Obamacare: The HateThat Can’t Be Cured

Enrique Chagoya: The Headache, a Print after George Cruikshank, 2010

GARRY WILLS, N.Y. REVIEW OF BOOKS

I fear that the president declared a premature victory for the Affordable Care Act when he said that its initial goals were met, it was time to move on to other matters, and the idea of repealing it is no longer feasible. He made the mistake of thinking that facts matter when a cult is involved. Obamacare is now, for many, haloed with hate, to be fought against with all one’s life. Retaining certitude about its essential evil is a matter of self-respect, honor for one’s allies in the cause, and loathing for one’s opponents. It is a religious commitment.
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That kind of commitment looks all the nobler to those preserving it as they resist attacks. I presume that Obamacare will become just successful enough to endure after adjustments and repair; but that will not make it any less hated by the people who have spent years encouraging each other to inveigh against it in extreme exercises of vilification (death panels, socialism, destruction of the Constitution, etc.). We have to remember that Social Security remained hated long after its success made it undislodgeable. As a symbol of the New Deal, Republicans have tried to defeat it down through the decades. Paul Ryan is still at it. George W. Bush tried to use his re-election mandate to privatize it. Once such a cause is made sacred by sacrificing for it, it will remain a cult object forever.

The irrelevance of evidence in the face of sacred causes explains the dogged denial of global warming, the deep belief that the Obama Administration was responsible for the killing of Ambassador J. Christopher Stevens in Benghazi and that Obama is not a legitimate American. To go back farther, it explains the claims that FDR arranged for the attack on Pearl Harbor and gave much of the world away to Stalin at Yalta (an idea Joe Scarborough is still clinging to). Repealing Obamacare will eventually go the way of repealing the New Deal. But the opposition will never fade entirely away—and it may well be strong enough in this year’s elections to determine the outcome. It is something people are willing to sacrifice for and feel noble about. Creeds are not built up out of facts. They are what make people reject all evidence that guns are more the cause of crime than the cure for it. The best preservative for unreason is to make a religion of it.

IT WAS UGLY BUT OBAMACARE RULES!

JACK KRUGMAN, N.Y. TIMES

Holy seven million, Batman! The Affordable Care Act, a k a Obamacare, has made a stunning comeback from its shambolic start. As the March 31 deadline for 2014 coverage approached, there was a surge in applications at the “exchanges” — the special insurance marketplaces the law set up. And the original target of seven million signups, widely dismissed as unattainable, has been surpassed.

But what does it mean? That depends on whether you ask the law’s opponents or its supporters. You see, the opponents think that it means a lot, while the law’s supporters are being very cautious. And, in this one case, the enemies of health reform are right. This is a very big deal indeed.

Of course, you don’t find many Obamacare opponents admitting outright that 7.1 million and counting signups is a huge victory for reform. But their reaction to the results — It’s a fraud! They’re cooking the books! — tells the tale. Conservative thinking and Republican political strategy were based entirely on the assumption that it would always be October, that Obamacare’s rollout would be an unremitting tale of disaster. They have no idea what to do now that it’s turning into a success story.

So why are many reform supporters being diffident, telling us not to read too much into the figures? Well, at a technical level they’re right: The precise number of signups doesn’t matter much for the functioning of the law, and there may still be many problems despite the March surge. But I’d argue that they’re missing the forest for the trees.

The crucial thing to understand about the Affordable Care Act is that it’s a Rube Goldberg device, a complicated way to do something inherently simple. The biggest risk to reform has always been that the scheme would founder on its complexity. And now we know that this won’t happen.

Remember, giving everyone health insurance doesn’t have to be hard; you can just do it with a government-run program. Not only do many other advanced countries have “single-payer,” government-provided health insurance, but we ourselves have such a program — Medicare — for older Americans. If it had been politically possible, extending Medicare to everyone would have been technically easy.

But it wasn’t politically possible, for a couple of reasons. One was the power of the insurance industry, which couldn’t be cut out of the loop if you wanted health reform this decade. Another was the fact that the 170 million Americans receiving health insurance through employers are generally satisfied with their coverage, and any plan replacing that coverage with something new and unknown was a nonstarter.

So health reform had to be run largely through private insurers, and be an add-on to the existing system rather than a complete replacement. And, as a result, it had to be somewhat complex.

Now, the complexity shouldn’t be exaggerated: The basics of reform only take a few minutes to explain. And it has to be as complicated as it is. There’s a reason Republicans keep defaulting on their promise to propose an alternative to the Affordable Care Act: All the main elements of Obamacare, including the subsidies and the much-attacked individual mandate, are essential if you want to cover the uninsured.

Nonetheless, the Obama administration created a system in which people don’t simply receive a letter from the federal government saying “Congratulations, you are now covered.” Instead, people must go online or make a phone call and choose from a number of options, in which the cost of insurance depends on a calculation that includes varying subsidies, and so on. It’s a system in which many things can go wrong; the nightmare scenario has always been that conservatives would seize on technical problems to discredit health reform as a whole. And last fall that nightmare seemed to be coming true.

But the nightmare is over. It has long been clear, to anyone willing to study the issue, that the overall structure of Obamacare made sense given the political constraints. Now we know that the technical details can be managed, too. This thing is going to work.

And, yes, it’s also a big political victory for Democrats. They can point to a system that is already providing vital aid to millions of Americans, and Republicans — who were planning to run against a debacle — have nothing to offer in response. And I mean nothing. So far, not one of the supposed Obamacare horror stories featured in attack ads has stood up to scrutiny.

 

So my advice to reform supporters is, go ahead and celebrate. Oh, and feel free to ridicule right-wingers who confidently predicted doom.

Clearly, there’s a lot of work ahead, and we can count on the news media to play up every hitch and glitch as if it were an existential disaster. But Rube Goldberg has survived; health reform has won.

Surveys and Reports Show Obamacare Leads to Health Coverage for At Least 9.5 Million Previously Uninsured.

Applicants stand in line at Panorama Mall in Panorama City to sign-up for Covered California at an enrollment event Friday. (Irfan Khan / Los Angeles Times / March 28, 2014)

L.A. TIMES

 President Obama's healthcare law, despite a rocky rollout and determined opposition from critics, already has spurred the largest expansion in health coverage in America in half a century, national surveys and enrollment data show.

As the law's initial enrollment period closes, at least 9.5 million previously uninsured people have gained coverage. Some have done so through marketplaces created by the law, some through other private insurance and others through Medicaid, which has expanded under the law in about half the states.
The tally draws from a review of state and federal enrollment reports, surveys and interviews with insurance executives and government officials nationwide.

The millions of newly insured also create a politically important constituency...
Precise figures on national health coverage will not be available for months. But available data indicate:

• At least 6 million people have signed up for health coverage on the new marketplaces, about one-third of whom were previously uninsured.

• A February survey by consulting firm McKinsey & Co. found 27% of new enrollees were previously uninsured, but newer survey data from the nonprofit Rand Corp. and reports from marketplace officials in several states suggest that share increased in March.

• At least 4.5 million previously uninsured adults have signed up for state Medicaid programs, according to Rand's unpublished survey data, which were shared with The Times. That tracks with estimates from Avalere Health, a consulting firm that is closely following the law's implementation.

