Opinion

TMC Brief Presented by US Chamber's Global Intellectual Property Center: WH Returns to Sales Mode, Insurers are Offered Assistance for Losses

Today’s Washington Read:White House returns to Obamacare sales mode
from Politico by Carrie Budoff Brown and Jonathan AllenPresident Barack Obama will launch a coordinated campaign Tuesday by the White House, congressional Democrats and their outside allies to return attention to why the Affordable Care Act passed in first place. The White House will take the lead in emphasizing a different benefit each day until the Dec. 23 enrollment deadline for Jan. 1 coverage.
The federal HealthCare.gov enrollment portal still isn’t able to transmit completed applications to state Medicaid agencies, so the CMS is suggesting a workaround to make sure Medicaid-eligible applicants to the site get coverage that begins Jan. 1.

Today’s Business Strategy Read:

Insurers Are Offered Assistance for Losses
from New York Times by Robert Pear

The Obama administration floated several proposals on Monday to “help offset the loss in premium revenue and profit” that it said might occur if insurers went along with President Obama’s request to reinstate canceled policies. In a notice published Monday in the Federal Register, the administration acknowledged that insurers had a valid concern: They may be stuck with sicker, higher-cost customers in the new insurance exchanges because healthier Americans will stay on their existing health plans for another year.

Mark Your Calendars (All Times Eastern):
Tuesday: National summit on health care price, cost and care transparency @8am
Tuesday: Big 10/ACC College Basketball Challenge starts @715pm
Wednesday: Health Affairs briefing on future of emergency medicine @830am
Wednesday: House W&M hearing on the challenges of the ACA @10am
Wednesday: House E&C hearing on ACA’s impact to Medicare Advantage @10am
Wednesday: House Small Business hearing on ACA’s business aggregation rules @1pm
Wednesday: Big 10/ACC College Basketball Challenge continues @7pm
Thursday: Texans play at Jaguars on Thursday Night Football @825pm
Friday: House Oversight field hearing on ObamaCare implementation @10am
Friday: Alliance for Health Reform briefing on hospital observation status @1215pm

NEWS ARTICLES
1-6: General
7-9: Payers
10-11: Providers
12-14: Pharma/Biotech/Device
15-16: Health IT

OPINIONS, EDITORIALS, PERSPECTIVES
17: New York Times
18: USA Today
19: Washington Post
20: LA Times
21-22: Bloomberg
23:
Wall Street Journal

NEWS ARTICLES
General1) White House returns to Obamacare sales mode
from Politico by Carrie Budoff Brown and Jonathan AllenPresident Barack Obama will launch a coordinated campaign Tuesday by the White House, congressional Democrats and their outside allies to return attention to why the Affordable Care Act passed in first place. The White House will take the lead in emphasizing a different benefit each day until the Dec. 23 enrollment deadline for Jan. 1 coverage.
The federal HealthCare.gov enrollment portal still isn’t able to transmit completed applications to state Medicaid agencies, so the CMS is suggesting a workaround to make sure Medicaid-eligible applicants to the site get coverage that begins Jan. 1.

2) Heavy traffic on HealthCare.gov after fixes; users report mixed results on insurance site
from the Washington Post by Sarah Kliff and Lena H. Sun

The White House announced early Sunday that, given the recent improvements in the site, most HealthCare.gov shoppers should be able to have an experience like Issa’s. By 10 a.m., however, the Web site seemed to be struggling with high traffic. Federal health officials said they saw an increase in error rates and a slowdown in response times and decided to deploy “queueing” software designed to limit the number of users permitted on the site at one time.

3) Health-care enrollment on Web plagued by bugs
from Washington Post by Amy Goldstein and Juliet Eilperin

The enrollment records for a significant portion of the Americans who have chosen health plans through the online federal insurance marketplace contain errors — generated by the computer system — that mean they might not get the coverage they’re expecting next month. The errors affect roughly one-third of the people who have signed up for health plans, according to two government and health-care industry officials. The White House disputed the figure but declined to provide its own.

