KHN Morning Briefing

Summaries of health policy coverage from major news organizations

Viewpoints: HHS Officials Must Tell Congress, Citizens What Is Happening To Marketplaces; ‘Rate Shock’ Didn’t Materialize; Problems With Medical Credit Cards

The Wall Street Journal: Sebelius On The Run
The Affordable Care Act's botched rollout has stunned its media cheering section, and it even seems to have surprised the law's architects. The problems run much deeper than even critics expected, and whatever federal officials, White House aides and outside contractors are doing to fix them isn't working. But who knows? ...  Health and Human Services Secretary Kathleen Sebelius is even refusing to testify before the House Energy and Commerce Committee in a hearing this coming Thursday. ... The department is also refusing to make available lower-level officials who might detail the source or sources of this debacle (10/18).

Los Angeles Times: No Way To Run A Health Exchange
The new federally run health insurance exchanges have stumbled badly in trying to sign up customers online, stymied by both design flaws and inept execution. If the website's problems aren't solved soon, they could inflict a greater toll on the Affordable Care Act than the law's opponents have. There's some consolation in the fact that shoppers can sign up over the phone or in person, and that they can enroll as late as mid-December and still have coverage on Jan. 1. But the failures are mind-boggling and inexcusable, especially considering how much time the government had to prepare (10/20).

The New York Times: Obamacare, Failing Ahead Of Schedule
Like the Bush administration in Iraq, the White House seems to have invaded the health insurance marketplace with woefully inadequate postinvasion planning, and let the occupation turn into a disaster of hack work and incompetence. ... But if the fix-it effort moves too slowly, it's possible to envision a worst-case scenario unfolding. If the Web site doesn't work soon, even liberals concede that the mandate would have to be delayed, because you can't very well fine people for failing to buy a product they can't access. And that combination — a hard-to-navigate online portal and no penalty for staying uninsured — could effectively discourage all but the most desperate customers from shopping, which in turn would create an unsustainably expensive insurance pool (Ross Douthat, 10/19). 

The Washington Post Wonkbook: One Nation, Two Health-Care Systems
In the last two weeks, Oregon has cut the ranks of its uninsured by 10 percent through Obamacare. They're not the only state seeing huge gains. California has signed up 600,000 low-income Golden Staters for the law's expanded Medicaid, and over 100,000 are in some stage of applying for insurance on the marketplaces. In Washington state, over 40,000 people have signed up for Obamacare. In New York, the numbers are even larger. Kentucky's online marketplace has been a model of glitch-free performance, with more than 10,000 signing up on the first day alone. It's increasingly possible that Obamacare, at least in its early years, will be a success in blue states (and red states run by Democrats, like Kentucky) even as it flails in red states (Ezra Klein and Evan Soltas, 10/18).

The New York Times: Driving A New Bargain On Obamacare
[W]ith all the conflict and vituperation over Obamacare, it sometimes seems that one of the few things Democrats and Republicans agree on is that the law is imperfect at best. And they also agree that it could be improved. Even if a bipartisan deal to create a better health care system seems far off today, it's not too soon to start imagining what a future bargain might look like (Tyler Cowen, 10/19).

The New York Times: Lousy Medicaid Arguments
In other words, the technical problems, while infuriating — heads should roll — will not, in the end, be the big story. The real threat remains the effort of conservative groups to sabotage reform, especially by blocking the expansion of Medicaid. This effort relies heavily on lobbying, lavishly bankrolled by the usual suspects, including the omnipresent Koch brothers. ... Before I get there, a word about something that, as far as we can tell, isn't happening. Remember "rate shock"? (Paul Krugman, 10/21).

Los Angeles Times: Is Obamacare Forcing Bonnie Doon Ice Cream Out Of Business?
Maybe you've heard about the beloved local ice cream company that's been forced to close its doors because of Obamacare? Earlier this week, Newt Gingrich shared the dreadful news with Sean Hannity on Hannity's radio show. It’s awful, just awful, the two men agreed, that small businesses are being driven under by the "job-killing" Affordable Care Act. It didn't take me long to identify the company: Bonnie Doon Ice Cream Corp., an Indiana ice cream maker. ... Or to figure out that the Affordable Care Act probably has nothing to do with the business's failure (Robin Abcarian, 10/18). 

