Garance Franke-Ruta

Garance Franke-Ruta is a senior editor covering national politics at The Atlantic. More

Franke-Ruta was previously national web politics editor at The Washington Post, and has also worked at The American Prospect, The Washington City Paper, The New Republic and National Journal magazines. In 2007, she and the other contributors to The American Prospect 's blog "Tapped" won the Hillman Prize. In 2006, she was fellow at the Joan Shorenstein Center on the Press, Politics and Public Policy at the Harvard Kennedy School in Cambridge, Mass., and in 2007, a summer fellow with The Iowa Independent, based in Des Moines, Iowa. Garance has lectured at the John F. Kennedy School of Government, the Harvard Art Museums, Williams College, Wellesley College, Brandeis and Georgetown Universities, and taught in Georgetown's Master of Professional Studies in Journalism program. She has also has made numerous appearances on national and regional television and radio programs. Born in the South of France, Franke-Ruta grew up in San Cristobal de las Casas in Chiapas, Mexico; New York City; and Santa Fe, New Mexico. She has lived and worked in Washington, D.C., since graduating from Harvard in 1997.

Bill de Blasio and New York City's Liberal Comeback

Bill de Blasio with his daughter, wife, and son at a polling station in Park Slope, Brooklyn on Tuesday. (Lucas Jackson/Reuters)

Updated, 9:07 p.m.

New York City Public Advocate Bill de Blasio decisively won the mayoral contest in America's largest city Tuesday, after weeks of maintaining an enormous lead in polling in the contest against Republican Joe Lhota.

Lhota, despite being one of the city's heroes of September 11 and a critical deputy to Mayor Rudy Giuliani during the terrible months that followed, failed to ever introduce himself adequately to voters and suffered from a lack of support from allies of outgoing Mayor Michael Bloomberg, an independent who was first elected on the Republican ticket in 2001.

De Blasio, meanwhile, was able to consolidate support and goodwill rapidly during the Democratic primary after former Representative Anthony Weiner's comeback campaign imploded and City Council Speaker Christine Quinn's hit a ceiling of support. De Blasio's "tale of two cities" message connected with a Democratic electorate hungry for a liberal standard-bearer, and he used the momentum from his primary win over Quinn and former Comptroller Bill Thompson to draw wide support across the city with promises to speak up for New Yorkers who felt left behind by the Bloomberg era.

It turns out there are a lot of them, and exit-poll results Tuesday night showed that his broad support held on election day. With his mixed-race family and his harsh criticism of Bloomberg's stop-and-frisk policies, de Blasio was able to unite the city's minorities and liberal whites into a formidable coalition looking for a new direction.

"De Blasio will win because New Yorkers have not accepted that this tale of two cities needs to be our future," said John del Cecato, the de Blasio campaign's chief media strategist, on Tuesday afternoon. But the win isn't just the heavily Democratic city returning to type after five terms with Republican or independent mayors, as some have postulated: The extraordinary margin of support for de Blasio—a lead of more than 40 percent in pre-election polls—showed a hunger for "a mayor who will take the city in a progressive new direction to address the needs of the middle class, working class, and poor while keeping our city safe and making it a city of neighborhoods again," del Cecato said.

Conservative opponents have warned darkly of a return to the crime and grime New York of the 1980s, the last time a Democrat won the office. But with crime down in cities nationwide and New York's physical spaces much improved over the past 20 years, that seems unlikely. As The New York Times reported in August, "New York has added 40,000 new buildings since [Bloomberg] took office, and the census counted an additional 170,000 housing units in 2010, up from 10 years earlier, more than any other city." And that's not even counting the improvements of the Giuliani era.

But New York's most recent comeback, after the Great Recession, was unevenly distributed. Wall Street soared to new heights, but the poverty rate ticked up by 2012 to 21.2 percent and income inequality reached record levels. Last year Manhattan had "the dubious distinction of having the biggest income gap of any big county in the country," according to the Times.

De Blasio is "where the city wants to be right now—the things de Blasio is talking about," said Jerry Skurnik, a Democratic New York political consultant. He ticked them off: reforming the police, less top-down government, addressing income inequality, a more traditional kind of New York government.

By that Skurnik also meant a more Democratic approach to government, one that considers paid sick days a more important way to help New Yorkers get healthy than outlawing oversized sugary drinks.

 "The message he’s doing really fits the mood of the city right now," said Skurnik. "People think Bloomberg did a pretty good job as mayor and they can’t wait to get rid of him."

The Infinite Bewilderment of Signing Up for Obamacare Subsidies

Screenshot

Having spent quite some time last week deep in the weeds of Obamacare, whacking my way through the burrs and brush of its extensive questionnaires with a story subject, I am here to tell you two things. First, it is confusing. Second, every little bit of misinformation and confusion matters.

The main reason the uninsured give for not buying insurance after visiting the new Obamacare websites is that they're not certain if they can afford a plan, according to a report Monday by the Commonwealth Fund's Affordable Care Act Tracking Survey. You might hope to answer this question easily with a few pieces of information and a calculator. But you can't.

Take, for example, the site eHealthInsurance.com, the largest private exchange for purchasing health insurance in America. It's has put together a user-friendly calculator allowing people who are having trouble with Healthcare.gov or the state health-insurance-exchange sites to get a sense of whether or not they are eligible for subsidies under Obamacare. Reporters have started using the information from the calculator to debunk Obamacare horror stories. Regular people have started using it to think about what they're eligible for. The online insurance company offered just last week to take over the "shopping and enrollment process in all 36 federal exchange states—without cost to the taxpayer" while Healthcare.gov is getting fixed. The company is a licensed partner of the Department of Health and Human Services, and it's becoming a place where people can actually buy federal-subsidy-eligible insurance plans.
 
But until Friday night, its existing subsidy calculator (screenshot, above) was wrong. Right there, where it asked people for income, it clarified that it was asking for taxable income. But Obamacare subsidies are not calculated using taxable income (line 43 on a Form 1040). According to the IRS and Kaiser Family Foundation Vice President Gary Claxton, they are calculated using something called MAGI: modified adjusted gross income (which is basically line 37, with some minor modifications).
 
The difference between the two figures is that the income on which you pay a tax has already been reduced by the amount of either Schedule A itemized deductions, or the standard deductions. The net result is that if people use this calculator and enter their taxable income into it, they will think they are eligible for subsidies of a certain size—or maybe even eligible for subsidies at all—when they in fact are not, because they will be working from the wrong version of what their income is.
 
Nate Purpura, director of communications for eHealth, said the calculator was not supposed to be totally accurate. "This is one of those things where its really hard to calculate for everyone," he told me. "It's not perfect. It's an estimator, and we try to really explain how this works in the longer disclaimer."
 
Prompted by a call from The Atlantic, the company added a link from their calculator to a page talking about MAGI over the weekend.  That sort of fixes the problem, but only for people who normally go two clicks in on a site, which as everyone who works on the web knows only a small minority of them.
 
The situation is not much better over at the Kaiser Family Foundation's subsidy calculator, which is, by reputation, the best independent mechanism people can use to get a sense of whether they are eligible for subsidies or not:
 

As you can see, the calculator asks for total household income. But, as I discovered last week, this is easier said than done for people who work as freelancers, contractors and the like—precisely the sort of self-employed people you're most likely to find in the individual insurance market. The difference between gross income and adjusted gross income is not going to be huge for most people who are lower- to middle-class and get paid through W2s. But for people paid through 1099s and piecemeal work, adjusted gross income can be thousands of dollars lower than gross income, since it's the figure that comes after all the Schedule C deductions (such as for home office, internet, business use of a phone, computer equipment, etc.).

Forms that are not precise about what constitutes income for the purposes of calculating the subsidy make the process of figuring out eligibility for Obamacare subsidies as confusing as doing your taxes without an accountant, TurboTax or that fat newsprint book of instructions from the IRS.

To Kaiser's credit, if you check its FAQ, it does explain the MAGI situation. But for individuals who are perhaps not so good at doing their own taxes, this is still not the world's clearest explanation. Not to mention the fact that it asks people to predict their 2014 income, when at this point in the year they are often still trying to figure out what it was for 2013, because of all the Schedule C deductions. (If you've never lived in the world of piecework and Schedule C deductions, imagine saving all your expense receipts for an entire year and then having to do them before you can begin to calculate what your MAGI is. This is, in fact, exactly what has to happen.)

The New York State of Health exchange run by New York seems to be doing a pretty solid job of enrolling people in the new plans. But here again we see a calculator—and an application—that hardly seem optimized for self-employed individuals. Here's their calculator, which you have to download as an Excel file.

