Wonkbook: Obamacare keeps cutting the uninsured rate, but it’s still unpopular

May 6

Welcome to Wonkbook, Wonkblog’s morning policy news primer by Puneet Kollipara. To subscribe by e-mail, click here. Send comments, criticism or ideas to Wonkbook at Washpost dot com. To read more by the Wonkblog team, click here.


(Photo by Andrew Harrer/Bloomberg)

Wonkbook’s Number of the Day: 13.4 percent. That's the uninsured rate at the end of the first quarter, the lowest rate since at least 2008, per Gallup.

Wonkbook’s Chart of the Day: Teenage pregnancy, birth and abortion rates have reached historic lows, a new report says.

Wonkbook's Top 5 Stories: (1) Obamacare cuts the uninsured rate; (2) the GOP establishment strikes back?; (3) don't ignore wages in the jobs report; (4) immigration stagnation; and (5) climate action heats up.

1. Top story: How Obamacare is shrinking the uninsured rate

The nation's uninsured rate keeps falling. "Obamacare reduced the percentage of U.S. adults without health insurance to its lowest point since 2008 even as the law remains unpopular with the public, separate surveys showed. The share of American adults without health insurance declined to 13.4 percent in April from 15.6 percent in the first quarter of 2014, Gallup said, attributing the reduction to the Patient Protection and Affordable Care Act known as Obamacare." Alex Wayne in Bloomberg.

Primary source: U.S. uninsured rate drops to 13.4 percent. Gallup.

And the repeal fervor seems to be ebbing. "Sure, you can still hear congressional Republicans talking about repealing the Affordable Care Act. But there's clearly something different about the current climate, and the GOP approach to Obamacare. The thrill of repeal may not be gone for Republicans, but much of the urgency of repeal is....While the energy for repealing the health law may have receded from where it was two or three years ago, that's not to say that it has turned the corner in public perception — far from it." Frank James in NPR.

Pew poll: Obamacare disapproval rating is at an all-time high. Aaron Blake in The Washington Post.

Another poll: Obamacare approval is rising. Christian Science Monitor.

The ACA's late surge helped reach the uninsured. "The uninsured rate fell 2.2 percent between April and the first quarter of 2014, suggesting that Obamacare's late enrollment surge was driven by people who previously lacked coverage. We won’t have the uninsured statistics from official government surveys for a while, but the Gallup poll has shown a steadily decreasing rate in the uninsured since the Affordable Care Act’s health insurance exchanges opened in October." Jason Millman in The Washington Post.

Romneycare lowered death rates in Massachusetts. Could the same hold for Obamacare? "The death rate in Massachusetts dropped significantly after it adopted mandatory health care coverage in 2006, a study released Monday found, offering evidence that the country’s first experiment with universal coverage — and the model for crucial parts of President Obama’s health care law — has saved lives, health economists say.....The mortality rate...fell by about 3 percent in the four years after the law went into effect....A national 3 percent decline in mortality among adults under 65 would mean about 17,000 fewer deaths a year." Sabrina Tavernise in The New York Times.

But is it worth the cost? Wonks debate. "But the costs of saving those people adds heavy costs to the law. To save one person a year, the study concluded about 830 people would have to sign up for health insurance and pay into the exchanges....The study has sparked an online debate about whether the law is really worth it....Harold Pollack, a professor at the University of Chicago, agrees it’s not cheap but says the law was worth it, especially when you take into consideration other potential savings to the healthcare system." Ferdous Al-Faruque in The Hill.

Massachusetts tosses in the towel on its Obamacare exchange. "RomneyCare’s pioneering health insurance exchange is headed for the scrap heap. Bay State officials are taking steps this week to junk central parts of their dysfunctional health insurance exchange — the model for President Barack Obama’s health care law — and merge with the federal enrollment site HealthCare.gov. The decision is part of an expensive plan that would occur alongside a parallel, last-ditch attempt to still build a working state system....A move by Massachusetts to the federal exchange would represent a symbolic blow for local Obamacare supporters." Kyle Cheney in Politico.

