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Thursday, October 24, 2013

Health Care Reform Articles - October 24, 2013

SPC Interview about the ACA and Medicare for All on the Jeff Blankfort show, "Takes on the World" - KZYX community radio, Mendocino, CA

 Dr. Caper says problems inherent in Congress, beholden to corporate health insurance industry, produced complicated, confusing Affordable Health Care bill; how medical-industrial-complex spends 4 times more lobbying than military-industrial complex; compares US system unfavorably with that of other countries, latter provides better outcomes at half the price; cites difference between socialized medicine and single payer; believes AHC, by allowing states option to create own programs, may lead to Medicare for all if public demands it and holds Congressional feet to fire.

 http://www.radio4all.net/files/jblankfort@earthlink.net/1752-1-102313caperinterview.mp3


BUNGLED ROLLOUT? THAT’S JUST THE LATEST OBAMACARE FAILURE

BY RICHARD MALABY, SPECIAL TO THE BDN
POSTED OCT. 23, 2013, AT 2:56 P.M.
ON OCT. 17, THE BDN PUBLISHED DR. PHILIP CAPER’S COMMENTARY “ACA’S BUNGLED ROLLOUT ASIDE, GOVERNMENT HEALTH INSURANCE WORKS.” CAPER WAS CURIOUSLY SELECTIVE IN HIS PRESENTATION OF THE FACTS REGARDING THE AFFORDABLE CARE ACT: THE BUNGLED ROLLOUT OF THE ONLINE EXCHANGES IS BUT THE MOST RECENT SYMPTOM OF POORLY CONCEIVED AND POORLY CRAFTED LEGISLATION.
THE FIRST MAJOR COMPONENT OF THE ACA WAS THE CLASS ACT, THE COMMUNITY LIVING ASSISTANCE SERVICES AND SUPPORTS PROGRAM. THIS INITIATIVE WAS INTENDED TO ESTABLISH A LONG-TERM CARE PROGRAM FOR OUR ELDERLY AND DISABLED POPULATIONS. THE FIRST SEVEN YEARS’ PREMIUMS WERE PROJECTED TO PRODUCE AN $86 BILLION POSITIVE CASH FLOW BY 2020 THAT WOULD SUBSIDIZE THE IMPLEMENTATION OF THE ACA. TWO YEARS AGO THIS WEEK, U.S. HEALTH AND HUMAN SERVICES SECRETARY KATHLEEN SEBELIUS CANCELED THE CLASS ACT, CITING ITS FISCAL UNSUSTAINABILITY. CONGRESS LATER REPEALED IT.
LIKEWISE THE SECOND PART OF THE ACA WAS THE PRE-EXISTING CONDITION INSURANCE PLAN. IN EFFECT SINCE 2012, THIS PLAN WAS MEANT TO INSURE THE 400,000 PLUS AMERICANS WHO ARE THE VERY HIGHEST-COST CONSUMERS OF HEALTH CARE. FREQUENTLY THESE INDIVIDUALS HAVE CANCER, HEART DISEASE AND OTHER SERIOUS ILLNESSES. THIS PLAN WAS FUNDED BY $5 BILLION IN FEDERAL FUNDS AND WAS DESIGNED TO BE THE BRIDGE UNTIL THE HEALTH INSURANCE EXCHANGES COMMENCE IN 2014, AT WHICH TIME THOSE INDIVIDUALS COULD ACCESS THE EXCHANGES. THIS HIGH-RISK POOL HAS BEEN USED EFFECTIVELY IN A VARIETY OF STATES AND IS OFTEN TERMED A REINSURANCE POOL. UNFORTUNATELY IN FEBRUARY OF THIS YEAR, SEBELIUS ANNOUNCED THAT REIMBURSEMENTS TO PROVIDERS WERE BEING SLASHED AND ENROLLMENT HAS BEEN CAPPED AT 135,000 INDIVIDUALS, AS THE PROGRAM IS OUT OF FUNDS.