Note how this page also erroneously asks for taxable income. The site is trying to speak plain English. The result is confusing rather than illuminating.

The real New York State of Health application, on the other hand, is much more specific, according to the below screengrab sent to me by someone trying to fill it out. Individuals used to getting paid for work piecemeal are asked to imagine themselves as businesses filling out reports of sales, rents, royalties, inventory, and monthly business expenses.

Note: They are effectively being asked to calculate their quarterly adjusted gross income, which is to say, to do their taxes. Right there, in the application form. (And also ignore that the year is standardized to 2014 when it is still 2013.)

These applications and calculators make IRS forms, smoothed out over years of use by millions of people, look well designed. How will a person who gets paid by 1099s know to gather up three months of them and then subtract all her work expenses, and that this is the right thing to do? Will she know from the above that she also can deduct part of her self-employment taxes, as well as the cost of the tax-deductible part of what she's already been paying for health insurance, as instructed by this great MAGI description from UC-Berkeley's Labor Center? No. None of this is transparent.

In short, for the self-employed, applying for Obamacare subsidies can be as much fun as doing your taxes, because—depending on the state forms—it can actually involve doing part of your taxes. But without any of the user-friendly infrastructure the IRS has developed over decades, and the careful and precise attention to detail of that agency, there's a high risk that people using these systems will spend days wandering fruitlessly in the weeds before figuring out what they are supposed to do to proceed, or if they're eligible for subsidies, in the first place.

The Hidden Marriage Penalty in Obamacare

City Hall wedding, Chicago 2009 (Janet Mesic-Mackie)

The first time I heard Nona Willis Aronowitz talk about getting divorced to save money on health insurance I thought she couldn't really be serious. We were at Monte's, an old Italian place in South Brooklyn, having dinner with a group of New York women writers in late July.

"Don't do it!" I urged her, certain, having watched my friends over the years, that no matter how casually she or her husband might treat the piece of paper that says they are married, getting unhitched would inevitably change their relationship as profoundly as getting hitched in the first place.

But with the arrival of the Affordable Care Act's insurance exchanges, the question for Nona and her husband Aaron Cassara moved from the realm of casual conversation to a real financial conundrum. Aged 29 and 32, respectively, they were facing tough times for their professions, a wildly expensive city, and the scary prospect that both of them could shortly be uninsured. Right now Nona only has a COBRA plan—"which I can barely afford"—that ends January 1, she tells me. Her last staff job ended when the media outlet she was working for laid off its whole editorial team; she's been a full-time freelancer since. Aaron, a filmmaker who works part-time and also freelances, has been uninsured since her layoff, because it would be too expensive to have him on COBRA too.

Any married couple that earns more than 400 percent of the federal poverty level—that is $62,040—for a family of two earns too much for subsidies under Obamacare. "If you're over 400 percent of poverty, you're never eligible for premium" support, explains Gary Claxton, director of the Health Care Marketplace Project at the Kaiser Family Foundation.

But if that same couple lived together unmarried, they could earn up to $45,960 each—$91,920 total—and still be eligible for subsidies through the exchanges in New York state, where insurance is comparatively expensive and the state exchange was set up in such a way as to not provide lower rates for younger people. (Subsidy eligibility is calculated using a complicated formula involving income in relation to the poverty line, family size, and the price of plans offered through a state's marketplace.)

Nona and Aaron's 2012 income was higher than the 400 percent mark, but not by much. In New York City, that still doesn't take you very far for two people. If their most recent months of income are in the same range, they will get no help at all with buying insurance through the exchanges if and when they apply, according to the Kaiser Family Foundation and eHealth subsidy calculators. Premiums for the two for silver-level plans came in at $9,248 for the year.

But if they applied as unmarried individuals with something like their 2012 income, one of them would get at least $3,964 in subsidies toward the purchase of a plan, or possibly even be eligible for Medicaid, thanks to their uneven individual earnings that year. And if they fall below the 400 percent threshold, which Nona says they might this year, they could get substantial subsidies as a couple that are still worth less than what they'd be eligible for as individuals. These gaps are the marriage penalty.

Married people who are uninsured make up just a small fraction of the uninsured, for obvious reasons: It is easier to be insured if you have two potential pathways of getting there. Only 15.4 percent of married people were uninsured 2012, according to research from the Kaiser Family Foundation; the uninsurance rate for "single adults living together" was more than twice as high—33.4 percent.

That may be one reason the Obamacare subsides are more generous to single people and one- or two-parent families with children in the house than to couples who lack children. They were designed to help single moms and struggling middle-class families with children, not married creative-class millennials in pricey cities who have not yet settled into well-paid work, or barring that, work for a single employer.

Health insurance isn't the only place where there's a marriage penalty. The federal income tax also hits married couples with similar earnings harder than couples with one main breadwinner.

"In the tax code, you have a different set of tax rates for married couples that mitigates the marriage penalty to some degree," says Robert Rector, a senior research fellow at the Heritage Foundation who has been writing about the marriage penalty in health reform since 2010. Under Obamacare, however, there are "dramatic" penalties that are "substantial—particularly with couples in the upper age range," he says.

"What you are doing is saying ... you have to pay a penalty of multiple hundreds of dollars—a substantial portion of your income—to stay married," Rector says. "It's saying society is basically hostile to the institution of marriage."

Experts on the impact of marriage penalties were skeptical that many couples would consider divorce over insurance rates. Still, there is some data to suggest that marriage penalties embedded in government programs can discourage marriage among those who are benefiting from programs that favor the unmarried.

"The received wisdom in public finance is that marriage per se can be financially discouraged if both members of a couple have decent earnings potential and would face a higher combined tax rate as a married couple than as a pair of singletons," explains Gary Burtless, a senior fellow at the Brookings Institution. "At the lower end of the income scale, if the combined earnings potential of the couple is not very promising, marriage might prevent the mom and kids from receiving as much government assistance as they can receive if the adult couple remains unmarried."

There's no data yet on the potential size of the population potentially affected by such concerns under the Affordable Care Act, but Medicaid and other means-tested programs "already created that kind of potential marriage penalty," he notes. At least half of the newly insured under ACA will be insured under Medicaid.

The great irony, Nona explains, is "we wouldn't be married if it weren't for a situation that happened in 2009 where he needed health insurance."  

Despite its administrative beginnings, their City Hall marriage has lasted so far. Aaron was on Nona's insurance at first; later, when their job arrangements changed, she was on his. Now Nona is looking to land a full-time staff job, in hopes of once again having an employer-based plan that Aaron, too, can join.

"I guarantee you that in six months I will either be divorced or I will have a full-time job," she says.

The Squeaky-Wheel Problem in Obamacare Coverage

Kai Pfaffenbach/Reuters

Conservative writer David Frum points to something in a column today that I think explains a lot of the somewhat-overwrought coverage of the individual insurance market:

Talking Points Memo today offers a chart suggesting that the losers under Obamacare will number about 3 percent of the population. Why, that’s only … 9 million people. Nine million of the best educated, most affluent, and most vocal people in the country. How much trouble can they make? So really—it’s no story. 

It's all well and good to argue that only a small fraction of Americans will see premium increases in the individual market, but most of those who are seeing them—and who also are subsidy-ineligible under Obamacare—are from the middle to upper-income part of the middle class. More than 40 percent of people in the individual market are there because they are self-employed or running a small business. They're entrepreneurial and independent-spirited by nature, and when they squeak, they make a lot of noise.

By contrast, I'll be shocked if we see nearly as much attention devoted to the personal stories of the tens of thousands of low-income people now getting insurance through Obamacare's Medicaid expansion. Instead, we get experts tut-tutting over whether the planned expansion that's intended to cover an additional 9 million near-poor people over the next year is going to be a burden on the states.

The Only Pictures of Michelle Obama With Elmo and Rosita You Need to See

Yuri Gripas/Reuters

There is widespread agreement that the position of first lady is both an anachronism and not something that can be done away with, because of the politics of the post and Americans' affection for it.

The reasons it's an anachronism are legion: As the current president has noted, the first lady has paid staff but is not paid herself, even when she devotes herself full-time to the most substantive sort of first ladying. She defaults into the post when her husband is elected, no matter who she is, but also has no real option to opt out of the role. The nation looks to her often to be a kind of national mater familias, if you will, focused on home-and-hearth issues—even if that's never been her real area of professional focus. Meanwhile, the conflict-of-interest and security issues involved in her continuing to work outside the White House can make maintaining her own independent career impossible.

There's also no question that Michelle Obama, who like her husband is an Ivy League-trained attorney, has performed the role with aplomb. She remains ridiculously popular, even as the president's approval has sunk in tandem with that of the Republicans in Congress he's been battling.

