As Sen. Ted Cruz (R-Texas) stood in the Senate in vocal opposition to the implementation of the Affordable Care Act, President Barack Obama took a veiled shot at the freshman senator during a health-care summit at the Clinton Global Initiative.

Obama didn't mention Cruz by name, but he referred to "one of the major opponents" who wants to "potentially shut down the government over Obamacare."Cruz has led the charge in the Republican Party to strip funding for Obamacare in the continuing resolution that keeps the government funded. 

During an hour-long discussion with President Bill Clinton at the CGI in midtown Manhattan, Obama knocked Cruz for his stated reasoning to oppose Obamacare.

"Part of what I think the resistance that we’ve seen ramp up particularly over the last couple of months is all about is the opponents of health care reform know they’re going to sign up," Obama said, referring to state exchanges that open up next Tuesday.

"In fact, one of the major opponents, when asked, well, why is it that you’d potentially shut down the government at this point just to block Obamacare, he basically fessed up. He said, well, once consumers get hooked on having health insurance and subsidies, then they won’t want to give it up.

"I mean, that’s — you can look at the transcript. This is one of the major opponents of health care reform. It is an odd logic. Essentially they’re saying people will like this thing too much and then it will be really hard to roll back."

Cruz and other conservatives have argued that it will be difficult to roll back Obamacare once it starts to become fully implemented next week. And he admits that it will be even more difficult after Jan. 1, when some of its benefits — government subsidies for health insurance and Medicaid expansion — start to take effect.

Obama and Clinton spent nearly an hour talking health-care policy and the Affordable Care Act. With Clinton moderating and asking the questions, Obama spent most of that time arguing that the new system would help the economy and sink the long-term budget deficit — all at the personal cost of a monthly cell-phone bill. 

Obama lamented what he called a "political" effort to dismantle the law. He made reference to the same debate he said took place under the Clinton administration.

"Let's face it, it's been a little political, this whole Obamacare thing," Obama said to laughter.

"And so what you’ve had is an unprecedented effort that you’ve seen ramp up over the last month or so in which those who have opposed the idea of universal health care in the first place and have fought this thing tooth and nail through Congress and through the courts and so forth have been trying to scare and discourage people from getting a good deal.  And some of you may have seen some of the commercials out there that are a little whacky."

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During his marathon speech on the Senate floor Tuesday in opposition to funding the Affordable Care Act in the continuing resolution, Sen. Ted Cruz (R-Texas) took a break ... to read bedtime stories to his two young girls. 

He said that his two daughters were watching C-SPAN2 at home — he told them to turn on the station at 8 p.m. Cruz read his daughters verses from the Bible. And then he moved on to the Dr. Seuss classic, "Green Eggs and Ham."

Jason Johnson, Cruz's chief campaign strategist, tweeted a photo of Cruz's daughters watching him on television at home:

Below is video of Cruz's dramatic rendition on the Senate floor. He concluded by telling his daughters, "Daddy's going to be home soon, to read to you in person."

And, yes, "Green Eggs and Ham" will now forever be in the Senate record.

SEE ALSO: How conservatives are secretly winning the war on the government shutdown fight

FULL COVERAGE: Ted Cruz's epic 'defund Obamacare' speech in the Senate

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(Reuters) - Americans will pay an average premium of $328 monthly for a mid-tier health insurance plan when the Obamacare health exchanges open for enrollment next week, and most will qualify for government subsidies to lower that price, the Obama administration said on Wednesday.

The figure, based on data for approved insurance plans in 48 states, represents the broadest national estimate for how much Americans will pay for health coverage under President Barack Obama's healthcare reform law next year. The prices of the new plans are at the heart of a political debate over whether they will be affordable enough to attract millions of uninsured Americans.

Prices were lower in states with more competition among insurers and higher in states with fewer players, the U.S. Department of Health and Human Services (HHS) said in its report. Americans will be able to sign up for the new plans via online state exchanges beginning on October 1.

"For millions of Americans these new options will finally make health insurance work within their budgets," HHS Secretary Kathleen Sebelius said during a briefing with reporters.

The Obama administration is counting on signing up 7 million Americans in the first full year of reform through the state exchanges, including 2.7 million younger and healthier consumers who are needed to offset the costs of sicker members.

Debate over whether Obamacare will prove affordable for millions of uninsured Americans has been sharp during the past few months, as states have announced rates. States that have supported the law said it will lead to lower prices. Others that have opposed the reform - including Georgia, Florida, and Indiana - warned of "rate shock" for consumers compared to what they could buy on the individual insurance market a year ago.

HHS said the average price was 16 percent lower than its own projections on premiums. In addition, consumers who earn up to 400 percent of the federal poverty level, or $62,040 for a couple, will qualify for subsidies that will lower the price further.

TEXAS RATES BELOW AVERAGE

The data is mostly based on 36 states where the federal government will operate the insurance exchange. About 14 other states and the District of Columbia are running their own exchange.

Politics aside, states with the lowest average premium tend to have more insurance companies offering plans, the report said. It said eight issuers on average were selling plans in the states with average premiums in the lowest 25 percent, while states with average premiums in the top 25 percent had only three insurers on average.

Texas has been among the Republican-led states most fiercely opposed to Obamacare, but its monthly rates came in below the national average, HHS said. In Austin, Texas, with 76 plans to choose from, a 27-year-old would pay $169 per month for the lowest cost mid-tier plan. In Dallas-Fort Worth, with 43 plans to choose from, that price was $217 per month, the report said.

