Politico: Obamacare And The Low Expectations Game
The Obama administration is playing the expectations game when it comes to enrollment numbers for Obamacare’s second season. In its first projection Monday, the administration lowballed the number of Americans who it predicts will sign up for the exchanges that form the foundation of the health care law — estimating that 9 million to 9.9 million people would enroll by the end of 2015. (Pradhan, 11/10)

The Wall Street Journal: Health-Law Enrollment in 2015 Won’t Meet Forecast
Millions fewer people will enroll in private health plans under the Affordable Care Act next year than the Congressional Budget Office had predicted, the Obama administration said Monday. The developments are the latest sign that the law, which Democrats passed in 2010 to provide near-universal health insurance, is struggling to reach that goal quickly. Attracting new enrollees to the health law’s insurance exchanges has proven more difficult than advocates had predicted, and a slice of those who do sign up for plans haven’t kept up with premiums. (Radnofsky, 11/10)

The New York Times: Estimate Of Health Coverage Enrollment Leaves Room To Grow
The new estimate appeared to be part of an effort by federal officials to lower public expectations, so the goal would be easier to meet and to surpass. In addition, the new number could indicate that administration officials believe it will be difficult to find and enroll many of the uninsured while retaining those who signed up in the last year. (Pear, 11/10)

Los Angeles Times: Estimates Lowered Of How Many People Will Sign Up For Obamacare In 2015
The Obama administration has substantially scaled back estimates of how many people will sign up for insurance in 2015 through the federal healthcare law, projecting that millions fewer Americans will use marketplaces created by the Affordable Care Act. Instead of 13 million customers in the second year of the marketplaces, as had been predicted, the Department of Health and Human Services now says 9 million to 9.9 million people probably will get coverage by the end of next year. (Levey, 11/10)

The Associated Press: Admin. Dials Back Goal For Health Law Sign-Ups
With sign-up season launching this weekend, officials sharply dialed down expectations Monday for the second year of President Barack Obama’s health insurance law. Health and Human Services Secretary Sylvia M. Burwell said she’s aiming to have 9.1 million paying customers enrolled in 2015 for subsidized private coverage through HealthCare.gov and state insurance markets. ... After a chaotic rollout last year, Obama's signature program faces an even tougher test this time around. The public remains skeptical and Congress is now fully in the hands of Republicans committed to repeal it. (Alonso-Zaldivar, 11/10)

USA Today: Feds Offer Cautious Health Care Enrollment Predictions
HealthCare.gov and state exchanges went live Sunday night for consumers who want to browse and compare plans before open enrollment starts. Once people start buying plans on Saturday, Department of Health & Human Services officials said they are expecting just 9 million to 9.9 million enrollees for 2015, far below the 13 million the CBO projected would have insurance and pay their premiums through the federal and state marketplaces by 2015. CBO's estimates were made before final data on 2014's open enrollment were completed. CBO also projected enrollment in exchanges would reach 25 million by 2017. That was based on CBO's assumption that along with the 13 million people in 2015, there would be 24 million signing up for 2016, and 25 million in 2017. (O'Donnell, 11/10)

McClatchy: Fewer Than 10 Million Expected To Enroll Under Health Law In 2015
Senior administration officials say there’s “mixed evidence” and “considerable uncertainty” about the CBO’s expectation of a large two-year movement away from job-based coverage and individual coverage purchased outside the marketplace. Those uncertainties and the history of slower enrollment growth in programs like Medicaid and the Children’s Health Insurance Program suggest it could take four to five years – until 2019 –for the state and federal marketplaces “ramp up” to 25 million enrollees. (Pugh, 11/10)

NBC News: Administration Lowers Its Obamacare Sights
The federal government expects only about 9 million people to sign up for health insurance on the new online exchanges this year — four million fewer than projected just this spring. (Fox, 11/10)

The Baltimore Sun: Federal Officials Lower Expectations For Exchanges
The Obama administration has substantially cut estimates of the number of people who will sign up for insurance coverage in 2015 through the federal health law, projecting that millions fewer consumers will use marketplaces created by the Affordable Care Act. The Department of Health and Human Services had predicted 13 million people, including Marylanders, would get coverage from the marketplaces through next year. On Monday the agency revised that figure to fewer than 10 million. (Cohn and Levey, 11/10)

