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The latest news on Obamacare from Business Insider

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    jeffrey zients

    An in-depth New York Times piece today reveals the behind-the-scene details of's disastrous the launch and the rescue effort that ensued to try to save President Obama's signature legislative achievement.

    Communication between the White House, the Centers for Medicare and Medicaid Services and the lead contractors assigned to build the site was so bad that when it went live on October 1st, administration officials were thrilled to learn of the high traffic while panic was setting in amongst technicians of CGI Federal, the IT firm responsible for the site. The opposing reactions show just how little oversight the White House had over the site.

    It did not take long for that panic to spread to Pennsylvania Avenue. It was quickly clear that the problems with the exchange website were far worst than anyone imagined. It had barely been tested and could handle only 500 concurrent users. 

    White House Chief of Staff Denis McDonough debated with his aides what to do. One idea was to take the entire site down. The administration's biggest fear was not that it would take too long to fix the site. It was that the site wasn't fixable at all.

    From the Times report:

    [I]n a meeting in Mr. McDonough’s office that first weekend after the start, someone asked the question on everyone’s mind: Should we just take the website down altogether for a time so it can be fixed?

    No, Mr. Park said, after consulting with the engineers in Herndon — the website needs to be up to see where the problems are. One senior White House official said they briefly considered scrapping the system altogether. They decided it was fixable.

    That's how bad the launch was. More than three years and hundreds of millions of dollars after the law passed, the White House considered getting rid of altogether on the day it launched.

    Once they decided to keep the site, attention turned to how to fix it. Jeffrey Zients was put in charge of coordinating the recovery effort. He then tapped Quality Software Services Inc. (QSSI) as a "systems integrator."

    Technicians set up a "war room" in QSSI's offices in Columbia, Maryland and worked around the clock. Private IT specialists were brought in and the race began to fix the site before Zient's self-imposed December 1st deadline when it was supposed to work for "vast majority" of users.

    Today, that deadline arrived and the White House has declared victory. They say that 50,000 people can use the site at once and errors have been reduced dramatically.

    Despite these front-end fixes, the status of the back-end remains unknown. While consumers saw a number of problems when they first attempted to purchase health insurance on October 1st, insurers saw an equal number of errors on the other side. 834 forms, which tell insurers information about their beneficiaries and the plans they selected, had numerous errors, including inaccurate data and duplicate signups.

    Whether those problems have been cleared up is unclear. The administration has been reluctant to release any information on those, knowing that the media is largely focused on the front-end errors. If consumers can now purchase plans, but insurers are still getting inaccurate information, then the rescue effort is only halfway done.

    Join the conversation about this story »

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    About 100,000 people signed up for health insurance in November through, the plagued online federal health exchange, according to Bloomberg News' Julianna Goldman. The number would mean about four times as many people enrolled through the federal exchanges in November when compared to October.

    The Obama administration has yet to release specific enrollment numbers, saying it will do so officially on a monthly basis. The numbers reflect individuals that have selected a plan successfully.

    The number, while encouraging for the administration, is still far from its original goal. Marilyn Tavenner, the administrator of the Centers for Medicare & Medicaid Services, said at a Senate hearing last month that the administration had hoped for 800,000 enrollees in October and November.

    Just more than 100,000 people total signed up for health insurance under the Affordable Care Act in October. The bulk of that came from state-run exchanges. Only 26,794 signed up via, the rollout of which was disastrous at the beginning of October. The federal website serves 36 states.

    The Obama administration announced a "tech surge" in late October as the problems piled up, and on Sunday it declared that it had met the goal of improving the website to the point where the "vast majority" of users can use the site without much trouble.

    Some of the key changes touted in a progress report from the administration:

    • The site will now be able to support a maximum of 800,000 visitors per day, including a target of 50,000 concurrent visits.
    • The site is now online 90% of the time, according to the The Centers for Medicare and Medicaid Services.
    • The "tech surge" that came to the site in late October has helped to fix 400-plus bugs and glitches on a "punch list."
    • The average response time of the site is now less than one second, an improvement from about 8 seconds in late October.

    "The bottom line: on December 1st is night and day from where it was on October 1st," Jeff Zients, the official in charge of the tech surge, said in a conference call with reporters on Sunday. 

    SEE ALSO: Obama Administration Declares That It Has 'Met The Goal' Of Improving The Obamacare Site

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    A day after the Obama administration touted improvements in the dysfunctional federal health exchange website, I tried to start an application process on the site. 

    I couldn't even start an application. I got the error message at right. 

    This could be interpreted in a couple of ways. First, it's pretty bad that the day after declaring a success in fixing more than 400-plus bugs and glitches on the site, even the first step in signing up for insurance under the Affordable Care Act isn't working. The administration also had said that the site would be functional more than 90% of the time.

    It also means, according to the administration's calculation that the site can now support up to 50,000 concurrent visits, that there are more than that number currently browsing This, at least, indicates high interest. The option to get an email notification when is back online is also a relatively new feature.

