First Edition: October 7, 2013

Today's headlines include reports detailing the ins and outs of the federal government's online health insurance markeplace as well as the latest from Capitol Hill on the shutdown.

Kaiser Health News: A Reader Asks: If I Don't Have Insurance, How Can I Pay For A Colonoscopy?
Kaiser Health News consumer columnist answers a reader's question about paying for this procedure (10/7). Read the answer.

Kaiser Health News: Marketplace Plans Vary Widely In Costs, Within Counties And Across The Country
Kaiser Health News staff writers Jordan Rau and Julie Appleby report: "Consumers shopping in the new health insurance marketplaces will face a bewildering array of competing plans in some counties and sparse options in other places, with people in some areas of the country having to pay much more for the identical level of coverage than consumers elsewhere" (Rau and Appleby, 10/4). Read the story.

Kaiser Health News: Capsules: Federal Insurance Marketplace Can't Yet 'Talk' To State Medicaid Agencies
Now on Kaiser Health News' blog, Phil Galewitz reports: "The health law's online insurance exchanges were supposed to be a one-stop shop where consumers browsing for coverage could enroll in a private health plan or in Medicaid if they qualified" (Galewitz, 10/4). Check out what else is on the blog.

The Wall Street Journal: Software, Design Defects Cripple Health-Care Website
Six days into the launch of insurance marketplaces created by the new health-care law, the federal government acknowledged for the first time Sunday it needed to fix design and software problems that have kept customers from applying online for coverage. The Obama administration said last week that an unanticipated surge of Web traffic caused most of the problems and was a sign of high demand by people seeking to buy coverage under the new law. But federal officials said Sunday the online marketplace needed design changes, as well as more server capacity to improve efficiency on the federally run exchange that serves 36 states (Weaver, Ovide and Radnofsky, 10/6).

NPR: Glitches Slow Health Exchange Sign-ups
The launch of Georgia's health care exchange began with a great deal of optimism at the East Point Pubic Library, just south of Atlanta. The chair of the Fulton County Commission, John Eaves, stressed that despite the federal government's shutdown, the exchanges would be open. ... About 22 million Americans are uninsured and eligible for the exchanges. More than 1.8 million live in Georgia and it's that group that federal officials and new health care navigators want to reach. Navigators are the hands-on experts who were supposed to walk people through the system (Lohr, 10/5).

Los Angeles Times: Flood Of Consumer Inquiries Could Make – Or Break – Obama Health Law
Kentucky health officials thought they might get a handful of serious shoppers when they flipped the switch Tuesday on Kynect, the new online insurance marketplace the state created under President Obama's healthcare law. … By the end the week, more than 16,000 Kentucky individuals and families had begun online applications to get health coverage next year. It has been a similar story across the country. Since the new marketplaces opened Tuesday, millions of Americans have flooded websites, call centers and insurance offices seeking information about health coverage offered through the Affordable Care Act, also known as Obamacare (Levey and Terhune, 10/5).

The Associated Press/Washington Post: Health Care Website Gets Some Down Time Weekend to Fix Problems That Aggravated Consumers
It's not the sign that the Obama administration wants people to see on its health overhaul website: down for repairs. Using overnight hours this weekend to debug the system, the Health and Human Service Department hoped to fix the technological problems that overwhelmed the launch of new health insurance markets. Glitches have frustrated millions of consumers unable to complete their applications (10/5).

USA Today: Obama Adviser: Demand Overwhelmed HealthCare.gov
The government website launched this week to sell health insurance was overwhelmed by up to five times as many users as it was designed to handle, President Obama's top technology adviser said Saturday in an exclusive interview with USA TODAY.U.S. Chief Technology Officer Todd Park said the government expected HealthCare.gov to draw 50,000 to 60,000 simultaneous users, but instead it has drawn as many as 250,000 at a time since it launched Oct. 1. Park's comments are the administration's most detailed explanation for the glitches that have frustrated millions of consumers who have tried to enter the site or complete applications for health insurance under the Affordable Care Act. "These bugs were functions of volume,'' Park said. "Take away the volume and it works"  (Mullaney, 10/6).