Arizona Central-Republic: Outreach Aims To Help Uninsured With Affordable Care Act
A second deadline to apply for health insurance is quickly approaching and anyone that wishes to have coverage kick in by the new year must apply by Dec. 15. (Soules, 11/10)

The Fiscal Times: Obamacare 2015: Low Premium Increases, High Deductibles
Obamacare’s second open enrollment begins this Saturday and consumers can already start window-shopping for health policies sold on the federal exchange, Healthcare.gov. (Ehley, 11/11)

The Associated Press: Health Insurance Enrollment Opens Nov. 15
Reaching the uninsured may prove more difficult the second time around as the second enrollment season under the Affordable Care Act kicks off Saturday. Florida Health officials are feeling the pressure to re-enroll nearly 1 million Floridians plus recruit new enrollees who sat out the first year — all in half the time. The three-month enrollment period begins Nov. 15. (Kennedy, 11/10)

Kaiser Health News: Consumer Guide On Health Law Enrollment: Is The Second Time The Charm?
Haven’t thought about the health care law for a while? Now’s the time. Passed in 2010, the law requires most Americans to have health insurance or pay a fine. While many Americans get health coverage through their employers, starting Nov. 15 consumers who currently have insurance through the federal or state online marketplaces, or exchanges, set up by the law can reenroll. In addition, people who still need health insurance can sign up. Subsidies are available to help many people afford coverage, and some states have expanded their Medicaid programs as part of the law. (Carey, 11/11)

Kaiser Health News: How Employers Are Getting Ready For Open Enrollment
Some large employers will face penalties if they don’t offer workers health insurance in 2015. In addition, workers can expect to see increased cost-sharing and employers pushing them to “private exchanges” to save money. Kaiser Health News' Mary Agnes Carey and Jay Hancock discuss some of the issues you need to know before open enrollment in the health law’s marketplaces begins again on November 15 (11/11).

Kaiser Health News: Pay Close Attention To The Enrollment Calendar To Avoid Penalties
Mind the gap. When the 2015 open enrollment period begins on Nov. 15 for plans sold on the individual market, consumers should act promptly to avoid a gap in coverage. Failing to do so could not only leave you exposed to unexpected medical bills—hello, appendicitis!—but you could also be hit with the penalty for not having health insurance that kicks in if you’re without coverage for three months or more during the year. The coverage requirement applies to most people in group and individual plans unless they qualify for a hardship or other type of exemption. (Andrews, 11/11)

In the background, the Supreme Court's decision to hear a case regarding the overhaul's insurance subsidies continues to reverberate -

NBC News: A Court Case And A New Congress: What's Next For Obamacare?
The newest round of open enrollment under the Affordable Care Act begins in less than a week, just as the law comes under a new threat with the Supreme Court’s decision that it will hear a new challenge questioning its government subsidies. The case raises the stakes for Healthcare.gov too; the last thing the Obama administration needs is a repeat of last year’s embarrassing technical glitches. (Todd, Murray and Dann, 11/10)

The Associated Press: Store, Mobile App Among New Ways To Enroll In Kentucky
Kentuckians looking for discount health insurance can now shop online, on their phones or at the mall. Democratic Gov. Steve Beshear announced Monday that kynect, the state's health insurance marketplace, has a mobile app for Android and Apple phones along with a brick and mortar store opening Thursday at the Fayette Mall in Lexington. It's part of a host of new features state officials are rolling out in advance of the new open enrollment period that begins Saturday and runs through Feb. 15, 2015. (Beam, 11/10)

KIRO Radio: Washington State Offers More Plans, Hopes For Lower Health Insurance Costs
Another open enrollment period begins this Saturday for individual health insurance through the state's marketplace. Local managers are promising more options and the possibility of lower costs, but the Obama administration is lowering expectations about how many Americans will participate. Getting more people to sign up for individual insurance is supposed to reduce health care costs. (Haeck, 11/10)