And the FBI is looking into Oregon's failed exchange. "The Federal Bureau of Investigation is looking into problems that plagued Oregon's implementation of the Affordable Care Act, after the state was forced to scrap its problematic health insurance exchange that was never fully functional, according to people familiar with the investigation. The FBI has already interviewed some individuals as part of their inquiry, which was first reported by local station KATU and the Portland Oregonian last week." Damian Paletta and Devlin Barrett in The Wall Street Journal.

Other health care reads:

Medicare covers routine dementia screening, but experts say evidence of its value is lacking. Michelle Andrews in The Washington Post.

The comeback of polio a public health emergency. Jason Beaubien in NPR.

Texas is shutting down abortion clinics, and the Supreme Court can't do anything about it. Sophie Novack in National Journal.

Teenage pregnancy, birth, abortion rates all falling, report says. Amina Khan in the Los Angeles Times.

KRUGMAN: Inventing a failure. "Last week, House Republicans released a deliberately misleading report on the status of health reform, crudely rigging the numbers to sustain the illusion of failure in the face of unexpected success. Are you shocked? You aren’t, but you should be. Mainstream politicians didn’t always try to advance their agenda through lies, damned lies and — in this case — bogus statistics. And the fact that this has become standard operating procedure for a major party bodes ill for America’s future." Paul Krugman in The New York Times.

COHN: Obamacare doesn't look so bad, after all. "Remember that bombshell study that made Obamacare look so bad a year ago? It used data from Oregon to show that giving people health insurance might not make them healthier. Critics of the Affordable Care Act seized on the paper, which appeared in the New England Journal of Medicine, as yet more proof the health care law would be a boondoggle. Now a new study is out. It's based on data from Massachusetts. And it makes Obamacare look good." Jonathan Cohn in The New Republic.

McINTYRE: Health insurance saves lives. That means it will improve them, too. "If you think the study’s primary findings are impressive, consider their implications: “mortality amenable to health care” does not just magically decline. If fewer people are dying, that is almost certainly because diseases are being better treated, managed, or prevented—because of improved health. It’s hard to come by data on objective measures of health at the state level, but the “improved health” story is consistent with other findings in the paper: individuals had better self-reported health, were more likely to have a usual source of care, received more preventive services, and had fewer cost-related delays in care." Adrianna McIntyre in The Incidental Economist.

McARDLE: The White House's Obamacare data bind. "The White House is in an interesting bind: It is trying to dispute the numbers while claiming that it doesn't know how many people have paid. It seems quite likely that the White House is right, and that the paid rate is well above 67 percent. But from White House spokesman Jay Carney’s response, it also seems quite likely that it has a very good idea of how many people have paid, and thus, that whatever the true value is, it is not the kind of number they’re eager to tout." Megan McArdle in Bloomberg View.

Top opinion

SUMMERS: Britain's economic growth is not a sign that austerity works. "Interpreting the British experience correctly is important because of the political stakes in Britain, the impact on future British policy and, most important, the effect on economic policy debates around the world. Unfortunately, properly interpreted, the British experience refutes austerity advocates and confirms Keynes’s warning about the dangers of indiscriminate budget-cutting in the midst of a downturn." Lawrence Summers in The Washington Post.

ORSZAG: How to keep the health cost slowdown. "During the past six months, spending on health care in the U.S. has accelerated substantially, new data on gross domestic product suggest. Naturally, that's led to some breathless commentary suggesting the era of low health-cost growth we’ve been enjoying for the past few years is over. In truth, the case for that conclusion is pretty weak. But that doesn’t mean there's no cause at all for concern. We are missing a crucial opportunity to make sure that the recent slowdown never ends." Peter R. Orszag in Bloomberg View.

FRUM: Immigration reform isn't just about reform numbers — it's about skills, too. "Education reform cannot work without an immigration reform worthy of the name: a reform that thinks of immigration in human-capital terms, a reform whose goal is to reduce the total number of migrants while raising their average skill levels. Such a reform would appreciate that the decisions of the past have already laden the United States with a daunting enough educational challenge. The country cannot afford to allow selfish and short-sighted interest groups to add to that load an even more impossible challenge in the decades ahead." David Frum in The Atlantic.

