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 US debt default.
They pillory administration officials at Capitol Hill hearings. They cite the millions of people getting dropped by insurers despite President Obama’s promise that it would not happen. They harp on the program’s flawed enrollment process.
Now they are relishing Obama’s apology to those who are losing health insurance plans he had repeatedly said they could keep.
‘‘If the president is truly sorry for breaking his promises to the American people, he’ll do more than just issue a halfhearted apology on TV,’’ Senate’s minority leader Mitch McConnell of Kentucky said in a statement.
Republicans once pinned their health care criticisms largely on computer glitches in the application and enrollment process. Today, they are accusing Obama and congressional Democrats of much worse, including deceit and incompetence.
Conservative groups are pouring money into ad campaigns reminding voters that many Democrats had promised Americans they could keep their current insurance policies if they wanted. In particular, Republicans hope these efforts will help them with women, who tend to vote Democratic and often make health care decisions for their families and in-laws.
In the 2014 elections, ‘‘this is going to be a big issue, and it’s not going away,’’ said Daniel Scarpinato of the National Republican Congressional Committee. ‘‘Democrats who voted for Obamacare,’’ he said, ‘‘are pretty desperately running around with their hair on fire, trying to distance themselves, which they’re not going to be able to do.’

A Senate Democrat Takes On Party Leaders in Pursuit of a Middle Ground

By 

WASHINGTON — In late August, Senate Democrats gathered on a conference call with President Obama’s national security adviser, Susan E. Rice, to hear why the administration had to respond militarily to a chemical weapons attack by the Syrian government.
Senator Joe Manchin III of West Virginia hung up, took a phone call from another red-state Democrat, Heidi Heitkamp of North Dakota, and together they rejected their president’s reasoning. Within days, they were circulating new language calling for a diplomatic solution. Republicans joined the effort, Secretary of State John Kerry seemed to endorse the approach, and with the American public dubious about intervention, the drive toward a military strike fizzled.
It has been that way all year for Mr. Manchin, a centrist Democrat from an increasingly Republican state who has shown an impulsive, almost reflexive, willingness to reject the position of his leaders and try to entice fellow senators to a middle ground. Now he is trying to delay parts of the new health care law, the latest effort by Mr. Manchin, a former governor and the grandson of an Italian immigrant, to engage on virtually every issue flaring up on Capitol Hill, just as he did in West Virginia.
“There wasn’t anything going on in any part of the state that he wasn’t involved in,” said State Senator Jack Yost, a Democrat who had his share of clashes with a governor more inclined to bipartisanship than some in his party always liked. “It doesn’t surprise me that he has his hands in everything there, too.”
As he nears the three-year mark in the Senate, Mr. Manchin has found himself sometimes on the president’s side, and sometimes a thorn in his side. In a state where Mr. Obama got just 36 percent of the vote in 2012, that is just fine, said Gil White, who served in the West Virginia Legislature for 14 years as a Republican before working for the governor as his chief legislative liaison.
“I don’t think that Joe has anything to worry about regarding his West Virginia base,” Mr. White said.
Mr. Manchin’s latest gambit — to delay key parts of the president’s health care law and force significant changes to its carrying out — may prove his most significant so far.

Why the silence from the sponsors of the superior Full Medicare for All?

By Ralph Nader 
The Nader Page, Nov. 1, 2013
With the Tea Partiers relentless attacks on each of the troubles besetting Obamacare since its complicated, computer glitch-ridden startup on October 1, 2013, the compelling question is: Why aren’t the Congressional sponsors of H.R. 676 – full Medicare for all with free choice of physician and hospital – speaking out as strongly on behalf of this far superior universal health care coverage?
There are fifty-one members of the House who openly favor the single-payer solution for many good reasons. Legislators behind H.R. 676, such as Reps. Robert Brady (D-PA), Michael Capuano (D-MA), Donna Christensen (D-VI), Judy Chu (D-CA), Yvette Clarke (D-NY), Wm. Lacy Clay (D-MO), Steve Cohen (D-TN), Elijah Cummings (D-MD) and Danny Davis (D-IL) know that single-payer insurance with private delivery is by far more efficient, saving $400 billion a year just on administrative simplification.
Physician, scholar and advocate, Steffie Woolhandler, co-founder of Physicians for a National Health Program (PNHP) says that, “complexity is baked into Obamacare.” What does “complexity” mean beyond thousands of pages of legislation and many more pages of regulations? Over forty years ago, Canada’s single-payer system was enacted with a 13 page bill that covers everyone for less than half of the cost per capita than the U.S.’s waste-ridden, profiteering, corrupt medical-industrial complex that drives honest practitioners up the wall. And, the Canadian system produces better health outcomes at this reduced cost.
Unfortunately complexity means endless opportunities for insurance companies to game the system with fine print, tricks, confusing pricing and lobbying to get out of requirements and standards through waivers. Complexity means ongoing confusion for consumers and patients who go into these exchanges, either because they’ve been thrown out of their existing but substandard insurance policies or do not have any insurance.
Every year, these same consumers have to figure out whether their income has changed enough so that they can report any difference to get a higher or lower subsidy.