The Denver Post: Colorado Health Insurance Exchange Budget Rises $4M
Colorado's health insurance marketplace is anticipating a $4 million hike in the cost of keeping its call center functioning. The exchange opened Monday for early shopping with no big technical glitches surfacing in light early volume, although 2015 enrollment doesn't begin officially until Saturday. (Draper, 11/10)

Health News Colorado: ‘Blown-Out Budget’ Infuriates Exchange Board Member
Colorado’s health exchange managers expect to spend $4 million more on their call center than anticipated this year, a revelation that spurred a heated argument among board members on Monday. (Kerwin McCrimmon, 11/10)

Here are some specifics on state rates -

Modern Healthcare: States' 2015 Rate Filings Show Wide Variation In Exchange Premiums
The average monthly premium for exchange plans will vary wildly next year, but overall, rates in several states are expected to increase modestly and are likely to remain affordable for many consumers. In some areas, like Colorado, competition is high, which is forcing a decrease in premium rates. Colorado is expected to have 15 different health insurers offering plans on the exchange in 2015. But in others, which are heavily dominated by a single insurer, rates are going up. For example, in Tennessee, which had only four carriers last year. (Herman, 11/10)

Kansas Health Institute News Service: Kansas Hospitals Pressing Ahead With Medicaid Expansion
Kansas hospitals are moving ahead with plans to put a Medicaid expansion plan before lawmakers despite election results that returned Gov. Sam Brownback to office and solidified conservatives’ control of the Legislature. Democrat Paul Davis favored expansion but came up short in his bid to upset Brownback, a Republican who thus far has opposed expansion. Also, several Democratic House members who likely would have favored expansion lost narrowly to GOP challengers. (McLean, 11/10)

The Miami Herald: Florida Hospitals Could Lose Billions Without Medicaid Expansion, Group Warns
Florida legislators’ refusal to expand the eligibility criteria for Medicaid as called for under the Affordable Care Act might cost billions of dollars in lost funding for hospitals that treat many uninsured patients, according to a report released Monday by Florida Legal Services, a nonprofit legal advocate for the poor. The financial impact would be felt most acutely by so-called “safety net” hospitals statewide, and in Miami-Dade, particularly by the taxpayer-owned Jackson Health System, according to Florida Legal, which estimated that Jackson could lose more than $570 million a year. (Chang, 11/10)

Elsewhere, Tennessee Gov. Bill Haslam is continuing discussions with the Obama administration -

The Associated Press: Haslam Says Federal Medicaid Discussions Ongoing
Gov. Bill Haslam said Monday he's continuing to talk with Washington so he can make a decision about Medicaid expansion in Tennessee before the legislative session starts in January. Haslam told reporters following a veterans' ceremony that he talked to Health and Human Services Secretary Sylvia M. Burwell last week, and even brought up the subject when President Barack Obama called him Tuesday night to congratulate him on his election win. (Johnson, 11/10)

The Tennessean: Mother Pleads For Medicaid Expansion On Behalf Of Dead Daughter
[Michele] Fardan walked up to a microphone in front of the Tennessee Capitol on Monday and told how her daughter delayed getting medical care because she didn’t have insurance and died. ... She spoke at a rally for Medicaid expansion attended by about 60 people, several of them holding up big signs, some with clever rhymes such as “Close the Haslam Chasm.” There also was a book with 47,250 signatures asking Gov. Bill Haslam to take action on the health care coverage gap. (Wilemon, 11/10)

The Baltimore Sun: VA Head Outlines Fix For Troubled Agency
The new head of the Department of Veterans Affairs described the broad outlines Monday of an overhaul of the agency, which has been battered by scandals over lengthy delays setting up doctor's visits and attempts to cover up those backlogs. Advocates for veterans, meanwhile, said they were eager to see details of the plan. (Duncan, 11/10)

CNN: VA Chief Announces Restructuring, Firings
The Secretary of Veterans Affairs announced Monday a massive restructuring of the department in the wake of a scandal that left more than a hundred thousand veterans waiting for health care. VA Secretary Robert McDonald, who took over the agency three months ago after his predecessor Eric Shinseki resigned, said the VA has taken "disciplinary action" against 5,600 employees in the last year, and he said more firings will soon follow. (Devine and Diamond, 11/10)

