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Location: Douglas, Coffee Co., The Other Georgia, United States

Sid in his law office where he sits when meeting with clients. Observant eyes will notice the statuette of one of Sid's favorite Democrats.

Saturday, November 30, 2013

I sure hate it and getting most uncomfortable: More liberal, populist movement emerging in Democratic Party ahead of 2016 elections

From The Washington Post:

For more than two years, President Obama has endorsed reducing Social Security payments as part of an ambitious deal to tame the national debt. But then Sen. Elizabeth Warren (D-Mass.) — viewed by supporters on the left as a potential 2016 presidential candidate — embraced a far different proposal: increasing benefits for seniors.

As Obama struggles to achieve his second-term domestic agenda, a more liberal and populist voice is emerging within a Democratic Party already looking ahead to the next presidential election. The push from the left represents both a critique of Obama’s tenure and a clear challenge to Hillary Rodham Clinton, the party’s presumptive presidential front-runner, who carries a more centrist banner.

The left’s influence will be on display in coming weeks when a high-profile congressional committee formed after the government shutdown faces a deadline to forge a budget agreement. Under strong pressure from liberals, the panel has effectively abandoned discussion of a “grand bargain” agreement partly because it probably would involve cuts to Social Security.

“The absolute last thing we should do in 2013 — at the very moment that Social Security has become the principal lifeline for millions of our seniors — is allow the program to begin to be dismantled inch by inch,” Warren said recently on the Senate floor, announcing her support for a bill that would expand the program.

Liberals say Social Security is one example of how Democrats are likely to face sustained pressure in coming months to move in a more populist direction on a host of issues.

“The first Obama administration was focused too much on saving the banks and Wall Street,” said Sen. Tom Harkin (D-Iowa), a liberal who is retiring after four decades in Congress. “There’s going to be a big populist push on whoever’s running for office to espouse these kinds of progressive policies.”

Senate Democrats’ recent decision to abandon the filibuster for almost all nominees was a major victory for liberals, who had long championed the change, and paves the way for left-leaning nominees to join courts and helm agencies.

In addition, liberals have accelerated their push for a higher minimum wage — successfully persuading Obama to support a $10.10-an-hour proposal after he suggested $9 an hour this year. They also are making a case for tougher financial regulations, specifically targeting massive banks they would like to break up.

More broadly, liberals argue that the nation must do more to narrow economic inequality, to expand the safety net to help those who have lost jobs to globalization and to relieve some of the burden of student debt — goals that the president generally shares.

Obama’s defenders say he has a wide array of proposals to help the middle class that have been stymied by Republicans in Congress. Even his willingness to trim Social Security payments — by adopting a stricter formula for calculating benefits — includes protections for the poor, they note.

“It’s real things in the economy that Democrats have been too timid to address or Republicans have blocked them from addressing,” said longtime liberal activist Roger Hickey, co-director of Campaign for America’s Future.

But the push from the left carries political risks for Democrats, who could be accused of being reckless about the national debt or insensitive to the demands of business and economic growth.

What’s more, many Americans are uncomfortable with the notion of the government redistributing income far beyond what happens today in order to accomplish basic elements of the populist agenda. Liberal congressional or presidential candidates could pressure more moderate candidates to veer to the left, perhaps reducing their electability.

The arena where the populist push is likely to play out most clearly is in the nascent 2016 presidential campaign. Warren is the object of admiration among liberals, drawing huge audiences for her speeches. She has said she doesn’t plan to run for president, but she hasn’t made a firm commitment to stay out of the race. A spokeswoman said she was unavailable to comment.

At the same time, many on the left view Clinton suspiciously, arguing that longtime advisers to her and her husband, former president Bill Clinton, are too close to Wall Street.

Many liberals also argue that it was these same Clinton advisers — disciples of former Treasury secretary Robert Rubin — who led Obama away from a more populist agenda, embracing conservative thinking on the virtue of spending reductions and entitlement cuts.

