First Edition: December 3, 2013

Today's headlines include coverage of the mixed reviews regarding healthcare.gov's "relaunch" as well as the White House strategy to move past the website's difficulties. 

Kaiser Health News: When Palliative Care Is The Best Care
Kaiser Health News staff writer Anna Gorman, working in collaboration with The Seattle Times, reports: "Hospitals around the country are increasingly starting palliative care programs, designed to relieve seriously ill patients' pain, stress and symptoms regardless of how long they have to live. While some patients are close to death, others are still receiving treatment to extend their days. And as they do, the palliative care team, including doctors, social workers, nurses and chaplains, tries to improve their quality of life" (Gorman, 12/3). Read the story.

Kaiser Health News: Insuring Your Health: Mental Health Parity Rule Clarifies Standards For Treatment Limits, Coverage Of Intermediate Care
Kaiser Health News consumer columnist Michelle Andrews talks with Jennifer Mathis, director of programs at the Judge David L. Bazelon Center for Mental Health Law in Washington, about the parity law and the new regulations (Andrews, 12/3). Read the interview.

Kaiser Health News: Capsules: California's Small Business Insurance SHOP Opens, A Contrast To Feds; Administration: Bugs Reduced At Healthcare.gov; How Is Healthcare.gov Performing Now?;
Many Consumers Report Improvements With Healthcare.gov
Now on Kaiser Health News blog, Anna Gorman reports on California's SHOP exchange: "Just a few days after the federal government delayed online enrollment, California announced better news for small businesses who want to buy health insurance. Businesses with up to 50 employees can begin signing up online for coverage through the state's new marketplace, officials announced Monday" (Gorman, 12/2).

Also on Capsules, Phil Galewitz reports on how healthcare.gov is doing: "For the first time since its mangled Oct. 1 launch, users can now go to the federal government's insurance enrollment website and get detailed information about the costs and benefits of health plans in their county without first enrolling" (Galewitz, 12/2).

In addition, KHN's Mary Agnes Carey was on NPR's "Tell Me More" Monday morning to give an update on the federal government's troubled website. Listen to audio of Carey speaking with Michel Martin. 

Finally, Galewitz also reports on the experience some consumers are having with the federal marketplace: "Vickie Fleisher-Gann had been trying since Oct. 1 to complete her Obamacare application so she could start shopping for insurance on healthcare.gov, but she kept getting stopped by error messages. With her policy expiring at the end of the year, she feared time was running out. On Sunday morning, the former Harrisburg, Pa., hospital administrator finally was able to complete her application, shop for a plan and enroll -; all within about 30 minutes. 'I was shocked when it worked,' said Fleisher-Gann, 61. 'I just couldn't believe it'" (Galewitz, 12/2). Check out what else is on the blog.  

The New York Times: Insurers Are Offered Assistance For Losses
The White House is offering more money to insurance companies as an incentive for them to let people keep insurance policies that were to have been canceled next year. The administration floated several proposals on Monday to "help offset the loss in premium revenue and profit" that it said might occur if insurers went along with President Obama's request to reinstate canceled policies (Pear, 12/2).

Los Angeles Times: Healthcare.gov Has Rocky Relaunch
The Obama administration's overhauled healthcare website got off to a bumpy relaunch Monday as a rush of consumers caused an uptick in errors and forced the administration to put thousands of shoppers on the HealthCare.gov site on hold. … Bataille said about 375,000 visitors went to the site before noon, about double the normal traffic for a Monday morning. The volume caused pages to load slowly and the rate of errors to spike. About 10 a.m. EST, federal officials turned on a new queuing system that alerts some visitors to the site to come back later (Levey, 12/2).

