April 9, 2014

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

Wonkbook's Number of the Day: 9.3 million. That's the minimum estimated number of previously uninsured people who have enrolled in health care since 2013, mostly explained by Obamacare, an analysis says.

Wonkbook's Chart of the Day: These charts show the recent rebound in stay-at-home moms.

Wonkbook's Top 5 Stories: (1) The wage-gap debate explained; (2) new data shows what Medicare pays doctors; (3) how many uninsureds got covered by Obamacare?; (4) why words matter in foreign policy; and (5) the GOP's continuing immigration problem.

1. Top story: What you need to know about the wage-gap debate

Obama takes action to lift veil of 'secrecy' on pay. "President Obama took two steps Tuesday aimed at narrowing the wage gap between men and women, ordering federal contractors to let their employees share salary information with one another and to disclose more details about what their employees earn. The executive order and presidential memorandum, part of a broader effort by the White House to highlight the challenges women face in the workforce, came as Senate Democrats pushed for a floor vote on the Paycheck Fairness Act, which includes reforms like the ones that Obama is now applying to federal contractors." Juliet Eilperin in The Washington Post.

Politics are quickly drowning out the issue. "To mark Equal Pay Day 2014, both sides of the debate came out swinging on Tuesday. Economists Mark J. Perry and Andrew G. Biggs threw down the gauntlet in a Wall Street Journal op-ed, calling the 77 cent statistic a 'myth' and saying the gender wage gap 'all but disappears' once variables like education, marital status and occupations are factored in. Jillian Berman, a business reporter for the Huffington Post, quickly shot back. 'There is a very real gulf between how much money women and men make,' she wrote. 'That gender wage gap cannot be argued away.' It's the kind of deliberation that has ensued, to some extent, every year since 1996, when Equal Pay Day was first launched by the National Committee on Pay Equity. But it's particularly pronounced this year. In part, that's because Democrats are using the occasion to drum up support for the long-stalled Paycheck Fairness Act, which is coming up for a Senate vote despite having already failed to pass on two separate occasions. " Christopher Zara in International Business Times.

Primary source: The full text of President Obama's remarks. The Wall Street Journal.

Explainer: The gender pay gap may not be as big as the White House says it is. "According to the White House, full-time working women earn 77% of what their male counterparts earn. This means that women have to work approximately 60 extra days, or about three months, to earn what men did by the end of the previous year. However, our own estimate, which is based on hourly earnings of both full- and part-time workers, finds women earn 84 percent of what men earn. Based on our estimate, it would take approximately 40 days, or until the end of February for women to earn what men had by the end of last year. But for young women, the wage gap is even smaller -- at 93 percent -- meaning they caught up to their same-aged male counterparts by roughly the last week in January of this year." Eileen Patten in Pew Research Center.

The White House is cutting its gender gap, so why can't the rest of us? "You can see that since 2003, that wage gap has been shrinking, albeit in fits and starts. During the Bush administration, the gap shrank from nearly 25 cents in 2003 to fewer than 20 cents in 2008. The current gap of roughly 12 cents is higher than D.C.'s five-cent gender gap, and roughly congruent with the rest of the Federal workforce, which has an 11-cent gap. It's important to note that AEI and other commenters are correct when they argue that aggregate wage gap numbers are a blunt instrument. The gap is caused less by overt discrimination against women, and more by the fact that women tend to be employed in lower-paying fields than men. But this doesn't mean we should wash our hands of the issue and walk away. A more reasonable response would be to ask why women are in lower-paying jobs, and particularly why women tend to choose college majors that lead to lower-paying careers. Better support for maternity and family leave wouldn't hurt, either. And as the White House figures show, it is possible to reduce that wage gap over time." Christopher Ingraham in The Washington Post.

Federal-workers union says hire more feds to cut gap further. "The nation's largest federal-worker union has called on President Obama to replace government contract workers with federal employees to help close the pay gap between women and men. The American Federation of Government Employees argued in a statement on Tuesday the federal government is closer to pay equity than the private sector because it compensates workers based on their roles rather than subjective factors such as gender." Josh Hicks in The Washington Post.

Chart: The end of men, in one chart. Lydia DePillis in The Washington Post.

Audio: Why women often don't ask for more money. Ashley Milne-Tyte in NPR.

Obama, Republicans battle over bill for equal pay. "The White House and congressional Republicans blasted each other on Tuesday over equal pay in a battle for women's votes as Democrats try to hold the U.S. Senate in the November midterm elections. Republicans said pay discrimination was already illegal and predicted the Democrat-supported Paycheck Fairness Act would prompt frivolous lawsuits and discourage companies from hiring. The Democratic-led Senate is set to hold a procedural vote on the measure on Wednesday but even if the legislation clears that chamber, the Republican-dominated House of Representatives appears likely to oppose it. The dispute underscored the importance that both parties place on women voters in an election year where Democrats fear losing control of the Senate and Republicans are seeking to defend their dominance in the House of Representatives." Jeff Mason in Reuters.

