Wonkbook: Uh-oh. Obamacare may not be fixed by Dec. 1st

November 13, 2013

Welcome to Wonkbook, Ezra Klein and Evan Soltas's morning policy news primer. To subscribe by e-mail, click here. Send comments, criticism, or ideas to Wonkbook at Gmail dot com. To read more by Ezra and his team, go to Wonkblog.

(Photo by Andrew Harrer/Bloomberg)
(Photo by Andrew Harrer/Bloomberg)

On October 25th, Jeff Zients, the White House official tasked with managing the HealthCare.gov rescue effort, made a promise. "By the end of November, HealthCare.gov will work smoothly for the vast majority of users," he told reporters.

"The administration is obviously putting its neck on the line here," wrote Jon Chait. "If it fails to hit the deadline, all political hell will break loose."

Axe? Meet neck.

Amy Goldstein, Juliet Eilperin, and Lena Sun report that "software problems with the federal online health insurance marketplace, especially in handling high volumes, are proving so stubborn that the system is unlikely to work fully by the end of the month as the White House has promised, according to an official with knowledge of the project."

Officially, the White House denies that the Web site will still be buggy for most users come December 1st. And if there's been a delay in the timetable, no one told President Obama, who said, as recently as a week ago, that "by the end of this month, we anticipate that [the Web site] is going to be working the way it is supposed to.”

It's likely that no one knows for sure whether the Web site will be repaired by the end of the month. This isn't a linear process. It could be that one line of broken code is identified, fixed, and ends up instantly resolving huge problems. Or it could be that the repairs take much longer than the White House expected. But everything I've heard backs up the pessimists.

Blowing through the December 1st deadline obviously creates huge political problems for the White House. But does it create correspondingly huge policy problems for the law?

The answer depends on two things. First, does the White House's evident inability to repair the Web site in a timely fashion (or even, at this point, an untimely fashion) lead congressional Democrats to panic and support bills -- like a yearlong delay in the individual mandate -- that make it harder for the law to succeed even once its digital infrastructure is fixed?

The second question, of course, is how far off-schedule the White House really is. If HealthCare.gov is working smoothly for the majority of users on December 1st but it only works smoothly for the "vast majority" of users on December 15th, that won't matter much. If the Web site remains more or less unusable into 2014, that's obviously a much bigger problem for the law.

But because there's so little visibility into the process, no one really knows. And the White House, thus far, has not been a particularly credible guide.

Wonkbook's Number of the Day: 275,000. That's the number of people who are being "reinvited" by email to sign up on Healthcare.gov by the Centers for Medicare and Medicaid Services. 

Wonkbook's Quotation of the Day: "They were the ones who heard the promise, if you like what you’ve got you can keep it," former president Bill Clinton said of people who are now receiving cancellation letters from insurers. "I personally believe, even if it takes a change in the law, the president should honor the commitment the federal government made to these people and let them keep what they got." 

Wonkbook's Graph of the Day: Where your state's name came from.

Wonkbook's Top 5 Stories: (1) reforms, by definition, must change things; (2) Yellen's hearing is tomorrow; (3) who killed immigration reform; (4) nuclear option can't launch; and (5) how a green economy emerges.

1. Top story: What Bill Clinton wants from Obamacare isn't even possible

Obamacare disapproval hits new high as Obama hits new low. "President Obama's approval rating has hit a new low, according to a third pollster. The Quinnipiac University poll shows just 39 percent of Americans now approve of Obama's job performance, compared with 54 percent who disapprove. The drop in Obama's fortunes appears directly tied to the rough rollout of his health care law, which has become significantly more unpopular since the Obamacare exchanges Web site went live on Oct. 1...The poll is the first to show a significant increase in opposition to Obamacare since the exchanges were launched." Aaron Blake in The Washington Post.

@freddoso: If Landrieu's bill became law, the exchanges would be rubble. No one could buy insurance. They'd have to repeal the rest, even over a veto

Healthcare.gov unlikely to be fully functional by deadline. "Software problems with the federal online health insurance marketplace, especially in handling high volumes, are proving so stubborn that the system is unlikely to work fully by the end of the month as the White House has promised, according to an official with knowledge of the project. The insurance exchange is balking when more than 20,000 to 30,000 people attempt to use it at the same time — about half its intended capacity, said the official, who spoke on the condition of anonymity to disclose internal information. And CGI Federal, the main contractor that built the site, has succeeded in repairing only about six of every 10 of the defects it has addressed so far." Amy Goldstein, Juliet Eilperin and Lena H. Sun in The Washington Post.

