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The latest news on Obamacare from Business Insider

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    Barack Obama

    President Barack Obama successfully enrolled for health insurance under the Affordable Care Act over the weekend, the White House said Monday. 

    A White House official said that Obama selected a "bronze" plan on the D.C. marketplace. Obama's move, the official added, is a "symbolic" one to show support for the process, since the president's health care is provided by the military.

    "He was pleased to participate in a plan as a show of support for these marketplaces which are providing quality, affordable health care options to more than a million people," the White House official said.

    Earlier on Monday, the White House confirmed that it had pushed back a key deadline for people to sign up for health insurance. Plans can now be selected through Tuesday night at 11:59 p.m. ET — previously, the deadline was Monday night at 11:59 — to be eligible for coverage that begins Jan. 1.

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    Barack ObamaWASHINGTON (Reuters) - The White House is coming under pressure from some of its closest allies on healthcare reform to name a chief executive to run its federal health insurance marketplace and allay the concerns of insurers after the rocky rollout of Obamacare.

    Advocates have been quietly pushing the idea of a CEO who would set marketplace rules, coordinate with insurers and state regulators on the health plans offered for sale, supervise enrollment campaigns and oversee technology, according to several sources familiar with discussions between advocates and the Obama administration.

    Supporters of the idea say it could help regain the trust of insurers and others whose confidence in the healthcare overhaul has been shaken by the technological woes that crippled the federal insurance shopping website and the flurry of sometimes-confusing administration rule changes that followed.

    The advocates include former White House adviser Ezekiel Emanuel, the brother of President Barack Obama's former chief of staff Rahm Emanuel, and the Center for American Progress, the Washington think tank founded by John Podesta, the president's newly appointed senior counselor.

    The White House is not embracing the idea of creating a CEO, administration officials said.

    "This isn't happening. It's not being considered," a senior administration official told Reuters.

    Some healthcare reform allies say the complexity of the federal marketplace requires a CEO-type figure with clear authority and knowledge of how insurance markets work.

    Obama's healthcare overhaul aims to provide health coverage to millions of uninsured or under-insured Americans by offering private insurance at federally subsidized rates through new online health insurance marketplaces in all 50 states and in Washington, D.C.

    Only 14 states opted to create and operate their own exchanges, leaving the Obama administration to operate a federal marketplace for the remaining 36 states that can be accessed through

    The marketplace is now officially the responsibility of the U.S. Centers for Medicare and Medicaid Services (CMS) and its administrator, Marilyn Tavenner. Healthcare experts say there is no specific official dedicated to running the operation.

    A CMS spokesman said exchange functions overlap across different groups within the agency's Center for Consumer Information and Insurance Oversight.

    The lack of a clear decision-making hierarchy was identified as a liability months before the disastrous October 1 launch of by the consulting firm McKinsey & Co.

    Obama adviser Jeffrey Zients, who rescued the website from crippling technical glitches last month, also identified the lack of effective management as a problem.


    Former Microsoft executive Kurt DelBene has replaced Zients as website manager, at least through the first half of 2014.

    "We're fortunate that Kurt DelBene is now part of the administration - there's no one better able to help us keep moving forward to make affordable, quality health insurance available to as many Americans as possible," Obama healthcare adviser Phil Schiliro said in a statement to Reuters.

    The White House appears, for now, to be concentrating on ironing out the remaining glitches in to ensure millions more people are able to sign up for coverage in 2014. Good enrollment numbers are seen by both critics and supporters of Obamacare as a key measure of the program's success.

    "So my sense is that they're not thinking about appointing a CEO in the short term," said Topher Spiro, a healthcare analyst with the Center for American Progress.

    The CEO proposal calls for removing day-to-day control of the marketplace from the CMS bureaucracy and placing it under a leadership structure like those used in some of the more successful state-run marketplaces, including California.

    The new team would be managed by a CEO, or an executive director, who would run the marketplace like a business and answer directly to the White House, sources familiar with the discussions say.

    They point to insurance industry and healthcare veterans as potential candidates, including former Aetna CEO Ronald Williams, former Kaiser Permanente CEO George Halvorson and Jon Kingsdale, who ran the Massachusetts health exchange established under former Governor Mitt Romney's 2006 healthcare reforms. None of the three was available for comment.

    Healthcare experts say the idea should have been taken up by the administration years ago.

    "It's the right thing to do. It's just two years late," said Mike Leavitt, the Republican former Utah governor who oversaw the rollout of the prescription drug program known as Medicare Part D as U.S. health and human services secretary under President George W. Bush.

    "The administration is confronted by a series of problems they cannot solve on their own. They do not possess internally the competencies or the exposure or the information," he told Reuters.

    Emanuel, one of the administration's longest-standing allies on healthcare reform, recommended a marketplace CEO in an October 22 Op-Ed article in the New York Times, calling it one of five things the White House could do to fix Obamacare.

    "The candidate should have management experience, knowledge of how both the government and health insurance industry work, and at least some familiarity with IT (information technology) systems. Obviously this is a tall order, but there are such people. And the administration needs to hire one immediately," he wrote.

    The administration has adopted Emanuel's four other recommendations: better window-shopping features for; a concerted effort to win back public trust; a focus on the customer shopping experience; and a public outreach campaign to engage young adults.

    (Reporting by David Morgan in Washington; Editing by Karey Van Hall, Michele Gershberg, Ross Colvin and Will Dunham)

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    More than 1.1 million people enrolled in a health insurance plan under the Affordable Care Act's federal exchange before a Dec. 24 deadline, the White House said early Sunday.

    Centers for Medicare & Medicaid Services Administrator Marilyn Tavenner said in a blog post that about 975,000 people enrolled in a plan in December alone through, the federal exchange website that was marred by a flawed rollout.

    That number is about more than seven times the combined total of sign-ups in both November and December. It does not include enrollments in 14 other states and the District of Columbia, which are running their own exchanges.

    The state numbers are likely to provide a significant boost for overall enrollment numbers. In the days ahead of the deadline, California — one of the states running its own exchange — said more than 50,000 people had signed up in a three-day period. Still, some states running their own exchanges have struggled.