The Washington Post: Health-Care Enrollment On Web Plagued By Bugs
The enrollment records for a significant portion of the Americans who have chosen health plans through the online federal insurance marketplace contain errors -; generated by the computer system -; that mean they might not get the coverage they're expecting next month. The errors cumulatively have affected roughly one-third of the people who have signed up for health plans since Oct. 1, according to two government and health-care industry officials. The White House disputed the figure but declined to provide its own (Goldstein and Eilperin, 12/2).

The Associated Press/Washington Post: Updated Healthcare.gov Gets Mixed Reviews
helping people use the federal government's online health exchange are giving mixed reviews to the updated site, with some zipping through the application process while others are facing the same old sputters and even crashes. The Obama administration had promised a vastly improved shopping experience on healthcare.gov by the end of November, and Monday was the first business day since the date passed (12/3).

The Washington Post: Heavy Traffic On Healthcare.gov After Fixes; Users Report Mixed Results On Insurance Site
The White House announced early Sunday that, given the recent improvements in the site, most HealthCare.gov shoppers should be able to have an experience like Issa's. By 10 a.m., however, the Web site seemed to be struggling with high traffic. Federal health officials said they saw an increase in error rates and a slowdown in response times and decided to deploy "queueing" software designed to limit the number of users permitted on the site at one time (Kliff and Sun, 12/2).

NPR: Could A Tech Giant Build A Better Health Exchange? Maybe Not
Oregon has spent more than $40 million to build its own online health care exchange. It gave that money to a Silicon Valley titan, Oracle, but the result has been a disaster of missed deadlines, a nonworking website and a state forced to process thousands of insurance applications on paper. Some Oregon officials were sounding alarms about the tech company's work on the state's online health care exchange as early as last spring. Oracle was behind schedule and, worse, didn't seem able to offer an estimate of what it would take to get the state's online exchange up and running (Henn, 12/2).

The Wall Street Journal: Health Website Problems Weren't Flagged In Time
When warning signs emerged earlier this year, the agency running the HealthCare.gov website mostly kept the problems to itself-;a decision that now looms large in explaining how the project went so badly astray. Over the weekend, the White House official leading the repair effort, Jeffrey Zients, described a series of improvements that took just six weeks to carry out under a new general contractor, underscoring how an earlier alert might have led to problems being addressed more urgently before the site's Oct. 1 launch (Nagesh, 12/2).

The New York Times: Cost Of Health Care Law Is Seen As Decreasing
The rollout of President Obama's health care law may have deeply disappointed its supporters, but on at least one front, the Affordable Care Act is beating expectations: its cost. Over the next few years, the government is expected to spend billions of dollars less than originally projected on the law, analysts said, with both the Medicaid expansion and the subsidies for private insurance plans ending up less expensive than anticipated (Lowrey, 12/2).

The Associated Press/Washington Post: Year-End Signups Crucial Test For Health Care Site
Some of those at risk are among the more than 4 million consumers whose individual policies have been canceled because the coverage didn't comply with requirements of the new health care law. A smaller number, several hundred thousand, are in federal and state programs for people whose health problems already were a barrier to getting private insurance before the overhaul (12/2).

Los Angeles Times: State Health Insurance Exchange Aims To Enroll 7,000 Small Firms
Trying to stem a steady erosion in employer health coverage, California's insurance exchange said it's looking to enroll 7,000 small businesses next year as part of the federal healthcare law. At an event in Los Angeles on Monday, officials with Covered California said their online marketplace for small firms is fully operational and that more than 1,500 businesses had already created shopping accounts on the state website (Terhune, 12/2).

Los Angeles Times: California's Health Insurance Exchange: 5 Things To Watch In December
Like many retailers, California's health insurance exchange is banking on a rush of December shoppers. California has already signed up nearly 80,000 people in private health plans and 135,000 more in Medi-Cal, the state's Medicaid program. But crunch time starts now as deadlines approach. People have until Dec. 23 to sign up for coverage that takes effect Jan. 1. Open enrollment runs through March (Terhune, 12/2).