THE THIRD MAJOR COMPONENT OF THE ACA WAS THE MANDATORY EXPANSION OF MEDICAID ELIGIBILITY FOR INDIVIDUALS EARNING UP TO 138 PERCENT OF THE FEDERAL POVERTY LEVEL. LAST YEAR, THE SUPREME COURT RULED THAT AN UNCONSTITUTIONAL VIOLATION OF STATES’ RIGHTS, AND THE EXPANSION IS NOW ELECTIVE. CURRENTLY, 26 STATES, INCLUDING MAINE, HAVE CHOSEN NOT TO EXPAND, AS THE 1965-DESIGNED MEDICAID SYSTEM IS INFLEXIBLE, DYSFUNCTIONAL AND HAS PERVERSE INCENTIVES FOR BOTH CONSUMERS AND PROVIDERS.
WHICH BRINGS US TO THE CURRENT DEBACLE: THE FEDERAL GOVERNMENT’S INABILITY TO CREATE A FUNCTIONING, ONLINE EXCHANGE IS SOMEWHAT ASTOUNDING. THE GOVERNMENT HAS HAD THREE YEARS TO DESIGN THE SYSTEM, AND IT IS NOT AS IF THEY ARE DOING SOMETHING NEW OR INNOVATIVE. THE PRIVATE MARKET HAS BEEN DOING THIS FOR 15 YEARS. SITES SUCH AS EHEALTHINSURANCE.COM HAVE BEEN OFFERING AN ONLINE HEALTH INSURANCE MARKETPLACE EFFECTIVELY SINCE 1999, AND IT FUNCTIONS VERY WELL IN THOSE STATES WHOSE LAWS ENCOURAGE COMPETITION. (THAT PRECLUDES MAINE.)
CAPER, IN HIS BDN COMMENTARY, THEN STATES THAT THE REAL PROBLEM WITH ENACTING COMPREHENSIVE SYSTEMIC HEALTH CARE REFORM IS THE NEED TO ACCOMMODATE THE SPECIAL INTERESTS OF THE MEDICAL INDUSTRIAL COMPLEX. IS CAPER REFERRING TO THE FACT THAT CONGRESS HAS GRANTED TO THE AMERICAN MEDICAL ASSOCIATION THE EXCLUSIVE RIGHT TO DETERMINE HOSPITALS’ CHARGEMASTER PRICING THROUGH THE CREATION OF THE RELATIVE VALUE UNIT SYSTEM?
THE COMMENTARY GOES ON TO SAY THAT WE NEED MEDICARE-FOR-ALL.
IT IS WORTH NOTING THAT MEDICARE WAS 100 PERCENT OVER BUDGET BY THE FIFTH YEAR OF ITS IMPLEMENTATION, AND IT IS A FURTHER ANNUAL MULTIBILLION-DOLLAR DRAIN ON OUR BUDGET. MEDICARE REIMBURSEMENT NATIONALLY AVERAGES 89 PERCENT OF COSTS. IN MAINE, THAT NUMBER IS 79 PERCENT. IT SEEMS TO ME THAT, FOR SUCH A PROGRAM TO BE SUSTAINABLE, IT SHOULD AT THE MINIMUM PAY THE COSTS THAT IT INCURS.
EQUALLY IMPORTANT, CAPER STATES THAT MEDICARE HAS MUCH LESS OVERHEAD THAN PRIVATE INSURANCE COMPANIES: 6 PERCENT FOR MEDICARE VERSUS 15-20 PERCENT FOR PRIVATE INSURANCE COMPANIES. THESE NUMBERS DO NOT INCLUDE THE COST OF THE SOCIAL SECURITY ADMINISTRATION, WHICH DOES ALL OF THE COLLECTIONS FOR MEDICARE (FICA ON YOUR PAYCHECK), NOR DOES IT INCLUDE THE COSTS OF THE IRS, WHICH DOES THE ENFORCEMENT FOR MEDICARE, NOR DOES IT INCLUDE THE FREE MARKETING MEDICARE RECEIVES IN THE FORM OF PUBLIC SERVICE ANNOUNCEMENTS.
I DO NOT DISAGREE WITH THE INTENT OF THE ACA. I WOULD LIKE TO SEE BETTER ACCESS, LOWER COSTS, AND BETTER HEALTH CARE OUTCOMES. BUT I KNOW THAT MUCH OF THE IMPETUS FOR THE ACA HAS BEEN THE MEDICAL INFLATION WE HAVE WITNESSED OVER THE LAST 30 YEARS.
WE NEED TO FIRST REDUCE THE COST OF HEALTH CARE FOR ALL, AND I AM NOT CERTAIN THAT THE ACA WILL DO THAT.
REP. RICHARD MALABY, R-HANCOCK, REPRESENTS DISTRICT 34 IN THE MAINE HOUSE. HE SERVES ON THE LEGISLATURE’S HEALTH AND HUMAN SERVICES COMMITTEE.

