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Daily Archives: December 9, 2013

Some California Insurance Plans Narrow Doctor, Hospital Choices

MILL VALLEY, CALIFORNIA – When Diane Shore got a letter that her health policy would be canceled, the small premium increase for a new plan didn’t bother her that much. What she’s really troubled by is: “My physicians will no longer be in this network of physicians, or the hospitals won’t be as well.”

Sixty-two year old Shore owned an IT consulting business in the San Francisco Bay Area, and retired when she sold her business in 2000. She says she wants to stick with the providers that she’s had for years, including the surgeon who cared for her during a bout of breast cancer in 1998.

“I have full confidence in her,” she says. “And my primary care doctor has been my primary care doctor for 20 years.”

In Shore’s case, the problem is that the Blue Shield of California plan being offered limits her choice of doctors and hospitals just to Marin County, where she lives, just north of San Francisco. But, she says, “All my doctors are in San Francisco. I live 20 minutes from San Francisco. In fact, it’s more convenient for me to go to San Francisco than to the hospital here in Marin County.”

Susan Shargel is an insurance broker who has been helping clients understand the new “exclusive provider organization” plans offered on Covered California (Pauline Bartolone, Capital Public Radio).

Shore’s experience doesn’t surprise San Francisco-based insurance broker Susan Shargel, who’s trying to sort out all the new ways insurers are contracting with doctors. Some health plans will have fewer doctors and hospitals. Blue Shield, for example, says it will have half the doctors and three quarters of the hospitals next year as they have this year in the individual market.

Shargel thinks that the changes are not clear in the cancellation letters. “There isn’t something that says: ‘Alert. Be aware. Take action now to be sure this works for you or to be sure you know what’s happening.’ There needs to be a red alert,” she says.

The health plan offered to Shore was a Blue Shield of California EPO plan. EPO stands for “exclusive provider organization.” The company says it is offering these lower-cost plans for the first time next year to buyers on the individual market. Other insurers are offering similar plans.  

Patrick Johnston, president of the California Association of Health Plans, notes that the federal Affordable Care Act requires more benefits than most insurance plans have provided up until now. That includes free preventive care, a limit on annual out-of-pocket spending and a ban on lifetime “caps” for medical expenses. So, to keep health plans affordable for buyers on the individual market, one of the few cost variables to work with is doctor contracts. 

“In areas where there are a lot of hospitals, some more expensive than others, and a lot of doctors, it’s only natural that a health plan will sign up some, but maybe not all,” he says.

So Johnston says if you’re buying your own insurance next year and want to keep your doctors, you may have to shop around. “Transitioning might mean looking or having difficulty signing up exactly the same doctors,” he says.

Insurers are negotiating hard, according to Gerry Kominski, director of the Center for Health Policy Research at UCLA, saying to providers, for example:“We’re willing to pay you $50 a visit. If you’re not willing to do that, we know a doctor’s group across the street that will accept that.”

Kominski acknowledges the trend of narrowing provider networks pre-dates the Affordable Care Act, but has been accelerating under the law. And not just for individual policyholders; it’s been happening for people who get insurance through work as well. 

But, he’s quick to add that it’s necessary: “If we want to keep health care from becoming completely unaffordable for everyone, at some point something has to give. And in this case what’s giving is the ability to choose any doctor and any hospital.”

And, he says, some of the plans may have a wider variety of doctor and hospital choices, but they are likely to cost more.

This story is part of a reporting partnership that includes Capital Public Radio, NPR and Kaiser Health News.

Blue Shield of California Foundation helps support KHN coverage of California.

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Many HIV Patients In Texas Unable To Enjoy Expanded Coverage

When Dena Hughes learned about the Affordable Care Act’s passage, she rejoiced.

Hughes, who is HIV positive, has struggled to find insurance coverage, because HIV is considered a pre-existing condition. But even under the new law, Hughes said her care providers had advised her not to enroll in the federal health care exchange yet. It is unclear, they said, how the law will affect HIV care when marketplace coverage begins Jan. 1.

“Right now we get good care, and I’m not interested in having my stuff all shifted around,” she said from her Houston home.

Minister Freedom Gulley led a candlelight vigil in recognition of World AIDS Day on Dec. 1, 2013, in Houston (photo by: Michael Stravato).