4) Sebelius Headed Back to Capitol Hill
from the Hill by Elise Viebeck

Health and Human Services Secretary Kathleen Sebelius will testify again before lawmakers now that the deadline for fixing HealthCare.gov has passed. She will appear before the House Energy and Commerce subcommittee on Health, led by Rep. Joe Pitts (R-Pa.), on Wednesday, Dec. 11.

5) West Wing Set for New Blood
from Wall Street Journal by Peter Nicholas and Carol E. Lee

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

6) A New Wave of Challenges to Health Law
from New York Times by Sheryl Gay Stolberg

More than a year after the Supreme Court upheld the central provision of President Obama’s health care overhaul, a fresh wave of legal challenges to the law is playing out in courtrooms as conservative critics — joined by their Republican allies on Capitol Hill — make the case that Mr. Obama has overstepped his authority in applying it. A federal judge in the District of Columbia will hear oral arguments on Tuesday in one of several cases brought by states including Indiana and Oklahoma, along with business owners and individual consumers, who say that the law does not grant the Internal Revenue Service authority to provide tax credits or subsidies to people who buy insurance through the federal exchange. At the same time, the House Judiciary Committee will convene a hearing to examine whether Mr. Obama is “rewriting his own law” by using his executive powers to alter it or delay certain provisions. The panel also will examine the legal theory behind the subsidy cases: that the I.R.S., and by extension, Mr. Obama, ignored the will of Congress, which explicitly allowed tax credits and subsidies only for those buying coverage through state exchanges.

Payers7) CMS Offers HealthCare.Gov Workaround to Enroll Medicaid Applicants
from Modern Healthcare by Virgil Dickson
As a stopgap measure for the Medicaid issue, the CMS has been sending weekly data transmissions to state Medicaid officials with limited information about individuals who have been tentatively deemed eligible for the program. These transmissions, known as “flat files,” were never meant to be used to enroll anyone, according to the CMS. Rather, they were meant to prepare agencies for the work of sorting through new enrollees. However, in a letter sent to state officials late Friday (PDF), the federal agency reversed course and is now asking states to use the files to enroll people in the program.

8) Insurers Are Offered Assistance for Losses
from New York Times by Robert Pear

The Obama administration floated several proposals on Monday to “help offset the loss in premium revenue and profit” that it said might occur if insurers went along with President Obama’s request to reinstate canceled policies. In a notice published Monday in the Federal Register, the administration acknowledged that insurers had a valid concern: They may be stuck with sicker, higher-cost customers in the new insurance exchanges because healthier Americans will stay on their existing health plans for another year.

9) UnitedHealth Projects 2014 Results Below Analysts’ Estimates
from Wall Street Journal by Tess Stynes

UnitedHealth Group Inc. projected 2014 earnings and revenue below analysts expectations ahead of its annual investor conference in New York. The managed-care provider forecast per-share earnings of $5.40 to $5.60 and revenue of $128 billion to $129 billion. Analysts polled by Thomson Reuters most recently expected $5.67 and $132.28 billion, respectively.

Providers10) Cost of Health Care Law is Seen as Decreasing
from New York Times by Annie Lowrey

The rollout of President Obama’s health care law may have deeply disappointed its supporters, but on at least one front, the Affordable Care Act is beating expectations: its cost. Over the next few years, the government is expected to spend billions of dollars less than originally projected on the law, analysts said, with both the Medicaid expansion and the subsidies for private insurance plans ending up less expensive than anticipated. Economists broadly agree that the sluggish economy remains the main reason that health spending has grown so slowly for the last half-decade. From 2007 to 2010, per-capita health care spending rose just 1.8 percent annually. Since then, the annual increase has slowed even further, to 1.3 percent. A decade ago, spending was growing at roughly 5 percent a year. But even though the Affordable Care Act might be more a beneficiary of changes in health care spending than the primary driver of them, the law’s provisions to control costs could prove increasingly important as the economy improves, demand for health care increases and spending picks back up.

