Wonkbook: This quote shows why Obamacare is here to stay

December 27, 2013

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Sen. Ron Johnson, a tea party Republican from Wisconsin, knows that the politics of Obamacare are changing.

“It’s no longer just a piece of paper that you can repeal and it goes away,” he told the New York Times. “There’s something there. We have to recognize that reality. We have to deal with the people that are currently covered under Obamacare.”

Jan. 1 isn't likely to be a glitch-free day for Obamacare. There will be people who try to use their insurance and find they can't, or it's not the plan they meant to buy, or it's not a plan that covers their doctor. But those problems will, eventually, be solved. And their wake will be a game-changing reality: At least 2 million people will have health insurance through Obamacare's exchanges, and more than 4 million people will have health insurance through the law's Medicaid expansion.

The GOP's campaign against Obamacare has been most effective when Republicans could claim, reasonably or not, that the law was taking something away from people: Canceling their plans, or penalizing them for going without insurance, or changing their doctor. But by the end of March, it's likely that at least 8 million to 10 million people will be getting insurance through Obamacare.

At that point, the politics of loss aversion shift. Obamacare's major changes to existing insurance plans will be finished. It will be the GOP's promises of repeal that threaten what people already have. As Johnson says, "We have to recognize that reality. We have to deal with the people that are currently covered under Obamacare.”

That realization is how repeal-and-replace becomes criticize-and-reform. Johnson suggests ending the individual mandate and letting people buy less comprehensive plans. Sen. Kelly Ayotte wants to do more to promote health savings accounts. Almost all Republicans want to repeal the medical-device tax, and they may ultimately decide they want to repeal the excise tax, too. Medical malpractice reform remains an option, as does changing the way the law limits discrimination against older applicants.

Republicans who want to reform Obamacare remain the (growing) minority. But in another sign that Republicans see the politics of Obamacare changing, there's more talk of producing an actual Republican alternative before the 2014 elections. Rep. Paul Ryan (R-Wis.), for instance, plans to unveil the successor to his Patients' Choice Act act early next year. That, too, is an admission that something like the Affordable Care Act is here to stay, and Republicans need to begin proposing policy for a post-health reform world rather than fantasizing about a return to a pre-health reform world.


Rep. Paul Ryan (EPA/MICHAEL REYNOLDS)

Wonkbook's Number of the Day: 73 out of 100. That's how many people a Stanford research team could identify from their metadata using a basic Google search. It may not be as anonymizing as the NSA suggests.

Wonkblog's Graphs of the Year -- so far: From Ta-Nehisi Coates, Jonathan Franzen, Bill McKibben and Emily Oster.

Wonkbook's Top 5 Stories: (1) last-minute signups make it a merry Obamacare Christmas; (2) appropriators gonna appropriate; (3) bye bye, extended unemployment benefits; (4) check out this government waste; and (5) the NSA has too much data.

1. Top story: Obamacare enrollment spiking

Obamacare had lots of sign-ups on deadline day. "California estimates that 27,000 people picked insurance plans this past Monday and 29,000 the Friday prior. Just last week, the state was averaging 15,000 sign-ups per day. Washington state had 10,000 people enroll Monday, and a total of 20,000 from Dec. 20-23. That accounts for one in 10 Washingtonians picking private health insurance plans. And New York had about 20,000 sign-ups come in that same day." Sarah Kliff in The Washington Post.

Two states seek refunds from health site creator. "Massachusetts health officials said they will meet in early January to decide whether to suspend payments to the company, CGI Federal, which has also been criticized — and questioned during a congressional hearing — for its central role in building the problem-plagued federal health insurance exchange. The state may also seek a refund from the firm, which is an American subsidiary of the Canadian-based CGI Group. Already, Vermont has refused to pay $5.1 million of its contract with the company and is trying to get hundreds of thousands of dollars refunded." Rick Lyman in The New York Times.

@yeselon: Obamacare--by incentivizing the non-insured to seek health insurance--is creating the constituency for universal access that will save it.