The New York Times: A New Wave Of Challenges To Health Law
A federal judge in the District of Columbia will hear oral arguments on Tuesday in one of several cases brought by states including Indiana and Oklahoma, along with business owners and individual consumers, who say that the law does not grant the Internal Revenue Service authority to provide tax credits or subsidies to people who buy insurance through the federal exchange.  At the same time, the House Judiciary Committee will convene a hearing to examine whether Mr. Obama is "rewriting his own law" by using his executive powers to alter it or delay certain provisions. The panel also will examine the legal theory behind the subsidy cases: that the I.R.S., and by extension, Mr. Obama, ignored the will of Congress, which explicitly allowed tax credits and subsidies only for those buying coverage through state exchanges (Stolberg, 12/2).

Los Angeles Times: Supreme Court Declines To Hear Case On Obamacare's 'Employer Mandate'
The Supreme Court will not reconsider the part of President Obama's healthcare law that requires employers to provide basic health insurance for their workers or pay a tax penalty. The justices on Monday dismissed an appeal brought by a conservative Christian college in Virginia that contended the "employer mandate" is unconstitutional (Savage, 12/2).

The Associated Press/Washington Post: High Court Ends Liberty U. Lawsuit Over Health Law
The Supreme Court has turned away a Christian university's attempt to overturn a key part of the Obama administration's health care law. The justices did not comment Monday in leaving in place a federal appeals court ruling dismissing Liberty University's lawsuit (12/2).

Politico: Supreme Court Rejects Liberty University Employer Mandate Challenge To Health Law
The Supreme Court on Monday declined to wade into the constitutionality of Obamacare's employer mandate. The high court rejected a petition from Liberty University, which challenged the law's employer coverage requirements, individual mandate and contraception coverage requirements. A lower court upheld the law in Liberty's case. Last week, the justices agreed to review two other cases, brought by the Hobby Lobby craft-store chain and Conestoga Wood Specialties, that focus specifically on the law's contraception coverage requirement and these for-profit companies' claim of religious exemption (Haberkorn, 12/2).

The Wall Street Journal: Democrats Face Battles In South To Hold The Senate
Three of the four most vulnerable Senate Democrats in the 2014 election are from the South. Mr. Pryor and Sens. Kay Hagan of North Carolina and Mary Landrieu of Louisiana-;as well as Democratic candidates in Kentucky and Georgia-;must contend with the dismal approval ratings of President Barack Obama in their home states. They face increased political pressure from the problem-ridden rollout of the health-care law (Hook, 12/2).

The Associated Press/Washington Post: Obama Tries To Move Past Health Care Website Woes
President Barack Obama will focus on those benefits at a White House event Tuesday. Flanked by Americans who the White House says have benefited from the overhaul, the president will try to remind Americans that his health law is preventing insurance discrimination against those with pre-existing conditions and is allowing young people to stay on their parents' coverage until age 26. He'll also take aim at Republicans, arguing that the GOP is trying to strip away those benefits without presenting an alternative (12/3).

Politico: White House Returns To Obamacare Sales Mode
President Barack Obama will launch a coordinated campaign Tuesday by the White House, congressional Democrats and their outside allies to return attention to why the Affordable Care Act passed in the first place. After two months of intense coverage of the botched HealthCare.gov rollout, the president will host a White House event kicking off a three-week drive to refocus the public on the law's benefits, senior administration officials told POLITICO (Budoff Brown and Allen, 12/2).

The Wall Street Journal's Washington Wire: Obama Speech To Kick Off Health Push
President Barack Obama on Tuesday will launch a new effort aimed at highlighting the benefits of the Affordable Care Act, as the White House works to shift the conversation away from the botched rollout of HealthCare.gov. A White House official said that while work continues on the website, the administration wants to renew its focus on aspects of the law that it says are already helping consumers. Mr. Obama will speak Tuesday at 2:30 p.m. at the White House, kicking off a three-week, coordinated campaign that will feature a benefit of the federal-health law each day (Nelson, 12/3).

