7.3 Million Who Picked Exchange Plans Paid Their Premiums
That number, which reflects the tally of people who obtained insurance via the health law, fell slightly from the estimated 8 million mark that was released in the spring. It means that at least 700,000 consumers who initially signed up for a health plan let it go.
The New York Times: Health Care Act Still Covers 7.3 Million
The Obama administration said Thursday that 7.3 million people who bought private health insurance under the Affordable Care Act had paid their premiums and were still enrolled. Marilyn B. Tavenner, the administrator of the Centers for Medicare and Medicaid Services, disclosed the latest count at a hearing of the House Committee on Oversight and Government Reform (Pear, 9/18).
Los Angeles Times: Obamacare Enrollment Falls Slightly To 7.3 Million In August
Enrollment in health plans offered through the Affordable Care Act dropped slightly through this year, falling from about 8 million this spring to 7.3 million in mid-August, the Obama administration announced Thursday. The tally represents the first update the administration has provided since the April close of the open enrollment period (Levey, 9/18).
The Wall Street Journal: Obama Administration Says 7.3 Million Who Picked Health Plans On Exchanges Have Paid Premiums
The Obama administration said Thursday that 7.3 million people who picked health plans through the new insurance exchanges had paid premiums and retained their coverage as of mid-August, suggesting that at least 700,000 people who signed up for coverage earlier this year later let it go. The number of people with paid-up coverage has long been the subject of contention. ... Paying is the final step necessary for people to enroll in coverage (Radnofsky, 9/18).
Politico: 7.3 Million In Obamacare Plans, Beats CBO Forecast
The administration’s announcement that 7.3 million people are now enrolled in health insurance plans on the Obamacare exchanges immediately ignited a new round of arguments about the success or failure of the health law. ... But it’s much higher than the 6 million that the Congressional Budget Office forecast would be covered this year, a number that seemed unattainable when the botched launch of HealthCare.gov slowed signup to a crawl last October (Haberkorn, 9/18).
The Associated Press: Health Law Enrollment Now 7.3M
As expected, the latest figures showed slippage. Insurers had said that about 10 percent of their new policyholders failed to seal the deal by paying their first month’s premium. Tavenner, whose agency oversees HealthCare.gov, said the new count represents paying customers as of Aug. 15. She expects total enrollment to remain basically stable until the next open enrollment season starts Nov. 15 (9/18).
McClatchy: HHS Says 700,000 Have Lost Insurance Coverage Since May
After enrolling more than 8 million people into marketplace health insurance this year, roughly 700,000 have lost their coverage, Medicare administrator Marilyn Tavenner testified Thursday before Congress. Her surprise disclosure came during a House Oversight and Government Reform Committee hearing in which Republicans blasted Tavenner about a lack of transparency and ongoing data security problems with the HealthCare.gov website (Pugh, 9/18).
Bloomberg: Obamacare Enrollment Reaches 7.3 Million In August
The figure, announced by Marilyn Tavenner, administrator of the Centers for Medicare and Medicaid Services, is 9 percent lower than the government’s estimate in May that 8 million had signed up for Obamacare plans. That estimate didn’t reflect how many people had paid their premiums and were actually covered by health insurance. The number has been long sought by Republican lawmakers who oppose the law. Tavenner released the new figure at a hearing yesterday by the House Oversight and Government Reform Committee in Washington, where Republicans opposed to the Patient Protection and Affordable Care Act peppered her with questions about the security of the insurance website and the destruction of e-mails she wrote before the site opened for business (Wayne, 9/9).
In other coverage-related news -
Oregonian: Oregon's Uninsurance Rate Cut More Than Half Following Federal Health Reforms, Researchers Say
The number of uninsured Oregonians has dropped 63 percent, from 550,000 to 202,000 people, since national health care reforms took effect, researchers say. An estimated 95 percent of Oregonians now have health coverage, up from 86 percent last year, according to a study released Thursday by Oregon Health & Science University and the Oregon Health Authority. The study results echo the anecdotal experiences of local hospitals and other providers, which say they've seen a huge drop in uninsured patients (Budnick, 9/18).