Obamacare hits snag in states as it finds footing at federal level. "From Maryland to Hawaii, Obamacare’s state-run enrollment operations are running into technical difficulties, creating new headaches for the White House even as the federal insurance website finds its footing. While the U.S. site has seen volumes surge this month, online exchanges run by those two states, along with systems in Massachusetts, Oregon, Minnesota and Vermont, have struggled with technology delays and low sign-up levels." Alex Nussbaum and Alex Wayne in Bloomberg.

Obamacare's nervous New Year's. "The arrival of Jan. 1 will be a big event for President Barack Obama’s health care law — the day when Americans across the country can use their new health insurance for the first time. It could be a day of badly needed success stories, if people have a smooth time and sing the praises of their new private health insurance or Medicaid coverage. But it could also be a day of hiccups, and if there’s any reality to some of the new problems health care analysts have been warning about — like people who thought they were covered but find out they’re not, or can’t sign up in time to replace their canceled coverage — that’s when we could start hearing about them." David Nather in Politico.

Health law cemented, Republicans adjust. "Republicans are considering several ideas for how to proceed. Mr. Johnson argued that Congress should do away with the mandate that most people obtain insurance, but not the online exchanges at the heart of the law. Instead, he said, the options in the marketplaces should be augmented by other choices that fall short of the law’s coverage standards, such as catastrophic health plans.... Senator Kelly Ayotte, Republican of New Hampshire, said she was teaming up with Democrats on a host of incremental changes to the law, such as expanding health savings accounts and repealing a tax on medical devices." Jonathan Weisman in The New York Times.

Longread: The problem of hospital monopolyPhillip Longman and Paul S. Hewitt in Washington Monthly.

Vista workers told their health insurance doesn't meet Obamacare standards. "The notice has surprised and worried workers in AmeriCorps, the federal community service program that is often described as a domestic version of the Peace Corps. Mary Strasser, the director of AmeriCorps’ Vista program, described the changes in a bulletin to members on Dec. 16.... The impact on community service workers is another unanticipated consequence of the health care law, which is making coverage available at little or no cost to many uninsured people but disrupting coverage for others who already had it." Robert Pear in The New York Times.

@davidfrum: "Obamacare is deficit neutral" wasn't technically a lie, but it was highly misleading. Middle class will pay and is paying.

COOPER: For better or worse, Democrats must own Obamacare. "The typical moderate Democrat instinct here is to make some move toward the Republican side. But no amount of distancing themselves from the president or Obamacare will help. In fact, if they are to rescue their electoral fortunes, the answer is more liberal health-care reform, not less." Ryan Cooper in The Washington Post.

Music recommendations interlude: Andrew Bird, "Imitosis."

Top opinion

KRUGMAN: The fear economy. "More than a million unemployed Americans are about to get the cruelest of Christmas “gifts.” They’re about to have their unemployment benefits cut off. You see, Republicans in Congress insist that if you haven’t found a job after months of searching, it must be because you aren’t trying hard enough. So you need an extra incentive in the form of sheer desperation." Paul Krugman in The New York Times.

Debate: The latest issue of journal Democracy features a forum with Theda Skocpol, Alan Abramowitz and others to discuss the future of the Tea Party. Read more here. Two excerpts follow.

SKOCPOL: The Tea Party isn't going anywhere. "Even though there is no one center of Tea Party authority — indeed, in some ways because there is no one organized center—the entire gaggle of grassroots and elite organizations amounts to a pincers operation that wields money and primary votes to exert powerful pressure on Republican officeholders and candidates. Tea Party influence does not depend on general popularity at all. Even as most Americans have figured out that they do not like the Tea Party or its methods, Tea Party clout has grown in Washington and state capitals. Most legislators and candidates are Nervous Nellies, so all Tea Party activists, sympathizers, and funders have had to do is recurrently demonstrate their ability to knock off seemingly unchallengeable Republicans." Theda Skocpol in Democracy.

ABRAMOWITZ: Republicans face a fork in the road. "The Republican Party today faces major challenges in seeking to remain competitive in national elections in the face of long-term shifts in cultural attitudes and in the demographic composition of the electorate. The Tea Party movement isn’t making it any easier for the party to adapt to these profound shifts in the electoral environment." Alan I. Abramowitz in Democracy.

