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The latest news on Obamacare from Business Insider

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    At 3:08 p.m. this afternoon, the White House tweeted out a photo of President Barack Obama, urging people to sign up for health insurance through the Affordable Care Act, that was kind of begging to be photoshopped:

    It took Sen. Ted Cruz's (R-Texas) digital staff 10 minutes to "fix" that sign:

    Rapid response.

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    Barack Obama

    President Obama's repeated insistence that people could keep their healthcare plans once Obamacare kicked in was named Politifact's "Lie of the Year"— the fourth time in five years the "Lie of the Year" has been about this one health care law.

    There were solid odds that some Obamacare "lie" would be the winner, given that six of the 10 finalists selected by the fact-checking organization (which is part of the Tampa Bay Times) involved the law in one way or another. It was also likely to be this particular "pants on fire"-ranked statement given its significance in the public debate over the past few months. Perhaps if Health and Human Services Secretary Kathleen Sebelius had sworn under oath that Healthcare.gov would work perfectly on October 1, that might usurp the title. But as the supercut compiled by New Yorkmagazine suggests, this was pretty inescapable for Obama.

    Here's how Politifact described the award-winner.

    Boiling down the complicated health care law to a soundbite proved treacherous, even for its promoter-in-chief. Obama and his team made matters worse, suggesting they had been misunderstood all along. The stunning political uproar led to this: a rare presidential apology.

    It also points out that three of the previous four winners since "lie of the year" was inaugurated in 2009 have been about Obamacare. The legislation "has been subject to more erroneous attacks than any other piece of legislation PolitiFact has fact-checked," Angie Drobnic Holan writes for the site.

    In fact, it was only in the wake of last year's presidential election that the winnerwasn't about Obamacare. In 2012, Mitt Romney only won one contest, handed the "lie of the year" designation for his insistence in campaign ads that Jeep was moving production to China. It wasn't and isn't.

    Otherwise, the winners break down like this:

    • In 2009, Sarah Palin won, for her insistence that Obamacare would include "death panels."
    • In 2010, it was Republican consultant Frank Luntz's assertion that Obamacare would lead to a "government take over of health care."
    • In 2011, various Democrats were given the title for saying that Republicans had voted to end Medicare.

    Obama can find some consolation in that history. Palin has been unchastened by the ignominious distinction, continuing even this year to claim that death panels exist. And the right continues to suggest that Obamacare amounts to a government takeover. It would be hard for Obama to backtrack at this point, but given that he's termed out anyway, he should feel perfectly free to pick this line back up in 2015 or so. By then, there will have been another two Obamacare-related lies of the year to muddy the waters.

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    us supreme court building

    The Obamacare challenges never stop.

    Two states have brought cases against the federal government that are intended to undermine President Obama's greatest legislative achievement by denying subsidies to their residents.

    You read that correctly. These states want to stop the federal government from giving money to their residents to purchase health insurance.

    Here's what you need to know:

    What are the two cases?

    One case was filed by Oklahoma Attorney General Scott Pruitt against the Obama Administration earlier this year. Indiana Attorney General Greg Zoeller filed the other in early October. In August, U.S. District Court Judge Ronald A. White allowed Pruitt's case to proceed, rejecting the government's motion to dismiss.

    Businesses and individuals in Virginia and D.C. have filed cases as well. U.S. District Judge Paul Friedman also shot down the Justice Department's attempt to have the D.C. case dismissed in October.

    So there are a bunch of cases. What is Oklahoma and Indiana's argument?

    Everyone involved in these lawsuits is making the same case: that the federal government cannot give subsidies to individuals enrolling in Obamacare through the federal exchange. The idea comes from Case Western University law professor Jonathan Adler and the Cato Institute's Michael Cannon. They scoured the law's text and discovered that the the federal government must offer subsidies to qualifying Americans who purchase insurance “through an Exchange established by the State." Adler and Cannon argue that that means the government cannot give subsidies to residents of any state that has not set up its own exchange.

    The Obama administration expected most states to set up their own exchanges, but they were wrong. Thirty six states, including Oklahoma and Indiana, chose not to do so. Only 14 states and the District of Columbia set up their own exchanges. Adler and Cannon argue that the law clearly states that the government can give subsidies to residents using a state exchange, not the federal one. They say that Congress wrote the law so that the subsidies were an incentive for states to build their own exchanges.

    Obamacare also contains individual and employer health insurance mandates that are tied to the exchange subsidies. The individual mandate penalty only applies to people who decline to buy insurance that is affordable; removing the subsidies will make insurance unaffordable for many people, as defined by the law, thus exempting them from the penalty if they don't buy insurance.

    Some employer penalties for failing to cover full-time workers are linked to those workers' use of exchange subsidies; eliminating the subsidies in states using federal exchanges will save some employers from penalties. Adler and Cannon argue that this gives employers standing to sue to prevent provision of subsidies in federal-exchange states. Of course, these financial savings to individuals and businesses are dwarfed by the loss of the subsidies themselves.

    That seems pretty straightforward - it says it directly in the law's text after all. So what's the federal government's rebuttal?

    The Obama Administration says that the intent of the law was clearly to allow the government to give subsidies to all states, not just those that set up their own exchange. They say it was an oversight in the legislation and that there is no evidence that Congress intended to use the subsidies as an incentive to persuade states to set up their own exchanges. Government lawyers also point to a couple of different areas in the law that would prove unnecessary if Adler and Cannon's argument were correct.

    Okay that's not so clear-cut. What would happen if Oklahoma and Indiana win their cases?