    The administration was quick to tout some of the key changes in a progress report on Sunday:

    • The site will now be able to support a maximum of 800,000 visitors per day, including a target of 50,000 concurrent visits.
    • The site is now online 90% of the time, according to the The Centers for Medicare and Medicaid Services.
    • The "tech surge" that came to the site in late October has helped to fix 400-plus bugs and glitches on a "punch list."
    • The average response time of the site is now less than one second, an improvement from about 8 seconds in late October.

    Join the conversation about this story »

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    When the administration's self-imposed deadline to have the site working for the "vast majority" of Americans hit Sunday, the administration unsurprisingly declared it a success and said they've upheld that promise.

    They say the site can handle up to 50,000 concurrent users and 800,000 in a single day. Once the number of users surpasses 50,000 - as happened yesterday - a queue forms and allows people to receive an email when they can return and access the exchange. However, yesterday that queue began forming before the site hit 40,000 users. In addition, the White House touts that load times and error rates are both down considerably.

    That's all great and anecdotal evidence from the first day seems to indicate that more users can successfully access the site and sign up for a plan.

    But there is a major problem lurking in the background that the administration has refused to address: the back-end errors. 

    When the site launched on October 1st, it wasn't just consumers having problems and receiving error messages. Insurers were too. In order for the law to work, the exchange website must pass on information on what plans people sign up for to insurance companies. This comes in the form of 834 transmissions. But when the site went live, there were numerous problems with these 834s. Some people were signed up multiple times. Others received confirmation from that they had signed up for a plan, but that information was never passed on to the insurance company. Other 834s had inaccurate data. If these back-end problems were not fixed, the site still wouldn't be functional no matter how good the consumer experience.

    Yesterday, the Washington Post reported that up to a third of people who have signed up for coverage on the federal exchange website have had misinformation passed on to insurers:

    The errors, if not corrected, mean that tens of thousands of consumers are at risk of not having coverage when the insurance goes into effect Jan. 1, because the health plans they picked do not yet have accurate information needed to send them a bill. 

    Center for Medicare and Medicaid Services (CMS) spokeswoman Julie Bataille told reporters yesterday that an error causing 80 percent of the issues with 834 reports had been fixed. That's good news, but Bataille refused to comment on how many completed signups had already been affected or how many Americans could face an unwelcome surprise in January when they find out that their insurer has no record of them purchasing a plan. She did stress that people should call their insurers to confirm they paid their first month's premium.

    Until the administration has cleared up all of these back-end errors, the website still doesn't work. It doesn't matter how easy the site is for consumers to navigate or how many concurrent users it can handle. If insurers are receiving inaccurate 834 transmissions or aren't receiving signup information at all, then the website doesn't function properly. It's certainly possible that CMS has cleared up the majority of these errors, but they have been reluctant to answer any questions regarding the 834 forms, a sign that back-end issues may still exist. 

    Join the conversation about this story »

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    Barack Obama

    Fresh off progress fixing the federal health exchange website and news that Obamacare sign-ups nearly quadrupled in November, President Barack Obama is set to embark on a massive sales pitch of sorts on the Affordable Care Act starting Tuesday. 

    At 2:30 p.m. ET from the White House South Court auditorium, Obama will deliver a statement on the health care law. A White House official laid out what to expect from the speech: 

    "President Obama will hold an event at the White House to deliver remarks about the Affordable Care Act, highlighting the benefits that have already kicked in for millions of middle class families who have insurance and the importance of continuing to help as many hardworking Americans as possible enroll for their new health care options through the Marketplaces. Americans who have personally benefitted from the health care law and supporters of reform will join the President at the event."

    Tuesday's event is only the start of a nearly month-long campaign from the White House and Democratic groups designed to promote the law's benefits and hit Republicans who argue for its repeal. Politico reports that the White House will look to highlight a new benefit of the law every day from now until Dec. 23, the deadline for people to sign up for insurance to get benefits by the new year. 

    On cue, the Democratic National Committee on Tuesday launched a new website — The site blasts Republicans for supporting repeal of the 2010 health-care law, something that Democrats clearly believe is going to become a liability. They cite polls showing that despite general opposition to Obamacare and clear problems with its implementation, still fewer than 40% of Americans support full repeal.

    "That is a contrast that we are going to drive home every single day between now and the election," Mo Elleithee, the DNC's communications director, said in a statement of the difference between the Democratic position of arguing for fixes and the Republican position of repeal. 

    A DNC official said that the website would serve as a hub of sorts, leading to local Democratic officials going on the offensive using that messaging.

    Congressional Democrats are also jumping on board, as well. In a memo to their caucus last week obtained by Business Insider, Senate Democrats urged an offensive that contained a number of "action items" to do that. Some of those — like collecting stories of people who "Got Covered" under Obamacare, collecting "Thank you ACA" testimonials, and the launch of a "#GetCovered" online campaign — are already underway. 

    The memo also suggests that Democratic senators could release a report on the consequences of repeal, including a sample press release headline: 


    As The Washington Post's Greg Sargent points out, Democrats "own" Obamacare. And they're betting that the narrative is shifting, even if the website fixes aren't the end-all to the law's problems. Two new ones were detailed on Tuesday — about one-third of Americans' applications to insurers contain errors, and there appear to be significant security issues with the site.

