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The Obamacare counterattack begins

Ezra Klein's Wonkbook

Dec. 4, 2013

Welcome to Wonkbook, Ezra Klein and Evan Soltas's morning policy news primer. Send comments, criticism, or ideas to Wonkbook at Gmail dot com. To read more by Ezra and his team, go to Wonkblog.

Wonkbook's Number of the Day: 1 million. That was the number of visitors to Healthcare.gov on Monday.

Wonkbook's Graph of the Day: In this one graph, you'll see why economists think raising the minimum wage wouldn't cause job losses.

Wonkbook's CBO Analysis of the Day: The budgetary impacts of policies that could improve people's health.

Wonkbook's Top 5 Stories: (1) Obama goes on the offensive over Obamacare; (2) the fight you haven't heard over guns you can't find; (3) 'mint the coin' was the real deal; (4) the leaning tower of U.S. education; and (5) changes in Obama's green team.

1. Top story: HealthCare.gov's counterattack

Obama embarks on new health-care push after Web site fixes, urges Americans to sign up. ""Our poor execution in the first couple months on the Web site clouded the fact that there are a whole bunch of people who stand to benefit," Obama said at a White House event, flanked by people who said they had benefited from the law. "Now that the Web site's working for the vast majority of people, we need to make sure that folks refocus on what's at stake here, which is the capacity for you or your families to be able to have the security of decent health insurance at a reasonable cost."" Zachary A. Goldfarb and Juliet Eilperin in The Washington Post.

Obama's challenge to Republicans: "If despite all the millions of people who are benefitting from it, you still think this law is a bad idea then you've got to tell us specifically what you'd do differently to cut costs, cover more people, make insurance more secure. You can't just say that the system was working with 41 million people without health insurance. You can't just say that the system is working when you've got a whole bunch of folks who thought they had decent insurance and then when they got sick, it turned out it wasn't there for them or they were left with tens of thousands of dollars in out-of-pocket costs that were impossible for them to pay."

Behind the speech: After months of apologizing and taking hits, the White House thinks Obamacare is working well enough for them to go on the offensive.

Full transcript of Obama's remarks: http://1.usa.gov/19gJkGA

@morningmoneyben: I for one am pretty surprised Obama isn't jumping on this repeal Obamacare thing. That really came of left field right there.

Three things we learned from today's Obamacare update. "There were 1 million visitors to HealthCare.gov Monday. And there have been 380,000 visitors to HealthCare.gov as of noon today. This is slightly higher traffic than Monday, when 375,000 visitors came to the Web site by noon...Approximately 13,000 shoppers Monday ended up in the queuing system. The system began queuing, as we learned Monday, when there were 30,000-some visitors on the Web site. All had the option to drop in their e-mail address and get a note from HealthCare.gov about when would be a good time to return." Sarah Kliff in The Washington Post.

@brianbeutler: Follow @afrakt for some empirical skepticism of healthcare.gov 's functionality.

Obamacare anger fades among congressional Democrats. "For the first time in weeks, congressional Democrats are starting to breathe easier. They're relieved that the White House managed to upright the troubled HealthCare.gov website -- enough to allow 1 million visitors to peruse insurance options on Monday. And President Barack Obama is going on offense on Tuesday, kicking off a campaign to defend the health care overhaul and sell its benefits to the country." Seung Min Kim in Politico.

Democrats worry about the midterm. "Polling suggests new dangers to Democratic candidates if the party cannot reverse public impressions of the law. A recent CNN/ORC poll gave Republicans a narrow edge on the question of which party voters would like to see control Congress--an abrupt change from mid-October, when Democrats had an eight-point lead...The health law has put many Democrats in a difficult position. After voting for the law, they can draw only so much distance from it. Democratic leaders have decided that the best course is to show voters they are working to fix the law and to fault Republicans for trying to repeal it." Colleen McCain Nelson, Patrick O'Connor, and Siobhan Hughes in The Wall Street Journal.

Wonkbook reality check: The midterm election is 11 months away. Extrapolating from polls now is a mug's game.

Alright now, who's getting fired for what happened at HealthCare.gov? "For weeks, the president and his aides have said they are not interested in conducting a witch hunt in the middle of the effort to rescue the website...Possible targets include Kathleen Sebelius, the health and human services secretary; Marilyn Tavenner, the head of the Centers for Medicaid and Medicare Services; Mike Hash, the head of the health and human services health reform office; Michelle Snyder, the chief operating officer at Medicaid and Medicare; Henry Chao, the chief digital architect for the website; Jeanne Lambrew, the head of health care policy inside the White House; David Simas, a key adviser involved in the rollout; and Todd Park, the president's top adviser on technology issues." Michael D. Shear in The New York Times.

