Wonkbook: What happens one second after Obamacare goes live?

December 30, 2013

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(Photo by Daniel Acker/Bloomberg)

Wonkbook's Number of the Day: 975,000. That's how many people signed up for private health insurance plans through Healthcare.gov from December 1 to December 24.

Wonkblog's Graphs of the Year: The series continues, with new entries from Vaclav Smil, Paul Farmer, Anne-Marie Slaughter, Sen. Ron Wyden, Chris Hayes, Chuck Schumer, Brian Greene

Wonkbook's Top 5 Stories: (1) launching Obamacare plans; (2) Democrats and labor; (3) inside TAO; (4) the 2014 energy outlook; and (5) gay marriage, from sea to shining sea.

1. Top story: What happens one second after Obamacare goes live?

Will Obamacare be tested right out of the gate? ""People are going to start showing up at emergency rooms at midnight on New Year’s eve and the hospitals will need to figure out which insurers are covering them,” said Tim Jost, an advocate of the healthcare law and professor at Washington and Lee University School of Law. “Some, perhaps many, enrollees will not have insurance cards or show up on the records of insurers and this will all need to be straightened out. People will go to out of network doctors or pharmacies, or need drugs not on their plan’s formulary,” Mr Jost said." Stephanie Kirchgaessner in The Financial Times.

Medical billing enters an era of ultra-specific codes. "[A] transformation is coming to the arcane world of medical billing. Overnight, virtually the entire health care system — Medicare, Medicaid, private insurers, hospitals, doctors and various middlemen — will switch to a new set of computerized codes used for determining what ailments patients have and how much they and their insurers should pay for a specific treatment...The new set of codes, known as I.C.D.-10, allows for much greater detail than the existing code, I.C.D.-9, in describing illnesses, injuries and treatment procedures. That could allow for improved tracking of public health threats and trends, and better analysis of the effectiveness of various treatments" Andrew Pollack in The New York Times.

@TimothyNoah1: Today's Obamacare insight: I find dealing with the health exchange (govt) a picnic compared to dealing with the insurer (private sector).

Patients cram in health tests before Obamacare starts. "Many insurers offering plans under the law are slimming down their networks of doctors and hospitals in a bid to lower the cost of policies, which begin coverage Wednesday. Health insurers are especially focused on paring academic teaching and research hospitals from their networks because they generally charge more than community hospitals for similar services." Timothy W. Martin in The Wall Street Journal.

The December deluge: 1.1 million have enrolled on HealthCare.gov. "More than 975,000 of them signed up this month, prior to the Dec. 24 deadline. In other words: Enrollment in the federal exchange was about nine times as high in December than all of October and November." Sarah Kliff in The Washington Post.

CMS: HealthCare.gov handled traffic surge. "The Obama administration said Friday that the HealthCare.gov website adequately handled a massive surge of Internet traffic ahead of Tuesday’s deadline for consumers seeking healthcare plans that begin Jan. 1...Bataille said that in the four days leading up to the Dec. 24 enrollment deadline, response times averaged half a second, and error rates were at less than 1 percent. The website produced those numbers under the strain of record traffic. According to the administration, 2 million people visited the site on Monday, and an additional quarter of a million phoned the call centers. About 1 million people visited the site, and 200,000 called in over the weekend." Jonathan Easley in The Hill.

@jonlovett: This IS NOT true. RT @kerpen: Latest numbers make it clear Obamacare will cause a NET DECREASE in private insurance coverage January 1.

Beneath health law’s botched rollout is basic benefit for millions of uninsured Americans. "Adam Peterson’s life is about to change. For the first time in years, he is planning to do things he could not have imagined. He intends to have surgery to remove his gallbladder, an operation he needs to avoid another trip to the emergency room...“I get these messages from acquaintances on Facebook saying, ‘Let me keep my doctor,’ ’’ Peterson said. “Well, what about those of us who didn’t have health insurance before? . . . I have been walking a tightrope and have had some twists and falls off of it. To not have to worry about this anymore is a tremendous relief.”" Lena H. Sun and Amy Goldstein in The Washington Post.

Explainer: 5 states where Obamacare has been a successJonathan Easley in The Hill.