“I personally have Clinton fatigue, noting that it was a Clinton team that has been running Obama’s economics,” said Lawrence Mishel, president of the labor-backed Economic Policy Institute. “A Clinton administration seems like a continuation of the same team.”

Some consider the debate an opportunity for Hillary Clinton to embrace a more populist message. Bill de Blasio (D), her New York campaign manager in 2000, was just elected mayor of New York on an inequality agenda.

Top officials at the Center for American Progress — sometimes viewed as a Clinton shadow cabinet — started an independent think tank several weeks ago, the Center for Equitable Growth, to study income inequality. At its Washington opening, Chairman John D. Podesta, who was Bill Clinton’s White House chief of staff, hinted about restoring the domestic success of the 1990s.

“All the gains, I think, to fight poverty and reduce the poverty level during the Clinton administration in which I served have been washed away,” he said.

In an interview, Podesta said the think tank is an academic effort not intended to benefit any candidate in particular. But he said he has no doubt that Hillary Clinton would be able to succeed on populist political terrain.

“I’m an admirer of Senator Warren’s, but I think that Hillary Clinton really connects with working people and she showed that in the 2008 race against Obama,” he said.

Liberals, however, are fawning over Warren, who was the brains behind the new Consumer Financial Protection Bureau and focused on the economic condition of the working class when she was a professor at Harvard. In addition to calling for breaking up the big banks and expanding Social Security, she has proposed a range of new policies to cut student debt.

Warren received a resounding response when she spoke at the AFL-CIO convention this past fall in what many considered an encapsulation of her populist message going forward.

“We know even though pundits and big corporate lobbyists in Washington might need to be dragged kicking and screaming, we know America agrees with us. We believe Wall Street needs stronger rules and tougher enforcement. And you know what? So do more than 80 percent of people,” she said. “Wall Street will fight us, but the American people are on our side.”

Another potential source of pressure building on the left is Sen. Bernard Sanders (Vt.), an independent who caucuses with Democrats. He has said he might run for president if no liberal he considers adequate steps up.

Although his chances would be slim at best, he could serve as an agitator who pulled other candidates to the left — or as a potential spoiler if his campaign got off the ground.

“I don’t wake up every morning saying, ‘Oh my goodness, I really want to be president,’ ” Sanders, who calls himself a democratic socialist, said in an interview. “But somebody’s got to be out there, and if nobody is, I’ll do it.”

No comment: Coalition apologizes for killing Afghan child, seeks to shore up prospects of security deal

From The Washington Post:

The U.S.-led coalition in Afghanistan apologized Friday for mistakenly killing a 2-year-old boy during an airstrike, the latest crisis to confront American officials hoping to finalize a long-term security agreement between the two countries.

The U.S. is on track to overtake Saudi Arabia as the world's biggest oil producer by 2015.

From The Wall Street Journal:

OPEC holds outsize sway in global oil markets, producing more than one out of every three barrels burned in the world. But its ability to move prices significantly has been hindered recently by a surge in non-OPEC crude, including a boom in U.S. production of shale oil.

The U.S. is on track to overtake Saudi Arabia as the world's biggest oil producer by 2015, according to the International Energy Agency.

All politics and no play makes Johnny a dull boy - I love it: Caveat Emptor: Lovers of Latin Try to Sell a Dead Tongue - They Update It With a Word for 'Internet,' but Europe Isn't Buying

From The Wall Street Journal:

INCOURT, Belgium—A modest white schoolhouse near Brussels is in the vanguard of a long-struggling movement of Latin enthusiasts who refuse to say requiescat in pace to the ancient language.

At Schola Nova, dozens of students are required to take up to 10 hours of Latin a week, but they don't dwell just on Virgil or Ovid. They speak what is known as "modern" Latin: The children talk on telephonis gestabilibus (cellphones); they use computatoria (computers) to surf the reticulum interretiale (Internet); and they wear bracas Genuenses (jeans).