And on the Medicare Advantage front -
Reuters: U.S. Says Medicare Advantage Enrollment At All-time High
Elderly Americans have enrolled in privately managed Medicare health plans in record numbers even as average premiums continue to rise, the U.S. Centers for Medicare and Medicaid Services (CMS) said on Thursday. The agency said the average Medicare Advantage premium would increase by $2.94 a month next year, to $33.90 per month, but 61 percent of enrollees will not see any premium increase at all. Based on Medicare Advantage bids, CMS projects that plan enrollment will grow to just over 16 million in 2015 from 15.6 million this year, an increase of 3.17 percent, spokesman Raymond Thorn said in an emailed statement (9/18).
Will Illinois Build State Exchange? Calif. Exchange Neutral On Prop 45
Time is running out for deadlocked Illinois lawmakers to build a state-based exchange. Meanwhile, California exchange officials stay neutral on a ballot initiative to allow the state insurance commissioner to regulate rates, and MNsure is back in the political fray.
Chicago Tribune: Clock Ticking For Illinois To Form State-Run Obamacare Exchange
Unless Illinois acts quickly, it will leave hundreds of millions of federal dollars on the table that would go toward building its own health insurance marketplace, potentially upping the cost of coverage for nearly 170,000 Illinois residents. State lawmakers, unable to break a years-long standoff, have not passed a law authorizing a state-based exchange, the marketplaces created under the Affordable Care Act that allow consumers to compare and buy health coverage, often with the help of federal tax credits. As a result, Illinois was one of 36 states that relied on the federal government to host its marketplace on HealthCare.gov, the website that survived a disastrous launch late last year to enroll about 217,000 Illinoisans, 77 percent of whom received federal help (Frost, 9/18).
Sacramento Bee: California Health Exchange Stays Neutral On Proposition 45
After months of intense discussions, California’s health insurance exchange on Thursday remained on the sidelines of a Nov. 4 ballot initiative that would allow the state’s elected insurance commissioner to regulate rates. Covered California Board Chairwoman Diana Dooley, secretary of the Health and Human Services Agency, acknowledged the many concerns of the exchange and its more than 1 million consumers should Proposition 45 be approved. Among the impacts are its potential to interfere with the exchange’s role negotiating with health insurers, possible delays caused by third-party rate-challengers, unforeseen effects on federal subsidies and the risk of plans pulling out of the program. But taking a formal position against the measure could undermine the agency’s efforts to largely remain above the political fray as it enters its second year of the federal health care overhaul, Dooley said at the board’s meeting in Sacramento (Cadelago, 9/18).
California Healthline: San Diego Gearing Up For Targeted Outreach In Second Open Enrollment
Despite enrollment glitches and consumer complaints over limited and hard-to-decipher health care provider networks, the first year of coverage under the Affordable Care Act has been positive in many ways for the San Diego health care community, according to experts and stakeholders. "We have seen a decline in the number of patients that are self-pay with no insurance," said Marc Reynolds, senior vice president for payer relations with Scripps Health System. That situation is likely to improve for providers in 2015. According to Reynolds, Scripps will be in more insurers' networks next year than in 2014, potentially expanding its access to more than 75% of Covered California participants (Zamosky, 9/18).
Minneapolis Star Tribune: MNsure Back At Center Of Political Debate As Johnson, Dayton Tussle Over Issue
The decision this week by MNsure’s top-selling insurance company to withdraw from the state exchange injected Minnesota’s health care exchange efforts back into the political debate as the November election nears. Republican gubernatorial candidate Jeff Johnson sharply criticized Gov. Mark Dayton on Thursday over his management of MNsure, using its struggles as a means of questioning the incumbent DFLer’s competence on the job. Dayton has repeatedly apologized for the troubled launch of MNsure, but has talked up its benefits while charging that Johnson “doesn’t know what he’s talking about” on the issue (Condon, 9/18).
Minneapolis Star Tribune: More Than 40 Percent Of Minnesotans Rate MNsure A Failure
More than 40 percent of Minnesotans say the state’s online health insurance exchange, MNsure, has been a failure in its first year, according to a Star Tribune Minnesota poll (McGrath, Hargarten and Hutt, 9/18).
Minnesota Public Radio: ‘Routine’ Updates Frustrate MNsure Clients
Is your baby married? It's a ridiculous question. But if you just had a baby and went to MNsure to update your family status, the health exchange website may ask you anyway. That kind of routine update is proving to be a big problem for MNSure and the Minnesotans using it to buy health coverage (Sepic, 9/18).
