First Edition: December 11, 2013

Today's headlines include the latest on how the health law's implementation is impacting President Barack Obama's public approval ratings.

Kaiser Health News: Obamacare Benefits Elusive For Many Working Poor In Northern Florida
Reporting for Kaiser Health News, in partnership with NPR, Eric Whitney writes: "Getting people to sign up for health insurance under Obamacare is an uphill battle in much of Florida. Politicians have put up roadblocks to the law from the beginning - from joining in the lawsuit to thwart it in 2011 to placing restrictions on what health care navigators can discuss with those they advise. That means many don't know what the law might offer them" (Whitney, 12/10). Read the story.

Kaiser Health News: Capsules: Iowa To Expand Medicaid After Feds OK Money For Private Plans; People With Medicare Have Good Access To Doctors, Study Finds
Now on Kaiser Health News' blog, Julie Appleby reports on Iowa's plan to expand Medicaid: "The Obama administration Tuesday granted Iowa much of what it requested to move forward with a Medicaid expansion through the use of private insurance plans but refused to allow the state to charge premiums for those who earn less than the federal poverty level. If the state accepts the terms of the agreement, it would become the second to be allowed to use federal dollars to finance the purchase of private health insurance for the newly Medicaid eligible. Arkansas was earlier granted that permission by the Centers for Medicare & Medicaid Services" (Appleby, 12/10). 

Also on the blog, Mary Agnes Carey reports on issues related to Medicare beneficiaries and their access to care: "As key congressional committees consider legislation to repeal Medicare’s physician payment formula, a new study shows that the program’s beneficiaries have generally good access to doctors. The report, prepared by the Kaiser Family Foundation, found that 96 percent of beneficiaries report having access to a doctor’s office or clinic, and about 90 percent of beneficiaries say they can schedule timely appointments for routine and specialty care" (Carey, 12/10). Check out what else is new on the blog.

The New York Times: Obama Sees A Rebound In His Approval Ratings
President Obama’s approval ratings, which hit his all-time low last month, have returned to where they were before the rollout of the health care law’s enrollment process, but Americans still lack confidence in the White House’s management of the Affordable Care Act, according to the latest New York Times/CBS News poll. The public’s opinion of the law itself has improved after repairs to the enrollment website (Stolberg and Kopicki, 12/10).

USA Today: Poll: Can The Economy Rescue Obama From 'Obamacare'
The fate of President Obama's second term is emerging as a battle between improving news about the economy and souring views of his signature health care law. A year-end USA TODAY/Pew Research Center Poll chronicles what a drag the Affordable Care Act has become on Obama's reputation, helping to drive down his standing as a trustworthy leader and one who can get things done to the lowest levels of his presidency. Disapproval of the health care law hits a new high (Page,12/10).

Los Angeles Times: Obama's Approval Ratings Stabilize In Latest Poll
President Obama can’t yet claim to have turned a corner, but he does seem to have stopped a politically damaging slide in public approval for himself and his new healthcare law, new polling data indicate. After seven months of steady decline, public approval of Obama’s job performance has ticked upward, according to a new Pew Research Center survey. The poll finds 45% of Americans approve of Obama’s work and 49% disapprove (Lauter, 12/10).

The Wall Street Journal: Poll: Health Law Hurts President Politically
The federal health-care law is becoming a heavier political burden for President Barack Obama and his party, despite increased confidence in the economy and the public's own generally upbeat sense of well-being, a new Wall Street Journal/NBC News poll suggests. Disapproval of Mr. Obama's job performance hit an all-time high in the poll, at 54%, amid the flawed rollout of the health law. Half of those polled now consider the law a bad idea, also a record high (King Jr., 12/11).

The Washington Post’s The Fix: The Worse May Be Behind Obama. But It Cost Him Dearly.
After weeks filled with nothing but bad news for President Obama, there have been some reasons for optimism in recent days. But even if Obama has moved past the lowest low of his presidency, there is no way around the reality that his image has been badly damaged since he triumphed at the polls last fall. The latest bit of good news for Obama came in a pair of new polls released Tuesday. A Pew Research Center-USA Today poll shows a slight uptick in his job approval rating, from 41 percent last month to 45 percent, which was about where he stood before the troubled health-care rollout. A separate New York Times/CBS News poll shows Obama’s approval rating has jumped from 37 percent last month to 42 percent (Sullivan, 12/11).