"The rates in Texas are looking good," said Gary Cohen, who is charged with overseeing the exchanges at the Centers for Medicare and Medicaid Services.

Enrolling enough consumers is key to making the healthcare overhaul work economically, with price considered the most important factor driving enrollment, according to insurance industry surveys.

Another concern has been that insurance companies will limit access to doctors in order to keep prices low. Cohen said that these so-called "narrow networks" were a trend before the Affordable Care Act went into effect.

The law was adopted in 2010 but two of its main pillars, the health exchanges and the expansion of Medicaid, take effect in 2014. Household names like UnitedHealth Group Inc, Aetna Inc, WellPoint Inc and Humana Inc will sell plans on at least some exchanges. Newcomers such as Medicaid specialist Molina Healthcare Inc will also play a role.

(Reporting by Caroline Humer in New York; Additional reporting by Lewis Krauskopf in New York; Editing by Michele Gershberg and Lisa Shumaker)

* On average (which doesn't exist). Not including tax credits. And not including the new taxes you may pay to fund the program.

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The Affordable Care Act, aka Obamacare, aims to get more Americans on health insurance.

However, many economists agree that one of the direct impacts of this new legislation is more part-time jobs and reduced hours for workers.

You see, under the employer mandate of Obamacare, businesses employing 50 or more workers will be forced to offer health insurance or pay a penalty of $2,000 per full-time worker (i.e., those working over 30 hours per week).

The simple way to get around this penalty is obviously to reduce each employee's hours, but offset that by hiring more workers.

"Our analysis of a similar program in Massachusetts suggested that this law could slow job growth in the United States," wrote UBS's Drew Matus in a June research note. "Given the impact on Massachusetts, we could see a reduction in job growth of almost 500,000 during the first few years of the act’s implementation.  Alternatively, we could see more hiring driven by part-timers not eligible for health insurance (which could increase hiring) with a commensurate decline in the average workweek."

Obamacare hasn't yet been implemented, but there's already numerous anecdotes showing that employers are already making changes.

Here's a recent anecdote from The Economist:

BEFORE the recession, Richard Clark’s cleaning company in Florida had 200 employees, about half of them working full time. These days it has about 150, with 80% part-time. The downturn explains some of this. But Mr Clark also blames Barack Obama’s health reform...

Mr Clark says he is "very careful with the threshold". To keep his full-time workforce below the magic number of 50, he is relying more on part-timers. He is not alone. More than one in ten firms surveyed by Mercer, a consultancy--and one in five retail and hospitality companies--say they will cut workers’ hours because of Obamacare. A hundred part-timers can flip as many burgers as 50 full-timers, and the former will soon be much cheaper.

Part-time jobs have been a driver of new jobs this year, supporting the theory that this shift is happening nationally.

But economists warn that Obamacare may be just one of many factors causing this.

"Job growth has been overshooting GDP growth by a substantial margin this year,"noted Credit Suisse's Neal Soss in an August research note. "And while there are numerous hypotheses as to why that might be happening (lower productivity, doubling-up of part-time workers due to Obamacare concerns, and others), none are entirely convincing."

So, what do the jobs numbers actually say?

Well, employers wishing to "game the law" would most likely be going after the jobs that are already near the 30-hour work week level.

Wells Fargo's John Silvia looked into this.

"If managers were engaging in a conscious effort to reduce employee hours to less than 30 hours per week, so as to make those workers 'part-time' employees and, therefore, not subject to the employer mandate of the ACA, then it seems reasonable that hours would be falling most in industries closest to this cutoff point,"wrote Silvia. "There is some indication that employers have been reducing hours in preparation for the ACA, but a slightly longer-term view of the macro data does not yet offer conclusive evidence on the prevalence of this practice."

"There is no empirical evidence that hiring practices relate to concerns over benefits,"argued Westwood Capital's Daniel Alpert on the matter.

So, while it might make intuitive sense that employers would cut hours because of Obamacare, and while there may be anecdotes that employers are blaming Obamacare for reducing hours, the jury's still out on whether Obamacare is really having a material impact on the U.S. labor market.

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On Tuesday, Sen. Ted Cruz (R-Texas) referenced a speech by Ashton Kutcher and read "Green Eggs and Ham" to his daughters at bedtime.

On Wednesday morning, by the 18-hour mark of his marathon speech in opposition to the Affordable Care Act, he did a Darth Vader impression. 

Cruz compared his battle to defund Obamacare in the continuing resolution to the George Lucas classics. Cruz was inspired by Sen. Rand Paul's (R-Ky.) reference to a "a rebellion against oppression," which conjured up the image of the Rebel Alliance fighting against the Empire. In this case, he and Paul are the Rebel Alliance, fighting against the Empire of the Washington, D.C., establishment.

"Immediately upon hearing that phrase, I wondered at some point if we were going to see a tall gentleman in a mechanical breathing apparatus come forward and say, in a deep voice, 'Mike Lee, I am your father,'" Cruz said, in a Darth Vader voice, referencing Sen. Mike Lee (R-Utah). 

"The Empire will strike back," Cruz said. "But at the end of the day, I think the Rebel Alliance — I think the people — will prevail."

Here's the video, via Red Alert Politics:

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Ted Cruz rose in the Senate early Tuesday afternoon in opposition to the inclusion of funding for the Affordable Care Act in the Senate's continuing resolution to keep the government funded. 