WILLIAMS: GOP walking into Obama's immigration trap. "Boehner later downplayed his public display of contempt. He told reporters the only problem is that he 'can rib people just a little too much.' And he predictably tried to distract attention from the GOP infighting over immigration by attacking the party’s favorite whipping boy, President Obama....In fact, the Speaker’s outburst is evidence of a strong political instinct sensing approaching disaster for his party. Obama and the Democrats in Congress have been steadily pulling House Republicans into a trap." Juan Williams in The Hill.

Astronomy interlude: Just how big is the Moon?

2. Can the GOP establishment strike back in 2014?

Tea party vs. establishment as primary season opens. "The five primaries in which senators face direct challenges from tea party conservatives will be most closely watched for clues about the balance of power in the GOP. They involve Senate Minority Leader Mitch McConnell (Ky.), Thad Cochran (Miss.), Lindsey O. Graham (S.C.), Pat Roberts (Kan.) and Lamar Alexander (Tenn.). All of those incumbents are favored to win....What does this say about the tea party movement? For one thing, it may not be so easy to defeat incumbents in primaries." Dan Balz in The Washington Post.

GOP establishment faces big test in N.C. primary. "The biggest question headed into Tuesday's primary in North Carolina is a simple one: Will Republican Thom Tillis, the preferred candidate of the GOP establishment, get more than 40 percent of the vote and secure his party's nomination for U.S. Senate without having to endure a runoff? More and more, it looks like Tillis will, close watchers say. Because of a vigorous effort by his allies as well as an underfunded and overmatched field of opponents, the establishment choice is on the verge of turning back tea party challengers in one of the most crucial contests of 2014." Sean Sullivan in The Washington Post.

Republicans are learning to fight back against the tea party. "What turned things around for Tillis? The Republican establishment rushed to his aid....If the GOP establishment and the outside groups that support it come through for Tillis on Tuesday, it will be a big step forward for Republicans who have been plagued by ultra-conservative candidates who have squandered Republican opportunities in recent years, helping Democrats maintain control of the Senate." Pema Levy in Newsweek.

Can the GOP get it right this time? "The month of May will go a long way toward answering one of the overriding questions of Election 2014: Can the Republican establishment finally tame the tea party and retake the Senate?...Republicans in Washington have been pushed around by grass-roots activists for two straight elections. The infighting helped produce poor nominees and cost the party control of the Senate, as some tea party-backed candidates couldn’t win general elections and other establishment-backed contenders floundered." Manu Raju in Politico.

Profile: Inside the N.C. race that will tell you what the GOP's base is really for. David Weigel in Slate.

The tea party may need to aim lower on the ballot. Janet Hook in The Wall Street Journal.

GOP appears favored in congressional ballot. "Republicans are beating Democrats in a generic ballot for the 2014 midterm elections — a reversal from just two months ago, a new poll says. According to a Pew Research poll released Monday, 47 percent said they would vote for the GOP candidate in their district while 43 percent said they would vote for the Democrat....The poll also suggests President Barack Obama will likely be more of a liability for Democrats than he was in 2010." Jonathan Topaz in Politico.

The implications for 2016, and beyond. "The Republican primary for a Senate seat in North Carolina Tuesday offers the most desperate political prognosticators a chance to read the tobacco leaves heading into 2016. That’s because former Florida Gov. Jeb Bush, Kentucky Sen. Rand Paul and former Arkansas Gov. Mike Huckabee — three men eying White House bids in 2016 — have all thrown their support behind separate candidates....All three potential White House hopefuls represent a disparate wing of the GOP, and so do the candidates they’re supporting." Patrick O'Connor in The Wall Street Journal.

