Wonkbook: Obamacare’s newly uninsured

December 23, 2013

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

Pennsylvania's insurance commissioner, Michael Consedine, estimates that about 250,000 people in his state have seen their insurance policies cancelled this year — many of them because of Obamacare. But only 11,000 people have enrolled in new insurance through HealthCare.gov.

North Dakota's insurance commissioner, Adam Hamm, estimates his constituents have seen 11,000 cancellations and only about 265 enrollments through HealthCare.gov.

Many of the people whose plans were cancelled have gone and bought new insurance through brokers or directly from insurance companies. So the gap between plan cancellations and new plan sign-ups is considerably smaller than these numbers suggest. But it's not at all likely that it's been closed.

Today is the last day for people to sign up for insurance under Obamacare that begins on January 1st. That means that if people whose plans have been cancelled don't find new insurance by the end of the day, then they'll be uninsured on January 1st.

As Sarah Kliff reported on Friday, Obamacare's four million Medicaid enrollments should ensure that the ranks of uninsured fall on January 1st. But it's also possible that hundreds of thousands — and, depending on whose numbers you believe, perhaps even millions — of people who had private insurance in 2013 will not have it on the first day of 2014.

The previous theory was that the individual mandate would force them to enroll by the end of March. But last week the Obama administration announced that anyone with a cancelled plan gets a hardship exemption from the individual mandate. That means rate shock, anger at Obamacare's cancellations, or even simple procrastination could keep these people uninsured.

The good news for Obamacare is that HealthCare.gov is working better every day. At Friday's press conference, President Obama said more than 500,000 people signed up for insurance through HealthCare.gov during the first three weeks of December — more than in October and November combined. But that's still less than the total number of people who've had their plans cancelled.

The Obama administration is bracing for a surge in enrollments today. But the bigger question is whether there's a surge in enrollments in January, February and March, when people realize they're now uninsured and have to decide whether to do anything about it.

Wonkbook's Number of the Day: 0. That is how many more days you have to sign up for health insurance for 2014 through Healthcare.gov. You have to do it today.

Wonkbook's Graph of the Day: Healthcare.gov's traffic rank since its launch, from Alexa.com. It'll be interesting to see whether this surges today.

Wonkbook's Top 5 Stories: (1) the final rush to Healthcare.gov; (2) Obama administration tries to stop courts from ruling on NSA; (3) dismal scientists can be hopeful, too; (4) solar vs. The Man; and (5) Utah makes it 18 states with same-sex marriage.

1. Top story: Obamacare's Dec. 23rd deadline

Today is a big Obamacare deadline. "For most Americans, Monday is the deadline to sign up for health insurance that takes effect on Jan. 1...Kevin J. Counihan, the chief executive of the Connecticut exchange, said calls to its telephone call center had tripled in the last three weeks, to 6,000 a day. “We are really bracing for Monday,” Mr. Counihan said. The Connecticut exchange is increasing its call center staff to 114 from 63...[E]arly data from states suggest that people ages 55 to 64 are overrepresented while those younger than 35 are underrepresented. In Colorado, 43 percent of people signing up for private plans in the first couple of months were in the 55-to-64 age bracket. In Connecticut, Rhode Island and Washington, the share was 40 percent. And in California and Kentucky, the proportion was 35 percent. Nationally, about 12 percent of the population is 55 to 64." Robert Pear in The New York Times.

@sarahkliff: Shopping on http://healthcare.gov today or tomorrow? I want to hear about it! Let me know how it's going at Sarah.Kliff@washpost.com

It does not seem like the Obama administration ran its individual-mandate suspension idea past the insurers. "The number of Americans enrolling continues to fall short of the goals the Obama administration has laid out, which is a problem for the White House. It also represents a problem for the insurance industry, which calculated that the prospect of millions of new customers brought their way by the Affordable Care Act and its coverage requirements would make up for any disruption that came along with the law. Karen Ignagni, the industry's top representative in Washington, spent the weekend managing the fallout after the administration overhauled its approach to people who buy coverage on the individual market." Elizabeth Williamson and Louise Radnofsky in The Wall Street Journal.