When It Comes To Health Prices, Getting Information Is Difficult
New Hampshire is one of a handful of states that requires disclosure of health care prices. Also, The Miami Herald continues its coverage of the problems Miami-Dade County has in trying to get details about what it spends on health care for workers.
Kaiser Health News: How Much Does That X-Ray Cost? You Can Find Out In New Hampshire
New Hampshire is among 14 states that require insurers to report the rates they pay different health care providers—and one of just a handful that makes those prices available to consumers. The theory is that if consumers know what different providers charge for medical services, they will become better shoppers and collectively save billions. In most places, though, it’s difficult, if not impossible to find out how much you will be charged for medical care. And with more people enrolled in high-deductible insurance plans, there is a growing demand for accurate price information (Appleby, 9/18).
Miami Herald: Health Care Price Averages Don't Give Miami-Dade Tools To Cut Costs
Last year, Miami-Dade employees, retirees and dependents cost the county’s health plan about $2.25 million for medical procedures that fell under an obscure-sounding category called "major joint replacement or reattachment of lower extremity," according to AvMed Health Plans, manager of the county plan. But even though at least eight hospitals provided the service — which could range from a hip replacement to reattachment of a foot — no two hospitals were paid the same amount. ... The numbers, provided by AvMed, offer some insight into Miami-Dade’s employee health benefits expenses. But healthcare experts and hospital administrators say that because they are averaged payments, they also obscure details that would allow the county to truly understand and manage its labor healthcare costs (Chang, 9/18).
Meanwhile, Marketplace takes a critical look at corporate wellness programs -
Marketplace: The Shortcomings Of The Corporate Wellness Program
Corporate wellness programs have become a $6 billion industry for one, possibly flawed, reason: they help reduce companies' healthcare costs, while saving their employees money. To some degree, they have been a success. Growth in premiums has hit its lowest point in the last 16 years. A new survey by the Kaiser Family Foundation shows that 71 percent of employers believe corporate wellness programs are either "very" or "somewhat" effective at reducing spending on providing benefits for their employees, who would be rewarded with these benefits by meeting various incentives. But companies can also impose a penalty. They can charge an employee more for smoking or being overweight. It's the very reason why, says Professor Nancy Koehn of the Harvard Business School, these programs don't work (Ryssdal, 9/18).
Obama Orders Plan To Reduce Peril Of Antibiotic Resistance
The measures include incentives to develop new drugs, tighter control of existing ones and better tracking of resistant microbes. "Super bugs" are thought to cause 23,000 deaths and two million illnesses in the U.S. every year and $20 billion in spending.
The New York Times: U.S. Aims To Curb Peril Of Antibiotic Resistance
The Obama administration on Thursday announced measures to tackle the growing threat of antibiotic resistance, outlining a national strategy that includes incentives for the development of new drugs, tighter stewardship of existing ones, and improvements in tracking the use of antibiotics and the microbes that are resistant to them (Tavernise, 9/18).
The Washington Post: Obama Directs Federal Agencies To Ramp Up Efforts To Deal With Antibiotic Resistance
After years of warnings from the science and medical communities about the depletion of the world’s arsenal of effective antibiotics, President Obama directed federal agencies Thursday to significantly ramp up their efforts to deal with the threat (Ellis Nutt, 9/18).
The Wall Street Journal: Obama Orders Plan Against Antibiotic Resistance
The White House unveiled new measures on Thursday to try to preserve the effectiveness of infection-fighting drugs as strains of bacteria become increasingly resistant to the existing arsenal of antibiotics. The moves signal a growing concern over drug-resistant infections, which are linked to two million illnesses and 23,000 deaths in the U.S. each year, according to the Centers for Disease Control and Prevention. Some infections are almost entirely untreatable because the appropriate antibiotics have been rendered powerless (Tracy and Burton, 9/18).
Reuters: White House Calls For Task Force To Tackle Antibiotic-Resistant Bugs
The U.S. government will set up a task force and presidential advisory council to tackle the growing threat of antibiotic resistance, setting a Feb. 15 deadline for it to outline specific steps, White House advisers said on Thursday. The secretaries of Defense, Agriculture and Health and Human Services will set up the task force to advise on steps to ensure the remaining medically important antibiotics available to treat humans stay effective and look at their use in animal feed. Antibiotic resistance in bacteria has led to "super bugs" linked to 23,000 deaths and 2 million illnesses every year in the United States, and up to $20 billion in direct health care costs (9/18).