SPELLINGS: Student test scores depend on accountability. "While our recent scores are quite disheartening, they don’t tell the whole story. The message from education pundits has been that U.S. schools are stuck at mediocre. But had our students continued to improve in 2012 as they did in 2009, the picture of national education achievement would be much different.... [T]he substantial gains through 2009 coincided with states widely adopting rigorous accountability policies.... Student gains have stalled just as policymakers have scaled back the key policies that had begun to lift student achievement." Margaret Spellings in The Washington Post.

Opinion interview: Harold Pollack speaks with Frederick AlticeThe Washington Post.

Reading list: David Brooks gives out the 2013 Sidney AwardsThe New York Times.

KLEIMAN: How to legalize it. "The results of legalization depend strongly on the details of the post-prohibition tax and regulatory regimes. In the current situation, continued prohibition might be the worst option. Full commercial legalization on the alcohol model might well be the second-worst. But that’s the way we’re heading.... The relevant tax on cannabis would be closer to $300 an ounce." Mark A. R. Kleiman in Washington Monthly.

Oh Internet interlude: Open data from balloons and kite photography.

2. Appropriators gonna appropriate

Lawmakers see progress on appropriations before deadline. "With the next budget deadline just weeks away, top lawmakers said this week that they had made significant progress negotiating a huge government-wide spending bill that gives the once mighty congressional Appropriations Committees an opportunity to reassert control over the flow of federal dollars.... While most members of Congress have scattered for the holidays, the panels’ bipartisan leadership and senior staff members have been assembling a $1 trillion measure that splits an extra $45 billion between military and domestic needs under the terms of the overarching budget deal reached this month and signed into law by President Obama on Thursday." Carl Hulse in The New York Times.

Obama signs budget agreement. "The deal passed both the House and Senate with support from both parties earlier this month. Mr. Obama signed the measure the day after Christmas while vacationing in Hawaii." Colleen McCain Nelson in The Wall Street Journal.

Obama signs defense law, calls it a ‘welcome step’ toward closing Guantanamo Bay prison. "President Obama signed a sweeping defense policy law here Thursday that cracks down on sexual assault in the military and eases restrictions on transferring detainees from the federal prison at Guantanamo Bay, Cuba, to the custody of foreign countries. Marking a rare step toward achieving his goal of closing the controversial detention facility, Obama released a statement crediting Congress for relaxing regulations that he said had significantly hindered efforts to transfer detainees who had been cleared to leave." Philip Rucker in The Washington Post.

Wonkbookmark interlude: A site for puzzle players.

3. Unemployment benefits set to expire

U.S. jobless claims fall while holiday sales rise. "Initial claims for state unemployment benefits decreased 42,000 to a seasonally adjusted 338,000, the Labor Department said on Thursday. While the holiday season has made recent claims data so volatile it has been difficult to interpret, Thursday's report showed claims continue in a range that supports expectations for faster economic growth next year." Reuters.

Explainer: Unemployment benefits for 1.3 million expire Saturday. Here’s what you should knowBrad Plumer in The Washington Post.

Map: Where the 1.3 million people losing unemployment aid this week liveNiraj Chokshi in The Washington Post.

Poll: 55 percent say extend the benefitsBernie Becker in The Hill.

Regulators have three days to respond to this court challenge of the Volcker rule. "The Federal Reserve, Federal Deposit Insurance Corp. and Office of the Comptroller of the Currency have until Monday to respond to the American Bankers Association's request to delay the provision, according to an order filed in the U.S. Court of Appeals for the District of Columbia Circuit.... The ABA sued the regulators Tuesday, arguing the agencies acted with "utter disregard" to community banks in defining a provision of the recently finalized Volcker rule that deals with a type of collateralized debt obligation owned by hundreds of small lenders. The agencies said they would agree to temporarily postpone the provision in question through an administrative stay until Jan. 10." Andrew R. Johnson in The Wall Street Journal.

Toledo, Ohio enjoys a windfall of investment from China. "Toledo turned to China to make the 360 panels, 1,300 pounds each, needed for an extension to the Toledo Museum of Art. Some here resented the move after China supplanted the United States as the world’s top glass producer. But in the process, city leaders began an improbable and remarkable relationship. Over the past seven years since the museum project was completed, ties between Toledo and China have grown numerous. Chinese companies have paid more than $10 million in cash for two local hotels, a restaurant complex and a 69-acre waterfront property. Mayor Michael P. Bell has taken four trips to China in four years in search of investors. His business cards are double-sided, in English and Chinese." Timothy Williams in The New York Times.

