KHN Morning Briefing

Summaries of health policy coverage from major news organizations

First Edition: November 1, 2013

Today's headlines include information from the inside about what happened on day one of the health law's online insurance marketplace roll out, as well as details about how nervous some Democrats are getting about how the overhaul is shaping up.  

Kaiser Health News: As Robot-Assisted Surgery Expands, Are Patients And Providers Getting Enough Information?
Kaiser Health News staff writer Marissa Evans reports: "The use of robotic surgical systems is expanding rapidly, but hospitals, patients and regulators may not be getting enough information to determine whether the high tech approach is worth its cost. Problems resulting from surgery using robotic equipment—including deaths—have been reported late, inaccurately or not at all to the Food and Drug Administration, according to one study" (Evans, 11/1). Read the story

Kaiser Health News: A Reader Asks: If My Son Gets Insurance From The Indian Health Service, Is He Fulfilling His Health Law Requirements?
Kaiser Health News consumer columnist Michelle Andrews answers this reader's question (11/1). Read her response.

Kaiser Health News: Why State Exchange Sites Worked While The Federal Site Faltered
The Seattle Times’ Patrick Marshall, working in partnership with Kaiser Health News, reports: "When President Obama addressed massive problems with the federal health-insurance exchange website last week, he couldn't cite any actual enrollments in health plans offered through the site. At the same time, several states running their own exchanges have exceeded federal-enrollment targets, including California, Connecticut, Kentucky, New York, Rhode Island and Washington. As of Oct. 28, Washington’s online site — the Washington Healthplanfinder — had enrolled 48,995 people" (Marshall, 10/32). Read the story.

Kaiser Health News: Florida Insurer Says It Didn't Drop Customers, Just Insurance Plans
The Miami Herald’s Daniel Chang, working in partnership with Kaiser Health News, reports: "This month, Florida Blue, the state’s largest and oldest health insurer, notified 300,000 members that when their plans expire in 2014 they must enroll in new plans that comply with requirements of the ACA that insurers offer coverage to everyone, regardless of pre-existing conditions, and that plans cover 10 ‘essential health benefits’’ such as hospitalization, prescription drugs and maternity care" (Chang, 10/31). Read the story.

Kaiser Health News: Capsules: Troubles Don't Change Public's View Of Health Law, Poll Finds
Now on Kaiser Health News’ blog, Jordan Rau reports: "The public has a dim view of how the government has rolled out the health care law so far, but those stumbles have not changed people’s overall opinions of the law itself, a new poll finds. The Kaiser Family Foundation poll found that 48 percent of people think the federal government has done a poor job of implementing the law, and another 32 percent give the government an ‘only fair’ review. (KHN is an editorially independent program of the foundation.) Only 14 percent gave the federal government good or excellent reviews for the rollout of the law.  The public was slightly less critical about state government management of the law, but even there, 63 percent said their state had done either a poor or ‘only fair’ job" (Rau, 11/1). Check out what else is on the blog.

The New York Times: Troubled Start for Health Law Has Democrats Feeling Anxious
Already under fierce attack from Republicans over the new health care law, President Obama now faces broad and mounting Democratic concerns that the troubled start of the insurance program will cut into the political benefit the party received from the government shutdown and cost Democratic candidates in next year’s midterm elections (Weisman, 10/31).

Politico: Senate Dems Vent To W.H. On Obamacare
Anxious Senate Democrats gave senior White House officials an earful over the bungled rollout of the health care law, pushing the Obama administration to rectify problems that have become a political liability for their party. At a private lunch briefing Thursday in the Capitol, senior administration officials heard concerns over the law’s new website, frustration about the cancellation of some insurance policies and fears that the White House’s poor messaging failed to convey how Obamacare will actually work. While the mood was cordial, senators said, the questions were pointed and the anxiety was palpable (Raju, Everett and Haberkorn, 10/31).

The Washington Post: In First Month, The Vast Majority Of Obamacare Sign-Ups Are In Medicaid
The first month of the new health law’s rollout reveals an unexpected pattern in several states: a crush of people applying for an expansion of Medicaid and a trickle of sign-ups for private insurance. This early imbalance — in some places, nine out of 10 enrollees are in Medicaid — has taken some experts by surprise. The Affordable Care Act, which expanded Medicaid to cover millions of the poorest Americans who couldn’t otherwise afford coverage, envisions a more even split with an expanded, robust private market (Kliff, 10/31).

The Washington Post: Obamacare's Launch Looked Even Worse From The Inside had tallied exactly six successful enrollments by the morning of Oct. 2, new documents released by the House Oversight Committee show. By the end of Oct. 2, the health law Web site that serves 36 states had received 248 insurance enrollments (Kliff, 10/31).

Politico: Six Enrolled On Health Site On Day 1
Only six people enrolled in health insurance via the Obamacare exchanges on the website’s first day, newly released documents reveal. "War room notes" obtained by the House Oversight and Government Reform Committee and posted by CBS News from the morning of Oct. 2, the day after the exchange site opened, show that amid ongoing problems with the site, just six people had completed enrollment as of that morning (Kopan, 11/1).