Outside spending is transforming the N.C. races. "The primary race for Justice Hudson’s Supreme Court seat alone has drawn more than $1 million — the bulk of it by independent groups including the Republican committee and an arm of the state Chamber of Commerce, which has spent $250,000 to promote both of her opponents with money from companies including Reynolds American, Blue Cross Blue Shield and Koch Industries....The costly and fierce primary shows how the revolution in financing political campaigns, with the surging role of 'super PACs' and other groups financed by corporations, unions and other interests, has entered what was the quieter arena of judicial elections." Erik Eckholm in The New York Times.

Dancing interlude: 100 days of dance, featuring music from "Napoleon Dynamite."

3. Another number to pay attention to in the jobs report — wages

Tepid wage growth shows signs of fragility. "The single best gauge of the economic recovery — better than the headline unemployment rate — may be wage growth. So ignore April’s sharp drop in unemployment. Pay no attention to the creation of 288,000 jobs announced on Friday. The most important number in the latest jobs report did not change at all. Average hourly wages for American workers held steady at $24.31 last month. They have increased just 1.9 percent over the previous 12 months. But after adjusting for inflation, real wages have increased by something like 0.5 percent." Binyamin Appelbaum in The New York Times.

Another Republican backs hiking the minimum wage. "Former Pennsylvania Sen. Rick Santorum on Monday morning said he agrees with former Minnesota Gov. Tim Pawlenty that Republicans should support an increase in the minimum wage. Speaking with Chuck Todd on MSNBC, the 2012 Republican presidential candidate said the GOP stance on minimum wage 'makes no sense.'...Last week, on the same day that Democrats brought legislation to raise the minimum wage to the Senate floor, Pawlenty, a Republican, said he thought his party should support a minimum wage increase." Jonathan Topaz in Politico.

A minimum-wage deal in the next 6 months? "Sen. Charles Schumer (D-N.Y.) on Monday said he predicts Congress will reach a deal on the minimum wage this year. 'We’ll get a deal on minimum wage within the next six months,' Schumer said on MSNBC’s 'Morning Joe.' 'There are lots of different areas where we can compromise.'  Schumer remained confident that Republicans would cave and agree to Democrats’ proposal to raise the minimum wage from $7.25 to $10.10 an hour." Rebecca Shabad in The Hill.

Want to help the unemployed? Maybe try a two-tiered minimum wage. "What if companies could pay the long-term unemployed relatively less? That might make up for some of the stigma associated with prolonged joblessness. And that's why a higher minimum wage shouldn't apply to the long-term unemployed, not for now. If it did, it could become a permanent hiring obstacle for people who need to be hired the most. Now, I know what you're going to say: It's bad enough that the long-term unemployed can't find work, and you want to pay them less when they do? No. I want to pay them the same, but I want to make sure they find work first." Rand Ghayad in The Washington Post.

Other economic/financial reads:

Orders propel services industry as sales improve. Shobhana Chandra in Bloomberg.

Home price gains not boosting borrowing. Nick Timiraos in The Wall Street Journal.

Europe forecasts stronger growth; boosts for exports from U.S. seen. Jim Puzzanghera in the Los Angeles Times.

Maryland is the latest state to hike its minimum wage. Reuters.

Housing reform criticized for abolishing affordable-housing goals. Chris Arnold in NPR.

Banks in U.S. eased commercial loan policies, Fed survey shows. Jeff Kearns in Bloomberg.

Animals interlude: This bird dances to the music.

4. Neither side of immigration debate can figure out what to do next

Will the House vote on immigration? "House Republicans can’t shake their identity crisis. Their struggle over how and whether to push an immigration bill continues to plague an already divided party. The party’s establishment wing is hinting it wants to vote on some aspect of the issue before the midterm elections. But hardcore conservatives, angry with Speaker John Boehner, R-Ohio, for mocking their tactics in a speech last month, have vowed to be vigilant against letting any kind of distasteful legislation slip through to the floor." Franco Ordoñez and David Lightman in McClatchy Newspapers.

Immigration reform advocates don't know what to do next either. "Immigration reform was once a real thing on Capitol Hill. Lawmakers huddled in secret; political risks were calculated and taken; tentative deals were struck. But now, despite some suggestions from Sen. Chuck Schumer about a lame-duck legislative fix, there's really no chance of an overhaul of the dreadful U.S. immigration system. The groups lobbying for reform have failed to gain traction with their strategy of shaming Republicans into action, leaving advocates confused and conflicted about where to go next. Indeed, many say that at this point, they don't even know what they're fighting for." Fawn Johnson in National Journal.