Demand For $84,000 Hepatitis C Drug Slows
Health care providers may be waiting for other, soon-to-be-released drugs to treat hepatitis C. Also, an Indian pharmaceutical company faces Justice Department questions on pricing data for Medicaid.
The Washington Post’s Wonkblog: The New $84,000 Hepatitis C Treatment Is Losing Momentum, For Now
After recording the best launch of any drug in history, it looks like the pace is starting to slow down for Gilead Sciences' Sovaldi -- the new $84,000 hepatitis C cure that's sparking a new focus on specialty drug costs. Data released by CVS Health on Tuesday show that use of Sovaldi has slowed down since May after the drug's record-setting start last December. The slowdown can partly be explained by the health-care industry's anticipation of more hepatitis C treatments soon hitting the market, including another one from Gilead that could gain FDA approval any day now (Millman, 9/18).
Bloomberg: Indian Pharmaceutical Drug Prices Questioned By Justice Department
Indian generic drugmaker Ranbaxy Laboratories Ltd. (RBXY) was questioned by the U.S. Department of Justice on how it reports pricing data for medicines it sells through Medicaid, the U.S. health program for the poor. The Justice Department has requested documents and information through what is called a civil investigative demand. The inquiry doesn’t allege wrongdoing or propose a fine, the Gurgaon, India-based company said in a statement today. Ranbaxy said it would cooperate. Ranbaxy is being bought by Sun Pharmaceutical Industries Ltd. It has been hurt by import bans on four of its Indian facilities and increased regulatory costs. This year it also received a subpoena from the U.S. Attorney for the District of New Jersey requesting documents related to its banned ingredient factory in Toansa (Gokhale, 9/17
The Wall Street Journal’s Pharmalot: Ranbaxy Faces Medicaid Pricing Probe By The Justice Department
Manufacturing woes are not the only issue plaguing Ranbaxy Laboratories. The generic drug maker has been asked by the U.S. Department of Justice to provide documents on pricing data provided to Medicaid, according to a filing with the Bombay Stock Exchange (Silverman, 9/18).
In A Change, VA Auditor Says Wait Times May Have Played A Role In Deaths
In testimony before the House Committee on Veterans' Affairs, Acting Inspector General Richard Griffin says that delays in getting treatment at some VA centers may have been a factor in the deaths of some veterans.
CNN: VA Inspector General Admits Wait Times Contributed To Vets' Deaths
In a stunning reversal, the VA's acting inspector general now says that long wait times at VA health care facilities in Phoenix did contribute to a number of veterans' deaths. In a hearing before the House Committee on Veterans' Affairs Wednesday, Acting Inspector General Richard Griffin was grilled by lawmakers about the findings of his office's August report, which stated that while the investigation into 40 veterans' deaths found "poor quality of care," the office was "unable to conclusively assert that the absence of timely care caused the death of these veterans" (Devine and Bronstein, 9/18).
The Arizona Republic: Auditor Ties VA Waits To Deaths
The Department of Veterans Affairs' internal watchdog testified Wednesday that delayed treatment for thousands of Arizona veterans may have contributed to some deaths, a strikingly different emphasis than in an August report on the Phoenix VA medical center that emphasized that delayed care had not conclusively caused patient fatalities. In a frequently contentious hearing before the House Committee on Veterans' Affairs, acting Inspector General Richard Griffin defended his Aug. 26 report on the Phoenix VA Health Care System against criticism that the findings amounted to a "whitewash" to downplay the impact of delayed medical care on Arizona patients. "We are scrupulous about our independence and take pride in the performance of our mission," Griffin insisted while being grilled by lawmakers (Wagner, 9/17).
CQ Healthbeat: VA Secretary Vows Action To Instill Accountability
Veterans Affairs Secretary Robert McDonald told a House panel Wednesday that he was "taking all the actions the law allows me to take" to instill accountability at the department and respond to a final inspector general report on allegations of scheduling manipulation and patients deaths at the facilities in Phoenix. In his first appearance before the House Veterans' Affairs Committee, McDonald said his department had put together proposals that are under review by the Office of Management and Budget, after analyzing the laws governing the VA. He declined to specify those proposals (O’Brien, 9/18).
Some Doctors Could Face Stiff Fines Because Of Shifting CMS Rules
The physicians, who have already spent millions of dollars to set up electronic health record systems, could now face penalties because of a timing glitch in federal rules.