    It would be a deadly blow to Obamacare. Without the subsidies, millions of Americans would be unable to afford coverage. States who set up their own exchanges would be unaffected but the 36 states that are using the federal exchange would have trouble signing up many of their uninsured.

    Who is likely to win?

    It's unclear. No judge has ruled on the merits on the case yet, but it's likely that the lawsuits will head to an appeals court after that happens. In D.C., that would mean the D.C. Circuit Court which Democrats are in the process of filling with like-minded judges. That could give the administration an advantage there. It could potentially head to the Supreme Court after that.

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    Doctors

    Philip Klein writes that Obamacare will get blamed for all sorts of problems in the American health care system, even problems that would have existed with or without the law:

    Given that the law was sold as a way to fix a broken health care system, rightly or wrongly, the law is going to be blamed for any persistent problems. It’s impossible for Americans to sort out whether a given change took place as a result of the law or whether it would have happened anyway. If they don’t like a change to their health care situation that occurred after a giant new law went into effect, they’re going to blame that giant new law.

    If I were a vulnerable Democrat incumbent in 2014, I wouldn’t want to pin my re-election hopes on being able to convince angry voters that changes that they hate would have happened with or without the health care law. “Correlation doesn’t equal causation” is not exactly a winning campaign slogan.

    Klein is right. And his analysis explains why Republicans have had the same health policy strategy for 20 years: Nominally favoring big fixes to our health care system but not enacting them.

    Many Republicans say they favor converting the tax exclusion for employer-provided health insurance into a tax credit. This would help some people with moderate incomes afford to buy health insurance. It would also increase the cost of health care for many people, particularly those with high incomes or high-cost health plans. That would upset a lot of people.

    Many Republicans say they want to equalize the tax treatment of employer-provided health insurance and individually-purchased health insurance. This would lead some employers to drop coverage, which would upset a lot of people.

    Many Republicans say they favor allowing health insurance plans to be sold across state lines. That would lead health insurers to exit many states' insurance markets, clustering in those states that have insurer-favorable regulations, much in the way credit card issuance is now concentrated in South Dakota, Nevada and Delaware. That would lead to the cancellation of a lot of existing health insurance plans in the individual market, which would upset a lot of people.

    Those problems would cluster on top of problems that arise all the time in health insurance markets, absent any public policy change: Rising prices, doctors changing what insurances they accept, employers changing their benefit offerings, whatever. Conservative health reformers would take the blame for all the problems their reforms created, and many problems they didn't, just as has happened to liberals with Obamacare.

    So it's no surprise Republicans haven't enacted any of the big reforms they like to talk about. The only reforms they've been able to implement are ones that hand out new benefits without creating any losers: A new prescription drug benefit in Medicare and expanded tax advantages for health spending, such as Health Savings Accounts.

    These policies haven't addressed the problems of high costs or of lack of insurance for many people under age 65. But they also haven't exposed Republicans to attack for causing people's health plans to change.

    Liberals chose to reform health policy despite the political risks, because their political coalition includes the people who are most extensively screwed by the health policy status quo. Conservatives have decided that cynicism is a better political strategy, for the reasons Klein inadvertently lays out. They're probably right on the politics, but that's nothing to be proud of.

    SEE ALSO: The American Health Care System Sucks

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    Microsoft Office President Kurt DelBene

    The Obama administration is set to announce that Microsoft executive Kurt DelBene will be brought on to succeed White House official Jeff Zients in leading the overhaul of HealthCare.gov, Secretary of Health and Human Services Kathleen Sebelius announced Tuesday.

    "Kurt has proven expertise in heading large, complex technology teams and in product development. He will be a tremendous asset in our work," Sebelius said in a blog post.

    "Kurt will work closely with me, the White House, and the teams and senior leadership in place at HHS and CMS to see this project through its next important phase as the CMS team continues to build on their initial progress."

    Sebelius said that DelBene has agreed to serve in his role for at least the first half of 2014.

    DelBene is the husband of Rep. Susan DelBene, a Democratic congresswoman from Washington.

    Zients had been enlisted to lead the "tech surge" of HealthCare.gov, the federal website where people can sign up for health insurance under the Affordable Care Act.

    DelBene announced his retirement from Microsoft earlier this year amid the company's big reorganization. He was president of the Microsoft Office division of the company. He has been with Microsoft since 1992.

    Late last month, a group of Democratic senators led by Sen. Jeanne Shaheen (D-N.H.) wrote a letter to President Barack Obama urging him to quickly find a replacement for Zients, who is set to become the director of the National Economic Council. 

    The others who signed onto the letter were Sens. Richard Blumenthal (D-Conn.), Mark Warner (D-Va.), Christopher A. Coons (D-Del.), Mary Landrieu (D-La.), Mark Udall(D-Colo.) and Tim Kaine (D-Va.).

    "A project of this size and scope demands the sustained leadership and day-to-day management of a chief executive officer – someone whose sole responsibility would be an unrelenting focus on HealthCare.gov and who has experience overseeing large and complex consumer-facing technology projects," the senators wrote.

    "Sustaining the steady management focus that this position has already brought to the project would go a long way toward earning back the trust jeopardized by last month’s deeply flawed rollout."

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    Before Obamacare rolled out on Oct. 1, the Koch brothers-backed activist group Generation Opportunity campaigned to get uninsured young people to opt-out of the Affordable Care Act, and instead pay a fine to procure healthcare elsewhere.

    The face of the group? A guy in a disturbing Uncle Sam mask moonlighting as a perverted proctologist and gynecologist.