No one knows if Obamacare will increase health care coverage next month. "On Jan. 1, Obamacare's huge coverage expansion officially begins. But with millions of insurers canceling health insurance plans and many Americans finding it difficult to sign up for coverage on HealthCare.gov, will the number of uninsured go down -- or up? Health care experts say that Obamacare's Medicaid expansion is likely to offset any cancellations and drive the ranks of the uninsured down. But they acknowledge that deciphering the truth will be nearly impossible, especially when it comes to figuring out whether private insurance coverage went up or down." Sarah Kliff in The Washington Post.

@avik: If the Obamacare “product is good,” why is it a “hardship” that people need to be exempted from?

There is no Plan B for Obamacare's launch. "Last Wednesday Jason Furman, chairman of the Council of Economic Advisers, joined the Washington think tank Third Way for a wide-ranging discussion. Near the end of the session, Third Way scholar Bill Schneider brought up Obamacare. "Does the administration have any kind of backup plan — if not enough young healthy people sign up for the Affordable Care Act, what's going to happen?" Schneider asked...Schneider was still curious. "But you have no particular backup plan?" "There's a Plan A," Furman answered. "Which is to enroll as many young healthy people as you possibly can."" Byron York in The Washington Examiner.

Sen. Manchin wants a yearlong transition to Obamacare. "While speaking on CNN's "State of the Union" with Candy Crowley Sunday morning, Manchin touted his bipartisan bill with Sen. Mark Kirk (R-Ill.) that pushes for a delay of the Affordable Care Act's individual mandate..."I am worried about having a product that the market will buy. So we said why don't we have 2014 be a transitional year?" Manchin asked." Laura Barron-Lopez in The Hill.

Obama: 500K healthcare signups in December. "President Obama said during a Friday press conference that more than 500,000 people signed up at HealthCare.gov in the first three weeks of December, a major spike in enrollments that signals improvement at the troubled website. The 500,000 figure outpaces the total number of enrollments for October and November combined, and brings the number of people enrolled in ObamaCare to more than 1 million." Elise Viebeck in The Hill.

@freddoso: Obama says that the fundamentals of Obamacare remain strong.

Obama names healthcare rollout his biggest mistake of dismal year. "Asked about his worst error, Obama said that he had stressed the need for consumers to have “a good experience, an easy experience” in the run-up to the launch of HealthCare.Gov. He continued: “The fact is it didn’t happen in the first month, first six weeks, in a way that was at all acceptable. And since I’m in charge, obviously we screwed it up.”" Niall Stanage and Amie Parnes in The Hill.

Obamacare's impact on the middle class. "An analysis by The New York Times shows the cost of premiums for people who just miss qualifying for subsidies varies widely across the country and rises rapidly for people in their 50s and 60s. In some places, prices can quickly approach 20 percent of a person’s income. Experts consider health insurance unaffordable once it exceeds 10 percent of annual income. By that measure, a 50-year-old making $50,000 a year, or just above the qualifying limit for assistance, would find the cheapest available plan to be unaffordable in more than 170 counties around the country, ranging from Anchorage to Jackson, Miss." Katie Thomas, Reed Abelson and Jo Craven McGinty in The New York Times.

@ByronYork: Remember when Obamacare advocates said system needed 7 million enrollments, and about 40% of them had to be young and healthy?

In tech buying, U.S. still stuck in last century. "[D]espite Mr. Obama’s promises in the last two months to “leap into the 21st century,” there is little evidence that the administration is moving quickly to pursue an overhaul of the current system in the coming year...Officials said the administration was conducting a “review of options” for improving the government’s use of technology and was beginning to discuss the issue with stakeholders inside and outside government. But they declined to say whether Mr. Obama would call for changes in how Washington delivers technology projects during his State of the Union address early next year and whether the White House had any specific plan to make good on the president’s oft-stated interest in tackling the thorny, bureaucratic issue." Michael D. Shear and Annie Lowrey in The New York Times.

Jeff Zients helped salvage HealthCare.gov. Now he’ll be Obama’s go-to guy on economy. "As Mr. Fix-It for HealthCare.gov, Zients demonstrated key traits that his fans say will help advance Obama’s second-term agenda when he enters the West Wing in a few weeks as the president’s top economic adviser...Now, the question is whether he can replicate that success as director of Obama’s National Economic Council, where he will start in February. With progress uncertain in a divided Congress, the most likely changes will come through more muscular and better coordinated use of executive power." Juliet Eilperin and Zachary A. Goldfarb in The Washington Post.