He didn't stop speaking until noon ET on Wednesday. In all, he was on the floor for approximately 21 hours and 19 minutes.

"I rise today in opposition to Obamacare," Cruz said at 2:41:35 p.m. on Tuesday, after being recognized on the Senate floor. He declared he would speak "until I am no longer able to stand."

That's almost true – he had to stop talking Wednesday by 1 p.m. under Senate rules. That is approximately when the Senate will have its first procedural vote on its continuing resolution, the bill that keeps the government funded past Sept. 30 and avoids a government shutdown. 

Though it's reminiscent of Rand Paul's filibuster of CIA director John Brennan's nomination in March, Cruz is not actually participating in a filibuster — because he doesn't have any real power to prevent a vote from happening on Wednesday.

"This is not a filibuster," a Senate Democratic aide said Tuesday. "Since cloture has been filed, the cloture vote will occur tomorrow no matter how long Senator Cruz speaks. This is not anything tricky, just basic Senate rules."

Adam Jentleson, the communications director for Senate Majority Leader Harry Reid, tweeted Tuesday afternoon that the terms of Cruz's speech were pre-negotiated: 

Fun fact: Senator Cruz pre-negotiated the terms of his #fakefilibuster with Senator Reid yesterday. Not exactly a Mr. Smith moment.

— Adam Jentleson (@AJentleson) September 24, 2013

But Cruz embarked on 21-plus hours of theatrics that inspired Republicans and grassroots conservatives to rally around him in support.

In the speech's first hour, Cruz compared his fight to standing up to Nazi Germany in the 1930s, to the British in the Revolutionary War, and the Soviet Union in the Space Race.

"So, we get to Obamacare," Cruz said. "What do all those voices say? Can't be stopped. You can't win. Cannot defund it.

"By any measure, Obamacare is a far less intimidating foe than those that I have discussed, with the possible exception of the moon. The moon might be as intimidating as Obamacare."

About an hour into his speech, he "took a question" from Sen. Mike Lee (R-Utah), who has led the fight to defund Obamacare with Cruz. The procedure is meant to give Cruz a break from speaking.

In the hours that followed, Cruz was helped on the floor by a number of Republican senators — including Lee, David Vitter (R-La.), Pat Roberts (R-Kans.), Jeff Sessions (R-Ala.), Rand Paul (R-Ky.), Marco Rubio (R-Fla.), Mike Enzi (R-Wyo.), and James Inhofe (R-Okla.).

Along the way, there were memorable moments. A little before 5 p.m., Cruz heaped praise on a speech by Ashton Kutcher at the Teen Choice Awards earlier this year. A little after 8 p.m., he read his daughters — who were watching on C-SPAN — bedtime stories, which included a dramatic reading of the Dr. Seuss classic, "Green Eggs and Ham." On Wednesday morning, he referenced the Star Wars movies and did a Darth Vader impression on the floor.

And at various points during his talk-a-thon, Cruz read aloud tweets from Americans who were using various hashtags, such as #MakeDCListen.

Two Democratic senators also stepped to the floor during the marathon to ask Cruz questions — Sens. Dick Durbin (D-Ill.) and Tim Kaine (D-Va.). 

Cruz's exchange with Kaine was lengthy, and it provided him with his most significant challenge from the Democratic opposition all night. Kaine argued that the issue of Obamacare was settled in the 2012 election. Cruz retorted that both presidential parties almost entered into a "bipartisan agreement" not to run on Obamacare, even though both Obama and Mitt Romney did make the issue big themes in their respective campaigns.

"I very much hope you introduce health care reform legislation," Kaine said.

Cruz's marathon ended just after noon, when a new legislative day began in the Senate. Under the Senate rules, he did not have to yield control of the floor — he could have kept speaking for another hour. 

"This has been a big waste of time," Reid said afterward.

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This afternoon, Sen. John McCain (R-Ariz.) offered a civics lesson to Sen. Ted Cruz (R-Texas) and other conservatives pursuing a scorched earth approach to defunding Obamacare. That is, sometimes, when you're in the minority, you lose:

We fought as hard as we could, in a fair and honest manner, and we lost. And we lost, one of the reasons is because we were in the minority. And, in democracies, uh, almost always, the majority governs and passes legislation.

McCain's remarks followed Cruz's 21-hour speech urging the Senate to block any bill keeping the government open that does not defund Obamacare.

McCain also added that "elections have consequences" and Republicans should "respect the outcome" of the 2012 election, in which Republicans campaigned on repealing Obamacare but could not defeat Obama:

I campaigned all over America for two months, everywhere I could. And in every single campaign rally I said "we had to repeal and replace Obamacare." Well, the people spoke. They spoke, much to my dismay, but they spoke and they re-elected the President of the United States. No that doesn’t mean that we give up our efforts to try to replace and repair Obamacare. But it does mean elections have consequences and those elections were clear, in a significant majority, that the majority of the American people supported the President of the US and renewed his stewardship of this country. I don’t like it, it’s not something that I wanted the outcome to be. But I think all of us should respect the outcome of elections, which reflects the will of the people.

Acknowledging that losing elections can lead to the implementation of policies you dislike might seem like common sense, but it is a hotly contested notion among conservative activists. Earlier this month, McCain hinted that he will retire when his term is up in 2016, which leaves him freer to dispense #realtalk like this.