What makes HealthCare.gov so complicated?
By: Kyle Cheney
October 24, 2013 08:25 AM EDT
Building a website in 2013 should be as easy as U-R-L, so what’s the deal with HealthCare.gov?
The White House billed the Obamacare portal as the Kayak.com of health coverage — only instead of plane rides, it was selling health insurance. It was supposed to be a one-stop click and shop place to compare and buy health plans in the 36 states not running their own insurance exchanges — and for the millions who are eligible, get federal subsidies.
Hundreds of millions of dollars later, it’s fundamentally broken and a frantic fix is underway.
What made it so complicated?
The Obama administration has done little to give outsiders a peek under the hood — although it promises daily briefings from the Department of Health and Human Services starting Thursday.
(POLITICO's full Obamacare coverage)
But it’s way more complicated than tweaking a simple commercial site.
“This is one of the most complex IT projects the federal government has ever undertaken,” said Dan Schuyler, senior technology expert at Leavitt Partners.
With the contractors who built the system preparing for a grilling from House Republicans today, here’s a quick guide to all the things that have to go right for HealthCare.gov to start humming.


Don Berwick reflects on health law woes

By Tracy Jan

 |  GLOBE STAFF  
  OCTOBER 24, 2013
WASHINGTON — Health care guru Donald Berwick is staking much of his campaign for Massachusetts governor on the lead role he played, as head of a key Washington agency, in helping kick off President Obama’s new health coverage law.
But now that the much-anticipated debut of the government’s online insurance marketplace has turned into a frustrating mess, Berwick is at a loss to explain the failures. He said he was not involved in crucial strategy and contracting decisions made during his tenure that dictated how his agency, the Centers for Medicare and Medicaid Services, would build the computer network.
The web portal is critically important to the political and practical success of the Affordable Care Act, because it is supposed to allow millions of newly empowered consumers to smoothly purchase plans. Yet Berwick said in an interview this week that he did not see launching the marketplace computer network as a major part of his role as chief of the agency.
“Those were staff level functions,” Berwick said. “My leadership investment was in the vision of CMS as a major force of improvement of care for the nation.”

Health Care Law Fails to Lower Prices for Rural Areas


By ,  and 

As technical failures bedevil the rollout of President Obama’s health care law, evidence is emerging that one of the program’s loftiest goals — to encourage competition among insurers in an effort to keep costs low — is falling short for many rural Americans.
While competition is intense in many populous regions, rural areas and small towns have far fewer carriers offering plans in the law’s online exchanges. Those places, many of them poor, are being asked to choose from some of the highest-priced plans in the 34 states where the federal government is running the health insurance marketplaces, a review by The New York Times has found.
Of the roughly 2,500 counties served by the federal exchanges, more than half, or 58 percent, have plans offered by just one or two insurance carriers, according to an analysis by The Times of county-level data provided by the Department of Health and Human Services. In about 530 counties, only a single insurer is participating.
The analysis suggests that the ambitions of the Affordable Care Act to increase competition have unfolded unevenly, at least in the early going, and have not addressed many of the factors that contribute to high prices. Insurance companies are reluctant to enter challenging new markets, experts say, because medical costs are high, dominant insurers are difficult to unseat, and powerful hospital systems resist efforts to lower rates.
“There’s nothing in the structure of the Affordable Care Act which really deals with that problem,” said John Holahan, a fellow at the Urban Institute, who noted that many factors determine costs in a given market. “I think that all else being equal, premiums will clearly be higher when there’s not that competition.”
The Obama administration has said 95 percent of Americans live in areas where there are at least two insurers in the exchanges. But many experts say two might not be enough to create competition that would help lower prices.
For example, in Wyoming, two insurers are offering plans at prices that are higher than in neighboring Montana, where a third carrier is seen as a factor in keeping prices lower.
It is unclear how the online marketplaces might evolve over time. Many large insurers are closely watching what happens in the first year to decide whether to more aggressively pursue new markets. In the meantime, problems with the healthcare.gov Web site are making it harder for them to know whether the exchanges’ slow start is the result of technical difficulties or more serious underlying problems, such as a lack of consumer demand, that would discourage them from entering.

Republicans, Sensing Weakness in Health Law Rollout, Switch Tactics


By  and 

WASHINGTON — Emboldened by the intense public criticism surrounding the rollout of the online insurance exchange, Republicans in Congress are refocusing their efforts from denying funds for the health care law to investigating it.
In changing tactics, Republicans hope to tamp down the continuing public criticism of their previously fruitless attack on the Affordable Care Act, one that led to a 16-day government shutdown, by focusing on the problems with the law that they say they have warned the nation about, unheeded, for three years.
“I think the biggest part of Congress’s job is to provide proper oversight of the executive branch of government,” Speaker John A. Boehner said Wednesday at a news conference. “And when it comes to Obamacare, clearly there is an awful lot that needs to be held accountable.”
Beginning Thursday, the House will hold the first of a series of hearings across multiple committees to examine the problems with the troubled Web site, as well as the law’s exemption and waiver components, and the problems that some consumers are having accessing their doctors through the program.
The Energy and Commerce Committee will hold the first hearings, including one with Kathleen Sebelius, secretary of health and human services, next week. The Ways and Means and oversight committees are expected to follow.
“What we’re trying to figure out,” said Representative Fred Upton, Republican of Michigan and chairman of the Energy and Commerce Committee, “is how did all this taxpayer money get wasted and what is their remedy?”
At the same time, Republican political groups are beginning to broadcast radio advertisements attacking the law — and the Congressional Democrats who passed it — in an attempt go back on offense and recast themselves as providers of needed oversight, after Democrats painted them as government obstructionists during the budget standoff.
“If the Web site glitches are just the tip of the iceberg,” said Representative Greg Walden of Oregon, chairman of the National Republican Congressional Committee, “it’s only a matter of time before the law sinks and takes with it those Democrats who wrote it, voted for it and are proud of it.”