• An additional 3 million young adults have gained coverage in recent years through a provision of the law that enables dependent children to remain on their parents' health plans until they turn 26, according to national health insurance surveys from the federal Centers for Disease Control and Prevention.

• About 9 million people have bought health plans directly from insurers, instead of using the marketplaces, Rand found. The vast majority of these people were previously insured.

• Fewer than a million people who had health plans in 2013 are now uninsured because their plans were canceled for not meeting new standards set by the law, the Rand survey indicates.
Republican critics of the law have suggested that the cancellations last fall have led to a net reduction in coverage.
That is not supported by survey data or insurance companies, many of which report they have retained the vast majority of their 2013 customers by renewing old policies, which is permitted in about half the states, or by moving customers to new plans.

We are on target to exceed what was estimated," Lisa Sbrana, counsel for New York's insurance marketplace, said on a recent call organized by Families USA, a Washington-based advocacy group that supports the law. About 70% of New Yorkers signing up for coverage through the marketplace or Medicaid were previously uninsured, Sbrana said. In Kentucky, about 75% of the state residents signing up on that state's marketplace or for Medicaid had no insurance, a state study indicates. As of Friday, more than 280,000 new people had enrolled in Medicaid in Kentucky, or nearly 91% of the residents officials estimated would become eligible for the program this year.
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 The solid enrollment in the first year has built a foundation that for now appears robust enough to support more growth next year.
In several states, including Rhode Island, Connecticut, Kentucky, Iowa and South Dakota, more insurers are looking to join state marketplaces when second-year enrollment begins this fall, according to marketplace and insurance industry officials.
And after initial resistance, a growing number of states with GOP governors or legislatures are looking to expand coverage further.
New Hampshire's Legislature just voted to expand its Medicaid program. Utah, Indiana and Pennsylvania are looking for ways to do the same.

http://www.latimes.com/nation/la-na-obamacare-uninsured-national-20140331,0,5472960.story?page=2#ixzz2xbmyULso

OBAMACARE ENROLLMENT HIT 6 MILLION. IS THAT SIGNIFICANT OR WHAT?

CREDIT: AP Photo

GREG SARGENT, WASHINGTON POST

Obamacare enrollments have now hit six million, and with an estimated 3.5 million now eligible for Medicaid, that brings the total to 9.5 million. Supporters of the law, however, are greeting the news with lingering caution about its long term prospects. Liberals such as Jonathan Cohn and Paul Krugman are noting with satisfaction that the law is clearly functioning, but also that there are many unknowns: How many people have actually paid? How many were previously insured? Will marketplaces in the states work over time?
Meanwhile, even as it is now clear the law is more or less on track as intended, GOP certainty in an Obamacare-fueled Senate takeover is only deepening — which in turn is leading Congressional Republicans to ramp up their plans to repeal and replace it with, well, something, once they control both houses of Congress. {This scenario remains a big if--Esco]

David Drucker reports on the latest thinking among Congressional GOP leaders:

The possibility that the Republicans might flip the Senate is influencing House GOP leaders’ decisions as they plot health care strategy for the 2014 campaign and 2015 congressional session, according to GOP members and other Republican sources. A major goal is to place the various current Republican proposals under one health care umbrella, while ensuring that this year’s campaign rhetoric matches next year’s legislative agenda.
In particular, House Republican leaders believe their caucus must have a plan for how to respond after Obama inevitably vetoes a bill that would fully repeal and replace the Affordable Care Act. They anticipate that Americans will demand that something be done to fix a law that voters have never embraced. Following through on these targeted reforms would require negotiations with the White House.

The good news: Republicans now appear to be operating from the premise that Obamacare isn’t going to get repealed, and seem ready to enter into a new phase of negotiating over the law’s future. The bad news: Republicans still seem to think voters will want them to vote on repealing the law in 2015, nearly a year from now.
The truth is, some voters very well may want that, but the vast majority of them will probably be Republicans. The new Kaiser poll finds that only Republicans want to repeal the law, and only Republicans want the debate over the law to continue.
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Getty Images

Customers sit with an insurance agent from Sunshine Life and Health Advisors as they and others try to purchase health insurance under the Affordable Care Act at a store setup in the Mall of Americas on March 20, 2014 in Miami, Florida.

A good New York Times report explains: Now that Obamacare enrollment has hit six million, that is a milestone, but what really matters for whether the law will work over time is how the exchanges and the demographic mix work in individual states. Kaiser’s Drew Altman:

“The whole narrative about Obamacare — ‘Will they get to six million? What is the percentage of young adults going to be?’ — has almost nothing to do with whether the law is working or not, whether the premiums are affordable or not, whether people think they are getting a good deal or not. It’s almost like trying to predict the local weather from national averages.”

Like it or not, as one expert notes in the article, it is probably going to take a few years before we know whether the individual marketplaces are working. Sorry!

* HOW TO UNDERSTAND THOSE 6 MILLION ENROLLMENTS: Jonathan Cohn has a very fair piece reminding us of everything we don’t know about the six million enrollees, suming up the big picture this way:

But it also isn’t hard to find stories of people grateful to get insurance that, for the first time, is available to all Americans regardless of pre-existing conditions. Nor is it difficult to find people grateful that they can finally afford coverage, thanks either to newly expanded Medicaid programs or the financial assistance — worth, in some cases, thousands of dollars a year — through the marketplaces. And the fact that enrollment will probably be close to the original projections suggests that the law is working more or less like it’s supposed to work.

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* OBAMACARE’S HIDDEN VICTORY: Sophie Novack points out that even the six million enrollment figure might not do justice to the true number of signups, which means a factor that could actually help the law’s prospects over time is not being acknowledged:

As the final figures before the end of open enrollment are posted, a significant chunk of people who bought insurance under the law will be missing from the official tally. That’s because people who bought insurance directly from insurers, and not through the law’s exchanges, will not be included…It’s quite possible this number would more than balance out the premium payment discrepancy—but unfortunately for HHS, we might not know for a very long time.

Did I mention that we just don’t know yet how the law will work over the long haul?

Seven states that show just how hard it is to measure Obamacare's success

WASHINGTON POST

March 23 marks the Affordable Care Act's fourth anniversary, and March 31marks the deadline for people to sign up for health insurance before fines kick in. That means that people are going to be talking quite a bit about the health care law and how its implementation is going.

The Kaiser Family Foundation has released information about how many people have enrolled in health-care exchanges in each state through March 1. Where people are signing up — and where people aren't — tend to follow an easy political rubric. Out of the entire population eligible to join the health-care exchanges, 15 percent have already signed up, a number likely depressed by the Affordable Care Act's inelegant Internet debut. In conservative states where the exchanges are run by the federal government — 27 in all — only 12 percent of the eligible population has signed up. In the 17 states that built their own exchanges, 20 percent of eligible people signed up. Even when you break down the state-based exchanges by party, the percentage of the population remains the same. ...

.... some of federally facilitated exchanges have had great success in signing up people. In some states where Obamacare has incredibly low approval ratings, people are signing up in extraordinary numbers. In some states where the health-care law is popular, sign-ups are nonexistent.
What gives?
Here's a look at a few states that show how complicated analyzing Obamacare's success can be this early in the game. The law definitely hasn't performed to initial expectations so far, but there's no doubt it's also found success in unanticipated places.