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    doctorsAs the Affordable Care Act, better known as Obamacare, kicks in and the population ages, hiring in the health care industry is expected to generate the largest number of jobs compared to all other industries by 2020, according to the Bureau of Labor Statistics.

    That's a total of 5.6 million jobs with an annual growth rate of 3%.

    To find out which jobs offer the best opportunities in health care, job search site CareerCast analyzed survey data that weighed stress, physical demands, and both the current and future employment outlook of 200 occupations.

    "What's similar for the jobs on this list, with the exception of biomedical engineer, is that they work individually one-on-one with another person," Tony Lee, publisher at, tells Business Insider. "When you're working with someone else, the job satisfaction is pretty high because you see someone often and they're giving you feedback, as opposed to having very few people thanking you."

    Lee predicts that the need for these professionals will last for years to come. "Baby boomers are entering retirement, and as our body ages, the type of medical professionals that are needed to help people deal with that are going to be in greater demand."

    The overall score for each job takes into account the pay; hiring outlook; stress; emotional factors, including the level of competitiveness and degree of public contact; and physical demands, such as stamina required and work conditions, that normally come with a job. Once the categories are combined, a lower overall score signals that the job is more desirable to employees.

    Much of data used to evaluate the jobs comes from the BLS, other government agencies, trade associations, and private survey firms.

    12. Physician assistant

    Overall score: 414

    Annual median salary: $90,930

    BLS projected growth (through 2020): 30% 

    Work environment score: 72

    Stress score: 31

    What they do: Aid in the performance of essential procedures, which frees physicians to attend to more specialized aspects of their work.

    The ranking is based on data that weighted stress, physical demands, and both the current and future employment outlook across 200 occupations from the U.S. Bureau of Labor Statistics.

    11. Medical records technician

    Overall score: 354

    Annual median salary: $34,610

    BLS projected growth (through 2020): 21% 

    Work environment score: 44

    Stress score: 7

    What they do: Maintain complete, accurate, and up-to-date medical records for use in treatment, billing, and statistical surveys.

    The ranking is based on data that weighted stress, physical demands, and both the current and future employment outlook across 200 occupations from the U.S. Bureau of Labor Statistics.

    10. Respiratory therapist

    Overall score: 350

    Annual median salary: $55,870

    BLS projected growth (through 2020): 28% 

    Work environment score: 60

    Stress score: 19

    What they do: Treat and rehabilitate patients suffering from cardiopulmonary (heart and lung) ailments that interfere with normal breathing.

    The ranking is based on data that weighted stress, physical demands, and both the current and future employment outlook across 200 occupations from the U.S. Bureau of Labor Statistics.

    See the rest of the story at Business Insider

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    Barack Obama

    For the first time in his presidency on Tuesday, President Barack Obama's approval rating sunk below 40% in the Real Clear Politics average of eight prominent polls. 

    It's the latest in a series of approval-ratings lows for the president over the past few weeks, as problems with the Affordable Care Act's rollout have lingered into another month. In individual polls, his approval rating has dipped below the 40% level, but the average of these polls confirms what is, for Obama, an unwelcome trend into dangerous territory. 

    The sinking approval ratings don't bode well for Obama and his legislative agenda — which, early next year, will a new push to pass comprehensive immigration reform. They also present a plausible problem for Democrats running for election and re-election next year. 

    It has proven historically difficult for recent presidents who dive into the 30s to rebound back to good approval ratings, especially in their second terms in office. George W. Bush first hit 39% in Gallup's daily tracking survey on Oct. 13-16, 2005. He never moved back above 43% after that.

    Three of the polls in the RCP average have Obama's approval rating at either 37% or 38%. Two more have it right at 40%. The biggest margin of an approval-to-disapproval split is an Economist/YouGov poll, which found that 37% approve and 58% disapprove.

    In the past few days, the Obama administration has announced progress on fixing the dysfunctional website, and enrollment numbers spiked in November

    From Real Clear Politics, here's a look at how Obama's approval ratings have shifted from a high at the beginning of this year to now:

    Obama approval rating

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    Barack Obama

    More people signed up for health insurance through the federal exchange website over the past two days than did for the entire first month it was online, according to a report in Politico.

    Politico reports that 29,000 people enrolled through, the plagued federal insurance exchange site, over the past two days. Only 26,794 signed up through in October. The surge comes in the two days following the Obama administration's announcement that it had successfully fixed a slew of tech issues with the site.

    The Centers for Medicare and Medicaid Services could not confirm the enrollment numbers. But a CMS spokesperson said that "we certainly expect enrollment to increase given the technical improvements we’ve made to the site."

    "We are two months into a sustained six-month-long open enrollment period that we expect will ramp up over time," the spokesperson said in an email.

    The Obama administration also leaked numbers on Monday — still unofficial — that showed enrollment through, which serves 36 states, had quadrupled from October to November. But the implied pace of enrollment over the past two days would be five times faster than the approximately 100,000 sign-ups in November.

    Over the past two days, CMS said, there have been almost 2 million visits to Among other tech fixes, the site can now handle up to 50,000 concurrent users.