Politico: Lew Says Obamacare Website Issues 'Not Uniques'
Treasury Secretary Jack Lew said on Sunday he didn't have an exact number of people who signed up for Obamacare and dodged questions about the issues with the signup website. "What happened this week is we saw 7 million people rush to go on to the webpage to find out, what are their choices in this new marketplace to buy affordable health care?," he said on "Fox News Sunday." "You know, they have six months to sign up.  This is a big decision" (Parti, 10/6).

Politico: Obamacare Glitches Give Paper Applications New Life
Obamacare is supposed to be a 21st-century shopping experience, but the health law can't escape living in an older paper world. One of President Barack Obama's favorite claims about his health law is that finding coverage is as easy as going online to buy a plane ticket. That's always been an overstatement, even before the online insurance marketplaces' glitch-filled launch (Millman, 10/7).

The Washington Post: Maryland's Health Insurance Web Site Stumbles Badly In First Days
Barely 24 hours after President Obama signed his landmark health law, Gov. Martin O'Malley promised that Maryland would "lead the nation" in putting it in place. In the three years since, Maryland has been at the forefront of implementing the Affordable Care Act. It established six policy work groups. It trained more than 5,000 people to help consumers enroll in new health-coverage options. When its online insurance exchange passed a critical test in the summer -; one of the first in the country to do so -; a top official gave an emotional speech thanking workers. If any state was going to be ready for Oct. 1, when millions of uninsured Americans would be able to start buying coverage under the health law, it would be Maryland (Sun, 10/4).

The Associated Press/Washington Post: 4 Tips For Buying Health Insurance Without Help From The Overhaul's Income-Based Subsidies
The health care overhaul is expected to help millions of uninsured obtain coverage, but that assistance has limits. Individuals who do not have the option to obtain insurance from their employer, and who make more than about $46,000 -; or a family of four bringing in more than $94,200 -; will not be eligible for income-based tax credits under the new health care law (10/4).

Politico: Obamacare Showdown In Texas
The ground war over Obamacare -; the one that will determine whether people sign up -; will be won and lost in places like Texas. If Obamacare fails in the Lone Star State -; that is, if a significant portion of the 6.1 million uninsured Texans don't or can't enroll -; then the White House could miss its national enrollment targets, the new health insurance exchanges could falter and insurance rates could spike (Haberkorn, 10/7).

Politico: Lower Premiums In Co-Op States
States with new member-owned CO-OP health plans as part of Obamacare have premiums that are more than 8 percent lower than states that don't, a new study shows. The Consumer Operated and Oriented Plans, with startup money loaned by the health care law, have zero or very few customers yet, given all the problems with the sign-up system. But they are going toe-to-toe with traditional insurers on the exchanges in 22 states, introducing new competition to insurance markets. And there's some early evidence that they may be helping to lower costs (Norman, 10/7).

The Wall Street Journal: Obamacare Aims To Close Medicare 'Doughnut Hole'
There's a Medicare prescription-drug coverage abyss that is playfully referred to as the "doughnut hole," though there is nothing sweet or amusing about it. But thanks to the Affordable Care Act, which had a rocky launch last week, Medicare beneficiaries will see that gap shrink again in 2014 and in each year until 2020, according to Medicare.gov. The doughnut hole is the temporary limit on what Medicare drug plans pay after certain dollar thresholds for drugs have been met (Waters, 10/6).

The Wall Street Journal: How Obamacare Benefits Older Workers
For those 65 years or older and on Medicare, the health-care reform law doesn't require doing anything different. It will lead to slightly expanded coverage, but won't dramatically change the landscape. It's a different story for those in the years approaching retirement who don't already have health insurance. For that group, the ACA could provide an opportunity to get more-affordable insurance than in the past and make it possible to get coverage for those who might otherwise be denied insurance or find it too costly. And it's a particular plus for those considering early retirement, but who would otherwise need to hold on to a job just to keep their insurance  (Lauricella, 10/6).

USA Today: Health Law Changes Everyone's Open Enrollment
The Affordable Care Act, which led to the creation of state and federally run health insurance exchanges that launched last week, is generally thought of as being for the uninsured. But that's not entirely true. It could help the Callaways, too. The law offers many new protections for anyone who has employer-provided health insurance. It could even help some people with hard-to-afford plans and/or plans that don't cover enough of their health costs (O'Donnell, 10/6).