    The weird ads came with the slogan "Don't let government play doctor." 

    The Creepy Uncle Sam ads got millions of views on YouTube, but plenty of hate as well. Not only did Obamacare advocates attack them for their opt-out message, but many felt the ads were just plain gross.

    This time, the strange opt-out mascot is playing to a smaller crowd on Snapchat, one that is more personal and has already consented to dealing with him.

    If Snapchat users send a snap to creepyuncle.sam, they'll start getting around two snaps a day. Here's one, using a post we published from the Christian Science Monitor:

    creepy snap BI

    Business Insider spoke with Generation Opportunity's director of communications David Pasch and spokesperson Corie Whalen about the Snapchat campaign, which takes advantage of Obamacare's disastrous launch.

    "We're experimenting with Snapchat, and have been pleasantly surprised," Whalen said.

    The project began last Monday and will last for as long as people are engaged.

    The group currently has more than 500 Snapchat followers.

    This one, sent on Dec. 10 at 4 p.m., had one of the biggest responses:

    creepy snap eye c u

    This was the other most popular one, sent out Dec. 12 around 11 p.m.:

    creepy snap error

    The whole campaign has cost Generation Opportunity "well under $1,000." Several people have access to the creepyuncle.sam account and send out pictures to followers on a whim.

    The majority are sent out to every follower, but the account will send a personal snap if the situation calls for it. For example, a follower asked for one of the campaign's "optout kits," and creepyuncle.sam replied with this (we censored the user's Snapchat name):

    creepy snap nick2

    And sometimes Generation Opportunity just uses the account to make fun of the Obama administration, like this snap it sent mocking President Barack Obama's selfie at Nelson Mandela's memorial:

    creepy snap selfie

    Generation Opportunity's team is based in Virginia and targets college campuses. Its staff is almost entirely under the age of 30.

    After Creepy Uncle Sam's polarizing ads from September, the mascot went on a college circuit, and was requested at tailgates and events at schools like Notre Dame, the University of Wisconsin—Madison, and the University of Miami. Those schools have some of Generation Opportunity's biggest fanbases, according to Pasch.

    The Snapchat campaign is meant for these kinds of Generation Opportunity fans, with the intention of inspiring them to promote the opt-out movement.

    "We want to be on the forefront of new opportunities for activism, like Snapchat," Whalen said.

    Pasch said the group will "definitely" continue the opt-out campaign, either through snaps, videos, or another channel.

    Here's one of the especially creepy ads from September, called "The Glove": 

    SEE ALSO: Obama's Current Approval Rating Is The Ugliest Since Nixon

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    Earlier today @barackobama Tweeted this:

    Screen Shot 2013 12 17 at 9.33.05 PM

    There's something a little bit annoying about these calls to talk about Obamacare over Christmas, though on the other hand...

    -- Getting healthcare coverage is an important topic for a lot of people

    -- Political and economic issues are more fun to talk about at holidaytime than most other topics that people chit-chat about.

    But this is not what conservatives are reacting to.

    They're flipping out that the face of un-covered America is not manly looking enough.

    Here are a couple of representative tweets, but really there are a lot more.

    Screen Shot 2013 12 17 at 9.37.13 PM

    Screen Shot 2013 12 17 at 9.37.56 PM

    This is a good reminder that sex and testosterone are ever-present forces in politics, even in areas where you think they wouldn't be, like a tweet about signing up for health insurance.

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    Greg Sargent had a great post yesterday on how public opinion on Obamacare has changed very little over the years.

    The Washington Post-ABC News poll yesterday morning saw support for the law bounce back after falling to record lows in November. If you go through the Post's historical poll numbers for Obamacare, you can see how steady public opinion has been. 

    Here's a look at the figures in graph form:

    WaPo Obamacare

    This is only one of 19 polls over the course of four years though. Aggregating polls from a number of different sources would be even more accurate. But if the Post polls are any clue, public opinion on Obamacare is deeply entrenched.

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    young people startup happy gen y employees office

    Last Wednesday, the Department of Health and Human Services (HHS) released November enrollment numbers for the federal and state exchanges.

    Immediately, the internet lit up with pundits analyzing the total number of enrollments. The 365,000 people who enrolled in October and November was below the administration's goal of 1.2 million, but the pace of sign-ups is growing quickly.

    While this data is certainly entertaining to analyze, it doesn't really matter very much — at least for the sustainability of the insurance market — whether the government is on pace to reach 7 million signups by March 31.

    It matters a little whether the enrollees are older than expected, but not as much as people tend to think.

    First, the CBO, not the administration, predicted that seven million people would enroll in exchange-based private insurance before the end of March. This was never a White House goal.

    In fact, the CBO projects that 24 million Americans will sign up on the exchanges by 2017. That means less than one third of the total enrollees are expected to happen in the first period. If only, say, five million people enroll right now, more could do so in 2014 and 2015. Multiple enrollment periods must pass before we can tell whether people are signing up as the CBO projected. If fewer than (or, in the unlikely scenario, more than) seven million Americans enroll by the end of March, that is not particularly worrisome.

    "If there are fewer people overall signed up, that may be a problem of political optics, but not one that really gets to the heart of whether the law is working well or not," said Larry Levitt, vice president at the Kaiser Family Foundation.

    Second, a lot of people are focused on the signups because of concern that low participation could undermine the exchange insurance markets. If participation is not what insurers expect, they might raise prices in future years. But to prevent "death spiral," where people leave insurance markets because of spiking prices, the key issue isn't whether enough people sign up. It's whether those who do sign up are younger and healthier (or older and sicker) than expected, and we don't yet know where we are on that.

