First Edition: November 11, 2013

Today's headlines include reports about how Republicans are positioning themselves to capitalize on the health law's implementation difficulties in the upcoming election season. 

Kaiser Health News: FAQ: How Does The Health Law Impact Federal Employees' Health Benefits
Kaiser Health News staff writer Mary Agnes Carey reports: "Open enrollment season begins Monday for the approximately eight million federal workers and their dependents who receive health care coverage through the Federal Employees Health Benefits Program or FEHB. The 2010 health law calls for some changes in that coverage. Below are some frequently asked questions and answers about how the measure will impact federal workers' health insurance" (Carey, 11/11). Read the story.

Kaiser Health News: Health On The Hill: Detailing Long-Awaited Mental Health Parity Law Regulations
Kaiser Health News' Mary Agnes Carey and CQ HealthBeat's Rebecca Adams discuss the final rules released Friday by the Obama administration for the 1996 and 2008 laws that expanded the kinds of mental health and substance abuse care insurers must cover (11/9). Listen to the audio or read the transcript.

Kaiser Health News: How Much Is That X-Ray? Still Hard To Say, Even In Massachusetts
WBUR's Martha Bebinger, working partnership with Kaiser Health News and NPR, reports: "Finding out how much an X-ray costs sounds like a simple question. But it is actually very difficult to get an answer. In Massachusetts, a new state law requires insurers to be able to tell members how much a test, treatment or surgery will cost. But while the new law pulls back the curtain on prices of health procedures to some degree, the burden is still on the patient to ask for information. And, as a recent test drive of the new law showed, there are quite a few hoops for patients to jump through" (Bebinger, 11/9). Read the story.

Kaiser Health News also tracked weekend health policy headlines, including news about how Republicans are seeking to rebound and take advantage of issues surrounding the health law (11/10).

The Associated Press/Washington Post: Republicans Seize On Health Law's Growing Problems To Slam Democrats, Brighten Hopes For 2014
The health care law's seemingly endless problems are giving congressional Republicans a much-needed boost of energy, helping them to move past the government-shutdown debacle and focus on a theme for next year's elections. Republicans are back on offense, and more quickly than many had expected, after seeing their approval ratings plunge during last month's partial shutdown and worrisome talk of a possible U.S. debt default (11/11).

The Wall Street Journal: Health-Law Rollout Weighs On Obama's Ratings, Agenda
President Barack Obama, bogged down by problems with his signature health-care program, is seeing both his approval and personal-favorability ratings with Americans sag, creating new complications for his second-term agenda. During past turbulence in Washington, Americans' approval of the job Mr. Obama is doing dipped. But in those stretches, Mr. Obama was buoyed by voters' general admiration for him as a person and by their trust in his credibility (Nicholas and Nelson, 11/10).

Politico: ACA's 'Catastrophic' Coverage Flies Under Radar
President Barack Obama promised to find ways to help people whose health plans have been canceled and are scrambling for an affordable alternative. For some of them, there may be an option: a little-known, little-discussed slimmed-down Obamacare "catastrophic" health plan. But it, too, is caught up in the HealthCare.gov mess. People don't know about it, have trouble finding out about it -; and can't yet tap into it because of a gap in the sign-up process. Plus, health policy experts note that it might not help all that many people -; and could divert people from the main insurance plans needed to make Obamacare sustainable (Cheney, 11/11).

The New York Times: Cuts in Hospital Subsidies Threaten Safety-Net Care
The uninsured pour into Memorial Health hospital here: the waitress with cancer in her voice box who for two years assumed she just had a sore throat. The unemployed diabetic with a wound stretching the length of her shin. The construction worker who could no longer breathe on his own after weeks of untreated asthma attacks and had to be put on a respirator. Many of these patients were expected to gain health coverage under the Affordable Care Act through a major expansion of Medicaid, the medical insurance program for the poor. But after the Supreme Court in 2012 gave states the right to opt out, Georgia, like about half the states, almost all of them Republican-led, refused to broaden the program. Now, in a perverse twist, many of the poor people who rely on safety-net hospitals like Memorial will be doubly unlucky. A government subsidy, little known outside health policy circles but critical to the hospitals' survival, is being sharply reduced under the new health law (Tavernise, 11/8).

The New York Times: Con Men Prey On Confusion Over Health Care Act
To the list of problems plaguing President Obama's health care law, add one more -; fraud. With millions of Americans frustrated and bewildered by the trouble-prone federal website for health insurance, con men and unscrupulous marketers are seizing their chance. State and federal authorities report a rising number of consumer complaints, ranging from deceptive sales practices to identity theft, linked to the Affordable Care Act (Silver-Greenberg and Craig, 11/9).