The school is the brainchild of founder Stéphane Feye, a bearded Belgian and native speaker of Franco-Gallici (French), who dreams of resurrecting Latin as Europe's lingua franca.

"We have a single money, the euro," Mr. Feye says. "We should have a single language, Latin."

Given the economic problems created by the euro, it might seem like a non sequitur to encourage a single language for the continent. But a hard core of Latin enthusiasts say the language would foster a sense of European unity that's been lacking since the decline of the Holy Roman Empire, which used Latin as one of its official languages.
Ever since the empire officially ended during the Napoleonic wars and Europe dissolved into a patchwork of fractious nation states, Latin has been more a scourge of Western schoolchildren than a living language.
A loose group of scholars and enthusiasts now connects the "Living Latin" movement. A number of them live in Germany and Austria: Despite not being derived from Latin, German's grammatical structure—heavy on declensions—makes Latin easier for German speakers to grasp.
Among Latinists, the idea of updating the language is controversial. The Academia Vivarium Novum, a school in Rome where students from around the world take immersion courses in Latin, deplores the corruption the language suffered during the Middle Ages. It aims to preserve Latin as it was spoken during the time of Cicero, not adapt it to the era of Mr. Berlusconi.
"We already have a common language that would allow us to speak about these trifles," said Luigi Miraglia, director of the academy, in a speech (in Latin) earlier this year. "If we must speak about Coca-Cola or McDonald's, we can speak English."
"The dead language is important because it is dead," Mr. Miraglia said in an interview.
Latin campaigners have over the years petitioned EU officials to add Latin as one of its official languages (there are now 24), or even to designate Latin as a pan-European language. But the European Commission, the EU's executive arm, has nixed the idea.

Friday, November 29, 2013

Medicaid Growth Could Aggravate Doctor Shortage

From The New York Times:

Dr. Ted Mazer is one of the few ear, nose and throat specialists in this region who treat low-income people on Medicaid, so many of his patients travel long distances to see him.

But now, as California’s Medicaid program is preparing for a major expansion under President Obama’s health care law, Dr. Mazer says he cannot accept additional patients under the government insurance program for a simple reason: It does not pay enough.

“It’s a bad situation that is likely to be made worse,” he said.
His view is shared by many doctors around the country. Medicaid for years has struggled with a shortage of doctors willing to accept its low reimbursement rates and red tape, forcing many patients to wait for care, particularly from specialists like Dr. Mazer.
Yet in just five weeks, millions of additional Americans will be covered by the program, many of them older people with an array of health problems. The Congressional Budget Office predicts that nine million people will gain coverage through Medicaid next year alone. In many of the 26 states expanding the program, the newly eligible have been flocking to sign up.
Community clinics, which typically provide primary but not specialty care, have expanded and hired more medical staff members to meet the anticipated wave of new patients. And managed-care companies are recruiting doctors, nurse practitioners and other professionals into their networks, sometimes offering higher pay if they improve care while keeping costs down. But it is far from clear that the demand can be met, experts say.
In California, with the nation’s largest Medicaid population, many doctors say they are already overwhelmed and are unable to take on more low-income patients. Dr. Hector Flores, a primary care doctor in East Los Angeles whose practice has 26,000 patients, more than a third of whom are on Medicaid, said he could accommodate an additional 1,000 Medicaid patients at most.
“There could easily be 10,000 patients looking for us, and we’re just not going to be able to serve them,” said Dr. Flores, who is also the chairman of the family medicine department at White Memorial Medical Center in Los Angeles.
California officials say they are confident that access will not be an issue. But the state is expecting to add as many as two million people to its Medicaid rolls over the next two years — far more than any other state. They will be joining more than seven million people who are already in the program here. One million of the newly eligible will probably be enrolled by July 2014, said Mari Cantwell, an official with the state’s Department of Health Care Services.
On top of that, only about 57 percent of doctors in California accept new Medicaid patients, according to a study published last year in the journal Health Affairs — the second-lowest rate in the nation after New Jersey. Payment rates for Medicaid, known in California as Medi-Cal, are also low here compared with most states, and are being cut by an additional 10 percent in some cases just as the expansion begins.
“The symbolism is horrible,” said Lisa Folberg, a vice president of the California Medical Association.
The health care law seeks to diminish any access problem by allowing for a two-year increase in the Medicaid payment rate for primary care doctors, set to expire at the end of 2014. The average increase is 73 percent, bringing Medicaid rates to the level of Medicare rates for these doctors.
But states have been slow to put the pay increase into effect, experts say, and because of the delay and the fact that the increase is temporary, fewer doctors than hoped have joined the ranks of those accepting Medicaid patients.
“There’s been a lot of confusion and a really slow rollout,” Ms. Folberg said, “which unfortunately mitigated some of the positive effects.”
Adding to the expansion of the Medicaid rolls is a phenomenon that experts are calling the “woodwork effect,” in which people who had been eligible for Medicaid even before the Affordable Care Act are enrolling now because they have learned about the program through publicity about the new law. As a result, Medicaid rolls are growing even in states like Florida and Texas that are not expanding the program under the law.
Managed-care companies that serve the Medicaid population here through contracts with the state are still hustling to recruit more doctors and other providers to treat the new enrollees.