So great interlude: The best news bloopers of 2013.

4. Check out this government waste

Hospice firms draining billions from Medicare. "Hospice patients are expected to die: The treatment focuses on providing comfort to the terminally ill, not finding a cure. To enroll a patient, two doctors certify a life expectancy of six months or less. But over the past decade, the number of “hospice survivors” in the United States has risen dramatically, in part because hospice companies earn more by recruiting patients who aren’t actually dying, a Washington Post investigation has found. Healthier patients are more profitable because they require fewer visits and stay enrolled longer. The proportion of patients who were discharged alive from hospice care rose about 50 percent between 2002 and 2012." Peter Whoriskey and Dan Keating in The Washington Post.

Government pulls in reins on disability judges. "The Social Security Administration, smarting from recent scandals, this weekend is set to tighten its grip on 1,500 administrative law judges to ensure that disability benefits are awarded consistently and to rein in fraud in the program.... Many judges have operated as if they were independent of the agency and awarded or denied benefits based on their own judgments. A few weeks ago, the SSA notified the judges of the changes. The job descriptions will no longer include the words "complete individual independence."" Damian Paletta in The Wall Street Journal.

For military, benefits and reform are challenge. "Defense Secretary Chuck Hagel has said reforms in military compensation can’t be avoided. “We all know that we need to slow cost growth in military compensation,” Hagel told a Pentagon news conference last week.... In an era of tight budgets, personnel costs now make up nearly half of the Pentagon’s funding, and officials fear continued growth will force disproportionate cuts in other areas, such as training and equipment." The Associated Press.

Remember the neediest interlude: The Wonkblog guide to holiday giving.

5. You are your metadata

Study: NSA can figure out who you are from your metadata. "The National Security Agency likes to claim that intelligence officers are only collecting the phone records of millions of Americans, safely omitting their actual names from analysis. But a Stanford researcher, Jonathan Mayer, found that he and his co-author could easily match so-called “meta-data” to individual names with little more than a Google search. “If a few academic researchers can get this far this quickly, it’s difficult to believe the NSA would have any trouble identifying the overwhelming majority of American phone numbers,” they wrote.... To conservatively approximate human analysis, we randomly sampled 100 numbers from our dataset, then ran Google searches on each. In under an hour, we were able to associate an individual or a business with 60 of the 100 numbers. When we added in our three initial sources, we were up to 73." Gregory Ferenstein in TechCrunch.

NSA struggles to make sense of flood of surveillance data. "William Binney, creator of some of the computer code used by the National Security Agency to snoop on Internet traffic around the world, delivered an unusual message here in September to an audience worried that the spy agency knows too much. It knows so much, he said, that it can't understand what it has. "What they are doing is making themselves dysfunctional by taking all this data," Mr. Binney said at a privacy conference here. The agency is drowning in useless data, which harms its ability to conduct legitimate surveillance, claims Mr. Binney, who rose to the civilian equivalent of a general during more than 30 years at the NSA before retiring in 2001. Analysts are swamped with so much information that they can't do their jobs effectively, and the enormous stockpile is an irresistible temptation for misuse." Julia Angwin in The Wall Street Journal.

Reading material interlude: The best sentences Wonkblog read today.

Wonkblog Roundup

The Wonkblog guide to holiday givingDylan Matthews.

Unemployment benefits for 1.3 million expire Saturday. Here’s what you should knowBrad Plumer.

Our insane healthcare system, prisons editionHarold Pollack.

Obamacare had lots of sign-ups on deadline daySarah Kliff.

Jonathan Franzen's graph of the yearWonkblog.

Bill McKibben's graph of the yearWonkblog.

Emily Oster's graph of the yearWonkblog.

Ta-Nehisi Coates's graph of the yearWonkblog.

Et Cetera

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

Wonkbook is produced with help from Michelle Williams.

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Dylan Matthews · December 26, 2013