For Democrats, it's all about the wages. "The Democrats' approach on wages is now taking shape: raise the minimum wage, expand the EITC, and pressure companies to narrow the wage gap between men and women. The Republican approach on wages has been to call for rolling back regulations they say raise the costs of doing business, and repeal the health care law, which many in the GOP believe is causing companies to cut hours or pay. The wage debate creates a relatively populist opening for both parties. It goes like this: many Americans want more money in their paychecks. Whichever party can offer ways to boost income could end up outperforming at the November elections." Damian Paletta in The Wall Street Journal.

Why Democrats think the pay-gap issue will have crossover appeal to men. "For many men, it's a matter of self-interest: Two-income families are part of a long-term trend, as many families find two paychecks essential to cover the bills in an era of rising prices and stagnant, if not falling, wages. U.S. Labor Department statistics indicate that in nearly 60 percent of households with children in 2012, both parents worked. In husband-and-wife households without children (the agency's data doesn't account for same-sex families) the percentage of dual-earner households was close to 50 percent. Meanwhile, nearly a quarter of married women earn more than their husbands, compared to about 6 percent in 1960. That's why a big part of the Democrats' election year message is that the issue of equal pay goes beyond women or gender justice." Frank James in NPR.

Explainer: How Republicans are shifting tactics on the equal-pay issue. Nia-Malika Henderson in The Washington Post.

Another women's issue in the news: More moms staying at home, reversing long-term decline. "After decades of decline, the share of mothers who stay home with their children has steadily risen over the last several years, a new report has found. In 2012, 29% of all mothers with children under age 18 stayed at home, a figure that has steadily risen since 1999 when 23% of mothers were stay-at-home, the Pew Research Center reported Tuesday. The share of stay-at-home moms had been dropping since 1967, when about half of all moms stayed home. Pew attributed the rise of stay-at-home mothers to a mix of demographic, economic and societal factors. The vast majority of married stay-at-home mothers, 85%, say they are doing so by choice in order to care for their families. That rate is much lower for single stay-at-home mothers, at 41%, and cohabitating mothers, at 64%. The report also found a drop in women working because of the recession, a trend that has lingered as the economy recovers." Laura Meckler in The Wall Street Journal.

Key finding: Big shift among non-college-educated immigrants. "The shift is most noticeable among women who are immigrants and who do not have college educations. Though both American-born and foreign-born mothers exhibited increases, 40 percent of immigrant mothers stay home to raise their children, compared with 26 percent of mothers who were born in the United States. Similarly, though all racial and ethnic groups saw increases, Hispanic and Asian mothers were more likely to stay home with their children -- more than one out of three, compared with barely one out of four white and black mothers. Pew's analysis showed that 86 percent of all Asian mothers were born in another country, as were 60 percent of Hispanic mothers. In contrast, only 13 percent of black mothers and 6 percent of white mothers were foreign-born." Carol Morello in The Washington Post.

Primary source: Pew Research Center's report.

Other economic policy reads:

In new tack, IMF aims at income inequality. Eduardo Porter in The New York Times.

IMF chief economist says global recovery strengthening despite risks from Europe, Japan. Ian Talley in The Wall Street Journal.

Job openings hit six-year high in February. Lucia Mutikani in Reuters.

Fed policymakers want more clarity on rate-hike plans. Ann Saphir and Jonathan Spicer in Reuters.

The polarized partisan geography of income inequality. Michael Zuckerman in The Atlantic.

Why extending jobless benefits could be logistical nightmare. Ylan Q. Mui in The Washington Post.

MILBANK: Republicans only scaring away the women vote even more. "This was not the way Republican leaders had planned to observe Equal Pay Day. On the eve of Tuesday's commemoration -- the day symbolizing how far into 2014 women must work to catch up to the wages men earned in 2013 -- a small newspaper in Louisiana, the Ouachita Citizen, reported that its congressman, Republican Rep. Vance McAllister, had been videotaped making out with a low-paid staffer....Republicans aren't responsible for McAllister any more than Democrats are to blame for Anthony Weiner's weirdness. But for Republicans, who have a big disadvantage among unmarried women, this reinforces a perception. The Democrats' accusation of a GOP 'war on women' sticks not because of what Democrats say but because of what Republicans do -- and the big problems aren't personal pratfalls but rather public policy." Dana Milbank in The Washington Post.