The Coverage Gap: The Real Failure of Obamacare
Right now, the corporate media are focused like a laser on the “scandal” of the malfunctioning of the national health insurance exchange website. Although these glitches reflect negatively on the Obama administration, they are technical problems that will be fixed. They have nothing to do with the substance of the law. A more important failure is the number of people, particularly poor people, who will remain uninsured after the Affordable Care Act (ACA) is implemented. This is not the fault of the act as written, but is the result of the Supreme Court decision on its constitutionality and intractable opposition from Republican politicians.

An October study by the Kaiser Family Foundation (KFF) estimates that 5.2 million non-elderly adults living below the federal poverty level (FPL) will remain uninsured in 2014 because they live in the 26 states that—at the time of the study—had declined to participate in the Medicaid expansion. These states are concentrated in the South and West and are controlled largely by Republican governors and legislatures. About half of Americans, but 58% of America's uninsured working poor, live in those states. Pennsylvania is among them. Our Medicaid expansion status is uncertain, but even if the Corbett administration reaches agreement with the federal government on an expansion plan, it is unlikely to be implemented in 2014.

To review, of the approximately 30 million people who were expected to be insured for the first time under the ACA, fully half of them—the poorest half—were to be insured through Medicaid expansion. Traditional Medicaid is jointly administered by the state and federal governments. Federal law requires that all children be covered if their family makes less than the FPL. Children under six are covered up to 133% of FPL. The eligibility rules for adults are determined by the states. In most states, adults without children don't qualify no matter how poor they are. The income level at which parents with dependent children qualify for Medicaid varies from a low of about 20% of FPL in the least generous states to a high of 133% is the most generous states. (In Pennsylvania, it is 46%.)

Conceptualizing Health Care Policy

Mike Konczal has written an important article in which he asks: (1) What parts the Affordable Care Act (ACA) are not working well, and why?, and (2) What does this imply about future developments in health care policy? Will government abandon the effort to provide health care for all, or will we move toward a single-payer system?

Paul Krugman has described the ACA as a “kludge.” It is too complicated, and those complications are making the system inefficient and expensive, while depriving many Americans of health insurance. Konczal notes four specific problems:
  1. The process of signing up for health insurance in the federal exchange (HealthCare.gov) is complicated because everyone must be means tested. The government must be able to confirm virtually every datum the applicants enter: their identity, their citizenship, their income, their eligibility for coverage through other federal or state programs, etc. All this is necessary to determine whether each applicant is entitled to a subsidy, and if so, the amount.
  2. A further complication is that each applicant must be matched to a private insurer. The government must check that all of the thousands of insurance plans meet their minimum standards. They must clearly communicate the important characteristics of each policy to consumers, even though the insurance companies deliberately try to confuse them. They must contend with insurance company sabotage such as canceling plans abruptly and arbitrarily raising rates.
  3. The ACA faces the threat of adverse selection—the possibility that the oldest and sickest among us will patiently navigate the exchange and eventually purchase a policy, while the youngest and healthiest will ignore the law and hope the penalty for not buying insurance is unenforceable. If Americans in poor health are more likely to buy insurance, the costs go up and there is a very real possibility that the system will collapse.
  4. Finally, the federal government has to deal with attempted sabotage by states controlled by Republican governors and legislatures, exemplified by their refusal to set up state exchanges and to participate in Medicaid expansion, which is denying coverage to over 5 million low income Americans.

A Clouded Vision, Part 1: The Stick

With his reelection campaign coming up next year, PA Governor Tom Corbett is apparently no longer able to resist the pressure to accept Medicaid expansion under the Affordable Care Act (ACA). Yesterday he unveiled the bare bones of a plan to expand Medicaid, while claiming that he is not. The plan lacks critical details and leaves many questions unanswered. It has not yet been accepted by the Obama administration, and should they not agree to it, it would fall through. It has, however, been endorsed by two powerful health care lobbies, the Pennsylvania Medical Society and the Hospital and Health System Association of Pennsylvania.

The plan is called “Healthy Pennsylvania,” and is described in official propaganda as “Governor Corbett's vision” for Pennsylvania. Much of the plan is empty rhetoric, referring to health care policies that are already in place, or new initiatives that appear not to be accompanied by any proposed legislation. Some of the new initiatives—such as “reform” of the medical liability system—are not good ideas, but I'll save that argument for another day. Of the four documents the Corbett administration has released, those parts of the plan that refer to Medicaid reform or expansion are described most clearly in this document.

A Clouded Vision, Part 2: The Carrot

Please read Part 1 of this post.