The Associated Press/NBC: Obama Tells Americans Not To 'Give Up' On Problem-Plagued Health Care Program
Defending the shaky rollout of his health care law, President Barack Obama said frustrated Americans "definitely shouldn't give up" on the problem-plagued program now at the heart of his dispute with Republicans over reopening the federal government. Obama said public interest far exceeded the government's expectations, causing technology glitches that thwarted millions of Americans when trying to use government-run health care websites. "Folks are working around the clock and have been systematically reducing the wait times," he said. The federal gateway website was taken down for repairs over the weekend, again hindering people from signing up for insurance (Pace, 10/4).

Politico: Obama Doesn't Know Number Of People Who've Gotten Insurance Through Exchanges
There's been skepticism from Republicans and the press about whether the White House really doesn't know how many people have enrolled this week. Obama said that early interest in the exchanges far exceeded the government's expectations for the first few days, but "folks are working around the clock and have been systematically reducing the wait times." HealthCare.gov is down for the weekend to give the administration uninterrupted time to improve the site. Ultimately, Obama said, the outlook for the exchanges is good. By the time signups end in March, "we are going to probably exceed what anybody expected in terms of the amount of interest that people had (Epstein, 10/5).

The New York Times: Boehner Hews To Hard Line In Demanding Concessions From Obama
Speaker John A. Boehner stood his ground on Sunday alongside the most conservative Republicans in Congress, insisting that the House would not vote to finance and reopen the government or raise the nation's borrowing limit without concessions from President Obama on the health care law. … With his hard line, Mr. Boehner reaffirmed that the stalemate with the White House over the six-day-old government shutdown was now compounded by an even more economically risky fight over raising the government's borrowing limit by Oct. 17 to pay for bills already incurred (Calmes and Peters, 10/6).

The Washington Post: Boehner, White House Harden Stances As Shutdown Continues, Potential Default Nears
As Boehner hardened his stance, the White House did the same, dispatching Treasury Secretary Jack Lew to appear on four of the six major Sunday talk shows. Repeatedly, Lew said Obama is willing to enter negotiations to address the nation's long-term budget problems but not until Republicans drop their campaign against Obama's health-care initiative, end the government shutdown and lift the $16.7 trillion debt limit (Montgomery, 10/6).

The Wall Street Journal: Boehner Ties Del To Talks On Debt
The fight to this point has centered on Republican demands to delay or dismantle parts of the 2010 health-care law in exchange for funding the government. Now, by pairing the standoffs over funding the government and raising the debt ceiling, the speaker is trying to force President Barack Obama and Senate Majority Leader Harry Reid (D., Nev.) to agree to GOP priorities on deficits and federal spending in return for movement on both. The two Democrats have repeatedly rejected GOP attempts to use the mid-October deadline to increase the debt limit as a bargaining chip. White House officials responded to Mr. Boehner's comments in a series of Twitter messages. Deputy press secretary Josh Earnest said Republicans "don't have to give up anything. Just pay nation's bills on time, no strings attached." Mr. Reid challenged Mr. Boehner's view that he lacks the votes to pass a government-funding bill without Republican priorities (O'Connor and Nicholas, 10/6).

The New York Times: A Federal Budget Crisis Months In The Planning
Shortly after President Obama started his second term, a loose-knit coalition of conservative activists led by former Attorney General Edwin Meese III gathered in the capital to plot strategy. ... Out of that session, held one morning in a location the members insist on keeping secret, came a little-noticed "blueprint to defunding Obamacare." ... The groups have also sought to pressure vulnerable Republican members of Congress with scorecards keeping track of their health care votes; have burned faux "Obamacare cards" on college campuses; and have distributed scripts for phone calls to Congressional offices (Stolberg and McIntire, 10/5).

The New York Times: Conservative Georgia District Urges G.O.P. to Keep Up The Fight
Just down the road from where Union troops suffered their worst defeat of the Civil War, Jeff Epperson sang the praises of his congressman, Representative Tom Graves, whose Defund Obamacare Act set the table for the partial government shutdown. ... The Republican insistence in the House on tying financing of the federal government to dismantling the Affordable Care Act is being driven by a deeply conservative caucus from places like Mr. Graves's 14th Congressional District, newly created by Georgia's Republican-controlled Legislature.  Voters here viewed the Washington stalemate just as Mr. Graves and many of his party members in Congress portray it: a tale of Republicans who have repeatedly shown a willingness to compromise, while Democrats petulantly refuse to meet halfway (Gabriel, 10/5). 