The making of an Obamacare management failure. "In the days after HealthCare.gov went live, White House chief of staff Denis McDonough quietly dispatched Jeff Zients, a favorite West Wing fixer, to assess the operation and report back. When Zients did, President Barack Obama learned the project was in worse shape than suspected — riddled with coding problems, management issues and communication gaps, according to a senior administration official. It was only then that Obama and his top aides realized the extent of what they didn’t know." Carrie Budoff Borwn in Politico.

Bill Clinton identifies 3 big problems with the Obamacare rollout. "In an interview with the new magazine Ozy published Tuesday, former president Bill Clinton identified three problems with the fall rollout of the Affordable Care Act, "only two of which the administration can fix."...Obama needs to deliver on his promise that the new law would not force Americans to change their insurance plans, Clinton said. "They were the ones who heard the promise, if you like what you’ve got you can keep it," he said, referring to people who are now receiving cancellation letters from insurers. "I personally believe, even if it takes a change in the law, the president should honor the commitment the federal government made to these people and let them keep what they got."" Juliet Eilperin in The Washington Post.

Watch: Ozy's interview here.

Why did Obama promise people could keep their health insurance? Blame Bill Clinton. "The irony of Bill Clinton coming out to advise that Obamacare be changed — somehow — to let everyone keep their current plans is that he's the reason Obama made the disastrous promise in the first place. Veterans of the effort to pass Clinton's health-care plan believed that their core mistake was producing a plan that upended the insurance arrangements of almost every American...In the aftermath of Clinton's failure, health-care reformers swung far to the other side. Rather than building a plan in which almost everyone lost their insurance, they began trying to build plans in which almost no one lost their insurance — and selling them under the promise that literally no one would. That promise, as the Obama administration is now learning, went too far." Ezra Klein in The Washington Post.

@JohnJHarwood: If filing Bill Clinton's call for WH/Congress to change ACA to let ppl keep old health plans, it goes in IRRELEVANT/MEANINGLESS folder

White House tech team missed Healthcare.gov alert. "[N]either the SWAT team nor other measures Mr. Obama introduced to overhaul government technology prevented the HealthCare.gov site from becoming a high-profile government technology failure. White House technology executives failed to recognize the severity of the problems and lacked the authority to fix them, say people involved in the process. One particular missed signal: In March, a federal website flagged the project as high-risk, but that didn't trigger any special intervention." Gautham Nagesh in The Wall Street Journal.

In January, expect rate shock, part 2. "That’s when millions of Americans who select health insurance plans on the new marketplaces may realize that their new insurance plans don’t pay the bills right away. They come with high deductibles and co-pays. In recent weeks, many people have focused on the monthly cost of buying a health insurance plan in the insurance marketplace. What I’m talking about is different: The out-of-pocket costs they may face when they go to use that new policy." Charles Ornstein in ProPublica.

Q-and-A: Wonkblog's Sarah Kliff took questions on Reddit yesterday, and she rocked. Go read her answers to RedditorsThe Washington Post.

Watch: Harold Pollack and Aaron Carroll talk about ObamacareHealthinsurance.org.

Explainer: Everything you need to know about the risk of a health-insurance 'death spiral.' Matthew O'Brien in The Atlantic.

275,000 to be invited to try HealthCare.gov again. "Those people were “stuck” in the open enrollment process on the ObamaCare website after it first launched Oct. 1, the Centers for Medicare and Medicaid Services revealed Tuesday. CMS began sending out the email notices on Tuesday, now that issues related to creating accounts on the site have been resolved. The quarter of a million people who previously failed to create accounts will receive invitations back to the site." Rebecca Shabad in The Hill.