The Carrot

If the Obama administration agrees to the Medicaid "reforms" described in Part 1, then Pennsylvania will accept its gift of virtually free money. However, there is an important catch. People who make up to 133% of the Federal Poverty Level (FPL) will be given this money to purchase private insurance policies through the national health insurance exchange. (Corbett refused to establish a PA exchange, so Pennsylvanians will be using the national exchange.) This means that people who would have been eligible for Medicaid expansion under the Affordable Care Act (ACA) will now be exposed to all the disadvantages associated with the private insurance market, including copayments that are likely to be considerably higher than PA Medicaid's current copayments. An exception is made for people in this income group deemed to be “medically frail,” who will be allowed to enroll in PA Medicaid.

Fighting to Stop an Entitlement Before It Takes Hold, and Expands


By 

WASHINGTON — Underlying fierce Republican efforts to stop President Obama’s health care law and the White House drive to save it is a simple historical reality: Once major entitlement programs get underway, they quickly become embedded in American life. And then they grow.
That makes the battle over the Affordable Care Act more consequential than most Washington political fights. “If it’s in place for six months, it will be impossible to repeal it or change it in ways that significantly reduce the benefits,” said Robert D. Reischauer, a Democrat who used to lead the Congressional Budget Office.
Douglas Holtz-Eakin, another former C.B.O. director, reflects the concern of fellow Republicans in framing the stakes more dramatically. Either the law’s health insurance exchanges “can’t cut it,” he explained, or “it’s Katie, bar the door — we have an explosively growing new program.”
Ever since President Franklin D. Roosevelt’s New Deal during the Great Depression, the dominant pattern for major entitlements — the term for government assistance programs open to all who qualify and not subject to annual budget constraints — has been durability and expansion. That is the record Senator Ted Cruz of Texas refers to in warning Republicans not to allow Americans to become “hooked on the subsidies” — an argument Mr. Obama sarcastically recast as, “We’ve got to stop it before people like it too much.”
Congress enacted Social Security in 1935 to provide benefits to retired workers. In 1939, benefits were extended to their dependents and survivors. Later the program grew to provide disability coverage, cover self-employed farmers and raise benefit levels.
President Lyndon B. Johnson’s Great Society created Medicare and Medicaid in the 1960s to provide health coverage for the elderly and the poor. They followed the same pattern.
In 1972, Congress extended Medicare eligibility to those under 65 on disability and with end-stage renal disease. In 2003, Congress passed President George W. Bush’s plan to offer coverage under Medicare for prescription drugs.
Lawmakers initially linked Medicaid coverage to those receiving welfare benefits, but over time expanded eligibility to other “poverty-related groups” such as pregnant women. In 1997, President Bill Clinton signed into law the Children’s Health Insurance Program, which now covers eight million children whose families’ incomes are too high to qualify for Medicaid.
“You pull more people in, and the benefits become more generous,” Mr. Holtz-Eakin said. “Congress knows how to fix an inequity — write a check.”

Obama in Bind Trying to Keep Health Law Vow

By  and 

WASHINGTON — Under intense bipartisan pressure to answer mounting consumer complaints about the botched health care rollout, White House officials are struggling to make good on President Obama’s promise that Americans can keep their insurance coverage without undermining the new health law or adding unaffordable costs.
After the president’s apology last week for wrongly assuring Americans that they could retain their health plans if they wanted, senior White House aides said the president wanted to ensure that people who were forced off older policies with less comprehensive coverage were not stuck with higher monthly premiums to replace their insurance. But administration officials declined to say how they might achieve that goal, how much it would cost or whether it would require congressional approval.
At the same time, officials signaled the president’s strong opposition to calls from across the political spectrum — including one Tuesday from a key ally, former President Bill Clinton — to support bipartisan legislation that would allow people to keep their current insurance plans even after provisions of the Affordable Care Act go into effect next year.
White House officials refused to discuss in detail what options Mr. Obama was considering. But they made clear that the president was skeptical of any solution that would allow insurance companies to continue selling what officials consider to be cheap and substandard policies.
“Broadly speaking, we do not see that as fixing the problem,” Jay Carney, the White House press secretary, said Tuesday.
The split between lawmakers and the White House reflects the dilemma the president finds himself in as he seeks to follow through on last week’s acknowledgment about his incorrect promise on health care coverage. Hundreds of thousands of people have received cancellation notices from health insurance companies because their plans do not conform with minimum standards set by the new law.
With lawmakers promoting their simple-sounding solution, the challenge for Mr. Obama is to find a workable and politically practical way to address the issue to the satisfaction of those who have lost policies.
“Any fix that would essentially open up for insurers to sell new plans that did not meet the standards would create more problems than it would fix,” Mr. Carney told reporters. It was unclear how the administration could make new plans more affordable, or whether that solution would be interpreted by Americans as keeping the promise that the president made in selling the health care law. Republicans in Congress would be certain to oppose efforts by the White House to expand subsidies.
The idea of passing legislation to allow all Americans to keep their coverage got a fresh boost on Tuesday when Mr. Clinton added his voice to the debate. In an interview, Mr. Clinton joined the intensifying criticism of the health care rollout and called on Mr. Obama to accept a change in the health care law that would allow insurance companies to keep selling policies that do not meet the new standards.

