First Edition: January 13, 2014

Today's headlines include news about how the health law's enrollment process is working and about the federal government's decision not to renew the contract for the company that was overseeing the repairs for healthcare.gov.  

Kaiser Health News: A Reader Asks: Will A Tax Lien Affect My Premium Tax Credit?
Kaiser Health News consumer columnist Michelle Andrews answers a reader's question (1/13). Read her response.

The New York Times: Enrollees At Health Exchanges Face Struggle To Prove Coverage
Paul D. Donahue and his wife, Angela, are among more than a million Americans who have signed up for health coverage through the federal insurance exchange. Mr. Donahue has a card in his wallet from his insurer to prove it. But when he tried to use it to get a flu shot and fill prescriptions this week, local pharmacies could not confirm his coverage, so he left without his medications. Similar problems are occurring daily in doctors' offices and drugstores around the country as consumers try to use insurance coverage that took effect on Jan. 1 under the Affordable Care Act (Pear and Goodnough, 1/10).

The Wall Street Journal: Health Insurers Cite Slow Premium Payments For New Plans
Insurers are struggling to get their premium payments from people who signed up for coverage through the health-law marketplaces, leaving many plans with fewer enrollees than expected at the start of the new year. ... "It's been pulling teeth," said Shaun Greene, chief operating officer of Utah-based Arches Health Plan, a startup. As of Thursday, Arches had collected about 60% of premiums for people who signed up for coverage that took effect Jan. 1. He said Arches would urge customers in email and phone calls to pay for at least a few more days, even after the deadline (Mathews and Weaver, 1/10).

Politico: Administration: Birth Control Doesn't Directly Violate Company's Religious Rights
The Obama administration has asked the Supreme Court to uphold the Affordable Care Act's requirement that most employers provide contraception in their health plans, even if a company's owners have religious objections. In arguments filed late Friday, Justice Department lawyers told the court that an employer's religious beliefs aren't a legitimate reason to deny something as important as preventive care to an employee who is entitled to it under the health law (Haberkorn, 1/11).

USA Today: Student Health Plans Forced To Adapt To ACA Requirements
Thanks to the Affordable Care Act, most young Americans can stay on their parents' health insurance until age 26 -; a shift in law that has extended health coverage to more than 3.1 million people, according to the Obama administration. But many college and graduate students -; either by choice or because their parents lack coverage -; are still enrolling in university-sponsored health care plans, which have been forced to adapt or discontinue with the gradual implementation of the ACA over the past few years (Dame, 1/11).

The Washington Post: Second Wave Of Health-Insurance Disruption Affects Small Businesses
When millions of health-insurance plans were canceled last fall, the Obama administration tried to be reassuring, saying the terminations affected only the small minority of Americans who bought individual policies. But according to industry analysts, insurers and state regulators, the disruption will be far greater, potentially affecting millions of people who receive insurance through small employers by the end of 2014 (Cha, 1/11).

The New York Times: Contractor For Health Portal Replaced, But Says 'We Were Not Fired'
The contractor hired to build the computer enrollment system for President Obama's health care law said Friday that it would stop working on the troubled insurance exchange when its contract expires at the end of February. CGI Federal, which was blamed by many in the administration for the glitches and missed deadlines that plagued the law's rollout, will not pick up its option for a two-year maintenance contract for the HealthCare.gov website. "Let me be very clear, we were not fired," said Lorne S. Gorber, the senior vice president for the CGI Group of Montreal, of which CGI Federal is an American subsidiary (Austen, 1/10).

The Washington Post: Obama Administration To End Contract With CGI Federal, Company Behind Healthcare.gov
According to officials familiar with the matter, who spoke on the condition of anonymity because the decision is not yet public, leaders of CMS became frustrated with the pace and quality of CGI's work on the repairs. As federal officials and contractors have been trying to fix various aspects of the Web site in the past few months, about half the new software code the company has written failed when it was first used, according to internal federal information (Eilperin and Goldstein, 1/10).

The Wall Street Journal: CGI's Contract To Help Run Health Site Won't Be Renewed
CGI Group Inc. said federal officials won't renew its contract to oversee key parts of HealthCare.gov, the online insurance marketplace that launched with major defects on Oct. 1. The government is selecting a new contractor to continue developing and running the federal health site, but no deal has been signed, a person familiar with the matter said.  Accenture PLC is one of the companies in discussions with the government to take over the contract, the person said (Weaver and Ante, 1/10).