The Wall Street Journal: Health-Site Flaws Put Navigators On Front Lines
Christine Kaufmann and thousands of other people hired to help consumers sign up for health insurance on the new exchanges this fall knew they would be busy. But problems with the federally run website have placed these "navigators" on the front lines, facing a deluge of questions and resorting to pen-and-paper applications to enroll consumers (Martin, 10/31).

Politico: Obamacare Marketing Push On Hold
Team Obamacare is sitting on hundreds of millions of dollars of essentially frozen assets — yet another consequence of the failed launch of There’s no point in an ad blitz directing people to sign up on a website that doesn’t work. And while advocacy groups say they had always planned to spend more money on the back end to boost enrollment in lagging states at the end of this year and early next year, they didn’t count on the opening month fizzle (Palmer and Allen, 10/31).

The Associated Press/Washington Post: Oracle, Red Hat Join In Effort To Fix Problems Crippling Obama's Healthcare Site
The Obama administration has recruited engineers from several prominent technology companies to help fix the problems preventing people from signing up for government-mandated health insurance. Oracle and Red Hat are pitching in as well as Michael Dickerson, an engineer on leave from Google, according to a blog post Thursday by Julie Bataille, a spokeswoman for the Centers for Medicare & Medicaid Services (10/31).

The Wall Street Journal: Data Security Added To Worries About Website
Concerns about the security of personal information on the website are getting closer attention in Washington, potentially adding to the list of problems with the new federal health-insurance exchange. The House Oversight and Government Reform Committee, led by Rep. Darrell Issa (R., Calif.), on Thursday subpoenaed information about the website from the Obama administration, including on whether the site was well-protected from hackers (Dooren and Schatz, 10/31).

Los Angeles Times: IRS Eases Rules On Healthcare Flexible Spending Accounts
Workers faced with forfeiting unused money in their flexible spending accounts for healthcare expenses may be getting some relief under a new federal rule. The U.S. Treasury Department and Internal Revenue Service changed the use-it-or-lose-it rule for flexible spending arrangements, or FSAs, to allow account holders to carry over as much as $500 from one year to the next without penalty (Terhune, 10/31).

The Wall Street Journal: Consumers Can Roll Over $500 In An FSA
The Obama administration loosened rules governing health-care savings accounts known as flexible-spending arrangements, or FSAs, allowing consumers to roll over as much as $500 in unused funds each year. The change—likely to be popular with consumers—modifies the use-it-or-lose-it rule that has governed the tax-advantaged accounts for decades (McKinnon, 10/31).

NPR: Which Plans Cover Abortion? No Answers On
As if the rollout of the federal health law didn't have enough problems, abortion is back in the spotlight. How the various health plans in the exchanges would or would not pay for abortion was one of the very last issues settled before the bill was passed in 2010. Now abortion's invisibility on the federal website has some people pretty upset (Rovner, 11/1).

The Washington Post: Does Obama's Health-Care Law Make Men Pay For Maternity Care? Breaking Down The Facts.
It was one of the lighter moments in a House hearing Wednesday in which Health and Human Services Secretary Kathleen Sebelius testified about the government’s problem-ridden health insurance exchange. Rep. Renee L. Ellmers (R-N.C.) said the health-care law was forcing many Americans to pay for benefits they would never need, such as maternity coverage. "To the best of your knowledge, has a man ever delivered a baby?" Ellmers asked. The back-and-forth focused attention on a key part of the law: Starting next year, individual plans must provide a minimum package of essential benefits — including maternity care — to everyone (10/31).

The Associated Press/Washington Post: Still All Smiles: new Insured who Became Latest Faces Of Health Overhaul Defend Their Choice
It didn’t take long for the friendly-looking young woman whose face was splashed across to spiral from smiling stock photo to laughingstock. As it scrambles to correct problems with the website, the Obama administration is now asking people who have successfully purchased health insurance to let their pictures be used instead (11/1).

The New York Times: When Insurers Drop Policies: Three Stories
Each, in a different way, represents the relatively small part of America that the Obama administration did not talk about while campaigning for the Affordable Care Act: people who have health insurance that they like, but who will be unable to keep it under the law. Now that new insurance marketplaces are opening, insurance companies are canceling millions of individual plans that fail to meet minimum standards. The dropped plans have become the political talking point of the moment — and, according to many Republicans, a symbol of the president’s flawed ambitions (Thomas and Abelson, 10/31).

The Wall Street Journal's Washington Wire: Q&A: Explaining The Widespread Health-Plan Cancellations
As many as 10 million Americans are expected to have their health plans terminated by their insurers effective Jan. 1 or after. Here’s a look at who’s affected, why and options for staying covered (Needleman and Martin, 10/31).