And yet some days it's hard not to look at her daily rounds and be reminded of the fundamental weirdness of the post she occupies. On Wednesday, Michelle Obama continued her long-standing efforts to encourage young Americans to get more exercise and eat more healthfully during an appearance with two Sesame Street characters, Elmo and Rosita. The occasion was the decision by the Sesame Workshop to allow produce companies to use the Sesame Street Muppets to market fruits and vegetables to children.

Yuri Gripas/Reuters

The pictures from Michelle Obama's photo op with the muppets were just as amazing as you'd imagine. And then there was their patter. What follows is only about the half of it:

MRS. OBAMA: Today, we have a very special surprise. I am thrilled to be joined by two furry friends from Sesame Street—(laughter)—who will be playing such an important role in this new effort. Ladies and gentlemen, I present to you Elmo and Rosita!  (Applause.) 

ROSITA:  Hola!

ELMO:  Hello, Mrs. Obama!  (Laughter.)

MRS. OBAMA:  It's great to see you. Elmo, I love the tie. You dressed up for our press conference.

ROSITA:  And I wore my pearls, my mom's pearls.

MRS. OBAMA:  Oh, my God, they're beautiful.

ELMO:  Can Elmo tell you a secret?

MRS. OBAMA:  Yes, please.

ELMO:  It's a clip-on. [tie]

MRS. OBAMA:  It's a—oh, it's a clip-on.

ELMO:  It's a clip-on.

MRS. OBAMA:  So, how do you guys feel about getting kids pumped up and excited about eating healthy foods?

ELMO:  Oh, well, it’s wonderful.  Elmo loves healthy foods.  Yes, Elmo thinks that fruits and vegetables are delicious.

ROSITA:  Yes, sí, sí, sí, me, too.  And you know what?  They help us grow healthy and strong. Check out these muscles.

MRS. OBAMA:  Let me see your muscle. Let me see it.

ELMO:  Oh, that's a giant muscle, Rosita.  (Laughter.)

MRS. OBAMA:  It’s mighty, mighty.  Oh, yes.  Oh, Elmo, oh, your muscle, too, is so powerful.

ROSITA:  Let me see your muscle.  Oh.  (Laughter.)  Wow, strong. 

ELMO:  You know, Elmo eats lots of fruits and vegetables every day, Mrs. Obama. 

MRS. OBAMA:  That's very good.

ROSITA:  Oh, that's wonderful, Elmo, because you know what?

ELMO:  What?

ROSITA:  Fruits and vegetables are anytime foods. 

MRS. OBAMA:  They are.

ROSITA:  You know what that means?

ELMO:  What?

ROSITA:  They're so good for you that you can eat them every single day.  (Laughter.)

MRS. OBAMA:  All the time.  All the time.

Yuri Gripas/Reuters

One thing's for sure: Given the way Big Bird became a 2012 campaign issue, the furry visitors don't seem like the sort who would have been invited to a Romney White House.

Only 23% of Republicans Want More Women Elected to Congress

Jessica Rinaldi/Reuters

New polling from ABC News-Fusion reveals a startling partisan divide on whether there should be more women in the House and Senate.

Just 23 percent of Republicans surveyed in the poll agreed that "it would be a good thing if more women were elected to Congress." Meanwhile, 60 percent of Democrats agreed with the statement.

The Rutgers Center for American Women and Politics highlighted the results of the poll, which was released October 28 and produced by Langer Research Associates, in a graphic.

As you can see, there's a bit of a gender divide, with Democratic women being the most supportive of the idea of more women in Congress. Democratic men support the idea by 15 fewer points, but they're still much more likely to think having women in office is something positive than Republican men or women are.

"Another interesting result is that, among Republicans, partisanship trumps gender in views on electing women to Congress," observed pollster Gary Langer in an accompanying article. "There’s essentially no difference between Republican men and GOP women in calling this a good thing, 22 vs. 24 percent."

The major alternative to thinking that it's a "good thing" to have women in office was not opposing it, but feeling it didn't matter one way or the other, according to the pollsters.

Also interesting was that 68 percent of Democrats agreed that "women have fewer opportunities than men in the workplace," while just 38 percent of Republicans think that.

The worldviews on display here are starkly disparate: Republicans of both genders are likely to believe women have already achieved equal footing with men and that it doesn't matter if they are elected to Congress. Democrats, meanwhile, believe both that women have fewer opportunities than men and that it's important for them to be elected to Congress.

The vast majority of women who have been elected to the House and Senate are Democrats.

Obama to People With Canceled Plans: 'Just Shop Around in the New Marketplace'

Brian Snyder/Reuters

Speaking in Boston Wednesday afternoon, President Obama addressed the issue of people losing their current insurance plans head on, encouraging them to use online exchanges to find new plans.

"Almost all the insurers are encouraging people to join better plans with the same carrier and stronger benefits and stronger protections," he said during remarks on the Affordable Care Act delivered at Faneuil Hall, "while others will be able to get better plans with new carriers through the marketplace, and that many will get new help to pay for these better plans and make them actually cheaper."

If that's not exactly what people have being hearing in the press, Obama said it was because of people who "leave that stuff out" and are "being grossly misleading, to say the least," about the effects of his signature legislation.

"If you're getting one of these letters [canceling a plan], just shop around in the new marketplace. That's what it's for," Obama said. Of course, getting new plans through the exchanges so far has been easier said than done: As Obama spoke, the Healthcare.gov site was not usable due to a Verizon data hosting problem.

The remarks were Obama's first public response to the furor over his many statements telling insured Americans if they liked their health insurance, they could keep it even after the Affordable Care Act too effect. His assurance has turned out to come with some pretty big caveats—more like if you like your insurance and your insurer chooses to keep offering it and doesn't make any significant changes to the plan that would trigger HHS rules requiring further changes, then you can keep it.

But the affable Obama on display in Boston was a far cry from the more miffed chief executive who a few weeks ago stood in the Rose Garden and described the rollout of Healthcare.gov as frustratingly unacceptable. He wasn't backing down or apologizing this time.

Here's the section of his speech on what's been happening in the existing individual-insurance market:

Now it is also true that some Americans who have health insurance plans that they bought on their own through the old individual markets are getting notices from their insurance companies suggesting that somehow because of the Affordable Care Act, they may be losing their existing health insurance plans. This has been the latest flurry in the news.

There's—because there's been a lot of confusion and misinformation about this, I want to explain just what's going on.

One of the things health reform was designed to do was to help not only the uninsured but also the underinsured. And there are a number of Americans, fewer than 5 percent of Americans, who've got cut-rate plans that don't offer real financial protection in the event of a serious illness or an accident.

Remember, before the Affordable Care Act, these bad apple insurers had free rein every single year to limit the care that you received or used minor pre-existing conditions to jack up your premiums or bill you into bankruptcy. So a lot of people thought they were buying coverage, and it turned out not to be so good.

Before the Affordable Care Act, the worst of these plans routinely dropped thousands of Americans every single year. And on average, premiums for folks who stayed in their plans for more than a year shot up about 15 percent a year. This wasn't just bad for those folks who were—had these policies; it was bad for all of us, because, again, when tragedy strikes, and folks can't pay their medical bills, everybody else picks up the tab.

Now if you had one of these substandard plans before the Affordable Care Act became law and you really liked that plan, you were able to keep it. That's what I said when I was running for office.

That was part of the promise we made.

But ever since the law was passed, if insurers decided to downgrade or cancel these substandard plans, what we said under the law is, you've got to replace them with quality, comprehensive coverage because that too was a central premise of the Affordable Care Act from the very beginning.

And today that promise means that every plan in the marketplace covers a core set of minimum benefits, like maternity care and preventive care and mental-health care and prescription drug benefits and hospitalization, and they can't use allergies or pregnancy or a sports injury or the fact that you're a woman to charge you more. They can't do that anymore. They can't do that anymore.

If you couldn't afford coverage because your child had asthma, well, he's now covered. If you're one of the 45 million Americans with a mental illness, you're now covered. If you're a young couple expecting a baby, you're covered. You're safer. The system is more secure for you and it's more secure for everybody.

So if you're getting one of these letters, just shop around in the new marketplace. That's what it's for ....

Because of the tax credits that we're offering and the competition between insurers, most people are going to be able to get better, comprehensive health care plans for the same price or even cheaper than projected. You're going to get a better deal.

Now, there's a fraction of Americans with higher incomes who will pay more on the front end for better insurance with better benefits and protections like the patient's bill of rights, and that will actually save them from financial ruin if they get sick. But nobody is losing their right to health care coverage. And no insurance company will ever be able to deny you coverage or drop you as a customer altogether. Those days are over, and that's the truth. That is the truth.