In the news: Chris Matthews will interview President Obama tomorrow on MSNBC. Justin Sink in The Hill.

As hospital prices soar, a single stitch tops $500. "A day spent as an inpatient at an American hospital costs on average more than $4,000, five times the charge in many other developed countries, according to the International Federation of Health Plans, a global network of health insurance industries. The most expensive hospitals charge more than $12,500 a day. And at many of them, including California Pacific Medical Center, emergency rooms are profit centers. That is why one of the simplest and oldest medical procedures -- closing a wound with a needle and thread -- typically leads to bills of at least $1,500 and often much more." Elisabeth Rosenthal in The New York Times.

States divide on letting insurers extend old health plans. "At least 21 of 30 states with GOP governors have said they are willing to let insurers extend policies through 2014 that otherwise would be canceled because they don't comply with the new federal health law. Many of the Republican-led states are allowing renewals that would extend coverage well into 2015...At least 10 Democratic-led states and the District of Columbia are in the "no" camp, the Journal's survey found, including Connecticut, Massachusetts, Minnesota, New York and Washington. Almost all of these 10 run their own health-insurance exchanges. Nine Democratic-led states have agreed to the president's plan, including Illinois, Kentucky, Missouri and Oregon." Leslie Scism and Louise Radnofsky in The Wall Street Journal.

Explainer: These two paragraphs say everything about HealthCare.gov's problems. Sarah Kliff in The Washington Post.

Nearly all hospitals will give you the price of parking. Barely any will give you the price of health care. "Two researchers in Philadelphia reached out to 20 local hospitals, asking them how much they would charge for electrocardiogram. This is a pretty simple test to measure the rate of a heartbeat...Three hospitals were able to provide that information. By way of contrast, 19 hospitals were able to respond to a query about how much it would cost to park at the hospital, even when some of those parking prices had a few variables." Sarah Kliff in The Washington Post

New Obamacare weapon for GOP: doctors. "As other controversies surrounding the law begin to fade, House Republicans are increasingly focused on President Barack Obama's pledge that "if you like your doctor, you will be able to keep your doctor." They're hoping to replicate the uproar over canceled insurance plans...Here is the gist of the GOP contention: Some insurers have limited the number of doctors or hospitals their customers can go to in their new coverage plans, and some people will have to get new coverage plans under Obamacare. While a limited inventory of doctors is typical of most insurance policies both on and off the Obamacare exchanges, it runs counter to the Obama administration's promise that people won't have to change doctors under the health care law." Seung Min Kim and Jennifer Haberkorn in Politico.

Audit: Obamacare subsidies susceptible to fraud. "The new tax credits that the IRS will handle under ObamaCare are susceptible to fraud, according to a new federal audit released Tuesday. Treasury's inspector general for tax administration said the IRS has yet to complete its strategy for battling fraud concerns like wrongly issued tax credits. The IRS's systems for protecting private information also have software flaws, the audit found." Bernie Becker in The Hill.

@samsteinhp: Next segment on O'Reilly: "would Jesus like Obamacare?"

Judge hears arguments on Obamacare subsidies. "A federal judge in Washington offered few hints Tuesday of how he plans to rule during arguments in a case challenging the legality of federal subsidies available to some consumers who purchase health insurance through federally run online exchanges...A group of challengers now are contesting an Internal Revenue Service regulation that says the subsidies are available no matter whether a person buys insurance through a state exchange or the one run by the federal government." Brent Kendall in The Wall Street Journal.

SUROWEICKI: Controlling healthcare costs. "For consumers, this means higher deductibles and co-pays, and having to think more about prices...Meanwhile, a McKinsey study of almost a thousand plans on the A.C.A.'s health-care exchanges found that nearly half had narrower networks of hospitals and doctors than most plans currently offer. Narrower networks let insurers push their customers toward cheaper hospitals, and also give them more leverage in bargaining down prices." James Suroweicki in The New Yorker.

ROY: Obamacare excuses. "In the Nixon days they used to say that "the cover-up is worse than the crime." So, too, are the excuses Mr. Obama is making for health-insurance cancellations: Over the course of explaining away the first fabrication, the president has uttered four more that will come back to haunt him." Avik Roy in National Review Online.

COHN: Is HealthCare.gov working? "Drawing definitive conclusions about the state of healthcare.gov is difficult and will remain so for some time. (That's why I keep using words like "seems" and "appears.") But it's obvious the site is working much, much better than it did at the launch. For all of October and most of November, it was difficult to find stories of people successfully navigating their way through the system. Now, those stories are popping up everywhere--on social media, in blog posts, and, yes, even in the comments section of newrepublic.com." Jonathan Cohn in The New Republic.