11) As Hospital Prices Soar, a Single Stitch Tops $500
from New York Times by Elisabeth Rosenthal

In a medical system notorious for opaque finances and inflated bills, nothing is more convoluted than hospital pricing, economists say. Hospital charges represent about a third of the $2.7 trillion annual United States health care bill, the biggest single segment, according to government statistics, and are the largest driver of medical inflation, a new study in The Journal of the American Medical Association found.

Pharma/Biotech/Device 12) FDA preps for expanded drug oversight
From the Hill by Julian Hattem The Food and Drug Administration (FDA) is getting ready to increase its powers to oversee major drug compounding centers. On Monday, the FDA unveiled draft guidance for how large pharmacies can register as “outsourcers” and submit information about their products. The effort is the first stage of implementation for the Drug Quality and Security Act, which President Obama signed into law last week.

13) 23andMe Stops Genetic Test Marketing
from  Wall Street Journal by Peter Loftus

Genetic-test maker 23andMe Inc. said Monday it stopped all marketing of its service last week in response to a U.S. regulatory order. A spokeswoman said the company decided to stop all advertisements on television, radio and online for its $99 personal genome service, which analyzes consumers’ saliva samples for genetic clues to ancestry and risk for various diseases.

14) Obama reveals $100 million HIV research initiative
from Modern Healthcare by Associated Press

President Barack Obama has announced a new initiative at the National Institutes of Health in pursuit of a cure for HIV. Obama says his administration is redirecting $100 million into the project to find a new generation of therapies. He said the U.S. should be at the forefront of discoveries to eliminate HIV or put it into remission without requiring lifelong therapy.

Health IT15) Health Website Problems Weren’t Flagged in Time
from Wall Street Journal by Gautham NageshWhen warning signs emerged earlier this year, the agency running the HealthCare.gov website mostly kept the problems to itself—a decision that now looms large in explaining how the project went so badly astray. The agency in charge of creating the federal health-insurance website, the Centers for Medicare and Medicaid Services, originally served as its own general contractor. It had several warnings between March and July that the project was going off-track, but didn’t seek deep White House involvement or change the leadership structure, according to officials, congressional aides and emails from the period.

16) 34 Chicago-area hospitals launching RHIO
from Modern Healthcare by Joseph Conn

Thirty-four Chicago-area hospitals have joined forces to launch a regional health information exchange organization, MetroChicago HIE, which they expect to begin routing information between members in early 2014.  They aim to implement “direct messaging,” a federally developed package of electronic messaging standards and implementation specifications that will permit basic, encrypted clinical messaging, such as the transmission of referral letters or care summaries, between providers with established authentication and business relationships.

OPINIONS, EDITORIALS, PERSPECTIVESNew York Times17) Fast Recovery for Health Care Website
from New York Times by Editorial Board

The Obama administration says it has made enormous improvements in its website for enrolling consumers in new health insurance plans. There are still major hurdles to surmount, but the strides made raise the prospects that the website will be able to help millions of Americans buy policies from private insurers on new insurance exchanges, either by Dec. 23, the deadline for policies that will take effect on Jan. 1, or by March 31, the deadline for taking out coverage without being fined. There will be federal subsidies to help those on modest incomes pay the premiums.

USA Today

18) Obamacare Isn’t Perfect, But It’s a Decent Fix
from USA Today by Duncan Black

As the problems with HealthCare.gov, the website marketplace for individual health insurance for people in states which opted not to run their own health care exchanges, begin to fade, we will have more of an opportunity to examine the deeper flaws in the Affordable Care Act, commonly known as Obamacare. The failures of the website provided an easy (and justified) target for both conservative and liberal critics of the law. Going forward, however, conservatives especially are going to find it increasingly difficult to find criticisms of the law which aren’t fundamentally just criticisms of our health care and health insurance systems generally. Essentially it’s too complicated and too expensive, and many people simply can’t afford insurance coverage that provides them with affordable health care when they need it. Obamacare offers some improvements over the prior status quo, but it does not go nearly far enough.