So for people without health insurance, they're finally going to be able to get it. For the vast majority of people who have health insurance that works, you can keep it. For the fewer than 5 percent of Americans who buy insurance on your own, you will be getting a better deal. So anyone peddling the notion that insurers are canceling peoples' plan without mentioning that almost all the insurers are encouraging people to join better plans with the same carrier and stronger benefits and stronger protections while others will be able to get better plans with new carriers through the marketplace, and that many will get new help to pay for these better plans and make them actually cheaper—if you leave that stuff out, you're being grossly misleading, to say the least.

It's Too Late to Delay Obamacare

Jason Reed/Reuters

Delay is in the air.

Marco Rubio on Monday introduced the “Delay Until Fully Functional Act” to postpone the Affordable Care Act's individual mandate until six months after the government could certify "that the exchange website is fully functional." Ten Democratic senators have now signed on to a letter, drafted by New Hampshire Senator Jeanne Shaheen, asking the president to extend the open-enrollment period beyond March 31. West Virginia Democratic Joe Manchin called for a "transition period" in Obamacare and some mechanism to prevent costs to people already in the individual market from going up. "Nobody should be forced to buy a policy that costs more than what they had and is inferior to what they had," Manchin said Sunday on ABC News's This Week. An individual-mandate-delay bill already passed in the House in July 2013, with 22 Democrats joining Republicans to vote for it, and then again right before the government shutdown in September. Several Republicans have called for a halt in the whole system while Healthcare.gov is fixed. "Congress should press 'pause' on the tech surge and figure out what went wrong first before throwing good money after bad and forcing the public to use a broken site," said Pennsylvania Rep. Tim Murphy at a hearing in October.

But it is too late to delay Obamacare. The private health-insurance market is in the throes of major changes, and there is no going back. Anyone who is calling for the system to be put on pause at this point is calling for the millions of people being moved out of existing private-market plans to have fewer options for new coverage, instead of more, and for them to be denied opportunities to find subsidies for plans. And anyone calling for a significant delay in imposing the individual mandate is putting at risk the affordability of the entire private individual-insurance market as it's been shaped to meet the law's requirements over the last three years, insurers warn.

“The individual mandate is inextricably linked to the insurance-market reforms included in the health-care-reform law," said Robert Zirkelbach, a spokesman for the industry group America's Health Insurance Plans. There are historical precedents for trying to overhaul the insurance system without mandates in the states, and those precedents are failure.

"In the 1990s, several states enacted insurance-market reforms without achieving broad participation and it failed," Zirkelbach said. "Premiums increased dramatically, consumers and employers had fewer coverage choices, and the number of uninsured increased." To avoid "repeating the state experience," the 2010 health-insurance overhaul mandated that everyone purchase coverage and established a long initial open-enrollment period "to incentivize young, healthy people to purchase and maintain health insurance rather than waiting until after they get sick or injured to sign up." Without these young people purchasing insurance in the markets, the whole pricing structure of the private health plans in the new markets goes haywire.

Even delaying the mandate past the March 31 deadline, which may sound intuitively like a fair thing to do, would fundamentally disrupt the markets in a way that increases costs, insurers warn. Everything insurers have done was designed around a fixed plan, and any significant changes in mid-course—and we are now in mid-course—will destabilize what's being rolled out this year and for 2015 (open enrollment for 2015 will take place in late 2014).

“The administration’s proposal to align the individual-mandate penalties with the open-enrollment sign-up period ending on March 31 is consistent with what health plans assumed in their premiums for next year. Going beyond this proposal by delaying the individual mandate and/or extending the open enrollment period past March 31 could have a destabilizing effect on insurance markets, resulting in higher premiums and coverage disruptions for individuals and families," Zirkelbach said.

“Moreover, if these vital enrollment incentives were to change, the premiums health plans filed for next year would have to increase to account for fewer young and healthy people signing up for coverage.”

Health and Human Services Secretary Kathleen Sebelius pointed out during the House Energy and Commerce hearing Wednesday that the open-enrollment period being offered consumers by the exchanges is already "extraordinarily long."

"It's about six times as long as a typical generous open-enrollment period," she said. "And it's important for the insurance partners to know who is in their pool so again they can stay in the market next year and know who they are insuring."

If Healthcare.gov is fixed by November 30, the administration's stated target, customers will have four full months to enroll, she noted.

"We think it's important for everyone to understand that the individual mandate is critical to making the insurance reforms work and to ensuring affordable coverage for consumers," the Blue Cross/Blue Shield Association told TPM. "Unless everyone is covered, the reforms included in this law fundamentally do not work. An extension of the open-enrollment season is effectively a delay of the individual mandate, with the same serious consequences for consumers."

This is something especially for Democrats calling for delays and extensions to consider: Rather than fixing a political problem for themselves and a practical enrollment problem for their constituents, delaying the mandate and extending enrollment would provoke a fresh round of problems with the exchanges during the fall of 2014. A fresh round of open enrollment is set to begin on October 15—just weeks before the midterm elections.

This would be great for Republicans, politically. But it's hard to imagine it working out better for Democrats than focusing on making the process the nation is already in the middle of a success.

Mike Lee: 'Anger Is Not an Agenda'

Senator Mike Lee (left) and Sarah Palin on the National Mall during the government shutdown. (Joshua Roberts/Reuters)

Utah's Mike Lee must have looked at his image in the polling out of his state and not liked what he saw reflected back. On Tuesday, the U.S. senator who Stood with Ted to Make America Listen on Obamacare stood before an audience at the Heritage Foundation and gave a fascinating speech calling for the Republican Party to take a course different from the one he'd just taken.

"Especially in the wake of recent controversies, many conservatives are more frustrated with the establishment than ever before," Lee said. "And we have every reason to be. But however justified, frustration is not a platform. Anger is not an agenda. And outrage, as a habit, is not even conservative."

Instead of "outrage, resentment, and intolerance," the party should project a message—and more than a message, a principle—of "optimism," he said.

"American conservatism, at its core, is about gratitude, and cooperation, and trust, and above all hope," Lee said. "It is also about inclusion. Successful political movements are about identifying converts, not heretics."

His comments are entirely unlike any recent speeches from Tea Party-backed senators, calling not for an ever-more-public fight with the Democrats but for reflection and a turn inward. "[A] month like the one we have been through should lead us not only to re-commit to this essential, ongoing struggle, but also to step back and ask ourselves where we should be headed more generally," he said, asking: "What’s next for conservatives?"

Lee looked back to the last great era of conservative reinvention, the 1970s, as he sketched out an agenda that seemed to marry the compassionate conservatism of the Bushes and the anti-cronyism cries of fellow Tea Party leader Sarah Palin.

"What that generation did—comprehensively re-expressing conservative convictions to fit the time—has not been done since," Lee said of the Reagan revolutionaries. "Yet as the decades pass and a new generation of Americans faces a new generation of problems, the party establishment clings to its 1970s agenda like a security blanket."

Where conservatives of the 1970s confronted inflation, poor growth, and "Soviet aggression," the party now, he said, should take on "America’s growing crisis of stagnation and sclerosis—a crisis that comes down to a shortage of opportunities."

"This opportunity crisis," he continued, "presents itself in three principal ways: immobility among the poor, trapped in poverty; insecurity in the middle class, where families just can’t seem to get ahead; and cronyist privilege at the top, where political and economic elites unfairly profit at everyone else’s expense. The Republican Party should tackle these three crises head on."

Tackling poverty, aiding the middle class, confronting entrenched privilege: Those goals, and the array of legislative initiatives Lee proposes to get at them, are enough of a detour from the usual Republican message coming out of Washington that Lee just made himself, once again, one of the most interesting figures in town.

You can—and should—read the full speech here.

The New Problem With Obamacare Isn't Socialism, It's Creative Destruction

The president and vice president shared a moment after Obama signed the Affordable Care Act in 2010. (Larry Downing/Reuters)

The latest noisy controversy in the rollout of Obamacare is over millions of citizens being moved out of plans they purchased on the individual market. Even doggedly liberal commentators are attacking the administration for misleading these customers into thinking they could keep their exact same plans under Obamacare. But while the politics may be bad, the demise of these plans has been long expected as part of a wave of rationalization and creative destruction in the existing private-sector market.

In some cases, insurers are dropping policies because it is no longer profitable to offer them once they have to meet higher standards under the Affordable Care Act, such as accepting those with pre-existing conditions and actually covering outlays when people get sick. In other cases, as in Pennsylvania, it is the sickest people being dropped, as insurers get rid of their individual-market "guaranteed-issue" plans for people with pre-existing conditions now that all plans have to accept those who have them.