Why can't Romneycare and Obamacare play nice? "Only 2,800 people have enrolled so far on the state's new health exchange. About 45,000 health-insurance applications are currently being processed in Massachusetts so enrollments are expected to jump in coming weeks. On Monday, the state said people could sign up as late as New Year's Eve for coverage beginning Jan. 1...Originally Massachusetts had planned to shut down the state's Commonwealth Care at the end of 2013 and transfer those people either into private health-insurance plans newly available under the federal law or to Medicaid, depending on their incomes. Now, while it continues to process applications under the new health-care exchange, it also is extending the older program through March because of the technology troubles." Jennifer Corbett Dooren in The Wall Street Journal.

@JeffYoung: Fun fact: Obamacare requires Tony Romo to pay double for all his medical care.

COHN: We don't know if Obamacare is working well. But we know it's working. ""Given the technical problems at the start, and given that the important deadline is March 31, what matters right now is the trend in enrollment.  In terms of overall enrollment, the trend looks quite good," Gruber says. "What matters more is the mix in terms of the health of those enrolling, and we won't have a clear answer on that until we see 2015 rates from insurers."" Jonathan Cohn in The New Republic.

Movie recommendations interlude: Wonkbook just saw "American Hustle," and it was great.

Top opinion

KRUGMAN: Fiscal fever breaks. "[A] combination of rising tax receipts and falling spending has caused federal borrowing to plunge. This is actually a bad thing, because premature deficit-cutting damages our still-weak economy — in fact, we’d probably be close to full employment now but for the unprecedented fiscal austerity of the past three years. But a falling deficit has undermined the scare tactics so central to the “centrist” cause. Even longer-term projections of federal debt no longer look at all alarming." Paul Krugman in The New York Times.

HARFORD: The robots are coming and will terminate your jobs. "In 2008, robots still struggled with a problem known as “Slam” – simultaneous localisation and mapping, the process of mentally building up a map of a new location, including hazards, as you move through it. In 2011, Slam was convincingly addressed by computer scientists using Microsoft’s “Kinect” gaming hub, an array of sensors and processors that until recently would have been impossibly costly but is suddenly compact and cheap. Problems such as language recognition and Slam have so far prevented robots working alongside humans; or on tasks that are not precisely defined, such as taping up parcels of different sizes or cleaning a kitchen. Perhaps the robots really are now on the rise." Tim Harford in The Financial Times.

DEARIE AND GEDULIG: Immigrants are the job creators. "Immigrants represent 13% of the U.S. population but account for nearly 20% of small businesses owners...Immigrants also launch half of the nation's top startups, and research by the Kauffman Foundation has established that startups account for virtually all net new job creation. A study by the National Foundation for American Policy found that of the top 50 venture capital-backed companies in the U.S. last year, 23 have at least one foreign-born founder, while 37 have at least one immigrant in a major management position." John Dearie and Courtney Gedulig in The Wall Street Journal.

DIONNE: Was 2013 really that bad? "I’d suggest that 2013 was not his worst year. That distinction should be reserved for 2011, when the president emerged from the summer looking weak after protracted negotiations with House Republicans over a debt-ceiling increase...[S]omething else happened this year that may, over time, prove far more important than the great Web site flop. In 2013, the tea party began to decline in both real and perceived power, and Republicans began a slow retreat from the politics of absolutism." E.J. Dionne in The Washington Post.

Linguistics is plain awesome interlude: 12 old words that survived by embedding themselves in idioms.

2. Democrats, once again the party of labor?

Bipartisan bill pushed to extend for jobless benefits. "With 1.3 million jobless workers losing their benefits Saturday, Democrats on Capitol Hill are pushing for a three-month extension that is slated to face a key procedural vote as soon as next week. The bill, introduced by Sens. Jack Reed (D-R.I.) and Dean Heller (R-Nev.), would prolong emergency unemployment benefits that have been in place since the depths of the recession in 2008. Reed said the bill would offer retroactive benefits. He added that his priority is securing a filibuster-proof majority during a Senate vote scheduled for Jan. 6." Jia Lynn Yang in The Washington Post.

