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California just unveiled a wide array of choices for the 5.3 million people expected to qualify to purchase coverage through its online marketplace established by federal health overhaul.

It's the first disclosure of prices in the nation's most populous state for individual health insurance that complies with the Affordable Care Act, and the menu of affordable options surprised some consumer advocates and analysts who had been expecting premiums to be much higher.

"I'm impressed," said Betsy Imholz, director of special projects for Consumers Union. "I actually think they are good prices," she said, especially for those who will receive federal insurance subsidies.

The worry had been that shoppers in the individual insurance market would face sticker shock when the sweeping changes of the health law take effect beginning in January 2014. The law prohibits health plans from rejecting people with pre-existing conditions and doesn't allow insurers to charge women and sicker people more.

Nearly three dozen health plans submitted bids to sell their products in the competitive marketplace, and 13 were selected. But California exchange officials, authorized by state lawmakers to negotiate on behalf of consumers, rejected bids that were too expensive, they said, or failed to include enough choices of doctors and hospitals.

"We've hit a home run for consumers," said Peter V. Lee, the executive director of the California exchange, known as Covered California.

The companies approved to sell individual insurance on the exchange include the state's dominant commercial players, such as Anthem Blue Cross, Kaiser Permanente, HealthNet and Blue Shield of California. A number of regional and quasi-public health plans that rely on public and university hospitals and community health centers to deliver medical care to low-wage workers were also approved.

The proposed premiums still get the OK of state insurance regulators. Three of the nation's largest players in the employer-sponsored insurance market — UnitedHealthCare, Cigna, and Aetna — aren't going to be selling on the California exchange.

The proposed premium prices vary depending on where in California the buyer lives. Other factors that affect pricing include the consumer's age and the richness of benefits.

Under the premiums unveiled Thursday, a 25-year-old in Los Angeles could choose a Health Net catastrophic plan for $117 a month or a more comprehensive plan for $147 a month from L.A. Care, the nation's largest public health plan.

People making less than about $45,600 per year would qualify for a subsidy that would lower the premiums further.

More than half of Californians shopping for insurance through the state-run marketplace will be eligible for federal income tax credits. Those credits will help offset the price of private insurance: a 40-year-old individual in Los Angeles, for example, who earns $1,915 a month, or 200-percent of the federal poverty level, would pay a monthly premium of $90 for a Health Net HMO "Silver" plan in 2014, according to the rates released by Covered California.

At a media briefing in Sacramento, which had a celebratory air, exchange officials said the restrained premiums largely reflected deft negotiating by the health plans with thousands of doctors and hospitals, including powerful hospital chains whose market clout has been blamed for rising health care costs in California.

"We made the pitch that we can't sustain the current system with 7 million Californians not being insured," said Paul Markovich, president of Blue Shield of California. "We felt there was a rate at which they could still be financially viable, but it would make rates much more affordable for this population."

The rate for an individual plan offered by Blue Shield of California will increase an average of 13 percent for existing customers, said Markovich. But the benefits, he said, as mandated by federal and state regulators and uniform across all health insurance packages, will look more like the comprehensive insurance workers receive from employers.

Health care analysts said simply calculating how much an individual's premium might increase next year was an incomplete — and faulty — assessment of the competitive marketplaces the federal health law was meant to unleash in each state. Caroline Pearson, a vice president at Avalere Health, a consulting firm Washington, said she judged California's performance by whether residents would have access to insurance products priced around $5,200 a year, the Congressional Budget Office's estimate for an average individual market premium.

And every region in California, based on her analysis, will offer plans below $4,000 a year. The offerings "strike me as very competitive," said Pearson. "It speaks to the number of carriers that were attracted to the market, and that the exchange created competition to drive down prices."

For the first time in seven years, the U.S. Senate has confirmed a judge to sit on the important federal appeals court for the District of Columbia. The Senate unanimously confirmed Deputy Solicitor General Sri Srinivasan on Thursday for the seat previously held by Supreme Court Chief Justice John Roberts.

Srinivasan was confirmed because he had huge bipartisan support in the legal community and because he served in both the Bush and Obama administrations, while having no record in partisan politics. But the federal appeals court for the District of Columbia still has three vacancies.