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    Signing up for insurance on the new healthcare exchange websites has proved tricky enough on its own. Now, efforts by a California Republican group are making it just that much more difficult.

    Golden State conservatives have taken to distributing official-looking mailers informing people that they will be required to purchase insurance under the Affordable Care Act.

    Fair enough, but the five-page pamphlet then directs readers to, an equally official-looking website run by the California Assembly’s Republican caucus with a URL very similar to that of state’s official exchange site.

    Instead of helping people sign up for insurance, is more interested in scoring political points while detailing what it sees as the detrimental effects of Obamacare.

    California’s actual health insurance exchange website is

    While does include a link to California’s official exchange (added after reports of the site’s potentially misleading nature broke earlier this week), the Republican page consists of a mixture of basic factual information about the new law and material detailing how the recent changes to the nation’s health care system will negatively affect California citizens along with links to news articles critical of Affordable Care Act’s implementation.

    ‟Constituents needing useful information about how to deal with the Affordable Care Act would be well advised to look elsewhere,” advised the Los Angeles Times. ‟As an aid to understanding and navigating the Affordable Care Act's new requirements and opportunities for coverage, the GOP site is worse than useless.”

    The mailers, which were distributed by legislators like Assemblyman Scott Wilk (R-Santa Clarita), take a much more neutral tone toward the Affordable Care Act than does the website to which it directs users. The GOP website was first launched in August.

    disclaimer on the site reads:

    The California State Assembly does not warrant or make any representations as to the quality, content, accuracy, or completeness of the information, text, graphics, links and other items contained on this server or any other server.

    “Hard-working Californians have serious questions about how the new federal health care mandate will affect them and they are looking to lawmakers for answers,” Assembly Republican Leader Connie Conway (R-Bakersfield) in a press releaseannouncing the creation of “Our new website will give Californians the answers they are seeking and help them navigate through the confusing bureaucracy of the new federal health care law with ease." is registered to Conway’s Communications Director Sabrina Lockhart, who insisted that the site was created in response to a flood of quetions about Obamamcare the state’s Republican legislatiors have gotten from their constituents. 

    “The site is promoted as a resource guide. It doesn’t give people the ability to purchase a plan,” Lockhart explained, charging that much of the backlash is, “an effort by the left to distract from the real problems of the law’s failed implementation.”

    “There are 38 million people in California, but only five million of them are projected to be eligible to purchase a plan through,” Lockhart added. “Our site is designed to be a guide for everyone to better understand the law.”

    California Attorney General Kamala Harris has made an effort to shut down private health insurance websites allegedly designed to trick people into thinking they were the state’s official exchange page. State law prohibits individuals or entities from claiming to provide services on behalf of the California exchange without explicit permission to do so. Also prohibited is the use of domain names "confusingly similar” to the one used by the state exchange.

    Harris's office has filed cease-and-desist orders against nearly a dozen such sites that employed phrases like "Get Covered" and "Covered California."

    “We have some concerns about misleading sites, but I don’t think … [] falls in the category of ones that break the law,” explained Sarah Sol, an information officer at CoveredCA. “That said, we encourage people come directly to our site if they want to get more information about the Affordable Care Act.”

    California’s official health care exchange site, which has avoided many of the technical glitches that have plagued other state and federal sites, is considered one of the more successful state efforts. By the middle of last month, reported it had signed up some 80,000 people for insurance plans.

    H/T Crooks & Liars | Photo by jfcherry/flickr

    Disclosure: The author briefly worked as an unpaid intern on Harris’s 2003 campaign for San Francisco Attorney General.

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    Politico is reporting an "enrollment surge" on According to "an official familiar with the program," the website enrolled 29,000 people in private health insurance plans on Sunday and Monday, the first two days of December.

    That's more people than enrolled in the entire month of October. And by my back-of-the envelope math, it means is now enrolling people at 38% of the pace needed to reach the administration's goal of 7 million signups by March 31.

    That's not fast enough, but it's a marked improvement over the last two months (October's enrollment pace was 3% of what's necessary) and it's reason to hope that further improvements will be enough to prevent problems of low enrollment.

    Here's my math. serves residents of 36 states that do not run their own exchange websites, which contain about 2/3 of the country's population. So, it should account for about 4.7 million signups if the target is to be reached. That's 4.55 million more people than had already signed up through December 2, according to reported and rumored numbers.

    As of yesterday, there were 120 "shopping" days left through March 31, meaning we would need 38,000 signups a day to meet the goal. A pace of 14,500 per day is 38% of the way to that level.

    Basically, the signup pace has risen 12-fold since October. It needs to rise again by 1.5 fold and we'll be on pace to hit the signup target.

    It would also be good to know more about the composition of the enrollees — are they older and in worse health than insurers were expecting? — but this is a positive sign.

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    Barack Obama

    The Obama administration has spent the last few days touting progress and fixes to, the federal health exchange website that has been plagued by dysfunction for most of the two-plus months it's been online.