Hughes and her husband, Daniel, also HIV positive, receive some health coverage under the Ryan White Care Act, a federal health care program for HIV and AIDS patients. Community advocates expected the Affordable Care Act to provide nearly universal health coverage for HIV patients, freeing up funding from the Ryan White program to cover services beyond primary care.

But many HIV patients in Texas live below the poverty line and are therefore ineligible for subsidies on the exchange. Add Texas’ decision not to expand Medicaid to cover poor adults, and the bulk of low-income HIV patients are missing out on expanded health coverage.

Dena and Daniel Hughes, who have four dependent children, recently started a home repair business and do not know how much they will earn next year.

The stakes are high. If their income is below $31,590 — the requirement for a family of six to receive tax subsidies on the federal exchange — they will rank among the thousands of HIV-positive Texans whose incomes are too low for subsidized private insurance but too high for Medicaid. Roughly 14,000 Texans with HIV used assistance from the Ryan White program to pay for antiretroviral medication in 2011, while nearly 19,000 were not receiving any HIV-related medical care, according to the Department of State Health Services.

Daniel Hughes receives medical care at Legacy Community Health Services, a federally qualified health center in Houston. Katy Caldwell, its executive director, said she had struggled to advise HIV patients about the marketplace with certainty that their health plans would cover all their medications. “You’ve got people on some complicated drug regimens that you want to make sure people stay on, and it’s not as easy as it sounds,” she said.

Referring to patients living below the poverty line, she added, “One of the hard things to explain to people is you’re actually too poor to get help.” At Legacy, 58 percent of patients are uninsured.

Texas’ Medicaid eligibility requirements are among the country’s strictest. For a family of six, adults without a disability must earn less than $4,608 per year to qualify for coverage.

But Gov. Rick Perry has adamantly opposed Medicaid expansion, citing worries about the program’s efficiency.

“The fact is that Medicaid is a broken system in need of fundamental reform,” Lucy Nashed, a spokeswoman Perry, said in an email. She added that “Texas has a proven history of providing services and effective HIV medications to HIV-positive Texans through the HIV-STD Program and the Texas HIV Medication Program.”

Katherine Record, a senior fellow at Harvard Law School’s Center for Health Law and Policy Innovation, directed a project that modeled how health reform would affect HIV patients in Texas. She found that roughly 65 percent of Texans who received assistance from the AIDS Drug Assistance Program, a Ryan White program, would be eligible for Medicaid under the expansion.

By comparison, “Pre-ACA, you could only qualify for Medicaid if you proved you were disabled, which pretty much meant having your HIV progress to full-blown AIDS,” she said.

For Santiago Estrada, a 53-year-old patient in Abilene, AIDS allowed him to enroll in Medicare, which covers his antiretroviral medication. He said the drugs alone would have cost him $2,000 per month out of pocket.

Estrada visits the Big Country AIDS Resources center in Abilene for care. He says the “wraparound” services the center provides with Ryan White funding, like assistance with nutrition and transportation, are paramount for his well-being.

Betty Sims, the center’s executive director, says the Affordable Care Act could mean big changes for many of her clients’ access to coverage. But for the 48 percent of her clients who live below the federal poverty line, most have never qualified for Medicaid “and are really left out in the cold,” she said.

Advocates say demand for transportation services ranks highly among the wraparound benefits that Ryan White money could assist with, if more HIV patients had primary care coverage under the Affordable Care Act. For Sims’ clinic and others that serve large rural populations, patients’ lack of access to a vehicle is a significant obstacle to HIV care. “There’s only one infectious disease specialist in the 19 counties we serve,” Sims said. The center has partnered with infectious disease physicians at Texas Tech University to consult with patients electronically.

“The Ryan White services that we provide are going to continue to be needed here no matter whether people have access to insurance or not,” Sims said.

One way states have sought to make the most of their Ryan White money under the new health law is to use the AIDS Drug Assistance Program funds to pay for HIV patients’ insurance premiums, rather than purchasing expensive drugs directly. Because the Affordable Care Act requires insurers to cover pre-existing conditions like HIV, “in almost every case now it will be cost-effective” to spend the money on HIV patients’ insurance premiums, even if they do not qualify for subsidies, said Ann Lefert, director of policy and health care access at the National Alliance of State and Territorial AIDS Directors.

Christine Mann, a spokeswoman for the Texas Department of State Health Services, said the agency was looking into such a measure.

Many advocates expect Texas to expand its Medicaid program eventually. But in the meantime, Ryan White funding will continue to shoulder primary care costs for the majority of impoverished Texans with HIV.