Two previous Obama appointees, Goodwin Liu and Caitlin Halligan, also had stellar legal credentials but were filibustered by Republicans who portrayed them as judicial activists. Halligan was opposed primarily because as New York solicitor general, she represented the state's pro-gun control positions in court. After Liu's nomination was blocked, California Gov. Jerry Brown quickly nominated him to the California Supreme Court, where he now serves.

The partisan war over judicial nominees has accelerated in recent years as Republicans have stalled and, in some cases, filibustered record numbers of appeals court and trial court nominees. It took nearly a year to win confirmation for Srinivasan, who had no formal opposition.

At the same time, the Obama administration has been slow to fill vacancies.

There are three vacancies on the D.C. Circuit, out of 11 seats. The last D.C. Circuit judicial nominee to win confirmation was Brett Kavanaugh in 2006. He had previously served in the Bush White House counsel's office and as a top assistant to then-special prosecutor Kenneth Starr during the investigation of President Clinton and his relationship with Monica Lewinsky.

In the current politically polarized atmosphere, nominees to the D.C. Circuit face particular scrutiny because so many of them go on to serve on the U.S. Supreme Court. Four of the current Supreme Court Justices — Chief Justice Roberts and Justices Ruth Bader Ginsburg, Antonin Scalia and Clarence Thomas — all served on that court first. And a fifth justice, Elena Kagan, was nominated to the circuit court by President Clinton but never got a vote.

Srinivasan, 46, is the first South Asian ever to serve on an appellate court. Born in India and raised in Lawrence, Kan., he likely would be high on the short list for a Supreme Court vacancy should one occur.

The state of Texas is turning down billions of federal dollars that would have paid for health care coverage for 1.5 million poor Texans.

By refusing to participate in Medicaid expansion, which is part of the Affordable Care Act, the state will leave on the table an estimated $100 billion over the next decade.

Texas' share of the cost would have been just 7 percent of the total, but for Gov. Rick Perry and the state's Republican-dominated Legislature, even $1 in the name of "Obamacare" was a dollar too much.

"Texas will not be held hostage by the Obama administration's attempt to force us into this fool's errand of adding more than a million Texans to a broken system," Perry said.

Texas Republicans have moved steadily to the right — to where the very concept of public health insurance of any kind is looked at through narrowed eyes. Still, it's not easy to walk away from $100 billion from the federal government to help your state's poor, elderly and disabled, especially when you have powerful stakeholders like hospitals, doctors and cities clamoring for the state to take the money for their sakes.

Texas hospitals stand to lose about $7 billion.

"I don't think we will be OK, actually, especially when you consider the state cut us about $700 million a year in Medicaid payments because of the budget shortfall," says John Hawkins, a senior vice president at the Texas Hospital Association. "Now we're dealing with sequestration, which is another 2 percent.

Shots - Health News

Texas Medicaid Debate Complicated By Politics And Poverty

A day after school officials approved shutting down 50 schools, the Chicago Teachers Union and community activists say they'll hold a voter registration and education campaign. The union is agitated that Mayor Rahm Emanuel, school board members and some lawmakers failed to listen to parents, teachers and others who called for the schools to remain open.

Before they voted yes on the sweeping school closure plan, school board members faced a torrent of criticism Wednesday. Protesters tried to conduct a sit-in at the front of the boardroom, but security officers escorted them out.

Sonya Williams, a parent who had come to testify in defense of her school, said she understood the passion and the outbursts.

"It's just like going to a long funeral and no one will close the casket yet," she said. "The fate of your position, the fate of your job, the fate of your children are up in the air, and they're based on a few people making a decision."

This was the last time before the vote that people could make their pitch to keep schools open. Chicago Alderman Bob Fioretti was among them.

"Substantial research shows that closing schools and moving students increases the dropout rate and the incidence of street violence," he said.

Chicago's 'School Utilization Crisis'

The arguments did not deter Chicago Public Schools CEO Barbara Byrd-Bennett, who, along with Mayor Emanuel, has argued that Chicago has to "right-size" its school district. They have said demographic shifts in mostly black neighborhoods left schools underutilized — plus, the district faces a budget deficit of a billion dollars.

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