    The total enrollment numbers are also likely to be far less than the Obama administration's official goal of 3.3 million sign-ups by the December deadline. The administration has also predicted that 7 million people would enroll by March 31, the deadline to enroll in health plans established by the Affordable Care Act.

    The White House did not release a detailed breakdown of the enrollment numbers, which typically have been released in the middle of every month. 

    Tavenner said that on Dec. 23, the improved was able to handle 83,000 concurrent users.

    "We are in the middle of a sustained, six-month open enrollment period that we expect to see enrollment ramp up over time, much like other historic implementation efforts we’ve seen in Massachusetts and Medicare Part D," she said.

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    Barack Obama

    More than 2 million people have enrolled in a private health insurance plan under the Affordable Care Act through December, the Department of Health and Human Services said Tuesday. 

    That's far short of the 3.3 million the Obama administration had hoped would sign up by the end of 2013, but it represents a big pickup from initial enrollment numbers stuck in the gutter because of a faulty federal website rollout. The approximate 2.1 million figure comes from both state and federal exchanges.

    Coverage starts kicking in on Wednesday for people who signed up by a Dec. 24 deadline and have paid their first premium. But Secretary of Health and Human Services Kathleen Sebelius could not say how many of the 2.1 million have paid that premium to ensure coverage begins on Wednesday.

    "Tomorrow is New Year's Day and is a new day in health care for millions of Americans," Sebelius said in a conference call with reporters on Tuesday. 

    Almost 1 million of the enrollees in private exchanges came in December. Overall, Marilyn Tavenner, the administrator of the Centers for Medicare and Medicaid Services, said that December enrollment was more than six times that of October and November combined. Only 106,000 signed up in October, the first month people could sign up. 

    "For many of the newly insured," Sebelius said, "it will be the first time that they can enjoy the security that comes with health coverage."

    The administration has hoped that 7 million people would enroll in a plan by March 31, the deadline to enroll in health plans established by the Affordable Care Act.

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    wal-mart walmart

    (Reuters) - Wal-Mart Stores Inc said on Tuesday it will provide a month's supply of certain prescriptions at no upfront cost to participants of U.S. President Barack Obama's signature healthcare law who have not yet received a plan identification number.

    The move by Wal-Mart, the world's largest retailer, comes a day after Walgreen Co instituted a similar practice.

    The U.S. government has struggled to roll out the Affordable Care Act, also known as Obamacare. A plethora of enrollment problems have affected the site's website,, since its October launch. Many insurance companies have said they are not getting accurate enrollee information required to process forms.

    Wal-Mart said it will fill up to a 30-day supply of prescriptions through the end of January for customers who have enrolled in Obamacare, but do not have an ID yet from an insurer.

    It was not immediately clear if Wal-Mart would seek reimbursement once customers obtain their Obamacare IDs, though Walgreen said it would do so.

    A Wal-Mart representative was not immediately available to comment.

    (Reporting by Ernest Scheyder; Editing by Bill Trott)

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    Late on New Year's Eve, Justice Sonia Sotomayor granted a small number of religiously affiliated groups a temporary injunction from a provision in the Affordable Care Act that allows them notto cover contraception in their health care plans if they fill out a form that states that they want an exemption from the law for religious reasons.

    Go ahead and read that sentence again. These Catholic non-profits that wanted an exemption from covering their employees' contraception needs—and got an exemption from covering their employees' contraception needs—are now fighting the provision (that exempts them from covering their employees' contraception needs) simply because they don't want to have to fill out a form that states that they are exempt.

    Why? Because their employees need that form in order to get birth control directly from their insurers (which they need to do because their employers—these Catholic non-profits—are exempt, as they want to be). 

    That's right: These groups are arguing that filling out a form is a violation of their religious freedom, and that "religious freedom" means that you should have control over your employee's health care decisions even when they happen outside of the insurance coverage you directly provide for them. Even the lawyer for one of the groups, the Little Sisters of the Poor Home for the Aged, admits that this lawsuit is about trying to weasel out of nothing more onerous than signing a piece of paper.

    "Without an emergency injunction," Mark Rienzi told the AP, "Mother Provincial Loraine Marie Maguire has to decide between two courses of action: (a) sign and submit a self-certification form, thereby violating her religious beliefs; or (b) refuse to sign the form and pay ruinous fines."

    And a spokeswoman for the Becket Fund for Religious Liberty, lead counsel for the Little Sisters, said, "The government has lots of ways to deliver contraceptives to people. It doesn't need to force the nuns to participate." The problem is that the government agrees and has set up a system so that the nuns can opt out. The nuns refuse to opt out, however, because opting out on paper will allow their employees to get that contraception coverage.

    It's important not to read too much in Justice Sotomayor's willingness to grant these groups a temporary injunction from signing a piece of paper. The injunction is only to allow the status quo to continue until the case gets heard in court. That won't be great for the employees of these groups, who will have to continue without employer-provided contraception coverage and will also be unable to get coverage directly from their insurance companies, but it doesn't necessarily mean that the court is siding with the Sisters on this one.

    Amanda Marcotte is a Brooklyn-based writer and DoubleX contributor. She also writes regularly for the Daily Beast, Alternet, and USA Today. Follow her on Twitter.

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    Flu Shot Vaccine Doctor Influenza

    If you're one of the 10.9 million Americans currently unemployed, you're faced with sorting out all the different health insurance options and taking on a much higher monthly cost just at the time you're most strapped for cash.

    Although many may consider forgoing health insurance altogether while they try to get back on their feet, it's a mistake, says Sally Poblete, the founder and CEO of Wellthie, a website that aims to help consumers and businesses better understand their health insurance options. She believes it's especially important to protect yourself against surprise medical bills when money is tight, since health-care costs have contributed to 62% of individual bankruptcy filings.

    "You may not think you’ll be able to afford insurance, but considering the average three-day hospital stay costs about $30,000, how could you not?" says Poblete.

    She provides the following five tips for getting the cheapest health care possible:

    1. Beware of COBRA.

    You may be eligible to keep your old insurance via COBRA, but Poblete warns that "sticking with the familiar can be comforting but costly." The average monthly cost for single coverage in an employer-sponsored plan is $490, whereas the average middle-of-the road plan on the exchange is $336. This online tool, provided by Wellthie and EmblemHealth, can help you figure out how the Affordable Care Act (ACA) applies to you.