Molina Healthcare, which provides coverage to Medicaid patients in California and nine other states, has hired more than 2,000 people over the last year, said Dr. J. Mario Molina, the company’s chief executive. They include not just doctors, he said, but nurses, case managers and call center workers to help new Medicaid enrollees who may be confused about “where to go or what to do or how to access health care.”  
Dr. Molina said the temporary rate increase for primary care doctors had helped his company recruit them to its networks. Recruiting specialists has been harder, he said, adding, “Rheumatology is difficult; neurosurgery is difficult; orthopedic surgery is difficult.”
Ms. Cantwell of the Department of Health Care Services said federal and state rules assured “geographic and timely access” for Medicaid patients, and the state closely monitors managed-care plan networks to make sure they include enough doctors. In California, she said, some 600,000 of the people entering Medicaid in January have already been assigned primary care doctors through an interim health care program for low-income residents that will end next month.
She also said that since the expansion population will be older on average than current adult Medicaid beneficiaries — until now, most adults who qualified were pregnant women or parents of young children — the state had decided to pay doctors a rate “somewhere in between that for our regular adult population and our disabled adult population” for their care.
Dr. Paul Urrea, an ophthalmologist in Monterey Park, said he was skeptical of “blue-sky scenarios” suggesting that all new enrollees would have access to care. “Having been in the trenches with Medi-Cal patients who have serious eye problems,” he said, “I can tell you it’s very, very hard to get them in to see those specialists.”
Dr. Urrea said that when he recently tried to refer a Medicaid patient with a cornea infection to another eye specialist, he was initially informed that the specialist could not see the patient until February. “And this is a potentially blinding condition,” he added.
Dr. Mazer, who leads a committee of the California Medical Association that grapples with Medicaid issues, said the managed-care plans he contracts with “keep on sending us patients, and right now I’m scheduled four weeks out.”
Oresta Johnson, 59, who sees Dr. Mazer through the state’s interim health care program for low-income residents but will switch to Medicaid in January, said she had faced “excessively long” waits to see specialists who could treat her degenerative joint disease. Dr. Mazer is monitoring her thyroid gland, she said, and she is hoping she will not have a problem getting back in to see him next spring, when she may need a biopsy.
“I understand there’s a lot of people who need help,” she said. “But am I not going to be able to see who I need to see?”

Pres. Obama, please move on to other things: Prisoners Fight U.S. Over Repatriation From Guantanamo Bay - Effort to Close Prison Hits Snag as Some Detainees Resist Transfer to Home Countries

The Obama administration's effort to close the Guantanamo Bay prison has hit a snag: detainees who don't want to be repatriated.
Two Algerian citizens held at the naval base in Cuba are fighting a transfer to their homeland, people familiar with the situation say. The two men say they fear that Islamist extremists will try to recruit them and may attack or kill them when they discover the detainees don't share their commitment to violence, these people say.