HealthCare.gov contract: Politics not a factor, but neither were firm’s ties to failed projects. "CGI Federal, the company responsible for building the problem-plagued Web site for the Affordable Care Act, won the job because of what federal officials deemed a “technically superior” proposal, according to government documents and people familiar with the decision. Not considered in the 2011 selection process was the history of numerous executives at CGI Federal, who had come from another company that had mishandled at least 20 other government ­information technology projects more than a decade ago. But federal officials were not required to examine that long-term track record, which included a highly publicized failure to automate retirement benefits for millions of federal workers...In hindsight, one former CMS official said, the AMS record “could well have knocked [CGI Federal] out of the competition, and probably should have.”" Jerry Markon and Alice Crites in The Washington Post.

For the mentally ill, finding treatment is only getting harder. "Last year, according to the U.S. Department of Health and Human Services, almost 91 million adults lived in areas like here where shortages of mental-health professionals made obtaining treatment difficult. A departmental report to Congress earlier this year said 55% of the nation's 3,100 counties have no practicing psychiatrists, psychologists or social workers, a combination of budget cuts and doctors leaving the profession...Such shortages are expected to only grow now, as the federal health-care law goes into effect and allows more people to seek help." Gary Fields and Jennifer Corbett Dooren in The Wall Street Journal.

ROSENTHAL: How to further fix U.S. healthcare. "[W]e could strictly regulate prices or preset payment levels, as is currently done for hospital stays under Medicare, the national insurance program for people over 65, or at least establish fair price corridors for procedures and drugs. We could require hospitals and doctors to provide price lists and upfront estimates to allow consumers to make better choices. We could stop paying doctors and hospitals for each service they performed and instead compensate them with a fixed monthly fee for taking care of each patient. We could even make medical school free or far cheaper and then require service afterward. But the nation is fundamentally handicapped in its quest for cheaper health care: All other developed countries rely on a large degree of direct government intervention, negotiation or rate-setting to achieve lower-priced medical treatment for all citizens. That is not politically acceptable here." Elisabeth Rosenthal in The New York Times.

LASZEWSKI: Obamacare's slippery slope. "I have to believe this will not be the last concession to Democrats under reelection pressure. One has to wonder how this can't other than further undermine how people feel about Obamacare––particularly its fairness––and taking their "social responsibility" to sign-up seriously." Robert Laszewski on his blog.

CAPRETTA: Obamacare is falling apart. "[B]y conceding that the individual mandate can and should be delayed for one group, the administration has opened a major can of worms.  For starters, this exemption is going to strike many Americans as blatantly unfair and arbitrary.  It comes at the 11th hour, after millions of people, including those with canceled plans, have already made their choices based on the rules they thought would be in effect." James C. Capretta in The Weekly Standard.

Music recommendations interlude: Rockwell, "Somebody's Watching Me," 1984.

Top opinion

KRUGMAN: Bits and barbarism. "Keynes would, I think, have been sardonically amused to learn how little has changed in the past three generations. Public spending to fight unemployment is still anathema; miners are still spoiling the landscape to add to idle hoards of gold. (Keynes dubbed the gold standard a “barbarous relic.”) Bitcoin just adds to the joke. Gold, after all, has at least some real uses, e.g., to fill cavities; but now we’re burning up resources to create “virtual gold” that consists of nothing but strings of digits." Paul Krugman in The New York Times.

COWEN: Don't mistake this for gridlock. "When evaluating the claim of gridlock, it is useful to examine it within a broader historical setting. In his 1980 book, “The Hare and the Tortoise: Clean Air Policies in the United States and Sweden,” Lennart J. Lundqvist, a Swedish political scientist, recognized what is perhaps startling to the contemporary observer: that the United States was the relatively rapid “hare” in decisively addressing its air-pollution problems, while the Swedish government was the “tortoise,” moving more gradually...Lunging and lurching forward with big changes, then enduring periods of backlash, consolidation and frustration, is often a better description of our political system than is “gridlock,” which is too unidimensional a concept to capture the reality." Tyler Cowen in The New York Times.