    2. Scope out Obamacare for deep discounts.

    Poblete notes that 17 million people are estimated to qualify for tax credits through the ACA. You can get discounts immediately without having to wait until you file your taxes. She suggests using this calculator to check your eligibility.

    3. Hack your prescriptions.

    Rather than pay full price, Poblete suggests using under-the-radar services to get a discount on prescriptions. For example, prescription assistance programs help patients obtain free or low-cost medications. You can also search for coupons on website GoodRX that can cut the price of prescriptions in half.

    4. Take advantage of all special circumstances.

    Don't shy away from special programs, advises Poblete. If you need to cover your children, for example, they may qualify for the Children's Health Insurance Program (CHIP), a low-cost health coverage that also covers pregnant women and parents in some states. Additionally, if you're under 30 and relatively healthy, she says choosing a catastrophic insurance plan could save you money, since these plans typically have lower premiums and kick in only if you need a lot of care.

    5. Try your local health center.

    Health centers are a lower-cost option that cover a range of services, including checkups, immunizations, and mental health treatment, says Poblete. There are about 1,200 health centers that operate nearly 9,000 sites in the U.S., and you can look for one in your area here.

    SEE ALSO: How To Get Out From Under $100,000 In Debt

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    Ron Johnson

    Rep. Jim Sensenbrenner (R-Wis.) tore into fellow Wisconsinite and Sen. Ron Johnson (R-Wis.) for what Sensenbrenner described as a frivolous "political stunt" of a lawsuit designed to block health care subsidies for members of Congress and their staffs. 

    Johnson outlined the goals of his suit in a Wall Street Journal op-ed published Monday. Johnson filed his suit against the Office of Personnel Management, which has interpreted the Affordable Care Act to mean that the federal government may offer tax-free subsidies to help members of Congress and their staff buy exchange health plans.

    Johnson is seeking to block the federal government from helping to pay for coverage, arguing that OPM's interpretation does not fall in line with the text of the Affordable Care Act.

    Sensenbrenner responded in a scathing statement, saying that Johnson's lawsuit would unintentionally lead to an exodus of talent from Capitol Hill staffs: 

    "Senator Johnson’s lawsuit is an unfortunate political stunt. I am committed to repealing Obamacare, but the employer contribution he’s attacking is nothing more than a standard benefit that most private and all federal employees receive — including the President," Sensenbrenner said.

    "Success in the suit will mean that Congress will lose some of its best staff and will be staffed primarily by recent college graduates who are still on their parents’ insurance. This will make it even more difficult to fight the President and his older, more experienced staff."

    At heart is another intra-GOP dispute over health-insurance subsidies for congressional lawmakers and staff under the Affordable Care Act. Several Republican lawmakers have drafted legislative proposals aimed at the same goal as Johnson's, efforts that have been led by Sen. David Vitter (R-La.).

    If Johnson's lawsuit is successful, it would amount to an effective pay cut of thousands of dollars for congressional staff and lawmakers. They would also, effectively, be the only employees in the U.S. who are barred from receiving employer subsidies on health care. It's an issue that has ruffled feathers among staffs on both sides of the aisle.

    “Senator Johnson should spend his time legislating rather than litigating as our country is facing big problems that must be addressed by Congress — not the courts," Sensenbrenner said.

    "All Republicans want to repeal Obamacare, but this politically motivated lawsuit only takes public attention away from how bad all of Obamacare really is and focuses it on a trivial issue. Fortunately, Senator Johnson’s suit is likely frivolous and will not achieve the result he’s seeking."

    Johnson responded to Sensenbrenner with a statement of his own, saying he was "disappointed and puzzled" by Sensenbrenner's reaction. 

    "By no means do I believe this issue is trivial, or my lawsuit to overturn this injustice is frivolous. This is an issue of basic fairness that I believe is worth fighting for," Johnson said.

    SEE ALSO: Boehner Secretly Defended A Special Obamacare 'Exemption' He Has Publicly Derided

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    hospital emergency room sign

    The Murray-Ryan deal includes a change to an obscure Medicaid policy called disproportionate share hospital (DSH) payments that will make it much more difficult for supporters of the Medicaid expansion to convince states to accept it anytime soon.

    Here's how DSH payments work: 

    Every years, hospitals treat uninsured patients who lack the means to pay them back. To offset these costs, Medicaid sends DSH payments to hospitals that face a higher rate of uncompensated care. In 2011, DSH payments were $11.3 billion. This isn't small change.

    The Affordable Care Act gradually phases these payments out so that they are almost gone by 2020. The rationale for this is that most people would have insurance under the new law so almost no one would be unable to pay their hospital bills. This would be particularly true for low-income Americans, most of whom would be covered by the Medicaid expansion.

    That was before the Supreme Court ruling allowed states to opt out of the expansion. Right now, only 25 states and the District of Columbia are expanding Medicaid. Of the 25 that have not yet expanded, 23 have Republican governors (two are in the process of expanding).

    After the ruling, many Obamacare supporters felt confident that red state governors would expand Medicaid, because hospitals would pressure them to do so.

    In states that didn't expand their Medicaid programs, hospitals would still not receive compensation from many low-income, uninsured patients, but now they would also not receive DSH payments to offset those costs. In states that chose to accept the expansion, Medicaid would cover those patients and reimburse the hospital. This gave hospitals a major incentive to lobby state governments to take part in the expansion.

    At least, that was the case before the Murray-Ryan budget, but the deal delays the reduction in DSH payments for two years

    Part of the reason for that is the horrible launch of the federal exchange website and the resulting slower-than-expected rate of enrollments. Fewer enrollments means fewer people covered and higher rates of uncompensated care for hospitals.

    But the main driver is the refusal of many states to expand Medicaid, which leaves a significant number of low-income Americans uninsured and unable to cover their health care costs. The budget deal ensures that hospitals in those states continue to receive compensation for those costs. 

    The political pressure from hospitals was one of the strongest forces pushing states to take part in the expansion. Without it, Republican governors will find it much easier to reject it. This is yet another blow to advocates of the Medicaid expansion and a boon for Republicans who are against it.