Why Some People Can’t Keep Their Insurance Plans

Despite repeated assertions by President Obama that people who like their health insurance will be able to keep it under the new health care law, many people who bought insurance on their own — a small fraction of the insurance market — will have to buy new plans.

http://www.nytimes.com/interactive/2013/10/30/us/why-some-people-cant-keep-their-insurance-plans.html?ref=us

When Healers Get Too Friendly

By ABIGAIL ZUGER, M.D.
It takes only a moment to step over the line, especially when no one knows exactly where the line is. In my case, it started with a visit from my old friend the activist.
The activist became my patient back in the mid-1990s, when H.I.V. was slowly morphing into a treatable disease. He was young then, with a mop of dark curls — excitable, suspicious and frantic about his health. He was convinced the new drugs were pure synthetic poison, a profiteering scam by the government and Big Pharma. He was also feeling sick enough that he thought he might just give them a try.
He lurched back and forth between these two incompatible positions once or twice a month, dragging me and my prescription pad behind him in a flurry of abandoned amber plastic bottles. Eventually, though, good sense kicked in and he had to admit that on meds he felt a lot better than otherwise. He managed to retain his contempt for the system while regularly filling his prescriptions. I no longer winced at his name on my schedule.
And now it is suddenly decades later, his H.I.V. has long been perfectly controlled, and he is still fomenting revolution. He used to march and holler; now he works social media with a miserable old desktop computer that keeps breaking down.
As it happens, about a week before one of our infrequent appointments — he barely needs me any more — I had treated myself to a brand new laptop, sending an old perfectly good model into the back of the closet.
Of course I wiped its hard drive clean and gave it to him — for he is my old friend. But (also of course) we met furtively in a back corridor and I carefully concealed the contraband in a nest of old grocery bags — for he is my patient, and gifts to patients …well, we don’t usually do that.
Once again, apparently, we were dealing with two incompatible positions. Everyone knows that professional boundaries guide all medical activity in hospital, office and clinic. But aside from indisputable sexual and financial depredations, no one agrees exactly where these boundaries lie.
Kindness to friend and duty to patient: Are they one and the same? Or separated by a barbed-wire fence? Opinion is all over the map.

Officials Say They Don’t Know Cost of Health Website Fixes


By  and 

WASHINGTON — Obama administration officials working on the federal health insurance website were unable to tell Congress during a hearing on Wednesday how much it would cost to fix the site, a pillar of President Obama’s plan to provide affordable coverage to millions of Americans.
The administration has spent more than $600 million on the troubled website, HealthCare.gov, and is racing to meet a self-imposed Nov. 30 deadline for repairs.
Todd Park, Mr. Obama’s chief technology adviser; Henry Chao, the chief digital architect of the website; and Steven VanRoekel, the chief information officer for the federal government, could not answer questions about the cost of repairing the site, which has been plagued with scores of software and hardware problems since it opened on Oct. 1.
The questions came from Representative John J. Duncan Jr., Republican of Tennessee, at a hearing of the House Committee on Oversight and Government Reform.
Many questions focused on website procedures that required consumers to create password-protected accounts before they could see the exact cost of health plans for which they were eligible.
Mr. Chao rebuffed Republican suggestions that the administration had blocked “anonymous shopping” because it feared consumers would be alarmed if they saw the full unsubsidized prices of insurance policies.
In fact, Mr. Chao said, federal officials blocked the “anonymous shopping” function because it had failed tests.
“It failed so miserably” that consumers could not use it, Mr. Chao said.
Mr. Park acknowledged that millions of Americans had been frustrated trying to use the site.
“These problems are unacceptable,” Mr. Park said. “The website is getting better each week, as we work to improve its performance, its stability and its functionality. As a result, more and more individuals are successfully creating accounts, logging in, and moving on to apply for coverage and shop for plans.”
The chairman of the oversight committee, Representative Darrell Issa, Republican of California, denounced the administration’s decision to go forward on Oct. 1.
“This was a monumental mistake to go live and effectively explode on the launchpad,” Mr. Issa said.