In all cases, there's been no move by the federal government specifically to help the 15 million people in the individual insurance market move into new plans that serve their needs and keep their costs low as new options become available through the state-based exchanges. Between 40 and 67 percent of the old individual-market plans are expected to be affected by the new rules, NBC reports. Meanwhile, insurers have been offering to auto-enroll customers in new plans that are much more expensive than the old ones, sparking outrage. So far more than 2 million people in the individual insurance market have received notices that they need to get or accept new plans over the course of 2014, according to CBS.

President Obama, while campaigning for the health-care overhaul in 2009, frequently said things like, "If you like your doctor or health care plan, you can keep it." Sometimes, since then, he's modified that statement to be, at times, a little more specific, and mention that he was talking about people who had insurance through their employers. The current version of the claim on the White House website is a model of confusion, speaking of "Americans who already have health insurance" and "the uninsured or those who don’t get their coverage through work"—which are in fact two very different categories of people.

A 2012 study by the Kaiser Family Foundation found that 6.6 percent of the 188.7 million non-elderly adults in America were in the individual insurance market and 21.4 percent were uninsured. Only 5.2 percent of those with incomes over $40,000 were in the individual insurance market (an important benchmark, since those with incomes in the mid-40s or higher aren't eligible for Obamacare subsidies); 78.3 percent with incomes that high were covered through the employer-based health insurance system. The major reason people were in the individual insurance market was that they were self-employed.

The dirty secret of the individual market was that insurers often kept premiums low by an amalgam of tricks. Insurers excluded as much as 33 percent of people who applied for plans, depending on the state, according to the Kaiser Family Foundation, and profited by offering plans that seemed like steals on a monthly basis but left policy-holders with ruinous costs if and when they needed insurance most.

In one of the legendary horror stories aired during the lead-up to the Affordable Care Act, my friend Sarah Wildman wound up getting stuck with more than $20,000 in costs after having a baby despite having maternity insurance, because it turned out her individual-market plan in Washington, D.C., capped maternity coverage at $3,000, and she'd needed to have a Caesarean section. Her low-cost plan was revealed to be a high-cost one as soon as she tried to use it for something major.

This sort of bait-and-switch was typical for the individual market, according to Kaiser's research. "Despite lower premiums, individuals with non-group coverage generally pay a higher share of their health expenses out of pocket than those with employer sponsored coverage," the group reported in June 2010. Coverage so often involved high co-pays, high deductibles, and coverage caps that people were easily bankrupted. As recently as this summer, uncovered medical bills were found to be the No. 1 cause of people filing for bankruptcy in the U.S., thanks in part to inadequate insurance plans. The Affordable Care Act won't fully solve this problem, but by mandating that insurance plans meet certain baseline standards, it eliminates the junkiest of what those in the health industry call junk insurance plans.

From a consumer perspective, however, this looks very different. For those with junk plans who were healthy and never had to use them for anything beyond routine care, the plans seemed like a great deal. And while it's being presented as breaking news that ACA gets rid of these plans, the provisions of the law that do this have been well-known in health-care circles since 2010. During a background briefing this summer, the White House specifically mentioned the individually insured and the uninsured as the two categories of people who would be using the new exchanges.

But in public remarks, the White House has largely treated the existing individual insurance market as if it does not exist.

"Everyone who already has health insurance, whether through your employer, Medicare, or Medicaid, will keep the benefits and protections this law has already put in place," Obama said Saturday in his weekly address, again leaving out those who have insurance through the individual market.

These public elisions have now set up a political problem for the White House, as cancellation and rate-change notices outpace enrollment through the state- and federally-run exchange sites. And without a new form of public hand-holding for those facing a market in flux, the steady drumbeat of their complaints is sure to last all year.

The Case of the Vanishing Obamacare Girl

A familiar face was gone from the homepage of Healthcare.gov on Sunday.

Where'd she go?

The smiling young woman whose visage for more than three weeks greeted visitors to Healthcare.gov has vanished from the site. Gone with her are the middle-aged Asian women and other faces that frequent visitors to the site have come to know. All have been replaced by additional instructions and information designed to answer health-insurance shoppers' questions and direct them to the three other ways they can begin the process of getting insurance other than the website they are looking at.

The now vanished face of Healthcare.gov

The identity of the woman who became the face of Obamacare had become a subject of much speculation since the site launched October 1. BuzzFeed's Andrew Kaczynski and Ellie Hall recently detailed their attempt to find her identity. The closest they could get was a statement by Centers for Medicare and Medicaid Services spokesman Richard Olague that “The woman featured on the website signed a release for us to use the photo, but to protect her privacy, we will not share her personal or contact info with anyone.”

On Sunday, a Daily Caller associate editor said his publication had solved the mystery a month ago. "DontPanic @BuzzFeedAndrew @ellievhall We solved biggest mystery ever on earth like a month ago http://bit.ly/1bsoF42," Christopher Bedford tweeted.

Bedford pointed to a late September Daily Caller piece that identified a woman in other Healthcare.gov advertising as the sister of an HHS official based on the blog item "Alejandra’s story." It was written for the exchanges' pre-launch blog by her sister, Mayra Alvarez, director of Public Health Policy in the Office of Health Reform at the Department of Health and Human Services. Mayra Alvarez also wrote about her baby sister Alejandra for NBC Latino at the end of April, detailing the high costs the California college student faced for routine check-ups as a healthy young person and arguing that she was a perfect example of why people would appreciate the Affordable Care Act exchanges when they came online. The item was reprinted on the White House blog in May as "A Big Sister's Advice: Get Covered."

"Alejandra and sister" was an image emailed out by HHS—and also used by Mayra Alvarez to talk about her younger sister.

Despite Bedford's claim and the superficial resemblance, Alejandra is not the woman who was the face of Healthcare.gov, according to the feds.

"The person who was on the website was not Mayra's sister," an HHS official emailed The Atlantic

The official remained mum about the woman's identity, but did explain why she and others are now off the site. "In terms of the changes, HealthCare.gov is a dynamic website. As with all websites, we try to make meaningful enhancements and improvements that will help users understand key information, while maintaining the overall familiar design and navigation elements that are working well," the official said. "As we move from the initial launch of the Marketplace into the continuing Open Enrollment, we wanted to highlight that there are multiple options to apply for health coverage, as we’ve done in many of our communications over the last week."

And so the mystery remains.

Hillary Clinton's Endless Fight

Yuri Gripas/Reuters

Hillary Clinton didn't speak for very long at the 10th anniversary celebration for the Center for American Progress in Washington, D.C., Thursday night, but there was something poignant in her remarks, even as she showered the assembled past and future leaders of the group with praise. It wasn't just the question of whether progressives have the power to enact their agenda during a time of record partisanship in which a united Republican-led House opposes them. Clinton said:

We may have different experiences and backgrounds, but we share a set of values that animates our work and our lives. The values of justice and freedom, of opportunity and equality, that everyone the world over deserves to have in their lives—and in their societies—to have the chance to live up to their god-given potential, to participate fully in the economic, political, social lives of the places where they are born and live.

And so when you look at these values and how much the United States had to do in thrusting them into human history and nurturing them and protecting them for so many years now, it's always a little surprising that we have to keep fighting so hard on behalf of them, to make the case over and over and over again.

It seemed exactly like what someone who is both a staunch global advocate of women's rights and the former secretary of state would say. But it was also hard not to look up at the stage at Hillary—two decades into her career as a single-named force of nature, an emissary from the generation that still wears power suits instead of trendy sleeveless power dresses, a veteran of the cohort that first enacted the idea of women's equality in the public sphere through their own life choices—and feel her talking a little about what she's seen over the course of her journey from feminist pioneer to elder stateswoman.

On the question of gender equality in particular, the feminists and first-wave professionals of Clinton's generation thought we'd be so much farther along now than we are. And yet all over the world and all over Washington—at conferences and meetings and in nonprofit meeting rooms—that struggle in particular endures.

Instead of being a battle fought once, the fight for women's equality in public life turned out to be a battle that needs fighting again and again, as deep human patterns of dominance and social control frustratingly reasserted themselves anew and in fresh guises, in defiance of earlier efforts to address them. We have not yet figured out ways of organizing societies to redress the natural tendency toward inequality between men and women that's as effective as democracy is in seeking to redress the naturally occurring inequality between man and man.

Different nations have tried different approaches, but none have solved the riddle. The utopians of Clinton's optimistic generation thought many of the great social-equality battles, once won in theory, would have been settled in practice by now. But they are far from it. And there Clinton was—on stage, adored by the crowd—soldiering on in a fight that may have no end.

