Leading the News

Health Care Exchanges Go Live on October 1

On October 1, as the Congress failed to reach an agreement on a continuing resolution (CR) to fund
the government, the health exchanges created by the Affordable Care Act (ACA) went live. Speaking
the day before in an interview with NPR’s Steve Inskeep, President Obama warned that during the first
few months consumers can expect glitches with the health insurance exchanges. He noted that this is
not without precedent and that glitches are inevitable given the large scale of the exchanges and high
demand from consumers. In an interview on CNN, HHS Secretary Kathleen Sebelius stated that the
technical issues with healthcare.gov were caused by overwhelming demand. However, other analysts
have noted that the system itself may have design flaws.

Information about plans offered through the federal Health Insurance Marketplace was posted on
healthcare.gov on October 1. Plans are listed by insurer, benefit tier (catastrophic, bronze, silver, gold,
or platinum), state and county, and by potential plan recipients. On October 3, White House Press
Secretary Jay Carney stated that 7 million people visited healthcare.gov during the two days after the
opening of the health care exchanges; however, they do not yet know how many enrolled for coverage.
HHS later updated these estimates, reporting that healthcare.gov had received 8.6 million visitors in its
first week, with an additional 406,000 calls to their call centers and 225,000 requests for online chats.
Over the weekend, the enrollment section of healthcare.gov was briefly taken offline for scheduled

Implementation of the Affordable Care Act

On September 30, the Office of Personnel Management (OPM) released a final rule requiring members
of Congress and their staff to obtain health insurance through Washington D.C.’s small business health
insurance (SHOP) exchange in order to receive their subsidy.

On September 30, OPM announced that it entered into a contract with the Blue Cross and Blue Shield
Association to offer more than 150 Multi-State Plan options. These plans will be offered in the Health
Insurance Marketplaces of 30 states, the District of Columbia, and in 10 federally-facilitated

On October 1, Judicial Watch filed a lawsuit against the U.S. Department of Treasury and the IRS on
behalf of Kawa Orthodontics challenging the Administration’s decision to delay the employer mandate.

On October 2, the Center on Budget and Policy Priorities released a study which found that the ACA is
not causing employers to shift a significant part of the workforce to part-time work.

Other HHS and Federal Regulatory Initiatives

On October 1, the Food and Drug Administration (FDA) announced that it will continue activities
covered by user fees, including drug review and approval activities. However, the agency will be unable
to accept any new regulatory submissions because it will not have the legal authority to accept user fees
in FY 2014.

On October 1, due to the shutdown, the National Institutes of Health (NIH) was not permitted to
admit any new patients, unless deemed medically necessary by the NIH Director. NIH will be forced to
turn away approximately 200 people a week from joining new clinical trials, including on average 30

On October 4, a U.S. District Court judge ruled in a case between Public Citizen and HHS, Pfizer, and
Purdue Pharmaceuticals that Public Citizen could receive data on which agencies were investigating
which firms, the status of those probes, and the titles and duties of employees removed from their
usual work because they were charged with a crime or barred from certain work.

Other Congressional and State Initiatives

On October 3, the House Rules Committee cleared a bill to fund the FDA at 2013 spending levels. The
House is expected to pass the legislation Monday but it is unlikely the Senate will take up the proposal.

On October 3, a group of Democrats from the New Democrat Coalition and at least 20 Republican
Representatives circulated a letter to House Speaker John Boehner (R-OH) and House Minority Leader
Nancy Pelosi (D-CA), proposing the repeal of the medical device tax in exchange for a six-month
continuing resolution.

Other Health Care News

On October 1, President and CEO of the Association of American Medical Colleges Darrell Kirch
released a statement expressing his concern that the government shutdown will stymie medical research
and will limit the nation’s ability to train the next generation of doctors at a time when the U.S. is about
to face a critical shortage of doctors.

On October 1, the Kaiser Commission on Medicaid and the Uninsured released an updated fact sheet
which found that in the 26 states that are not implementing the Medicaid expansion, significant
coverage gaps will leave many poor, childless adults unable to access affordable health insurance.

Hearings and Mark-Ups Scheduled

Despite the government shutdown, several hearings are planned but schedules are likely subject to change.

On Monday, October 7, the Senate Homeland Security and Governmental Affairs Committee holds a
hearing titled “Social Security Disability Benefits: Did a Group of Judges, Doctors, and Lawyers Abuse
Programs for the Country's Most Vulnerable?”

On Tuesday, October 8, the Senate Finance Committee will hold a hearing titled “Transforming
Medicare Post-Acute Care: Issues and Options.”

On Wednesday, October 9, the Senate Committee on Veterans’ Affairs will hold a hearing titled “VA
Claims Transformation Efforts.”

On Wednesday, October 9, the Subcommittee on Health and Technology of the House Small Business
Committee will hold a hearing titled “The Effects of the Health Law's Definitions of Full-Time
Employee on Small Businesses.”

On Wednesday, October 9, the House Veterans’ Affairs Committee will hold a hearing titled “Effect of
Government Shutdown on VA Benefits and Services to Veterans.”

On Thursday, October 10, the Subcommittee on Health of the House Veterans’ Affairs Committee will
hold a hearing titled “Between Peril and Promise: Facing the Dangers of VA’s Skyrocketing Use of
Prescription Painkillers to Treat Veterans.”

On Thursday, October 10, the Subcommittee on Health, Employment, Labor, and Pensions of the
House Education and the Workforce Committee will hold a hearing titled “Strengthening the
Multiemployer Pension System: How Will Proposed Reforms Affect Employers, Workers, and