SOLTAS: Nobody should get rich off Obamacare. "For an industry that's supposed to be burdened by the launch of Obamacare, the health-care business is doing pretty well. Stocks of health-care companies are up almost 40 percent this year, the strongest performance of any sector in the S&P 500...[I]t's a bit concerning that health-care investors are so upbeat just as President Barack Obama's health-reform law goes into effect. It makes you wonder where the new profits are expected to come from...[T]he expected increase in health-care profits has a whiff of rent about it." Evan Soltas in Bloomberg.

Music recommendations interlude: TV On The Radio, "Will Do," 2011.

Top opinion

BARTLETT: Should we raise the minimum wage to drive out all the immigrants? "What is curious about the [Ron] Unz initiative is that he is a conservative who defends a higher minimum wage on conservative grounds...Unz has turned the principal conservative argument against a higher minimum wage - that it would reduce jobs by making employment more expensive - into a virtue...He asserted that those affected would primarily be newly arrived immigrants, those with the weakest ties to American society. Those who have been in the United States for a while, who have mastered English and put down roots, would likely be "grandfathered in" and not lose their jobs." Bruce Bartlett in The New York Times.

PAPACHRISTOS: Social networks can help predict gun violence. "In a study published last month in the American Journal of Public Health, my colleague Christopher Wildeman and I applied the science of social networks to patterns of gun homicide in Chicago. The idea is straightforward: Treat gun homicide like a blood-borne pathogen, something transmitted from person to person through specific risky behaviors. Put another way, gun violence is not an airborne pathogen: You don't catch a bullet like you catch a cold. More than 40 percent of all gun homicides in the study occurred within a network of 3,100 people, roughly 4 percent of the community's population. Simply being among the 4 percent increased a person's odds of being killed by a gun by 900 percent." Andrew V. Papachristos in The Washington Post.

EDSALL: The center cannot hold. "Carmines's five-group analysis produces more finely grained results than traditional analyses of political identification that focus on just three variables: conservative, liberal or moderate. These traditional surveys show a much larger bloc in the moderate center, generally 35 percent or more. This tripartite conservative-moderate-liberal approach results in what Carmine and his collaborators contend is far too large a group in the middle. Their method reveals a much weaker moderate core." Thomas B. Edsall in The New York Times.

SUNSTEIN: Left, right, and wrong on regulation. "The Obama administration's "regulatory lookback," as it is called, should become a regular feature of American government, not least because it can enlist evidence to cut through the competing dogmas, and help us to make progress in resolving disagreements that are otherwise intractable (as well as mind-numbingly predictable)." Cass R. Sunstein in Bloomberg.

Los Angeles Review of Books interlude: The return of the paperback?

2. The fight you haven't heard over guns you can't find

House votes to extend ban on plastic guns; Senate is expected to follow suit. "The House approved a bill Tuesday that would extend a ban on manufacturing plastic firearms that are not detectable by security-screening devices, the first federal gun legislation approved since the school massacre in Connecticut nearly a year ago. The Senate is likely to join the House in approving a 10-year extension of the ban on plastic guns when it returns from a legislative break next week. But some supporters continued to argue for more specific language that would outlaw the use of 3-D printers to manufacture weapons that can evade metal detectors...The National Rifle Association, which mounted a strong campaign against more-stringent background checks in the spring, remained silent on the issue of extending the ban on plastic guns. Many Republicans viewed the issue of banning such guns as a law-and-order measure that would keep weapons out of criminals' hands." Paul Kane in The Washington Post.

Gun control efforts must settle for small gains. "House Republicans and the National Rifle Association have pushed back aggressively against efforts by Democrats to tighten the law, known as the Undetectable Firearms Act, including requiring all guns have at least one metal component and addressing the use of three-dimensional printers...The Republican House version of the bill, which would renew the law with no additional provisions, passed the chamber on a voice vote Tuesday afternoon -- meaning no roll call was taken to provide a list of who had supported or opposed the measure...New York Sen. Chuck Schumer, the No. 3 Democratic leader, will likely attempt on Monday to pass a more comprehensive bill, one that requires a piece of metal to be permanently attached to guns to prevent them from becoming undetectable by removing their metallic parts. Republicans are expected to object to Schumer's move, meaning he wouldn't be able to secure a vote before the current law expires. The Democratic strategy appears to be a messaging effort to push the GOP to articulate its opposition." Ginger Gibson and Burgess Everett in Politico.

This is so affecting interlude: What it's like working on a suicide hotline.

3. 'Mint the coin' wasn't a joke

The Obama administration took the platinum coin pretty seriously. "The Obama administration was serious enough about manufacturing a high-value platinum coin to avert a congressional fight over the debt ceiling that it had its top lawyers draw up a memo laying out the legal case for such a move, The Huffington Post learned last week. The Justice Department's Office of Legal Counsel, which functions as a sort of law firm for the president and provides him and executive branch agencies with authoritative legal advice, formally weighed in on the platinum coin option sometime since Obama took office, according to OLC's recent response to HuffPost's Freedom of Information Act (FOIA) request." Ryan J. Reilly in The Huffington Post.