Politico: 7 Million Obamacare Customers? 
Health and Human Services Secretary Kathleen Sebelius once described 7 million new Obamacare customers in the first year as what "success looks like." The White House is now trying to affix another label to the estimate: meaningless. It might be too late. For months, the Obama administration embraced the projection by the nonpartisan Congressional Budget Office as a way to explain enrollment goals, boosting their political significance. But the broken HealthCare.gov website caused the program to lag far behind on signing up customers, and it’s a steep climb to register 7 million people by the March deadline (Budoff Brown and Millman, 12/11).

The New York Times: 100,000 Have Signed Up On New York Health Exchange, Officials Say
More than 100,000 people have signed up for coverage through New York State’s health exchange, with two-thirds of them in private plans, significant developments as the state tries to capture a large pool of uninsured residents, state officials said Tuesday. As of Monday, about 69,500 people had selected a private insurance plan through the exchange, in addition to 31,400 who have signed up for Medicaid, the government insurance for the poor, the state health department said. In mid-November, the Medicaid to private insurance ratio was about 50-50, but began tipping toward the private side after that (Hartocollis, 12/10).

The Associated Press/Washington Post:: Brown Says Md. Health Exchange Still Evolving
Under fire from political rivals in Maryland’s governor’s race, Lt. Gov. Anthony Brown pledged Tuesday to remain focused on fixing the state’s bedeviled health care exchange and conduct a full assessment later on why its website has been troubled with computer problems. Brown, who is running for governor, took the lead on implementing health care reform in Maryland. Now, as the state’s health care exchange remains challenged more than two months after its launch, Brown is faced with questions about whether the exchange is a lemon (12/10).

Politico: Michigan May Join States Banning Abortion In Obamacare Plans
Nearly half the states are banning abortion coverage in the new health insurance exchanges almost four years after battles over the issue nearly derailed passage of the Affordable Care Act. Michigan could become the 24th state to ban most abortions in exchange plans this week, after an unusual citizens’ petition drive that allows state lawmakers to resurrect a bill the governor had vetoed and vote it into law without his signature (Cunningham, 12/11). 

USA Today: SHOP For Health Care Is Help For Small Business
SHOP marketplaces are operating online in most of the states running their own small business marketplaces. That includes 10 states and the District of Columbia planning to run their own marketplaces for individual care, and two other states creating their own SHOP marketplace but using the federal government's HealthCare.gov site for the individual market. The other states under the federal system are a different story: Though businesses can still buy SHOP plans, they aren't available online and lack some of the major features for which they were originally intended (McGinnis, 12/11).

The Wall Street Journal: Group Says Plans Discourage HIV Patients
A coalition of 31 HIV/AIDS organizations is urging the Obama administration to investigate whether some health insurers are trying to discourage HIV-infected patients from enrolling in new policies being sold under the health-care law, a move the groups say could be illegal. The Affordable Care Act prohibits discrimination against people who are sick; insurers can't deny them coverage or charge them more than healthier peers (Beck, 12/10).

The Washington Post: House, Senate Negotiators Reach Budget Deal
House and Senate negotiators unveiled an $85 billion agreement late Tuesday to fund federal agencies through the fall of 2015, averting another government shutdown and ending the cycle of crisis that has paralyzed Washington for much of the past three years. … On top of sequester replacement, the deal calls for an additional $22 billion in deficit reduction by extending a small part of the sequester into 2022 and 2023. That shift would primarily affect Medicare providers, who would face an additional two years of 2 percent across-the-board cuts (Montgomery, 12/10).

The New York Times: Capitol Leaders Agree To A Deal On The Budget
The deal, while modest in scope, amounts to a cease-fire in the budget wars that have debilitated Washington since 2011 and gives lawmakers breathing room to try to address the real drivers of federal spending — health care and entitlement programs like Medicare and Social Security — and to reshape the tax code (Weisman, 12/10). 