 Hawaii has had the fewest number of sign-ups in the whole nation — 4,661 — mostly due to extended technical problems and little interest from small businesses. Because so few people are enrolled, the state isn't sure it will be able to pay for the exchange when the hundreds of millions of federal dollars run out in 2016.

 Maryland has only signed up 9.1 percent of their eligible exchangers, and has hired 200 additional people to work the phone lines because the Web site still doesn't work quite right. The phone lines are always busy, and the wait has frustrated many potential customers.

 Massachusetts' Web site is also not working well, and is unlikely to be fixed by March 31. The state has the smallest percentage of sign-ups in the country.

 Wonkblog called Oregon's Web site the "nation's worst Obamacare site" yesterday. They just completed a $228,000 review of their technology, and are trying to figure out what to do next. Joining the federally-run HealthCare.gov is an option. There are many state-run exchanges that have been far more successful. California and New York — which have two of the largest uninsured populations — have together signed up over 1.1 million people. Idaho has the fifth highest percentage of sign-ups by eligible population, although only 36 percent of its residents have a favorable opinion of Obamacare.

Hisham Uadadeh walks out of Leading Insurance Agency after enrolling in a health insurance plan under the Affordable Care Act on February 13, 2014, in Miami. (Photo by Joe Raedle/Getty Images)

The conservative state government of North Carolina decided not to build a state-run exchange — which would usually mean a small number of sign-ups, if you were to look at most of the states that followed the same course. But North Carolina, Maine and Florida have managed to sign up a significant number of people — when adjusting for the across- the-board decreased standards following the messy November rollout — despite the fact the state government hasn't been as aggressive in pushing sign-ups as states running their own exchanges. In North Carolina and Florida, the number of sign-ups looks promising to the Obama administration since they are two of the ten states with the highest number of uninsured residents. If the Obama administration's last-minute advertising blitz in these states — which also include California, Texas, New York, Georgia, Illinois, Ohio, Pennsylvania and New Jersey — they will get the national tally of sign-ups to go up considerably, too. And that national number is the one everyone will be looking at to give the Affordable Care Act the first semester grades that will define it for November elections.

Maria Burciaga (left) shops for health insurance with the help of navigator Anna Ray at a Houston art gallery. Texas ranks the lowest among states for Obamacare sign-ups.

Texas — where one in four people are uninsured — is likely a lost cause for sign-ups in the near future. The state passed laws this January that makes it difficult to become a navigator, the people who walk enrolees through the complicated sign-up process. Only 39 percent of Texas residents have a favorable opinion of Obamacare. Conservative candidates who have been all over television commercials the past few months have focused much of their attention on the law.
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Cedric Anthony and Alysia Greer are two of the navigators working in Houston neighborhoods for United Labor Unions Local 100.

Who knows how these successes and slip-ups will change in the next years, but it's important to note that there's no one story to tell about the Obamacare rollout, as we learn more data about premiums and sign-ups and Medicaid enrollment in the upcoming months. With such a complex law, there's probably no way we'll know what to make of Obamacare by November. The only thing we have for sure is a crash course in what's working in some states, and what's bombing in others, regardless of whether people like what's happening or not. With such a confusing portrait, it's especially easy for politicians to spin the law every which way. This election, you're going to hear a million different things about Obamacare, and as the above snapshots show, about half of them could even be right.

the political battle over Obamacare is like ‘Groundhog Day’

How the political battle over Obamacare is like ‘Groundhog Day’

Stop us if you've heard this one before.
A conservative group ties a congressional Democrat to President Obama's refrain that all Americans could stay on their health insurance plans after implementation of the federal health-care law. The Democrat's campaign responds by pointing to her effort to push Obama to live up to his word.
That's what happened in the Louisiana Senate race Thursday. It's a scene that has played out before and promises to repeat itself again and again across the map in 2014. In the political showdown over Obamacare, the battle lines are, to a large extent, already drawn. And that makes for a landscape that's shaping up to resemble the film "Groundhog Day."
In the movie, TV weatherman Phil Connors, played by Bill Murray, finds himself in a seemingly endless cycle of repeating the same day over and over again -- to the point that he is able to anticipate what's about to happen.
That's where the political realm is right now in the health-care tussle. The conservative group Americans for Prosperity released a TV ad Thursday reminding voters of Obama's if-you-like-it-you-can-keep-it line, which was revealed last year to be inaccurate. The spot then shows Sen. Mary Landrieu (D-La.) echoing the president's refrain in her own words.
If the advertisement sounds familiar it's because it is. The group released similar commercials targeting Sens. Kay Hagan (D-N.C.) and Jeanne Shaheen (D-N.H.). The spots followed another Shaheen ad from a different conservative group that deployed the same formula.
Unless and until the public changes its opinion about the president and his health-care law, it's a recipe Republican groups and candidates are expected to use this year. A lot.
Obama's vow that all Americans could keep their plans -- judged to be the "Lie of the Year" by the fact-checking Web site Politifact -- has diminished Americans' trust and confidence in him. Americans were split over the question of whether Obama is honest and trustworthy in a December Washington Post-ABC News poll. Fourteen months prior, a clear majority (56 percent) said they trusted the president.
The December poll also showed most Americans (62 percent) disapproving of the way Obama handled the implementation of his signature health-care law. So, it makes complete sense that Republicans would plan to flood the airwaves with ads against vulnerable Democrats mentioning Obama and health care as much as possible.
For those Democrats -- Landrieu is clearly one -- the counter-punch strategy has been pretty consistent: Distance oneself from the president on health care and point to where one has sought to pressure him on the matter.
"The fact is Sen. Landrieu has always supported measures to fix and improve the Affordable Care Act. She introduced legislation to keep the president's promise," said Landrieu campaign manager Adam Sullivan.
Sullivan largely echoed the thrust of Landrieu's first ad, in which she touted her plan to allow Americans to stay on their plans. The ad also suggested that her pressure helped lead to the president announcing a change in policy to clear the way for Americans facing plan terminations to extend their coverage temporarily. Meanwhile, Shaheen has separately proposed her own Obamacare fix.
It's true that the ways Republicans attack Obamacare and the ways Democrats defend themselves could change in the lead-up to the November election. But for now, there are no signs of that happening. Instead, it's Groundhog Day. Over and over again.

OBAMACARE ENROLLMENT DOUBLES. POLLS INDICATE THE WORST IS OVER

TALKING POINTS

Health insurance is so hot this holiday season. Some 250,000 people selected plans through state and federal online exchanges in November—twice as many than did during Healthcare.gov’s glitchy first month, according to a report released Wednesday by the Department of Health and Human Services. But the total is way below the White House's goal of 3.3 million enrollees by December 31, although administration officials insisted they could still reach their goal of seven million enrollees by March. Additionally, more than 800,000 people have realized they are eligible for Medicaid.




