It is now the second week the exchanges have been open and the second week the government has been partially closed. The exchanges still have glitches, and Congress still has not agreed on a way to fund the government, although some evidence of cooling among leading participants was becoming evident as this update was finalized, signaling a temporary way out of at least the dreaded default possibility. The possibility of temporarily raising the debt ceiling was raised this week as a way to give Congress more time to come to a longer-term solution on both the debt ceiling and a continuing resolution. The president and Senate Democrats have been insisting that they will only negotiate once the debt ceiling is raised and government lights are back on; however, House Republicans have been insisting that negotiations be the vehicle for averting the debt ceiling and reopening the government. The House has introduced several bills that would fund individual parts of the government; however, the Senate refuses to vote on these bills and the president threatens to veto them because they want the government to be funded comprehensively, as is normally the case, and because, like the House, they want to protect their priorities.

ON THE HILL

It became clear this week that attempts to pass a continuing resolution and to deal with the approaching debt ceiling may need be tied together in any potential fix or at least considered simultaneously;  however, late breaking developments suggest that the debt ceiling crisis may be averted first, giving negotiators time to arrive at a comprehensive package that both funds the government and further extends the country’s borrowing authority. The Treasury initially projected October 17 as the day we would hit the debt ceiling; however, analysis this week points out that we may not actually default until October 31. Even if the United States technically has more time than the Treasury projected before its bills come due, many are concerned that the markets will be affected by the uncertainty of no solution by October 17. The House has been saying it will not raise the debt ceiling without negotiations, and President Obama and Senate Democrats have been asserting that they will not negotiate until a deal has been struck that addresses the debt ceiling and opens the government. As noted above, some evidence of a short term debt ceiling increase with time to resolve other fiscal issues, including funding government operations, may be emerging as a solution, but resolution remains far from clear at this point.

On October 9, House Budget Committee Chairman Paul Ryan (R-Wis.) offered a two-step plan to lift the debt ceiling and reopen the government for enough time to allow Congress to pass long-term entitlement reform. On October 9, Rep. Ryan authored an op-ed in The Wall Street Journal in which he called for modest structural changes to Social Security and Medicare as a solution to the fiscal crisis. Today, Congressman Ryan is scheduled to head to the White House, along with 17 other House Republicans, for a meeting with President Obama.

On October 6, amid calls for House Speaker John Boehner (R-Ohio) to put a clean debt ceiling bill on the floor, Rep. Boehner said there were not enough votes for it to pass in the House. President Obama and some Senate Democrats argued that there would be enough votes. Congressman Boehner has also told Republican lawmakers concerned about the looming debt-ceiling deadline that he would not allow a federal default.

The Senate Committee on Finance was scheduled to hold a hearing on October 8 on Transforming Medicare Post-Acute Care; however it was postponed, likely because of the government shutdown.

The Medicare Payment Advisory Commission (MedPAC), the independent body that advises Congress on issues affecting the administration, has canceled its meeting scheduled for October 10 and 11, due to the government shutdown. As of now, its November meetings are still scheduled. The Medicaid and CHIP Payment and Access Commission, MACPAC, however, remains open. We will provide more information as it becomes available.

Sen. Rob Portman (R-Ohio) raised the possibility of a plan that calls for a wide-ranging set of cuts to mandatory spending, preserves the spending cuts under sequestration and makes a change to the Affordable Care Act (ACA) that would ensure the recipients of federal health care subsidies are eligible for them. The plan is based on proposals from Reps. Diane Black (R-Tenn.) and Sen. Tom Coburn (R-Okla.) that would help prevent ACA fraud.

On October 9, the House Oversight and Government Reform Committee held a hearing at which Sarah Hall Ingram, the director of the Internal Revenue Service (IRS) Affordable Care Act office, testified. She reported that despite exchange glitches, things in the IRS office have been running smoothly since open enrollment began last week.

On October 10, House Intelligence Committee Chairman Mike Rogers (R-Mich.) warned that the federal data hub for the ACA exchanges is vulnerable to cyberattacks. Rep. Rogers cautioned that online hackers could access health records, credit histories, Social Security numbers and other sensitive information that enables identity theft.

Republicans on the House Committee on Energy and Commerce asked the Department of Health and Human Services (HHS) for enrollment data in the new exchanges. CMS confirmed this week that it would likely not release enrollment data until mid-November in order to ensure accuracy of the figures.

On October 8, the House voted 224 to 197 to create a bicameral committee similar to the Supercommittee of last year to help Congress overcome the government shutdown and come to agreement on the debt ceiling. The Office of Management and Budget (OMB) said President Obama would veto this proposal.

AT THE AGENCIES

Health exchanges are now in their second week of being online and are still full of glitches and problems, some of which the administration says are due to high traffic but others may be due to a less than perfect foundation. Last week after widespread issues with online enrollment, HHS took the Healthcare.gov application offline for the weekend to perform scheduled maintenance. Officials reported that the repairs performed over the weekend were helpful but that there were still further problems. The system was taken offline on the morning of October 8 for further Web fixes. The administration continues to request patience as glitches are worked out. Though the administration has not predicted a date when the problems would be resolved, it continues to remind potential enrollees that they have several months to enroll.

This week, the chief administrative officer (CAO) of the House sent a fact sheet on a directive from the Office of Personnel Management (OPM) to members of Congress. The OPM directive and the guidance from the CAO instruct that in 2014, members of Congress and designated congressional staff will choose from 112 options in the Gold Metal tier on the DC SHOP exchange.

IN THE STATES

Policymakers and reporters in Ohio are beginning to expect the state to expand its Medicaid program in the near term.

The Covered California exchange said that in its first week of enrollment, 16,311 applications were completed by Californians looking to obtain health insurance.

IN THE WHITE HOUSE

On October 8, President Obama delivered a statement and took questions from reporters on the government shutdown and the dispute over raising the federal debt ceiling. Earlier in the day, he called Speaker of the House John Boehner (R-Ohio) to tell him he would not negotiate until after the debt ceiling and government shutdown issues were resolved.

IN THE COURTS

The Supreme Court started its new term this week. The justices will decide soon whether to hear a new challenge to the Affordable Care Act concerning the law’s requirement that employers provide insurance coverage for contraception. At least three petitions for the Supreme Court to decide the issue have been filed. On September 5, Liberty University filed a petition asking the Supreme Court to review the 4th Circuit Court of Appeals’ decision in Liberty’s case seeking to overturn the ACA’s requirement that employers provide health insurance that covers contraception. On September 19, the Conestoga Wood Specialties Corp., a Pennsylvania company filed a petition arguing that the Religious Freedom Restoration Act prohibits the federal government from imposing the ACA’s preventive services mandate on for-profit secular companies. Also on September 19, the Obama administration took the other side of the case and asked the Supreme Court to uphold the ACA requirement that nearly all employers provide coverage of birth control and other contraceptives in health plans. This third petition greatly increases the odds that the Supreme Court will take up the case.

To view our compilation of recent health care reform implementation news, click here.