    The Obama administration's goal is for 39% of exchange enrollees to be between the ages of 18 and 35. HHS has not released the demographics for signups in the federal exchange, but some states have released their own figures. In Kentucky and Connecticut, about 19% of enrollees are young. In Maryland, about 27% are. In California, it's 21%.

    These numbers are below the target, but they're not unexpected. The people who need coverage the most — older, sicker Americans  will sign up first. The website's catastrophic launch only exacerbated this trend as young people have little incentive to repeatedly try to sign up. They will wait until the website functions correctly. 

    "In many ways, I’ve been pleasantly surprised at how many young people have enrolled early on," Levitt said. "They’re actually higher than I would’ve expected."

    Third, the demographic data on the national level doesn't matter, because each state has its own risk pool. Every individual state will need to attract enough young, healthy people to enroll. National age demographics will give us a general understanding of young enrollment figures, but state-level data is necessary to determine the viability of each exchange.

    Fourth, even if some states have risk pools that skew older and sicker, that does not mean that a death spiral will take place. In particular, a 'risk corridor' program exists to mitigate the risk to insurers of receiving costly patients. Risk corridors stabilize premiums by covering insurers' excess costs if they miscalculate the actuarial value of their plans. Effectively, the government provides reinsurance to the insurers, taking on much of their risk of loss.

    On the other hand, if costs are lower than expected (perhaps because of an especially healthy signup pool), insurers will pass on some of those savings on to the government. In addition, insurers will not want to raise premiums after the first year and guarantee they won't receive young, healthy people in future years.age based rating

    A new analysis from Kaiser yesterday drives home this point. They find that if young adults only make up 33% of enrollees instead of 39%, then the costs to insurers wil be 1.1 percent greater than expected. If it is 25%, costs are only 2.4 percent above premium revenues.

    This is because the law limits, but does not eliminate, age-based rating. Insurers can charge older adults only three times as much as young ones. As the graph to the right shows, this forces younger Americans to pay more than they would otherwise, but the 3:1 limit does not drastically alter the relative premiums. Older Americans are still paying substantially more than younger ones, limiting the consequences if fewer than expected young people enroll.

    For these reasons, the enrollment totals aren't nearly as important as the media makes them out to be. The December figures will be more informative than the October and November data, but they still will only be a piece in a much larger puzzle that will take years to complete.

    "I know people are impatient," Levitt said. "but it’s important to wait a little bit and let things shake out." 

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    Aetna

    Last week, the Department of Health and Human Services (HHS) revealed that it is "encouraging" insurers to allow people to sign up for health insurance after the December 23rd deadline and into January for coverage that begins on January 1st.

    This would give Americans who had their insurance cancelled extra time to purchase a plan without facing any gap in coverage. These Americans have been hurt the most by the website's failures. They received cancellation notices in the past few months thanks to Obamacare. In return, they should have been able to purchase a new plan on the federal marketplace, but the website's catastrophic launch has prevented them from doing so, leaving them with no coverage.

    But allowing people to retroactively sign up for insurance is a risky move for insurers. A person could forego insurance until they become sick and then purchase coverage. Since insurers can no longer charge unhealthy people more than healthy ones, any people that enroll only once they become sick will increase insurers' costs. It's the same as a person purchasing homeowners insurance immediately after their house burns down. 

    However, the administration is not asking insurers to do this open-endedly, only through January so that people have additional time to enroll in a plan. This is also not something that insurers would widely publicize.

    According to Reuters, insurers are meeting HHS half-way. The largest health insurance company in Kansas, BCBS, is giving enrollees until January 10th to purchase coverage that will retroactively begin January 1st. 

    One of the biggest insurers in the country, Aetna, is also taking up the administration's advice as well:

    Aetna Inc, one of the biggest players on the exchange, is going to extend the payment date until January 8, make service workflow changes to support the deadline shift to December 23 from December 15 and already planned to ensure customers will not miss important appointments, such as cancer treatments

    This is an important development. If insurers allow people to purchase coverage that retroactively applies to January 1st, it will help mitigate the greatest consequence of the website's terrible launch: that people who had their insurance cancelled will be unable to enroll in a new plan. 

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    Kathleen SebeliusObama administration offers stopgap health insurance option for people with cancelled plans

    WASHINGTON (AP) — The Obama administration is trying avoid making more bad news over the rollout of the president's health care law.

    Trying to head off a break in coverage for people whose individual plans have been canceled, Health and Human Services Secretary Kathleen Sebelius is opening up a special coverage option created under the law for young adults.

    In a letter to senators released Thursday night, Sebelius says people whose plans have been canceled will, regardless of their age, be able to buy a bare-bones catastrophic plan intended mainly for people under 30.

    The insurance industry immediately criticized the special exemption, saying it could create market instability and confuse consumers.

    Copyright (2013) Associated Press. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.

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    hospital cat scan surgery doctorsGovt offering stopgap measures for those having trouble replacing canceled insurance policies

    WASHINGTON (AP) — People whose existing health care insurance has been canceled because of the Affordable Care Act will not be hit with tax penalties for failing to line up new coverage as required under the law.

    Health and Human Services Secretary Kathleen Sebelius says she will use authorities in the law to issue a "temporary hardship exemption" from those penalties.

    Under another stopgap option Sebelius announced Thursday, those whose plans were canceled will be able to buy a bare-bones catastrophic plan regardless of their age. Such plans had been intended for those under 30.