“They call it payer of last resort,” Dena Hughes said of that coverage. “But for some people, it’s the payer of first hope.”

Texas Tribune donors or members may be quoted or mentioned in our stories, or may be the subject of them. For a complete list of contributors, click here.

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State Insurance Exchanges Wrestle With Rollout Issues

In Iowa, an insurer uses sarcasm to woo consumers to buy policies away from the federal website. In Minnesota, insurers list problems which may keep consumers who think they’ve enrolled in a plan from being covered on Jan.1. Developments in Oregon and Colorado are also scrutinized.

The Associated Press: Iowa Insurer Pokes Fun At Federal Website In Ads
The television ads show a series of medical mishaps: a man kicking the wrong leg in a reflex check, a urine sample bottle that won’t open for a frustrated patient and a blood pressure cuff letting out a strange noise when the doctor presses the plastic bulb. After each scene, a narrator says: “Things don’t always work like they’re supposed to. Good thing the government exchange website isn’t the only place to buy health insurance” (Lucey, 12/8).

Kaiser Health News: Minnesotans Who Think They Signed Up For Health Insurance May Not Be Enrolled
In the most vivid detail yet, Minnesota’s top insurers have laid out a list of technological problems that they say may keep people who’ve enrolled in a health plan from being covered on Jan. 1. Insurance carriers selling plans on the state’s insurance marketplace say enrollment information they’re getting from MNsure, is inaccurate and incomplete – and that time is running out to fix these problems (Richert, 12/8).

The Oregonian: Cover Oregon: Take Care In Applying Those Advanced Premium Tax Credits
So if all goes as state officials hope, Oregonians who’ve applied for insurance through Cover Oregon will receive enrollment packets in the mail this week. If you’re among them, and you want coverage by Jan. 1, you’ll have until Dec. 15 to finalize some fairly complicated choices. You’ll have to pick which insurance plan (or plans) best suits you or your family. You’ll also have to decide – if you’re eligible – how much of a tax credit to take and when to take it (Hunsberger, 12/7).

The Oregonian: John Kitzhaber Says Extending Oregon Insurance Plans To 2014 Is Legal
Gov. John Kitzhaber said Friday that Oregon’s legislative lawyers got it wrong when they ruled the state’s insurance commissioner was out-of-bounds in allowing insurers to extend some health plans into 2014. More than 140,000 Oregonians faced Dec. 31 cancellations of their health insurance until Oregon Insurance Commissioner Laura Cali announced that insurers could extend those policies until the end of next year (Gaston, Ǭ/6).

Health Policy Solutions (a Colo. news service): Exchange Boss Withdraws Request For Pay Hike
The head of Colorado’s health exchange is withdrawing a request for a raise. … The news came after the Denver Post reported that Rep. Cory Gardner, R-Yuma,  planned to introduce legislation in Congress barring CEOs of state health exchanges from getting taxpayer-supported bonuses or raises. … [Patty Fontneau, the CEO and executive director of Colorado’s health exchange] gets paid $190,550 a year and received a 10 percent bonus last December (Kerwin McCrimmon, 12/6).

Health Policy Solutions (a Colo. news service): ‘Don’t Give Up,’ Commissioner Urges Angry Ski Resort Residents
Colorado Insurance Commissioner Marguerite Salazar wants to reduce high health costs in mountain resort communities, but can’t fix anything until 2015. Salazar met with a standing-room crowd of irate Summit County residents on Thursday to hear their concerns and explore solutions for health insurance rates that are up to three times higher than other parts of the state. The area is home to several of Colorado’s premier ski resorts including Keystone, Breckenridge, Copper Mountain and Arapahoe Basin (Kerwin McCrimmon, 12/6).

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Political Cartoon: 'Revisionist Future?'

Kaiser Health News provides a fresh take on health policy developments with “Revisionist Future?” by Bob Englehart. 

Here’s today’s health policy haiku:  

A SIGN OF THINGS TO COME?

Readmission rates 
fell… Because of incentives?
Ask the hospitals.
-Anonymous 

If you have a health policy haiku to share, please send it to us at http://www.kaiserhealthnews.org/ContactUs.aspx and let us know if you want to include your name. Keep in mind that we give extra points if you link back to a KHN original story.