McCain also said comparing Obamacare to the Nazi threat, as Cruz did during his long speech, "does a great disservice" to Americans who fought against the Nazis, such as his father and grandfather.

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In a rare moment for the United States Senate, the "world's greatest deliberative body" has voted, unanimously, on something. 

On Wednesday, the Senate voted 100-0 on the motion to proceed to debate the House of Representatives-passed continuing resolution to keep the government funded. The vote came about an hour after Sen. Ted Cruz (R-Texas) finished his 21-plus-hour speech in opposition to including Obamacare funding in the continuing resolution. 

Cruz, along with every other Republican senator that accompanied him on the floor during his speech, voted in favor of invoking cloture on the motion to proceed. 

This sounds confusing — after all, Cruz just spent nearly an entire day railing against passage of the bill. But this was Cruz's plan all along. He opposes invoking cloture to end debate on the bill — that vote will come either Friday or Saturday. 

Here's what Cruz said on the Senate floor Tuesday (emphasis added):

"The central vote the Senate will take on this fight will not occur today and it will not occur tomorrow. The first vote we are going to take on this is a vote on what is called cloture on the motion to proceed. Very few people not on this floor have any idea what that means and even, I suspect, a fair number of people on this floor are not quite sure what that means. That will simply be a vote whether to take up this bill and to begin debating this bill. I expect that vote to pass overwhelmingly, if not unanimously. Everyone agrees we ought to take this up, we ought to start this conversation. 

The next vote we take will occur on Friday or Saturday and it will be on what is called cloture on the bill. That is the vote that matters. Cloture on the bill, the vote Friday or Saturday, is the vote that matters.

Because the cloture vote has now passed, there's now a 30-hour shot clock in the Senate that allows for debate on the bill. 

Cruz signaled a willingness on Wednesday to accelerate parliamentary procedure so that the Senate could hold that all-important vote — on cloture to end debate — on Friday, so that more people would be paying attention. 

This is the vote that "matters"— and it's also where things will get awkward. At this point, the bill will still have the House language that strips funding for Obamacare, which is what conservatives have pressed for all summer.

At the same time, Cruz and other conservatives realize that Senate rules make it possible for Senate Majority Leader Harry Reid to introduce his amendment stripping the language that defunds Obamacare. And he will only need a majority vote for the amendment to pass.

Republicans' choice, then, is to either filibuster the bill that includes the language they wanted — and essentially endorse a government shutdown — or to essentially allow Reid to be able to introduce the amendment and strip the language. 

SEE ALSO: A recap of Ted Cruz's epic 21-hour speech

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Health care rollout would proceed if government shuts down, uninsured would still get covered

WASHINGTON (AP) — Republicans pulling on the budget thread can't neatly unravel President Barack Obama's health care law.

A partial government shutdown next week would leave the major parts of the law in place and rolling along, according to former Democratic and Republican budget officials, as well as the Obama administration itself. Health care markets for the uninsured would open as scheduled on Tuesday.

Deleting the money to implement the law, the GOP's dream scenario, would indeed cripple Obamacare. But that's much less likely to happen than a government shutdown. Obama wouldn't allow the ruin of his hard-fought namesake legislation.

Part of the reason a shutdown wouldn't stop the health care law is that government doesn't grind to a halt. National defense, law enforcement, air traffic control and other activities involving the safety of human life and the protection of property continue.

Ditto for big entitlement programs such as Social Security, Medicare and Medicaid, whose "mandatory" funding does not have to be renewed annually by Congress. The Affordable Care Act is the newest addition to that club of budget heavyweights.

The employees who administer such programs may also be considered essential. During the Clinton-era shutdowns, Social Security brought back nearly 50,000 employees to handle claims work after initially giving them furloughs.

"Many of the core parts of the health care law are funded through mandatory appropriations and wouldn't be affected," Gary Cohen, the Health and Human Services Department official overseeing the health care rollout, told reporters this week.

Translation: Obamacare's good to go.

That's pretty much how a former top GOP congressional budget expert sees it too. "A government shutdown, absent any legislation, does not fundamentally alter the Affordable Care Act," said Bill Hoagland, now a senior vice president at the Bipartisan Policy Center, an advocacy group that's trying to bridge the political divide in Washington.

Economist Douglas Holtz-Eakin, chief economic adviser to 2008 Republican presidential nominee John McCain, concurs. "As a policy matter, it won't succeed in stopping Obamacare," he said of a government shutdown. "We have put much of the government on cruise control."

The main benefits of the health care law — tax credits and expanded Medicaid — are mandatory spending and cannot be unwound through an annual funding bill for government operations. As for implementation money, much of it was provided under the law itself. Core functions such as operating call centers and building online systems are being handled by private contractors, not government employees. When money has run short, the administration has been able to divert unspent funds in other accounts.

In a report for Sen. Tom Coburn, R-Okla., the Congressional Research Service concluded it's likely the administration would continue to rely on alternative sources of implementation funding in the event of a shutdown.

So why are some Republicans prepared to go through with it? They're betting that the public will blame Obama for being stubborn, although polls don't bear that out. GOP party elders in the Senate are calling it a foolhardy strategy.

Defunding the 3-year-old health care law and thus preventing its full implementation, as the House has voted to do, would be a different story.

"If you take away the money, the rest of the law isn't going to work," said Paul Van de Water, a former top official of the Congressional Budget Office, currently with the Center on Budget and Policy Priorities, which advocates for the poor. Without subsidies to help the uninsured, the law's requirement that virtually all Americans get coverage would be unreasonable.