SOLTAS: How big is the gender pay gap? "'Some commentators are out there saying that the pay gap doesn't even exist,' President Barack Obama said yesterday. 'They say it's a myth. But it's not a myth. It's math.' The gender pay gap isn't math, though. It's statistics. And mostly misused ones at that. In this post, I'm going to share a cursory analysis of March Current Population Survey data from 1990 to 2013. My takeaway from this exercise: A gender pay gap seems to exist, though it is not particularly large and much smaller than it once was. It should be treated as the tip of the iceberg in terms of gender inequity rather than left to dominate the conversation." Evan Soltas.

CARLSON: Women can't afford to celebrate Equal Pay Day. "There may be irresolvable disagreement about whether it's fair for a CEO (even a superstar) to make hundreds of times the salary of a worker, but can't we at least agree that it's unfair that a man should be paid more than the woman beside him doing the same job. Ladies, let's raise a glass ourselves not to Equal Pay Day but to another year of Unequal Pay Days and vow to change it. Ask a colleague what he makes. Take it to your boss. The law's not on your side, but there's no law against asking. " Margaret Carlson in Bloomberg View.

McARDLE: Government can't fix real pay gap. "Who is right? Well, we're not going to settle the age-old dispute here about whether women choose to spend more time on childcare and housework because they care more about kids and housework or because they are victims of a sexist culture. I will offer one piece of anecdotal evidence, which is that women can escape some of this burden by being, like me, an untidy person married to a neat freak. Yet none of the women I know have adopted this strategy, or plan to. But we can, pretty confidently, answer a related question: How much of the pay gap is driven by those choices, and how much is driven by sexism in the workplace? The answer seems to be that almost all of the gap is driven by choice of occupation, and working hours, with an emphasis on working hours. Childless women who work the same hours as men make very close to what men do. Does that mean there is no discrimination against women? No. The residual gap that's left after you control for age, experience, work hours, choice of profession and so forth, is small. But it's not zero. That residual most likely represents sexism. As a woman, I kind of take exception to that." Megan McArdle in Bloomberg View.

PERRY AND BIGGS: The myth about women's pay. "The 23% gap implies that women work an extra 68 days to earn the same pay as a man. Mr. Obama advocates allowing women to sue for wage discrimination, with employers bearing the burden of proving they did not discriminate. But the numbers bandied about to make the claim of widespread discrimination are fundamentally misleading and economically illogical....The administration's claims regarding the gender pay gap are faulty, and its proposal to make it easier for women to sue employers for equal pay would create a disincentive for firms to hire women." Mark J. Perry and Andrew G. Biggs in The Wall Street Journal.

KESSLER: For millennial women, what pay gap? "Happy Equal Pay Day! Or, well, Unhappy Equal Pay Day! Because if everything were truly fine and dandy we wouldn't need to have an Equal Pay Day -- which symbolizes how long into the year women have to work to earn the same amount as men did the prior year. (According to the National Committee on Pay Equity, the day is always on a Tuesday to suggest how far women need to work into the next work week to earn what men did in the prior one; oh, and it's chosen to "avoid religious holidays and other significant events." But you get the point.) In an ideal world, Equal Pay Day would be no days and every day at once. For some of us, that may be close to a reality. It seems that a pay gap basically doesn't exist for millennial women, of which I am one." Zara Kessler in Bloomberg View.

Top opinion

COHN: Case against Obamacare takes another blow. "Republicans and their supporters frequently say that 5 million people 'lost' health insurance, because the old policies didn't comply with Obamacare's standards and/or insurers cancelled them pre-emptively. Sometimes Republicans and their supporters imply that these people actually ended up uninsured. But if Rand is right -- and, again, there's no way to be sure right now -- then it would appear most people who lost their old plans were able to get new ones instead. That's consistent with anecdotal reports from insurers. To be clear, that doesn't mean people who lost their old insurance policies are happy about the change -- or that they don't have a legitimate beef with the president, who famously promised that Americans could 'keep their plans.' Some these people are now paying more for their coverage. Some have fewer choices for doctors and hospitals. But plenty of people who lost coverage were able to replace it with plans that were cheaper, more comprehensive, or both. In short, not all the 4.8 million people who lost their old coverage are worse off. It's not even clear that a majority of them are. That's one more reason the case against Obamacare may be even weaker than you've heard." Jonathan Cohn in The New Republic.

THE WALL STREET JOURNAL: Jeb Bush's immigration heresy. "For a party that has lost the popular vote in five of the last six presidential elections, the GOP sure seems eager to banish people from its potential candidate ranks. First Senator Marco Rubio was expelled from impolite conservative company, then Rep. Paul Ryan came in for abuse, and now former Florida Governor Jeb Bush is being whipped for breaking from the anti-immigration orthodoxy on the right....Not too long ago that would have been called Reagan orthodoxy. Mr. Bush says he'll decide on whether to run for President by the end of the year, but if he does run he's already got a better immigration message than the self-defeating 'self-deportation' crowd that cost the GOP so dearly in 2012." Editorial Board.