WASHINGTON — Americans for Prosperity, the Tea Party group that has made rolling back the health care law one of its priorities, is starting a $2 million campaign of television, radio and Internet advertisements aimed at lawmakers facing tough re-election battles in four House swing districts.
The group, backed by the billionaire industrialist brothers Charles and David Koch, is focusing on two Democrats — Representatives Ron Barber of Arizona and Scott Peters of California — about the problem-plagued rollout of the program’s online health insurance exchanges.
And it is using the ads to thank two vulnerable Republicans — Representatives Mike Coffman of Colorado and Steve Southerland of Florida — for ‘’fighting back’’ and voting to repeal the law.
Americans for Prosperity has been spending millions in advertising in an effort to repeal the health law. It is also working aggressively to pressure state officials not to expand Medicaid, the government insurance program for the poor.
“A.F.P. has been consistently fighting Obamacare on the airwaves and on the ground since it passed,” said Tim Phillips, the group’s president. “We’re sending a message that politicians will be held accountable when they go against the will of the American people, and that we will support them for doing the right thing.’’

WASHINGTON — The Obama administration said Wednesday that people who obtained health insurance by March 31 would not face any tax penalties for being uninsured in the first three months of 2014.
Under President Obama’s health care law, most Americans will be required to have insurance next year, and they may be subject to tax penalties if they go without coverage.
People can sign up for insurance during a six-month open enrollment period that is scheduled to end on March 31. Under an earlier official interpretation of the law, people would have needed to sign up by Feb. 15 to avoid tax penalties.
The administration said it was working on a policy to match up the deadlines. In effect, the administration is extending the February deadline by six weeks so that it coincides with the end of the enrollment period.
“The administration is working to align those policies and will issue guidance soon,” an administration official said Wednesday. “This guidance will ensure that if you sign up for insurance by the end of March, you will not face a penalty.”
Without knowing the intricacies of the federal law and regulations, many consumers had assumed that they would be in compliance if they bought insurance by March 31. The administration is tweaking federal policy to match those expectations.
White House officials said their action was different from the type of relief being sought for other reasons by some members of Congress.
Because of technical problems in the Web site for the federal insurance marketplace, many Americans have been unable to buy insurance, obtain federal subsidies or compare the available health plans.
In view of these problems, some lawmakers say that Mr. Obama should extend the open enrollment period, delay the tax penalties or at least grant exemptions to people who have tried unsuccessfully to use the insurance Web site.
The White House has resisted such demands, saying that Mr. Obama hopes that the Web site will be fixed soon so consumers can use it more easily

Web Sites and Grave Sites


By 

Republicans are apoplectic about Healthcare.gov, the official Web site for the Affordable Care Act.
They are trying desperately to change the subject from their disastrous government shutdown by ranting about the failures of a government Web site that cost a tiny fraction of what was lost as a result of the shutdown.
Republicans are pretending that they care about the problems encountered in signing up for a system that many of them are bent on destroying.
They are demanding an immediate fix to something they want to break.
They are trying to deflect public outrage away from their record-low approval ratings.
The only problem for Republicans is that a technical issue isn’t likely to have legs. Yes, it’s embarrassing. Yes, it’s frustrating. Yes, it’s an unforced error.
But it’s also fixable, and in the grand scheme of things, a malfunctioning Web site is more understandable and less consequential than a malfunctioning political party.
The Web site will be fixed. Can the same be said of the party that has planted its flag on the outskirts of reason? Can the same be said of the party being hijacked by hyperpartisans?
In the long stretch of history, Obamacare will be judged on the merits of the policy, not the rollout of a Web site. That judgment will be sober and thorough. And along the way, as some things work and others don’t — as is the way with ambitious laws — things will be tweaked. But this is the law. It will be implemented, even over the wails of Republican resistance.
If Republicans are correct, that the law is the abomination that they say it is, it will be borne out in due time with jobs killed and premiums raised. If however they are not correct and the law succeeds, that will be borne out with a healthier, more secure population living longer lives with better financial futures.
In a way, it is the latter that worries some Republicans most — that the law will succeed over their Chicken Little, sky-is-falling naysaying. They need the law to fail to validate their enmity.