    (h/t Adrianne McIntyre)

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    IBM Virginia Rometty

    Yet another state has blamed yet another large IT vendor for the problems with its Affordable Care website.

    This time the state is Minnesota and the company on the hot seat is IBM.

    In mid-December Minnesota Governor Mark Dayton wrote a letter to CEO Ginny Rometty that dressed down IBM for a laundry list of big problems with the state's website, MNsure. The governor's office released the letter last week. (Posted in full below.)

    Dayton told IBM:

    Your product has not delivered promised functionality and has seriously hindered Minnesotans' abilities to purchase health insurance or apply for public health care programs through MNsure.... your product has significant defects, which have seriously harmed Minnesota consumers.

    IBM's software is used by the website to determine eligibility. He says it caused the Minnesota site to experience these problems:

    • It allowed people to submit multiple applications without keeping track. This "forced MNsure staff to spend thousands of hours" trying to clean up the data, he says.
    • It didn't do a reliable job of verifying eligibility in accordance with Federal law, he says, and left some applications floating in "pending status" where the state couldn't move the application forward and let people buy insurance.
    • Plus, he says, thousands of applications got "stuck in a queue" unable to be processed at all, he wrote. MNsure staff apparently didn't even know these stuck applications existed.

    All told, the letter blamed IBM for 21 problems.

    IBM’s Curam subsidiary wasn't the main contractor, but one several subcontractors working on the $46 million project. IBM says the main contractor, a company called Maximus, had "overall responsibility" for the site, including testing that it worked properly.

    After getting the letter, IBM swiftly sent dozens of workers to St. Paul and agreed to give the state 4,000 man-hours at no charge, reports the StarTribune's Jackie Crosby.

    Things are working better, though not perfectly, now, IBM says.

    On Friday, MNsure said 67,805 people had enrolled, including 14,600 who signed up in the last four days of December.

    To be sure, IBM isn't the only big vendor to be blamed for problems with a state health insurance exchange.

    In November, Oregon Senator Jeff Merkley blasted Oracle on television for problems with Oregon's website. Last month, Oregon Governor John Kitzhaber even said it would delay making a $20 million payment to Oracle until the site was fixed. Oracle had no comment.

    The truth is, that that these health care exchanges are like a perfect storm. Some 40% of large scale, complex software projects like these are disasters, a 2012 McKinsey study revealed. Add in politicians, public pressure and something as important as health insurance, and trouble with some of them is guaranteed.

    Here's IBM's full statement:

    "The majority of concerns with the Curam software that were expressed by Governor Dayton three weeks ago have been addressed. These are not the only issues related to the performance of the MNSure system. IBM is just one of several subcontractors working on this project. The prime contractor, Maximus, Inc, has overall responsibility for the MNsure system including integration and testing of all the components prior to October 1. IBM continues to work closely with the other suppliers and the State of Minnesota to make MNsure a more positive experience for Minnesota citizens. As an example, the percent of suspended applications for coverage decreased by two thirds between mid-December and early January and the system is now handling cases at over a 95% daily success rate.

    "To sustain the progress, we are providing on-site services and technical resources beyond the scope of IBM's contractual responsibilities to assist the State in resolving the remaining issues as quickly as possible. IBM Senior Vice President for Software Solutions, Mike Rhodin, has made this project a priority and has been in regular contact with Governor Dayton and the MNSure leaders. Although our original role on this project was limited, we are bringing the full resources and capabilities of IBM to the State because of the importance of the success of the project."


    Here's the full letter:

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    There's good news and bad news for President Obama and health reform today.

    The good news: young, healthy people are visiting the website.

    The bad: many of them and others visiting the site don't like what they're seeing. 

    The Commonwealth Fund released a new survey today on who is visiting the federal marketplace and the performance of the website. It finds that 24% of those who are eligible for Medicaid or to enroll in a new plan visited the site in December, up from 17% in October. Still, 37% are unaware of the new marketplaces, down slightly from October.

    Seventy-seven percent of those who visited the site are in excellent, very good or good health. The survey doesn't have information for how many of them actually enrolled in a plan, but the demographics of those visiting the site are still a good sign.

    In addition, 41% of those who visited the site are ages 19 to 34, right in line with the Obama administration's goal of 39%.

    It's important that young, healthy people enroll in plans to ensure that insurers don't raise premiums to cover costs. There are different provisions in the law to mitigate the risk that insurers end up with risk pools that skew older and sicker. In addition, insurers also have incentives to keep rates low during the next few years as they compete for millions of new patients.

    For those reasons, the chance of a "death spiral" has always been vastly overstated. This survey reinforces that.

    The news isn't all good for Obamacare though.

    Sixty nine percent of those who have visited the site rated their experience as fair or poor, down only one percentage point from October. Of those who visited the site more than once, 29% say it improved while 18% say it worsened.

    What's more worrisome for the law is that 60% say it is either somewhat difficult, very difficult, or impossible for them to find a plan with the type of coverage they need. That's actually up four percentage points from October. Fifty eight percent also say the same about finding a plan they deem affordable (down 3% since October). 

    That's a big problem. The long-term success of the law depends on people finding plans that they like and are affordable. Based on this Commonwealth survey, they aren't finding them.

    Additionally, more people found it easier to compare benefits, premiums and out-of-pocket costs of different plans in December than October, but many are still having trouble doing so:

    CommonWealth Fund

    Clearly, the website still has a long way to go.

    Finally, many of the people who have not visited the website plan to enroll in the coming months, including 58% of people aged 19-34 and 55% of those in excellent, very good or good health.

    The law is not likely to collapse under its own weight. Premiums are unlikely to skyrocket in the coming years and a "death spiral" isn't going to happen. What could severely damage the law is people disliking their choice of plans. That has always been the greatest threat to the law. The Commonwealth Survey shows that it's a very real possibility. 

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    Barack Obama

    The Department of Health and Human Services released new Obamacare numbers Monday for the federal exchange and the 14 state exchanges, including demographic information for the first time.

    As of December 28, nearly 2.2 million people had selected a plan on the exchanges. Twenty four percent of them were between the ages of 18 and 35.

    The White House had wanted 39% of enrollees to be within that age range to prevent insurers from receiving a significant number of high-risk beneficiaries. However, health analysts have noted in recent weeks that the age demographics are not what matters. It's the health mix that is most important.