But over the past three years, the many and varied requirements of the Affordable Care Act have become part of the way the government does business. Reversing course is not impossible, but it could be excruciating.

It would be messy because a host of mandates, taxes and regulations would remain on the books, and Medicare payment systems could get jumbled up.

Would insurers still be required to cover people with health problems? What about taxes that are already being collected and Medicare cuts that have gone through? Most employers still would have to cover dependent children of their workers up to age 26 and provide birth control free of charge as preventive care.

"It is chaotic," said Van de Water. "Legally, how that mess gets resolved, I wouldn't hazard a guess."

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Open enrollment looms for workers’ to sign up for employer-sponsored health-care plans. This enrollment season promises to resemble few others.

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Near the end of a fiery speech in which he decried Republicans' opposition to his signature legislative achievement, President Barack Obama's administration announced it was delaying another piece of the Affordable Care Act's implementation. 

Politico reports that the Obama administration will push back online enrollment in some of the small-business exchanges that are scheduled to open on Oct. 1. Small businesses looking to enroll in coverage on the "SHOP" exchanges will have to submit a paper application, instead.

The announcement is likely to stoke flames within the Republican Party, which has been pushing to defund and/or delay Obamacare through battles to avert a government shutdown and over raising the debt ceiling.

It came the same day that Democratic Sen. Joe Manchin (W. Va.) — who has been no fan of the law for quite some time — said he would support a one-year delay of the individual mandate feature that requires all Americans to purchase health insurance or pay a fine. 

And it came just as Obama was delivering one of his most impassioned speeches on the subject and the situation, accusing Republicans of "blackmail." During certain points of his speech in Largo, Md., he seemed to genuinely enjoy ridiculing Republicans. 

"One congressman said that Obamacare is the most dangerous piece of legislation ever passed," Obama said. "Ever, in the history of America. This is the most dangerous piece of legislation."

"You had a state representative somewhere say that it's as destructive to personal and individual liberty as the Fugitive Slave Act," Obama added, referring to a New Hampshire state representative's comments from August. "Think about that. Affordable health care is worse than a law that lets slave owners get their runaway slaves back. I mean, these are quotes. I'm not making this stuff up."

Republicans seized on the reported delay to argue the law isn't ready to be implemented. 

“Unbelievable, did anyone tell the president that his administration is delaying another piece of Obamacare before he tried swindling the American people again?" RNC Chair Reince Priebus said in a statement. "It’s clear all Americans deserve a delay from this trainwreck. Maybe even more Democrats will get on board with Republican efforts now.”

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With only five days before enrollment in insurance exchanges begin under the Affordable Care Act, the key issue facing the Obama administration is general confusion about the law and its effects on them, which has led to near-record unpopularity in numerous polls.

And according to a new CNBC poll, that confusion extends to what you call the law.

People's opinions are shaped by how pollsters refer to the law. According to the poll, calling it the "Affordable Care Act" leads to more intense feelings — both positive and negative — than calling it "Obamacare."

35% of respondents described their reaction to "Obamacare" as "very negative," compared with only 24% that said the same thing about the "Affordable Care Act." Similarly, 14% view "Obamacare" very positively, compared with only 10% who say the same when it's called the ACA. 

Overall, respondents viewed "Obamacare" negatively by a 46-29 split. That's similar to the 37-22 negative split on the "Affordable Care Act." But 30% don't know enough about the ACA to give an opinion, compared with 12% who say the same about Obamacare. 

The Obama administration announced another delay of one of the law's provisions on Thursday. Though it the delay doesn't appear to be significant, it has the potential to complicate messaging leading up to the rollout of the exchanges next week.

The groups that the administration needs to convince are political independents. Both Democrats and, especially, Republicans are quite sure in their opinions. In fact, just 18% of Republicans say they don't know enough about the ACA to give their opinion.

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Two developments today should make health insurers very worried.

First, Amy Goldstein, Juliet Eilperin and Lena H. Sun report in the Washington Post that the administration is unlikely to have the exchange website functioning for most Americans by December 1st. Jeff Zients, who took command over the site in October, emphasized that "Healthcare.gov will work smoothly for the vast majority of users." That seems unlikely at this point.

This is a big issue for insurers, because the worse the website is, the more susceptible they are to insurance pools composed mostly of high-risk beneficiaries. Old, unhealthy people, particularly those with pre-existing conditions, are most likely to spend hours on Healthcare.gov waiting for it to work. They are the ones who benefit most from the law and are eager to sign up for their new plans. Young, healthy people will see much less of a need to do so. They will wait until the site is working and can complete their signup in a few minutes.

The problem for insurers is if the site doesn't work for most users, then the majority of people signing up will be old and unhealthy. This will skew their risk pool towards more expensive customers and drive up costs. The law includes provisions to offset some of this risk, but it is still a major, unexpected headache. 

Second, Sen. Jeff Merkley (D-OR) became the second liberal Democrat (along with Sen. Dianne Feinstein) to sign on as a co-sponsor to Sen. Mary Landrieu's bill to fix Obama's "if you like your health plan, you can keep it" lie. The legislation grandfathers in all health plans up until January 1st, 2013, as Rep. Fred Upton's bill in the House does, but it takes it a step further. Landrieu does more than just allow insurers to continue offering health plans to current beneficiaries. She requires them to do so.