Los Angeles Times: Obama To Use Federal Health Insurance Exchange To Find A New Plan
The president plans to buy new health insurance through the online marketplace created by his signature healthcare law, a spokesman said Monday, confirming a promise the White House made nearly three years ago as it fought to push the legislation through Congress. White House spokesman Jay Carney told reporters that he did "not have any update" on the president's plans to enroll but suggested Obama was among the many Americans who are taking their time signing up for a new insurance plan. Open enrollment ends March 31 (Hennessey, 12/2).

The Wall Street Journal's Washington Wire: What Obamacare Coverage Costs Congressmen
Some members of Congress are about to get their own kind of sticker shock when they head to the new insurance exchanges. A few will get a price cut.  As the Journal has reported, a provision in the health law requires lawmakers to get their benefits alongside small-business employees for the first time, and that means lawmakers' premiums will suddenly be tied to their age (Ballhaus and Radnofsky, 12/2).

The Wall Street Journal: West Wing Set For New Blood
President Barack Obama will likely soon have three top staff positions to fill, at a time when he is under mounting pressure from the public and Democratic lawmakers to prove he can manage more adeptly and restore confidence in his signature health-care program. The White House said over the weekend that it would create a new, permanent position overseeing HealthCare.gov, the troubled website that has threatened the success of the 2010 health law and been one of the most serious challenges facing the Obama presidency. Jeffrey Zients, who leads the online effort on a temporary basis, leaves early next year to become director of the president's National Economic Council (Nicholas and Lee, 12/2).

Politico: Medicaid, Insurance Fixes May Be Big Trouble Later
An Obamacare fix quietly announced on Black Friday could put states at risk for higher Medicaid costs and even fraud. Although Medicaid sign-ups through HealthCare.gov have been considered a rare bright spot in the flawed Obamacare rollout, the federal portal has been unable to send those Medicaid applications to the states for final processing. If states can't receive and complete their work on Medicaid applications by the end of the year, people could go without Medicaid coverage in early 2014 despite having an eligibility determination (Cheney, 12/3).

The Washington Post: Wyoming Governor Says No To Medicaid Expansion
Wyoming Gov. Matt Mead (R) said Friday he doesn't want his state to accept federal funding to expand Medicaid coverage, due to problems with the rollout of the Affordable Care Act so far. Mead, a longtime opponent of the law, said the federal health-care exchanges set up under the ACA have hurt more than they have helped, undercutting his confidence in the federal government's commitment to cover 90 percent of the costs of Medicaid expansion into the future (Wilson, 12/2).

The New York Times: As Hospital Prices Soar, A Single Stitch Tops $500
In a medical system notorious for opaque finances and inflated bills, nothing is more convoluted than hospital pricing, economists say. Hospital charges represent about a third of the $2.7 trillion annual United States health care bill, the biggest single segment, according to government statistics, and are the largest driver of medical inflation, a new study in The Journal of the American Medical Association found (Rosenthal, 12/2).

Los Angeles Times: Cedars-Sinai And UCLA Health Teaming Up To Open Rehab Hospital
Two longtime rivals, Cedars-Sinai Medical Center and UCLA Health System, are teaming up to open a 138-bed rehabilitation hospital in Century City, reflecting both the growing need for this specialty care and the pressure on hospitals to control costs (Terhune, 12/2).

The Associated Press/Washington Post: Delaware Mental Health Task Force Continues Work
A task force studying Delaware's civil mental health laws is finishing up its work in advance of a Jan. 1 deadline for submitting a report with its full findings to the General Assembly and the governor. Among the issues that have been examined by the task force, which meets Tuesday, are immunity provisions regarding involuntary mental health commitments. The immunity provision were the subject of a task force report that was due earlier this year and which was followed with legislation signed by Gov. Jack Markell in March (12/3).