    A recent study by the Kaiser Family Foundation found that if young people made up 25% of enrollees, it would reduce insurer profits by 2-3%, but would not cause a "death spiral" where insurers raise premiums, driving healthy people out of the market, forcing them to raise premiums again and onwards. The administration is confident that the share of young people who sign up will only increase in the coming months.

    Of the 2.15 million people who have a selected a plan, 957,000 have done so through the state exchanges and 1.2 million have done so on the federal marketplace. Sixty percent of people have selected the silver plans, which are expected to cover approximately 70% of a person's health care costs.

    After the catastrophic launch of the federal website, the pace of enrollments has improved each week, as many expected would happen as the deadline for selecting a plan approached. More than seven times as many people signed up on the federal exchange in the first 28 days of December as did so throughout all of October and November. 

    An additional 3.9 million people were deemed eligible either for Medicaid or the Children's Health Insurance Program (CHIP). It's unclear how many of those 3.9 million are newly eligible because of the Affordable Care Act or have just became aware in recent weeks that they were already eligible.

    The administration did not say how many people had paid their first premiums, only how many had chosen a plan. Many insurers allowed people to pay their first premiums up until January 10 - or in some cases even later. The Wall Street Journal reported yesterday that one third-party billing firm that works with insurers in 17 states said that only two-thirds of those who have signed up have actually paid so far.

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    Obama Affordable Care Act Obamacare

    Keeping track of the deadlines to purchase coverage for the Affordable Care Act has not been easy. Luckily, today's deadline is pretty straightforward.

    Originally, you had to purchase coverage by December 15 for insurance that started on January 1. Then, the administration pushed that back to December 23 with the agreement of insurers.

    Then, you only had to sign up - not yet actually pay your first premium - by that date. When December 23 rolled around, the administration pushed the deadline back another day. Many insurers allowed beneficiaries to pay their first premium by January 10 - or even later in some cases - for coverage that began on January 1.

    That's all behind us. Today's deadline is for coverage that starts February 1.

    This is the normal deadline for purchasing coverage that begins the next month. If you purchase insurance after today (up until February 15), your coverage will start March 1.

    However, if you don't buy insurance today, that doesn't subject you to the individual mandate penalty. You still have until March 31 to enroll in a plan before you must pay it. But today's still an important date if you want coverage that starts in February.

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    magic johnson white house thumb

    Celebrities have been unofficially endorsing the Affordable Care Act since it launched on Oct. 1. Amy Poehler, Pharrell Williams, Kate Bosworth, Michael Cera, and Rosario Dawson were among the many who took to social media to promote the hashtag #GetCovered.

    But now the White House has directly produced its own endorsement ad, and its spokesman is Basketball Hall of Fame member and HIV survivor Earvin "Magic" Johnson. It is promoting the video on the homepage and its YouTube page.

    In the ad, Johnson specifically addresses young people and athletes, and tells them to "Make sure you get Obamacare."

    He proclaims that early detection of diseases can save lives, which is what gave him the chance to live a healthy life being HIV-positive for the past 22 years (though, of course, Johnson's wealth grants him access to the most advanced and expensive health care).

    Here's the video, which premiered on Wednesday:

    Johnson has been a health advocate for awhile now.

    He founded his non-profit, the Magic Johnson Foundation, in 1991, the same year he announced he was HIV-positive. It is dedicated to educating poor urban communities on HIV/AIDS prevention, and has established scholarship programs and community centers around the country.

    SEE ALSO: Inside The 'Creepy Uncle Sam' Anti-Obamacare Snapchat Campaign

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    Steven Brill Daily Show Obamacare

    Steven Brill, author of Time's in-depth health care analysis "Bitter Pill," appeared on "The Daily Show" this week to discuss his opinion of Obamacare.

    Brill's work exploded his career into a love-hate relationship with Obamacare, now leading to a book. Speaking with Jon Stewart, Brill certainly made his criticisms known, but we also think he pinpointed exactly why health care just can't work as a free market.

    Brill told the story of a cancer patient forced to pay $13,700 out-of-pocket, up-front for transfusion of a drug. And that cost only constituted part of a greater $83,000 payment. Brill claims, however, the drug only cost the pharmaceutical company $300.

    "The cost has shifted to the taxpayers — which I think is a good thing. But it's outrageous that we haven't done anything to control those costs," Brill explained.

    Certain laws actually prohibit Medicare from negotiating drug prices, the Los Angeles Times has reported. President Obama, who once condemned the pharmaceutical industry, may have conceded this lobbying point to ensure the Affordable Care Act's passage. 

    Stewart came back at Brill with the typical conservative argument — creating a free market for health care where patients pick-and-choose their coverage to create competition and therefore, better options.

    "Everyone says, 'Well it's a marketplace.' That guy [the cancer patient] has no choice in buying that drug. His doctor told him, 'This will save your life. You don't take it, you're gonna die,'"Brill responded.

    He further argued free markets must have two aspects — a balance between buyers and sellers and secondly, knowledge — neither of which the current U.S. system offers.

    "That cancer drug has a patent. That is a monopoly that the government has given the drug company. There is no other drug. That's the drug," Brill said.

    "It's not like he [the cancer patient] woke up one morning and said, 'Gee, I'd like to go shop for a cancer drug. I wonder what's out there. And if I like it, I'll buy it, and if I don't, you know, I'll buy a pair of shoes.'"

    "What does a free market usually have? There's a balance between the buyer and the seller. There is no balance now, you've got to buy that product."

    "In a free market, there's also knowledge. You don't have any knowledge. Your doctor is telling you what to buy — this cat scan and this MRI at a hospital that probably employs that doctor.  So he's got an incentive to do it."

    Watch his full interview below:

    SEE ALSO: Medicare May Be Paying Out Millions For Drugs That Doctors Never Prescribed

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    prisoner in cage california

    Ron Sanders may hold the record for the fastest round trip from and back into jail. Released after a year in a San Francisco county lockup—just one in a series of drug-related sentences he’d served over the years—he headed right back to the streets he knew best.