KONCZAL: It’s still too early for Congress to stop worrying about unemployment. "[W]e know that tighter labor markets will make it easier for everyone to find jobs, including the long-term unemployed...[I]n 1999, the long-term unemployed didn’t suddenly get exposed to cosmic rays that gave them those special worker “skills” that employers are always talking about. Instead, there was significant tightness in the labor market, with unemployment at 4 percent, which lead employers to go out of their way to find and hire them." Mike Konczal in The Washington Post.

HARFORD: An inheritance of inequality. "What the IFS [Institute for Fiscal Studies] finds is that the generation born in the 1940s – currently about 70 – was richer at the age of 60 than the 1950s generation is today, now aged about 60. And the 1950s generation was richer at the age of 50 than the 1960s generation is today, just as the 1960s generation was richer at the age of 40 than the 1970s generation is today." Tim Harford in The Financial Times.

LUCE: When disruption is useless and destructive. "If there is a buzzword that deserves to be strangled before New Year’s eve it is “disrupter”. Like many neologisms, it originated in Silicon Valley and has spread like a virus into US politics and media...As Washington gears up for yet another year of trench warfare, spare a thought for all those non-disrupters out there. The moment has arrived for quietly competent people to get their due." Edward Luce in The Financial Times.

LAZEAR: The young, the restless and economic growth. "In a current study analyzing the most recent Global Entrepreneurship Monitor (GEM) survey, my colleagues James Liang, Jackie Wang and I found that there is a strong correlation between youth and entrepreneurship. The GEM survey is an annual assessment of the "entrepreneurial activity, aspirations and attitudes" of thousands of individuals across 65 countries. In our study of GEM data, which will be issued early next year, we found that young societies tend to generate more new businesses than older societies." Edward P. Lazear in The Wall Street Journal.

Wintry interlude: How the Canadians plow snow.

2. Obama administration tries to stop courts from ruling on NSA

White House tries to prevent judge from ruling on surveillance. "The Obama administration moved late Friday to prevent a federal judge in California from ruling on the constitutionality of warrantless surveillance programs authorized during the Bush administration, telling a court that recent disclosures about National Security Agency spying were not enough to undermine its claim that litigating the case would jeopardize state secrets. In a set of filings in the two long-running cases in the Northern District of California, the government acknowledged for the first time that the N.S.A. started systematically collecting data about Americans’ emails and phone calls in 2001, alongside its program of wiretapping certain calls without warrants." Charlie Savage and David E. Sanger in The New York Times.

Key national-security longread: The incredible story behind U.S. covert action in ColombiaDana Priest in The Washington Post.

Federal agencies to hire more cyber defenders in 2014. "The Navy had 800 cybersecurity staffers in 2013 and will reach nearly 1,000 by 2017, working toward a mix of 80 percent uniformed personnel and 20 percent civilian employees and contractors. The Marines currently have 300 uniformed personnel, civilians and contractors at work, and plan to increase that number to just under 1,000 by 2017." John Slye in The Washington Post.

Data brokers outpace regulators as they mine new technologies. "In the past 18 months, US lawmakers and federal regulators have launched a series of investigations to uncover how data brokers collect, track, trade and use information about people. Yet no new regulations have emerged to govern the fast-growing business of profiling individuals...For years, data brokers have operated in the shadows. The vast and largely unregulated industry includes hundreds of companies with names that most consumers have never heard of, such as Acxiom, Experian and Epsilon." Emily Steel in The Financial Times.

What good does the NSA do, anyway? "A member of President Obama’s advisory committee on signals intelligence, the panel that recommended major restrictions on the National Security Agency’s data collection, on Sunday countered the notion that the panel had found no value in the agency’s activities. Michael J. Morell, a former acting director of the Central Intelligence Agency, said that although the panel of independent experts did not find evidence that the National Security Agency’s efforts had helped stop a terrorist attack, the ability to monitor whether foreign terrorists were calling Americans remained important." Emmarie Huetteman in The New York Times.