GREG SARGENT WASHINGTON POST

It’s too soon to reach any definitive conclusions. But new polls suggest Democrats can hit the pause button on their full blown panic about the health law’s political impact.
Yes, the new NBC/WSJ poll contains absolutely awful numbers for Obama and the Affordable Care Act. Fifty-four percent disapprove of the president, the highest of his tenure. He has slipped in key categories, such as honesty and crisis management. Half the country says the law is a bad idea. Notably, a majority says by 51-43 that they are bothered more by the terrible rollout and people losing plans than by GOP efforts to sabotage the law. Republicans are still mostly winning the public opinion war over the ACA.
But the poll also finds only 26 percent favor total elimination of the law. (Republicans will argue another 31 percent favors a major overhaul, which is true, but Dems can try to speak to that with a “keep and fix” message, while Republicans are trapped in a total repeal stance.) Also: 58 percent say it hasn’t had much of an impact on them; and Dems still hold a six point edge on the health care issue. After a crush of truly horrific press about the ACA, only one quarter of the country wants to get rid of the law, suggesting the law is probably still on probation with many voters, despite all its problems – meaning there may still be room to turn things around.
Meanwhile, a New York Times poll similarly finds half the country disapproves of the law and Obama’s approval rating is at 42 percent, but both of those are improvements since November. The Times headline — “Obama sees a rebound in approval ratings — seems like a big reach. But this claim from the article seems fair: “The political fallout from the website’s start-up might be over.”

Jason Reed/Reuters

Indeed, it’s possible the worst numbers reflect the awful rollout problems of November — which have now stabilized — and that the law will now begin to work moderately well. And that is all that matters: If it does work moderately well, and enrollment continues, and majorities continue to say it hasn’t affected them adversely, and only small minorities want to get rid of it, the law could recede from the headlines and have a mitigated political impact. Dems may be able to fight the Obamacare battle to a draw and fight out the 2014 elections over other issues, too. Of course, if it fails over the long haul, it will be a full blown political disaster for them. But only time will settle this.

A Contrite Obama Unveils a Health Fix

N.Y. TIMES

President Obama, trying to quell a growing furor over the rollout of his health care law, bowed to bipartisan pressure on Thursday and announced a policy reversal that would allow insurance companies to temporarily keep people on health plans that were to be canceled under the new law because they did not meet minimum standards.

The decision to allow the policies to remain in effect for a year without penalties represented the Obama administration’s hurriedly developed effort to address one of the major complaints about the beleaguered health care law. It seemed for the moment to calm rising anger and fear of a political backlash among congressional Democrats who had been threatening to support various legislative solutions opposed by the White House because of their potential to undermine the law.

Senate Democratic leaders said they did not see the need for an immediate legislative fix — a victory for White House officials worried that momentum was building toward consideration of a measure to force the change.

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It remained unclear, however, just how much impact the fix delivered by an apologetic Mr. Obama would actually have. Though his proposal grants discretion to insurers to allow people to stay on their existing plans, there is no guarantee that insurers will do so, or that the states will allow such renewals.

Also unclear are what prices will be charged by insurers for existing policies that are continued in force through 2014. Insurers generally did not have rates approved for the renewal of such coverage because the policies were supposed to be terminated at the end of this year.

Some state insurance commissioners caught off-guard by the announcement said they did not intend to allow insurers to reinstate the policies. And insurance companies denounced the president’s action.

 

“This fix won’t solve every problem for every person, but it’s going to help a lot of people,” said Mr. Obama, who repeatedly took personal responsibility for misrepresenting the law and saying Americans who like their coverage would be able to keep it.

“I completely get how upsetting this can be for a lot of Americans, particularly after assurances they heard from me that if they had a plan that they liked they could keep it,” Mr. Obama said. “And to those Americans, I hear you loud and clear. I said that I would do everything we can to fix this problem. And today I’m offering an idea that will help do it.”

The president’s plan would apply only to people who have policies that are being canceled. Those currently without insurance would not be able to buy the old plans.

 

The president’s “transition policy” was set forth in a letter to state insurance commissioners from Gary M. Cohen, the director of the federal Center for Consumer Information and Insurance Oversight.

Under the policy, Mr. Cohen said, “health insurance issuers may choose to continue coverage that would otherwise be terminated or canceled, and affected individuals and small businesses may choose to re-enroll in such coverage.”

People who keep the policies will be unable to obtain financial assistance available for new coverage purchased through insurance exchanges. If an insurer chooses to reinstate coverage that has been canceled, it must notify policyholders that they have a right to obtain coverage that complies with the law and provides additional benefits.

The administration said it would consider the impact of the transition policy in deciding whether to extend it beyond 2014.

 

JONATHAN CHAIT NEW YORK

 

In response to the raging Democratic freak-out in Congress, President Obama announced an administrative plan that would putatively permit people in the individual insurance market to keep their current plans. It’s impossible to say definitively what Obama’s proposal will do, but the most likely (and best-case) scenario is: very little.
The shorthand explanation for what’s going on here is that everybody — the insurance companies, members of Congress, and Obama — is bullshitting. The longhand explanation is a lot more complicated.

Insurance companies cancel their individual plans all the time. The Affordable Care Act grandfathered in current plans, but that grandfathering mostly depended on insurance companies deciding to keep those plans going, and few of them did: They decided instead to phase out their old plans and create new ones in the Obamacare exchanges. That’s why, even though Obama knew that his health-care law would disrupt the individual market, he didn’t expect the wave of cancellation notices that people have received. In his press conference today, Obama said that he expected that the provisions in Obamacare to grandfather in existing individual policy holders would work, and they didn’t.

 

Republicans in Congress, trailed by panicky Democrats, are trying to exploit people’s consternation by either allowing (in the case of Republican Fred Upton’s bill) or requiring (in the case of Democrat Mary Landrieu’s) insurance companies to continue these plans. But they are probably bullshitting about this, too: Insurance companies say it’s way too late for them to start reissuing plans for 2014 they hadn’t planned to issue.

Obama’s plan is to let people reup their individual market plans, if the insurers go along with it. Will many insurers go along with it? Probably not, but experts aren’t exactly sure. If not, then all the keep-your-plan promises floating around — Obama’s, the Democratic plans, the Republican plans — are closing the barn doors after the horses have fled.

To the extent any of these proposals actually would work, their effect would be harmful. Most people who have individual insurance now get that insurance because they’re really healthy. Draining them out of the exchanges would leave the exchanges with a sicker pool of customers, eventually driving up rates.

Now, that wouldn’t be a disaster in the short run. Obamacare creates protections for insurance companies that get stuck with sicker customers over the first few years. (A good, short explainer for how this works can be found here.) That would protect the system from the dreaded actuarial “death spiral," but would also cost the government money.

Does Obama’s plan solve the policy problem of people losing their plans? Probably not — the main mechanism is to let Obama throw the blame to insurance companies (many of whom, as noted, originally threw the blame at Obama.) Does it solve the political problem of angry individual market customers? Again, probably not — many and perhaps most people won’t be able to keep their individual plans. Democrats also want the chance to take an affirmative vote to “fix” Obamacare, and an administrative ruling doesn’t let them do that. Obama’s announcement mainly leaves the law in the same place it’s been for a month and a half: waiting to see if the administration can fix the website.