    A dedicated hotline for people who got cancellations, 1-866-837-0677, is being set up by the Health and Human Services Department as part of the effort to head off more bad news coming from the chaotic rollout of President Barack Obama's health care law.

    Democrats praised the steps as a common-sense backup in a difficult situation while Republicans panned the administration action as another patch to an unworkable law. The insurance industry immediately criticized the moves.

    "This latest rule change could cause significant instability in the marketplace and lead to further confusion and disruption for consumers," said Robert Zirkelbach, spokesman for America's Health Insurance Plans. Only Wednesday, the industry had announced its own accommodation — giving consumers an extra 10 days to pay January's premiums.

    The Oct. 1 launch of the HealthCare.gov website became an embarrassment for the administration after problems with the online gateway to coverage froze out millions of potential customers. But the biggest political damage to the president has come from cancellations issued to at least 4 million people who had individual plans they purchased themselves. Those plans did not pass muster under the health care law, which generally requires more robust benefits.

    On Thursday, the administration estimated at less than 500,000 those who have not yet found other coverage in the wake of seeing their coverage canceled.

    Obama was roundly criticized for reneging on a longstanding promise that if you liked your plan, you would be able to keep it under his health care law. The president apologized, and then said insurers could extend those plans for one more year. Most state regulators followed Obama's lead and gave insurance companies the additional latitude, but it's unclear whether the problem has been fully resolved.

    Although the website is now working more smoothly, there's still a concern that technology problems may prevent some people who got cancellations from signing up for a new plan. Consumers have until Dec. 23 — Monday — to pick a plan if they want their coverage to take effect Jan. 1, thus avoiding a break in coverage. The industry says it will accept payment of the first month's premiums until Jan. 10. Timely payment is required for the new plan to take effect.

    "There still may be a small number of consumers who are not able to renew their existing plans and are having difficulty finding an acceptable replacement," Sebelius wrote Sen. Mark Warner, D-Va., and several of his colleagues, adding: "These consumers should qualify for this temporary hardship exemption."

    Insurers are concerned that healthy customers who potentially would have bought full coverage may now stay out of the market, leaving the companies with a group of patients in worse health overall.

    Join the conversation about this story »


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    Kathleen Sebelius

    Last night, the Department of Health and Human Services (HHS) announced that it was delaying the individual mandate for those whose health insurance policies were cancelled and allow them to purchase catastrophic coverage on the exchange.

    This is yet another example where the White House is too worried about the politics of the law rather than the substance of implementation.

    The Affordable Care Act allows HHS to grant a 'hardship waiver' to anyone who experiences "an unexpected natural or human-caused event" that causes an increase in their expenses and makes it difficult to purchase insurance. This waiver exempts them from the individual mandate for a year and allows them to purchase catastrophic coverage, something previously only available to people under the age of 30. Last night, HHS said that having your plan cancelled qualifies for a 'hardship waiver.'

    On policy grounds, this accomplishes nothing. The problem for those whose insurance was cancelled is not that they are unfairly forced to buy a new plan by the March 31st deadline. On the contrary, these are people who already bought health insurance on their own before the mandate even existed. The mandate is not what concerns these Americans.

    The true problem facing people whose plan was cancelled is that they might face an unexpected gap in coverage if they have trouble enrolling in the federal marketplace. The White House estimates that there will be 500,000 such people come January 1.

    But granting hardship waivers to everyone whose plan was cancelled does nothing to fix that problem. It doesn't make it any easier for them to purchase a new plan.

    In fact, it makes implementation more difficult. Delaying the individual mandate only for those whose insurance was cancelled, but not everyone else is an inconsistent reading of the law. People whose insurance was cancelled face no more of a 'hardship' purchasing coverage than anyone else. The cancellation notices some Americans received did not make it any more difficult for them to buy a new plan. This will put huge pressure on the administration to delay the individual mandate for everyone.

    The only conceivable policy rationale for this change is to offer relief to those people whose insurance was unexpectedly cancelled and who would now rather go uninsured than enroll in any of the new plans. This exemption offers them that opportunity for the next year. If that is the rationale, then it makes sense to offer this exemption only to those whose plans were cancelled.

    But when does this end? Those Americans will see their premiums again next year and likely have the same feeling. Will Obama endlessly grant them exemptions? Of course not. If the goal of these waivers was to offer them relief, then it would make sense for the administration to do so forever. Why should a person whose policy was cancelled be exempted this year, but not the next? In that case, the policy rationale for these waivers is not to offer them relief due to their cancelled coverage, but to do so because they dislike their new plans. That returns us to the original inconsistency with this decision. Why should people whose plans were cancelled receive relief because they don't like their new options, but not everyone else?

    It is also a distraction from the fact that enrollment in the law is steadily improving. Earlier yesterday, California announced that it had enrolled more than 50,000 people in three days this week. There was no reason to make this move now as everyone has until March 31 to sign up for insurance before they must pay the penalty. The administration unnecessarily chose to make this announcement right when coverage of the law began to turn positive.

    So why did HHS make this move? Politics, of course.

    Those people whose insurance were cancelled and are having trouble buying a new plan rightfully feel unduly hurt by the law. They had insurance they thought they could keep and now they may face a gap in coverage due to the Affordable Care Act. They are a vocal constituency that is furious with the Democratic Party for lying to them and creating this problem.

    In response to this political pressure, six Democratic senators sent a letter to HHS Secretary Kathleen Sebelius arguing that she should grant hardship waivers for everyone whose plan was cancelled. This increased the pressure on the administration to act, but it did not force their hand.