The Washington Post: Let's Get Rid Of (The Term) Entitlements
Let's drop the whole notion of "entitlement." Just eliminate it. Politicians, pundits and academics who talk about entitlements would then have to name the actual programs and argue their merits and demerits. ... Social Security, Medicare (health insurance for the elderly) and Medicaid (health insurance for the poor) aren't the only big entitlement programs. Here are 12 of the largest in 2012, ranked by the number of recipients, according to the Office of Management and Budget (Robert J. Samuelson, 10/20). 

The Wall Street Journal: The Tea Party And The Entitlement Fight
Not appreciated is the powerful new meme Mr. Obama has handed them, which will transform entitlement politics in our country. The new "conservative" position will be to defend Social Security and Medicare, those middle-class rewards for a life of hard work and tax-paying, against Mr. Obama's vast expansion of the means-tested welfare state for working-age Americans. This will discomfit traditional free marketers. They know Medicare and Social Security are generous in excess to the taxes that beneficiaries paid into them (Holman W. Jenkins Jr., 10/18). 

Bloomberg: Obama's 'Abuse of Power' Is Hardly Unprecedented
A leading Republican complaint during the partial government shutdown was that President Barack Obama had delayed implementation of the Affordable Care Act for businesses but not individuals. Many party strategists argued that its protest should have been focused on delaying rather than defunding the law. I am skeptical that this would have turned the political drama to Republican advantage. What is more intriguing to me as scholar is the charge that Obama, in giving businesses an extra year to prepare, defied the language of the statute and acted beyond the powers of the presidency (Stephen L. Carter, 10/20).

Bloomberg: Cruz Emerges Stronger From Republican Debacle
In the aftermath of the U.S. government shutdown and a close call with default, there is a political consensus among Democrats, many Republicans, establishment conservatives, business leaders and the inside-the-Beltway commentariat: Senator Ted Cruz of Texas and Tea Party members in the House have done grievous harm to themselves and their brand. ... That, however, isn't the way Deedee Vaughters and Bob Vander Plaats see things. "We're winning this argument and now have to go back at Obamacare and getting our fiscal house in order," says Vaughters, a Tea Party activist in Aiken, South Carolina. Vander Plaats, who heads an influential family-values group in Iowa, agrees: "Ted Cruz is a rock star sucking all the energy in the conservative movement. He's making all the right enemies with the Republican establishment, which is taking him to unprecedented heights" (Albert R. Hunt, 10/20).

Bloomberg: Let's Fight Obamacare By Getting Out Of The Way
But did Republican tactics permanently compromise their ability to capitalize on the deeply flawed rollout of Obamacare, and what many analysts (myself included) believe will be its deleterious impacts on the U.S. health-care system? Not necessarily. Republicans can still use Obamacare’s failings to their advantage, but it will require a disciplined, realistic approach. And it means recognizing the impossibility of large-scale changes to the law while Barack Obama is president (Lanhee Chen, 10/20).

National Review: Kasich Is Wrong About Reagan
Governor Kasich bases his argument [for expanding Medicaid in Ohio] that he is doing what [President Ronald] Reagan would have done on the fact that Reagan expanded Medicaid when he was president. ... Aside from offering a genuine choice to the states (as opposed to the economic coercion of Obamacare), this expansion had a factor missing from the current debate: abortion. In an era when there were perpetual fights over using public funds for abortion, the expansion assured that pregnant women would not be financially worse off carrying their children to term than they would be if they chose to have an abortion (Edwin Meese III & Robert Alt, 10/21).

And on another subject -

The New York Times: Alarming Abuses Of Medical Credit Cards
Patients around the nation are being victimized by medical credit cards that can lead to financial calamity. These cards, issued by specialty finance companies as well as commercial banks, carry exorbitant interest rates after an initial period of zero interest expires — with heavy penalties for late payments. They are often pushed on patients with modest incomes by health care providers who want to make sure that they get paid, even if some of their patients end up with huge credit card bills they can’t afford. Unless strong regulatory action is taken to curb the abuses, financial companies will continue to gouge consumers at their most vulnerable moments, when they are in pain and need medical attention (10/19).

Health Policy Solutions (a Colo. news service): Noise Over ACA Shouldn't Distract Seniors From Medicare Enrollment
If you are an American over 65, you may have questions about the new health care law, what it means for you and what you need to do. The short answer is that very little changes, and most seniors will not have to do anything. Some meaningful changes have already occurred, such as the shrinking of the prescription drug “donut hole,” but most of the major reforms in the Affordable Care Act, such as the new health insurance marketplaces and penalties for not having coverage, simply do not affect seniors (Bob Semro, 10/18).

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.