Los Angeles Times: Government Shutdown: Doctors Urged To Tell Congress Their Views On ACA
As the political standoff over the Affordable Care Act keeps the federal government shut down for a fourth day, the editors of the New England Journal of Medicine are urging the nation's physicians to "lead by example" and "make your views known to your representatives in Congress." In an editorial published online Friday, Drs. Jeffrey M. Drazen and Gregory D. Curfman write that the journal – the oldest and arguably most prestigious medical publication in the country – has no official stance on the merits of the law that has come to be known as Obamacare. But as physicians who treat patients in Massachusetts, they write that their personal experience with a similar law has been overwhelmingly positive (Kaplan, 10/4).

The Washington Post: Cuccinelli, Cruz Address Conservatives In Richmond
Democrats have pounded Cuccinelli all week over his plans to appear at a Family Foundation dinner headlined by Cruz, widely considered the architect of the shutdown as a means of defunding the Affordable Care Act. Cuccinelli has said repeatedly that he disagrees with the tactic despite his fierce opposition the federal health-care law known informally as Obamacare. The impasse in Washington has forced Cuccinelli to walk a fine line: between his longtime tea party supporters, who regard Cruz as a hero, and independent voters in a state with a large federal workforce, who tend to take a dim view of Obamacare but an even dimmer one of the shutdown (Vozzella, 10/6).

The Washington Post: Pharmaceutical Firms Paid To Attend Meeting Of Panel That Advises FDA
A scientific panel that shaped the federal government's policy for testing the safety and effectiveness of painkillers was funded by major pharmaceutical companies that paid hundreds of thousands of dollars for the chance to affect the thinking of the Food and Drug Administration, according to hundreds of e-mails obtained by a public records request. The e-mails show that the companies paid as much as $25,000 to attend any given meeting of the panel, which had been set up by two academics to provide advice to the FDA on how to weigh the evidence from clinical trials. A leading FDA official later called the group "an essential collaborative effort" (Whoriskey, 10/6).

The Washington Post: Political Gridlock Puts Supreme Court At Center Of Controversial Social Issues
The court will again examine the use of race in university admissions and will almost certainly revisit the health-care law, called the Affordable Care Act, this time to rule on its requirement that insurance plans offered by private employers cover contraceptives. The court majority that decided the landmark Citizens United campaign finance case will also have a new opportunity to further loosen the restrictions on funding political campaigns (Barnes, 10/6).

Los Angeles Times: In New Term, Supreme Court May Steer To Right On Key Social Issues
The Supreme Court term that opens Monday gives the court's conservative bloc a clear opportunity to shift the law to the right on touchstone social issues such as abortion, contraception and religion, as well as the political controversy over campaign funding. … The justices are being asked to hear cases from Oklahoma in which they could uphold limits on the use of the abortion pill and require pregnant women seeking abortions to undergo ultrasound tests to see the fetus. And last month, Arizona's attorneys asked the court to uphold the state's ban on abortions after 20 weeks of pregnancy, a measure that was blocked on the basis of Roe vs. Wade. By next spring, the justices are likely to revisit part of President Obama's healthcare law to decide a religious-rights challenge to the requirement that large private employers provide their workers with coverage for contraceptives. Dozens of employers who run for-profit companies have sued, contending that providing health insurance that includes a full range of contraceptives violates their religious beliefs (Savage, 10/6).

The New York Times: Abortion Vote Exposes Rift At A Catholic University
Trustees of the Jesuit university will decide on Monday whether to remove coverage for elective abortions from the faculty and staff health care plans. The coming vote has exposed a deep rift over just how Catholic a Catholic university should be in the 21st century -; and how to maintain that distinctive Catholic identity amid growing diversity on campus (Lovett, 10/6).

The Washington Post: Arlington-Based Evolent Adds $100 M In Venture Capital As It Looks To Revolutionize Health Care Industry
Arlington-based Evolent Health got off the ground more than two years ago as the battle over health care reform raged on Capitol Hill and beyond. As the shutdown of the federal government last week illustrates, that debate is far from settled. But to chief executive Frank Williams and Evolent's other co-founders, it was clear then that the way hospitals deliver and get paid for care was changing, regardless of the political wrangling (Overly, 10/6).