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The federal health exchange website is live this week for window shopping and people will begin to purchase new health insurance there on Saturday. But the Affordable Care Act still has many political and legal challenges ahead. (Liasson, 11/11)

With the Affordable Care Act to start enrollment for its second year on Nov. 15, some unpleasant surprises may be in store for some. That's because a number of low-priced Obamacare plans will raise their rates in 2015, making those options less affordable. On top of that, penalties for failing to secure a health-insurance plan will rise steeply next year, which could take a big bite out of some families' pocketbooks. (Picchi, 11/12)

Worried consumers have cited that they think their health care premium costs are on the rise, but recent analyses show the price of insurance is going to vary widely – primarily depending on where people live, but also depending on medical providers, the number of insurance companies and how many people ultimately choose to enroll. (Leonard, 11/11)

The Congressional Budget Office thinks a total of 13 million people will be insured through the heath care exchanges under the Affordable Care Act in 2015. The Department of Health and Human Services says, no, it’ll be in the 9 million range. One reason for the discrepancy: The CBO assumes lots of employers will shift more workers from company insurance plans, to the exchanges next year. But in reality, they may not be in any rush. (Marshall-Genzer, 11/11)

One quarter of Hispanics in the U.S. lack health insurance, the highest rate for any racial or ethnic group, according to census data. Reducing that number will be one of the Obama administration’s biggest challenges when it reopens health-insurance exchanges for a second year on Saturday. During the first year’s sign-up period, just 2.6 million of an estimated 10.2 million uninsured Hispanics eligible for coverage enrolled in health plans, according to an October report by the Department of Health and Human Services. (Campo-Flores, 11/11)

Massachusetts and Minnesota have sharply increased the number of call center workers who will help people enroll in health plans through the states’ insurance exchanges. Colorado has created an online avatar named Kyla to guide consumers through the sign-up process. And Maryland has replaced its exchange, which floundered last year, with Connecticut’s successful model. (Goodnough, 11/11)

Some of the states that built Obamacare exchanges wasted tens of millions of dollars paying contractors to build websites that ultimately didn’t work. Some are still trying to get the money back but not very aggressively. And like most issues that concern the health law, state efforts to recover money from the botched exchanges are clouded by political accusations. (Pittman, 11/11)

Common questions about open enrollment and the Affordable Care Act. (Margot Sanger-Katz, 11/11)

Idaho is about to become the only state to break up with HealthCare.gov to enroll people in Obamacare. The evolution in Idaho — which will run its own website for 2015 sign-ups — is a sharp contrast to some of its neighbors’ experiences during the health care law’s first year. The exchanges in Nevada and Oregon suffered from such dysfunctional technology that both states are moving to the federal exchange for at least the upcoming enrollment season. (Pradhan, 11/11)

Idaho on Saturday becomes the latest state to launch its own health insurance exchange under the federal health law, with marketplace officials promising an easier shopping experience for consumers and greater responsiveness to insurance agents. But the exchange, yourhealthidaho.org, will be challenged to do as well as the federal insurance exchange during the first open enrollment period that ended last March. About 76,000 Idahoans signed up for private coverage at healthcare.gov, one of the most successful enrollments in any state. (Galewitz, 11/12)

As much as members of the GOP frequently criticize MNsure — and promise much more scrutiny of the exchange during the session that begins in January — with a Democratic governor and Senate still in place, big changes in MNsure remain unlikely. (Pugmire, 11/11)

The second annual open enrollment period for health insurance under the federal Affordable Care Act begins Saturday, Nov. 15, and a coalition of local health care agencies will mark the launch with educational fairs and events as part of the “Cover Yuma County” campaign. Last year consumers nationwide struggled to sign up via the broken Healthcare.gov website, and locals had the added glitch of two out of the six insurers they were given to choose from not actually contracting with any Yuma County providers. The available plans for 2015 were posted on Healthcare.gov Monday, and Justin Farren, business development director for Yuma Regional Medical Center, said history is repeating itself in at least one respect. (Herzog, 11/11)