GREG SARGENT WASHINGTON POST

But here’s the thing: No matter what Dems continue to say — and no matter how hard Republicans try to foment disarray among them — it’s far from clear that any legislative fix can pass and go to the president. As one senior Senate Democratic leadership aide put it candidly to me: ” House Republicans won’t support the Landrieu bill. Upton wouldn’t pass here. So nothing will pass both Houses and get to the president.”
All of which is to say that all of the chips have been placed on Obama’s administrative fix. That’s probably the only fix we’re getting, and the rest of the machinations among Dems are probably going to amount to little more than noise and posturing. Indeed, even Obama’s fix, if insurers don’t play along, is probably not going to be a major factor.
So we’re back where we’ve always been: All that really matters is whether the law works over the long haul, and the fate of Dem lawmakers is heavily bound up in that outcome. Dems should probably just resign themselves to that political reality and do all they can to make the law a success, and to communicate to constituents that patience and a long view are necessary.
 

DEMS GET ANXIOUS (VERY) OVER OBAMACARE PROBLEMS

Sen.Mary Landrieu (D., La)


N.Y. TIMES  

Anxious congressional Democrats are threatening to abandon President Obama on a central element of his signature health care law, voicing increasing support for proposals that would allow Americans who are losing their health insurance coverage because of the Affordable Care Act to retain it.

The dissent comes as the Obama administration released enrollment figures that fell far short of expectations, [cf. Five Star Final] and as House Republicans continued their sharp criticism of administration officials at congressional hearings examining the performance of the health care website and possible security risks of the online insurance exchanges.

In addition, a vote is scheduled Friday in the Republican-controlled House on a bill that would allow Americans to keep their existing health coverage through 2014 without penalties. The measure, drafted by Representative Fred Upton, the Michigan Republican who is the chairman of the Energy and Commerce Committee, is opposed by the White House, which argues that it would severely undermine the Affordable Care Act by allowing insurance companies to continue to sell health coverage that does not meet the higher standard of Mr. Obama’s health care law.

 

But a growing number of House Democrats, reflecting a strong political backlash to the rollout of the law, are warning the White House that they may support the measure if the administration does not provide a strong alternative argument. The approaching House vote is shaping up as an important test for both the health measure and the unity that Democratic leaders have so far been able to maintain around it despite a fierce Republican attack.

 

In a closed-door meeting Wednesday of House Democrats and White House officials, tensions flared as several lawmakers upbraided the administration, saying that the president had put Democrats in a tough political position by wrongly promising consumers that they could keep their existing health care plans. In fact, hundreds of thousands of Americans have received cancellation notices from their insurers because their health care coverage does not meet the minimum standards dictated by the new law.

 

“I think the Upton bill is terrible, but we need something else to vote for in order to keep our word to the American people. We told people in those plans that they were grandfathered in, and if they wanted to stay in them, they could, and we need to honor that.”

A similar proposal, which would allow people to keep their current health insurance permanently, is also drawing support in the Senate under an effort led by Senator Mary L. Landrieu, Democrat of Louisiana.

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Insurance companies, already deeply worried about the low enrollment in the plans they are offering on the insurance exchanges, say congressional proposals to force them to allow canceled policies to be reissued could be disastrous. Robert Zirkelbach, a spokesman for America’s Health Insurance Plans, the industry’s lobby, said insurers “have significant concerns on how it would work operationally.”

But with no alternative proposal from the White House as of Wednesday, Democrats were increasingly critical.

HUFFINGTON POST

 Senator Jeff Merkley — a blue state Dem — surprised Obamacare supporters when he signed on to Mary Landrieu’s fix to the bill, the “Keeping the Affordable Care Act Promise Act,” which would require insurers to continue plans for a year.

Coming from one of the Senate's most notably progressive voices, the Oregon Democrat's announcement was a particularly vivid demonstration of how nervous party members are over the state of the Affordable Care Act. The flawed website, combined with the steady stream of news of insurers forcing people to adopt more comprehensive and at times expensive plans in response to new regulations, had already persuaded five other Democrats to support the Keeping the Affordable Care Act Promise Act, introduced by Sen. Mary Landrieu (D-La.).

Meanwhile, in the House, ...lawmakers in that chamber were, by and large, staying away from the Republican-pushed measure that would allow people to stay on their plans for another year. But top aides were warning of a swarm of potential defections should the Obama administration not introduce its own administrative fix for the issue of canceled health insurance plans by the end of the week.

A Democratic aide said that the case being made against the Upton bill was multilayered. Not only would it allow current policyholders to continue their coverage, opponents argue, but it would allow new applicants to purchase that coverage as well -- all but encouraging healthy individuals to avoid the exchanges in favor of cheaper plans while leaving sick and older Americans in the newly created marketplace. The other major problem with the Upton bill that the aide noted was that it would extend this grandfather provision for just a year, meaning that people would be receiving cancellation notices in October of next year, a month before the 2014 elections. This, the aide noted, would be "problematic."
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Then there is the question whether any of these bills could possibly work. After all, hundreds of thousands of cancellation notices have already gone out from insurers. A law that would essentially nullify those cancellation letters would require a huge administrative undertaking to execute. Insurers would have to send out updated letters, they'd have to ensure that the old plans complied with state regulations, and they'd have to re-enroll individuals who wanted to retain their policies.
"I'm sure the industry would like to do this. Don’t get me wrong. But everyone has to realize it took the insurance industry the better part of the year here to get ready for this," said Robert Laszewski, a health insurance industry consultant at Health Policy and Strategy Associates and a skeptic about the ACA. "It is practically impossible to do this. You can't put the genie back in the bottle. The insurance industry was ready for Obamacare but the Obama administration is not. When the Obama administration hit the go button, the dominoes were set in motion."  

OBAMACARE ENROLLMENT NUMBERS ARE LOW, BUT LOOK CLOSELY

GREG SARGENT WASHINGTON POST

The enrollment numbers are in, and as expected, they are well short of projections. Around 106,000 enrolled in new plans during October — with approximately 27,000 coming from states where the federal government is running the exchange (with its extensive problems), and another 79,000 coming through the state exchanges. Republicans are gleefully pointing to the numbers as proof Obamacare needs to be scrapped entirely.
That confirms two things we’ve long known to be true: the website is a disaster, and short term enrollment figures are a serious political problem for the White House and Democrats. But to Larry Levitt, a vice president at the nonpartisan Kaiser Family Foundation, another very telling number is this one: over 975,000 have been determined eligible for a marketplace but haven’t yet chosen a plan.

“That’s one of the most telling numbers — a million people have been determined eligible,” Levitt tells me. “That means if the website had been working well, and a million people had gotten to the end of the process, we’d be looking at a very different trajectory now. We heard about the surge in traffic when HealthCare.gov went live. This suggests there is in fact a lot of interest.”
The thing is, though, that even this one-million number highlights both the perils and the potential upsides in not getting the damn website fixed. It shows us that if it isn’t fixed demand isn’t going to matter at all — enrollment will be very low, regardless of demand, putting Obamacare’s long term prospects in peril. But if it does get fixed, of course, you could see a real enrollment spike.

Meanwhile, the 100,000 number is getting a lot of attention, but the report also finds nearly 400,000 were determined eligible for Medicaid. “In total that’s over 500,000 people who signed up for insurance in the midst of a tumultuous launch,” Levitt says. “People make a distinction between the marketplace and Medicaid, but those are both elements of the Affordable Care Act — both are mechanisms to get people insured.”