U.S. declassifies some details of Bush-era surveillance. "The director of National Intelligence, James Clapper, and the deputy director of the NSA, Frances Fleisch, disclosed the declassification in formal statements filed late Friday in a long-running lawsuit brought in California by the Electronic Frontier Foundation, a civil liberties group..."The NSA's collection of the content of communications under the TSP [or Terrorist Surveillance Program] was directed at international communications in which a participant was reasonably believed to be associated with al Qaeda or an affiliated organization,'' wrote Mr. Clapper." Devlin Barrett in The Wall Street Journal.

Americans uneasy about surveillance but often use snooping tools, Post poll finds. "Nearly seven in 10 Americans are concerned about how much personal information government agencies and private companies collect, the poll found. But among parents 40 or older — the group most likely to have teenagers — 70 percent said they monitor the Web sites their children visit. Many also review their kids’ texts, e-mails and social-media use. A small number of Americans also report tracking the movements of their spouses or using video feeds to monitor elderly parents." Marc Fisher and Craig Timberg in The Washington Post.

Wonkbook's most favorite things ever interlude: Just added to the list is the Tumblr "lolmythesis.com."

3. Absolutely not dismal news about the U.S. economy

IMF will raise growth forecast for U.S. economy. Hooray! "The International Monetary Fund is raising its forecast for U.S. economic growth after Congress struck a budget deal and the Federal Reserve said it would begin to pull back on its signature bond-buying program, the fund's top official said Sunday. Ms. Lagarde did not immediately offer a new number in saying the IMF would raise its forecast. In October it said U.S. gross domestic product, the broadest measure of economic output, is expected to expand 2.5% in 2014. The IMF is set to update its World Economic Outlook in mid-January." Jeffrey Sparshott in The Wall Street Journal.

Explainer: Economic data coming your way this weekAmrita Jayakumar in The Washington Post.

Housing outlook for 2014 is steady and sturdy. "Stan Humphries, chief economist at real-estate site Zillow, is predicting his company's national home-price index will rise by 3% in 2014, versus 5.2% over the past year through October. A Zillow survey of 110 economists in the fourth quarter of this year found an average forecast of a 4.3% gain for next year...Forecasting firm IHS Global Insight is projecting construction starts to rise to 1.1 million next year, while real-estate research firm Zelman & Associates is predicting about the same." Conor Dougherty in The Wall Street Journal.

History: The Federal Reserve was created 100 years ago. This is how it happenedNeil Irwin in The Washington Post.

Yellen advances to final vote in January. "The Senate voted 59-34 Friday to end debate on the nomination of Janet Yellen to head the Federal Reserve, setting up a final vote in January. GOP Sens. Susan Collins (Maine), Bob Corker (Tenn.), Orrin Hatch (Utah), Mark Kirk (Ill.) and Lisa Murkowski (Alaska) voted with Democrats to end debate on her nomination." Ramsey Cox in The Hill.

When the Volcker rule gets real. "For the biggest banks compliance is especially important because the measure requires that chief executives attest in writing that their company has “reasonably designed” processes in place to achieve compliance...There are six parts to compliance, including writing policies and procedures to follow the rule, establishing internal controls, setting up management in a way that makes responsibility and accountability clear, independent testing and auditing, training and record keeping. Many of these factors contain the “reasonably designed” language." Gina Chon in The Financial Times. 

Those Fed regulators are toughening up. "The Federal Reserve clamped down on bank moves to evade tougher capital rules on Friday, warning that transactions intended to reduce risk would be closely scrutinised during annual stress tests on bank balance sheets...Some of these regulatory capital trades, which typically involve insurance offered by a third-party, are legitimate while others are evasion, the Fed indicated. If the risks are shifted to a “thinly capitalised counterparty or affiliated entity of the firm, any residual risk is effectively captured in the firm’s internal capital adequacy assessment”, the agency said in its guidance note to large banks." Gina Chon and Tom Braithwaite in The Financial Times.

Wonkblog interlude: How the media will report the apocalypse.

4. Solar power as a threat to power

In Hawaii, a solar boom so successful, it's been halted. "Hawaiian Electric Co., or HECO, in September told solar contractors on Oahu that the island's solar boom is creating problems. On many circuits, the utility said, there's so much solar energy that it poses a threat to the system and a safety issue. Studies are needed on whether grid upgrades are necessary. If they are, residents adding solar must foot the bill. And starting immediately, contractors and residents would need permission to connect most small rooftop systems to the grid...The policy change halted what has been a solar surge in Hawaii. Installations there jumped 169 percent last year from 2011. More than 4 percent of households have photovoltaics. Hawaii last year led the nation in the portion of its electricity that comes from solar, with 2.6 percent...The new struggle on Hawaii foreshadows what the rest of the country could face as solar moves closer to the mainstream, several involved in the debate said." Anne C. Mulkern in ClimateWire.