The Tortoise, the Hare, and the Massachusetts Lesson for Obamacare

Slow and steady wins the race, according to the old Aesop fable, and that's also what happened in the state of Massachusetts, when it rolled out its new health-coverage plans in 2007. Today, 97 percent of people in the state have health insurance of one type or another. But when the state's bid for universal coverage got started, it launched to a very slow start, according to those oversaw the rollout in the state. And that's without all the website issues that have plagued Healthcare.gov.

"To my friends in the media, I have one message: please take a chill pill. You won't see 7 million enrollees for a while, and that's not failure, that's real world," John McDonough, a professor at the Harvard School of Public Health who was deeply involved in the passage and implementation of Massachusetts' 2006 health reform law, wrote of the new Obamacare program in mid-October. In Massachusetts, getting people signed up "was a slow crawl, not a sprint."

Data from the first full year of enrollment in the Commonwealth Care plans in Massachusetts shows that the number of people who purchased premium plans was minuscule at first, with a rate of increase of only 123 people in February 2007. That surged to 3,645 in April and then remained fairly steady all year, before spiking to 7,783 in the month before the penalty deadline for remaining uninsured kicked in.
 

In contrast, the plans that were basically free saw much more rapid growth in enrollment and a much higher total number of enrollees by the end of 2007.

The lesson of this for the federal-health-insurance-exchange rollouts is clear: Lower-income people do not layaway shop for insurance, and they will take their time to make decisions when they have to pay for premiums themselves, even if the premiums are subsidized.

This is what CNN investigative reporter Drew Griffin found while visiting two Milwaukee clinics for low-income people this week, according to a summary on Mediate: 150 new people on Medicaid, "but not one under a health plan sponsored by the Affordable Care Act."

Part of that's likely due to the Healthcare.gov issues. But part of it is also to be expected. "When people must pay premiums that piece of enrollment is slow in the early months and it will accelerate and increase over time," McDonough told The Atlantic. "So regardless of the issues around the website, people should not be surprised to see slow enrollment—slower than some people might expect who don't have a lot of experience in this arena."

But it should pick up by mid-December, he predicted: "There's no advantage to signing up now as opposed to signing up [in] December except to get it out of the way."

Will the Obamacare Rollout Become the First Real Scandal of the Obama Administration?

Reuters

What makes something a scandal? Evil intent or incompetence? Sometimes, when it comes to the federal government, it doesn't really matter. Bad management that has bad consequences for real people can be a scandal, whether anyone wanted the result to happen or not.

For years, Republicans have been trying to transform management problems at federal agencies into arguments about the alleged malicious intent of the Obama Administration. So far they have not succeeded.

Benghazi was a security disaster and a tragedy, but the killing of an American ambassador at a barely staffed diplomatic mission—not even a consulate, let alone an embassy—was a result of the State Department strategy about how to deploy diplomats getting ahead of the bureaucracy intended to keep them safe, not a desire by the administration to see American deaths. With the IRS kerfuffle, congressional investigators solicited a biased inspector general's report and held partial hearings that gave a distorted picture of the agency's activities. Extensive efforts to cast the White House as using the IRS in a Nixonian manner to go after political enemies failed.

Now the Republicans are getting ready for a new round of hearings, focused on the launch of Healthcare.gov on October 1. There is no question about the president's intentions when it comes to the rollout of this last, most complex part of his signature legislative initiative: He wants it to work. And yet it is here, where we are beyond any conspiracy-mongering about White House intentions, that the administration may finally find itself caught by its accusers.

If by late November the website for accessing the exchanges in 34 states is largely functional and people are able to buy insurance in a smooth manner, the problems and glitches of its debut will recede into memory, as did similar ones at the launch of Medicare Part D. But if they are not—well, Republicans will have the scandal they long have been seeking. And plenty of Democrats are sure to join them in their criticism.

The president is responsible for his signature legislative accomplishment in a way that runs deeper than his responsibility for nearly anything else the government has done on his watch. Even if the Affordable Care Act is full of legislative compromises, and even if it is falling victim to known flaws that a partisan Congress has been resistant to fixing, it remains quintessentially his law. If it works, it will be his greatest affirmative legacy to America on the domestic front.

Obama should have been fully informed about what the launch was going to be like. If he wasn't told about potential problems with the site, as his Health and Human Services Secretary Kathleen Sebelius told CNN Tuesday, that's a problem. It's a problem that she appears not to have known about the extent of the troubles that would plague the site, either. What happened lower in the chain of command to prevent such critical information about the system from reaching the men and women at the top—because the president is right that when he says fixing something is a priority, people jump—is a question for the oversight committees to tease out.

Americans deserve to know how something that has so divided the country over the years, that so many have spent so much energy defending, and that so many people in need have been waiting for turned out the way it did. The administration's message—this is unacceptable and we're fixing it now—may be an understandable public-facing management approach to moving forward. But it's not ultimately going to be an adequate one.

Today, the House Energy and Commerce Committee has been holding a hearing focused on the contractors. Three of the four testifying today previously appeared before the committee on September 10.

Here is a little background on them, and key points from their prepared testimony. I've put the parts of the system they are responsible for in italics so it's easier to follow along in the weeks ahead. I have a feeling we're going to all be hearing about these a lot more in the months ahead.

* Cheryl Campbell, a senior vice president at CGI Federal Inc., a massive IT contractor, who has responsibility for all of its projects at HHS and several other federal agencies. In her prepared testimony for Thursday's hearing, she outlined what her company does for Healthcare.gov and pointed the finger at the feds, as the ultimate authorities over what her teams did, for any problems:

Centers for Medicare and Medicaid Services (CMS) have the overall responsibility for administering the Federal Exchange Program System, or the “Federal Exchange.” CGI Federal is the contractor that has developed a portion of the Federal Exchange, the software application known as the Federally Facilitated Marketplace or “FFM.”...

CGI Federal and the many other contractors selected to develop the Federal Exchange perform under the direction and supervision of CMS. As I stated in my September 10 testimony, CMS serves the important role of systems integrator or “quarterback”on this project and is the ultimate responsible party for the end-to-end performance of the overall Federal Exchange. The FFM is a combination of a website and a complex transaction processor that must simultaneously help millions of Americans determine their eligibility for insurance and federal subsidies, shop for health plans, and enroll in a qualified health plan.

* Andrew Slavitt, group executive vice president of Optum, a business unit of UnitedHealth Group. Optum owns Quality Software Services, Inc., or QSSI, which built the Data Services Hub part of Healthcare.gov, as well as what he described in prepared testimony as "a registration and access management tool—called the EIDM—that is used as one part of the registration system that allows consumers to create and use an account." The data hub, by all accounts, is in solid shape. But the EIDM is the much-noted login system that prevented many people from creating accounts in the first few weeks of Healthcare.gov's existence.

* Lynn Spellecy, corporate counsel at Equifax Workforce Solutions. Her company provides "income verification services ... to the Centers for Medicare & Medicaid Services (CMS) to assist in their administration of the benefit programs defined by the Affordable Care Act." Equifax Workforce Solutions is a subsidiary of the Equifax credit-reporting agency. According to her prepared testimony, "The Equifax Workforce Solutions income verification solution is working as designed. Since the exchanges first went live on October 1, 2013, we have not experienced any significant problems."

* John Lau, program director of Serco, which provides "eligibility Support Services in support of paper application processing and error and issue resolution on applications regardless of the manner in which they were submitted. Our primary role in the early days of the implementation is to key enter paper applications into the eligibility system."

The key takeaway from his prepared testimony: "Our challenges have included coping with the performance of the portal as that is our means of entering data just as it is for the consumer. With the relatively low volumes of applications we have received thus far, this has not been a problem for us."

The White House Used the Same Trick as Tyrion Lannister to Out a Leaker

HBO

It's not exactly promising Princess Myrcella to three different suitors, but the technique used by Tyrion Lannister on HBO's epic Game of Thrones to uncloak the member of the Privy Council betraying him to his sister and mortal foe—giving different information to Varys, Littlefinger, and Grand Maester Pycelle—made an appearance in a recent hunt inside the White House for the pseudonymous national-security tweeter @natsecwonk, according to the Washington Post:

Three weeks ago, the group hatched a plan to trick the suspected NSC staffer into revealing himself. They would intentionally plant inaccurate, but harmless, information with him to see if it would pop up as a 140-character tweet, according to a U.S. official with knowledge of the effort.