    If Sebelius had ignored the letter and continued to implement the law, it wouldn't have been a problem. There isn't an imminent rebellion in the Senate that could create a political nightmare and put the law at risk as there was in November when Democrats were panicking over President Obama's "if you like your plan, you can keep it" lie. Then, there was mounting Democratic support for legislation that would have undermined the law. The White House's fix was necessary to calm the fears of congressional Democrats.

    No such fix is necessary now, but the administration created one anyways.

    This perfectly represents everything wrong with how the White House has handled implementation of the law. Whenever a decision needs to be made, the administration is motivated by politics, not policy.

    For instance, it delayed important rules regarding insurance premiums and 'essential health benefits' until after the 2012 election, giving insurers little time to comply — and HHS and its contractors too little time to build a working website.

    It also made a last-minute change with the website that forced people to create an account before they could see their expected premium. HHS didn't want people seeing the costs of insurance before factoring in the subsidies. But this put unnecessary stress on the website and exacerbated its problems.

    In addition, the White House has been frustratingly vague about the true extent of problems with the website during the past few months. It has spent more time trying to spin negative stories instead of giving honest assessments of the exchange. This stoked fears that the site had more problems than people imagined.

    These are all unnecessary political solutions from a White House too concerned with its image and not focused enough on implementing the law. Obamacare's political success depends on its policy merits. Anyone whose plan was cancelled won't remember their anger over these initial speed bumps if they end up finding cheaper, more comprehensive coverage on the exchange. If their new plan is more expensive and restrictive, that will be what makes them angry, not the cancellation notices.

    Which is to say, the same thing that will make other Americans angry at their new options is what will anger those who had their insurance cancelled. 

    Since the administration is not prepared to grant endless exemptions, there is no reason for those who lost their coverage to deserve that relief over anyone else who dislikes their new plan options. Choosing to exempt them, but not everyone else is a political calculation.

    As long as nothing threatens to obstruct the implementation of the law, the White House should not be making any such moves for political purposes.

    In this case, they made one that is not only motivated entirely by politics, but will actively make implementation more difficult. It once again puts the long-term success of the law at risk in return for a short-term political gain. That's a terrible tradeoff to make.

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    Massachusetts state police on Friday seized 1,250 bags of heroin containing bizarre labels like "Obamacare" and "Kurt Cobain."

    The state police confiscated the bags during a traffic stop in Hatfield, Mass., the department said in a statement that was posted to its Facebook page. Four people were taken into custody. 

    "During the stop, evidence of illegal narcotics led to a request for a State Police K9. Trooper David Stucenski and K9 Frankie located 1,250 individual bags of heroin in the vehicle," the statement read.

    Here's a look at the "Obamacare" bags:

    Obamacare heroin

    And "Obamacare" with "Kurt Cobain":

    Obamacare heroin

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    Barack Obama

    President Barack Obama just held his year-end press conference in the White House briefing room.

    Some topics that came up: the Affordable Care Act, its latest delay, and the crucial upcoming sign-up deadline.

    The surveillance debate was, in the wake of a report a White House advisory panel released this week recommending changes to National Security Agency surveillance programs and methods.

    It was also a time for Obama to reflect on his year, which even his closest allies would suggest has been something of a lost one. A new CNN poll has his approval rating at 41% — down 14 points from a year ago.

    Check out our full recap below:

    In his opening statement, Obama said that more than half a million people had enrolled for health insurance in the first three weeks of December. That's up significantly from the first two months of enrollment.

    On the economy, including Friday's stellar GDP report, Obama said that he believes 2014 can be a "breakthrough year for America."

    Question 1: "Has this been the worst year of your presidency?"

    Obama joked that press secretary Jay Carney prepared a list of which reporters had been "naughty and nice." He called on the AP's Julie Pace, who asked him if this was the "worst year of his presidency." He laughed off the question.

    "I think this room has probably recorded 15 near-death experiences," Obama joked.

    Question 2

    The second question, from Reuters, is about the NSA and surveillance. Obama was asked to respond to the advisory panel's recommendations, as well as a federal judge's ruling that one of its programs is likely unconstitutional. And he's asked, directly, if the NSA's gathering of phone metadata has stopped terrorist attacks.

    "I'm going to make a pretty definitive statement in January," Obama said. He defended the NSA, saying that there has been no evidence they have abused their power. 

    "I have confidence in the fact that the NSA is not engaging in domestic surveillance or snooping around," he said.

    Question 3 

    The third question is from Fox News' Ed Henry. Henry hearkened back to assurances Obama gave when the NSA programs were first exposed in June, when he said that the agency had "struck the right balance" between privacy and national security. He questioned Obama's credibility.

    Obama suggested that he was responding to people's concerns — even if they weren't always legitimate. 

    "People right now are concerned that their phone calls are being listened to even though they are not," he said.

    Question 4

    The fourth question came as a reflection on the year and the troubled rollout of the Affordable Care Act. ABC's Jon Karl asked Obama what had been his personal mistake, and he cited the rollout of his signature legislative achievement. 

    "We screwed it up," Obama said.

    But he pivoted to the year ahead, saying again 2014 is a year in which the U.S. is "poised" to break out. "The economy is stronger than it has been in a long time," Obama said.

    Question 5

    The fifth question, from CNN's Brianna Keller, is on the debt ceiling. Obama said that he won't negotiate over Congress paying its bills.