    But a significant, lingering problem on the back end of the site is still causing complications for insurance companies. And it could provide a rude awakening next month for consumers who thought they purchased a plan through

    At issue are "834s," the enrollment forms sent to insurance companies after a customer enrolls in a plan. Glitches on the site have led to garbled, incomplete, or missing forms. The Washington Post reported Monday night that the issue has affected about one-third of customers. The White House disputed the number, but did not offer one of their own.

    In fact, the White House has been mostly reluctant to talk about the issue, beyond acknowledging that it's a major problem and pledging to fix the issue. 

    The Centers for Medicare and Medicaid Services holds a conference call with reporters daily to provide operational updates on the website. For the past three days, it has stonewalled reporters asking questions about the back-end enrollment issues. 

    Julie Bataille, a CMS spokeswoman, said Monday that CMS had fixed "one bug" that was responsible for about 80% of the 834 enrollment errors. The bug, she said, prevented a Social Security number from being included in the form.

    But she wouldn't say how many people had been affected, and did not disclose any other "bugs" or errors being worked on. On the conference call, three different reporters asked for hard numbers. Three times, she said she couldn't provide those numbers — even though, as one of the reporters noted, if the administration fixed 80% of the errors with one bug, it should be able to do the remaining math. 

    "That's the information I've got today," she said at the end of the third reporter's question on the back-end enrollment issues.

    Bataille went on to say that customers should check with their insurance companies to confirm that they have enrolled. She also pledged that the administration would make a "concerted effort" to help consumers on the "next steps."

    Wednesday's conference call was more of the same. And late Wednesday evening, the CMS released an unusual joint statement with America’s Health Insurance Plans, an insurance industry trade group, and the Blue Cross Blue Shield Association. The statement promised progress reports to come, but it didn't offer any specifics of the issue. 

    The full statement:

    “Ensuring that all Americans who need coverage are properly enrolled is a top priority for all of us. We are working together closely to resolve back-end issues between health plans and This is a very focused effort that is being driven by a team of experts from CMS, key outside contractors working closely with health plan representatives and overseen by CMS’s general contractor, Optum/QSSI. We will report on our progress.”

    More people signed up through the federal site on Monday and Tuesday than did in the entire month of November. Over the past three days, the site has seen more than 2.7 million visits. The key question is whether this increasing success with the site's front-end will be matched with back-end fixes to ensure that enrollments work correctly.

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    David Kennedy on CNBC

    The fixes completed this past weekend to get the federal Obamacare website running more smoothly for consumers did nothing to address security concerns, a cybersecurity expert who testified before Congress last month told CNBC on Thursday.

    "If you look at the report that was released, they had fixed 400 bugs. None of those were addressed on security," said David Kennedy, a so-called "white hat" hacker who tests online security by breaching websites.

    "There haven't been any [security] fixes yet, he said in a "Squawk Box" interview. "You're trying to rush to keep the website — the front-end that we see everyday — up-and-running. Unfortunately when you do that and you don't do any testing around that, you introduce new exposures."

    House Intelligence Committee Chairman Mike Rogers, R-Mich., echoed those sentiments in a separate appearance on the show. "We know that it's never been end-to-end stress-tested in way that the industry would accept to even put anything online."

    (Read more: Site fixed, Obamacare enrollments spike)

    Shortly after delivering his assessment of vulnerabilities to a House panel on Nov. 19, Kennedy appeared on "Squawk Box," saying security was never built into the website in the first place. It was an assertion disputed at the time by the Department of Health and Human Services, which oversaw the implementation of the

    HHS had said the components used to build the site are compliant with standards set by federal security authorities. It stood by that statement Thursday, saying: "The privacy and security of consumers' personal information are a top priority for us. Security testing happens on an ongoing basis using industry best practices to appropriately safeguard consumers' personal information."

    Kennedy disagreed then and did so again on Thursday, telling CNBC that the so-called back-end of the website is a "train wreck."

    Rogers said needs to be shut down and fixed by "outside, independent groups that do this for a living."

    The federal website has almost 5 million lines of code, he said, claiming that the average corporate e-commerce site would have around 500,000.

    "So now you've got all that added vulnerability that's really never been tested," he claimed.

    He said the worst-case scenario of a breach could be a sophisticated "nation-state hacker" getting behind the government's online firewall. That would increase the likelihood the intruder would get sensitive data from the IRS, Department of Homeland Security or other federal agencies.

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    Gallup is out with a new poll this morning on what respondents would like Congress to do with Obamacare. Despite the horrible launch of the federal exchange website, opinion over what to do with the site has barely budged in two years.

    Take a look:

    Gallup Obamacare

    The percentage of people who want to keep the law or expand is the same as it was in January 2011. Support for repeal has grown slightly since the beginning of October, but is the same as in January 2011 as well.

    The biggest threat to Obamacare the past few months has not been public opinion. It's been the website.

    As long as the website worked, millions of Americans would have the opportunity to browse new insurance plans. Many of those who had their plans cancelled would find cheaper policies. Some would not. But the success or failure of the law would be based on its policy outcomes.

    People are not going to care about a two month delay in the site if they can find less expensive, better health insurance. They also are not going to care about the website's launch if their premiums rise and they lose their doctor. They will care about how Obamacare affects their lives.