2014 may see Democrats turn the minimum wage into a top political issue. "The effort to take advantage of growing populism among voters in both parties is being coordinated by officials from the White House, labor unions and liberal advocacy groups. In a series of strategy meetings and conference calls among them in recent weeks, they have focused on two levels: an effort to raise the federal minimum wage, which will be pushed by President Obama and congressional leaders, and a campaign to place state-level minimum wage proposals on the ballot in states with hotly contested congressional races." Jonathan Martin and Michael D. Shear in The New York Times.

Judge bars minimum-wage hike for some in SeaTac. "Judge Andrea Darvas’s ruling said the recently approved measure applies to about 1,600 hotel and parking lot workers in the city of SeaTac, but that the city initiative does not have authority over 4,700 employees and contractors working within Seattle-Tacoma International Airport, which is operated by the Port of Seattle." The Associated Press.

Socialism comes to Seattle. No, really. "Ask her about almost any problem facing America today, and her answer will probably include the “S” word as the best and most reasonable response. Socialism is the path to real democracy, she says. Socialism protects the environment. Socialism is the best hope for young people who have seen their options crushed by the tide of low-wage, futureless jobs in the post-recession economy." Kirk Johnson in The New York Times.

Home prices break prerecession peaks in some areas. "The 10 metro areas enjoying a full-scale rebound are based on figures for the entire region. The Wall Street Journal also analyzed Zillow price data individually in more than 4,400 cities and towns in the country's largest metro areas. Nearly 10% of municipalities have seen prices reach new highs this year when compared with their previous peak, and prices are within 5% of their previous highs in 300 more. These cities are largely exceptions, and prices in many parts of the U.S. are still well below their peak. In some 1,500 cities, values are still at least 25% lower than their previous highs." Nick Timiraos in The Wall Street Journal.

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

Signs point to stronger job market in 2014. "The labor picture has brightened since the depths of the 2007-09 downturn, but progress has been fitful. In 2013, employers created an average of 189,000 positions a month, picking up the pace in October and November, when they added 200,000 and 203,000 jobs, respectively. In the past two years, the unemployment rate has eased to 7.0% from 8.3%—but much of the decline was due to jobless individuals ceasing to look for work." Brenda Cronin in The Wall Street Journal.

Econ longread: Academics who defend Wall St. reap rewardDavid Kocieniewski in The New York Times.

The White House wants to bring change to the IMF. "The White House is pushing Congress to include provisions in a new spending bill that would change how the U.S. finances the International Monetary Fund and give emerging markets greater influence with the organization. As developing economies have expanded rapidly, their power within the fund hasn't grown in proportion. Obama administration officials say those nations need more say at the IMF to encourage them to act "responsibly" in the global economy. The IMF's board of governors approved the proposed governance changes, as well as a doubling of the emergency lender's reserves, three years ago." Ian Talley in The Wall Street Journal.

Mass-transit commuters are about to get slammed. "An expiring tax-code provision means commuting by mass transit will cost some people more when the new year begins Wednesday. The maximum monthly tax exemption for transit riders is set to drop to $130 in 2014, while the benefit for drivers' parking expenses will rise slightly, to $250. This year, mass-transit users have been allowed to set aside up to $245 a month of their pretax income to pay for commuting expenses." Andrew Grossman in The Wall Street Journal.

To emulate or not to emulate, that is the question interlude: The daily routines of famous writers.

3. Inside TAO

Documents reveal top NSA hacking unit. "The NSA's TAO hacking unit is considered to be the intelligence agency's top secret weapon. It maintains its own covert network, infiltrates computers around the world and even intercepts shipping deliveries to plant back doors in electronics ordered by those it is targeting." Der Spiegel.

How private is your phone, exactly? "As an experiment, I decided to access my own data files from third parties to find out. The results were surprisingly revealing, showing my favourite lunch locations, sporting preferences and even the methods I use to get our newborn son to sleep at night. All companies in the EU will now give users data held on them on request, but the telecoms groups have come under particular scrutiny given how much information they hold is shared with government departments. Even a relatively superficial trawl of the data they hold can be used to compile an accurate log of movements and communications." Daniel Thomas in The Financial Times.

Long arc toward justice interlude: Fallon Fox, the first transgender woman in MMA.