The Washington Post's The Fact Checker: What Will Have A Greater Impact In Reducing The Deficit: The Sequester Or 'Obamacare'?
First of all, a caveat: The information that follows is based mostly on estimates by the nonpartisan Congressional Budget Office, some of which are long-range estimates subject to many variables. Reasonable people might disagree on whether these estimates are correct -; skeptics might argue that the long-term cost of "Obamacare" is undercounted–but it's the best that we have at the moment. Although Furman did not directly address Jansing's comment, we were curious to see if the impact of the sequester and the Affordable Care Act on the deficit could be measured for fiscal year 2013. The deficit fell by $409 billion, so how much can be attributed to either the health care law or the sequester? (Kessler, 11/11).

The New York Times: Health Website Tests A Tycoon And Tinkerer
Jeffrey D. Zients, a multimillionaire entrepreneur and management consultant, joined the Obama White House in 2009 with a mandate to streamline the federal bureaucracy. A year later, he issued a prescient warning. The government "largely has missed out" on the information technology revolution, Mr. Zients said in a 2010 internal memo. "I.T. projects too often cost hundreds of millions of dollars more than they should, take years longer than necessary to deploy and deliver technologies that are obsolete by the time they are completed," he wrote (Stolberg, 11/10).

The Washington Post: White House Relying More On Insurance Carriers To Help Fix HealthCare.gov
The White House is increasing its reliance on insurers by accepting their technical help in efforts to repair the problem-ridden online health insurance marketplace and prioritizing consumers' ability to buy plans directly from the carriers. The Obama administration's broader cooperation with insurers is a tacit acknowledgment that the federal insurance exchange -; fraught with software and hardware flaws that have frustrated many Americans trying to buy coverage -; might not be working smoothly by the target date of Nov. 30, according to several health experts familiar with the administration's thinking (Eilperin and Goldstein, 11/9).

The Wall Street Journal: HealthCare.gov Getting Fresh Dose Of 'Agile' Treatment
The HealthCare.gov contractor hired to fix the troubled online marketplace is assigning programming teams to release multiple software releases each week to fix specific portions of the site, according to the Obama administration. Experts say that focused fixes, conducted by contractor QSSI, could end up doing greater harm to the website if programmers fail to bring a holistic view to the project (Boulton, 11/8).

Los Angeles Times: White House Calls Subpoena For Top Tech Official 'Unnecessary'
The White House is reviewing a subpoena for testimony from its top technology chief, but a spokesman called the request from the House Oversight and Government Reform Committee an "unnecessary" distraction from the administration's work to fix the broken health insurance website. Rick Weiss, a spokesman for the Office of Science and Technology Policy, said officials will "respond as appropriate" to the subpoena issued Friday by committee Chairman Darrell Issa (R-Vista). Issa is investigating why the federal website, three years in the making, was not ready for launch on Oct. 1 (Hennessey, 11/9).

Politico: White House Tech Chief Now In Obamacare Spotlight
President Barack Obama's chief technology officer didn't build HealthCare.gov, but he's busy trying to fix it. Todd Park, one of the most accomplished health IT entrepreneurs in the country, is just the kind of techie Obama needs to save the botched website -; so much so that many wonder why Park wasn't tasked to oversee the project in the first place (Norman, 11/9).

USA Today: Even Doctors In Dark About New Health Plans
More than a month after HealthCare.gov and 15 state-based exchanges opened for business, consumers and even physicians are finding it's isn't easy or even possible sometimes to find out which doctors and hospitals are in the plans' provider networks (O'Donnell and McGinnis, 11/10).

The New York Times: As Washington Keeps Sinking, Governors Rise
Washington these days is the symbol of governmental failure, rocked by a shutdown, legislative paralysis and the disastrous debut of President Obama's health care program. ... One striking difference between the federal and state level is how governors have dealt with the new health care law. Even as lawmakers in Washington have been embroiled in battles to repeal it, governors in Arkansas and Iowa, to name two, have successfully worked with both parties in search of a compromise to expand insurance coverage for their constituents (Nagourney and Martin, 11/9).

USA Today: Adjoining States Face Differences With Health Care Law
When Joe Atkins hunkered down to draft legislation outlining how Minnesota would implement the Affordable Care Act, he had no idea the results would be so dramatic. The Gopher State is now enrolling individuals through its health-insurance exchange by the thousands and at premium rates that are among the lowest in the country. Next door in Wisconsin, the numbers of Obamacare enrollees have barely hit the hundreds and rates are between 25 and 35 percent higher than in Minnesota (Slack, 11/10).

The Associated Press/Washington Post: In Iowa, Unlike Washington, A Divided Government Decides It Would Rather Compromise
While the recent federal government shutdown was the perfect example of split-party gridlock in Washington, in other parts of the country opposing parties are actually working together. Welcome to Iowa: a state with a Republican-controlled state House, a Democratic-majority state Senate and a Republican governor. The leaders in this triangle disagree on issues ranging from abortion to taxation, but this year came to bipartisan agreements on a massive property tax cut, increased education spending and an expansion of Medicaid under the newly enacted federal health care overhaul (11/10).