Politico: CMS Glitch Could Cost Doctors Millions
Physicians who just spent hundreds of millions of dollars to install new electronic health record systems will face millions in federal penalties due to a technical glitch that affects their compliance with a federal program, vendors and doctors say. "It's beyond understanding why we’d be penalized after making such an investment," said Dr. Jonathan Lowry, an eye specialist and surgeon at Morganton Eye Physicians in western North Carolina. "This was not our fault." The Catch-22 stems from the shifting rules that the Centers for Medicare and Medicaid Services (CMS) has established in a $30 billion program intended to incentivize physicians and hospitals to switch from paper to electronic health records (Allen, 9/18).
Also, in other health IT headlines -
Reuters: Electronic Health Record Providers Integrating With Apple's Mobile Health Service
Cerner Corp and Athenahealth Inc, two leading U.S. electronic health record providers, said on Thursday they are working with Apple Inc to develop applications that leverage Apple's mobile health service HealthKit. Cerner and Athenahealth representatives said they are building integrations with HealthKit and working with Apple. Previously, Apple announced a partnership with rival electronic health record company Epic Systems. Apple did not respond to a request for comment. The goal is to help doctors monitor patients with chronic conditions from home and identify health risks. HealthKit gathers data from various applications and devices, including blood pressure cuffs, accelerometers and glucose measurement systems, and makes it easier for doctors to view it all in one place. Across the United States, hospitals are rolling out pilots using HealthKit to improve [preventive] care, and potentially cut costs (9/18).
Health Law, Medicare Remain Hot Topics In Campaign Commercials
Politico reports that, although the health law and other related issues may not be the flashpoints they were in other recent election years, they still have muscle on the campaign trail. For instance, Kentucky's Senate candidates both are running Medicare ads. In Georgia's Senate race, rural health care is part of the buzz.
Politico: Firm: Health Care Still Big In Midterms
It may not pack the punch it did a few years ago, but health care is still a potent issue in the battle for the Senate this fall. So says an analysis Thursday by the Republican data firm Deep Root Analytics that reported the issue -- which includes Obamacare and Medicare -- has been the subject of more campaign commercials than any other (Hohmann, 9/18).
The Associated Press: New KY Senate Campaign Ads Target Medicare
Kentucky's U.S. Senate candidates turned their attention to Medicare on Thursday with a pair of statewide TV ads targeting the state's roughly 800,000 seniors who benefit from the government health insurance program. Democrat Alison Lundergan Grimes turned to her grandmother once again for a starring role, only this time it was a serious discussion about her grandfather's stroke in 2000. Elsie Case, who appeared in a popular ad during Grimes' 2011 run for Secretary of State, talked about the financial pressure caused by her husband's stroke in 2000. Grimes comes from a wealthy family. Her father owns several successful businesses, and records show her family has made political contributions of more than $100,000 over the years. But in a statement released by the campaign, Case said she and her husband, who died in 2010, have always been proud people and "we wanted to do it on our own." "This is why we have to strengthen Medicare. Senator McConnell has voted over and over again to raise seniors' Medicare costs. I'll never do that," Grimes said. McConnell's campaign responded quickly with an ad on the air by midafternoon designed to show his compassion for seniors dealing with health issues (Beam, 9/18).
Georgia Health News: What Nunn, Perdue Have To Say About The Rural Care Crisis
Rural health care -- and what to do about it -- has emerged as a political issue during this election year. The topic has gained traction in the wake of four rural Georgia hospitals closing in the past two years over financial difficulties. Many others have severe cash flow problems, and rural counties have an extreme shortage of primary care physicians. A large percentage of residents have chronic health conditions. Michelle Nunn and David Perdue, in a tight race for a U.S. Senate seat in Georgia, have widely differing solutions to this crisis. In an updated election guide, produced by Healthcare Georgia Foundation, the two candidates answer a new question about rural health care (Miller, 9/18).
State Highlights: Kan. Employment Support For Those With Mental Illness
A selection of health policy stories from California, Kansas, Washington state and Maryland.
San Jose Mercury News: Drugging Our Kids: California Calls For New Checks On Psych Meds For Foster Kids
In a significant step toward curbing the overuse of psychiatric drugs in California's foster care system, doctors will soon be required to get extra authorization to prescribe antipsychotics, a new safeguard to protect some of the state's most overmedicated children. Beginning Oct. 1, a state pharmacist must verify the "medical necessity" of each antipsychotic prescription before the medications can be given to children who are 17 and younger and covered by Medi-Cal, the state's health program for the poor that also includes foster children (De Sa, 9/18).