4. The 2014 energy outlook

New energy struggles its way to market. "To stave off climate change, sources of electricity that do not emit carbon will have to replace the ones that do. But at the moment, two of those largest sources, nuclear and wind power, are trying to kill each other off...Energy companies announced this year that five nuclear reactors would be closing or not reopening, and the owners blamed competition from natural gas and wind. In the Pacific Northwest, wind and hydroelectricity — neither of which produce carbon — are sparring to push each other off the regional power grid." Matthew L. Wald in The New York Times.

U.S. carmakers are still trying to figure out how they can take advantage of ultralow natural-gas prices. "US carmakers are struggling to reconcile customers’ growing interest in running vehicles on newly abundant natural gas with the logistical challenges of supplying the technology for the still-niche market, according to senior automotive executives...Normal vehicles can use the plentiful fuel – which produces fewer greenhouse gas emissions than petrol or diesel fuel – with the addition of large fuel tanks and minor modifications to the engine. Big customers can sign long-term contracts to buy natural gas at low prices. However, Chrysler, smallest of the big three US carmakers, is offering only one vehicle with a CNG fuel option, while General Motors, largest by sales, is offering only a few models." Robin Wright in The Financial Times.

Climate change debate ready to heat up. "The Environmental Protection Agency is expected to announce historic final standards aimed at curbing carbon emissions from the nation's power plants in June, but not before lawmakers and industry groups give their two cents on the issue...Also, expect noise from oil groups and environmentalists in 2014 as the State Department's final environmental impact statement on the proposed Keystone XL pipeline is due to be released in the coming weeks. " Laura Barron-Lopez in The Hill.

Chinese art interlude: Li Hongbo.

5. For Scalia, does this count as winning by losing, or losing by winning?

Scalia finds his predictions on same-sex-marriage ruling being borne out. "When the court last June struck down the federal Defense of Marriage Act and said the federal government must recognize same-sex marriages performed in those states where it was legal, Scalia sounded a loud warning. While the five-member majority of the court said it was not deciding whether a constitutional right to marriage must be extended to same-sex couples, Scalia said the reasoning of the decision made that outcome practically preordained...Scalia’s words have been highlighted in the two recent decisions about same-sex marriage that will return the issue to the Supreme Court." Robert Barnes in The Washington Post.

Utah ruling puts judge in spotlight. "For a judge who would go on to make same-sex marriage legal in Utah, a deep-red state where streets in the capital are numbered by their distance from the Mormon temple, Robert J. Shelby arrived on the bench with enthusiastic praise from Republican leaders. He had been a combat engineer in the Persian Gulf conflict and was, according to state voter records, a registered Republican. Senator Orrin G. Hatch, a seven-term Utah Republican, recommended him for a federal judgeship, calling him an experienced lawyer “with an unwavering commitment to the law.” Senator Mike Lee, a Tea Party Republican, said that Mr. Shelby was “pre-eminently qualified” and predicted he would be an outstanding judge." Jack Healy in The New York Times.

Reading material interlude: The best sentences Wonkblog read today.

Wonkblog Roundup

SeaTac’s minimum wage workers might not get their raise after allLydia DePillis.

Brian Greene’s Graph of the Year “reveals an astounding feature of the universe." Wonkblog.

Vaclav Smil’s graph of the year: The natural-gas boomWonkblog.

Paul Farmer’s Graph of the Year: Rwanda’s plummeting child mortality rateWonkblog.

Anne-Marie Slaughter’s graph of the yearWonkblog.

Sen. Ron Wyden’s Graph of the YearWonkblog.

Chris Hayes’s graph of the year: our racist criminal justice system in one chartWonkblog.

The December deluge: 1.1 million have enrolled on HealthCare.govSarah Kliff.

Et Cetera

Key longread: A deadly mix in BenghaziDavid D. Kirkpatrick in The New York Times.

Congress could reconsider military pension cut in January. Lisa Rein in The Washington Post.

France's 75-percent tax rate will go into effect after challenge failsHugh Carnegy in The Financial Times.

Red, blue states move in opposite directions in a new era of single-party controlDan Balz 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 · December 29, 2013