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Morning Briefing

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Tuesday, Nov 25 2014

Full Issue

Health Chief Calls For 'Culture Of Increased Transparency'

Meanwhile, advocates praise new rules that will make it easier for consumers to figure out which drugs are covered in exchange plans while others parse rules about abortion coverages.

Health and Human Services Secretary Sylvia Mathews Burwell is looking for ways to make her department more transparent after the House GOP discovered that officials had overstated Obamacare enrollment. Burwell emailed senior HHS leadership Sunday night asking them to work toward a 鈥渃ulture of increased transparency, ownership, and accountability.鈥 ... When Burwell was nominated in April to be HHS secretary, she pledged to bring a greater openness and management structure to the agency. She鈥檚 generally made a good impression among lawmakers in her first six months on the job, but the flap over the enrollment numbers has created a new round of criticism. (Haberkorn, 11/24)

The health department acknowledged Nov. 20 that it had double-counted about 393,000 people in dental plans when it announced that 7.3 million Americans were enrolled in August. Enrollment was revised downward as a result, to 6.9 million in August and 6.7 million in October. ... Republicans have suggested the Obama administration intended to mislead the public by double-counting the dental plans, though so far there isn鈥檛 any evidence to support that claim. (Wayne, 11/24)

Consumer advocates churning through the details of a 324-page rule proposed late Friday by the Centers for Medicare and Medicaid Services for 2016 exchange plans quickly spotted language they liked 鈥 provisions to make it easier to understand what drugs are covered by health plans offered in the new health law marketplaces. Carl Schmid, deputy executive director of the AIDS Institute, also praised language to prevent health plans from discriminating against patients with costly medical conditions, such as AIDS. (Reichard, 11/24)

The Obama administration is seeking to clarify rules for the coverage of elective abortion in health insurance exchanges. ... A complicated compromise that got the final few anti-abortion Democrats to agree to vote for the [health law] in 2010 required every exchange to include health plans that do not cover abortions except in the cases of rape, incest or a threat to the life of the pregnant woman. Plans that do offer abortion other than in those cases are required to segregate funds and bill for that abortion coverage separately. But that did not happen. (Rovner, 11/24)

The聽added complications that some individuals and companies may face at tax time are also explored -

For people who bought their insurance through public health insurance exchanges, or who will face a penalty for being uninsured during some or all of the year, filing taxes could be considerably more complicated. And that worries officials at Connecticut鈥檚 exchange, Access Health CT. (Levin Becker, 11/25)

If a business is subject to the mandate, to which employees must it offer insurance in order to avoid the penalty? On the surface, the rule seems straightforward: Every full-time employee 鈥 that is, anyone who puts in 30 hours of service a week, or 130 hours a month 鈥 is entitled to an offer of coverage from the company for that month (the monthly figure is 130 hours rather than 120 hours because most months are a few days longer than four weeks). ... But things become complicated when employee hours vary week to week or month to month. (Mandelbaum, 11/24)

When it comes to catching Obamacare insurance cheats, tax preparers are working without a net. For the first time, people will have to indicate on their 2014 tax forms whether they have health coverage. The IRS will have to figure out who is covered and who is fibbing to avoid the penalty under the Affordable Care Act individual mandate. (Dixon, 11/24)

Returning Obamacare customers should take a close look at their coverage options for 2015 instead of just automatically re-enrolling in the same policy they had this year, health officials say. Otherwise, some policyholders could find themselves stuck with significantly higher rates. (Ehley, 11/24)

KHN's consumer columnist Michelle Andrews answers readers' questions about plans, premiums and provider networks. (Andrews, 11/25)

Obamacare premiums are going up for 2015. But your Obamacare premium doesn't have to. Multiple experts have sliced and diced the Obamacare health insurance offerings for 2015, and most, if not all, have found that premiums are rising, on average. ... all this doesn't mean that consumers will pay more for coverage through the exchanges next year. Many more insurers are offering plans for 2015 so most consumers will have a wider selection in terms of premiums, deductibles, doctor networks and coverage options, experts said. That's why it's crucial that people browse through all the Obamacare plans available. (Luhby, 11/24)

Other stories look at what's ahead for the lame duck session of Congress, including testimony by MIT economist Jonathan Gruber -

Jonathan Gruber, the former ObamaCare adviser in hot water for his comments about the 鈥渟tupidity of the American voter,鈥 has agreed to testify at a House panel next month, setting up a healthcare showdown in what could be the final week of this Congress. The House Oversight and Government Reform Committee will also hear from Obama administration official Marilyn Tavenner, who is under fire this week for using inflated enrollment figures for the healthcare law. (Ferris, 11/25)

As Congress struggles to replace the formula that triggers Medicare fee cuts to doctors, lawmakers are also feeling pressure to prevent reductions to primary care doctors who treat low-income patients and to sort out funding for other programs that factor into the health law鈥檚 coverage expansion. The daunting "to-do" list stems from provisions that are all due to expire over the next 10 months and fund four separate federal health programs. Most pressing is language in the health law expiring at year's end that for the past two years has paid doctors who treat patients in Medicaid, the federal-state health program for the poor, at higher Medicare rates. Other high-priority programs include community health centers and loan repayment and training programs for health professionals. (Attias, 11/24)

This is part of the Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.
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