NORDHAUS AND SHELLENBERGER: How not to talk about global warming. "Showtime's producers undoubtedly have the best of intentions. There are serious long-term risks associated with rising greenhouse gas emissions, ranging from ocean acidification to sea-level rise to decreasing agricultural output. But there is every reason to believe that efforts to raise public concern about climate change by linking it to natural disasters will backfire. More than a decade's worth of research suggests that fear-based appeals about climate change inspire denial, fatalism and polarization." Ted Nordhaus and Michael Shellenberger in The New York Times.

SALMON: Why the boom in wonky journalism makes sense. "Call it the Wonk Bubble. If you're in the market for serious, empirical, quantitative analysis of national policy -- or of just about anything else in the news these days -- the East Coast Media Elite has you covered like never before....All of these properties, to a greater or lesser extent, claim to be in it for the money: They're for-profit entities that see real financial value in providing accessible wonkery to the online masses. But is that really credible? Is there any realistic hope that the tens of millions of dollars being poured into these sites will ever pay real dividends for the media companies hiring all these eggheads? Or is the Wonk Bubble just the latest bandwagon, an act of desperation from fearful executives who don't want to seem behind the curve and who have no real idea what they're doing? One thing is certain: Not all of these projects will make money. (This is the media business, after all.)...But there's actually more here than the skeptics might think." Felix Salmon in Politico Magazine.

GROSSMANN: How policy has gone liberals' way for 70 years. "To be sure, the conservative failure to shrink government does not imply constant liberal victory. No change is still the most likely outcome in any legislative battle. Obstruction is strategic: shared powers, checks and balances and multiple veto points make policy change difficult to achieve. Some liberal policies, such as the minimum wage, lose effectiveness if they are not regularly updated. A few conservative successes, particularly in tax policy, can overwhelm more numerous liberal laws. But the federal government has continually expanded its role in education, civil rights, the environment and health care -- and Republican presidents have played large roles in this....This history does not bother some Republicans, who see opportunities to fashion new ideas and bargain in pursuit of conservative objectives. But even past policymaking designed to promote markets, safeguard morality and protect the homeland usually expanded government. If contraction is the goal, a positive policy agenda is unlikely to succeed. Conservatives like DeMint mean it: Their priority is a smaller government that does less -- and it may not be achievable. The arc of the policy universe is long, but it bends toward liberalism. Conservatives can slow the growth of government but an enduring shift in policy direction would be unprecedented. History shows that a do-nothing Congress is a conservative's best-case scenario." Matt Grossmann in The Washington Post.

Animals interlude: Cats sort of react to magic.

2. What the new trove of Medicare payment data tells us

Data uncover nation's top Medicare billers. "The Medicare program is the source of a small fortune for many U.S. doctors, according to a trove of government records that reveal unprecedented details about physician billing practices nationwide. The government insurance program for older people paid nearly 4,000 physicians in excess of $1 million each in 2012, according to the new data. Those figures do not include what the doctors billed private insurance firms....Among the highest billers were a cardiologist in Ocala, Fla., who took in $18.1 million, mainly putting in stents. A New Jersey pathologist who received $12.6 million performing tissue exams and other tests. And a Michigan vascular surgeon who got $10.1 million....Overall, the data cover $77 billion in billing involving 880,000 practitioners in 2012." Peter Whoriskey, Dan Keating and Sandhya Somashekhar in The Washington Post.

Charts:

How much Medicare pays doctors. Dan Keating, Cristina Rivero, Kat Downs and Emily Chow in The Washington Post.

Searchable interactives: Check how much Medicare reimbursed your provider in 2012. The New York Times and The Wall Street Journal.

Background reading: How a secretive panel uses data that distort doctors' pay. Peter Whoriskey and Dan Keating in The Washington Post.

The top biller has history of scrutiny from the feds. "The doctor who bills the most for Medicare in the country is a South Florida ophthalmologist whose offices were twice raided last year by the FBI and whose generous political contributions and cozy relationship with New Jersey Senator Robert Menendez are under investigation by federal public corruption prosecutors, a New York Times analysis of Medicare data shows. Data released Wednesday by the Centers for Medicare and Medicaid Services show Dr. Salomon E. Melgen, 59, who moved to Florida from the Dominican Republic in the late 1970s, received $21 million in Medicare reimbursements in 2012 alone. The doctor billed mostly for Lucentis, a medication used to treat macular degeneration made by a company that pays generous rebates to its doctors. The release of the Medicare figures was the latest in a series headline-grabbing disclosures that have dogged the doctor since January of last year....Dr. Melgen's lawyer warned against presuming that the doctor's high bills to Medicare meant he was engaged in fraud. In a statement released late Tuesday, his lawyer said the large reimbursements from the Centers for Medicare and Medicaid Services, known as CMS, were easily explained: The doctor has a big practice." Reed Abelson and Sarah Cohen in The New York Times.