Johnson & Johnson Said to Agree to $4 Billion Settlement Over Hip Implants

By 

Johnson & Johnson has tentatively agreed to a settlement that could reach up to $4 billion to resolve thousands of lawsuits filed by patients injured by a flawed all-metal replacement hip, said two lawyers briefed on the plan.
The tentative plan, which must win court approval, represents one of the largest payouts for product liability claims involving a medical device.
A spokeswoman for the company’s DePuy Orthopaedics unit declined to comment on the possibility of a settlement. An announcement about the plan is expected in the coming days, the lawyers said.
The agreement will include those patients who have already been forced to have the device, known as the Articular Surface Replacement, or A.S.R., removed and replaced with another artificial hip, said the lawyers who spoke about the agreement only on the condition of anonymity.
Under the deal, each patient would receive about $350,000 on average in compensation, though that figure will vary depending on factors like a patient’s age and medical condition.
The precise value of the settlement is unclear because lawyers for patients are still trying to estimate how many of the 12,000 related lawsuits involve patients who had a replacement. Lawyers believe that number may be 7,000 to 8,000 cases.
The final cost of the deal to Johnson & Johnson could rise, depending on how many claimants who received the device undergo replacement operations in the future, the lawyers said. Under the plan, patients who have not had a replacement would not receive compensation, the lawyers said.
The A.S.R. hip was sold by DePuy until mid-2010, when the company recalled it amid sharply rising early failure rates. The device, which had a metal ball and a metal cup, sheds metallic debris as it wears, generating particles that have damaged tissue in some patients or caused crippling injuries.

Experts Reshape Treatment Guide for Cholesterol

By 

The nation’s leading heart organizations released new guidelines on Tuesday that will fundamentally reshape the use of cholesterol-lowering statin medicines, which are now prescribed for a quarter of Americans over 40. Patients on statins will no longer need to lower their cholesterol levels to specific numerical targets monitored by regular blood tests, as has been recommended for decades. Simply taking the right dose of a statin will be sufficient, the guidelines say.
The new approach divides people needing treatment into two broad risk categories. Those at high risk because, for example, they have diabetes or have had a heart attack should take a statin except in rare cases. People with extremely high levels of the harmful cholesterol known as LDL — 190 or higher — should also be prescribed statins. In the past, people in these categories would also have been told to get their LDL down to 70, something no longer required.
Everyone else should be considered for a statin if his or her risk of a heart attack or stroke in the next 10 years is at least 7.5 percent. Doctors are advised to use a new risk calculator that factors in blood pressure, age and total cholesterol levels, among other things.
“Now one in four Americans over 40 will be saying, ‘Should I be taking this anymore?' ” said Dr. Harlan M. Krumholz, a cardiologist and professor of medicine at Yale who was not on the guidelines committee.
The new guidelines, formulated by the American Heart Association and the American College of Cardiology and based on a four-year review of the evidence, simplify the current complex, five-step process for evaluating who needs to take statins. In a significant departure, the new method also counts strokes as well as heart attacks in its risk calculations, a step that will probably make some additional people candidates for the drugs.
It is not clear whether more or fewer people will end up taking the drugs under the new guidelines, experts said. Many women and African-Americans, who have a higher-than-average risk of stroke, may find themselves candidates for treatment, but others taking statins only to lower LDL cholesterol to target levels may no longer need them.
3 Things to Know About the New Cholesterol Guidelines
By HARLAN M. KRUMHOLZ, M.D.
The American College of Cardiology and the American Heart Association just released new cholesterol guidelines to reduce atherosclerotic cardiovascular risk –- and the change from the previous version, last updated in 2004, is profound. Here are three things you need to know about these new guidelines.
First, the guidelines have moved away from achieving target cholesterol levels.
Americans have long been urged to focus on their laboratory numbers. Many people are obsessive about checking their cholesterol levels and pursuing even better numbers. Doctors have been told to focus on these numbers and, in some cases, the quality of their care was assessed by the percentage of their patients with low cholesterol levels.
Those days are over. The new guidelines recognize that for patients who have exhausted lifestyle efforts and are considering drug therapy, the question is not whether a drug makes your lab tests better, but whether it lowers your risk of heart disease and stroke. Studies over the past several years have shown that improving your lab profile with drugs is not equivalent to lowering your heart risks. Drugs have thousands of effects on the body, and a drug’s effect on an individual lab test cannot necessarily predict its overall effect on you.
Importantly, the guidelines still state that cholesterol is important. But the point is that changing your cholesterol level with medications is now accompanied with the appreciation that other effects of the drugs may offset any benefit to reducing cholesterol.
There’s one exception to the numbers rule. People with very high levels of the harmful cholesterol known as LDL still need to worry about targets. The new guidelines set that LDL level at 190 milligrams per deciliter – but the principle is that if people have very high cholesterol levels, then their cardiovascular risk is so high that it is likely that treatment to reduce the levels would offset any risks of the drug treatment.
So, the new guidelines are saying: we should not be chasing the cholesterol levels alone. The “know your number” campaign is no longer consistent with the guidelines, and the days of doctors adding additional medications to get you to some arbitrary cholesterol level should no longer occur.