Besides the fact that this plan is likely technically infeasible, it also is a massive government intervention into the insurance market. Many insurers cancelled plans because they were filled with high-risk people. They would now have no choice to continue offering them. Others, like United Healthcare in California, have pulled out of the state individual insurance market altogether; they would now be forced back in, unless they choose to also exit the much-larger group insurance market.

When Landrieu's legislation was supported by mostly red-state Democrats who were up for re-election in 2014, insurers had little to worry about. It was all politics. But now, with Landrieu and Merkley as co-sponsors, this bill just gained mainstream Democratic support. It's unclear what its chances are in the House, but its momentum is building.

Insurers have largely been quiet the past month and a half as the administration tries to get the website working. Everyone involved has the same goal so insurers have seen little value in publicly criticizing the White House. But it's becoming increasingly likely that insurers will face an unexpectedly expensive pool of beneficiaries in their plans and that any legislative fixes to the law will come at their expense. So far, they've stuck by the administration. That could change in the near future.

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For the last few weeks, Republicans have been full of schadenfreude over President Obama's broken "If you like your plan, you can keep it" promise.

Now, this issue is about to blow up in Republicans' faces.

Sen. Mary Landrieu (D-La.), who faces a tough re-election fight in a red state next year, has introduced a bill to address the president's broken promise through greater government control over the individual health insurance market. Her bill would obligate insurers to continue offering all the plans they offer today unless they entirely exit the health insurance business in a state.

What will Republicans do with this proposal? Do they really want a federal law that says health insurers can't enter or exit specific lines of business?

Rep. Fred Upton (R-Mich.) has introduced a bill in the House that would allow insurers to continue offering plans that would have been prohibited under the Affordable Care Act, but his bill is vulnerable to the criticism that it will still lead to a raft of plan cancellations as insurers choose to discontinue plans because the ACA has changed the financial incentives they face.

If Congress really wants to make sure people can take their plans, it will need to use the heavy-handed Landrieu approach; the light-touch Upton approach won't work. Erick Erickson (of all people!) understands this; he wrote a piece this morning called "It's a trap":

The House, with the help of a good number of Democrats, will pass the Upton plan and send it to the Senate. Harry Reid will substitute the Landrieu plan and send it back to the House. The House will be forced to either vote for the Landrieu plan or be characterized as siding with insurance companies against people.

In one fell swoop, the Democrats will have the GOP on record saving Mary Landrieu’s re-election in Louisiana by casting her as the one who saved Americans’ health care plans, and also getting on record as really being in favor of fixing Obamacare with the use of mandates.

Pretty much. And it's the comeuppance conservatives are getting for (1) having no health care agenda of their own and (2) endorsing the bizarre idea that health reform should not lead to health plan changes. With no health policy guidestar other than they're against what the president is for, Republicans are liable to walk into traps like demanding more health insurance regulation than the president wants.

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The political gains that Democrats made on the generic congressional ballot as a result of the federal government shutdown have evaporated over the past few weeks.

Republicans and Democrats are now tied on the generic congressional ballot, according to a new Quinnipiac University survey released Wednesday. The ballot has moved nine points in the past six weeks from what was a 43-34 Democratic lead on Oct. 1.

Most striking from the poll is the extent to which independent voters have shifted since Oct. 1, when they favored voting for a generic Democrat by a 32-30 margin. That number has shifted 13 points, as independents now prefer Republicans by a 37-26 margin. 

The same Quinnipiac survey also revealed that President Barack Obama's approval rating has dipped to its lowest level ever recorded in his tenure in office. It follows a more than a month of disastrous problems with the launch of the Affordable Care Act, featuring a dysfunctional website and piling-up concerns about plan cancellations.

Democrats gained momentum in the generic congressional ballot during the 16-day federal government shutdown last month, for which Republicans took the brunt of the blame. According to the Real Clear Politics polling average, they moved from a 4-point average lead on Oct. 1 to a 6.6-point average lead by the end of the month.

But as the shutdown ended, coverage piled up on the problems with the health care law's rollout. 

A silver lining for Democrats in the poll: Congressional Republicans are still more disapproved of (73-20) than congressional Democrats (62-30).

Quinnipiac surveyed 2,545 registered voters nationwide from Nov. 6-11. The poll has a margin of error of +/- 1.9%.

Here's a look at how Democrats gained and then lost their advantage in the generic ballot (data points are from May, July, August, October, and November):

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Just more than 100,000 people have selected plans for health insurance through exchanges under the Affordable Care Act through Nov. 2, the Obama administration said Wednesday.

The Centers for Medicare and Medicaid Services released much-anticipated data on Wednesday showing that from Oct. 1-Nov. 2, 106,185 Americans successfully selected a plan through the exchanges. 

Of that number, only 26,794 came through HealthCare.gov, the federal exchange site that serves 36 states. 79,391 came from state websites. 

CMS is now holding a conference call to discuss the numbers with reporters, featuring Secretary of Health and Human Services Kathleen Sebelius. 

The number is far from the 500,000 sign-ups the Obama administration expected in the first month of November. Enrollment includes those who have selected a plan who either have or have not yet paid the first month’s premium.

Sebelius told reporters that the Obama administration will be able to provide data on how many people have paid for plans by Dec. 15.

The official numbers come amid a disastrous rollout of the Affordable Care Act that has featured a dysfunctional HealthCare.gov website, which serves as the marketplace for 36 states. The White House has said that HealthCare.gov is fixable, and has said that it will be working "smoothly" by Nov. 30.