@igorbobic: True story: If Obamacare enrollment numbers are lower than 50K, Obama has to resign

It’s not quite time to freak out over Obamacare’s enrollment number. "Some of this apparent calm could simply be the deliberate optimism of the health care law's advocates. But, putting aside any such bias, we can still make a case that the health law's debut is not a complete disaster. First, we can compare the rollout to that of the Massachusetts health care law, which had 123 enrollees sign up during the first month of coverage. That ended up accounting for 0.3 percent of first-year enrollment. If we tally up 40,000 enrollees in the federal marketplace --and another 49,000 in the state exchanges, as counted by consulting firm Avalere Health --that works out to about 1.2 percent of the 7 million people the Congressional Budget Office has projected will sign up on the exchange in 2014." Sarah Kliff in The Washington Post.

New York reports 50,000 healthcare enrollees. "Nearly 50,000 people in New York have enrolled in ObamaCare since the insurance marketplace launched on Oct. 1, according to the state’s health department. Nearly 200,000 New Yorkers have completed the full application process, the department says. Those are the largest figures reported by any state so far but includes people who have enrolled or applied for expanded Medicaid under ObamaCare." Rebecca Shabad in The Hill.

@Noahpinion: Obamacare is the most complained-about website since Quartz fixed the up-scrolling thing.

...And in California, one million policies could be cancelled. "More than 1 million cancellation notices have been sent to Californians as the Affordable Care Act begins allowing individuals to buy insurance through exchanges, [state Insurance Commissioner Dave] Jones said. The federal law requires policies to offer minimum levels of coverage, forcing companies to terminate many existing plans" The Associated Press.

Republicans' anti-Obamacare playbook leaks. "The memo obtained by CQ Roll Call, titled “House Republican Playbook: Because of Obamacare … I Lost My Insurance,” is a manual for House Republicans on how to highlight the recent issues with the health care law and how to best “communicate in your district about the disastrous Obamacare rollout.” Of particular interest to Republicans is the president’s oft-repeated line that “if you like you health insurance, you can keep it.”" Matt Fuller in CQ Roll Call.

Primary source: Read the playbook.

...And here's the RNC's new line of ads about Obamacare. "The Republican National Committee on Tuesday released a new round of comical Web ads attacking President Obama’s healthcare law. The Web ads targeting young people play on the old PC vs. Mac ads — featuring a bumbling, disheveled actor named ObamaCare and his friend. The group released an earlier round of similar ads late last month." Mario Trujillo in The Hill.

House Republicans back new constitutional challenge to ObamaCare. "Forty House Republicans filed a brief last week in support of a legal challenge against ObamaCare that argues the law imposes billions of dollars in new taxes but did not originate in the House, as tax bills must under the Constitution. Rep. Trent Franks (R-Ariz.) spearheaded the effort by filing a "friend of the court" brief on Friday with the U.S. Court of Appeals for the D.C. Circuit. That brief argued that ObamaCare violated the Origination Clause of the Constitution, which holds that all bills for raising revenue "shall originate in the House."" Pete Kasperowicz in The Hill.

Darrell Issa is loving this mess. "[W]ith the troubled rollout of the health care law, the administration has offered Mr. Issa his richest target yet. And he is running with it...The barrage of claims and counterclaims that has emerged — as Mr. Issa and others selectively leak an array of investigation documents, including those that discuss allegations that the health care site might be vulnerable to cyberattacks — has some experts worried that the investigations themselves could cause lasting damage to the health care effort, even once the insurance exchange is fixed." Eric Lipton and Sheryl Gay Stolberg in The New York Times.

Continuing our now-regular section, "meanwhile in health policy": A new strategy to cut heart risk. "The current strategy of reducing a person's heart-attack risk by lowering cholesterol to specific targets is being jettisoned under new clinical guidelines unveiled Tuesday that mark the biggest shift in cardiovascular-disease prevention in nearly three decades. The change could more than double the number of Americans who qualify for treatment with the cholesterol-cutting drugs known as statins." Ron Winslow in The Wall Street Journal.

...Once they start sharing notes with patients, docs don't want to stop. "Not one of the 105 primary care doctors elected to stop providing access to notes after the experimental period ended, and 99 percent of the 13,564 patients wanted to keep with the program of seeing their notes long past when the pilot was over...[P]atients with access to notes written by their doctors in an initiative called OpenNotes felt more in control of their care and reported a better understanding of their medical issues, improved recall of their care plan and were more likely to take their medications as prescribed." Diana Manos in Government Health IT.