Insurers Press for Way Around Healthcare.gov

By ,  and 

Some major health insurers are so worried about the Obama administration’s ability to fix its troubled health care website that they are pushing the government to create a shortcut that would allow them to enroll people entitled to subsidies directly rather than through the federal system.
The idea is only one of several being discussed in a frantic effort to find a way around the technological problems that teams of experts are urgently trying to resolve.
So far, the administration has resisted the idea, partly because of concerns about giving insurance companies access to personal data. People familiar with the matter said no such modifications are planned, and even some insurers are not holding out much hope.
But senior White House officials said the administration was open to ways in which insurers could handle more enrollments and had stepped up efforts to make that possible because of the technical problems with the site.
“It was something we were always doing,” one official said, but it is “of additional value now.”
In a statement, Chris Jennings, a senior health care adviser to President Obama, said the administration was “continuing to pursue additional avenues by which people can enroll, such as direct enrollment through insurance companies, that will help meet pent-up demand.”
In proposing the idea, the insurers said a bypass giving them direct access to the federal platform that determines a consumer’s eligibility for a subsidy would alleviate the traffic on the website, healthcare.gov, and provide more breathing room to fix complicated technical problems that threaten to persist beyond a crucial, self-imposed Dec. 1 deadline.
But even if such a shortcut could be designed, federal officials are concerned about protecting personal data, such as confidential financial and tax information and immigration status. The security and privacy issues are likely to overshadow any possible compromise, according to people briefed on the discussions.

Official at Health Site Says He Didn’t Know of Potential Risk


By 

WASHINGTON — The chief digital architect for the federal health insurance marketplace has told congressional investigators that he was not aware of tests that indicated potential security flaws in the system, which opened to the public on Oct. 1.
The official, Henry Chao, made the statement Nov. 1 to investigators for the House Committee on Oversight and Government Reform, led by Representative Darrell Issa of California.
Mr. Issa, a Republican and a fierce critic of the 2010 health care law, released excerpts from the interview late Monday. Mr. Chao and other administration officials are scheduled to testify Wednesday at a committee hearing on technical problems with the website, HealthCare.gov, that have frustrated millions of Americans trying to use it.
In the interview, Mr. Chao said he had not seen a Sept. 3 memorandum describing potential security risks in the online insurance marketplace. The memo, from Tony Trenkle, the chief information officer at the federal Centers for Medicare and Medicaid Services, noted six security problems, two of which were described as posing high risks.
Mr. Chao, the deputy chief information officer at the Medicare agency, said he was surprised he had not been informed of the findings, based on tests by the Mitre Corporation, a contractor responsible for assessing the website’s security controls. The controls help prevent unauthorized access and identity theft.
On Sept. 27, Mr. Chao and another official sent a memo to the head of the agency recommending that the website go live on Oct. 1, even though security testing was “only partly completed.” At that time, he said, he was not aware of the test findings that indicated possible risks to security.

Problems With Federal Health Portal Also Stymie Medicaid Enrollment

By 

WASHINGTON — Problems with the federal health insurance website have prevented tens of thousands of low-income people from signing up for Medicaid even though they are eligible, federal and state officials say, undermining one of the chief goals of the 2010 health care law.
The website, HealthCare.gov, is primarily seen as a place to buy private insurance with federal subsidies, but it is also a gateway to Medicaid, which generally provides more benefits at less cost to consumers.
That door has been closed for the last six weeks, with the federal government unable to transfer its files to state Medicaid programs as it is supposed to do.
The delays are affecting people in 36 states that rely on the federal exchange, regardless of whether those states are expanding eligibility for Medicaid as authorized by the health care law. About half of all states have chosen to do so.
Obama administration officials once envisioned a seamless application process in which consumers would use a single form to apply for Medicaid, tax credits and theChildren’s Health Insurance Program, and most eligibility decisions would be made instantaneously. Under rules issued last year by Kathleen Sebelius, the secretary of health and human services, an exchange must transfer information to Medicaid “promptly and without undue delay,” using a “secure electronic interface.”
The administration is not meeting its own standards.
Marilyn B. Tavenner, the administrator of the Centers for Medicare and Medicaid Services, who oversaw the creation of the troubled federal website, said she decided in September to delay the Medicaid transfers so technicians could “spend more time concentrating on the application process” and other priorities.
The White House has not released enrollment data, but some states running their own exchanges, like Kentucky, Minnesota and Washington, say more people have signed up for Medicaid than for private insurance.
The Obama administration has adopted what it calls a “no wrong door” policy: If a person files an application with the exchange for private insurance but appears to be eligible for Medicaid, the exchange will automatically transfer the full application to the state Medicaid agency, and vice versa.

No Health Insurance? Just Drink.

By JULIET LAPIDOS
This is the strangest P.R. campaign yet against the Affordable Care Act. Generation Opportunity, the Koch-funded group behind the Creepy Uncle Sam ads, is throwing tailgate parties to “educate” young people about the exchanges. Read: To convince young people to forgo health insurance.
The group’s communication director, David Pasch, wrote an email to The Tampa Bay Times describing a drunken event at Saturday’s University of Miami-Virginia Tech football game:
“We rolled in with a fleet of Hummers, F-150’s and Suburbans, each vehicle equipped with an 8’ high balloon bouquet floating overhead. We hired a popular student DJ from UMiami (DJ Joey), set up OptOut cornhole sets, beer pong tables, bought 75 pizzas, and hired 8 ‘brand ambassadors’ aka models with bullhorns to help out.”