Thursday, November 28, 2013

HealthCare.gov tech team scrambling to create workaround for site before deadline

From The Washington Post:

Days before the Obama administration’s self-imposed Nov. 30 deadline for fixing HealthCare.gov, its technology team is scrambling to build a new part of the Web site as a workaround that would enable more people to buy health insurance without relying directly on the site.

The new mechanism, EZ App, would permit people who are eligible for financial help from the government to enroll for coverage without calculating an exact subsidy amount, which has been a major stumbling block, according to government and insurance industry officials who spoke on the condition of anonymity in order to be frank. It would allow call centers, and eventually insurance companies and brokers, to help people enroll based on estimates of what their federal subsidies would be.

But insurers are uncomfortable with the add-on because they do not want to shoulder the financial liability for customers signing up for plans with a rough estimate of their final premiums, rather than a precise figure verified through the site.

The workaround, aimed at diverting consumers from the Web site, is the latest indication that significant uncertainty remains about how the government will handle the large number of people who are likely to want to sign up for health plans soon.

Online Health Law Sign-Up Is Delayed for Small Business - The problems engulfing President Obama’s health care law are remarkable because administration officials had repeatedly brushed aside doubts about whether they would be ready.

From The New York Times:

The Obama administration on Wednesday announced a one-year delay in a major element of the new health care law that would allow small businesses to buy insurance online for their employees through the new federal marketplace.

It was yet another setback for the rollout of the health care law and resulted, in part, from the well-documented problems of the insurance marketplace website. Administration officials said they had to focus on the basic functions of the website, so that individuals could shop for insurance, before offering online enrollment for small businesses. In the meantime, businesses and their employees can apply through brokers.
Many employees of small businesses are uninsured, and the businesses themselves are much less likely than big companies to provide coverage to workers and their families.
The latest delay, coming just as the White House was boasting of major improvements in the health insurance website, HealthCare.gov, opens the door to more complaints about the health care law and could increase pressure to delay other provisions.
“The president bit off more than he can chew with this health care law, and small businesses are now forced to bear the consequences,” said Speaker John A. Boehner of Ohio. “Business owners across the country are already having health care plans for their employees canceled by this law, and now they’re told they won’t have access to the system the president promised them to find different coverage. Instead, they’ll have to resort to a system you’d expect to see in the 1950s.”
It was not the first delay for small businesses. The administration had previously delayed online enrollment for them to the end of this month from Oct. 1.
The date has now been pushed back to November 2014 for coverage that takes effect in January 2015, according to the Health and Human Services Department.
The announcement, just before Thanksgiving, was reminiscent of the way the White House announced, just before the Fourth of July weekend, a one-year delay in the requirement for larger employers to offer health insurance to employees.
The marketplace for small businesses — the Small Business Health Options Program, or SHOP exchange — was one of the few provisions of the 2010 law with some Republican support, and it was originally championed by Senator Olympia J. Snowe, Republican of Maine.
John C. Arensmeyer, the chief executive of Small Business Majority, an advocacy group that supports the health care law, said, “It’s disappointing that the online portion of the federal small business marketplace through Healthcare.gov will be delayed, and it’s important it get up and running as soon as possible.”
The marketplace, he said, “is still the most important provision in the Affordable Care Act for small businesses.”
For years, small businesses have had difficulty getting affordable insurance. Many owners cite the rising cost of health insurance as their top concern.
The administration said that small businesses and their employees seeking coverage in the federal exchange could still apply and enroll through an agent or broker, as many do now. “Agents and brokers are essential to making this happen,” an administration official said.
However, the high-tech capability once promised by the White House will not be available until late next year.
“The agent, broker or insurer will help the employer fill out a paper application for SHOP eligibility and send it in to the SHOP marketplace,” the administration said. The insurer can also tell employers what premiums they would have to pay and can enroll employees.
Some small businesses may qualify for tax credits worth up to 50 percent of their premium costs. The tax credits will be available only for plans purchased through the small business exchange.
Amanda L. Austin, a lobbyist at the National Federation of Independent Business, a trade group, said she had heard rumors that the online small business exchange might be delayed, but was surprised that it had been put off for a year. “That’s pretty significant,” Ms. Austin said. “The online exchange is a key component of the Affordable Care Act, and administration officials have hailed it as the answer to small businesses’ health care concerns.”
While the online exchange is being delayed, she said, “many small businesses face higher premiums in 2014 because of new taxes, including a new federal tax on the health insurance they purchase.”
Kathleen Sebelius, the secretary of health and human services, said that the website was “vastly improved each and every day,” with hardware upgrades and software fixes that produced lower error rates and faster response times for users.
An employer using the SHOP exchange must offer coverage to all full-time employees — generally those working at least 30 hours a week, on average.
In April, the Obama administration delayed a requirement that SHOP exchanges offer a variety of competing insurance plans to employees. The administration cited “operational challenges” as a reason for that delay.
Congress had wanted to provide small business employees with a range of health plan options. While some state-run exchanges will allow employers to offer such choices to employees, the federal exchange will not do so until 2015.
E. Neil Trautwein, a vice president of the National Retail Federation, said, “If the law is so burdensome for the administration to implement, just think how hard it is for small businesses.”
In a separate announcement, officials at the Health and Human Services Department said Wednesday that they would replace the contractor that manages computer servers handling the enormous load of data collected by HealthCare.gov.
Terremark, a subsidiary of Verizon Communications that now provides the service, will be replaced in March by Hewlett-Packard, officials said. A spokeswoman at the Centers for Medicare and Medicaid Services said the change had been planned at least since July. Issues related to the raw computing capacity of the servers provided by Terremark have been cited as a factor in the website problems. A spokesman for Verizon declined to comment.
The problems engulfing President Obama’s health care law are remarkable because administration officials had repeatedly brushed aside doubts about whether they would be ready.
Testifying before a congressional panel on Oct. 29, Marilyn B. Tavenner, the administrator of the Medicare agency, said, in response to a question, that the website for the small business exchange would be in operation by the end of this month.