COHN: Clinton is wrong about how Obamacare works. "Bill Clinton has been one of Obamacare’s most effective advocates—the "Secretary of Explaining Things," as President Obama famously called him. But in a new interview already getting attention and sure to get more, Clinton didn't explain things very well. He made a statement that's likely to create some misimpressions about the possibilities of health care reform, while giving the administration and its allies yet another political headache. But maybe it's also an opportunity to have a serious conversation about the law's tradeoffs—the one that should have happened a while ago." Jonathan Cohn in The New Republic.

BEUTLER: GOP about to hurt itself again!: New ploy to kill Obamacare will blow up. "Starting on Jan. 1, votes to repeal Obamacare will become votes to take health insurance away from a lot of people. Just how many people will depend on when the votes take place (assuming they take place at all), and when Healthcare.gov is finally up and running. But repeal votes will cease to be abstractions. They’ll be deeply relevant to hundreds of thousands of people." Brian Beutler in Salon.

JENKINS: Obamacare questions nobody asked. "You tout the Affordable Care Act as a triumph over special interests, but the stock prices of the insurance industry have enjoyed a huge run-up. Isn't this because your program, boiled down, just throws more tax dollars at an unreformed health-care system that every analyst, including you, says spends resources inefficiently?" Holman W. Jenkins Jr. in The Wall Street Journal.

Music recommendations interlude: Little River Band, "Help Is On Its Way," 1977.

Top opinion

WARSH: Where does Yellen stand? "The president nominated Janet Yellen, a friend and former colleague, to be the next chairman of the Federal Reserve. I expect she will marshal her strong intellect, meticulous preparation and ample experience to lead the central bank successfully. In the coming weeks and months, financial-market participants will try to gauge whether the change in personnel at the Fed means a change in policy. In particular, they will seek to divine whether Ms. Yellen's views on quantitative easing will lead to still more asset purchases and a longer period of near-zero interest rates." Kevin Warsh in The Wall Street Journal.

NOCERA: Unlearning gun violence. "In 1995, an epidemiologist named Gary Slutkin returned to the United States from Africa where he had spent the previous decade helping Africans stem the spread of diseases...Once back in Chicago, however, friends kept telling him about the epidemic of violence in inner-city neighborhoods. As he began to study the problem he came to the view that gun violence in poor neighborhoods did indeed resemble the epidemics he had treated in Africa. Maps that charted gun violence showed clustering." Joe Nocera in The New York Times.

PORTER: Rethinking the rise in inequality. "[There is] new vigor to a critique, mostly by thinkers on the left of the political spectrum, that challenges the idea that educational disparities are a main driver of economic inequality. “It is absolutely clear that educational wage differentials have not driven wage inequality over the last 15 years,” said Lawrence Mishel, who heads the Economic Policy Institute, a liberal-leaning center for economic policy analysis. “Wage inequality has grown a lot over the last 15 years and the educational wage premium has changed little.”" Eduardo Porter in The New York Times.

WILKINSON: Why Warren won't split Democrats. "I'm having a hard time following the crackup narrative for two reasons: consolidation and fear. The most important challenge facing the Democratic Party isn't figuring out how to rectify rising entitlement spending and recurring budget deficits in the face of Republican opposition to taxes. (That can wait.) It is to sustain the Affordable Care Act. Every other task pales in comparison. If Obamacare fails, the Democratic Party fails, and the philosophy that drives it -- collective action by the national government to advance the common good -- takes a brutal hit." Francis Wilkinson in Bloomberg.

KLEIN: No, gagging over interracial marriage is not the ‘conventional view.’ " I think that Cohen is using "conventional views" to mean "culturally conservative views." But insofar as "conventional" means "based on or in accordance with what is generally done or believed," acceptance of interracial marriage is overwhelmingly conventional. A July poll from Gallup finds that 87 percent of Americans approve -- up from 4 percent in 1959." Ezra Klein in The Washington Post.

SUNSTEIN: How people lie about gay sex and homophobia. "Social theorists, above all Duke University’s Timur Kuran, have drawn attention to the phenomenon of “preference falsification.” The basic idea is that when people speak in public, they aren’t always truthful about their preferences. What they say is different from what they really think...When people are assured of anonymity, it turns out, a lot more of them will acknowledge that they have had same-sex experiences and that they don’t entirely identify as heterosexual. But it also turns out that when people are assured of anonymity, they will show significantly higher rates of anti-gay sentiment." Cass R. Sunstein in Bloomberg.

