First Edition: November 21, 2013

Today's headlines include reports about President Barack Obama's White House meeting with state insurance regulators.  

Kaiser Health News: President's Cancellation 'Fix' Likely To Affect Limited Number Of Consumers
Kaiser Health News staff writer Julie Appleby reports: "A week after President Barack Obama urged insurers to renew policies that don’t meet all the requirements of the health law, it remains unclear how many people might be affected by the proposed fix. That’s because regulators in at least a half dozen states say they won’t allow insurers to do it and many more have yet to decide.  Even if states give insurers a green light to reinstate the policies, many insurers say they’re not sure if they can pull it off in time and no one knows how many customers who received the cancellations will want to renew" (Appleby, 11/21). Read the story.

Kaiser Health News: Hispanics Interested In 'Having Providers Who Can Appreciate Their Culture,' Medical Leader Says
Kaiser Health News staff writer Marissa Evans reports: "Dr. Elena V. Rios is president of the National Hispanic Medical Association, which she  founded in 1994 and which advocates on behalf of the nation’s 45,000 Hispanic health care professionals. One of the goals in the Affordable Care Act is building diversity in the health care workforce. The number of Hispanics attending medical school continues to increase, rising to 1,826 enrollees, according to an October 2013 report from the Association of American Medical Colleges. Despite that increase, Hispanics represent only slightly more than 9 percent of the enrollees compared with their nearly 17 percent of the population, making health care work force diversity a continuing challenge for the NHMA" (Evans, 11/21). Read the story.

The Washington Post: Obama: Republicans Share Blame For Health-Care Problems
But the strategy presents difficult challenges for Obama, who is seeking to refocus Americans’ attention on the benefits of the Affordable Care Act as the administration works on fixing the online enrollment system. Insurers and insurance commissioners, who are among the groups most closely invested in the program’s success, are questioning the Obama administration’s approach to it. The president’s own credibility with the public has ebbed in the wake of the rocky rollout. And some of the strongest arguments for the law — that it could contain health-care costs over time and ease the financial burden on hospitals required to treat uninsured patients — are longer-term benefits that are harder for the public to easily comprehend (Eilperin and Wilson, 11/20).

Politico: Obamacare Tradeoffs: Now The Tell Us…
The broken HealthCare.gov website, while an excruciating embarrassment, is on the path to repair. If Amazon and the airlines can manage millions of transactions a day over the web with ease, say experts, the federal government’s class of slow students surely will solve the problem in due course. But the problem with Obamacare’s stumbling start is that it shined a harsh light on intended consequences — more costs and more government regulation — that were always embedded in the ACA, yet were deliberately downplayed by Obama and Democrats on the way to passage. Backers hoped the costs of the ACA and its roster of losers would remain obscured after launch in a rush of good feeling about the laws benefits and its roster of winners (Harris and Nather, 11/20).

The Washington Post: Obama Meets With State Insurance Regulators
State insurance commissioners met Wednesday with President Obama at the White House, where they say he acknowledged that some states were unlikely to implement his proposal to reverse millions of health insurance cancellations. The commissioners shared their own concerns about the workability of his plan, which would give insurers an additional year to sell coverage that does not comply with the Obama health-care law’s regulations (Sun and Kliff, 11/20).

The Associated Press/Washington Post: State Insurance Regulators Meet With Obama On His Proposed Fix For Canceled Health Plans
Louisiana Insurance Commissioner Jim Donelon, president of the National Association of Insurance Commissioners, says both sides acknowledged the issues are complex and states will come to different decisions. More than 4 million people who buy their own insurance have gotten cancellation notices because their plans don’t meet requirements of Obama’s health law. The president has proposed allowing those customers to keep their existing plans for another year (11/20).

The New York Times: States Are Left To Decide On Health Plan Change
A group of state insurance commissioners emerged from a meeting with President Obama and other federal officials on Wednesday saying that state regulators would continue to decide on their own whether to go along with his recent proposal to let consumers keep older insurance plans for an extra year, even if the plans did not comply with regulations under the new health care law (Abelson and Craig, 11/20).