Kansas Health Institute News Service: Kansas To Expand Employment Support To Mentally Ill
The Kansas Department for Aging and Disability Services has been awarded a five-year, $3.9 million federal grant to expand employment services for Kansans with severe mental illness, including those with a mental illness and co-occurring substance disorder. KDADS received the grant to expand individual placement and support services from the federal Substance Abuse and Mental Health Services Administration, an agency within the U.S. Department of Health and Human Services. The Enhancing Supported Employment in Kansas (ESEK) project is designed to help people with mental illness achieve steady employment in mainstream competitive jobs, either part-time or full-time (9/17).
Seattle Times: Planned Parenthood ‘Office Visit’ Via App Gets You Birth Control
“Isn’t there an app for that?” Turns out there is, if what you’re after is birth control or a test for a sexually transmitted infection. In the latest example of fast-growing “telemedicine,” video conferencing that virtually extends medical expertise, Planned Parenthood is rolling out a pilot project for real-time “office visits” that bring patient and medical provider face to face on a smartphone, tablet or personal computer. Fueling the Planned Parenthood Care project, under way in Washington and Minnesota, is a “horrible statistic,” says Chris Charbonneau, president and CEO of Planned Parenthood of the Great Northwest: “People are sexually active for six to nine months before they get a really reliable birth-control method” (Ostrom, 9/18).
Kansas City Star: Hospital Will Start Billing Health Insurers For Claims In Auto Accidents Instead Of Collecting From Auto Insurance Settlements
Truman Medical Center in Kansas City has agreed to stop a billing practice that involves refusing to accept a patient’s health insurance. The concession is part of a proposed settlement valued at $478,000 to dispose of a lawsuit against the hospital. Truman Medical Center allegedly didn’t file health insurance claims for some patients injured in auto accidents, which allowed it to avoid the deep discounts typically required by health insurers. It could then seek more money for its medical services, mainly from auto insurance settlements. In court documents, the hospital said it is ready to stop the billing method and provide some financial relief to more than 180 patients who were subjected to the billing practice. The hospital said it will partly reimburse those who have already paid their bills and seek no further payments from those who haven’t (Everly, 9/18).
Baltimore Sun: A Push For Paid Family Leave
A growing movement of workers -- and their supporters in Annapolis and Washington -- wants to make the [paid leave] benefit universal. Democrats in Congress have proposed a fund that would pay a worker up to two-thirds of his or her monthly wages for 12 weeks to care for a new child or an elderly family member. California, New Jersey and Rhode Island have expanded their state disability insurance programs to cover family leave. The Obama administration has offered grants for other states to study how they might also offer the benefit. In Maryland, Del. Heather Mizeur proposed a paid family leave program modeled on California's during her unsuccessful campaign this year for the Democratic gubernatorial nomination. In California, a portion of the state payroll tax paid by employees goes into a fund. Eligible workers on family leave can draw on that fund to cover a portion of their salary (King and Campbell, 9/19).
Va. Legislators Return To Bitter Medicaid Expansion Debate, Kill Plan Without Formal Vote
Elsewhere, Utah Gov. Gary Herbert may be gaining ground in Washington with the state's alternative Medicaid expansion plan, but the concept still faces opposition at home.
The Washington Post: Va. Legislators Approve Budget Deal, Reject Medicaid Expansion
State legislators united across party lines Thursday to plug a $2.4 billion hole in the state budget but quickly reverted to bitter partisanship as they debated Medicaid expansion, with House Republicans ultimately killing a bill to expand the health-care program without giving it a formal vote (Vozzella and Weiner, 9/18).
The Associated Press: GOP Resistance To Herbert’s Medicaid Plan Remains
Gov. Gary Herbert says he's made great progress negotiating an alternative Medicaid expansion plan with officials in Washington, D.C. But he may still have a tough sell at home. Some Republican state lawmakers remain skeptical of the plan and a watered-down requirement that participants work in exchange for health coverage. Federal officials won't allow a work requirement, but Herbert says they're open to a "work effort" that funnels people into job search and training programs. That evolution is frustrating, Rep. Francis Gibson, R-Mapleton, said Thursday at a meeting of the state's Health Reform Task Force (Price, 9/18).