Wonkbook: Will your Obamacare insurance work when you go to the doctor?

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(Photo by Daniel Acker/Bloomberg)

Wonkbook's Number of the Day: 40 percent. That's how much a study found that emergency-room use increases when people get Medicaid. 

Wonkbook's Graph of the Day: Where does the farm-bill money go?

Wonkbook's Top 5 Stories: (1) ER trips rise with Medicaid; (2) thread by thread, the safety net undone; (3) Snowden stays away while snow comes to Northeast; (4) "crude oil doesn't explode like that"; and (5) a new kind of farm bill?

1. Top story: Will your Obamacare insurance work when you go to the doctor?

Here come the Obamacare snags? "Consumers began test-driving insurance coverage under the federal health-care law Thursday, seeking care at pharmacies and clinics, and in some cases running into hiccups as their policies took effect...Insurers said Thursday they saw a few cases of consumers who weren't in their systems seeking care, including both late sign-ups and others whose enrollment data may have been lost to government marketplaces' glitches. Health-care providers said they expected problems would likely play out over weeks, as consumers begin to file claims and seek authorization for procedures." Anna Wilde Matthews, Timothy W. Martin and Christopher Weaver in The Wall Street Journal.

@sarahkliff: Back in health reporter mode this AM: Anyone use their new Obamacare insurance/Medicaid yesterday? Drop me a line! sarah.kliff@washpost.com

How to tell if Obamacare is working. "The Congressional Budget Office projects that about 30 million people will gain coverage over the next decade, compared to a scenario where the Affordable Care Act had never passed. That will be one yardstick by which to tell if the health-care law is working: Whether more people have coverage...Are Americans getting healthier? The whole idea of health insurance -- as the name pretty bluntly implies -- is improving health. That's why this is another metric that will likely be tracked with the Affordable Care Act, whether the insurance expansion is making the population healthier." Sarah Kliff in The Washington Post.

Study: Expanding Medicaid doesn’t reduce ER trips. It increases them. "As the health-care law expands Medicaid to cover millions more Americans, a new Harvard University study finds that enrollment in public program significantly increases enrollees' use of emergency departments. The research, published Thursday in the journal Science, showed a 40 percent increase in emergency department visits among those low-income adults in Oregon who gained Medicaid coverage in 2008 through a state lottery. This runs counter to some health-care law supporters' hope that Medicaid coverage would decrease this type of costly medical care, by making it easier for low income adults to see primary care providers." Sarah Kliff in The Washington Post.

Explainer: These six things may change how the public sees ObamacarePhil Galewitz in Kaiser Health News.

Poll: 59 percent report negative experience with ObamacareMario Trujillo in The Hill.

Will Eric Cantor be the first Republican to bring a constructive reform to Obamacare to a vote? "House Majority Leader Eric Cantor said Thursday that he plans to schedule a vote next week on a measure placing more security requirements on the new Obamacare insurance exchanges. He said he’ll draw from legislation that’s been introduced by Reps. Diane Black of Tennessee, Kerry Bentivolio of Michigan and Gus Bilirakis of Florida...The Obama administration has insisted that no security breaches have occurred — and reiterated that on Thursday, saying there’s ongoing security testing to make sure private information is kept safe." Paige Winfield Cunningham in Politico.

@ProfEmilyOster: Oregon study headline fact: medicaid makes you go to ER more, not less. Not best news for Obamacare.

New ad campaign goes after pro-Obamacare politicians. "A conservative advocacy group backed by the billionaire Koch brothers said Thursday it will spend $2.5 million on television advertisements targeting three vulnerable Democratic senators who supported President Obama’s health care law...[T]he ads [are] against Senators Kay Hagan of North Carolina, Mary L. Landrieu of Louisiana and Jeanne Shaheen of New Hampshire" Sheryl Gay Stolberg in The New York Times.

Abortion-rights group finds anti-abortion regulations accelerating. "The number of anti-abortion laws passed in the last three years surpasses all those passed in the previous decade, according to an analysis by the Guttmacher Institute, an abortion rights group. According to the group, 22 states passed 70 different restrictions on abortion in 2013, a number second only to 2011’s 83 laws. Overall, 205 restrictions have passed in the past three years, compared to 189 from 2001 to 2010. No year from 1985 through 2010 saw more than 40 new abortion restrictions; since 2011, every year has topped that number." Blake Neff in The Hill.

@samsteinhp: I assume operatives are rested and ready to pounce on pro and anti-obamacare stories today

BEUTLER: The fake outrage strategy. "This week they will begin exploiting for political gain the misfortunes of people who seek medical care under the impression that they’re covered only to find out, for some reason, that they’re not. These might be beneficiaries who, due to technical woes and clerical backlogs, are having trouble accessing their benefits, or people who thought they had enrolled but never actually did. When someone finds he’s eligible for fewer subsidies than he believed, conservatives will pretend to share his outrage; when a family earns more money than expected and must rebate subsidy dollars to the IRS (a clawback provision Republicans supported!) the GOP will be there." Brian Beutler in Salon.