White House press secretary Jay Carney tempered expectations ahead of the announcement, saying that no one will be "satisfied" with the numbers because "they will be below what we sought" going into October.

In addition to the enrollment numbers, the Obama administration said that nearly 400,000 Americans have been determined or assessed eligible for Medicaid or the Children's Health Insurance Program.

obamacare_enrollment.pdf

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My heart sank when I got an email late last month from my friend Robert, who has been battling multiple sclerosis for the past decade.

He wrote to tell me that he was among the many Americans who in recent weeks received letters from their insurance companies saying that their policies won’t be available next year.

Insurance companies are sending those letters primarily because the policies they will no longer offer don’t provide enough coverage — or have deductibles that are too high — to comply with the Affordable Care Act.

In many cases, however, the policyholders getting those letters are simply victims of a business practice insurers have engaged in for years: discontinuing policies because they’re no longer sufficiently profitable.

Robert understandably was worried. Like most of us, he’d been seeing the news stories about people who had received similar letters and seemed to be resigned to having to pay more in premiums next year for comparable or even less coverage, thanks to Obamacare.

Considering his very serious and costly preexisting condition — his medications alone cost more than $5,000 a month — Robert was nervous as he started looking for a replacement policy. How much more would he have to pay to stay insured?

A couple of weeks went by. I assumed Robert, like many others, was still waiting for the Obama administration to fix Healthcare.gov so he could shop online for coverage. It turns out Robert wasn’t willing to just wait. He decided to call an insurance agent and talk to a real live human being about his options for next year.

He could barely believe what he heard: he could get better coverage than the policy being discontinued — and pay less — thanks to Obamacare.

“The overall cost of the plans I’m considering is cheaper than the plan I am currently paying for,” he wrote me this week. “My total cost for coverage now, including premiums and out of pocket costs, is about $9,800. Two of the plans I’m seriously considering for next year have total costs of $8,400. I’m shocked, but in a good way.” 

So not only did Robert not experience the sticker shock he had been expecting, he will save $1,400 next year on health insurance.

The plan he is leaning toward — a top-of-the line “platinum” plan — will have a higher monthly premium, but he will still save on average about $117 a month because of the way his out-of-pocket costs will be calculated.

Robert is among many who are losing their current coverage but in the end will be better off. In fact, considering that many folks buying coverage on the individual market have at least one pre-existing condition — which insurers can no longer take into consideration when pricing their policies — it’s likely that more people will get more for their insurance buck next year than less.

In addition, most of the people who buy coverage through the new insurance marketplaces (as Robert will when the balky Healthcare.gov website is working more smoothly) will be eligible for tax credits and subsidies from the federal government that will lower their monthly and overall costs even more.

Robert knows that you can’t determine how much you’ll spend on coverage during a given year just by multiplying the monthly premium by 12. If you don’t take into consideration out-of-pocket costs and just pick the policy with the cheapest premium, you could wind up paying more overall than if you picked a plan with a slightly higher monthly premium.

Robert also will be able to spread the cost of his coverage more evenly over the year. Under his current plan, he had to have at least $5,000 in the bank at the beginning of every year when his policy renewed to cover the cost of his medications for just one month. Under the new plans he is considering for next year, his monthly out-of-pocket costs will range from $80 to $120 a month.

“It will be easier to manage paying for my drugs spread out over a period of 12 months instead of in one lump sum at the beginning of the year,” Robert told me.

Robert said the insurance agent told him his case is not unique, that a lot of the people she talks to who have been frightened by the media coverage are pleasantly surprised to learn that they will get better coverage for less money next year. Once the Healthcare.gov website is fixed, more people who have received letters from their insurance companies will get a similar pleasant surprise.

SEE ALSO: How The Supreme Court Justices Made Their Millions

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Loathe to accept Obamacare, the Republican National Committee is fighting back; this time in the form of parody videos.

Mimicking the old Mac vs. PC ads starring Justin Long and John Hodgman, Republicans are hoping to get the last laugh when it comes to the fight against the Affordable Care Act.

We first saw the ads on The Daily Dot.

The 20-something in the video represents the Private Sector while the man on the floor in the suit represents Obamacare.

Here's one of the ads - titled "I'm ObamaCare - Whatever": 

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When he was seeking passage of the Affordable Care Act, one of the things President Obama really wanted to be able to say was that his plan didn't increase the deficit. So the law was designed to hold down explicit spending by relying heavily on mandates and cross-subsidies to get people covered without direct government outlays.

That choice is causing a lot of the political headaches the president is facing today.

Obamacare's explicit funding sources are mostly new taxes on people with high incomes and cuts to Medicare provider payments. But some of the "shadow fiscal policies" in Obamacare are effective tax increases on people with moderate incomes; these people didn't expect to face a tax increase under Obamacare, and now that they're discovering they are, they're getting angry.

This is another example of the closing wonk gap: Members of the general public figuring out facts about Obamacare that policy wonks on both sides of the debate have known for years.

Obamacare relies heavily on cross-subsidies as it greatly expands the market for individually-purchased health insurance. Premiums in this market will be tightly regulated so young and healthy people pay more than they're expected to get back in claims and older and sicker people pay less. This is a tax, of sorts, on a subset of young and healthy people that goes to finance health care for people who need more of it. And the individual mandate is designed to make sure they pay the tax, one way or another.