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Lawmakers Seeing Same Online Insurance Exchange Successes, Failures As All Americans

Members of Congress are a microcosm of what’s happening for people trying to sign up for health coverage in the health law’s online insurance exchanges across the nation — some are getting through, some are seeing glitches still and some are avoiding it altogether.

Politico: Members’ Obamacare Sign-Up Headaches
Staring down a deadline to sign up for Obamacare, some lawmakers are getting hit by technical glitches or sticker shock. Others are breezing through the website, elated by lower premiums and better health services. And at least one won’t sign up at all — opting to pay a penalty instead. In short, the Obamacare experience is the same mixed bag on Capitol Hill as it is across the nation (Kim and Haberkorn, 12/9).

CNN: Now Who’s Having Trouble With Health Care Signup? Ask Congress
Congress itself is now having so much trouble signing up for the Obamacare exchanges that late Friday the top administrator in the House of Representatives laid out a backup plan in case lawmakers and staff can’t get through the process by the time their enrollment ends Monday. The red flags started reaching critical mass Thursday and Friday, when some staff and members of Congress told House administrators they were having trouble enrolling through the Washington health exchange, known as DC Health Link. The D.C. exchange is the official signup portal for Congress, where members must go to get health care through their job (Desjardins, 12/7).

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Lawmakers Close In On 'Cease-Fire' Budget Deal

Lawmakers are close to finding accord on a budget that would undo only a few parts of the government cuts known as “sequester.” In addition, the proposed budget wouldn’t lower the debt or change the costs involved with health care programs in addition to leaving other programs intact.

The Washington Post: Budget Deal Expected This Week Amounts To A Cease-fire As Sides Move To Avert A Standoff
House and Senate negotiators were putting the finishing touches Sunday on what would be the first successful budget accord since 2011, when the battle over a soaring national debt first paralyzed Washington. The deal expected to be sealed this week on Capitol Hill would not significantly reduce the debt, now $17.3 trillion and rising. It would not close corporate tax loopholes or reform expensive health-care and retirement programs. It would not even fully replace sharp spending cuts known as the sequester, the negotiators’ primary target (Montgomery, 12Ǟ).

The Wall Street Journal: Congress Readies A Year-End Dash
Because Republicans have refused to raise taxes and Democrats have declined to consider major cuts to Medicare or other entitlement programs, any deal is likely to mitigate only a modest chunk of the sequester. To permit spending to rise above levels set in 2011, lawmakers would need to agree on ways to trim the federal budget deficit elsewhere, potentially by increasing fees for airport security and federal guarantees of private pensions. An agreement would mark a rare moment of bipartisan accord brokered without the specter of a government shutdown or financial chaos. However, even a deal reached by two lawmakers popular within their own parties would still have to secure the support of a GOP caucus unafraid to buck its leadership and a Democratic caucus concerned about other expiring programs. In recent weeks, Democrats have pushed to extend emergency benefits for the long-term unemployed past their Dec. 28 expiration, but Mr. Durbin said Sunday he didn’t expect it would become a make-or-break issue in the budget talks (Peterson and Crittenden, Ǭ/8).

Lawmakers are also contemplating a change in how Medicare pays doctors, and a group of senators voice their support for a set of rule exemptions allowing doctors to self-refer for some in-office procedures —

JAMA: Fixing The (Un)Sustainable Growth Rate Formula: Shifting From Volume To Value
Although much media coverage around health care reform recently focused on the Obamacare rollout, another profound but far less publicized change could be coming. Congress is closer than ever to correcting the sustainable growth rate (SGR) formula, an ill-conceived policy that annually threatens physicians with indiscriminate cuts in fees to control Medicare spending (Sanghavi, O’Shea and McCelallan, 12/6).

Medpage Today: Docs In Senate Back Stark Law Exemptions
The physician members of the Senate wrote to congressional leaders this week backing the current Stark Law exemptions for in-office self-referrals. Sens. Tom Coburn, MD (R-Okla.), John Barrasso, MD (R-Wyo.), Rand Paul, MD (R-Ky.), and John Boozman (R-Ark.) said they support physicians referring for services such as radiation therapy, diagnostic imaging, pathology, and physical therapy within their respective practices. The Stark Law prohibits physicians from making self-referrals for certain services but allows self-referral for advanced diagnostic imaging, radiation therapy, anatomic pathology, and physical therapy (Pittman, 12/6).