Missouri health insurance consumers can get a first look at rates for 2015 coverage on HealthCare.gov, but they may be in for a bit of sticker shock. St. Louis-area customers will have almost twice as many options to consider once open enrollment begins Saturday. Four insurers are selling a total of 42 different plans, a substantial increase from last year when only two carriers combined to sell 25 plans. ... But the increased competition isn’t necessarily driving down costs. (Shapiro, 11/10)

Nevada’s health exchange will look different this time around. After a bumpy first year, the exchange has uncoupled from its technology provider, Xerox Corp. , and connected instead to HealthCare.gov, the federal-government site. It also has a new leader, and new challenges. (Radnofsky, 11/11)

If Texas wants to keep receiving billions of federal dollars to help hospitals care for uninsured patients, state lawmakers may have to look again at expanding Medicaid coverage for impoverished adults, some political observers say. That's because in 2016, Texas will have to ask the federal Centers for Medicare and Medicaid Services to renew a five-year waiver to pump $29 billion into state health care coffers. Since landing its first such waiver in 2011, Texas leaders have defiantly refused to expand Medicaid as envisioned under the Affordable Care Act, leaving more than 1 million impoverished Texans with no health insurance. (Walters, 11/11)

A Florida-based group is trying to stop Gov. Gary Herbert's Healthy Utah alternative to Medicaid expansion with a new website urging Utahns to sign a petition against the plan. The petition on UnhealthyUtah.com asks Herbert not to bring "D.C. values" to the state with his plan for spending the $258 million available to Utah for Medicaid expansion under the Affordable Care Act, also known as Obamacare. ... Jonathan Ingram, director of research for the Foundation for Government Accountability, incorporated in 2011 in Naples, Florida, said Utahns need to hear their case against Healthy Utah. (Roche, 11/11)

Gov. Corbett this summer achieved what few thought was possible: Overcoming unlikely odds, the Republican won Obama administration approval for Pennsylvania to run its own version of Medicaid expansion. With that the program to bring insurance coverage to about 600,000 people gained support from disparate interests - insurance companies, health-care providers, and advocates for the uninsured. Corbett's reelection loss last week all but doomed his signature program, "HealthyPA," just as it was about to begin. And now confusion may loom for as many as 1.4 million people - those currently enrolled in Medicaid and those uninsured but newly eligible. (Worden, 11/11)

The future of Truman Medical Centers, a two-hospital safety-net system [in Kansas City, Mo.], depends on the state legislature—and no one understands that better than its new chief executive, Charlie Shields. Mr. Shields, a genial 55-year-old, spent 20 years as a Republican lawmaker, ending up as the leader of the Missouri Senate before term limits forced him to step down. In 2010, he became chief operating officer of one of Truman’s hospitals, and in July he succeeded longtime Truman CEO John W. Bluford III. (Wilde Mathews, 11/11)

Texas and Florida, with their large uninsured populations, are not expected to offer coverage to many low-income patients. Kaiser Health News staff writers Phil Galewitz and Mary Agnes Carey discuss what you need to know before open enrollment in the health law’s marketplaces begins again on November 15th. (Carey and Galewitz, 11/12)

[Pennsylvania] Gov. Tom Corbett's administration is telling hundreds of thousands of adult Medicaid enrollees that their benefits will change as part of an overhaul of the medical coverage plans beginning Jan. 1. Notices were mailed last week, and adult enrollees will be sorted into one of two plans that best fit their needs, according to a spokeswoman for the Department of Public Welfare. ... The overhaul in medical plans under the traditional Medicaid program — which already insures many nursing home residents, childless adults with no income and some low-income parents — is separate from the vast, federally funded expansion of Medicaid eligibility set to take effect in Pennsylvania on Jan. 1. (Levy, 11/11)

The MIT economics professor, best known until now for his key role advising the Obama administration on the Affordable Care Act, has come under attack after a year-old video of a University of Pennsylvania panel surfaced that featured him referring to the "stupidity of the American voter" and a “lack of transparency” as crucial to the passage of the 2010 health reform law. Those comments have struck a nerve on the right, with some of the law’s critics pointing to Gruber’s comments as evidence that the administration intentionally deceived the American public on the costs of the program. (DelReal, 11/11)

Just a few days before Americans get the pleasure of wading through the upgraded though still not completely debugged Healthcare.gov Website, another bombshell that paints a picture of public deception in pushing through the president’s unpopular health law has been dropped by Obamacare’s chief architect. (11/11)