Don’t give up on the uninsured


By , Published: October 23


Obamacare is working.
True, that sentence comes with a large asterisk. It is working in states that have followed the essential design of the Affordable Care Act, particularly in Kentucky, Connecticut, Washington and California. The law was written with states’ rights and state responsibilities in mind. States that created their own health-care exchanges — and especially those that did this while also expanding Medicaid coverage — are providing insurance to tens of thousands of happy customers, in many cases for the first time.
Those seeking a model for how the law is supposed to operate should look to Kentucky. Gov. Steve Beshear , a Democrat in a red state, has embraced with evangelical fervor the cause of covering 640,000 uninsured Kentuckians. Check out the Web site — yes, a Web site — for regular updates on how things are going there.
“We’re signing up people at the rate of a thousand a day,” Beshear said in a telephone interview. “It just shows the pent-up demand that’s out there.”
Beshear urges us to keep our eyes on the interests of those the law is intended to serve, our uninsured fellow citizens. “These 640,000 people are not some set of aliens,” he says. “They’re our friends and neighbors. . . . Some of them are members of our families.” As for the troubled national Web site, Beshear offered this: “If I could give unsolicited advice to the critics, and maybe to the media, it’s: Take a deep breath.”
Wise counsel. But there can be no denying the system failure that is a profound embarrassment to the Obama administration and threatens to undermine all the good the law could do, since its enemies will use any excuse to discredit it.
Much is inexplicable about how the administration blew the launch. Everyone involved knew that this is President Obama’s signature achievement. Everyone knew that the repeal crowd would pounce on any difficulty, let alone a massive set of technical problems so easy to mock in an age when everyone has views as to what an online experience should be like. Everyone knew going in that this was a complicated endeavor. It is very hard to understand how the officials in charge could risk ignoring the red flags they apparently saw before the site went live.

Wonkbook: The GOP’s Obamacare chutzpah

By Ezra Klein and Evan Soltas, Published: October 24 at 8:40 am
The classic definition of chutzpah is the child who kills his parents and then asks for leniency because he's an orphan. But in recent weeks, we've begun to see the Washington definition: A party that does everything possible to sabotage a law and then professes fury when the law's launch is rocky.
On Tuesday, Rep. Paul Ryan became the latest Republicans to call for HHS Secretary Kathleen Sebelius to step down because of the Affordable Care Act's troubled launch. "I do believe people should be held accountable," he said.
Okay then.
How about House Republicans who refused to appropriate the money the Department of Health and Human Services said it needed to properly implement Obamacare?
How about Senate Republicans who tried to intimidate Sebelius out of using existing HHS funds to implement Obamacare? "Would you describe the authority under which you believe you have the ability to conduct such transfers?" Sen. Orrin Hatch demanded at one hearing. It's difficult to imagine the size of the disaster if Sebelius hadn't moved those funds.
How about congressional Republicans who refuse to permit the packages of technical fixes and tweaks that laws of this size routinely require?
How about Republican governors who told the Obama administration they absolutely had to be left to build their own health-care exchanges -- you'll remember that the House Democrats' health-care plan included a single, national exchange -- and then refused to build, leaving the construction of 34 insurance marketplaces up to HHS?
How about the coordinated Republican effort to get the law declared unconstitutional -- an effort that ultimately failed, but that stalled implementation as government and industry waited for the uncertainty to resolve?
How about the dozens of Republican governors who refused to take federal dollars to expand Medicaid, leaving about 5.5 million low-income people who'd be eligible for free, federally-funded government insurance to slip through the cracks?
The GOP's strategy hasn't just tried to win elections and repeal Obamacare. They've actively sought to sabotage the implementation of the law. They intimidated the people who were implementing the law. They made clear that problems would be exploited rather than fixed. A few weeks ago, they literally shut down the government because they refused to pass a funding bill that contiained money for Obamacare.
The Obama administration deserves all the criticism it's getting for the poor start of health law and more. Their job was to implement the law effectively -- even if Republicans were standing in their way. So far, it's clear that they weren't able to smoothly surmount both the complexities of the law and the political roadblocks thrown in their path. Who President Obama will ultimately hold accountable -- if anyone -- for the failed launch is an interesting question.
But the GOP's complaints that their plan to undermine the law worked too well and someone has to pay border on the comic. If Republicans believe Sebelius is truly to blame for the law's poor launch, they should be pinning a medal on her.