    "To repeat — the debt ceiling is raised to pay bills we have already accrued," he said. "It is not something that is a negotiating tool. ... I've got to assume folks are crazy enough to start that whole thing again."

    Question 6

    CBS' Major Garrett follows up on the "60 Minutes" report last week, in which one NSA official said there should be a conversation over whether to grant Edward Snowden amnesty if the remainder of his stolen documents are secured. Obama did not comment directly, citing an ongoing investigation. 

    "I think there was a way for us to have that conversation without that damage," he said.

    "This has done unnecessary damage to U.S. intelligence capabilities and U.S. diplomacy."

    Question 7

    NBC's Chuck Todd asked about Obamacare, and the latest delay that the Obama administration announced Thursday night. 

    "The basic structure of that law is working, despite all the problems — despite the website problems, the messaging problems, all that," Obama said.

    Question 8

    Obama is asked about the "message" he was trying to send when announcing his delegation to the Sochi Olympics, which includes three out gay members.

    "The delegation speaks for itself," Obama said.

    Question 9

    Obama is asked about Sen. Max Baucus (D-Mont.) and his nomination to become the U.S. ambassador to China. Obama said that he believes Baucus will be an "excellent ambassador" to China.

    Question 10

    The 10th question is about Iran, in light of a newly introduced Senate bill that proposes new sanctions.

    "It is my goal to prevent Iran from obtaining a nuclear weapon. But I sure would like to do it diplomatically," he said, adding that there was "no need" for new sanctions legislation.

    He added: "I don't think the Iranians have any doubt that Congress would be willing to pass more sanctions."

    One more question, on staff shakeups, and that's it. No questions on Syria, South Sudan, former FBI agent Robert Levinson, and more.

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    attached image

    President Barack Obama said in his end-of-year press conference Friday that more than 500,000 people had enrolled in health insurance plans on the federal health care website through the first three weeks of December.

    "For all the challenges we've had ... more than half a million Americans have enrolled in HealthCare.gov through the first three weeks of December alone," Obama said. "Millions of Americans are now poised to be covered by quality, affordable health insurance come New Year's Day."

    A senior administration official confirmed that in total, more than 1 million people in total had signed up for health insurance on both federal and state exchanges. 

    But already, December's enrollment numbers mark a surge in sign-ups. Only about 137,000 people in total had signed up for insurance through HealthCare.gov in October and November combined. 

    The surge is a reflection of trends nationally. In California this month, for example, enrollment has spiked significantly. In the first three days of this week alone, more than 50,000 people signed up on the state's exchange.

    When asked about any regrets he had this year during the end-of-year press conference, Obama cited the initial rollout of the Affordable Care Act. 

    "We screwed it up," he said.

    SEE ALSO: Recap Obama's press conference here

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    Barack Obama

    A new CNN-ORC International poll today finds that just 35% of Americans support the Affordable Care Act with 62% opposing it. This is a nine point swing from CNN's November poll when 40% supported it.

    Forty-two percent say the health law will make them personally worse off while 16% say it will help them. Even greater percentages (63%) say Obamacare will personally increase their medical costs.

    However, not everyone opposed to the law favors the Republicans' "repeal and replace" position. Fifteen percent oppose Obamacare because they would like to replace it with a more liberal alternative. That means that half the country either supports the law or supports a more liberal version of it. Forty three percent believe the law is too liberal.

    These numbers come after a rough couple of months for Obamacare. The launch of healthcare.gov was catastrophic and Obama was forced to backtrack and apologize for his "if you like your plan, you can keep it" broken promise. Just last week, the administration delayed the individual mandate for a year for anyone whose health insurance was cancelled. 

    SEE ALSO: The Partial Individual Mandate Delay Exemplifies Everything Wrong With How The Administration Is Implementing Obamacare

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    Kathleen Sebelius

    A new report from the Washington Post reveals how the main contractor for the federal exchange website, CGI Federal, did not deliver on its promise. The question is what went wrong.

    CGI blames the administration and its management of the process, including delaying a number of important rules for political purposes. Federal officials lay much of the blame at CGI.

    But even there, the blame can be traced back to Centers for Medicare and Medicaid (CMS) officials who selected CGI in the first place.

    CMS accepted bids from a group of firms to build Healthcare.gov. They received bids from IBM, Computer Sciences Corp., Quality Software Services and CGI Federal. The agency was to evaluate each bid on seven specific criteria, including proposed cost, security requirements and past performance.

    It is on this last evaluation metric that CMS officials reportedly failed.

    In 2004, CGI Group, the parent company of CGI Federal, acquired American Management Systems (AMS) for nearly $900 million. AMS, which was eventually renamed CGI Federal, already had a number of federal contracts and thus gave the Montreal-based CGI Group its entrance into the market for government contracts.

    But AMS did not have a great track record with federal work. It had screwed up a number of projects, including a Philadelphia school computer system and Mississippi tax system. In the latter case, AMS had to pay a $474 million for its failure. 

    It also screwed up on a $60 million contract with the Federal Retirement Thrift Investment Board.

    Despite these red flags, CMS selected the firm for the project. In fact, CGI Federal has nearly a billion dollars in federal contracts, good for the 29th largest federal IT contractor. For the website, CGI Federal received almost $100 million.

    While CMS officials should have been more careful in selecting the firm for this project, they were not influenced by politics in the process. Had the Washington Post investigation found otherwise, the Obama administration would be dealing with an entirely different story today.

    CMS's failure to adequately vet CGI Federal speaks to an even larger problem with the federal contracting process. This is something that Obama himself has spoken of since healthcare.gov's launch. 