Next year, House Republicans will try again to transform Medicare and Medicaid, repeal the Affordable Care Act, shrink domestic spending and substantially cut taxes for high earners through the budget process. Then they will leave it to the new Senate Republican majority to decide how far to press the party’s small-government vision, senior House aides said this week. (Weisman, 11/12)

Two potential 2016 Republican presidential candidates -- Wisconsin Rep. Paul Ryan and Florida Sen. Marco Rubio -- are teaming up on a proposal to replace President Barack Obama's signature health care law. Their plan could be voted on in the new Congress next year, when the GOP will control both the House and Senate. (Walsh, 11/11)

Obamacare has been under a consistent attack from Republicans since its creation, and while President Barack Obama said he's open to making "responsible changes to the Affordable Care Act to make it work better," former White House senior adviser David Axelrod said compromise is key. And while on MSNBC's "Morning Joe," Axelrod pointed directly at the definition of full-time workers under the law. "I think the key is to say, 'Are there areas in which they can work?'" Axelrod said. "Is it, you know, the number of hours from 30 to 40 in terms of how people are categorized for the program and what businesses have to do, whether a 30-hour week is enough to qualify for the program or whether you need more hours, those are things they ought to be able to compromise on." (Merda, 11/11)

Ted Cruz is still ready to use any means necessary to repeal Obamacare. But even his fellow conservatives aren’t all jumping on board – a sign that the Republican repeal or bust movement is struggling while Obamacare continues to enroll millions of people with health insurance. (Nather, 11/11)

Thom Tillis is a newly-minted senator from North Carolina, having narrowly defeated the incumbent, Sen. Kay Hagan (D). But in one of his first interviews since the campaign ended, he hauled out a stale talking point that has long been debunked. What’s dismaying about this is that The Fact Checker called out Tillis on this issue back in February, when his campaign first aired an ad making this claim. Time for a refresher course! (Kessler, 11/12)

Two abortion-rights groups released a four-state poll Tuesday that they say shows the Democrats’ focus on women’s health issues wasn’t the reason for their midterm election losses. (Villacorta, 11/11)

The House's chief appropriator on veterans' issues is making the case that it has been too difficult for doctors who want to volunteer their time at short-staffed Department of Veterans Affairs facilities and has readied legislation to address the issue in the upcoming lame duck session. Texas Republican John Culberson, who chairs the House Military Construction-Veterans Affairs Appropriations Subcommittee, said in an interview that the process of volunteering time at the VA is a "bureaucratic morass" and argued the department was turning away free help. (O'Brien, 11/10)

HealthCare.com likes to describe itself as the "Kayak of healthcare." On Tuesday, the Miami-based private online marketplace for insurance announced it closed a Series A funding round of $7.5 million from the owners of Priceline.com and Kayak, among other brands including most recently, OpenTable. The funding announcement comes as the U.S. government’s Healthcare.gov begins its second year of enrolling patients under Obamacare. Vargas said HealthCare.com’s healthcare insurance comparison tool, released this fall, allows people to compare 75,000 state and federal exchange plans as well as off-exchange plans (but it will not include subsidies available through Healthcare.gov). “Going forward, we are going to be adding other comparison features into other products such as Medicare and dental insurance,” Vargas said in an interview with the Miami Herald Tuesday morning. (Dahlberg, 11/11)

Welcome to open enrollment season. That time of year when you get e-mail after e-mail from your employer reminding you of all the changes you need to make to your benefits. Of all the decisions that need to be made around now, one that often gets looked over is the chance to open a health savings account. (Marte, 11/11)

So, you're thinking you might like to check out one of those inexpensive new tests that would give you some insight into, say, the health implications of your ethnic heritage. It may, incidentally, turn up findings you may or may not want -- say, on your Alzheimer's disease risk, or your risk of developing lung, breast or skin cancer. ... Although the Genetic Information Nondiscrimination Act of 2008 bars the use of genetic information for health insurance coverage decisions, it does not do so when it comes to life insurance, disability insurance or long-term care insurance. (Healy, 11/11)