D.C. raising its minimum wage. "The District of Columbia Council voted unanimously Tuesday to gradually raise the minimum wage from $8.25 an hour to $11.50 by 2016 and index it to inflation afterward. The move was coordinated with two neighboring Maryland counties, which adopted similar measures last week. A final vote by the D.C. Council is expected by early January, said Council Chairman Vincent Orange, who championed the increase. The unanimous passage Tuesday suggests the second vote will be largely a formality and would withstand any potential mayoral veto." Allison Prang in The Wall Street Journal.

Where will workers go after their jobless benefits expire? Probably not on disability. "One oft-mentioned possibility is that many of these workers will just apply for disability insurance. After all, haven't we heard that more and more Americans are qualifying for these benefits in recent years? But there's little evidence to suggest this will actually happen. In a recent working paper from the National Bureau of Economic Research, three economists found that, by and large, American workers haven't been going on disability after their unemployment benefits have lapsed." Brad Plumer in The Washington Post.

Charts: Whom the Fed is enriching. Catherine Rampell in The New York Times.

Would Congress extend help further? "I'm told House Dems will hold a hearing on Thursday into the plight of those set to lose unemployment insurance if Congress fails to extend the Emergency Unemployment Compensation program, as part of an effort to pressure Republicans to agree to an extension. Sources tell me it will be presided over by Dem Reps. Nancy Pelosi, Chris Van Hollen, Sander Levin, and others, and will hear from witness who stand to lose those benefits...[S]ources tell me that in private discussions, House Republicans are giving the thumbs down to Dem entreaties for an unemployment benefits extension." Greg Sargent in The Washington Post.

China rising in international trade. "An announcement Tuesday by the obscure-sounding Society for Worldwide Interbank Financial Telecommunication, better known as SWIFT, may not get much ink. China's currency, it reported, was used in 8.66 percent of global trade finance transactions in October, the group said. It's now the No. 2 most widely used currency for trade finance, supplanting the euro. But that is a lot more important than it might sound. It gives an important window into how the global economy is changing--and why America's long reign of economic dominance is at risk." Neil Irwin in The Washington Post.

Tumblrs interlude: "Your LL Bean Boyfriend."

4. PISA, or the leaning tower of U.S. education

U.S. high school students slip in global rankings. "The results from the 2012 Program for International Student Assessment (PISA), which are being released on Tuesday, show that teenagers in the U.S. slipped from 25th to 31st in math since 2009; from 20th to 24th in science; and from 11th to 21st in reading, according to the National Center for Education Statistics, which gathers and analyzes the data in the U.S." Stephanie Banchero in The Wall Street Journal.

Lists interlude: The 44 worst people at a restaurant.

5. Obama's green team keeps changing

White House environmental council chief Nancy Sutley to step down. "Sutley will step down in February from her post as chair of the White House Council on Environmental Quality, which she has held since 2009...The White House has not named a replacement. Sutley is the latest in a string of environmental officials to leave the administration. Early last month, Obama's climate and energy aide, Heather Zichal, left her post." Laura Barron-Lopez in The Hill.

Panel says global warming carries risks of deep changes. "Continued global warming poses a risk of rapid, drastic changes in some human and natural systems, a scientific panel warned Tuesday, citing the possible collapse of polar sea ice, the potential for a mass extinction of plant and animal life and the threat of immense dead zones in the ocean...In a report released Tuesday, the panel appointed by the National Research Council called for the creation of an early warning system to alert society well in advance to changes capable of producing chaos. Nasty climate surprises have occurred already, and more seem inevitable, perhaps within decades, panel members warned. But, they said, little has been done to prepare." Justin Gillis in The New York Times.

Reading material interlude: The best sentences Wonkblog read today.

Wonkblog Roundup

How Facebook could kill the new wave of viral media. Ezra Klein.

This one number explains how China is taking over the world. Neil Irwin.

Cyber Monday won't kill Black Friday for a long time. Lydia DePillis.

Why are the monarch butterflies disappearing? Brad Plumer.

Twitter wasn't the biggest IPO of 2013. You haven't heard of the company that was. Lydia DePillis.

Three things we learned from today's Obamacare update. Sarah Kliff.

Where will workers go after their jobless benefits expire? Probably not on disability. Brad Plumer.

Nearly all hospitals will give you the price of parking. Barely any will give you the price of health care. Sarah Kliff.

These two paragraphs say everything about HealthCare.gov's problems. Sarah Kliff.

Et Cetera