The Wall Street Journal: Deal Brings Stability To U.S. Budget
The plan is modest in scope, compared with past budget deals and to once-grand ambitions in Congress to craft a "grand bargain" to restructure the tax code and federal entitlement programs. But in a year and an institution characterized by gridlock and partisanship, lawmakers were relieved they could reach even a minimal agreement (Hook, 12/10).

The Associated Press/Washington Post: GOP, Obama Line Up Behind Modest Budget Deal
The measure unveiled by House Budget Committee Chairman Paul Ryan, R-Wis., and his Senate counterpart, Patty Murray, D-Wash., blends $85 billion in spending cuts and revenue from new and extended fees — but no taxes or cuts to Medicare beneficiaries — to replace $63 billion in cuts to agency budgets over the coming two years (12/11).

USA Today: Leaders In Congress Unveil Two-Year Budget Deal
If approved, the agreement would put the congressional budget process back on track, allowing for passage of the 12 annual bills that cover federal spending other than mandatory programs such as Social Security and Medicare (Davis, 12/10).

The Associated Press/Washington Post: Bipartisan Fix Advancing For Medicare Doctors' Pay
It’s that time of year again: doctors caring for Medicare patients once more face a steep pay cut. But this time Congress is pursuing a permanent fix to the annual drama that has undermined the medical profession’s confidence in the nation’s premier health program. A fundamental change in the budget equation has handed lawmakers a rare opportunity to repeal Medicare’s broken physician payment policy, while also freeing them from having to waive billions of dollars in impending cuts every year. Slowing health care inflation has slashed the cost of repealing the old formula, bringing it down to $116.5 billion over 10 years, according to the latest estimates (12/10).

Politico: John Podesta Hire Signals A More Aggressive White House
In tapping Podesta for a one-year tour, Obama is layering in a well-respected former White House chief of staff while keeping the incumbent, Denis McDonough. At the same time, Phil Schiliro, who served as Obama’s top lobbyist on Capitol Hill in the first two years of the administration, is coming back for what is supposed to be a short stint at the White House, serving as the point person on coordinating the implementation of Obamacare (Allen and Budoff Brown, 12/10).

Politico: Kathleen Sebelius Back To The Hill For More Drubbings
Kathleen Sebelius isn’t going anywhere — but the White House isn’t exactly pulling out all the stops to defend her work. That’s the reality of Sebelius’s uncomfortable status as she returns to the Hill on Wednesday to catch more arrows over Obamacare. The Health and Human Services secretary seems to have largely escaped the early GOP calls for her resignation over the website fiasco, and by most accounts she still has a good personal relationship with President Barack Obama (Nather, 12/11).

The Washington Post: IRS Nominee On Track For Approval Despite Acrimony
President Barack Obama’s choice to head the Internal Revenue Service told senators Tuesday he will work to restore public trust in the agency in the wake of the tea party scandal even as the IRS takes on new responsibilities administering the president’s health care law. At the same time, John Koskinen warned that budget cuts are threatening the agency’s ability to collect revenue effectively and enforce the nation’s tax laws (12/10).

The Washington Post's Fact Checker: Harry Reid's Explanation For Why Not All Of His Staff Is Going On 'Obamacare'
If there is anything that illustrates the complexity of the Affordable Care Act, aka Obamacare, it’s the tiny section concerning members of Congress and their staff. The Fact Checker has spent some time digging into this issue, and it’s headache-inducing. The law requires members of Congress and at least some of their staff to leave the Federal Employees Health Benefit Program and join the health-care exchanges. That was easier said than done, in large part because congressional employees previously had received a stipend to help pay for premiums, whereas they generally make too much to qualify for subsidies in the exchanges. So a system has be gerry-rigged, using the DC small-business exchange (SHOP), to allow for continued health-care stipends from the federal government. See, it is headache-inducing (Kessler, 12/11). 

Los Angeles Times: Kaiser Permanente Reports Privacy Breach to 49,000 Patients
Healthcare giant Kaiser Permanente has notified about 49,000 patients of a privacy breach at its Anaheim Medical Center. Kaiser said a computer flash drive was reported missing Sept. 25 inside the hospital's nuclear medicine department. The storage drive included patient names, date of birth, their medical record number and the type and amount of a specific medication (Terhune, 12/10). 

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