The arguments for releasing the data. "While drug and hospital costs have been scrutinized, less attention has been paid to doctors' fees, which accounted for about 12 percent of Medicare's budget in 2012. Making the data available may allow the public and researchers to better identify fraud and waste by doctors in the $604 billion Medicare system. The data could also put more heat on doctors who engage in self-referral -- ordering up tests and procedures that are performed in their own clinics or in those in which they have a financial interest. The data release has been lauded by consumer groups seeking to spotlight possible fraud or overuse and criticized by physicians, including the American Medical Association, whose head has said misinterpretation could ruin doctors' careers. Medicare payments to doctors were kept from the public after medical associations argued in the early 1980s that their release would violate physicians' privacy. Last May, a federal judge lifted a 33-year-old injunction on the data following a lawsuit by Dow Jones & Co." Shannon Pettypiece and Alex Wayne in Bloomberg.

What is self-referral, and why does it matter? "As the data are sliced and diced in coming months, some of the most revealing story lines will undoubtedly involve physician groups that excel at what's called self-referral -- the practice of sending patients for tests and procedures that are performed in the doctor's own office or at an affiliated clinic, Mitchell says. These services include in-house pathology labs to analyze prostate and skin specimens; imaging machines such as MRI and CT scans to check for broken bones, and even high-end radiation devices to treat cancer patients in a urologist's or oncologist's office. While self-referral is illegal under federal law -- so that doctors won't put pay above patients in making medical decisions -- several exemptions in the statute have permitted the practice to flourish in the past decade. Multiple peer-reviewed studies on specialties that are rich in procedures, including orthopedics and urology, have shown that doctors with a vested interest order many more tests and procedures than doctors who have no financial stake in providing the ancillary services." Peter Waldman in Bloomberg Businessweek.

And here's why journalists will cheer. "For investigative journalists, any information that sheds more light on doctors' financial incentives to do controversial medical procedures will be helpful. Until now, we've relied on glimpses of physicians' wealth, gleaned from such sources as property records, divorce filings, and nonprofit tax returns, to give a picture of how lucrative it is for them to do certain medical procedures. The Medicare pay data should provide a much clearer and more direct picture of the income they get from their work." Peter Waldman in Bloomberg Businessweek.

Doctors group's arguments against the release of the data: Misinterpretation, privacy and errors. "The AMA has warned that the data could contain errors, and in some cases, one doctor's billing number may have been used by multiple support personnel for billing purposes. In addition, the billing figures reflect what a doctor receives in payment but does not show the actual profit after paying for equipment, support personnel and malpractice insurance. For some procedures, the overhead can reach three-quarters or more of the payment amount. Many of the highest billers, for example, were in fields with unusually high expenses, and that was likely to limit their personal share of the money." The Washington Post.

An example of the data's limitations: Many costly items aren't lucrative to physicians. "For instance, the 350 highest-paid ophthalmologists performed more than $1 billion worth of services. But only four commonly used eye drugs, including $160 million worth of the biologic medicine Lucentis for macular degeneration, represented more than 20% of those fees. Doctors must buy such drugs upfront, and many earn low margins on their use. At the same time, however, some procedures performed by ophthalmologists have come in for scrutiny. In 2013, CMS cut payments for cataract surgery by about 13%, largely because the old, higher rates didn't reflect that the procedure had gotten faster." Christopher Weaver, Tom McGinty and Louise Radnofsky in The Wall Street Journal.

Background reading: An effective eye drug is available for $50. But many doctors choose a $2,000 alternative. Peter Whoriskey and Dan Keating in The Washington Post.

AMA concerned, but won't fight the data's release. "The American Medical Association (AMA) won't go to court to block the Obama administration's planned release this week of previously undisclosed Medicare data. The AMA remains concerned about the privacy implications for physicians, an official with the organization told The Hill on Tuesday, but it won't seek a legal injunction to stop the release." Jonathan Easley in The Hill.

A long-simmering debate indeed. "Health officials have debated releasing the data for decades, said Gail Wilensky, former Medicaid program director under President George H.W. Bush. Opponents of releasing the information said people may not understand how to use it. In the 1990s, she said, hospitals made the same argument when required to release mortality rates....Transparency outweighs potential damage, she said, adding there should be a fast way for providers to correct errors." Meghan Hoyer and Kelly Kennedy in USA Today.