Republicans will argue that as it stands now, many more people are feeling an adverse effect from Obamacare — by losing coverage or seeing higher premiums. That is a very valid point. But the crux of the issue is that the question of how many will benefit, and how many will be adversely impacted, is far from settled. We don’t know how many people will sign up, and we don’t know how many people will really be adversely impacted, since many may find plans on the exchanges they like better – many may find those plans provide a better deal in the long run or that subsidies keep their prices low.
Indeed, if it’s true that today’s numbers show demand is high — and if the website does get fixed – GOP smugness about the collapse of Obamacare may look awfully shortsighted in a few months. As bad as today’s numbers may have been — and allowing that the law’s success over time is anything but assured — Obamacare is moving forward, and we have a glimpse of what that really looks like.

HARD TIMES FOR OBAMA

MICHAEL TOMASKY DAILY BEAST

There’s a new Pew poll that has him at 41 percent approval, 53 disapproval, which Pew notes ominously is only five percentage points better than George W. Bush’s at this point in his term. (Hurricane Katrina had happened in August of Bush’s fifth year.) Conservative columnists are chuckling and clucking and tweeting to beat the band. Centrist journalist Mark Halperin, on MSNBC yesterday, declared that Obama had lost the media, which was now cheering against the success of the Affordable Care Act and just wants to see… well, people go without insurance, I guess. If everything—everything!—isn’t fixed by Nov. 30, we’re looking at a presidency that is going to collapse into utter disaster. It’s obvious enough why conservatives would be saying this. They’ve wanted Obama to fail from the start, and they’ve certainly wanted the health-care bill to fail from the moment of its passage.

Mark Halperin

Journalists like Halperin say these things not for ideological reasons, but temperamental ones: In this Halperinesque/Politico-esque world view, politics is less about people’s lives than it is about who is displaying mastery of the game and who is being mastered at any given moment (of course, seeing politics so insistently through that lens is a kind of ideology of its own, but we’ll let that pass). To that group of mainstream journalists, how Obama handles the current crisis will determine whether the administration will survive or whether he might as well just resign now.

I don’t deny that the current situation is a crisis, and one of the administration’s own making. Obama misled people. It’s a small percentage of people. They’re at the mercy of the most horrible end of the private-insurance market, and the vast majority of them are going to be better off after everything shakes out and they see that their new plans are largely better than their old ones were. But even so, they’re people, and they’re getting termination notices, and he misled them. Combine it with the website chaos, and it’s bad, there’s no sense in denying it.

What I do deny, vigorously, is that this is a make-or-break moment. Yes, I know that Obamacare is his signature initiative and all that. And I know that if problems persist after Nov. 30, pressure will mount on Harry Reid to let some kind of tinkering legislation be debated. This is a very important three weeks for the administration, and the 30th is an extremely important deadline.

But there’s a certain type of political journalism that so exists in the moment that numerous such moments have been declared to be disasters for Obama, going back to Jeremiah Wright. This kind of hyperventilating approach always turns out to be wrong and overheated. It turned out that all those things were pretty bad, but it also turned out that Obama survived them. And he’ll survive this, too.

What will happen in all likelihood is what usually happens in life and politics—that is, nothing all that dramatic. Nov. 30 will come, and the website will be more or less (though not entirely) fixed up, and life, and Obamacare, will go on. There will be more horror stories, natch, but there will be more success stories too, and sometime between now and next March 31, when the enrollment period ends, the media are going to get a little bored with the whole thing, and it will just go on irresolutely for a while, but eventually it will start becoming clear to the American people that the reform is working pretty well in the states that tried and pretty poorly in the states that didn’t, and people will start to get the point about Republican sabotage.

And then, provided health care survives that initial stage without being altered for the worse by Congress, it’s going to start to work. Well. Resistant insurance companies and even some resistant governors and state legislatures are going to see that it appears to be here to stay, and they will accommodate themselves to that reality.

Obamacare will never be a raging success. This is another error much of journalism is prone to make—looking for it to be an overwhelming success. That won’t happen because at the end of the day we’re still talking about private health insurance, and private health insurance was a pain in the tuchus before Obamacare and will remain one after it. People will always complain about their coverage. But by early 2016, I have little doubt, there will be millions more Americans who’ll be doing the complaining, and they’ll be happy to have the opportunity to do so.

Conservatives are desperate for health care to be Obama’s Katrina. Certain centrist journalists want to see it just for entertainment’s sake or as a test of Obama’s presidential “character.”  I won’t say there’s zero chance of it happening. If Nov. 30 comes and the website is an unmitigated disaster, then maybe that’ll be the case. But I will say that I think the chances of it are very slim indeed. The unfortunate thing is the Republicans have just enough power to gum up the works [italics Esco's] so that even if the administration does fix up everything on its end, the GOP can keep hauling Kathleen Sebelius up to the Hill and taking other steps to make sure things look worse than they are. But Obama will survive, and more importantly, Obamacare will too.

 

POLL: AMERICANS BELIEVE IN OBAMACARE

GREG SARGENT WASHINGTON POST

With Democrats continuing to grow more skittish about Obamacare’s awful rollout problems, the Kaiser Family Foundation is out with some important new polling that deserves a careful look from Dem Congressional officials — and political commentators.
The most important finding in the Kaiser poll — which is in some ways the gold standard of health care polling — is that significantly more Americans want the Affordable Care Act kept or expanded than want it repealed and replaced with a GOP alternative or with nothing at all. Here’s the key finding:

What would you like to see Congress do when it comes to the health care law?
Expand the law: 22
Keep the law as is: 25
Repeal the law and replace it with a Republican-sponsored alternative 13
Repeal the law and not replace it: 24

A total of 47 percent wants to keep or expand the law, versus 37 percent who want to replace it with a GOP health reform plan or scrap it completely.

This poll was taken October 17-23, more than two weeks after the problem-plagued rollout began (though in fairness, before the “you can keep your plan” furor blew up).
How is it possible that more Americans want to stick with the law, when it’s obviously (as Republicans and some commentators say) such an epic disaster, both in policy and political terms alike?

The answer lies in the way the question was asked, and this has important larger implications. Kaiser’s line of questioning may be the best out there at shining light on what people really mean when they say they either support or oppose the law (a plurality of 44 percent view it unfavorably), and what they really mean when they say they want to get rid of it. If anything, the question is generous to Republicans, because it offers respondents the choice of an unspecified generic Republican alternative. Ultimately, what this finding suggests is that, whatever their dissatisfaction with Obamacare, people do not want to return to the previous system, and perhaps more crucially, do not believe Republicans are offering a serious alternative. Indeed, only 13 percent favor repeal and replace, GOP style.

...Among GOP voters, the Kaiser poll shows a split: Only 29 percent of Republicans want repeal and replace, versus 42 percent of Republicans who want to scrap the law and replace it with nothing.
In other words, the de facto GOP position is to go back to the old system. Rather than do that, more Americans want to stick with Obamacare.
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But Didn’t President Obama vow that Americans who like their insurance would get to keep it? 

JONATHAN COHN NEW REPUBLIC:

The essential transformation that I wrote about yesterday continues to frustrate many people who have health insurance.  Insurers are refusing to renew existing insurance policies for hundreds of thousands and maybe millions of Americans, usually because those new policies do not satisfy Obamacare regulations that take effect in 2014. The people losing insurance have a chance to get modified or new policies that typically offer better, more secure coverage. But the prices they are seeing tend to be higher than what they are paying now. These people are asking a lot of hard questions, which Republicans are amplifying today. Why can’t these people simply keep the policies they had before? Didn’t President Obama vow that Americans who like their insurance would get to keep it?