Some action is happening on the state level, though, with DREAM Act-like measures:

Virginia attorney general declares ‘dreamers’ eligible for in-state tuition. Laura Vozzella and Pamela Constable in The Washington Post.

Florida Senate advances tuition-aid bill for those brought to U.S. illegally. Lizette Alvarez in The New York Times.

Other legal reads:

Economists slam the war on drugs. Abby Haglage in The Daily Beast.

NSA interlude: About that gibberish tweet: It wasn't gibberish, after all.

5. Obama's climate focus is heating up

New report kicks off Obama's push. "President Barack Obama will argue this week that the effects of climate change must be confronted now, intensifying his focus on the issue a month before new and contentious rules are due out that will regulate emissions from existing power plants. Tuesday's release of a report called the national climate assessment will kick-start the administration's push on an issue the president views as a key component of his legacy....The report and a series of events in the next few days offer Mr. Obama an opportunity to reassure his liberal allies, who have long urged a more aggressive approach to climate change." Colleen McCain Nelson and Alicia Mundy in The Wall Street Journal.

Additional reading: More on the report. Lesley Clark in McClatchy Newspapers.

A top Obama aide says Congress won't stop EPA climate rules. "White House counselor John Podesta said congressional attempts to trump EPA’s climate rules will fail....Senate Minority Leader Mitch McConnell (R-Ky.) and some other Senate Republicans want to offer an amendment to bipartisan energy efficiency legislation this week that would undermine EPA’s proposed greenhouse gas rule for future power plants." Darren Goode in Politico.

A vote is coming on Keystone XL — and the jockeying is ramping up. "Supporters and opponents of the long-delayed Keystone XL oil pipeline jockeyed for position ahead of an expected Senate vote on legislation authorizing immediate construction of the project. An oil industry group that supports the pipeline launched a five-state ad campaign aimed at wavering senators, while an environmental group mobilized activists to urge lawmakers to vote against any attempt to force President Barack Obama to decide the pipeline's fate." Matthew Daly in the Associated Press.

Explainer: Why Keystone XL may not be game over on climate change. Christopher Ingraham in The Washington Post.

Background reading: Keystone down the line. The Washington Post.

Video: Is Keystone XL vote a win-win for Democrats? Gerald Seib in The Wall Street Journal.

Other energy/environmental reads:

Why the oil industry wants more regulation. Ben Geman in National Journal.

Rock-climbing interlude: These bears are masterful at it.

Wonkblog roundup

Health care’s $85 billion challenge – uncompensated care in the Obamacare age. Jason Millman.

George H.W. Bush received a profile in courage award. All it took was rewriting history. Steven Mufson.

Study ties hard work to Asian students’ higher grades. What’s your excuse? Max Ehrenfreund.

U.S. businesses are being destroyed faster than they’re being created. Christopher Ingraham.

How the anti-vaccine movement is endangering lives. Puneet Kollipara.

Keystone emissions amount to a fraction of what U.S. cows release into the atmosphere. Christopher Ingraham.

The surprising policy legacy of Ladies Home Journal. Harold Pollack.

Want to help the long-term unemployed? Try a two-tiered minimum wage. Rand Ghayad.

The uninsured rate keeps falling and falling, survey shows. Jason Millman.

Et Cetera

Student loans next on Democrats' "Fair Shot" agenda. Burgess Everett in Politico.

Support for Common Core seen widening among GOP, swing voters. Renee Schoof in McClatchy Newspapers.

Holder signals criminal charges coming against banks. Tom Schoenberg in Bloomberg.

SCOTUS upholds prayer at public meetings. Josh Gerstein in Politico.

House panels race against each other to reform NSA. Dustin Volz in National Journal.

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

Wonkbook is produced with help from Michelle Williams and Ryan McCarthy.

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