NBC News: VA Head Details 'Largest' Ever Restructuring at Agency
Veterans Affairs Secretary Robert McDonald announced “the largest restructuring in the department’s history” one day before Veterans Day. At the center of the changes is the ability for veterans to receive care outside of the VA. (Caldwell, 11/10)

Fox News: VA Secretary Pushes Major Overhaul, Firings At Agency
Veterans Affairs Secretary Bob McDonald on Monday announced a complete restructuring in the wake of the scandal over excessive wait times and poor care that critics blamed for patient deaths. The changes come a day after the secretary revealed on CBS' "60 Minutes" his intention to fire or otherwise discipline more than 1,000 workers -- and hire thousands more doctors and health care workers. (11/10)

Fox News: New Push For Military To Renew Focus On Mental Health
From 2004 to 2011, war was the top cause of death among active personnel, but suicide became the top cause of death in both 2012 and 2013, according to the Pentagon’s medical surveillance monthly report. (Snyder, 11/10)

Los Angeles Times: New VA Chief May Fire 1,000 Staffers Over Healthcare Scandal
The U.S. Department of Veterans Affairs announced a series of reforms Monday aimed at improving the agency’s customer service after concerns about substandard healthcare forced a leadership change earlier this year. Three months after taking the helm, Veterans Affairs Secretary Robert McDonald unveiled plans to create a chief customer service officer tasked with overseeing an agency-wide program to streamline the department’s regional centers into a single network. (Hansen, 11/10)

Meanwhile, a trade group representing nurse practitioners is positioning its members to take advantage of thousands of new openings at the agency -

The Hill: Nursing Industry Angles For Windfall Of VA Jobs
The trade group representing nurse practitioners is moving to position its members for a windfall of new jobs expected as part of an overhaul of the Department of Veterans Affairs’s healthcare system. VA Secretary Robert McDonald announced plans in September to hire tens of thousands of new clinicians as part of a plan to restructure the agency, following a scandal involving lengthy wait times at agency-run healthcare facilities that led to the ouster of his predecessor, Eric Shinseki. (Wheeler, 11/10)

WBUR: Judge Appears Skeptical About Partners HealthCare Deal
In a packed courtroom on the 10th floor of Suffolk Superior Courthouse, the question on the docket appeared to be a simple matter: Should a judge in the Business Litigation Division say yes or no to a deal negotiated between Partners HealthCare and Attorney General Martha Coakley? In any standard consent judgment, the judge would default to the attorney general. But again Monday, as she did in September, Judge Janet Sanders made clear she will not say yes, no, or come back with a revised deal until she understands the details and possible consequences. (Bebinger, 11/10)

Boston Globe: Judge, Coakley Tangle Over Partners Deal
A Suffolk Superior Court judge on Monday suggested that Attorney General Martha Coakley’s gubernatorial ambitions may have played a role in the expansion plan negotiated with Partners HealthCare, and said she might consult with the incoming attorney general, Maura Healey, before ruling. The comments from Judge Janet L. Sanders, near the end of a daylong hearing, provoked a tense exchange with Coakley, a Democrat, who just lost a tight election to Charlie Baker, the Republican governor-elect. (McCluskey, 11/10)

The (Charleston, S.C.) Post and Courier: Gov. Nikki Haley Names Insider Christian Soura As New Medicaid Director
During Keck's four-year tenure, the Medicaid program in South Carolina has steadily grown. According to data provided by the agency, the program will cost nearly $7 billion to administer this fiscal year, compared to $5.7 billion in 2012. In August, more than 1.1 million adults and children were enrolled in the Medicaid program, up from about 850,000 people four years ago. ... Keck, who is considered by health care experts around the country as a progressive leader in a red state, streamlined the process for signing children up by culling information from other state agencies so that they may be automatically enrolled. ... Despite these broadly popular initiatives, he may be best remembered for his uncompromising opposition to the new federal health care law. Keck has been adamant that South Carolina should not expand Medicaid eligibility under the Affordable Care Act. (Sausser, 11/10)