Yes, he did. And he was wrong to make that promise, at least in such clear-cut terms.

It applies perfectly well to the overwhelming majority of Americans who get insurance from an employer, Medicare, or Medicaid, since these plans and programs aren't really changing in ways that most consumers would notice. But people who buy coverage on their own, through brokers or directly from insurers, are in for some big changes. They constitute a tiny portion of the population but, because this is a large country, they are still a sizable group in raw numbers. (Somewhere between 10 and 20 million, depending whose estimates you believe.) Many of them are the ones hearing from insurers now.
It would have been perfectly fine for Obama to say most Americans get to keep their coverage or to qualify his statement in some other way. And administration officials offered such nuance when asked.


Health and Human Services Secretary Kathleen Sebelius has apologized to the nation for the botched launch of the Obamacare website, admitting that Americans 'deserve better

....
But ultimately the more important question is about what’s actually happening to these people losing their current policies—and why. This transformation is not just a consequence of Obamacare. It's very much the intent. And for very good reason.
By nearly everybody's reckoning, the "non-group" market is the most dysfunctional part of the American health insurance system. The dysfunction takes two primary forms. First, insurers have been selective about whom they would cover and how—charging higher premiums, covering fewer services, or simply denying benefits outright to people with pre-existing medical conditions. About half of all Americans have at least one such condition, according to official estimates, so roughly speaking about half the population couldn't reliably find comprehensive, affordable coverage if they had to buy it on their own.

The second big problem with the non-group market has been the lack of protection it provides even those people who think they have good insurance. At worst, plans in the non-group market border on fraud. They are “mini-med” plans that cover no more than a few hundred dollars of bills, which will last you about ten minutes if you visit the emergency room. But even the better, more respectable plans can exclude whole categories of services, like maternity care, rehabilitation, mental health, or prescription drugs. Typically they also have high deductibles and co-payments.
These policies may seem alluring, because they don’t cost much upfront. But these premiums are notoriously unstable. From time to time, insurers will “close” blocks—in other words, they stop letting new people into the plan—and then jack up rates once a few of the insured get sick. The paperwork on the plans is also opaque. While some people have trustworthy insurance brokers to help them, many rely on less informed counselors or attempt to sort out the confusing insurance options on their own. When they end up in the hospital, they discover they still owe tens of thousands of dollars in medical bills—sometimes, enough to force them into bankruptcy.
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 The major goal of Obamacare is to end these insurer practices and get those less protective policies off the market. The law prohibits insurers from withholding benefits, charging higher prices, or denying coverage altogether to consumers because they have pre-existing medical conditions. It sets a minimum standard for “essential benefits” that all policies must cover—including, yes, maternity care and mental health. It bans annual and lifetime limits on what policies will pay. And it limits the out-of-pocket costs consumers can pay in one year.
 But if insurers are going to cover more, they’re also going to charge more. That's why premiums for the new plans are higher. Obamacare addresses that problem by offering subsidies, worth hundreds of dollars in some cases and thousands of dollars in others. The result is that many people will actually pay less every month for the new policies than they are paying now. They may also get assistance with out-of-pocket expenses. But some people really will pay more for replacement policies and some of them will not find it easy. Meanwhile, many people eligible for the subsidies frequently don’t know they are available, let alone how much they are worth, because of the website problems. The media isn’t helping here, since stories about cancellations and higher rates frequently say very little about the subsidies—or fail to mention them altogether.

Obamacare isn't the only or even the best way to address the problems of the non-group market. You could move everybody onto a single, public insurance plan. You could regulate insurance prices as if the industry was a utility. Or you could simply increase the value of the subsidies. (I'd gladly support any of those.) But all of those require some combination of more government and more money, which is not politically possible right now. Conservatives have their own alternatives, some of which would let more people keep their current policies and some of which would almost certainly lead to more people losing their current policies. But under either of those options, many fewer people would get insurance—and those who had insurance would have less protection.

Regulation always involves tradeoffs. Food is more expensive because government demands the processing companies take steps to avoid contamination. Houses cost more because government insists builders use sturdy materials. Plenty of people would be happy to take their chances with less stringent regulations, but the government bans the sale of such products, even if they might be cheaper for some, because they are hazardous to the public's health.
A similar choice is at the heart of this latest controversy. You can set higher standards for insurance, even though it means forcing some people to get better coverage. Or you can leave the standards as they are, even though those standards expose people to financial and medical calamity. Obama and his allies chose the former. Those who disagree should explain why they prefer the latter.

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THE BIG CHOICE ON OBAMACARE: Jonathan Chait goes deep into the basic tradeoff that the law’s overhaul of the health care market requires, explaining why “letting people keep their insurance” would undermine that tradeoff. This:

People accept this transfer from the healthy to the sick because it is the only way to make medical care affordable to the sick…If you believe the healthy are entitled to keep the financial benefits of their good health, then you must also believe the sick must be denied medical care. Should that principle be the foundation of our health-care system?

As Chait suggests, this is the moral choice the law asks folks to make. The above polling suggests it’s possible people are prepared to make this trade. Republicans will argue that once more people clearly understand the true nature of this choice, they’ll want to get rid of it. Related to this is the question of how many people will pay more, and how many will benefit. We’ll just have to wait and see.



GREG SARGENT WASHINGTON POST
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There’s no minimizing the political problems the web site is currently creating for Dems, and it remains possible that the politics of Obamacare could get significantly worse. But one possibility that no one seems to be entertaining is that the current battle could end up seriously backfiring on Republicans. If the web site does get fixed — and if demand proves to be such that enough people enroll – what do Republicans say at that point?

Republicans will have spent weeks expressing outrage on behalf of Americans who have been unable to tap into the benefits of Obamacare because of administration incompetence, and on behalf of people who are “losing” coverage because of outrageous liberal Big Government overreach. At that point, though, the web site will be working, and untold numbers of people will be shopping for real, tangible plans. Many on the individual market will find plans that are better, and potentially even cheaper overall — whether because of subsidies, or because the plans don’t disguise their true long term cost, as the current, crappy ones do – than their previous ones. None of this is a given, obviously; again, it all turns on whether the law works.
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I don’t know how long public patience will last on Obamacare. Perhaps the fuse is very short. And the possibility that Obamacare will fail — creating a political disaster for Dems — remains real. But Republicans seem absolutely certain that this will inevitably be a long term political bonanza for them, and that there’s simply no chance the law could end up working. Of course, this is hardly surprising, given that they’ve largely organized the party around the guiding idea that Obamacare is nothing but an epic catastrophe that can only be redeemed by eviscerating it entirely, and that the public is with them all the way. That was partly what led Republicans to adopt the disastrous shutdown strategy. I wouldn’t discount the possibility that it could be leading them into another long term miscalculation right now.