In-network” and “out-of-network” – for people with health insurance, those words mean one thing: money. If you don’t want to get charged extra, you get your treatment done in-network. It sounds straightforward, but sometimes it doesn’t work out that way, even when patients think they’re playing by the rules. Jeffrey Craig Hopper, a probate attorney in Austin, Texas, knows all about following the rules. Still, accidents happen. Last June he was coaching a Little League practice session when an errant baseball smashed into his face. (Feibel, 11/11)

The CMS official in charge of coordinating care for Americans covered by both Medicare and Medicaid says some healthcare providers are illegitimately trying to dissuade dual-eligible beneficiaries from participating in a managed-care initiative designed to test ways to reduce costs and improve quality. She said her agency has increased its surveillance of these providers, though she did not identify any by name. “We are unfortunately seeing lots of bad behavior in most of the states,” said Melanie Bella, director of the Medicare-Medicaid Coordination Office at the CMS, during the National Association of Medicaid Directors (NAMD) on November 4. (Dickson, 11/11)

Many U.S. nursing home patients may not be receiving the level of care their loved ones believe they're getting, a Center for Public Integrity probe has found. Staffing levels reported by thousands of nursing homes on a widely-used government website were higher than the staff levels calculated by the Center for Public Integrity through an analysis of annual financial reports submitted by the homes, suggesting that consumers in those facilities may not be getting as many hours of skilled care as they expect. Experts have shown that the amount of care provided by nursing homes is linked to the quality of care. (Lowenstein, 11/12)

Kidney care providers in the United States say they are disappointed and seriously concerned about the CMS' decision to move forward with its five-star rating program for dialysis facilities. The federal agency announced late Friday that it would go ahead in January with the rollout of the rating system, using methodology that has drawn harsh criticism from kidney-care groups since they first viewed it this summer. Kidney Care Partners said Monday that it is deeply troubling that the CMS would “summarily dismiss” recommendations provided by dialysis providers during a review period. (Rice, 11/11)

The Kansas House member who last session championed a bill that expanded insurance coverage for autism treatment said it may be adjusted in the upcoming legislative session. Rep. John Rubin, a Shawnee Republican who was re-elected last week, said he will propose changes to House Bill 2744, which was a compromise struck between insurance companies and autism treatment advocates. The bill passed last session was expected to extend coverage to about 750 Kansas children from birth to age 5, which is about 20 percent of those estimated to need such treatment in the state. The new mandate requires insurance companies to cover up to 25 hours per week of a therapy known as applied behavior analysis treatment. Rubin said when the legislative session begins in January, he will push to loosen licensure requirements established in HB 2744 that restrict who can provide the treatment. (Marso, 11/11)

Virginia lawmakers approved emergency legislation Monday allowing health insurance companies to renew plans that do not meet the standards of the Affordable Care Act. (11/10)

Maui County hospitals in Hawaii's state-subsidized public hospital network will have a cash-flow deficit of more than $46 million in two years if the status quo continues, administrators said. Decreased state funding, a decline in federal Medicare reimbursements and increased infrastructure and labor costs are pushing the hospitals into the red, The Maui News reported Tuesday. The Maui region of Hawaii Health Systems Corp. includes Maui Memorial Medical Center, Kula Hospital and Lanai Community Hospital. The deficit may force the hospitals to drastically cut services and jobs. They say families may have to fly to Oahu to receive care, administrators said in a statement. (11/11)

An experiment to improve care for thousands of Massachusetts’ sickest residents is proving more complex and expensive than health insurers and regulators envisioned, forcing the state and federal governments to shoulder more costs for the first-in-the nation program. Called One Care, the initiative was designed to better coordinate health care services for about 95,000 disabled and low-income adults under age 65 when it launched last October. But the state’s latest count shows fewer than 18,000 enrolled, and officials have repeatedly declined to release detailed information about the program’s finances or the quality of patient care because they say they want to be able to analyze a year’s worth of data first. (Lazar, 11/10)

The measure garnered strong support from conservative groups, and reflects growing angst in conservative-leaning states about federal laws, including the health-care mandates. (Carlton, 11/11)