The technique is a well-established one in intelligence circles, it turns out, and was popularized by Tom Clancy as a Canary Trap in his novel Patriot Games. The tweeter was eventually revealed to be Jofi Joseph, a National Security Council staffer involved in negotiations around Iran's nuclear program.

Marco Rubio Wants to Lead the Next Wave of the Delay-Obamacare Campaign

Jonathan Ernst/Reuters

Ted Cruz convinced the Republican Party to shut down the federal government in a bid to defund Obamacare. The result: 120,000 lost jobs, a $24 billion hit to GDP, and a complete cratering of support for the Republican Party in national polls. But it wasn't all bad news—at least for Cruz personally. He raised quite a bit of money off his stunt, and he's a hero to Tea Party types who can lift a politician to a victory in the Iowa caucuses.

Now Marco Rubio, who mainly stayed invisible during Cruz's crusade, is picking up the baton in the anti-Obamacare fight with a proposal that seems, in comparison, logical, moderate, and oriented toward the practical goal of improving the lives of his constituents as they struggle with a federal enrollment system that's proved as unready for prime-time as Republicans warned. Unlike Cruz's bid, it's unlikely to provoke either a national political backlash nor do much to make him a hero to activists.

"It’s unfair that on the one hand you are telling people that if they don’t buy insurance next year the IRS is going to come after them with a fine," the Florida Republican senator told Bill O'Reilly on Fox News Tuesday. "It’s unfair to say that to them and then turn around and make it so difficult, or impossible, for them to buy that health insurance."

Rubio said he plans to introduce a bill on Monday, when the Senate is back in session, to "basically say ... that the Obamacare website has to be up and functioning for six consecutive months before they can begin to enforce this individual mandate on people."

"How you can punish people for not buying something that is impossible to buy because of the inability of this website to function because of government incompetence?” he asked.

It's a fair question. According to the law, anyone who is uninsured for more than nine months in 2014 would have to pay a tax penalty in 2015, but it's not totally clear that a bill is needed. The Department of Health and Human Services and the White House have repeatedly pointed to provisions in the law that already allow for exemptions from the penalty if an individual has been unable to obtain insurance for a variety of reasons. So it's still an open question if there needs to be a new law introduced or whether HHS can just issue additional guidance later in the year if it's not possible to get Healthcare.gov to a high enough level of functionality in time for people to use it to access the exchanges in the 36 states, including Florida, before the end of open enrollment.

Republicans have objected to the White House's use of administrative flexibility in the law to tweak certain provisions, and they have argued that earlier delays, such as of the mandate for large employers, were not legal. But they also have not been able to build a bipartisan coalition for legislation taking alternative approaches.

O'Reilly rightly questioned whether Rubio's proposal could get any support from Democrats, who showed enormous party unity in standing firm in defense of Obamacare during the recent government shutdown and showdown over the debt limit. The answer so far is no. The one Democrat who broke with the White House on the question of an individual mandate delay, West Virginia Senator Joe Manchin, will not back Rubio's bill, according to a spokesman.

"We are not going to support the Rubio bill," said Manchin communications director Jonathan Kott. "We are going to release our own bill." Manchin's bill, also likely to be introduced on Monday, would create a "delay in the individual mandate penalty for one year"—a move that would actually delay it longer than Rubio appears to be proposing to do.

Meanwhile, Democratic Senator Jeanne Shaheen of New Hamsphire has called on Obama to extend open enrollment in the exchanges and to clarify whether people who want to enroll but can't because of Healthcare.gov glitches will be assessed a penalty if they stay uninsured for more than three months next year.

"Given the existing problems with the website, I urge you to consider extending open enrollment beyond the current end date of March 31, 2014," she wrote in a letter to the president. "Allowing extra time for consumers is critically important so they have the opportunity to become familiar with the website, survey their options and enroll."

"If an individual is unable to purchase health insurance due to technical problems with enrollment, they should not be penalized because of lack of coverage," she said.

Arkansas Senator Mark Pryor, a Democrat who will face a tough challenger in GOP Rep. Tom Cotton in 2014, has also called for an extension of the open-enrollment period.

All of which is to say: Get ready for the next round of congressional wrangling over Obamacare. If you thought the shutdown's negative consequences for the party might have killed the Republican fixation with it, you thought wrong.

The Weird Obamacare Deadline Glitch May Get Fixed

Mike Segar/Reuters

One aspect of the Obamacare rollout that seems most like a bait-and-switch is that although the open-enrollment period is often described as being six months long, users actually only have four and a half months to buy insurance if they wish to avoid paying a fine for being uninsured.

While the Affordable Care Act only assesses penalties on those who fail to secure insurance by March 31 of each year—or who are uninsured for more than three months later in the year—to actually get insurance during the Obamacare open-enrollment period you need sign up by February 15.

As Consumer Reports put it, that's "the last date you can purchase insurance if you want to avoid being fined for not having insurance in 2014 .... to avoid the penalty, you need to have insurance in place by the end of March and not a day later. In order to do that, you’ll need to purchase coverage by Feb. 15. If you wait until Feb. 16 or later, coverage won’t start until April 1—one day over the three-month grace period."

So which is it: February 15 or March 31?

In a welcome sign of movement on this front, the Department of Health and Human Services told The Atlantic that it is working to put the open-enrollment deadline and the tax-penalty deadline in sync, so that people who purchase insurance before the March 31 deadline won't have to pay a penalty, even if their policy doesn't take effect immediately.

"There is a disconnect between the open-enrollment and individual-responsibility timeframes in the first year of the Marketplace only," an HHS official said. "The administration is working to align those policies and will issue guidance soon."

"We are exploring options currently," the official said.

A senior administration official told reporters Monday that "The law as written provides a great deal of flexibility to make sure that no one who is trying to get insurance or can't get insurance" will pay a penalty. Another emphasized the many penalty exemptions in the law. White House press secretary Jay Carney emphasized that point repeatedly during Monday's briefing, saying, "The law makes clear that people who do not have access to affordable care due to a state not expanding Medicaid or other factors will not be penalized."

A tax-penalty exemption for people who can prove they signed up and paid for insurance through the exchanges by March 31, even if they're not effectively insured until April 1 or later, would solve the disconnect.

The White House's 5-Month Plan for Obamacare

Screenshot

President Obama laid out the big-picture pitch for being critical and optimistic about Healthcare.gov at the same time in his remarks Monday morning. Later that afternoon, senior administration officials provided a more granular look at White House views on the behemoth website, its unacceptable performance so far, and where they think this is all going in the five months and one week of open enrollment left.

The meeting took place in the West Wing's basement Ward Room, notorious within the White House for its impenetrability to cell phone and wireless signals, and decorated with naval imagery and a bristly fall floral arrangement. This is the view from inside that bunker:

  • At the outset, the White House anticipates Medicaid enrollment may go faster than private-insurance enrollment through the exchanges because it involves only the extension of an existing system, and can sometimes—as in Oregon—be done in one big batch for tens of thousands of people who've already been identified by a state. This is also what happened in Massachusetts in 2007, when Commonwealth Care was launched; a free Medicaid-like program that was part of the state's implementation of its universal health-coverage law drew far more people than private plans during the earliest months of enrollment.
  • The administration thinks October will see the smallest number of people purchasing insurance. The real shopping in the individual market will begin in mid-to-late November and December. The White House has not released a figure for how many have gained coverage so far, though it's made public that nearly 500,000 have applications in process or completed for a mix of private insurance and Medicaid coverage through the state- and federally run exchanges. 
  • Officials expect the number of people seeking to enroll will spike right before the December 15 deadline for getting coverage by January 1, drop in January, level off in February, and spike again in March in advance of the end of open enrollment for 2014 on the 31st of that month.
  • Existing demand on the federal website for state exchanges has been huge, with 20 million unique visitors—not "hits" or pageviews—to Healthcare.gov in the first three weeks. In the first three days, there were 8.6 million unique visitors to the site, which created a well-documented traffic jam.
  • While this has been a challenge for the website, to say the least, the White House believes this level of intensity bodes well for finding and reaching new people to buy insurance. Of course, this also means the website issues will need to be largely resolved by mid-to-late November, so that when the anticipated surge of purchasing takes place, people can complete their transactions.
  • The strategy for enrolling people has put the website at the center, but there are redundancies built into the system and the other means of enrolling people—by phone, on paper (paper!)—are being strengthened to take some of the stress off Healthcare.gov as fixes are made to the site. Matt Yglesias is right to observe that this clearly was not anyone's plan A.
  • The number of people staffing the call center is being increased by 50 percent.
  • When Massachusetts rolled out Commonwealth Care in 2007, people used a variety of media to get information, and they took their time doing due diligence on products before making decisions. Based on that precedent, it won't be a surprise if people go the federal or state websites five or six times for information (this is assuming functional sites), and also call the call center, before making a decision about which plan to purchase.
  • Cabinet secretaries will be deployed around the country to help encourage enrollment in the months ahead, especially in the key urban areas identified as having high concentrations of the uninsured.
  • All the state exchanges are also using a key part of the federal data architecture. The data hub piece of the system, used to verify citizenship, Social Security numbers, and other personal information, is solid.
  • As for what is less solid, the Centers for Medicare and Medicaid Services (CMS) has brought in a tripartite "tech surge"—outside eyes, some full-time internal staff, and more contractors—to diagnose problems and debug the code on the federal site. The White House wouldn't say who the contractors and outside eyes were, referring that question to CMS. Update: On Tuesday, HHS released one name—Jeff Zients—and elaborated on the categories of people involved in the fix-it project.
  • Officials say CMS isn't lacking any resources to get fixes done.