Timeline: The long and winding road. The Wall Street Journal.

Beyond the ratings: More tools coming to help you pick your doctor. Charles Ornstein in ProPublica and the Los Angeles Times.

Other Medicare reads:

U.S. insurers still expect cuts in Medicare payments in 2015. Caroline Humer in Reuters.

Life's ponderables interlude: Why is ketchup so hard to pour?

3. Obamacare is covering uninsureds in a way few expected

Rand's Obamacare stats: 9.3 million new insureds, and counting. "The long-awaited Rand Corp. study of Obamacare's effect on health insurance coverage was released Tuesday and confirmed the numbers that had been telegraphed for more than a week: At least 9.3 million more Americans have health insurance now than in September 2013, virtually all of them as a result of the law. That's a net figure, accommodating all those who lost their individual health insurance because of cancellations. The Rand study confirms other surveys that placed the number of people who lost their old insurance and did not or could not replace it -- the focus of an enormous volume of anti-Obamacare rhetoric -- at less than 1 million. The Rand experts call this a 'very small' number, less than 1% of the U.S. population age 18 to 64....Rand acknowledges that its figures have limitations -- they're based on a survey sampling, meaning that the breakdowns are subject to various margins of error, and they don't include much of the surge in enrollments in late March and early April. Those 3.2-million sign-ups not counted by Rand could "dramatically affect" the figures on total insureds, the organization said." Michael Hiltzik in the Los Angeles Times.

@larry_levitt: Urban, Gallup, and RAND all say the number of uninsured is declining since the ACA went into effect. Now we can debate why and by how much.

Forget about the exchanges. Employer coverage is booming. "While the political world has spent the past several months watching enrollment numbers in Obamacare health insurance marketplaces, maybe we should have been focusing on employer-sponsored insurance. A new survey from Rand Corp. estimates 9.3 million people were newly insured between September 2013 and March 2014, a trend that was mostly driven by an enrollment increase in employer-sponsored plans. The growing market for employer-sponsored insurance is still the nation's most common source of coverage. The survey, which comes with some caveats, finds that of the previously uninsured who gained new coverage, 7.2 million were covered by employer plans, 3.6 million were covered by Medicaid and 1.4 million signed up through the Obamacare exchanges. In all, employer coverage increased by 8.2 million since September, Rand said." Jason Millman in The Washington Post.

As enrollments rise, GOP faces new Obamacare reality. "For all the challenges still facing Obamacare and its supporters, conservative health wonks are increasingly cautioning Republicans that the politics of the issue have changed in the wake of the 7 million initial sign-ups. Simply repealing the law is no longer an option, they warn, even if Republicans gain the power to do so. If they want to unwind the law, the least they'll have to do is coalesce around health care solutions of their own, lest they strip away benefits for millions of Americans without a plan of their own. And the party is far from a consensus on how they'd replace the law. This new dynamic is slowly setting in among GOP lawmakers and top-level candidates." Sahil Kapur in Talking Points Memo.

Quotable: ""If you want to say the further and further this gets down the road, the harder and harder it gets to repeal, that's absolutely true. As far as repeal and replace goes, the problem with replace is that if you really want people to have these new benefits, it looks a hell of a lot like the Affordable Care Act. ... To make something like that work, you have to move in the direction of the ACA. You have to have a participating mechanism, you have to have a mechanism to fund it, you have to have a mechanism to fix parts of the market." -- A GOP aide. Sahil Kapur in Talking Points Memo.

Republicans delay rollout of Obamacare replacement. House Republicans are delaying the rollout of their alternative proposal to Obamacare, according to lawmakers and aides involved in the process. The issue is one of 'policy, trying to get it all together,' House Majority Whip Kevin McCarthy said when asked why a planned April unveiling was being pushed back. The Republicans had said they would release the outlines of their proposal to replace President Barack Obama's 2010 health-care law over the two-week congressional break later this month at town-hall meetings with constituents. Instead, a Republican leadership aide said the rollout will occur at an unspecified time later this year. Republican leaders are set to meet this week to discuss their plans, McCarthy and Conference Chairman Cathy McMorris Rodgers said." Derek Wallbank in Bloomberg.

Interview: Affordable Care Act architect Ezekiel Emanuel, on why the exchanges' 7 million enrollments changes insurance forever. Ezra Klein in Vox.

Other health care reads:

U.S. has not determined legal authority to delay Obamacare mandate. David Morgan in Reuters.

House to pass new bipartisan Obamacare tweak. Pete Kasperowicz in The Hill.

An insurer bets on primary care doctors to lower costs. John Tozzi in Bloomberg Businessweek.

Many Obamacare critics accepted its subsidies. Charles Babington in the Associated Press.