Mr. Pasch specified that “student activists,” rather than anyone employed directly by Generation Opportunity, “brought (lots of) beer and liquor for consumption by those 21 and over.”
As a sort of afterthought, he added, “Oh yeah, and we educated students about their healthcare options outside the expensive and creepy Obamacare exchanges.”
According to Think Progress, this isn’t a one-time thing: “The group is touring 20 different campuses this fall in a $750,000 effort to convince college students that they’re better off being uninsured than getting health coverage through Obamacare.”
That’s a lot of money for a campaign that’s not only insanely irresponsible, but also insanely dumb. Generation Opportunity is the old guy at a house party, convinced he can win the cool kids’ respect with booze.

Palin Asked for Her Alternative to ACA; She NAILS It!

To all you haters out there:  You gotta hand it to Lady Blah-Blah.  Going on the lamestream media to face the wrath of the liberal machine, surely she knew that she was going to be asked about her plans for an alternative to the program she has been railing against for months.  And in typical Palin fashion, she studied hard and prepared a perfect response to the liberal, socialist/fascist health-care huggers.  
Just kidding.  
Warning:  you may need to play it several times to attempt to decipher the incoherent, rambling Palin gibberish session.  But as you learned in English class, the more words you use in a sentence, the more intelligent you sound.
I give you Palin, unedited.

When Doctors Share With Their Patients

By DANIELLE OFRI, M.D.
At our very first visit, I was overwhelmed by all of the issues my new patient faced. She was nearly 300 pounds and her diabetes was raging out of control. She had asthma, but smoked to ease her anxiety. Her obesity severely limited her mobility, but the constant stress in her life led her to overeat.
She had been raised in a family faced with psychiatric, medical and social challenges, and now the cycle seemed to be replicating itself. Her three children all had emotional and educational needs that required intensive services.
She couldn’t figure out how to get a handle on her life, and as her new physician, I wasn’t sure how to get a handle on it either. Should I work on her diabetes first? Her smoking? Her weight? Her asthma? Her anxiety and stress? Her life seemed frighteningly out of control. On what could we connect, I wondered?
In the middle of our visit, her cellphone rang. She glanced at the caller ID, then looked apologetically toward me. “It’s my son’s teacher,” she said.
I told her to please take the call. As a parent of three school-age children, I well understood how hard it could be to reach a teacher, and how critical such calls were.
“I know my son missed two assignments,” she said into the phone, as I scrolled through her labs. “Sometimes he’s anxious after therapy session, so I have to give him time on the playground.”
She paused and listened to the teacher. “We keep a chart,” she said, “and he gets a check for each homework he finishes.”
As she carried on the conversation, I found myself feeling more connected to her. I knew about the driving necessity of playground time. I knew about the charts and the checks required to keep children focused on their tasks. I knew the frenetic juggling required to keep up with three children and their schedules. I also knew the awkward sensation of explaining details of a life to a teacher, unsure if they will pass muster.
When she hung up the phone, she apologized for the interruption. “Don’t worry,” I reassured. “Teacher calls are important.” I was about to continue, to offer her some of our commonalities, thinking that common ground could offer us a good start on a working relationship

Sen. King recommends alternative health-care website

While consumers can’t buy coverage on TheHealthSherpa.com, they are directed to private insurance sites where they can enroll.

The Associated Press
AUGUSTA — U.S. Sen. Angus King is directing Mainers and other residents to an alternative website for viewing insurance plans under the federal health care overhaul.
The independent senator is recommending consumers use TheHealthSherpa.com while the federal website, Healthcare.gov, continues experiencing glitches.
Healthcare.gov, where consumers can go to view insurance plans and buy coverage under the Affordable Care Act, has experienced technical difficulties since its launch Oct. 1.
King says the alternative website allows consumers to compare the plans being offered in 34 states, including Maine. While residents can’t buy coverage on TheHealthSherpa.com, they are directed to private insurance sites where they can enroll.
King says it’s a temporary alternative until the federal government resolves the problems with healthcare.gov.

Health Law Enrollment Figures Far Lower Than Initial Estimates


By 

WASHINGTON — New data shows that just over 100,000 people picked health plans in the first month of open enrollment through the state and federal insurance marketplaces established by the Affordable Care Act, a figure far lower than the Obama administration initially estimated would sign up during that period.
The bulk of the new enrollees -- roughly three fourths -- signed up through the 14 state-run exchanges, according to data released by the Centers for Medicare and Medicaid Services. It said 76,391 enrolled through state marketplaces, some of which have technical problems of their own, while 26,794 signed up through the federal exchange.
Kathleen Sebelius, the secretary of health and human services, was to disclose the much-anticipated numbers during a conference call with reporters on Wednesday, after House Republicans spent the morning grilling the White House chief technology officer, Todd Park, and other administration officials about how the HealthCare.gov website went so awry, and what is being done to fix it.
The White House has spent weeks trying to lower expectations about the enrollment figures, which have set off a pitched political battle among supporters and critics of the health overhaul, each seeking political advantage in the numbers. One point of contention is around the way the Obama administration defines who, precisely, is enrolled.
The administration counts new enrollees as those who have “selected a marketplace plan.”
In explaining the relatively low enrollment figures, administration officials cite problems with the website, which have clearly prevented people from signing up.