Money money money interlude: The highest-paid federal employee's name is "Electron." No, we're not making this up. (h/t health wonk Adrianna McIntyre)

2. Yellen's hearing is tomorrow. Wonkbook gets you ready.

A helpful note: Yellen's hearing before the Senate Banking Committee begins at 10 a.m. EST.

To Yellen, the Fed's dual mandate is a real thing. "When senators question Janet Yellen on Thursday during her confirmation hearing to be the next leader of the Federal Reserve, she will likely turn their attention to the central bank's "dual mandate" of maximum employment and stable prices. Ms. Yellen has made this mandate the centerpiece of her argument for the Fed's unconventional easy-money programs aimed at spurring a stronger economic recovery and lowering unemployment, a point her recent comments suggest she will seek to reinforce." Victoria McGrane and Kristina Peterson in The Wall Street Journal.

One of her challenges: Teaching investors that forward guidance counts for something. "Ms. Yellen, the Fed’s vice chairwoman since 2010, has been a key architect of the push to more fully explain to the public the Fed’s actions, its reasoning and its plans. The theory is that the Fed can exert greater influence over investors, by enlisting them to hold down longer-term interest rates at a time when the Fed has cut short-term rates practically as low as they can go, by detailing an itinerary rather than sending occasional postcards. She is widely expected to double down on this strategy, assuming she is confirmed as chairwoman." Binyamin Appelbaum in The New York Times.

It looks like the economy might actually recover in 2014. But will it? "There has been a common thread in mainstream economic forecasting lately. It goes like this: "Yes, 2013 has been rough. But growth should pick up in 2014." The latest example is from the OECD, the organization of leading developed nations that on Tuesday projected improvement just around the corner, as its index of leading indicators rose. The same story shows up in almost any mainstream forecasters' estimates." Neil Irwin in The Washington Post.

Elizabeth Warren challenges Obama to break up 'too-big-to-fail' Wall Street banks. "Senator Elizabeth Warren cemented her growing reputation as a darling of the political left on Tuesday with a wide-ranging speech challenging the Obama administration to take on Wall Street and break up its biggest banks..."We have got to get back to running this country for American families, not for its largest financial institutions," said Warren, who said the issue was an indictment of how little had changed since the 2008 banking crash...In her speech to the Roosevelt Institute and Americans for Financial Reform, Warren did not mention wider political ambitions but focused on proposed legislation launched over the summer with Republican John McCain to break up large banks and build on the 2010 Dodd-Frank reforms." Dan Roberts in The Guardian.

House stalls momentum for trade pacts. "[T]he White House is now facing new hurdles closer to home, with nearly half of the members of the House signing letters or otherwise signaling their opposition to granting so-called fast-track authority that would make any agreement immune to a Senate filibuster and not subject to amendment. No major trade pact has been approved by Congress in recent decades without such authority. Two new House letters with about 170 signatories in total — the latest and strongest iteration of long-simmering opposition to fast-track authority and to the trade deal more broadly — have been disclosed just a week before international negotiators are to meet in Salt Lake City for another round of talks." Annie Lowrey in The New York Times.

Gas prices drop, relieving consumers at the pump. "U.S. gasoline prices have fallen to their lowest level in nearly 33 months amid a boom in domestic oil drilling, leaving consumers with some extra disposable income just in time for the holiday-shopping season. Tuesday's national average price of $3.18 a gallon—26 cents below a year ago—was the lowest since Feb. 22, 2011...Gasoline futures have fallen by 16% since late August." Ann Zimmerman, Neil Shah, and Brett Philbin in The Wall Street Journal.

This is wonderful interlude: The periodic table of storytelling.

3. Who killed immigration reform?

Longread: How immigration reform died. "Rep. Luis Gutiérrez’s phone was ringing. It was President Obama’s chief of staff. Gutiérrez (D-Ill.) was part of a bipartisan group of lawmakers in the middle of May that was on the cusp of a breakthrough agreement on immigration reform. Denis McDonough told Gutiérrez that Obama opposed a key concession that Democratic negotiators had made to House Republicans." Russell Berman in The Hill.