Moniz, a friend of fracking. "Energy Secretary Ernest Moniz is ending the year with a reminder: Carbon dioxide is the biggest enemy in the fight against climate change. Moniz, in a new interview, offers a quick tour of recent studies on methane emissions from natural gas development—a topic that's plenty controversial amid the U.S. fracking boom. "We need more data," he tells the news service Platts. But, he adds, methane is far from public enemy number one. That's carbon dioxide. "We do have, after all, measurements of the methane concentrations in the atmosphere and what they tell us is that the carbon dioxide concentrations remain by far the biggest forcer of climate change," he said in an interview that aired Sunday...The comments are the latest sign that Moniz does not see methane leaks undercutting the climate advantages that natural gas holds over coal." Ben Geman in NationalJournal.

TransCanada CEO: Obama will approve Keystone XL. "TransCanada CEO Russ Girling said he is "very confident" the proposed Keystone XL pipeline will be approved by President Obama. Girling said he expects the final environmental review of the pipeline, which would carry crude from oil sands in Alberta, Canada to Gulf Coast refineries, to be released by the State Department in the coming weeks." Laura Barron-Lopez in The Hill.

U.S. won't tighten pipeline rules. "The U.S. Transportation Department doesn't plan to change regulations to better protect underground pipelines from riverbed erosion, a year after Congress ordered it to evaluate its policies in the wake of pipeline breaks that spilled hazardous liquids into waterways. The department's Pipeline and Hazardous Materials Safety Administration said its review found that over the past two decades, riverbed erosion contributed to just one in every 200 significant hazardous-liquid incidents involving pipelines." Jack Nicas in The Wall Street Journal.

Janet McCabe to get top EPA pollution regulator nod. "President Obama announced plans to nominate Janet McCabe to a top post at the Environmental Protection Agency (EPA) late Thursday. Obama intends to nominate McCabe as assistant administrator for the agency's Office of Air and Radiation, a post she has been occupying in the acting capacity." Laura Barron-Lopez in The Hill.

Animals interlude: Sloth + cat.

5. Utah makes it 18

Utah's same-sex couples rush to get married. "A federal judge’s ruling on Friday afternoon striking down Utah’s ban on same-sex marriages touched off what Mayor Ralph Becker called a “thrilling pandemonium.” Hundreds of people filled the hallways and spilled out onto the sidewalks on Friday, hoping to marry before the county clerk’s offices closed for the weekend — and before an appeals court could stay the decision that made Utah, at least for the moment, the 18th state to allow same-sex marriages. For gay couples, it was a seismic change in a state where 66 percent of voters approved a ban on same-sex marriage in 2004. The Mormon Church also played a pivotal role in supporting a 2008 measure that banned same-sex marriage in California." Jack Healy in The New York Times.

Sides square off over judge’s overturn of Utah ban on same-sex marriage. "More than 17,000 people signed a petition urging Gov. Gary R. Herbert (R) to let U.S. District Judge Robert J. Shelby’s ruling stand, organizer Tim Wagner said...Herbert criticized the ruling, saying it attempts to “override the will of the people of Utah” and that the state will fight it to defend traditional marriage. He urged Shelby to grant a motion to stay the decision until the state’s appeal can be heard." The Associated Press.

Reading material interlude: The best sentences Wonkblog read today.

Wonkblog Roundup

The Federal Reserve was created 100 years ago. This is how it happenedNeil Irwin.

It’s still too early for Congress to stop worrying about unemploymentMike Konczal.

Et Cetera

When the right to bear arms includes the mentally illMichael Luo and Mike McIntire in The New York Times.

Fears multiply amid a surge of deportationJulia Preston in The New York Times.

Report: Use of death penalty shows decline in United StatesPete Yost in The Washington Post.

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

Wonkbook is produced with help from Michelle Williams.

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Neil Irwin | December 21, 2013