    "What is true is that, as I said before, our I.T. systems, how we purchase technology in the federal government is cumbersome, complicated and outdated," Obama said in a November interview.

    "It's part of the reason why chronically federal I.T. programs are over budget, behind schedule."

    Going forward, it is unclear how much of the contracting process will change. The federal exchange is just one of many federal contracts have technology companies have botched in recent years. In fact, the New York Times reports that by one study, 40% of federal contracts have failed compared to only 4.6% that have succeeded (more than 50% have proved "challenging").

    After health reform calms down a bit (as it will), the administration should take a long look at procurement process and find ways to improve it, either by executive authority or with the help of Congress. The current system isn't cutting it.

    Correction: AMS was purchased by CGI Group for $900 million (not billion), CGI Federal has nearly a billion (not trillion) dollars in federal contracts and their contract for the federal exchange website was for $100 million (not billion).

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    Obamacare

    Last week, the Obama administration announced that anyone whose health plan was cancelled due to the Affordable Care Act and believe other plans offered are unaffordable will receive a 'hardship waiver.' This waiver exempts them from the individual mandate and allows them to purchase a cheaper catastrophic plan that was previously available only to those under the age of 30.

    But losing your health insurance is not the only experience that qualifies a person for a waiver. In fact, there are 13 other ways that people qualify.

    Here are all 14 straight from the Centers for Medicare and Medicaid:

    1. You were homeless.
    2. You were evicted in the past 6 months or were
      facing eviction or foreclosure.

    3. You received a shut-off notice from a utility company.

    4. You recently experienced domestic violence.

    5. You recently experienced the death of a close family member.

    6. You experienced a fire, flood, or other natural human-caused disaster that caused substantial damage to your property.

    7. You filed for bankruptcy in the last 6 months.

    8. You had medical expenses you couldn’t pay in the last 24 months.

    9. You experienced unexpected increases in necessary expenses due to caring for an ill, disabled, or aging family member.

    10. You expect to claim a child as a tax dependent who’s been denied coverage in Medicaid and the Children’s Health Insurance Program (CHIP), and another person is required by court order to give medical support to the child.

    11. As a result of an eligibility appeals decision, you’re eligible either for: 1) enrollment in a qualified health plan (QHP) through the Marketplace, 2) lower costs on your monthly premiums, or 3) cost-sharing reductions for a time period when you weren’t enrolled in a QHP through the Marketplace.

    12. You were determined ineligible for Medicaid because your state didn’t expand eligibility for Medicaid under the Affordable Care Act.

    13. You received a notice saying that your current health insurance plan is being cancelled, and you consider the other plans available unaffordable.

    14. You experienced another hardship in obtaining health insurance.

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    healthcare.gov obamacare website

    During the past couple of months, deadlines for the Affordable Care Act have changed frequently due to the horrible launch of the federal exchange website.

    The administration has said for a while that today is the last date for people to sign up for coverage that begins January 1. According to the Washington Post, though, that isn't even true. They've secretly pushed back that date a day to tomorrow. 

    These changes can be very confusing so here's what it all means:

    What was today actually supposed to be the deadline for?

    Normally, to be covered by January 1, you have to purchase coverage by December 15. This gives insurers time to file paperwork and configure their computers for the new enrollees. This was never a hard deadline, but a functional one. Insurers wouldn't be able to process applications after December 15 in time for coverage to begin January 1. 

    But after the website was nearly unusable until the end of November, the administration realized that 15 days was not a long enough time for people to purchase coverage. In response, they persuaded insurers to extend that functional deadline until December 23. They also convinced them to accept payments for coverage starting in January all the way up until January 10.

    So, the originally deadline to sign up for coverage was today. What did the administration secretly change?

    According to the Post, the Obama administration made a change to the computer system that gives people an extra day to enroll in a plan. That means you have until 11:59 p.m. tomorrow night to sign up for coverage that starts January 1. According to the Post, the White House wanted to an extra day of time in case demand overwhelms the site today as Americans sign up at the last minute. 

    OK, so tomorrow is my absolute last day to purchase health insurance that begins January 1?

    Actually, that isn't even totally true. In a few circumstance, you may even be able to sign up for a plan after tomorrow and still have coverage starting in January. The Department of Health and Humans Services (HHS) has been "encouraging" insurers to allow people to sign up for a plan after today and even into January with coverage that starts Jan. 1, 2014. Some insurers are listening to HHS and will allow enrollees to have coverage retroactive to January 1.

    But many insurers are not doing so. For those that aren't, tomorrow is the final day for people to sign up for coverage that begins in January. You don't have to pay your first premium yet - you still have until January 10 for that - but you must at least enroll in the plan.

    What about the individual mandate and the penalty? If I don't have coverage in January, will I face a fine?

    No. The penalty for not having coverage doesn't kick in unless you haven't signed up for insurance after March 31. That means you can forego insurance for another couple of months without any consequences.

    How does this all fit in with the individual mandate delay last week? Does that cover me?

    Last week, HHS announced that they would give a hardship waiver to anyone whose insurance was cancelled due to the law. The waiver delays the individual mandate one year for these people and allows them to purchase the cheaper catastrophic plans that were originally only available to people under the age of 30.

    If your plan was not cancelled, then this policy change does not affect you at all. If it was cancelled, then you can go all of 2014 without insurance and won't have to pay the penalty. However, none of this affects tomorrow's deadline.

    SEE ALSO: Insurers Are Helping To Fix One Of The Worst Consequences Of Healthcare.gov's Horrible Launch

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