The Joint Legislative Audit and Review Commission, generally known for staying above the General Assembly’s partisan and ideological fights, was headed for a sharply divided vote on a two-year study of Medicaid that would rely on outside consultants at an unspecified cost. The commission decided to defer acting on the study resolution until next month, after advocates of the study agreed to give members more time to determine the potential costs and scope of the review. Later on Monday, the General Assembly agreed on legislation to allow health insurers to offer customers the option of keeping health policies that don’t comply with the Affordable Care Act through Sept. 30, 2017. (Martz, 11/10)

As many as 18,000 nurses went on strike Tuesday and picketed in front of Kaiser Permanente facilities in Northern California over concerns about patient-care standards and Ebola. The two-day strike by the nurses, who have been in contract talks since July, was expected to affect at least 21 Kaiser hospitals and 35 clinics and last until 7 a.m. Thursday. (11/11)

Now, after alleging that Texas Presbyterian had not done right by Duncan, his family has reached what its attorneys called a “resolution” with the health-care facility. According to a statement issued by the law offices of Miller Weisbrod, Duncan’s family will hold a press conference on Wednesday morning “regarding a resolution they have reached on behalf of the children and parents of the deceased with Texas Health Resources and all related entities,” as WFAA 8 reported. (Moyer, 11/12)

Michael Rosen, an admitted gambling addict, is well-acquainted with the danger of proximity to temptation. Twice during substantial periods of abstinence, he found himself – by chance, he insists – staying in hotels with casinos. And both times, he didn’t remain in his room. “I couldn’t resist,” he said. Now 71 and “sober” since 2008, Rosen is a coordinator with the Maryland Center of Excellence on Problem Gambling. His job is to help others with a gambling problem get the help they need to prevent gambling from wreaking havoc with their lives. For many, that help may be the resolve to stay away from one of the five casinos that have sprouted in Maryland since voters approved casinos in 2008. Of the 23 states that allow casino gambling, 18 have statutes that provide services for people with gambling problems, according to the National Conference of State Legislatures. All five of the states that authorized casino gambling since 2004 (Florida, Kansas, Maryland, Oklahoma and Pennsylvania) passed legislation creating problem gambling programs at the same time. Some of the other states that previously allowed casino gambling, such as Nevada, New Jersey and New York, have since initiated their own addiction programs. (Ollove,11/11)

A number of liberal pundits working off of White House talking points became heavily invested in the argument that the election was not about Obamacare. They seemed to believe if the election was about something else, Obamacare wouldn’t be repudiated or the GOP would lack a mandate to get rid of it. This was, to put it mildly, silly and desperate. (Jennifer Rubin, 11/11)

Voters last week flatly rejected the Obama administration's policies and created a new opportunity to improve American health care by electing a Republican Congress that is firmly committed to repealing and replacing Obamacare. With a flawed website launch, failed state exchanges, burdensome mandates, mass cancellations of coverage and countless other broken promises paid for by Medicare cuts and a trillion dollar tax hike, it's no wonder so few Democratic candidates campaigned on the merits of Obamacare. (Sen. Orrin Hatch, R-Utah, 11/11)

Getting Obamacare up and running has been like trying to build a house while gangs were throwing rocks at the carpenters and inept plumbers were bungling the pipes. Between relentless attacks and self-inflicted mistakes, what would have been a tough job under good conditions has flirted with disaster. And yet, at least for now, the law survives. Millions more people have health coverage than a year ago, including many who previously couldn't afford it or qualify. (11/11)

In completing a book on the saga of Obamacare, due out in about seven weeks, I thought the argument in King v. Burwell by the Obamacare opponents was so absurd that I didn’t spend much time on it. But what I did find out is that no legislator or staff member on either side of the aisle that I spoke with ever thought that the subsidies would not go to the states using the federal exchange, and that the confusion and inconsistency in the wording was the result of some last-minute cutting and pasting of a phrase from a prior draft. Put simply, from what I can tell, the Obamacare opponents’ current argument that the sentence they have homed in on was put there to penalize states that did not set up their own exchanges is not something that was on the minds — or that emerged in the conversations, memos or drafts — of anyone involved in the negotiating, writing and passing of Obamacare. (Steven Brill, 11/11)