The Wall Street Journal: Accenture To Take Over Fixing HealthCare.gov Website
Accenture Federal Services, a subsidiary based in Arlington, Va., won a one-year contract to continue technical improvements to the site after the government chose not to renew its contract with CGI Group Inc. CGI, which has had a contract to run the website since 2011, had been largely responsible for assembling the portal and fixing it. The company and the Obama administration have blamed each other for enrollment problems that dogged the portal since its launch (Armour, 1/12). 

Los Angeles Times: Obama Administration Replaces Contractor On Troubled Healthcare Site 
CGI, which has drawn sustained criticism for its work on a centerpiece feature of the president's health law, was effectively demoted last fall, when administration officials turned to a subsidiary of insurance giant UnitedHealth to rescue HealthCare.gov from its disastrous Oct. 1 debut (Levey, 1/11).

The Washington Post: Maryland Officials Were Warned For A Year Of Problems With Online Health-Insurance Site
More than a year before Maryland launched its health insurance exchange, senior state officials failed to heed warnings that no one was ultimately accountable for the $170 million project and that the state lacked a plausible plan for how it would be ready by Oct. 1. Over the following months, as political leaders continued to proclaim that the state's exchange would be a national model, the system went through three different project managers, the feuding between contractors hired to build the online exchange devolved into lawsuits, and key people quit, including a top information technology official because, as he would later say, the project "was a disaster waiting to happen" (Wagner and Flaherty, 1/11).

Politico: O'Malley Defends Maryland Health Care Exchange
Maryland Gov. Martin O'Malley on Sunday defended his state's Obamacare exchange, saying that despite its initial rocky rollout, the website is now running smoothly for most Marylanders. ... Appearing on CNN's "State of the Union," O'Malley said "oh no" when asked if he and other Maryland state officials were asleep at the switch during the launch of the state's health-care exchange, which has been riddled with glitches and problems since its Oct. 1 debut. "This complex IT challenge had ups and downs every step of the way," O'Malley said. "There were lots of cautionary red lights" but green lights as well, the Democratic governor said (Kim, 1/12).

Politico: GOP Governors May Still Go For Medicaid Expansion - And Cash
Republicans counting on a year of nonstop Obamacare-bashing may be in for an unwelcome surprise: more red-state governors ditching the political script to take a second look at the law's huge expansion of Medicaid. Governors like Rick Perry of Texas and Bobby Jindal of Louisiana remain firmly in the "no way" camp. But Pennsylvania and Tennessee are actively working with the Obama administration to expand Medicaid, although their efforts to squeeze policy concessions on the GOP wish list -; like requiring enrollees to pay more -; could be a dead end. Indiana and Oklahoma are eyeing alternative versions of expansion and were granted a one-year reprieve by the Obama administration to extend existing state health care programs while they think about it (Cheney and Millman, 1/10).

The Wall Street Journal: Sen. Ron Wyden Is Set To Get A Wider Platform
He wants to shore up Medicare by better focusing the program on treatment of chronic health problems, according to his former chief of staff, Josh Kardon. In addition, Mr. Wyden could want more protections for workers and digital firms in pending trade legislation, which would also move through the Finance Committee. During 2014, Mr. Wyden also will have to focus on the relatively unglamorous task of finding ways to keep some costly programs going. Those include temporary tax breaks for businesses, as well as reimbursement rules for Medicare physicians. Both will likely require cuts elsewhere in the budget, higher revenue, or both (McKinnon, 1/12). 

The New York Times: House Votes To Increase Security Measures On Health Care Exchanges
The House voted on Friday to strengthen security protections on the HealthCare.gov website, requiring all security breaches of the health insurance exchanges to be reported in a timely fashion. The bill -; known as the "Health Exchange Security and Transparency Act" -; passed largely on party lines, 291 to 122, with 67 Democrats voting for the legislation. The measure would require the health department to inform affected consumers within two business days of any possible breach of the federal or state exchanges (Parker, 1/10).

The Wall Street Journal: House Passes Bill To Notify Users Of Health Exchange Security Breaches
House Republicans on Friday sought to keep up political pressure on the Obama administration's health-care rollout, with the House passing legislation intended to address alleged security weaknesses with the HealthCare.gov website. ... The legislation is part of a Republican strategy to keep attention on problems with the Affordable Care Act ahead of November's midterm elections. Republican leaders hope to blunt an aggressive push by the White House and Democrats to shift the policy debate to domestic economic issues (Crittenden, 1/10).