The Associated Press/Washington Post: Congress Governs Self Under 'Obamacare,' With Discretion, Coyness About who Is Covered And How
For House members and senators, it's about a section of the law that may — or may not — require lawmakers to toss some staffers off of their federal health insurance and into the Affordable Care Act's exchanges. The verdict from congressional officers is ultimately that lawmakers, as employers, have discretion over who among their staffs gets ejected, and who stays. And they don’t have to say who, how many or why (11/1).

NPR: For The Young And Healthy, Health Insurance Is A Hard Sell
Getting young, healthy people to sign up for health insurance is seen as critical to the success of the Affordable Care Act. It's precisely those people who will help offset the cost of the older, sicker ones. But while cheap health insurance and subsidies based on income are intended to make the program appealing to the young, what if they haven't even heard of the health care law? Or don't want to buy even an inexpensive policy? (Glinton, 11/31).

The Associated Press/Washington Post: Houston Launches Major Effort To Roll Out Federal Health Plan Despite Political Opposition
But this is no hurricane. Instead, it is Houston’s offensive to reach more than 1 million people across 600 square miles who don’t have health insurance and connect them with the new federal health insurance program that began accepting applications this month. The push is happening in one of the nation’s reddest states, an example of the gap between the vitriolic political opposition to President Barack Obama’s signature initiative in some conservative bastions and the actual response to it by local officials (10/31).

The New York Times: Conservative Group Tests New Attack On Health Law
A promise President Obama may come to regret — "If you like your health care plan, you can keep it" — is the centerpiece of the latest web video attacking the Affordable Care Act, released Thursday by Americans for Prosperity, the conservative advocacy group that is working to undo the health law. The video, titled "America’s Broken Promise," features a mash-up of clips of Mr. Obama’s statements and newscasters questioning his assertion, as foreboding music plays in the background (Stolberg, 10/31).

Politico: The Obamacare Sabotage Campaign
The opposition was strategic from the start: Derail President Barack Obama’s biggest ambition, and derail Obama himself. Party leaders enforced discipline, withholding any support for the new law — which passed with only Democratic votes, thus undermining its acceptance. Partisan divisions also meant that Democrats could not pass legislation smoothing out some rough language in the draft bill that passed the Senate. That left the administration forced to fill far more gaps through regulation than it otherwise would have had to do, because attempts — usually routine — to re-open the bill for small changes could have led to wholesale debate in the Senate all over again (Purdum, 11/1).

The Washington Post’s The Fact Checker: Obama’s Claim That The Massachusetts Enrollment Experience Is Relevant To Obamacare
The president traveled to Boston this week to tout his troubled health care law, to the very spot where his erstwhile rival, former governor Mitt Romney (R), has signed into law his own universal health care law with an individual mandate. He cited the experience in Massachusetts to point out that enrollment in Massachusetts started off slowly and increased substantially just before key deadlines. The administration has not released enrollment numbers, but presumably it is preparing Americans for relatively low numbers at first (Kessler, 11/1).

The New York Times: In Reversal, Court Allows Texas Law on Abortion
Only three days after a federal judge blocked a new Texas law that threatened to shut down many of the state’s abortion clinics, the United States Court of Appeals for the Fifth Circuit, in New Orleans, reversed the decision, saying the rule should take effect while the case is argued in the months to come (Eckholm, 10/31).

NPR: Appeals Court Gives Texas OK To Enforce Abortion Law
A federal appeals court has granted a Texas request to reinstate restrictions on abortion providers after a lower court blocked the state from fully implementing the new law. The stay follows a ruling by District Judge Lee Yeakel on Monday — a day before the law was to have gone into effect. It requires doctors performing abortions to have admitting privileges at a hospital within 30 miles of the clinics they practice in (Neuman, 10/31).

Los Angeles Times: Strict Texas Abortion Law Takes Effect
A federal appeals court allowed most of Texas' new abortion restrictions to take effect immediately, lifting an injunction Thursday that had suspended much of the law. The decision came three days after U.S. District Judge Lee Yeakel in Austin blocked restrictions that he found unconstitutional, including one that requires doctors at abortion clinics to have admitting privileges at nearby hospitals and another that limits medication-induced abortions (Hennessy-Fiske, 10/31).

USA Today: Court Reinstates Most Of Texas' New Abortion Restrictions
A federal appeals court reinstated most of Texas' tough new restrictions on abortions Thursday in a ruling that means as many as a dozen clinics around the state will not be able to continue performing procedures. The restrictions could take effect Friday, stopping abortion procedures in at least one-third of the state's licensed health centers, according to opponents of the law (Welch, 10/31).

Los Angeles Times: Patients Pour Into LA Sports Arena For Free Medical, Dental Care
An army of doctors, nurses, dentists and other health workers on Thursday began providing free care to a steady stream of patients at the annual Care Harbor clinic at the Los Angeles Memorial Sports Arena. Care Harbor founder Don Manelli estimated that 700 to 800 people would receive free care by the end of the day Thursday. In all, the clinic expects to serve about 4,000 Angelenos--many of whom don't have insurance, or don't have coverage for services like dentistry or vision care (Brown, 10/31). 

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