Wednesday, November 27, 2013

Lara Logan to take leave of absence from ‘60 Minutes’

The Washington Post reports that a CBS network review of the show’s segment on Benghazi found numerous flaws in the reporting, noting:
The “60 Minutes” story began to unravel after The Washington Post reported on Oct. 31 about the existence of an “incident report” that Davies had written for Blue Mountain in which Davies acknowledged that he spent most of the night at his beachside villa. It fell apart altogether when the New York Times revealed Nov. 7 that Davis had admitted as much to the FBI in an interview.

After defending the story for nearly two weeks, CBS and Logan retracted it and apologized on Nov. 8.

In his memo, Fager wrote, “There is a lot to learn from this mistake for the entire organization. We have rebuilt CBS News in a way that has dramatically improved our reporting abilities. Ironically, ‘60 Minutes,’ which has been a model for those changes, fell short by broadcasting a now discredited account of an important story, and did not take full advantage of the reporting abilities of CBS News that might have prevented it from happening.”

Health Website Deadline Nears, Democrats say "The core of support for the law is still there," but I wonder.

From The Wall Street Journal:

With the clock ticking toward a Saturday deadline, Obama administration officials promise that the HealthCare.gov website will work better. Exactly how much better? That is hard to say.

The measure of success, repeated by an array of administration officials, is that the online marketplace intended to be used by millions of Americans to obtain health insurance would be working smoothly for the "vast majority of users" by Saturday, the last day of November.
For now, Democrats on Capitol Hill are waiting to see whether the White House can deliver on its promise.
"There's rising concern on the Hill that's been building for a while, but most everyone hopes and expects that things will get turned around once they get the website up and running," he said. "The core of support for the law is still there."
Earlier this month, more than three dozen Democrats voted for a GOP plan to change the law to allow insurers to keep selling older health plans that don't comply with the law's mandates for a year.