Dana Milbank: Republicans need a new song


By , Published: October 23


Republicans’ efforts to amputate Obamacare, and the resulting federal government shutdown, brought the party to all-time lows in polls. So House Republican leaders surrendered, went home, took a few days to think it over, and returned to Washington saying . . . the same things that got them into trouble in the first place.
Speaker John Boehner (Ohio) met with his House GOP caucus Wednesday morning for the first time since last week’s collapse, then walked into the Republican National Committee’s headquarters to announce his plans to the assembled press corps. From the time he uttered a cheery “Good morning, everyone,” it took only 18 seconds before he announced, “We’ve got the whole threat of Obamacare continuing to hang over our economy like a wet blanket.”
Majority Leader Eric Cantor (Va.) went straight from “Good morning” to “The rollout of Obamacare is nothing short of a debacle.”
Majority Whip Kevin McCarthy (Calif.) didn’t even say good morning, launching right into, “It’s another day and a new glitch for the Obamacare rollout.”
The House Republican conference chairman, Cathy McMorris Rodgers (Wash.), informed reporters that Republicans had gone to the trouble of creating a new Web site where people can describe their troubles with the new health-care law. Her deputy, Lynn Jenkins, tried to retell a Conan O’Brien joke about Obamacare; nobody laughed. And Rep. Tim Murphy (Pa.) announced yet another committee investigation of — you guessed it — Obamacare.
Okay, okay, we get it: Republicans (still) don’t like the health-care law. But can’t they talk about anything else? “We know what happened with the effort to defund Obamacare,” Jennifer Steinhauer of the New York Times pointed out. “Do you think you have a better environment to do something? And what is the specific legislative strategy at this point?”
The “biggest part,” Boehner replied, will be oversight. “When it comes to Obamacare, clearly there’s an awful lot that needs to be held accountable.”
Great. Fresh from a shutdown and almost a default over Obamacare, House Republicans’ new legislative strategy is to investigate Obamacare. Is it any wonder this Congress, and congressional Republicans in particular, is held in such low public esteem?

Obama allies join in criticism of healthcare website

Even Democrats who support Obamacare suggest that parts may need to be postponed if changes aren't made quickly. Some call on President Obama to hold people accountable for the problems.

By Lisa Mascaro and Christi Parsons
5:25 PM PDT, October 23, 2013
advertisement
WASHINGTON — The rocky rollout of the Affordable Care Act again came under sharp criticism Wednesday, three weeks into the launch, but this time some of the loudest voices were among top Democrats, including President Obama's closest allies.
Democrats on Capitol Hill said they were unhappy with the performance of the Obamacare website, which has been plagued with problems since its debut Oct. 1. Even the president's longtime campaign guru, David Axelrod, was critical of the administration's handling of the issue.
"This has been shrouded in a little bit of mystery. I don't quite understand why that is," Axelrod said in an MSNBC interview this week. He added that if he were at the White House, he would be "very, very tough on the people who are responsible."
Even those who support the new healthcare law — and its promise of providing affordable insurance coverage to millions of Americans — suggested that aspects of it may need to be postponed unless changes can be put into place quickly. Some were calling on Obama to hold people accountable for the mistakes.
"Somebody's got to man up here — get rid of these people," said Rep. Rick Nolan (D-Minn.), who stopped short of calling for the ouster of any specific administration official or contractor but characterized the president's response to the rollout as "weak."
"There are people like myself who supported the Affordable Care Act, but I'm not oblivious to the fact that this layout has done harm and damage to the brand," Nolan said.
Democratic Party leaders also suggested that heads should roll, even while maintaining strong support for Obamacare.
"I absolutely believe that somebody should be held accountable," said Rep. Xavier Becerra (D-Los Angeles), the No. 4 Democrat in the House.
Becerra called website problems disturbing, but said, "I think it's even more disturbing when individuals intentionally work against the American people and the rights that they have now secured to access quality, affordable healthcare."
Health and Human Services Secretary Kathleen Sebelius, in an interview on CNN late Tuesday, would not say whether she and the president had discussed the possibility of her stepping down.
"I think my job is to get this fully implemented and to get the website working right," she said. "And that's really what I'm focused on."
http://www.latimes.com/nation/la-na-healthcare-website-20131024,0,3581716,print.story