    “Four hours after I got out, I got me a 40 [ounce bottle of malt liquor] and a rock of crack,” says Sanders, a wiry African American man with a scar on his forehead and a pair of spotless Nikes on his feet. “Then I turned around, and there was a cop right behind me.” He was back behind bars before the day was over.

    Slightly slower-paced versions of Sanders’ story play out every day all across the country. An astonishing two-thirds of the 730,000 men and women released from America’s lockups each year have either substance abuse problems, mental health problems, or both. Very often, those problems were largely responsible for getting them locked up in the first place. Most addicted and mentally ill prisoners receive little or no effective treatment while they’re incarcerated or after they’re turned loose, so it’s little surprise that, like Sanders, they soon wind up back in jail. But for some, that revolving door may stop spinning this year, thanks to a little-noticed side-effect of President Obama’s Affordable Care Act. Obamacare, it turns out, might be a crime-fighting tool.

    Numerous studies support the common-sense notion that treating offenders’ drug addictions and mental illnesses helps keep at least some of them from going back to jail. Get that junkie off heroin, and maybe he won’t steal your car stereo for fix money; get that mentally ill homeless person on proper medications, and maybe she can find a job instead of turning tricks in alleys. “It’s not the drug itself, it’s the stealing and robbing they do to get the drug,” says Abbie Zimmerman, a therapist atTransitions Clinic, a program based in San Francisco’s hard-bitten Hunter’s Point area that treats former prisoners (including Sanders, who is now an outreach worker there). “If I can keep them sober, I can keep them out of jail.”

    But no one has been willing to pay for such treatment for hundreds of thousands of ex-cons. And they certainly can’t afford it themselves: According to a recent report by the Council of State Governments, the vast majority of released prisoners re-enter society with little money and no health insurance. But now many of those former prisoners are eligible for insurance, courtesy of the federal government.

    Among many other reforms, the ACA is drastically expanding Medicaid, the federal insurance scheme for the poor. Previously, able-bodied childless adults were generally not covered by Medicaid, regardless of how impoverished they might have been. But starting this year, any American citizen under age 65 with a family income at or below 138 percent of the federal poverty line—about $25,000 for a family of three—is eligible for Medicaid (at least in the two dozen states that have so far agreed to participate in this aspect of Obamacare). Meanwhile, citizens and legal immigrants earning between 138 percent and 400 percent of the poverty line are now entitled to subsidies to help pay for private insurance. Taken together, those two provisions mean that tens, perhaps hundreds, of thousands of the inmates released every year are now eligible for health insurance, including coverage for mental health and substance abuse services.

    Providing treatment to those former prisoners could yield enormous benefits for all of us. The average cost to incarcerate someone for a year is roughly $25,000. That means if only one percent of each year’s released inmates stay out of trouble, taxpayers will save nearly $200 million annually—and the pool of troubled ex-cons looking to steal your car stereo will be that much smaller. “Success in implementing the Affordable Care Act has the potential to decrease crime, recidivism, and criminal justice costs, while simultaneously improving the health and safety of communities,” sums up a recent report by the federal Department of Justice.

    It all looks great on paper. But there are significant obstacles to making this work in the real world. One is the simple fact that many former prisoners aren’t even aware of their new entitlements. “I don’t really know what Obamacare is,” says Ernest Kirkwood, a Transitions client who spent 29 years in prison, when I tell him I’d like to talk to him about the new health care regime. “I never read the newspaper.”

    Making services available is one thing. Getting people whose judgment isn’t that great in the first place to actually use them is another. Plenty of drug users and mentally ill people don’t want to admit they have a problem. The stigma that persists around mental illness keeps some should-be patients away. Richard Rawson, a professor of psychiatry specializing in substance abuse at the University of California, Los Angeles, points out that an earlier experiment that provided residential treatment to just-released drug offenders didn’t work as well as hoped. “People said, ‘I just got out, I don’t want to be in rehab for another year,’” he says. And of course, many former inmates need more than just treatment to keep them straight—basics like decent housing and a job are also critical.

    “Even with all that, this is a watershed opportunity,” says Rawson. “It should put a significant dent in recidivism, no question.” Accordingly, government agencies, public health officials, and prisoner support organizations across the country are working to connect inmates with Obamacare. “We’re trying to enable people to enroll at many points in the criminal justice system, so they can walk into services the day they leave prison,” says Maureen McConnell, a spokesperson for Treatment Alternatives for Safe Communities, a Chicago non-profit. Her group, working with the Cook County Sheriff’s Department, is sending outreach workers into jails to get thousands of inmates started on the paperwork before they’re released. Illinois Governor Pat Quinn has formed a working group targeting the issue. Massachusetts has implemented an electronic Medicaid application system for inmates leaving incarceration. Similar efforts are underway in California, Maryland, and other states.

    Even the most determined outreach campaign won’t succeed in enrolling every single former prisoner, and not all of those who enroll will bother getting treatment. But at least some will get the help they need when they are sent back out on the streets. That should save them a lot of trouble—and the rest of us a bundle.

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    Barack Obama

    Moody's Investors Service on Thursday downgraded its outlook on U.S. health insurers from stable to negative, citing concerns with the implementation of the Affordable Care Act.

    In its announcement, Moody's said that the Affordable Care Act has continued to "create uncertainty for the industry."

    "While we've had industry risks from regulatory changes on our radar for a while, the ongoing unstable and evolving environment is a key factor for our outlook change," said Stephen Zaharuk, a Moody's Senior Vice President and author of the report. "The past few months have seen new regulations and announcements that impose operational changes well after product and pricing decisions were finalized."

    The past few months have been full of problems for President Barack Obama's signature health-care law. For much of October and November, website glitches led to low enrollment numbers. Though most of those website issues have been resolved, Moody's cited concerns with the demographic breakdown of enrollments.

    Specifically, Moody's said it was disconcerting that only 24% of enrollees so far have been between the ages of 18-34, when the original target for this group was around 40%. If the trend continues without enrollment from the young and healthy to balance out the older and sicker, it could lead insurers to increase rates.

    Moody's also cited a concern that insurers' premium calculations could be insufficient to cover the industry assessment tax — the new tax on medical devices that begins in 2014.

    "These changing dynamics will have an uneven effect on insurers, as the impact of these factors will vary by market segment and geography," the agency said in its announcement.