Tuesday, November 26, 2013

Obamacare update: Consumers see progress but insurers smell trouble - Some congressional Democrats, uneasy about the messy rollout of the exchange, have expressed a willingness to dismantle parts of the law if problems continue

From The Washington Post:

As the Obama administration closes in on its self-imposed deadline to fix the troubled online health insurance marketplace, consumer advocates say it is becoming easier for people to sign up for coverage but insurers warn that critical flaws continue to hinder participating health plans.

Administration officials have promised that HealthCare.gov will be working smoothly for most people by Saturday and are citing evidence indicating progress toward that goal. Workers helping people sign up for coverage have noticed that the site has been running better over the past two weeks, with consumers experiencing shorter wait times and fewer crashes.

But the online system is still marred by defects that will create havoc for insurance companies if a significantly larger volume of applicants starts to sign up in coming weeks. Among them are the error-riddled reports that insurers are receiving about who has enrolled, a problem that could be disastrous if not fixed soon.

There is little room for error at this point. People seeking to take advantage of the new coverage that kicks in Jan. 1, or whose health insurance policies are being canceled at the end of the year, have until Dec. 23 to choose a plan and until Dec. 31 to pay their first month’s premium. Some congressional Democrats, uneasy about the messy rollout of the exchange, have expressed a willingness to dismantle parts of the law if problems continue.

“If they get this fixed, it’s a chapter in somebody’s book. If they don’t get this fixed, it’s a chapter in history,” said Michael O. Leavitt (R), a former Utah governor who served as secretary of the Department of Health and Human Services during the tumultuous rollout of Medicare Part D, which added prescription drug coverage to Medicare. “They will need to demonstrate fairly soon that there’s improvement, or they will lose the support of their own party.”

On Friday, Sen. Al Franken (D-Minn.) told Minnesota Public Radio that if the Web site isn’t fixed on time, he would consider delaying the rule requiring most Americans to carry health insurance or face a fine. He joins a growing chorus of Democrats in Congress who have advocated for changes or delays to the law that could weaken it.

Administration officials contend that they are on track. By Saturday, they said, they will have doubled capacity to allow at least 50,000 users at a time without the system malfunctioning. They are also working on a new system that gives people alternate ways to sign up for coverage and get government subsidies, including going directly to insurers’ corporate Web sites.

They are also moving on to the outreach phase, which had taken a back seat as they grappled with the faulty Web site. Next week, the White House will host an insurance-oriented “youth summit” aimed at people ages 18 to 35, an age group whose participation in the health-care law will be critical to its success.

On Tuesday, White House officials are scheduled to meet with physicians, nurses and pharmacists about the health-care law.

Administration officials have sought to tamp down expectations, noting that improvements will be gradual in the coming weeks and months.

“The system will not work perfectly on Dec. 1, but it will operate much better than it did in October,” Julie Bataille, a spokeswoman for the Centers for Medicare & Medicaid Services, the federal agency in charge of HealthCare.gov, told reporters on Monday.

Even if it does work better for consumers, there are still problems — particularly the scrambled reports insurers are getting about people who have signed up for coverage through HealthCare.gov. Insurers say they are getting duplicate records and reports that misstate family relationships, such as listing a child as a spouse.

In some cases, enrollment reports are disappearing. With these “orphan records,” insurers have no way of knowing whether a person is signed up for coverage, unless a new customer happens to call the company with questions.

“The biggest concern is that there are going to be people showing up to get their care,” said one person close to the insurance industry, who spoke on the condition of anonymity to discuss sensitive issues. “Then [the doctors or hospitals] call us and we have no record, and then the consumer is left frustrated and worried and scared.”