The Wall Street Journal: Extending Health Plans A Tall Order
Many people whose existing health-insurance policies were canceled due to the new federal health law won't be able to extend them, despite President Barack Obama's request that insurers allow them to do so. Some carriers say they may not or won't reinstate canceled policies because of a lack of time to make changes and other obstacles. Others say the one-year extensions would come with higher rates. At least five states—New York, Washington, Massachusetts, Minnesota and Rhode Island—have rebuffed Mr. Obama, meaning insurers can't reinstate policies there even if they do so elsewhere (Martin, Scism and Radnofsky, 11/20).

The Wall Street Journal’s Washington Wire: Some Insurance Regulators Turn Down White House Invitation
Not everybody hops when they get an invitation to the White House. Several state insurance regulators said “thanks but no thanks” to a planned meeting at the White House Wednesday afternoon with an association representing state insurance-department regulators to discuss difficulties carrying out President Barack Obama’s plan to allow a one-year extension of health insurance policies that were canceled because they don’t comply with the Affordable Care Act, people familiar with the matter said (Scism, 11/20).

Politico: Health Official Blames Cancellations On Insurers
The Obama administration’s health exchange chief squarely blamed insurers for the millions of canceled policies that have become a flash point about broken promises under Obamacare. “I believe that the law provided insurance companies an opportunity to have grandfathered plans, which would make the president’s promise true,” Gary Cohen, head of the exchange office, told a Senate panel Wednesday (Norman, 11/20).

The Washington Post: How Obamacare Has Fared In Each State
A lot of ink has been spilled on the troubled rollout of the president’s landmark health-care law, but contextualizing it has been difficult (if not downright confusing). Earlier this week, our graphics department colleague Kennedy Elliott put together an easy-to-read table documenting how Obamacare has fared in each state, so we thought we’d make some charts (Chokshi, 11/21).

USA Today: How Health Care Law Is Playing Out In Three States
In August, USA TODAY reporters chronicled how residents of three states — California, Texas and West Virginia — were preparing for the Oct. 1 debut of the health care program, President Obama's signature legislative achievement. Now, eight weeks into its rocky rollout, that trio of states provides a window into the setbacks and successes of the controversial law (Schmit, Jervis and Toppo, 11/21).

The Washington Post: Insurers Restricting Choice Of Doctors And Hospitals To Keep Costs Down
As Americans have begun shopping for health plans on the insurance exchanges, they are discovering that insurers are restricting their choice of doctors and hospitals in order to keep costs low, and that many of the plans exclude top-rated hospitals. The Obama administration made it a priority to keep down the cost of insurance on the exchanges, the online marketplaces that are central to the Affordable Care Act. But one way that insurers have been able to offer lower rates is by creating networks that are far smaller than what most Americans are accustomed to (Somashekhar and Cha, 11/20).

The Associated Press/Washington Post: Next Worry: Narrow Choice Of Hospitals And Doctors Seen In New Health Overhaul Insurance Plans
After they get the website fixed, then what? Keeping your doctors and hospitals may be the next vexing challenge for Americans in the new health plans created by President Barack Obama’s law. Obama promised people could keep their doctors. But in many states the new plans appear to offer a narrow choice of hospitals and doctors. Overall, it’s shaping up as less choice than what people get through Medicare or employer-based coverage. Also, it can get complicated tracking down which medical providers are in what plans (11/20).

The Associated Press/Washington Post: New Health Plans Sold Through Exchanges Not Accepted At Some Prestigious NYC Hospitals
New Yorkers buying a health plan on the state’s new insurance exchange should read the fine print if they’re interested in getting care at some of the city’s top hospitals. Not all are participating in the new plans created by the Affordable Care Act (11/20).

The New York Times: Applicants Find Health Website Is Improving, But Not Fast Enough
Despite weeks of work by a small army of software experts to salvage HealthCare.gov, navigators in states that depend on the federal insurance exchange say they still cannot get most of their clients through the online enrollment process. Those navigators said they had seen improvements in the system since its disastrous rollout on Oct. 1, particularly in the initial steps of the application process. But the closer people come to signing up for a plan, the more the system seems to freeze or fail, many navigators said (Goodnough, 11/20).

Politico: Kathleen Sebelius Watches Obamacare Website Crash
Late-night TV comics who still need material about the troubled Obamacare website should have kept an eye on what happened to HealthCare.gov when HHS Secretary Kathleen Sebelius talked up the website this week in Florida. It crashed (Levine, 11/20).