@KipPiper: Understandable but naïve calls for Obamacare ‘CEO’ don’t understand age-old issues with CMS org culture, unique and complex functions.

SARGENT: The three stages of Obamacare acceptance. "Stage One: A dim awareness that there might be some good elements in the law, and that the public might not support returning to the old system...Stage Two: A genuine recognition that large numbers of people are already benefitting from the law, and that this reality needs to be reckoned with — such as by proposing alternatives or changes that purport to accomplish similar goals, even as the elimination or crippling of it remains a paramount aim...Stage Three: Republicans accept Obamacare is likely here to stay, abandon the premise that the only acceptable outcome is crippling or eliminating the law, and negotiate to achieve incremental changes they want." Greg Sargent in The Washington Post.

Music recommendations interlude: Better Than Ezra, "Good."

Top opinion

SOROS: The world economy's shifting challenges. "[T]he United States is emerging as the developed world’s strongest economy. Shale energy has given the US an important competitive advantage in manufacturing in general and in petrochemicals in particular. The banking and household sectors have made some progress in deleveraging. Quantitative easing has boosted asset values. And the housing market has improved, with construction lowering unemployment. The fiscal drag exerted by sequestration is also about to expire." George Soros in Project Syndicate.

BROOKS: I've smoked pot, dudes. "[L]ike the vast majority of people who try drugs, we aged out. We left marijuana behind. I don’t have any problem with somebody who gets high from time to time, but I guess, on the whole, I think being stoned is not a particularly uplifting form of pleasure and should be discouraged more than encouraged...In legalizing weed, citizens of Colorado are, indeed, enhancing individual freedom. But they are also nurturing a moral ecology in which it is a bit harder to be the sort of person most of us want to be." David Brooks in The New York Times.

MARCUS: Reefer madness! Reefer madness! "Marijuana legalization may be the same-sex marriage of 2014 — a trend that reveals itself in the course of the year as obvious and inexorable. At the risk of exposing myself as the fuddy-duddy I seem to have become, I hope not. This is, I confess, not entirely logical and a tad hypocritical. At the risk of exposing myself as not the total fuddy-duddy of my children’s dismissive imaginings, I have done my share of inhaling, though back in the age of bell-bottoms and polyester." Ruth Marcus in The Washington Post.

MEYERSON: How the minimum wage could help Democrats. "Whether they can raise their minimum wage or not, the nation’s ever-bluer cities have a range of other options to increase incomes. They could require developers that receive municipal tax breaks or other assistance to pay their employees a living wage above the minimum wage. They could enact paid sick leave or paid family leave requirements. They could reduce the local cost of living by requiring developers of luxury housing to build affordable housing as well." Harold Meyerson in The Washington Post.

Culture interlude: Yes, you really can listen to all of these classical concerts for free and live.

2. Thread by thread, the safety net undone

Bye bye, trade adjustment assistance? "Rep. Sandy Levin (D-Mich.) called on Congress to immediately extend the Trade Adjustment Assistance for Workers program when it returns in January. Levin said portions of 2009 reforms expired in the new year. The program helps retrain workers who may have lost their jobs because of trade partnerships or outsourcing." Ramsey Cox in The Hill.

...And which states will get hit hardest by the expiration of unemployment insurance? "[S]tates like California, Georgia, and New York, among others, will get hit the hardest now that benefits are capped at 26 weeks. They had the highest percentage of people on extended benefits, and now they have the highest percentage of people on their own who employers won't hire." Matthew O'Brien in The Atlantic.

Is the U.S. really about to boom? Politico asked eight top economists. "[Jared Bernstein: W]hile I join many of my colleagues in seeing more potentially positive than negative developments in the coming year, there’s still ample room for concern...So what’s not to like? First off, because there’s so much wage, income and wealth inequality embedded in our system, the fact that the economy is doing better doesn’t tell you enough about the people in it." Politico Magazine.

U.S. factories begin to hit growth stride. "The Institute for Supply Management's monthly index, which is based on a survey of purchasing managers, hit 57 in December. That was down slightly from 2013's high of 57.3, registered in November. Readings above 50 indicate expansion." Brenda Cronin in The Wall Street Journal.

Jobless claims drop. "Initial claims for jobless benefits, a measure of layoffs, decreased by 2,000 to a seasonally adjusted 339,000 in the week ended Dec. 28, the Labor Department said Thursday. Economists surveyed by Dow Jones expected 345,000 new claims for the week. The number of claims for the prior week was revised up to 341,000 from 338,000. The four-week moving average of claims, which evens out choppy weekly data, rose by 8,500 to 357,250. Despite the gain, the level is still consistent with a modestly improving labor market." Eric Morath in The Wall Street Journal.

<strong">Labor Department may change how it does data releases. "A Labor Department panel has called for abandoning media lockups for a key weekly measure of U.S. employment. The recommendation is the first formal call by a government entity to end media lockups and could hasten a move away from the government's decades-old practice of releasing sensitive economic data through the media." Brody Mullins in The Wall Street Journal.

Behavioral interlude: Why procrastinators procrastinate.