It's possible that the congressional Democrats who drafted Obamacare five years ago purposely sabotaged their signature accomplishment, failed to tell anyone and are now lying about it. More likely, they just made a mistake -- and the states can easily address it. ... Until last week, refusing to build a state exchange was an easy way for state Republicans to demonstrate opposition to Obamacare without actually incurring any cost to their constituents. That calculus has now changed. If the court rules that subsidies are illegal in states that use the federal exchange, insurance will become unaffordable for the almost 5 million people who now get those subsidies. (11/11)

More than 168,000 people in Illinois get a federal subsidy on their health insurance through the Affordable Care Act, better known as Obamacare. Beginning Friday and continuing through Feb. 15, thousands more people are likely to sign up for Obamacare, also finding it affordable because of the subsidy. For the sake of all these financially strapped people, the Illinois General Assembly should move quickly to make sure those tax considerations continue even if the U.S. Supreme Court next year rules against Obamacare’s current system of subsidies. (11/10)

The U.S. Court of Appeals for the Sixth Circuit last week essentially forced the Supreme Court to decide whether there's a constitutional right to same-sex marriage, by refusing to recognize such a right itself. The next day, the court agreed to hear a potentially fatal legal challenge to the Affordable Care Act. Taken together, these two cases transform the current Supreme Court term into a blockbuster -- and the linkage relationship between them will be all-important. ... if the Roberts Court (without Roberts’s vote) announces a fundamental constitutional right to marry, its liberal legacy will be so prominent that [Chief Justice John] Roberts may have reason that he can kill Obamacare without tarnishing the court’s reputation too much. (Noah Feldman, 11/11)

On Tuesday, Harvard law professor Noah Feldman speculated in a blog post about a possible “linkage” between the pending ACA case and a likely same-sex marriage case this Term. Not that he asserts any linkage in the facts, legal issues, or background principles, which would be a fascinating read. ... the conjecture in his BloombergView post is unpersuasive on its own terms and reflects a dismaying trend in constitutional-law writing: a hyper-legal-realism that is neither legal nor very real. (Dale Carpenter, 11/12)

If even a conservative Republican such as [Ohio Gov. John] Kasich (and [Kentucky Sen. Mitch] McConnell, for that matter) can see value in expanding Medicaid, why are the Republicans in the Virginia General Assembly so adamant against it? Have they simply backed themselves into an ideological corner they can’t get out of? Political analyst Mark Rozell at George Mason University says yeah, that’s pretty much it: “Kasich and some of the other GOP governors are pragmatists who happen to be conservatives. The legislators here who oppose taking the federal money are ideologues who happen to hold elective positions." ... Used to be, Republicans were considered the party of business. And you can’t get more businesslike than the Virginia Hospital and Healthcare Association (or the state Chamber of Commerce, for that matter). Both groups are pushing for Medicaid expansion, citing the kind of bottom-line figures that Republicans used to crave. GOP legislators appear unwilling even to listen to big voices in the business community. (11/9)

One health insurance-related mistake that I’ve seen many people make this year is to fail to realize that they have some control over the size of Affordable Care Act subsidies that they can receive for purchasing health insurance on the new exchanges. Assuming you meet the other requirements for eligibility (e.g., not having “affordable” coverage through your employer), your “household income” is what determines the size of the subsidies that you can receive. (Piper, 11/12)

Now declared Ebola-free, Craig Spencer left New York City’s Bellevue Hospital on Tuesday. How will he be received by a wary public? After returning from treating Ebola patients in West Africa last month, Dr. Spencer traveled around town in an Uber cab, went bowling and rode the subway hours before being diagnosed with the virus. He thus earned widespread condemnation in the media, charged with “selfishness,” “solipsism” and worse. ... Maybe it’s time to reconsider. (David Feith, 11/11)

The most positive aspect of health care reform is the widespread recognition of the complexity of the primary care of patients with chronic multiple comorbid illnesses. This includes the way in which frontline clinicians prioritize care needs in the context of numerous competing risks and value judgments, as well as the management of complex care transitions and the coordination of teams deployed to reflect the integration of all necessary care components. Mental health services, in this case to address dementia and depression in old age, must become a much higher priority in the health care system of the future. (Dr. Constantine G. Lyketsos, 11/11)