The New York Times: Talk Of Penalty Is Missing In Ads For Health Care
New York's health exchange slogan is "Today's the Day." Minnesota has enlisted Paul Bunyan. Oregon held a music contest, and California stresses the "peace of mind" that will come with insurance. The state and federal health insurance exchanges are using all manner of humor and happy talk to sell the Affordable Care Act's products. But the one part of the new system that they are not quick to trumpet is the financial penalty that Americans will face if they fail to buy insurance (Hartocollis, 11/10).

The Wall Street Journal: Maryland Delays Full Rollout of Health Website
Maryland officials decided Friday to delay the rollout of the small-business insurance exchange program until April so it can continue fixing  problems with marylandhealthconnection.gov, its new online marketplace. Maryland launched the exchange on Oct. 1 for uninsured individuals, and had planned to open it to small companies in January (Corbett Dooren, 11/8).

Los Angeles Times: Californians Have Their Doubts About Healthcare Law
Californians are more supportive of President Obama's healthcare law than the country at large, but they still worry it will raise healthcare costs and hurt the economy, a new poll of registered voters shows. Statewide, 50% said they backed the Affordable Care Act and 42% opposed it, according to the USC Dornsife/Los Angeles Times poll. That runs counter to national polls that show more people disapprove of Obamacare than support it (Terhune, 11/9).

The Wall Street Journal: Appeals Court Blocks Health Law's Contraception Requirement
A federal appeals court on Friday blocked a provision of the Obama administration's health-care law requiring employers to provide birth-control coverage in employee insurance, ruling that it imposed a "substantial burden" on religious rights of two Midwestern companies. The move by the Seventh U.S. Circuit Court of Appeals in Chicago marked the first time a federal appeals court has issued a ruling preventing the federal government from enforcing the provision (Palazzolo, 11/8).

The Wall Street Journal: Rules Spell Out How Insurers Must Cover Mental Health
The long-awaited final rule caps decades of efforts by psychiatrists, patients and other advocates to broaden coverage for the estimated one in four Americans who suffer from mental illness or substance abuse. It also ends mounting criticism from lawmakers who say the delay has allowed insurers to continue to impose barriers to care. Health and Human Services Secretary Kathleen Sebelius echoed that concern in unveiling the final rule at the Rosalynn Carter Institute for Caregiving in Atlanta Friday. "For way too long, the health insurance industry has openly discriminated against people with mental health and substance abused disorders," she said, noting that 60% of Americans with mental-health problems and 90% of those with substance-abuse issues don't receive the care they need. "We are finally closing the gaps in coverage" (Beck, 11/8).

The Washington Post: Insurers Directed To Treat Mental Health Issues The Same As Physical Ailments
It also represents a fulfillment of a promise made by President Obama, who vowed to put the finishing touches on the regulations as part of a broader effort to address the problem of mass shootings, which have thrust mental health issues into the spotlight in recent years. "For way too long, the health-care system has openly discriminated against Americans with behavioral health problems. In the past, it was legal for insurance companies to treat these disorders differently than medical and surgical needs," Health and Human Services Secretary Kathleen Sebelius said in announcing the rule Friday (Somashekhar and Eilperin, 11/8).

The Associated Press: New Rule Demands Parity For Mental Health Coverage
It's final: Health insurance companies must cover mental illness and substance abuse just as they cover physical diseases. The Obama administration issued new regulations Friday that spell out how a 5-year-old mental health parity law will be administered (Freking, 11/8).

The New York Times: Label Updates May Be Allowed For Generics
The Food and Drug Administration proposed a rule on Friday that would permit generic drug makers to update their labels if they received information about potential safety problems. The move puts the companies on equal footing with brand-name manufacturers, but it also opens the door to lawsuits against them for the first time since the Supreme Court barred such cases two years ago (Thomas, 11/8).

The Wall Street Journal: FDA Proposes Letting Generic-Drug Makers Change Labels
The step Friday by the FDA means that generic companies-;which sell about 84% of the prescription drugs by volume in the U.S.-;would have the same ability to change their labels as brand companies. The FDA would review any proposed changes, as it already does with changes to branded-drug labels. "Our effort is to keep all the labels the same, and to level the playing field," said Janet Woodcock, director of the FDA's center for drug evaluation and research. The proposal, she said, "would change current procedures, where only the brand companies can unilaterally put certain safety information in the label" (Burton and Kendall, 11/8).

The Wall Street Journal: Pros And Cons Of Concierge Medicine
When Samir Qamar practiced concierge medicine at Pebble Beach Resorts in Monterey, Calif., the hotel's "A-list clientele" paid $550 to see him and as much as $30,000 a month to keep him on retainer. But last year, Dr. Qamar decided to abandon VIP medicine and pursue a no-frills version of his practice, charging just $59 for monthly membership to his MedLion clinics (16 locations in five states) and $10 a visit-;and never billing insurance (Weiczner, 11/10).