Barack Obama, Insurance Salesman in Chief

Jason Reed/Reuters

Of all the things Barack Obama ever expected to be during the course of his life, a television insurance salesman is probably not one of them.

But that's the role he took on Monday morning in a Rose Garden speech pitching insurance through the Affordable Care Act's online marketplaces and acknowledging for the first time just how troubled the website to access them is. His remarks failed to address many of the specific concerns raised by reporters and technologists about the gargantuan Healthcare.gov website, and he and provided no new information about what went wrong or how, specifically, it will be fixed.

Instead, his message was more like an infomercial designed for the general public: We know there are problems with the site and we are on it. Meanwhile, we're offering a great product that will save you money, so keep on trying, even if it's a little frustrating.

Obama was introduced by Janice Baker, the first woman to enroll through the exchanges in Delaware and owner of the Heavenly Hound Hotel dog kennel in Selbyville. She said she got insured after making "a number of frustrating attempts."

That was the same word Obama used to describe his own feeling about the website. "There's no sugarcoating it. The website has been too slow. People have getting stuck during the application process," the president said. "And I think it's fair to say that nobody's more frustrated by that than I am."

But, he continued, "the product is good" and while "there's no excuse for the problems ... these problems are getting fixed."

He also described a letter from a Pennsylvania man that "pretty much sums my message today: Yes, the website really stank for the first week. But instead of paying $1,600 per month for a group insurance plan, we have a plan that will only cost us $692 a month, savings of $900 per month."

The man was "frustrated by the website. But he's feeling a little less frustrated once he found out that he was saving 900 bucks a month on his health insurance," the president said.

"The website's going to get fixed," Obama assured. "We are doing everything we can possibly do to get the websites working better, faster, sooner. We got people working overtime, 24/7, to boost capacity and address the problems. Experts from some of America's top private-sector tech companies, who've, by the way, have seen things like this happen before, they want it to work," he explained, in the most specific section of his remarks about what is happening to address the site.

"They're reaching out," he said. "They're offering to send help. We've had some of the best IT talent in the entire country join the team. And we're well into a tech surge to fix the problem."

Obama also reminded listeners that "the Affordable Care Act is not just a website"—it's a set of policy changes that alter how insurance is regulated and what sort of coverage is available. And he pitched the call center people can used to enroll if they can't get the website to work, or if they just prefer to use the phone.

"We've also added more staff to the call centers where you can apply for insurance over the phone .... But keep in mind, these call centers are already up and running. And you can get your questions answered by real people 24 hours a day in 150 different languages," Obama said.

"The phone number for these call centers is 1-800-318-2596," he continued. "I want to repeat that: 1-800-318-2596. Wait times have averaged less than one minute so far on the call centers, although I admit that the wait times probably might go up a little bit now that I've read the number out loud on national television."

The only thing missing was the classic infomercial promise of operators standing by.

Americans in Need Will Save Obamacare From Itself

Jonathan Bachman/Reuters

Much of the debate about the Obamacare rollout has centered on whether or not its early troubles will turn people off the idea that government can do big things well. But people do not turn to government programs because they believe in them. They turn to them because they need them, and the market is not meeting their needs. When your alternative is not something excellent but nothing, you use whatever is there. A bad lunch is still lunch, an overrun city college is still a pathway to prosperity, and Medicaid is far better than six months of calls from debt collectors.

That's going to save the Obamacare rollout. It's also going to make many people who don't normally deal with government programs for people in need feel uncomfortable as they encounter a level of bureaucratic inefficiency they are unused to. There are two main constituencies for Obamacare: people who don't have insurance, and people who have insurance in the private market already. Both are being funneled into Healthcare.gov, the woe-begone federally-run site for health-insurance marketplaces in 36 states. As Jeff Young at the Huffington Post pointed out this morning, a number of individual-market plans are shutting down now that they must meet higher standards, making it urgent for individual-market buyers to transfer to a new plan through Healthcare.gov or one of the state exchanges before the start of the new year. Meanwhile, the "Obamacare enrollment website remains badly broken despite two weeks of intensive round-the-clock efforts at repairs," according to Politico.

People who have experience with programs for the needy will recognize a familiar bureaucratic incompetence in the rollout. It's a tragedy to watch early efforts to sign up through a new government-mandated insurance access route—as by these working-class Floridians—turn into one more sad chapter in a long book called the humiliations and frustrations of not being well-off in America.

Yet the fact remains that there are uninsured who need health insurance, and they will need it whether or not it is easy to get. Most of these people are already inclined by demographics toward the Democrats, and as they come in contact with the effects of the Affordable Care Act, their views on it have become more positive, according to an October 16 memo from Democratic pollsters. "The biggest shifts on favorability since 2010 come not from partisans but from independents and key groups, including unmarried women, white non-college voters, and seniors. These are also the groups most likely to report that they are seeing the benefits of the law. This is not being driven by partisans aligning their views; this is being driven by the relevance of the changes to people’s lives," observe memo authors Stan Greenberg, James Carville, and Erica Seifert.

The Obamacare rollout is sure to become a legendary case study in high-profile government goofs. But polls show people now oppose the law less than they did just this summer, too.

* * *

Obamacare was damaged at the outset by the political tug-of-war over its very existence, and the conflicts at its creation have had serious downstream effects, placing the federal government in charge of far more than it was supposed to be doing. It also has also suffered from what Johns Hopkins University political scientist Steven Teles calls "kludgeocracy"—the tendency of interest groups, lobbyists, bureaucracy, and bad management to combine to create highly complex legislation and giant public-administration kludges, a term defined as "an ill-assorted collection of poorly-matching parts, forming a distressing whole."

That is what Obamacare is proving to be, though it has its bright spots, too among the 14 state exchanges. The law passed in March 2010, but final rules governing how the exchanges were to work were not issued until March 2013. A bid from the main IT contractor, CGI Federal, was accepted in September 2011, but the company did not start critical work until this spring because it was waiting for specifications from the government, leaving too little time to troubleshoot the enormously complex systems CGI and others were setting up.

The federal government needed to build many more sites than the program was designed for it to do. The law was set up to work state-by-state to respect existing state insurance markets. But Republican governors who opposed the idea of the exchanges and expanding Medicaid, coupled with a Supreme Court decision that they did not have to expand Medicaid, led the federal government to take on responsibility for many more states than it ever planned to do—36 in all. Deep and abiding problems with the federal procurement process meant expertise from Obama's close ties to new-media leaders could not be brought to bear on the project.

As troubles with the customer-facing sign-up process have lessened, thanks in part to a drop in traffic to Healthcare.gov coupled with a furious effort to solve sign-in problems, new tech issues have emerged to threaten the whole system. Problems on the back-end involving capturing customer data accurately, and questions about whether the site can feed accurate data to the insurers, who are now having to manually reconfirm the data they are getting, have sprung to the fore. This week, customers who called the Obamacare help center run by government contractor Vangent were told their passwords had been erased, but a senior administration official denied that and said call-center workers were merely working from an incorrect script that managers had not been able to get them to stop using it a week after the problem was identified.

If the site cannot solve the login and other problems for already-insured people transferring into the market, the new year could see not a win for the administration but a real crisis for those users. And it won't be doing anyone any good if the technical problems with the site scare off so many people—especially young, healthy people who need to be in the risk pools for premiums to stay low—that they forgo insurance rather than deal with the hassles.

Still, Gallup polling shows most of the uninsured, whether they understand the options available to them under Obamacare or not, plan to seek insurance. Ultimately, people in need need whatever there is, and once users get through the websites, they'll either be in a private plan or in Medicaid. And they won't have to tangle with Healthcare.gov or any of the state exchange sites again for at least a year.

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