That may be why immigration reformers are changing their approach. "Dwindling prospects for a sweeping congressional immigration bill have some supporters pivoting to a more confrontational approach, while at least one industry is looking for a backup plan if a broader deal fails. New ads from the AFL-CIO and Service Employees International Union take a sharper tone toward Republicans, particularly those vulnerable to Democratic challengers next year, over House inaction on immigration bills." Laura Meckler and Kristina Peterson in The Wall Street Journal.

This is so great interlude: A diary of a sad cat.

4. Nuclear option can't launch

Republican senators block another nominee for D.C. court. "Senate Republicans blocked the nomination of another federal judge Tuesday in a drama that has prevented President Barack Obama from filling court and administration vacancies. Cornelia 'Nina' Pillard, a nominee for the U.S. Court of Appeals for the District of Columbia Circuit, failed to win the 60 votes necessary to clear a procedural hurdle, garnering just 56 votes. Republicans this year have opposed three of four Obama nominees to the appeals court, including Ms. Pillard" Patrick O'Connor in The Wall Street Journal.

But Sen. Reid lacks the votes to go nuclear. "Senate Majority Leader Harry Reid (D-Nev.) is short of the 50 votes he would need to advance President Obama’s stalled judicial nominees via the “nuclear option,” according to sources who have advocated for filibuster reform. Reid is feeling pressure from labor unions and liberal advocacy groups to consider changing Senate rules after Republicans filibustered two of President Obama’s nominees to the D.C. Circuit Court of Appeals, the nation’s second most powerful court." Alexander Bolton in The Hill.

Philosophy interlude: This is your brain on moral problems.

5. How green energy rewires the economy

A recharging industry rises. "The only consensus is that the more opportunities there are to recharge, the better the sales of vehicles that can generally go fewer than 100 miles between plug-ins. Not surprisingly, the chief executive of a company that has bought up thousands of high-voltage devices thinks they are the best way to recharge. The CarCharging Group, based in Miami, has quietly purchased four companies with networks of chargers, 13,430 in all." Matthew L. Wald in The New York Times.

The inequality of climate change. "Typhoon Haiyan has left an estimated 10,000 dead and hundreds of thousands homeless in the Philippines. And it has once again underscored for many development experts a cruel truth about climate change: It will hit the world’s poorest the hardest. “No nation will be immune to the impacts of climate change,” said a major World Bank report on the issue last year. “However, the distribution of impacts is likely to be inherently unequal and tilted against many of the world’s poorest regions, which have the least economic, institutional, scientific and technical capacity to cope and adapt.”" Annie Lowrey in The New York Times.

Changing the global food narrative. "While we often hear that population growth, and the need to feed 9 billion people by 2050, is the driving issue for agriculture in the coming decades, the math doesn’t add up...So where does the “twice as much” idea come from? Mostly from assumptions about changing diets, not population growth alone. In fact, ecologist David Tilman, a friend of mine, and his colleagues have shown that changes in diet will likely be the dominant driver of future food demand." Jonathan Foley in Ensia.

Reading material interlude: The best sentences Wonkblog read today.

Wonkblog Roundup

Can Newscorp survive without FoxLydia DePillis.

It’s not just Lululemon and Abercrombie: Stocking plus sizes isn’t popularLydia DePillis.

It looks like the economy might actually recover in 2014. But will it? Neil Irwin.

Why did Obama promise people could keep their health insurance? Blame Bill ClintonEzra Klein.

What a deadly typhoon in the Philippines can tell us about climate adaptationBrad Plumer.

The U.S. Airways-American Airlines merger is a go. Here’s why it maybe shouldn’t beSteven Pearlstein.

It’s not quite time to freak out over Obamacare’s enrollment numberSarah Kliff.

No, gagging over interracial marriage is not the ‘conventional view.’ Ezra Klein.

Et Cetera

Hawaii is 15th state to legalize gay marriageReid Wilson in The Washington Post.

Congress’s approval rating hits new low: 9 percentAaron Blake in The Washington Post.

Got tips, additions, or comments? E-mail me.

Wonkbook is produced with help from Michelle Williams.

 

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Brad Plumer | November 12, 2013