How Vermont is trying to bring single-payer to America. Sarah Kliff in Vox.

What American health care can learn from Germany. Olga Khazan in The Atlantic.

Game interlude: World's biggest Tetris game.

4. Foreign policy is often just as much about words as it is about actions

At Senate budget hearing, Kerry verbally duels with critics of Obama foreign policy. "Secretary of State John F. Kerry gave as good as he got on Tuesday when lawmakers at a Senate hearing charged that President Obama's foreign policy was ineffective and weak. For more than two hours, Kerry traded quotations from Teddy Roosevelt, disputed facts asserted by his former colleagues on the Senate Foreign Relations Committee, and invited those who disagreed with him to come up with better ideas to deal with a world that he said has grown increasingly complicated....Although a handful of Democrats lobbed softballs at Kerry, McCain was far from the only critic." Karen DeYoung in The Washington Post.

Kerry accuses Moscow of creating 'pretext' for Ukraine invasion. "The US has accused Russia of fomenting unrest in eastern Ukraine, calling its efforts 'illegal and illegitimate' and warning that Moscow was seeking to create a pretext for possible military action....Mr Kerry called Russian special forces 'the catalyst' for uprisings over the last 24 hours that saw armed pro-Russian separatists seize government buildings in three cities in eastern Ukraine. He also cast those moves as part of a broader strategy by Moscow to create a justification for an invasion weeks after it followed a similar script that resulted in the annexation of Crimea in southern Ukraine....Mr Kerry's comments were the sharpest yet from the Obama administration pinning the blame on Moscow for escalating unrest that Kiev warned this week risked tearing the country apart." Roman Olearchyk and Kathrin Hille in The Financial Times.

U.S.-China differences are clear even as Hagel stresses cooperation in Beijing visit. "Near a banner offering him a 'warm welcome,' Defense Secretary Chuck Hagel urged officers at China's premier military university to work toward a new era of cooperation between the world's top military rivals. But during his first trip to China as Pentagon chief, icy body language and barbs telegraphed a relationship utterly devoid of warmth and very much saddled by suspicion. Chinese Defense Minister Chang Wanquan offered a defiant defense of Beijing's territorial claims over two sets of islands contested by Japan and the Philippines, disputes that are particularly vexing for Washington because it has defense treaties with both nations....Chinese officials have long viewed the Obama administration's policy to expand military and diplomatic engagements in Asia as an effort to contain Beijing's military rise and bolster its rivals in the region. U.S. officials have made a concerted effort to dispel that narrative, saying they welcome a rising China, as long as it acts in a way they deem constructive. That effort has a long way to go." Ernesto Londono in The Washington Post.

U.S. also toughening its rhetoric toward Iran regarding its choice for U.N. ambassador. "The White House stepped up its opposition Tuesday to Iran's choice for ambassador to the United Nations, but sought to keep the controversy from derailing negotiations over the Islamic Republic's disputed nuclear program. Hamid Aboutalebi, Iran's selection as envoy to the U.N., has drawn sharp criticism in the United States because he belonged to a student group that seized the U.S. Embassy in Tehran and took American diplomats hostage during the 1979 Islamic Revolution....The Obama administration, eager to avoid disruption of the international nuclear negotiations with Iran that resumed Tuesday in Vienna, has called Aboutalebi's selection 'extremely troubling,' but it stopped short of barring his entry. White House Press Secretary Jay Carney toughened up his language, however, saying U.S. officials have told Iran that the Aboutalebi selection is 'not viable.'" Christi Parsons and Paul Richter in the Los Angeles Times.

And Kerry raps Israel in faltering Mideast peace. "U.S. efforts to broker a Mideast peace agreement faltered after Israel refused to release prisoners as demanded by Palestinian leaders, then moved forward with plans to build new settlement housing in Jerusalem, America's top diplomat said Tuesday. But he still held out hope that negotiations would continue....Kerry noted that both Israeli and Palestinian leaders have taken what he termed unhelpful steps as an April 29 deadline approaches for deciding whether to continue negotiations or shelve the talks for now. But his words made clear that Israel's actions have thrown the process deep into doubt....But Kerry's comments infuriated Israeli officials, and drew a swift response from Naftali Bennett, a pro-settler Cabinet minister and a main coalition partner in Israeli Prime Minister Benjamin Netanyahu's government." Lara Jakes in the Associated Press.

Other foreign policy reads:

Tense standoff in eastern Ukraine could shape country's future. Will Englund and Kathy Lally in The Washington Post.

House Republicans seek stronger approach on Ukraine. Jordain Carney in National Journal.

U.S. to cut deployed nuke force by 50. Robert Burns in the Associated Press.

Sign language interlude: Rap battle with Wiz Khalifa.