GAME OVER! REBOOBLICANS LOSE. DEFAULT AVOIDED, GOVT REOPENS

N.Y. TIMES

Congressional Republicans conceded defeat on Wednesday in their bitter budget fight with President Obama over the new health care law as the House and Senate approved last-minute legislation ending a disruptive 16-day government shutdown and extending federal borrowing power to avert a financial default with potentially worldwide economic repercussions.  The Senate voted overwhelmingly on Wednesday evening, 81 to 18, to approve a proposal hammered out by the chamber’s Republican and Democratic leaders after the House on Tuesday was unable to move forward with any resolution. The House followed suit a few hours later, voting 285 to 144 to approve the Senate plan, which would fund the government through Jan. 15 and raise the debt limit through Feb. 7.  Most House Republicans opposed the bill, but 87 voted to support it.

The result of the impasse that threatened the nation’s credit rating was a near total defeat for Republican conservatives, who had engineered the budget impasse as a way to strip the new health care law of funding even as registration for benefits opened Oct. 1 or, failing that, to win delays in putting the program into place.

The shutdown sent Republican poll ratings plunging, cost the government billions of dollars and damaged the nation’s international credibility. Mr. Obama refused to compromise, leaving Republican leaders to beg him to talk, and to fulminate when he refused.

Under the agreement to reopen the government, the House and Senate are directed to hold talks and reach accord by Dec. 13 on a long-term blueprint for tax and spending policies over the next decade. Mr. Obama said consistently through the standoff that he was willing to have a wide-ranging budget negotiation once the government was reopened and the debt limit raised.


      

Mr. Boehner and his leadership team had long felt that they needed to allow their restive conference to pitch a battle over the president’s health care law, a fight that had been brewing almost since the law was passed in 2010. Now, they hope the fever has broken, and they can negotiate on issues where they think they have the upper hand, like spending cuts and changes to entitlement programs.       

 

 

But there were no guarantees that Congress would
not be at loggerheads again by mid-January, and there is deep skepticism in both parties that Representative Paul D. Ryan of Wisconsin and Senator Patty Murray of Washington, who will lead the budget negotiations, can bridge the chasm between them.



 
 Wisconsin Republican Rep. Paul Ryan (L) and Washington Democratic Sen. Patty Murray will co-chair a new joint budget committee conference charged with finding a budget and spending solution by Dec. 13

Senator Mitch McConnell of Kentucky, the Republican leader who was instrumental in ending the crisis, stressed that under the deal he had negotiated with the majority leader, Senator Harry Reid of Nevada, the across-the-board budget cuts [the sequester cuts] extracted in the 2011 fiscal showdown remained in place over the objections of some Democrats, a slim reed that not even he claimed as a significant victory.

For Mr. Boehner, who had failed to unite his conference around a workable plan, Wednesday’s decision to take up the Senate bill proved surprisingly free of conflict. Hard-line Republican lawmakers largely rallied around the speaker. Mr. Boehner, they said, ...his conference found itself divided among three conflicting factions: moderate Republicans who were simply eager to reopen the government; those who opposed a provision that would have made members of Congress, White House officials and their staffs ineligible for government contributions to their health insurance on the new exchanges; and conservatives who felt the proposal did not go far enough in dismantling the health care law.

Conservatives in the House also remained skeptical that they would gain the upper hand in the near future. [They] said that with the president still unwilling to negotiate in good faith, he thought it was unlikely that Republicans would extract many concessions in any upcoming conference over the budget between the House and the Senate.
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 An aide brings a cart stacked with pizza to the office of Speaker John Boehner


GREG SARGENT WASHINGTON POST

Dems [hope]that the closer to the 2014 elections we get, the harder it will be for Republicans to stage another debt ceiling hostage crisis.

Democrats don’t want such a crisis. They would prefer that Republicans simply agree to extend the debt limit cleanly. But by pushing this [early] into the 2014 election season, they are giving themselves a kind of insurance policy that guarantees that if Republicans do stage another debt limit crisis, Republicans will pay a serious political price for it.

On the one hand, you’d think that this arrangement simply guarantees that the debt limit will hang over the next talks, meaning it will give Republicans leverage. ... But Democrats ...believe Republicans will have capitulated on the debt limit twice in a row — this time, and earlier this year — and that the political fallout from the current crisis has been so bad for Republicans that party establishment types will be eager to avoid the same thing happening again [in] 2014.

It’s true that those who will try to force another debt ceiling crisis are Tea Party conservatives who don’t much care about the overall political health of the GOP. But as this Democratic aide explains to me, this is precisely the point: More pressure from the right for yet another debt limit crisis close to the election will be even worse for the GOP, because it could again divide the party and potentially force 2014 GOP candidates (particularly those involved in primaries) to adopt an extreme position, damaging them for general elections.

“The effect of this fight has been to destroy the Republican brand and put their 2014 candidates behind the eight ball,” the aide tells me. “We are not trying to bait them into another fight. We’d rather put it past the election. But it’s really up to them. If they want to recommit political suicide  [eight] months before an election, that’s going to be their choice. We’re going to make sure that if this happens it has real consequences for them.”

And so, Dems are hoping that Republican leaders will have even more of an incentive next time to squash any demands from the right for another default hostage crisis. In this scenario, Dems effectively  neutralize the debt limit over the long term, in exchange for accepting sequester level spending into December (only one month longer than under a “clean CR,” which Dems were already prepared to accept). If that worked, it wouldn’t be a bad outcome. Or, if the debt limit isn’t neutralized and Republicans do stage another hostage crisis, the GOP again would devolve into chaos, again underscoring the party’s addiction to destructive, intransigent, crisis-to-crisis governing with only months before Election Day 2014.

That’s the idea, anyway.

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WASHINGTON POST

....despite what most see as a debacle for Republicans, a core group of conservatives insisted Tuesday that they are winning their battle to force concessions from Democrats on fiscal issues.

The president, they say, has been forced into a negotiation, even though he has said he will cede nothing in exchange for opening the government and raising the debt ceiling. The nation’s attention has been focused on problems with the health-care law. And, they say, making Boehner move to the right is itself a victory.

Rep. Andy Harris (R-Md.) said conservatives have succeeded in exposing problems with the health-care law.
“Oh my gosh, we’ve lit up Obama­care for the whole nation,” he said, describing what his wing of the party had won in the shutdown. “Look, the rollout was atrocious, this is a fundamentally flawed plan, and we have made it crystal-clear to the American public that we stand with them on Obamacare.”

That attitude illustrated a split within the GOP that has only grown more profound in the days since the shutdown started: Hard-liners are sure that their position is gaining strength, while moderates and a number of Republican leaders counter that the party has experienced an epic collapse.
“We didn’t get anything. This has been a total waste of time,” said Rep. Peter T. King (R-N.Y.), one of the most consistent critics of his party’s most conservative members.




MICHAEL TOMASKY DAILY BEAST

This is a sad and sickening spectacle,...Today, we have a clavern of sociopaths who know nothing of honor, and we have no easy way to stop them. Except at the ballot box. Except that they’ve rigged that, too, with their House districts. They’ve rigged the whole game so that they light the match and then point at President Obama and shout: “Look! Fire!”
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This is the worst it’s ever been in modern America. But it is going to get worse. They aren’t going to stop hating Obama and Obamacare. They aren’t suddenly going to decide to make their peace with him or it. They sure aren’t going to decide that gee, using default as leverage is naughty. A big chunk of them want the United States to default on Obama’s watch, so they can then blame him for what they themselves caused, say, “The black guy wrecked the economy. Couldn’t you have predicted it?” New horrors await us that you and I, being normal people, can’t begin to dream up. But rest assured, they will.