The Washington Post: House Approves HealthCare.gov Security Bill
Republicans' aides openly boasted Friday about the 67 vulnerable Democrats willing to buck President Obama, who strongly opposed the measure. The White House said the proposal would create "unrealistic and costly paperwork requirements" that wouldn't improve the safety or security of the site's users (O'Keefe, 1/10).

The New York Times: Where Free Speech Collides With Abortion Rights
A couple of mornings a week, Eleanor McCullen stakes out a spot outside the Planned Parenthood clinic here and tries to persuade women on their way in to think twice before having an abortion. But she has to watch her step. If she crosses a painted yellow semicircle outside the clinic's entrance, she commits a crime under a 2007 Massachusetts law (Liptak, 1/12).

Politico: Supreme Court To Consider Abortion Clinic Protests
The Supreme Court is wading back into the nation's long battle over abortion, this time to examine limits on protesters' speech outside clinics. Abortion opponents who regularly gather outside Massachusetts clinics want the court to strike a 2007 state law that established a 35-foot "buffer" zone around entrances to the facilities. They argue it puts unconstitutional limitations on speech because they are prohibited from crossing the line while certain people associated with the clinic can go through (Haberkorn, 1/12).

The Washington Post's Capital Business: Information Technology Is Changing Health-Care System
With the implementation of the Affordable Care Act, health care was a hot topic in 2013. Rising costs and continued challenges make certain health care will continue to be a big issue in 2014. Recently, Capital Business sat down with experts from the University of Maryland and the Arlington consultancy Evolent Health to talk about health care and the opportunities ahead for information technology to improve efficiency and quality of care. Joining the conversation were Ritu Agarwal, founder and director of the Center for Health Information at the University of Maryland's Robert H. Smith School of Business; Karoline Mortensen, assistant professor of health services administration, University of Maryland Public Health; and Shandy Guharoy, vice president for information technology for Evolent Health (1/12). 

USA Today: States, Cities Prescribe Paid Sick Leave Rules
A growing number of cities and states are starting to require employers to provide paid sick leave. Jersey City's Earned Sick Time Ordinance goes into effect Jan. 24. New York City's Earned Sick Time Act – passed in June when the City Council overrode a veto by then-Mayor Michael Bloomberg – goes into effect April 1. They join such cities as Portland, Ore., where paid sick leave rules went into effect Jan. 1; Seattle, where paid sick leave rules went into effect Sept. 1, 2012; Washington in 2008; and San Francisco, which passed such regulations in 2006 and implemented them in 2007 (Daneman, 1/12). 

The New York Times: Twinned Cities Now Following Different Paths
But these days, when residents cross the bridge, they enter starkly different political territories. Since Republicans in Wisconsin took control of the State Legislature and governor's office in 2011, and since Democrats gained full dominance in Minnesota last year, people here have watched essential elements of their daily lives -; their savings plans, job expectations, personal relationships and health insurance -; veer apart (Davey, 1/12). 

The Associated Press: Terry McAuliffe Takes Oath As Va.'S 72nd Governor 
In his speech, McAuliffe made a brief pitch for one of his top legislative priorities -; expanding Medicaid to about 400,000 low-income Virginians under the federal health care reform law. The proposal faces a tough hurdle in the GOP-controlled House. "Like the majority of other states, we need to act on the consensus of the business community and health care industry to accept funding that will expand health care coverage, save rural hospitals, and spur job creation," the governor said (O'Dell, 1/11).

The Washington Post: Eight Things To Watch In The Mcauliffe Administration
Abortion access. McAuliffe has promised to be a "brick wall" against new limits on the procedure. But how far will he go in trying to roll back some of the restrictions imposed under McDonnell? Abortion rights activists hope -; and anti-abortion groups fear -; that he will soften the strict building codes imposed on clinics through administrative action. That move could alienate the Republicans he desperately needs to get anything through the GOP-dominated House and a Senate where control is in flux. Medicaid expansion. House lawmakers are flatly opposed the Democrat's top legislative goal, which they say will cost Washington money it doesn't have, with Virginia left picking up a $5 million-a-day tab. McAuliffe hopes delegates from conservative rural districts will be swayed, if not by him then by hospitals in their districts, which stand to lose money if the health-care program for the poor is not extended to more Virginians (Vozzella, 1/11).

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