more young people will lower costs because they are healthier and require less expensive care (Kennedy, 11/6).

Politico: Abortion Fight Returns To The Hill
Undeterred by charges that the GOP is too focused on social issues, Senate Republicans are gunning for a fight this fall over the hot-button subject of late-term abortions. Flanked by anti-abortion groups, Sen. Lindsey Graham (R-S.C.) will unveil legislation on Thursday to federally ban abortions after five months of pregnancy (Everett, 11/6).

The Wall Street Journal: Humana Profit Falls On Higher Costs
Humana and its peers next year face shrinking government funding for Medicare Advantage plans, which are private industry's version of the health plan for the elderly and disabled. Humana is more tethered to these plans than any other big insurers, making its ability to digest lower incoming payments while guarding profit margins a key issue. The company—which is one of the biggest providers of privately run Medicare Advantage health plans for seniors in the U.S.—also has bought stakes in doctor practices in an effort to push further into providing health services, and not just paying for them (Tadena, 11/6).

The Washington Post: AMA Panel Takes Steps Toward More Transparency
The American Medical Association panel that plays a key role in setting payment rates for physicians has voted to make public more of its deliberations and is revamping some of the methods it uses for determining the values of services. The panel has come under criticism in recent years because, despite its importance in the economy of U.S. health care, its meetings have not been freely accessible to the public. The panel advises the federal government on the value of physicians’ services and its estimates are widely used by insurance companies (Whoriskey, 11/6).

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