    The only serious threat to the law was if the website proved entirely unworkable. This was a legitimate concern inside the White House. Even if they scrapped the website and using paper applications, officials would still have had to use the system to input information. There was no magic cure to the website's ailments.

    Fortunately for the administration, that has proven not to be the case. Consumers seem to be having a much easier time navigating the site and signing up for plans. There are still serious concerns over the back-end errors, but it's unclear how significant those are since the Center for Medicare and Medicaid has been reluctant to comment on those issues.

    None of this is to say that the website's problems have not hurt the president. The public no longer trusts him and his approval rating has plummeted. This makes sense. Obama's "if you like your plan, you can keep it" promise and the website's horrible launch were not failures of Obamacare. They were failures of the president.

    For that reason, Americans have lost faith in the Obama administration. But their opinions on health reform have not changed since the law has not truly been tested yet. 

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    Hillary Rosner, a Colorado-based freelance journalist, tweets about her search for a post-Affordable Care Act health insurance plan:

    Here's the thing. You can have it one way on "rate shock" but you can't have it both ways.

    There are, broadly, two ways that individual market health insurance could work. One is the situation we have now in most states, where it works more or less like homeowners' insurance: The insurer evaluates how many claims you're likely to make and sets your premium at expected claims plus a profit margin. If you have diabetes, you'll pay more, just like you'd pay more for homeowner's insurance if you lived on the beach.

    Rosner is seeing a mild form of that problem. She's pricing out a policy that would start in 2013, meaning it's not subject to ACA rate-setting rules. The insurer thinks her prior Caesarian section makes her likely to make somewhat more claims so it's adding 20% to her premium. Rosner thinks that's "so f---ed up," and a lot of people agree.

    Which brings us to the other way you can price health insurance: mandate that insurers charge the same price to everyone, regardless of health risk. The ACA does this, with the caveat that insurers are allowed a limited degree of age-based premium variation. Under ACA rules, the insurer wouldn't be allowed to raise Rosner's premium over a c-section.

    But because insurers know they'll have to write a lot of policies to sick people at a loss, they're going to raise premiums across the board to make up the difference.

    That's why ACA-compliant health plans are "way too $" in Colorado, as Rosner puts it. The pricing structure doesn't just protect people with modest claim-increasing conditions like a prior c-section, but people with very expensive pre-existing conditions like diabetes or cancer or HIV/AIDS.

    That protection costs money. What Rosner is getting in exchange for a higher premium on an ACA-compliant plan is reassurance that insurance will be available to her, regardless of her future health condition.

    That said, it's likely that Rosner has been personally made worse off by health plan switches induced by the ACA. Even before the ACA, federal law barred insurers from dropping their existing members for developing a new health condition, or raising their premiums as a result of that condition. This is a policy called "guaranteed renewal."

    If Rosner had been able to stay on her old plan, she wouldn't face either a 20% c-section-related premium hike or the need to pay to cross-subsidize people with more costly medical conditions. But that narrow protection for pre-existing conditions, often cited by conservatives as a reason to think the existing individual market is working, hasn't been working very well for very many people.

    First, the value of the protection is limited. You can't change plans or insurers without subjecting yourself to a large premium increase or a coverage exclusion. The insurer can't raise your premium because of your personal health condition, but it can raise premiums based on the average claims filed by all the participants in your plan. To this end, the insurer can close your plan to new participants; over time, the healthier participants will tend to leave, driving up premiums for those who remain. And you're out of luck if you move to another state.

    Second, this protection only works if you maintain continuous coverage in the individual market from the same insurer, and very few people are doing that. Over 80% of people who lack coverage from an employer or the government go uninsured rather than buying coverage through the individual market. Those who do carry individual coverage often do so for only a short time, such as during a gap between jobs that provide coverage.

    Michael Cannon has noted that guaranteed renewal was a common feature of individual health insurance plans even before it was mandated by federal law, and it doesn't raise premiums nearly as much as the ACA's rules do. But that's actually a demonstration of how guaranteed renewal doesn't work: It's not very expensive for health insurers to offer because few insureds actually figure out how to turn it into effective coverage for expensive health conditions they develop.

    This is a key difference in how liberals and conservatives view the health insurance market. Conservatives see a market that is working so long as you're responsible enough to keep yourself covered at all times so guaranteed renewal protects you from pre-existing condition exclusions. Liberals see a market that is stacked against people's efforts to access such protections.

    Given how few people are making the protections of the existing system work, liberals have the better of this argument. They've found a way to make insurance available to the chronically sick that will actually work for most of the public. But they haven't been upfront about the fact that their fix will be paid for with higher premiums for lots of healthy people, including Rosner.

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    Click for sound.


    Economist Paul Krugman gives his take on the health care reform mess, and explains why Obamacare is "past the hump," despite vocal criticism by Republicans. Watch above.

    Produced by Justin Gmoser

    SEE ALSO: Watch The Winklevoss Twins Show How Difficult It Is To Explain What Bitcoin Actually Is

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    Rand Paul Mitch McConnell

    The Republican Party's political attacks on Obamacare have backed them into a corner and the only way out is to abandon their own policy ideas.