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Drugmaker Pushes New Drug Over Cheaper Equivalent At Medicare's Expense

The Washington Post explores the public impact of doctors’ decisions to choose a more expensive drug to prevent blindness despite trials showing the drug is equivalent to a much cheaper product. Other media report the federal court decision in Connecticut that temporarily blocks UnitedHealthcare from terminating more than 2,000 doctors from its Medicare Advantage network in that state.

The Washington Post: An Effective Eye Drug Is Available For $50. But Many Doctors Choose a $2,000 Alternative.
The two drugs have been declared equivalently miraculous. Tested side by side in six major trials, both prevent blindness in a common old-age affliction. Biologically, they are cousins. They’re even made by the same company. Avastin costs about $50 per injection. Lucentis costs about $2,000 per injection. Doctors choose the more expensive drug more than half a million times every year, a choice that costs the Medicare program, the largest single customer, an extra $1 billion or more annually (Whoriskey and Keating, 12/7).

Kaiser Health News: Judge’s Medicare Advantage Order Could Have National Impact
In a decision that could have national implications, a federal judge in Connecticut temporarily blocked UnitedHealthcare late Thursday from dropping an estimated 2,200 physicians from its Medicare Advantage plan in that state. While the judge’s decision affects only the physicians in Fairfield and Hartford Counties who brought suit, several other medical groups are considering filing similar actions (Jaffe, 12/6).

The CT Mirror: Judge Blocks UnitedHealthcare Medicare Advantage Doctor Cuts
A federal judge has temporarily blocked UnitedHealthcare’s move to terminate Connecticut physicians from its Medicare Advantage network. U.S. District Judge Stefan R. Underhill granted a preliminary injunction requested by the Fairfield County Medical Association and the Hartford County Medical Association. The two medical groups took legal action after UnitedHealthcare notified about 2,200 doctors that they would be dropped from its Medicare Advantage network as of Feb. 1 (Becker, 12/6).

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Maryland's Online Insurance Marketplace Plagued By Technical Issues, Discord

The director of the state exchange resigned Friday. Meanwhile, the web portal continues to be marked by operational difficulties that are undermining enrollment efforts.

The Baltimore Sun: Maryland Health Exchange Director Resigns After Questions About Vacation
The director of Maryland’s troubled health insurance exchange resigned Friday amid ongoing technical problems and questions about a Caribbean vacation she took while the online marketplace faltered. Rebecca Pearce, hired two years ago to build a $107 million exchange, leaves her post as officials struggle to repair the system that launched Oct. 1 (Cox, 12/7).

The Washington Post: Rebecca Pearce, Director Of Maryland’s Health Insurance Exchange, Resigns
The Maryland official who directly oversaw the rollout of Maryland’s health insurance exchange resigned Friday amid continuing technical problems that have hampered the state’s online enrollment efforts. After an emergency session Friday night, the board of the Maryland Health Benefit Exchange accepted the resignation of Rebecca Pearce, its executive director, and thanked her in a statement for working “tirelessly and with tremendous dedication” for more than two years (Wagner and Sun, Ǭ/6).

The Wall Street Journal: Health-Site Snafus Plague Maryland
Maryland is struggling to fix its troubled health-insurance website more than two months after it opened, showing how technology woes are affecting more than just the federal system. The official in charge of Maryland’s insurance marketplace, Rebecca Pearce, resigned late Friday after criticism of her decision to take a vacation in the Cayman Islands during Thanksgiving week. New statistics released Friday showed just a trickle of customers signing up for private coverage in the state (Dooren, 12/8).

The Baltimore Sun: Technical Problems, Discord Plagued Health Care Site
Although state officials have provided the public scant detail about the troubled launch of Maryland’s version of Obamacare, emails and documents show that the project was beset behind the scenes for months by an array of technical issues, warring contractors and other problems (Cohn and Walker, 12/7).

The Baltimore Sun: No E-mails From Brown On Health Exchange
As Maryland officials touted their implementation of the Affordable Care Act, Lt. Gov. Anthony G. Brown was front and center — proudly describing the state as a national leader in preparing for the overhaul. But even though Brown was helping to lead the health care effort, he wrote no emails to the state workers overseeing development of the state’s online health insurance marketplace — at least none that his office deemed fit for public release (Cohn and Walker, 12/7).

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California Exchange Shares Consumers' Names Without Their Consent

Officials with Covered California said they gave insurance agents the contact information of thousands of people who went online but didn’t enroll in coverage as part of a pilot program to help people sign up by Dec. 23.