The (Columbia, S.C.) State: Aide To S.C. Gov. Haley To Take Over State’s Medicaid Agency
Five days after saying changes were coming to her cabinet and senior staff, Gov. Nikki Haley announced the first shakeup – a change at the agency that oversees the state’s Medicaid program. Health and Human Services director Tony Keck, who helped increase the number of South Carolinians with health insurance while opposing the federal law to expand coverage, is returning to the private sector, Haley said Monday. Christian Soura, the governor’s budget expert, will take over the $7 billion-a-year agency if confirmed by the state Senate. (Shain, 11/10)

The Associated Press: Haley Names New Leader For S.C.'s Medicaid Agency
Gov. Nikki Haley on Monday nominated her former deputy chief of staff to replace the outgoing director of South Carolina's Medicaid agency. Christian Soura will take over from Tony Keck at the state Department of Health and Human Services starting Nov. 20. The Senate still must confirm his appointment. DHHS provides health care coverage to nearly 1.2 million of the state's poor, disabled and elderly residents, about a quarter of the state's population. (Adcox, 11/10)

North Carolina Health News: Wake County Doc Believes He Has A Cure for 'Dysfunctional Medicine'
On a rainy Wednesday morning in the thick of fall allergy season, Brian Forrest disappears into one of the plain yet cheerful exam rooms at Access Healthcare with longtime patient Winston Goodwin. Half an hour later, the primary care physician emerges, heads to his office and types up a detailed treatment plan that includes specific meal suggestions – leafy greens and salmon – and other health tips. All told, Forrest spends around 40 minutes on the patient. Most primary care physicians would go bankrupt if they spent that kind of time on routine visits, yet Forrest said he’s making two to three times the income of his colleagues while seeing only 16 patients a day. All Goodwin pays when he checks out is $64 for the visit, $10 for the flu shot. And even though he has Medicare, neither the patient nor the practice will file a claim. Goodwin can’t afford the monthly charge that Forrest offers his patients in lieu of accepting insurance, instead paying full cost for his visits. Even though he has Medicare, which he uses for hospital visits, Goodwin would rather pay out of pocket. (Ferris, 11/11)

The Associated Press: Former Jindal Health Secretary Pleads Not Guilty In Perjury Case Tied To Medicaid
Gov. Bobby Jindal's former health secretary entered a not guilty plea Monday on charges that he lied when questioned about the award of a now-canceled $200 million Medicaid contract. Bruce Greenstein was indicted on nine counts of perjury, charges tied to his sworn testimony during a state Senate confirmation hearing and to a grand jury reviewing the state's contract with Maryland-based Client Network Services Inc., known as CNSI. (DeSlatte, 11/10)

The Oregonian: State Manager Who Sought No-Bid Contract For Well-Connected Firm Is Moving On
Cathy Kaufmann, the manager who tried to award a $150,000 no-bid contract to the wife of a then-adviser to Gov. John Kitzhaber, is leaving state service for another job. Kaufmann will go to work for Families USA, an influential liberal health care advocacy group, as enrollment program director. Previously, she headed the Oregon Health Authority's Transformation Center, a federally funded $45-million project to foster innovations in reforms to the Medicaid-funded Oregon Health Plan. (Budnick, 11/10)

The Associated Press: Ohio Gov. Kasich Appoints New Medical Director
The Ohio Department of Health on Monday got a new medical director, a former state epidemiologist who was in charge of the state's response to the Ebola crisis. Dr. Mary DiOrio was appointed by Republican Gov. John Kasich. DiOrio has been with the agency for 13 years and will make $150,000 annually. She'll work under state Health Director Rich Hodges, whose appointment to the post by Kasich had been criticized because he is not a physician. (11/10)

California Healthline: Fragile, Rural Population About To Be Moved Into Medi-Cal Managed Care
Next month, state health officials will launch a transition of rural Medi-Cal beneficiaries into Medi-Cal managed care health plans. Medi-Cal is California's Medicaid program. The transition involves about 20,000 of the most frail and elderly segment of the rural Medi-Cal population -- seniors and persons with disabilities, known as SPDs. (Gorn, 11/10)