    Throughout October and November, Republicans repeatedly hammered the president for his "if you like your plan, you can keep it" promise.

    The attacks were twofold:

    1. Obama lied to the American people when he told them they could keep their plans.
    2. Everyone who likes their current insurance should be able to keep it.

    The first criticism is entirely justified and deserved. The president did lie and he must face the consequences of it. But the second one is a purely political attack that ignores the realities of health care reform.

    There is no possible way to reform the health care system and not disrupt millions of people.

    President Clinton's health reform died in the mid-1990s because he admitted that. Obama learned from that mistake and lied to the public that the Affordable Care Act wouldn't be disruptive. In the president's thinking, this was a necessary falsehood in pursuit of a larger goal.

    The ironic thing is, that for most Americans, Obama's statement holds true. The law doesn't make any major changes to the 160 million people who receive insurance through their employer, for instance. The major reforms take place in the individual market, which is comprised of 15 million Americans.

    That's a significant number of people, but it's only 5% of the country. As major reforms go, Obamacare is not very disruptive.

    On the other side, Republican health reform ideas would turn the market upside down. Eliminating the tax preference for employer-sponsored insurance was a focal point of both former president George W. Bush and presidential nominee John McCain's health reform plans. That would be extremely disruptive to the market.

    It's also a good idea. There's no reason that Americans purchasing coverage through their employers should receive a tax advantage. Eliminating this preferential tax treatment would cause many employers to stop offering coverage and instead raise wages. This would also give workers more flexibility to switch jobs because health insurance would no longer be tied to employment (Obamacare helps with that too).

    The problem is that Republicans have spent two months criticizing Obamacare for forcing insurers to cancel coverage. How can they propose a different health reform idea that would cause insurers to do just that? Republicans have set a standard for reform — that everyone can keep their plan — that they cannot meet.

    Conservative policy wonks worried about this in real time. Attacking Obamacare for disrupting the market was a short-term political winner, but a long-term loser. What happens if Republicans ever want to pass their own reforms? Democrats can hold them to the standard they set this past November. Republicans would have to ditch their ideas.

    According to The Wall Street Journalthat's exactly what is happening:

    [S]ome Republican policy specialists have started to advocate that the GOP instead adopt a more modest approach.

    "There's an acknowledgment that massive overturning of the employer-sponsored system is something people just aren't ready for," said Douglas Holtz-Eakin, a leading Republican economist and chief policy adviser to Mr. McCain's campaign.

    "Republicans will walk into the same buzz saw if they aren't savvier and more thoughtful," said Dean Clancy, vice president for public policy at FreedomWorks, a tea party-aligned activist group that backs conservative candidates. 

    Interest has grown, because Republicans can no longer support any health reform that radically disrupts the market. In trashing Obamacare, they have backed themselves into a corner.

    Americans have always been terrified of any major changes in the health insurance market. That's what prompted Obama to lie in the first place. But Republicans have made it much worse by telling Americans that reform shouldn't disrupt the market at all. Now, they have no choice but to abandon their health policy ideas.

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    There's big news in Washington DC today: Democratic and Republican leaders have agreed on a budget to avert a government shutdown come next year.

    Not only have they agreed on a budget, the deal actually undoes nearly half of the sequestration spending cuts.

    That means there will be less shutdown-related uncertainty and less austerity than we otherwise might have expected.

    And for that we can thank (in part) the disastrous Obamacare launch. Because Obamacare has rolled out terribly, Obama's approval ratings are in the toilet. This is a very welcome turn of events for the Republican party, which just over a month ago was in the toilet itself approval-wise. Republicans now have a good hand to play going into next November, and the only way they could obviously screw it up is by doing something stupid like shutting down the government again.

    So it appears that Republicans are content now to just not rock the boat and get to the next election which they hope will be a big one for them thanks to Obamacare.

    That's great news for the US economy.

    As we wrote yesterday, 2014 could finally be the year for the US economy. The economic data is starting to gather steam, and there's no major event risk to torpedo that. Whatever tail risk there was related to the budget now appears to be gone.

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    doctors with arms crossed

    In November, 258,497 Americans selected health insurance plans through insurance exchanges created by the Affordable Care Act, according to data released this morning by the Department of Health and Human Services. That was up from 106,185 in October.

    "Selected" means that the individual has enrolled in a plan but has not necessarily made the first premium payment necessary to activate the plan. Plans established by the Affordable Care Act are not effective until January 1, 2014, and premiums are not generally due until immediately before the plan start date.

    The Obama Administration has frequently referenced a goal of 7 million signups for such plans by March 31, meaning the administration is only about 4% of the way to its signup goal. Still, the pace of signups may be accelerating based on leaked data for signups in the first two days of December.

    An additional 803,000 Americans have been found to be eligible for Medicaid and the Children's Health Insurance Program, which are government health insurance programs for people with low incomes, since Oct. 1.

    While Americans have until March 31 to enroll in health plans established by the ACA for 2014, they must enroll by December 23 in order to have those plans become effective on January 1, 2014, so for many Americans, a signup deadline is looming.