    "Moody's view continues to be that the larger and more diversified insurers will be better positioned, both financially and strategically, to meet the challenges facing the sector."

    In separate, better news for the health-care law on Thursday, Gallup reported that the U.S. uninsured rate had dropped to 16.1% in January from 17.3% in December, driven by the unemployed and nonwhites.

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    Barack Obama John BoehnerWASHINGTON (Reuters) - Top Republicans are saying they can no longer just be the party of "No" on Obamacare: They need to come up with an alternative health care policy.

    While many Americans are skeptical of President Barack Obama's health care overhaul, they also tell lawmakers they worry about keeping their costs from getting out of control. For those voters, a party that offers a platform to repeal the 2010 law without anything to replace it may not be very attractive.

    As a result, lawmakers from both the establishment wing of the Republican Party and the more fiscally conservative small-government proponents in the Tea Party movement are exploring health care policies.

    U.S. House of Representatives Speaker John Boehner of Ohio said it would be a major topic at a Republican retreat next week.

    "We need to present the American people with a positive," said long-time Senator John McCain of Arizona, who in 2008 had a detailed health care reform plan as the Republican Party's presidential candidate against Democrat Obama.

    "A number of people are working on it, and we've come up with the various provisions, and now hopefully we're going to put together a Republican package" on healthcare, McCain told Reuters outside the Senate last week.

    Several bills have already been introduced by Republicans in the House and Senate but no single plan has yet emerged.

    Some start with the repeal of the Patient Protection and Affordable Care Act - a move that would almost certainly be vetoed by Obama if it passed both chambers, which is unlikely as long as Democrats hold the Senate.

    Some bills propose new tax credits or deductions to help people pay for health insurance.

    The law, commonly called Obamacare, passed Congress in 2010 as the most sweeping U.S. social legislation in 50 years and survived a legal challenge by opponents in the U.S. Supreme Court in 2012.

    It requires most Americans to buy insurance, offers subsidies to help low-income people receive coverage and sets minimum standards for coverage. It aims to dramatically reduce the number of Americans who lack health insurance policies.

    Instead of starting with a total repeal, Republican Senator Ron Johnson of Wisconsin has suggested transition legislation that might initially eliminate some provisions such as mandatory coverage of maternity care and move people with pre-existing conditions into high-risk insurance pools.

    Some Tea Party-backed House conservatives also are urging action, arguing that it may no longer be enough to simply denounce Obamacare as lawmakers start campaigning for congressional elections in November.

    "What's our alternative to this terrible thing called Obamacare?" asked Representative Jim Jordan of Ohio at a recent lunch meeting of House Republican conservatives.

    Another conservative, Representative Raul Labrador of Idaho, said that if Republicans want to win in 2014, they should start "letting the American people know what we are for."

    Boehner, who has presided over dozens of House votes to limit or curtail Obamacare, said that at their annual retreat January 29-31, House Republicans would discuss a plan to make healthcare insurance more accessible and affordable.


    Republicans have opposed the law for years. They say Obamacare relies too heavily on mandates and results in too much government interference in the marketplace.

    They point to the rocky rollout of the Obamacare website last October as evidence of flaws in the law. But analysts wonder whether they can unify around an alternative.

    "The Republicans historically had a lot of health care bills ... The Republicans never coalesced around a single bill, and that was the political weakness of the Republicans," said Bob Moffit, a senior fellow at the conservative Heritage Foundation who was a top health official under President Reagan.

    The administration says Obamacare is settled law now.

    Vice President Joe Biden on Thursday touted popular provisions such as prohibiting insurers from rejecting people with pre-existing conditions. "We will not go back. America has turned the page."

    Republicans are not averse to cherry-picking some of the more popular bits of Obamacare. Two separate House Republican proposals would address the needs of people with pre-existing conditions through state-run "high-risk" insurance pools.

    A House bill by Representative Tom Price of Georgia, an orthopedic surgeon, has been introduced for three Congresses in a row but has not had a single hearing or vote while Republicans have been more focused on trying to stop Obamacare.

    Price's bill proposes using refundable tax credits based on income to help Americans with the purchase of health insurance plans. McCain introduced a similar bill in the Senate.

    A bill by Republican Representative Phil Roe of Tennessee would apply a standard tax deduction to help Americans pay for insurance. It has 122 co-sponsors and has been embraced by the Republican Study Committee, the largest bloc of House conservatives.

    "No bill does everything," Roe, an obstetrician, said in a telephone interview. "Let's debate the differences ... I think people want to hear that there are alternatives out there."

    Some outside conservative groups also like the idea of alternatives to Obamacare. FreedomWorks is surveying its six million members on ideas and will release the results in March.

    Matthew Green, a professor of political science at Catholic University, thinks it was inevitable that Republicans would move from just opposing Obamacare to proposing alternatives.

    "You can only get votes for so long from people saying, 'I oppose the status quo'," Green said.

    (Additional reporting by Richard Cowan and David Morgan; Editing by Grant McCool)

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    Tom Coburn

    On the eve of President Obama's fifth State of the Union, three Republicans senators - Sens. Tom Coburn (Okla.), Richard Burr (R-N.C.) and Orrin Hatch (R-Utah) - have unveiled a new health reform plan to replace Obamacare.

    This is the most comprehensive Republican proposal to date that includes features of the president's health care law and centers it around solid conservative ideas.

    It focuses on eliminating many of the mandates and requirements in Obamacare while keeping many of its popular features.

    Here's a breakdown of what's in it:

    So, if the plan doesn't repeal Obamacare entirely, what does it keep?

    Not much. The Patient Choice, Affordability, Responsibility, and Empowerment Act ("Patient CARE Act") will keep the provision in Obamacare that allows young adults to stay on their parents' insurance up to age 26. It would also keep the ban on lifetime limits of insurer payouts. Besides that, it would increase the ratio that insurers can vary premiums between the old and young from 3:1 to 5:1, although states would have final say over this.

    Most importantly, the Patient CARE Act will continue to provide means-tested assistance to low-income Americans. The proposal would offer tax credits for people up to 300% of the federal poverty line (FPL) ($34,470 in 2013), a bit less than Obamacare which offers subsidies for people up to 400% of FPL. Individuals working for small businesses (less than 100 employees) and those who do not work for a large employer would be eligible for the credit. The tax credits are also age-adjusted and would grow at a rate of the Consumer Price Index plus 1%.