3. The debate over Snowden

THE NEW YORK TIMES: Edward Snowden, whistleblower. "Mr. Snowden deserves better than a life of permanent exile, fear and flight. He may have committed a crime to do so, but he has done his country a great service. It is time for the United States to offer Mr. Snowden a plea bargain or some form of clemency that would allow him to return home, face at least substantially reduced punishment in light of his role as a whistle-blower, and have the hope of a life advocating for greater privacy and far stronger oversight of the runaway intelligence community" The New York Times Editorial Board.

The story behind the editorial. "Andrew Rosenthal, The Times’s editorial page editor, told me Thursday that the editorial had been under discussion by the editorial board for weeks...“Sometimes,” he added, “you have to go beyond what is realistic” in an editorial recommendation, not necessarily saying what might happen but rather, “this is what should happen.”" Margaret Sullivan in The New York Times.

FRIEDERSDORF: No, clemency would not set a dangerous precedent. "The concepts of pardon and clemency are part our system precisely because there are instances when applying rules we've generally decided upon would be unjust and counterproductive. They are meant to be used judiciously, on an ad hoc basis, in what are clearly exceptional circumstances. Snowden's leak meets those tests. Urging clemency for Snowden is not a radical case against our existing system of rules—it is an acknowledgment that, like all rules, ours are imperfect." Conor Friedersdorf in The Atlantic.

1990 counts as a throwback? interlude: NYC, 1990.

4. "Crude oil doesn't explode like that"

Why does Bakken crude keep exploding? "After three fiery accidents involving trains carrying crude oil out of North Dakota's Bakken Shale, regulators and industry officials are trying to figure out why the oil is exploding. Crude is flammable, but before being refined into products such as gasoline it is rarely implicated in explosions. Yet earlier this week, when a BNSF Railway Co. train hauling 104 tank cars filled with Bakken crude struck another train, some of the cars exploded one after the other, releasing fireballs that blazed several stories above the frozen prairie. "Crude oil doesn't explode like that," said Matthew Goitia, chief executive of Peaker Energy Group LLC, a Houston company that is developing crude-by-rail terminals." Russell Gold and Lynn Cook in The Wall Street Journal.

Shale-oil boom puts spotlight on oil-export ban. "For decades, even discussing the possibility of exporting domestic oil was a political nonstarter in Washington. Now, surging U.S. production has led to the beginning of a glut along the Gulf Coast, home to the largest refinery complex in the world. Too much crude is driving down prices there, making producers eager to export some of their oil to places like Europe where prices are higher." Russell Gold in The Wall Street Journal.

From NASCAR to wind power: Congress just let 55 tax breaks expire. "The full array includes everything from a credit for corporate R&D to tax relief for underwater homeowners. The list also includes a batch of energy tax breaks, like a credit for wind farms that generate electricity or a deduction for commuters who take the bus to work. Those are now gone. In theory, Congress could still extend these (retroactively) for 2014. Back in December, Senate Majority Leader Harry Reid pushed for a one-year extension, and he'll no doubt try again when lawmakers return from recess. But there's a hitch: Extending all these breaks would increase the deficit by about $50 billion per year, estimates the Center on Budget and Policy Priorities, unless they're offset with tax hikes or spending cuts elsewhere." Brad Plumer in The Washington Post.

One problem with geoengineering: Once you start, you can’t really stop. "In theory we could set up a giant hose to spray sulfate particles into the air and cool the planet. We just have to hope that nothing ever happens to the hose. Or, if we start spraying and then discover some horrid unanticipated side effects a few decades out, it will be a lot harder to stop. This is one reason why many geo-engineering proponents, like Harvard's David Keith (who wasn't involved in this JGR study), argue that the technique would need to be done alongside reductions in greenhouse-gas emissions" Brad Plumer in The Washington Post.

NYC interlude: 100 ways to improve the subway, on a Tumblr blog.

5. A new kind of farm bill, or not?

Farm policy is about to change forever. "When lawmakers unveil a bipartisan compromise on a new five-year farm bill this month, they likely will trumpet a major change in policy: ending the long-established and much-maligned system of direct payments to farmers...[T]he emerging compromise, which would replace direct payments with beefed-up crop insurance and other protections for farmers, has already triggered criticism from outside groups who say it won't radically reduce the amount of risk the federal government assumes in the agriculture industry." Kristina Peterson in The Wall Street Journal.

Reading material interlude: The best sentences Wonkblog read today.

Wonkblog Roundup

Tim Cook takes a pay cut for Apple’s performance. FinallyLydia DePillis.

One problem with geoengineering: Once you start, you can’t really stop. Brad Plumer.

Study: Expanding Medicaid doesn’t reduce ER trips. It increases themSarah Kliff.

From NASCAR to wind power: Congress just let 55 tax breaks expireBrad Plumer.

Four ways to tell if Obamacare is workingSarah Kliff.

Et Cetera

Illegal immigrant may practice law legally in U.S., court rules. Jennifer Medina in The New York Times.

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

Wonkbook is produced with help from Michelle Williams.

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Brad Plumer · January 2, 2014