5. Republicans still have an immigration problem

Jeb Bush joins long list of conservatives who got in trouble for saying compassionate things on immigration. "In the middle of a quizzing about his presidential ambitions on Fox News last Sunday, former Florida governor Jeb Bush made an empathetic remark about the millions of people who live in the country illegally -- and cued some predictable ranting from his party. Bush's risky stance is, basically, that anyone should be able to summon sympathy for those who come to the U.S. to provide for their families. Illegal immigration is 'not a felony. ... It's an act of love. It's an act of commitment to your family,' Bush said. 'There should be a price paid, but it shouldn't rile people up that people are actually coming to this country to provide for their families.' Bush seemed to be urging moral decency, not progressive policy -- and anyone who read his 2013 book on immigration knows he does not support a path to citizenship. Bush isn't the first Republican to profess compassion for the illegal population in recent years. As the remarks from his colleagues show, revealing a soft spot on immigration doesn't always suggest an intention to act on the broken system." Nora-Caplan Bricker in The New Republic.

GOP lawmakers don't love Bush's comments. "Rep. Raul Labrador (R-Idaho), a conservative who has worked on immigration reform, suggested Bush was 'pandering.' 'When you trivialize the fact that these people have broken the law, I think your message is a little bit off. I think it's unfortunate,' Labrador said at a Tuesday event sponsored by The Heritage Foundation." Russell Berman in The Hill.

What's at stake: GOP's electoral future. "Florida is home to an ever-increasing Hispanic population that has skyrocketed in the past decade and shows no signs of slowing growth. In 2000, Hispanics made up approximately 16.8 percent of Florida's population. By 2005, that number had increased to 19.8 percent before taking an even larger leap to 23.2 percent by 2012. Bush knows this. He governed the state for eight years, and he knows that Republicans can't afford to alienate Hispanics any longer with harsh immigration politics. Boehner, on the other hand, doesn't have to deal with this fact himself. By contrast, Hispanics make up only 3.3 percent of Ohio's population, a small enough percentage that Boehner can afford not to make concessions toward Hispanic voters. That tactic may work in Ohio, but not on a national scale, especially not as national demographics continue to shift in the direction of a less white America. Nominally, most Republicans seem to recognize this, but there's been little progress despite the 2013 GOP 'autopsy report' and its recommendation that the party reach out to minority voters. House Republicans, led by Boehner, still drag their feet on immigration reform, for instance." Eric Brown in International Business Times.

Conservative commentator predicts Bush will feel backlash. "Conservative commentator Charles Krauthammer says comments from former Florida Gov. Jeb Bush about immigration being an act of love were 'bizarre,' predicting that when the Republican enters the presidential race, those words will come back to haunt him. 'If he was feeling any optimism before that interview, I think it's gone away after the interview,' Krauthammer said on Fox News's 'Special Report' Monday night." Tal Kopan in Politico.

Why immigration probably won't sink Marco Rubio. "Yes, you read that right. Rubio, who helped spearhead a sweeping reform package and subsequently saw his stock fall in the conservative base of the Republican Party. The senator who put lots of energy behind a bill that has gone nowhere in the GOP-controlled House. The reason why immigration probably won't doom Rubio's chances has less to do with him than it does with the field of Republicans he'd likely face if he makes a White House bid. Most of the biggest-name prospects for 2016 are not well-positioned to attack Rubio from the right on immigration because of where they stand on the issue." Sean Sullivan in The Washington Post.

Explainer: Obama is feeling pressure to act on immigration before the midterms. Here are his options. Fawn Johnson in National Journal.

Prank interlude: Facebook stalking in real life.

Wonkblog roundup

Why Uber is joining the race to dominate urban logistics. Emily Badger.

A dog groomer can do your taxes. Is that wrong? Jia Lynn Yang.

The White House is closing the gender pay gap, so why can't the rest of us? Christopher Ingraham.

Forget about Obamacare exchanges. Employer coverage is booming, survey finds. Jason Millman.

The End of Men, in one chart. Lydia DePillis.

Why extending unemployment benefits could be a logistical nightmare. Ylan Q. Mui.

Et Cetera

NHTSA fines GM $28K over ignition switch questions. David Shepardson in The Detroit News.

Comcast, Time Warner to face Congress regarding proposed merger. Diane Bartz and Alina Selyukh in Reuters.

Experts find door ajar in Internet security method thought safe. Nicole Perlroth in The New York Times.

Regulators act to require stronger bank capital. The Associated Press.

Untaxed corporate profits held overseas top $2.1 trillion. Kevin Drawbaugh and Patrick Temple-West in Reuters.

U.S. stops counting drug users. Abby Haglage in The Daily Beast.

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

Wonkbook is produced with help from Michelle Williams.

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