    In a sign of the improving performance of the federal health care website (which serves 36 states) nearly half of November enrollments in private exchange plans came in those states. In October, over 3/4 of insurance enrollments came in the 14 states and the District of Columbia that operate their own exchange websites, even though those jurisdictions contain only 1/3 of the U.S. population.

    In general, the states with the highest pace of signup operate their own websites. Nationally, less than 0.1% of Americans have enrolled in private insurance established by the ACA. But in Vermont, 0.8% have. That's followed by Connecticut (0.32%) and Kentucky (0.3%). If the national goal of 7 million signups is to be reached, those numbers will have to climb to 2.2% nationally.

    The state with the lowest rate of signup is Oregon, where just 44 individuals have selected an Obamacare plan. Oregon operates a state-based insurance exchange website that is even more troubled than Hawaii, another state that has had trouble with its state-based exchange, has produced only 444 signups.

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    My best guess is that signups for private insurance through the federally-run Affordable Care Act exchanges are rising very sharply: About 69,000 during the week ending Dec. 2, up from only about 2,000 in the program's first week, ending Oct. 7.

    That means the signup pace is nearly doubling, week-to-week.

    aca signups 2

    Unfortunately, I can't be sure, because the Department of Health and Human Services, which runs the federal exchange, is awfully cagey about its data.

    That chart I made is based on this chart from the report on Obamacare enrollments that HHS released this morning:

    Obamacare enrollment chart

    This chart is kind of maddening. For one thing, it shows cumulative signups, which is the wrong number to measure. Of course cumulative signups are going up from week to week; the key question for determining whether the ACA can hit its enrollment targets is how quickly is the number of weekly signups is rising.

    So I asked Aaron Jacobs, the HHS press officer who sent around the report, for the weekly numbers that underlie the chart. He told me he doesn't have them, which is weird; someone had to have those numbers in order to make the chart. So I printed out the report, got out a ruler, and tried to estimate the numbers myself.

    That process produced the chart below:

    aca signups 1

    This shows a worrying trend: a signup pace that improved sharply through week 8, and then plateaued. But wait, look at the chart from HHS. It says it covers the period from Oct. 1 to Nov. 30, which is 61 days. Nine weeks is 63 days. Maybe what's called "Week 9" on that HHS chart is really just the last five days of November?

    It seems like a good guess. But HHS couldn't tell me the answer to that, either. I don't know whether the approximately 40,000 enrollments in "Week 9" came over 5 days or 7.

    But here's one clue: on Dec. 4, Politico reported a leak from "an official familiar with the program" saying that there were 29,000 federal exchange enrollments on Dec. 1 and 2. (It's funny how quickly this information gets out when HHS wants it to.)

    If that leak is right, it's hard to believe there were only 40,000 enrollments in the whole week ending Dec. 2; that would mean there were only 11,000 signups on the last five days of November. It probably means the 40,000 signups figure indeed covers just the last five days of November.

    If we make that assumption, we can on add the leaked figure for the first two days of December and suddenly the chart looks a lot better, as shown at the top, with enrollments nearly doubling from Week 8 to Week 9.

    I think that's what happened. But I'm not sure.

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    About 365,000 people signed up for private health insurance through federal and state exchanges under Obamacare in October and November, according to data released by the Department of Health and Human Services on Wednesday. But the sign-up rate has varied widely from state to state.

    If you live in Vermont, you're seven times more likely than the national average to have signed up for Obamacare by now. If you live in Hawaii, you're only one-fourth as likely as the national average.

    This chart shows which states are doing well, and which ones are doing badly, at signing up for Obamacare:

    Obamacare sign-ups

    The first thing that jumps out is that the nine states with the highest enrollment by share of population all run their own exchanges — which, in general, have been working much better than, the federally-run exchange. The 14 states running their own exchanges are indicated in red on the graph.

    Vermont has, by far, the highest rate of sign ups as a share of its population: 0.8%. It's followed by Connecticut, Kentucky and California. Because of its large population, California accounts for about 30% of total Obamacare sign-ups, at 107,087. New York, another state running its own exchange, has provided more than 45,000 enrollments.

    Nationally, only 0.12% of Americans signed up for private health insurance made available by the Affordable Care Act between Oct. 1 and Nov. 30; that figure must rise to 2.2% for the Obama Administration to reach its goal of 7 million sign-ups by March 31.

    In general, the states with the fewest sign-ups rely on the federally run exchange, the infrastructure of which has been plagued by technical problems. Website performance has improved over time and enrollments have been accelerating. But some state-based exchanges are doing even worse than the federal one.

    Oregon, which runs its own exchange, has enrolled virtually none of its population. In fact, its website is so plagued that it has only enrolled people through a paper application process, according to the Washington Times. HHS reports just 44 enrollments in private insurance through Oregon's exchange as of Nov. 30, though a local press report puts the figure at 217. Either way, the figure is dismal.

    Hawaii and Massachusetts are also poor performers, challenging the stereotype that state-based exchanges outperform the federal exchange.

    Mapped, here's a look at the varied sign-up rate by state:

    Obamacare map

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