Obamacare hearings: Oversight or heckling?
By: David Nather
October 24, 2013 05:00 AM EDT
There’s congressional oversight that answers everyone’s most urgent questions — and then there’s just heckling from the partisan peanut gallery.
Over the next few weeks, Republicans are going to have to decide which path they’re going to take as they open hearings into the broken Obamacare website.
There’s a wealth of real questions to be answered at the hearings, starting with Thursday’s testimony by a group of contractors that worked on the website. What, exactly, went wrong with the development of the federal health insurance exchange? Who dropped the ball? And can it actually be patched up on the fly?
(Understanding Obamacare: A guide to the ACA)
Those are the most urgent questions that will be on lawmakers’ minds at the House Energy & Commerce Committee hearing Thursday and the others that will follow. The problem is, the hearings will be run by the same House Republicans who don’t even want the law in the first place, and have gone through 40-plus repeal votes and a politically disastrous government shutdown to prove it.
So Republicans have a lot to prove in the hearings. They can use the investigative powers of Congress pry out the answers to the serious questions that everyone has about the website — Democrats as well as Republicans — and repair their standing with the public by showing how thoughtful oversight ought to be done.
Or they can spend the whole time yelling, “BOOOOO! This is never going to work.”
(PHOTOS: HealthCare.gov: 10 quotes from Kathleen Sebelius)
Top Republicans insist they can keep the hearings on the correct side of the line. They say they can stick to a just-the-facts approach and focus on issues that all Americans should be concerned about — especially whether $400 million of taxpayers’ money was wasted in building an Obamacare website that’s mostly unworkable.
“This is a hearing where we don’t have the answers. We’re going to handle this in a very deliberative way,” Rep. Tim Murphy of Pennsylvania, chairman of the Energy & Commerce oversight subcommittee, said of Thursday’s hearing. “Is it fixable, and if not, should we put a pause on this ‘tech surge’? Are we going to spend hundreds of millions more on this, just to overhaul the engine of a car that’s still moving?”
“Every time we asked [the administration] for details, they said, ‘Don’t worry,’” Murphy told POLITICO. “My concern is that they weren’t upfront with us. Either they didn’t have any way to get the information, or they weren’t going to tell us. I don’t know which it was.”
(WATCH: 7 quotes on Obamacare glitches)
Experts on oversight say there’s no way Congress could avoid having these hearings. Even if Republicans really just want to repeal the law, the website is still “a problem that needs to be fixed,” said Angela Canterbury, director of public policy at the Project on Government Oversight, which conducts seminars for congressional aides on how to do investigations.
http://dyn.politico.com/printstory.cfm?uuid=58D081BE-79B0-405A-AC00-8A634C92B8E9

Let Mainers sign up for health insurance on our website, insurer says

That would help people avoid the troubled federal site, the company says, as it awaits a response from the U.S.

By Joe Lawlor jlawlor@pressherald.com
Staff Writer
One of the two companies in Maine that are selling health insurance in the federal marketplace created by the Affordable Care Act is asking the Obama administration for permission to let consumers bypass the government’s snarled website and enroll directly on the company’s site.
Maine Community Health Options is still awaiting a response from the U.S. Department of Health and Human Services, said company president Kevin Lewis. If the request is approved, he said, consumers interested in enrolling in one of the company’s plans will be able to sidestep healthcare.gov, which has been plagued by an array of technical problems.
“It will be a really helpful way to get people to enroll,” Lewis said Wednesday.
The other insurer selling plans through the marketplace in Maine, Anthem Blue Cross Blue Shield, did not respond to a request for comment Wednesday.
The much-maligned federal website has suffered from numerous glitches since it was launched Oct. 1, the day when individuals could start signing up for subsidized benefits that begin in 2014.
The move by Maine Community Health Options comes on the same day as the Obama administration announced that it will give Americans who buy insurance through the online exchanges an extra six weeks to obtain coverage before they incur a penalty, the Washington Post reported.
The announcement means that those who buy coverage through the exchange will have until March 31 to sign up for a plan, according to an official with the Department of Health and Human Services. The original deadline for enrollment was Feb. 15 under the first year of the Affordable Care Act.

Scammers using health-care act as tool to swindle Medicare recipients

By Steve Gilbert, The Keene Sentinel
Posted Oct. 24, 2013, at 7:33 a.m.
Al Kulas, the longtime weekend morning host on WKBK radio in Keene, thought the phone call was legitimate at first.
A representative purportedly from Medicare called him at his Winchester home early Wednesday afternoon, saying Kulas needed to update his Medicare card as required in the Affordable Care Act. Kulas’ caller ID showed it was coming from a 617 area code (Boston), and the voice sounded professional enough.
The caller asked for his name, mailing address, phone number. Then he asked Kulas for his Social Security number and bank account information.
“I’ll tell you what, I almost got sucked into it,” Kulas said. “All of a sudden I said, ‘Wait a minute,’ and I asked for a manager.”
Another voice came on the phone, then another, trying to cajole Kulas into giving up the information. By then he was well aware it was a scam, hung up, and later learned that the number appearing on his caller ID was out of service.
Such scams are becoming more and more prevalent, especially against senior citizens, said FairPoint Communications spokesman Jeff Nevins. What happened to Kulas is typical, he said, except many people fall for it and lose thousands of dollars. The new health care law is just one of many ploys scammers are using to pry credit card and bank account information out of people.
Kulas immediately called FairPoint’s security division, where an investigator took his information. The investigator said company policy forbids her to talk publicly, but she confirmed that Kulas’ account follows a scammer’s playbook. She added the phone call may have originated from India.
But Kulas didn’t stop there. He also called Medicare’s fraud division and the Inspector General’s Office in the U.S. Department of Health and Human Services to file a formal complaint.
A spokesman in the Inspector General’s Office said the health care law has become a primary target for scammers through sham websites, people asking for money beforehand to enroll in the marketplace and mail and email solicitations.
Nevins said it’s important to know Medicare representatives will never call an individual randomly unless the individual has called first. And the health care law has no effect on Medicare.
Kulas said he knows scammers prey on confusion and the unknown among senior citizens.