Washington Post

19) Obamacare is Here to Stay
from Washington Post by Dana Milbank

Winds were calm in the capital on Monday, except in the immediate vicinity of the White House, where gale-force exhalations were blowing out of the West Wing. After the administration’s claim Sunday that star-crossed HealthCare.gov had been repaired with “private sector velocity,” and the site’s relatively smooth functioning on Monday, Obama administration officials moved with aerospace-sector velocity to celebrate meeting their self-imposed deadline.

LA Times

20) Not a Good Enough Obamacare Fix
from LA Times by Jonah Goldberg

Success! The Obama administration announced over the weekend that it had hit its deadline of Nov. 30 for HealthCare.gov. Of course, there were caveats. The site will still probably get buggy when there’s a lot of traffic, which is why Health and Human Services Secretary Kathleen Sebelius advised people to use it at off-peak hours. But that simply means peak hours will be moved to after midnight. After all, you don’t alleviate crowding if you tell everyone to try a different door. Oh, and there will still be crashes, and occasionally the administrators will have to take the whole thing offline. But, HHS insists, the “user experience” will be boffo for the majority of users.

Bloomberg

21) Healthcare.Gov is ‘Fixed.’ What Wil Go Wrong Next?
from Bloomberg by Editorial Board

The Centers for Medicare and Medicaid Services has plenty of numbers to back up its claim that the website is mended. It cites more than 400 bug fixes, pages that load in one second (down from eight) and crash less than 1 percent of the time (down from 6 percent), and a website that’s functioning more than 90 percent of the time, up from 43 percent a month ago. The site can now handle a reported 50,000 users at once, twice as many as two weeks ago, and as many as 800,000 a day can now sign up through the site. Those figures call for both praise and criticism. The quick improvements may be impressive, but they also cast the failure to prepare the site for its Oct. 1 debut in an even harsher light. President Barack Obama can no longer claim that the three years since the Patient Protection and Affordable Care Act became law wasn’t enough time to build a functioning website. But the software repair measurements miss the crucial metric: the number of people who sign up for health insurance on the federal exchange. The test of the HealthCare.gov fixes will be the extent to which they accelerate those sign-ups, which reportedly reached 100,000 in November.

22) Does Obamacare Put Too Much Faith in Markets?
from Bloomberg by Mark Buchanan

The idea of Obamacare was to harness the power of the market to deliver better health care. Perhaps the resulting monstrosity is our punishment for being so slow to see that markets aren’t the solution to everything. When the kinks get worked out, the Patient Protection and Affordable Care Act will probably deliver benefits, particularly for many who would otherwise have no coverage at all. The system is so complicated because health-care markets are prone to failures and need all sorts of patches to work. We’re stuck with it because of ideological resistance to nonmarket solutions, especially anything resembling a system of national health care. But the trouble goes deeper than ideology.

Wall Street Journal

23) Don’t Get Your Operation on a Thursday
from Wall Street Journal by Eugene Litvak

New York, five other states and the District of Columbia are considering legislation that would mandate minimum hospital-nurse staffing levels. The Massachusetts Nurses Association is planning an initiative for the November 2014 state ballot asking voters to approve a law setting minimum staffing levels for all hospitals, a change they say would alleviate the dangerous strain on overworked nurses and result in improved patient care. The nursing associations in the six states (including Texas, Iowa, Mass., N.J. and Minn.) fervently support such legislation. In turn, hospitals vehemently oppose staffing mandates. Who is right and who is wrong? Although each side is right in some sense, there is a way to address the legitimate problems faced by nurses without a rigid formula like minimum staffing. It will help nurses and their patients while simultaneously saving hospitals money.

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