    For people making 200% of FPL, here's what the authors expect the value of the credits to be:Patient CARE ActOK, what does it get rid of?

    Just about everything else. The individual and employer mandates are gone. The requirement that insurers cover 10 essential health benefits is gone as well. States no longer have to use exchanges, though they can if they wish. Insurers also will no longer be required to cover people with pre-existing conditions.

    Wait what?! They can go back to rejecting me if I have a pre-existing condition?

    Yes, but only if you have not had continuous coverage in the past. This is key. The proposal requires insurers to offer coverage to anyone with pre-existing conditions as long as they have maintained continuous insurance for at least 18 months. It doesn't matter if they're switching from employer-provide insurance to the individual market or just switching plans in general.

    The plan will also revive state high-risk pools that can cover people with pre-existing conditions that insurers won't cover by increasing federal funding for them.

    For those who are uninsured when the plan is adopted, there would be a one-time open enrollment period when insurers would not be able to reject any individual for a pre-existing condition

    OK that's good at least. I remember that Obamacare included the individual mandate because insurers needed healthy people to enroll in coverage to ensure that they had balanced risk pools. If there is no individual mandate, how will insurers get healthy people to sign up?

    There are a couple of features in the plan that make up for the mandate. First, the requirement that individuals maintain continuous coverage if they want to ensure that insurers cannot reject them for having a pre-existing condition provides incentive for them to purchase insurance even when they are healthy.

    In addition, the tax credits will also incentivize low-income Americans to enroll in coverage. In some cases, individuals may qualify for tax credits that could fully cover the cost of a plan, but choose not to enroll. Under the Patient CARE plan, the state will auto-enroll these people in that plan for them. They can choose to opt out if they want, but the default option is enrollment. This will help ensure people sign up for coverage as well.

    Alright that seems like it could work. What about the Medicaid expansion? What's happening with that?

    It's gone as well. Instead, the Patient CARE Act will offer states a per-person allotment of funding for each person enrolled in Medicaid. The goal of this is to incentivize states to find cost-efficient ways to treat their low-income, uninsured population. As Avik Roy notes, it's a milder version of block granting. The plan would also allow Medicaid enrollees to opt out of the program and instead receive the tax credit to purchase private insurance.

    How much would all this cost? The tax credits sound expensive.

    The plan hasn't been scored yet, but the authors say it is likely to be deficit-neutral over the 10-year budget window. It does so by capping the employer health insurance exclusion at 65% of the average plan's costs. This isn't as ambitious as previous conservative health insurance plans that eliminated the exclusion altogether, but the senators decided that doing so would be too disruptive to the market after they saw the backlash from people whose plans were cancelled due to Obamacare.

    Deficit-neutral sounds good. Is there anything else in it?

    Yeah. The plan would incentivize states to adopt medical malpractice reform, a popular policy on the right. It also requires insurers and hospitals to be more transparent with their pricing and wants to use targeted reforms to extend eligibility for health savings accounts. Finally, it would allow small businesses to band together to negotiate for health plans, giving them greater purchasing power.

    Wow, this does sound like a viable replacement. Can you sum it up for me?

    Sure! The Patient CARE Act will likely cover fewer people than Obamacare but continues to provide protections for people with pre-existing conditions. It isn't a major change from the president's health reform law. Individuals would likely have access to a wider variety plans, but also will be at risk of purchasing one that covers few benefits. It will likely cost less, but still is deficit neutral. It's unclear how it would affect premiums.

    This post has been updated.

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    Barack Obama

    President Obama did not include any groundbreaking legislative ideas in his State of the Union last night.

    He continued to push Congress to raise the minimum wage and pass immigration reform while vowing to take more unilateral actions, starting by raising the minimum wage for new federal contractors to $10.10 an hour.

    His address won't do anything to convince Republicans to pass more of his legislative agenda.

    But the president did have two decisive victories last night, and neither had anything to do with his actual speech.

    1. Republicans gave in on the debt ceiling. Just before his address last night, Politico reported that House Republican leaders were privately saying that there would be no debt ceiling fight this time around. This is a massive victory for the president and Senate Majority Leader Harry Reid (D-Nev.) who both stuck to a hard line last October during the previous debt ceiling fight and refused to negotiate. This was a matter of principle. President Obama regretted making concessions in the debt ceiling fight in 2011 and want to set a standard that the debt ceiling cannot be used as an extortion device.

    If Republicans are truly waving the white flag, then the president has set that standard. He has disarmed the debt ceiling for good.

    2. Obamacare repeal is 100%, officially dead. Throughout the past couple of weeks, the Republican Party's position on Obamacare has slowly shifted from repealing the law to fixing it. They weren't vocal about this development but party leaders knew that repealing Obamacare in its entirety was no longer a politically viable strategy now that millions have gotten insurance through it. That's why the alternative health reform plan proposed by Sens. Tom Coburn (R-Okla.), Richard Burr (R-N.C.), and Orrin Hatch (R-Utah) kept some of Obamacare's most popular features and retained the same framework of the law.

    In both Rep. Cathy McMorris Rodgers (R-Wash.) and Sen. Mike Lee's (R-Utah) respective State of the Union responses, they made it clear that returning to the pre-Obamacare status quo is no longer an option.

    "No, we shouldn’t go back to the way things were," McMorris Rodgers said, "but this law is not working.  Republicans believe health care choices should be yours, not the government’s."

    Lee's acceptance of Obamacare was even more surprising given that he gave the tea party response and was one of the architects of the government shutdown last October that was intended to stop the law.

    "When it comes to healthcare, we know the best way to repeal Obamacare is to deliver better solutions," Lee said. "We can't just return to the old system."

    Lee uses the word 'repeal' here, but immediately admits that Obamacare is here to stay. For him to make such an admission in the tea party response is a clear indication that the repeal effort is officially dead.

    These are two gigantic victories for the president. Two of his biggest fights with Republicans over the past few years have been over raising the country's borrowing limit and ensuring Obamacare became the new status quo. Last night, he decisively won both of those fights.

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