Shadow fiscal policy in health care is not a new innovation in the ACA. The government has long used subsidies, mandates and regulations to coerce private actors into buying health care and into making cross-subsidy payments to each other. The group health insurance market is basically one big cross-subsidy scheme. But those cross-subsidies have evolved over time and are well-concealed. Until recently, employer payments for health insurance haven't even appeared on W-2 forms. The new cross-subsidies in Obamacare are much more readily apparent in the form of premium increases for specific people.

The law's supporters understand this, at least implicitly. They talk about the importance of young and healthy people buying health plans through the Obamacare exchanges. Why is it so important that these people participate? It's because we need them to make their cross-subsidy payments for the system to work.

And yet those supporters tend to talk about the law as though it's not creating any losers. The old, cheaper insurance these people had through the individual market was junk insurance, we're told. Well, sometimes it was, but often it wasn't. Insurance for the young and healthy isn't only cheap if an insurer intends to rescind it whenever someone gets sick. In a lot of cases, these people were simply enjoying the good fortune of being a low, easy-to-underwrite risk, and the implicit tax structure in Obamacare is taking away the good deal they once enjoyed.

So what should you say if you think (as I do) the Affordable Care Act is a positive change to health policy on net even as it makes a few million people worse off:

• This losing group is outstripped by a much larger group of people made better off by the law. "Winners" include people who didn't have health insurance before and will now be able to afford it through the exchanges; people with very low incomes who are now becoming eligible for Medicaid; older people or people with pre-existing conditions whose premiums are going down because of risk pooling; and people whose coverage did not cover services they needed, like maternity care;
• The main people the old individual insurance market was failing weren't the approximately 15 million getting coverage through it but the nearly 50 million who were going uninsured because the market did not meet their needs, and the new market will be better for them;
• The group of winners under Obamacare can be even larger if the federal government gets Healthcare.gov working properly and recalcitrant states agree to take the Medicaid expansion;
• Tweaks to the law could improve the lot of people on the "loser" side of the ledger, particularly people who make just over 400% of the poverty line and therefore just miss eligibility for premium subsidies. A single young adult making freelancer $50,000 a year isn't struggling, but it probably wasn't the best idea to design the law so his or her health insurance premium goes up markedly to pay for coverage expansion elsewhere. Cost cuts elsewhere (for example, a modest restriction on the tax exclusion for employer-sponsored health insurance) could pay for expanded insurance subsidies for middle-income people who are currently left out.

And in the long run, my hope is that politicians will learn the lesson that shadow fiscal policy is not necessarily politically easier than explicit fiscal policy, and take their future expenditure programs on-budget.

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On Monday, President Barack Obama announced an administrative fix that is intended to reduce the number of Americans whose existing health care plans are getting canceled.

Currently, the Affordable Care Act offers "grandfathering" to individual insurance market plans that are unchanged since Feb. 23, 2010. People on these plans may keep them, if their insurers choose to continue offering them, even if those plans do not meet many of the new requirements under the law.

Now the president has announced his administration will extend that treatment, allowing a one-year extension of plans that have changed since Feb. 23, 2010, or that consumers signed up for after that date.

After the announcement, the president took press questions, some of which were quite sharp.

Major Garrett of CBS asked the president about his "If you like your plan, you can keep it" promise. Doesn't the need for this fix make clear that it wasn't true?

The president replied that his promise "ended up not being accurate" because the law's grandfathering provisions were "insufficient."

"That's why I'm trying to fix it," he added.

Obama said he opposes legislative efforts that "undermine the law;" he is positioning this administrative proposal as an alternative to bills currently being discussed in Congress that might have more sweeping effects. For example, a bill offered by Rep. Fred Upton (R-Mich.) would allow new consumers to buy plans that do not meet Obamacare requirements, rather than just letting existing customers stay in such plans.

In advance of the President's remarks, House Speaker John Boehner said he was "highly skeptical" that an administrative fix to plan cancellations is possible, and that House Republicans will press forward with a plan to vote Friday on the Upton bill.

Republicans in Congress have been attacking the president for weeks over his promise that "if you like your health plan, you can keep it" which has been belied by several million Americans receiving cancellation notices for plans that don't meet the law's requirements.

Democrats have been growing increasingly restless over the issue; Sen. Mary Landrieu (D-La.) is sponsoring a bill that would not only allow but force insurers to keep offering existing plans; many House Democrats have been signaling that they might vote for the Upton bill.

One key matter to watch with the President's proposal is how many cancellations it will actually prevent. Even if insurers are allowed to offer renewals, they may not always choose to do so, either because of the logistical challenges associated with un-canceling health plans just 47 days before the start of the new year, or because the Affordable Care Act changes the insurance market in ways that make certain old plans unprofitable for insurers.

State insurance commissioners would also have to cooperate in the renewals, for example by approving premiums for 2014. That would be difficult on the tight timeline. That's why Landrieu's bill, unlike Upton's, forces insurers to offer renewals.

Jeff Mason of Reuters asked the president about this issue. Obama said, "My guess is, right away, you're going to see a number of state insurance commissioners" act to help ensure that existing plans can stay in place. But he noted there would be variation from state to state, depending on how permissive existing state insurance rules are.

Aside from the website and plan cancellation issues, the president offered a broader assessment of the rollout. 
"We fumbled the rollout of the health care law," he said, adding "I'm confident by the time we look back on this next year, people are going to say 'This is working well.'"

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