Politico: White House Email Chain Reveals Launch Fears
Top White House and health officials feared that HealthCare.gov would not work correctly and would set off a wave of bad publicity, according to emails shortly before the disastrous rollout of the Obamacare enrollment website. The emails, released Wednesday evening by House Oversight Chairman Darrell Issa, included a picture of an error message that has become emblematic of the launch debacle. They were dated Sept. 25 — less than a week before the enrollment portal opened and immediately created a crisis for the White House (Cunningham, 11/21).

NPR: Medicaid Enrollment Is Brisk Despite HealthCare.gov Troubles
Buried in the paltry enrollment numbers for the Affordable Care Act that were released last week was something that came as a surprise to many — the success states are having signing people up for the Medicaid program, which provides health care to low-income people (Rovner, 11/20).

Politico: Scott Walker Treads Own Path On ACA
Walker built his own plan on his rejection of Obamacare’s Medicaid expansion. Instead, he’s taking nearly 80,000 people off the state’s generous Medicaid program and encouraging them to join the Obamacare insurance exchange, where they can get federal subsidies. That would, in turn, make room to extend BadgerCare, as Medicaid is known there, to poorer people. He’s calling it a “creative alternative” and using it to polish his reputation as an outside-the-box innovator (Cheney, 11/20).

The Wall Street Journal: For Small Businesses, A Hidden Tax In Health Care?
Starting next year, small businesses are among those poised to bear the brunt of a little known tax created by the Affordable Care Act that will impose an annual "fee" on health-insurance companies. The fee is expected to bring in a total of $8 billion next year and as much as $14.3 billion by 2018, according to the legislation, and will be spread out among insurers based on the percent of the market they cover. But the Congressional Budget Office and industry experts say the expense will largely be passed on to small businesses and consumers who buy their own policies in the form of higher premiums (Needleman, 11/20).

The Wall Street Journal: Probe Of How U.S. Agency's Medicare Move Reached Investors Hits Wall
Investigators are hitting a wall in an insider-trading probe of how a government funding decision made its way to investors before it was officially released, according to people familiar with the probe. The Securities and Exchange Commission and Federal Bureau of Investigation have been examining whether anyone in government illegally passed along information April 1 about a pending decision on Medicare payments, according to officials involved in the probe (Mullins, Eaglesham and Bartlett, 11/21).

The New York Times: G.O.P. Maps Out Waves Of Attacks Over Health Law
The memo distributed to House Republicans this week was concise and blunt, listing talking points and marching orders: “Because of Obamacare, I Lost My Insurance.” “Obamacare Increases Health Care Costs.” “The Exchanges May Not Be Secure, Putting Personal Information at Risk.” “Continue Collecting Constituent Stories” (Weisman and Stohlberg, 11/20).

Politico: The House GOP's Obamacare Playbook
The House Republican leadership is coordinating an aggressive push to keep Obamacare’s problems front and center both on Capitol Hill and around the country. The House GOP effort includes investigations by at least eight committees, subpoenas for testimony from key administration officials and an initiative by Rep. Darrell Issa, chairman of the House Oversight and Government Reform Committee, to hold hearings around the country to highlight Americans’ problems with the law (Kim and Sherman, 11/20).

The New York Times' The Caucus: In An Attack Ad, An Alaskan Voter Is Really An Actress From Maryland
In a tough new advertisement from the Koch brothers-backed Americans for Prosperity, an unnamed woman looks directly into the camera and upbraids Senator Mark Begich, Democrat of Alaska. …  But there is a slight problem with the commercial. The woman is not from Alaska. She is actually an actress who lives in Maryland. And to some, the elegant kitchen she is standing in, done in French country style with granite countertops, might seem out of place somewhere as rugged and frontierlike as Alaska (Peters, 11/20).

The Wall Street Journal: Hospitals Push Coverage
Many of the city's financially strapped hospitals are scrambling to sign up people for health coverage through New York state's exchange or through Medicaid as they brace for federal cuts to providers of so-called charity care for the uninsured. At Montefiore Medical Center in the Bronx, the staff is posting insurance information on social-networking websites and giving presentations at churches and mosques. At Maimonides Medical Center in Brooklyn, officials have met with the Brooklyn Chamber of Commerce to ensure small businesses know their insurance options. Some hospitals are recruiting patients for coverage plans in emergency-room lobbies (Dawsey, 11/20). 

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