A reversal of fortune for Democrats after Obamacare

By , Published: November 12

Two months ago, polls showed Democrat Kay Hagan leading prospective opponents by double digits in her quest for a second term representing North Carolina in the Senate.
So why is she so nervous?
Well, her problem begins with Obamacare, ends with Obamacare and has a whole lot of Obamacare in between.
Hagan hosted a conference call for reporters Tuesday morning to discuss the problems with the health-care law’s rollout, and the Q&A session was so painful that the senator should qualify for trauma coverage under the Affordable Care Act.
Fox News’s Jim Angle asked what she thought about the reports showing that only 50,000 Americans had enrolled in the health-care exchanges on HealthCare.gov.
“You know,” she replied. “I know the — I believe this coming Friday, those numbers are going to be published and uh, you know, as soon as I see them, you know, obviously it’s, it’s m-much fewer than the administration expected.”
A reporter from the Greensboro (N.C.) News & Record asked why Hagan, like President Obama, had told people that if they liked their health plans they’d be able to keep their health plans.
There was a long pause before Hagan responded, then a deep intake of breath. “You know, Doug,” she responded, “the, um” — here she exhaled and paused again — “the way these, the — the regulations and the law, uh” — pause — “came forward recently, I think people were surprised that the, uh, the — the actual original plans would be, um, would be canceled.”
Another North Carolina reporter asked Hagan what she is telling constituents whose premiums have doubled or whose plans have been canceled.
Deep inhalation. “Well, a lot of people, I, I am encouraging everybody to go on the site, uh, uh, I — look through it, find out what the benefits are,” she began. She also said constituents could call her office, “and we will certainly, uh, do what we can to help those individuals and put them in contact, uh, with the right — with the right person, and, and, and help them.”
News reports about the law in Hagan’s home state have been brutal: businesses cutting workers’ hours, 160,000 people receiving cancellation notices, hardly anybody signing up for the health-care exchange.

Under Obamacare, large companies will punish employees who don’t quit smoking, lose weight

By Kathleen Kingsbury, Reuters
Posted Nov. 13, 2013, at 7:25 a.m.
Employers tried the carrot, then a small stick. Now they are turning to bigger cudgels.
For years they encouraged workers to improve their health and productivity with free screenings, discounted gym memberships and gift cards to lose weight. More recently, a small number charged smokers slightly higher premiums to get them to quit.
Results for these plans were lackluster, and healthcare costs continued to soar. So companies are taking advantage of new rules under President Barack Obama’s healthcare overhaul in 2014 to punish smokers and overweight workers.
Some will even force employees to meet weight goals, quit smoking and provide very personal information or pay up to thousands more annually for healthcare. That could disproportionately affect the poor, who are more likely to smoke and can’t afford the higher fees.
Nearly 40 percent of large U.S. companies will use surcharges in 2014, such as higher insurance premiums or deductibles for individuals who do not complete company-set health goals, according to a survey of 892 employers released in September by human resources consultancy Towers Watson and National Business Group on Health, which represents large employers.
That is almost twice as many as the last time they did the survey in 2011, when only 19 percent of companies had such penalties. The number is expected to climb to two-thirds of employers by 2015.
Employers are getting much more aggressive about punishing workers who are overweight or have high cholesterol. A study released on Wednesday by the Obesity Action Coalition, an advocacy group, covered workers at more than 5,000 companies who must participate in their employer wellness programs to receive full health benefits. Sixty-seven percent also had to meet a weight-related health goal such as a certain body mass index.
Almost 60 percent of these workers received no coverage that paid for fitness training, dietitian counseling, obesity drugs or bariatric surgery to help achieve a body mass index under 25, which is considered healthy.
“Weight requirements are an effective way to make it harder for people with obesity to qualify for full health coverage,” said Ted Kyle, the study’s lead author and founder of Conscienhealth, a Pittsburgh-based company that advises other companies on obesity programs.
“Some programs can verge on discrimination,” he said.

Penalties hit smokers hardest

Next year many more companies plan to penalize workers who use nicotine because of their much higher healthcare costs. Proctor & Gamble Co, the Cincinnati-based household-product giant, will begin charging such employees an additional $25 per month in 2014 until they have completed a company-paid cessation program.
Under similar provisions, state employees in Wisconsin and Washington State will pay as much as $600 more per year, while nonunion smokers at United Parcel Service Inc will pay as much as $1,800.