The Washington Post: Why Obamacare Risks Falling Into A ‘Death Spiral’
When the Supreme Court on Friday announced that it would take up another challenge to the Affordable Care Act in March, it delivered the threat of two mortal blows to the signature achievement of the Obama presidency. ... even if the justices make no such ruling, the very act of taking up the challenge to the law will itself undermine the law. The justices announced their decision just a week before the open-enrollment period for 2015 begins — and the looming possibility that the high court will strike down the law will probably deter those who are considering signing up for its coverage. (Dana Milbank, 11/10)

Los Angeles Times: The Congressional Deal That Could Save Obamacare
The received wisdom about the fate of the Affordable Care Act is that it's in the Supreme Court's hands .... But it's worth emphasizing a point I raised in a post earlier Monday: A great opportunity exists for a congressional deal to make the court action moot (whichever way it leans). This involves offering the GOP majority in Congress two of its key objectives on the ACA, in return for fixing the drafting glitch the Supreme Court is preparing to scrutinize. These two objectives are killing the medical device tax and eliminating the employer mandate. (Michael Hiltzik, 11/10)

The New York Times' The Upshot: G.O.P. Faces Tougher Job Finding Democrats To Repeal Health Law
The “Democrats Against Obamacare” caucus in the House of Representatives has been decimated through retirements and election defeats. But Republicans seeking a bipartisan veneer for their efforts to dismantle the health care law could ally with a few lawmakers. Of the 10 House Democrats who have joined Republicans most often in attempts to defund, repeal or change the Affordable Care Act, just two will stay on in the 114th Congress forming in January. (Derek Willis, 11/10)

Los Angeles Times: Will The Supreme Court Move America Closer To Two-Class Healthcare?
The chart at the top of this post identifies the black hole of American healthcare: The highest death rates are in a swath of states across the Deep South. Within a rough range, these rates match more specific metrics of health generated by the Department of Health and Human Services, such as the prevalence of strokes, obesity and hypertension. As a proxy for the efforts of state governments to improve the health status of their residents, the death rates tell a dismal story. In general terms these are the states with some of the highest ratios of medically uninsured residents and the greatest resistance by elected officials to take advantage of the Affordable Care Act by expanding Medicare and creating their own insurance exchanges. (Michael Hiltzik, 11/10)

The Wall Street Journal: ObamaCare Squatter’s Rights
The King case, and several others like it, raises a question of considerable national importance. The outcome could be disruptive, and a delay would make it more so. What’s more, there have been extraordinary political machinations by the administration, Senate Democrats and even lower-court judges, the manifest aim of which was to dissuade the justices from taking up the case. We don’t know if that last factor influenced the justices’ decision, but to our mind it is a very good reason to take the case. (James Taranto, 11/10)

Bloomberg: Repeal Obamacare? Yes, One Part Of It
Outright repeal would be about as pointless and foolish as it was the last few dozen times (but really, who's counting?) the Republicans tried it. Better instead to repeal the one part of the Affordable Care Act that both parties see as problematic: the employer mandate. (11/10)

Forbes: Republican Wave Put Obamacare In Surgery, And These Parts Could Be Amputated
Conventional wisdom is that President Obama would veto legislation that made any fundamental changes to his signature bill. But even the Act’s enthusiasts concede, that there are parts of Obamacare that are disliked, gratuitous, or simply unfeasible. The question is whether there’s enough common ground to make meaningful excisions to the original law, and secure White House support. There may be more changes in store than Washington’s conventional wisdom now portends. (Scott Gottlieb, 11/10)

The New York Times: Where Hell Is Other Patients
In the public imagination, forensic mental hospitals — where states place the criminally insane — are hellish scenes of cages and restraints, the better to keep us safe from the Hannibal Lecters of the world. And it’s true that these hospitals, including the one where I work, are hellish. But not because the patients are restrained. In fact, it’s the opposite. Patients, even violent ones, are often given a shocking amount of freedom. As a consequence, every day, across the country, these hospitals record dozens of assaults by patients against staff members and other patients — a situation that, thanks to expanded patients’ rights laws and state health bureaucracies, we can do almost nothing about. (Stephen Seager, 11/10)

Los Angeles Times: Who Will Pay To Stop Ebola?
Now that the American public has had a chance to see that the very few cases of Ebola in this country have little chance of leading to a dangerous outbreak, it's time to return our attention to the three West African nations where the virus is a daily and deadly threat. (11/10)