Hospital safety group ranks Maine first in the nation

By Jackie Farwell, BDN Staff
Posted Oct. 23, 2013, at 2:31 p.m.
A national hospital watchdog group has again ranked Maine’s hospitals the safest in the country.
Eighty percent, or 16 out of 20, Maine hospitals earned an “A” in the Hospital Safety Score ratings released Wednesday by the Leapfrog Group, a national patient safety organization.
Maine edged out Massachusetts for the No. 1 spot. Maine also topped the list earlier this year, when the rankings were last updated in May.
The letter grades reflect the risk that a patient could be harmed by a preventable medical error while hospitalized. Leapfrog, a nonprofit funded by employers, assigns A, B, C, D and F grades to more than 2,500 U.S. hospitals.
Leapfrog urged patients to use the rankings to protect themselves from errors, accidents, injuries and infections at hospitals. Up to 440,000 Americans die annually from preventable hospital errors, making such errors the third leading cause of death in the U.S., Leapfrog said in a press release, citing new research published in the Journal of Patient Safety.
That figure is four times the estimate of a widely cited but dated Institute of Medicine study, which said up to 98,000 Americans die each year from preventable medical errors.
“We are burying a population the size of Miami every year from medical errors that can be prevented,” Leah Binder, Leapfrog’s president and CEO, said in a press release announcing the new scores. “A number of hospitals have improved by one or even two grades, indicating hospitals are taking steps toward safer practices, but these efforts aren’t enough.”
On average, hospitals nationally showed no improvement in their performance on the 28 patient safety measures included in the score. The exception was hospital adoption of computerized physician order entry, in which health practitioners electronically enter instructions for patients’ treatment.
Leapfrog assesses public data on measures including falls, bed sores and how consistently hospitals follow recommended treatment protocols, such as administering antibiotics to patients within an hour before surgery.
Two new measures were added to the scores this fall: catheter-associated urinary tract infections and surgical site infections after major colon procedures.
Leapfrog rates only general hospitals. Specialty hospitals, such as cancer centers, and critical access hospitals, which serve rural areas, are not included.
In Maine, three hospitals saw their grades drop from this spring, while two moved up in the rankings.
MaineGeneral’s Augusta campus dropped from a B to a C, while its Waterville campus fell from an A to a C. St. Joseph Hospital in Bangor earned a C, a downgrade from an A in the May rankings.
Franklin Memorial Hospital in Farmington improved from a B to an A, while York Hospital moved up to an A from a C.
All the other Maine hospitals graded earned A’s.
“We’re most pleased with the consistency of the reviews of our hospitals’ high quality care,” Jeff Austin, vice president of government affairs and communications for the Maine Hospital Association, said in an email.
Austin credited frontline caregivers and added that the quality division of the federal Centers for Medicare and Medicaid Services also ranked hospital care in Maine the best in the country.
“Never-ending state and federal cuts imperil this success,” he wrote.


N. New England Telemedicine System Hits Milestone
10/24/2013 10:14 AM ET  
The Bangor-based New England Telehealth Consortium says it has now connected 200 facilities, marking the halfway point toward the 400 or so facilities in the consortium.
BANGOR, Maine (AP) _ A consortium that is electronically linking rural and urban health care facilities across Maine, New Hampshire and Vermont has hit a milestone.

The Bangor-based New England Telehealth Consortium says it has now connected 200 facilities, marking the halfway point toward the 400 or so facilities in the consortium.

The consortium is creating a broadband network connecting hospitals, community health centers and other facilities in primarily rural locations so they can share medical information and consult over the Internet.

Jim Rogers, founder of the consortium and president of the company managing the network's implementation, says the system improves health care capabilities in northern New England while cutting costs.

FairPoint Communications has upgraded and continues to build out its broadband system to provide the telemedicine services to the health care facilities.


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