Los Angeles Times: Covered California Gave Consumers’ Contact Information To Agents
Raising concerns about consumer privacy, California’s health exchange has given insurance agents the names and contact information for tens of thousands of people who went online to check out coverage but didn’t ask to be contacted. The Covered California exchange said it started handing out this consumer information this week as part of a pilot program to help people enroll ahead of a Dec. 23 deadline to have health insurance in place by Jan. 1 (Terhune, 12/6).

The Associated Press/Washington Post: Calif. Health Exchange Shares Data Without Consent
Peter Lee, executive director of Covered California, says the information was shared to ease the process for consumers. The exchange was set up in response to the federal Affordable Care Act. It has been struggling with a surge in applications ahead of a Dec. 23 deadline to have insurance in place by Jan. 1 (12/7).

In related news –

California Healthline: Forum Explores Other States’ Handling Of Exchange, Medicaid Enrollment
But California is not the only success story. Other states have established robust exchanges and yesterday officials from some of them talked about what they’ve been accomplishing in their own exchanges. “With Affordable Care Act-related enrollment, states have had nine weeks of experience,” said Catherine Hess, managing director for coverage and access at the National Academy for State Health Policy, a co-sponsor of yesterday’s online forum. … Hess pointed out that a big part of the open enrollment period, among the states that have created exchanges, includes successful expansion of Medicaid — Medi-Cal in California (Gorn, 12/6).

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GOP Uses Weekly Address To Reignite Obamacare Debate Ahead Of Election Season

In the GOP’s weekly address, Rep. Renee Ellmers, R-N.C., said the health law amounts to the Obama administration telling Americans what’s best for them and that it is also an example of the “war on women.” Elsewhere, the health law is figuring prominently in early election politics.

Politico: GOP Returns To Obamacare In Weekly Adddress
Rep. Renee Ellmers (R-NC) focused on how she said the Affordable Care Act is hurting families whose existing insurance plans have been canceled because they didn’t meet the health law’s coverage requirements. “The Obama administration is essentially saying it knows what’s best for you and your family,” Ellmers said, charging that many people also will lose longtime, trusted doctors because of Obamacare (Villacorta, 12/7).

McClatchy: Rep. Ellmers Calls Obamacare A ‘War On Women’
The Affordable Care Act is an example of a “war on women,” Rep. Renee Ellmers, R-N.C., said Saturday in the Republicans’ weekly address. Women make many of their families’ health care decisions, Ellmers said, emphasizing that she was speaking not only as a congresswoman and chairwoman of the Republican Women’s Policy Committee, but also as the mother of a college student. Ellmers said that the cancellations of some insurance policies showed that “the Obama administration is essentially saying it knows what’s best for you and your family” (Schoof, 12/7).  

The New York Times: Three Senators Try To Hold Off G.O.P. In South
Next year, Democrats will face not only a general hostility to the national party among Southern white voters, but also a keen dislike of President Obama’s Affordable Care Act. Representative Bill Cassidy, one of the Republicans opposing Ms. Landrieu, has an attack ad that calls her “Barack Obama’s rubber stamp.” She and her two Southern colleagues in the Senate voted for the health plan and have reiterated their support, though they have also rushed to criticize the administration’s handling of the rollout and pushed for modifications. Republicans are trying to exploit the opening, insisting that each of the incumbents muttered the decisive “aye” that allowed the law to pass, which was approved 60 to 39 (Robertson and Peters, 12/8).

NBC News: Races To Watch: Will Obamacare Sink Democrats In 2014? 
As the hobbled website becomes more functional, the president is offering more vocal praise for his signature domestic achievement. But some Democrats are keenly aware that the program’s poor debut could weigh them down in November. It’s already helped drag Obama’s approval ratings to a new low and distracted from perceived GOP failures during the shutdown. As the key battles for that control begin to unfold, here are seven contests to watch in 2014 (Taylor, 12/9). 

CBS News: Poll: After Rough Debut, Views On Obamacare Barely Budge 
Buffeted by terrible headlines since its online insurance marketplace debuted with a host of glitches on October 1, Obamacare is proving surprisingly resilient in the court of public opinion. According to a new Gallup poll, a slim majority of Americans – 52 percent – believe the law should be repealed entirely or scaled back. It’s a stout number, but not much changed since mid-October, when 50 percent voiced the same opinion (Miller, 12/6).

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