Until such errors stop, “you can’t open the floodgates” to large numbers of Americans using the Web site to sign up for coverage, said an insurance industry official who also spoke on the condition of anonymity to discuss private conversations with administration officials about how to improve the system.

The ripple effects of these flaws affect consumers, because the new coverage does not begin until they pay their first monthly insurance premiums. And without accurate information about new customers, health plans cannot send them correct bills.

Beyond the troubles with enrollment forms, which have been evident since the marketplace opened on Oct. 1, insurers are anticipating problems if IT workers from the government and outside contractors cannot soon build other parts of the online system that are running behind schedule.

For instance, starting in mid-December, the government and each participating insurance company are supposed to perform a monthly “reconciliation,” to make sure that each side has the same list of new customers, the benefits chosen by the consumers and the government subsidies for which they qualify. That feature of the online system, however, has not been built, according to people close to the industry and government officials.

Nor can the system handle another feature, scheduled to be ready when health plans take effect on Jan. 1, in which insurers are to be paid extra government money, through a method known as “risk corridors,” if their new customers are old and require expensive medical care. “It’s not built, let alone tested,” the industry official said.

Still, consumer advocates report steady improvement in HealthCare.gov since its launch. For example, about half of the people at a Nov. 7 Miami-Dade Community College enrollment fair in Florida were able to create accounts and peruse their options, said Justin Nisly, a spokesman for the advocacy group Enroll America. By the second fair on Nov. 16, that proportion had risen to 2 out of 3 people.

The news is heartening enough that Enroll America is going forward with its “chase” campaign Dec. 1 — following up with 50,000 uninsured people in 10 states to say, “If folks have had a frustrating experience on the Web site . . . why don’t you go back and try again,” Nisly said.

To reach Iran deal, secret diplomacy that worked - The world is safer from the Iranian nuclear threat today than it was a week ago.

David Ignatius writes in The Washington Post:

Count the Iran nuclear deal as a rare win for President Obama’s secretive, cerebral style of governing. His careful, closeted approach has produced many setbacks over the past five years, but it was at the heart of last weekend’s breakthrough deal with Tehran.

This was secret diplomacy that a Henry Kissinger could appreciate. Obama began by authorizing carefully concealed meetings back in March, through Oman, the most opaque and discreet nation in the Persian Gulf. The president sent as his personal emissaries two low-key, quintessentially gray men, Bill Burns and Jake Sullivan, the deputy secretary of state and vice presidential adviser, respectively.

It was a classic magic trick: While the eye was distracted by the show of the P5+1 talks, the real work was done elsewhere — and presented to the foreign ministers of Russia, China, Britain, France and Germany in Geneva two weeks ago almost as a fait accompli.

The definition of a good agreement is one that each side can sell to its public, and that’s the case here. The agreement seems broadly positive for the United States and Israel, at the outer edge of what was possible in terms of freezing the Iranian nuclear program and providing daily inspections to check against any trickery. The world is safer from the Iranian nuclear threat today than it was a week ago.

But it’s a good deal for Iran, too, and that’s going to upset those who wanted an Iranian capitulation. The agreement explicitly seeks a “comprehensive solution [that] would enable Iran to fully enjoy its right to nuclear energy for peaceful purposes under the relevant articles of the NPT [Nuclear Non-Proliferation Treaty],” including “a mutually defined [uranium] enrichment program.” The language is just fuzzy enough that the United States can claim it hasn’t endorsed a “right to enrich” — but the Israeli critique here is correct. The enrichment right has prospectively been conceded; it will never be rescinded, nor will it ever again form the basis for a U.N. Security Council resolution condemning Iran.

This big concession on enrichment is offset by the limitations on the Iranian program in the near term that are stronger than many analysts expected. For the next six months, the Iranians will mothball some centrifuges, delay installation of others, disconnect links between the cascades of centrifuges that would be necessary for bomb-level enrichment and provide unprecedented daily inspection of their once-covert facilities at Natanz and Fordow.

Could the Iranians pocket the modest $7 billion they will receive in sanctions relief and then press ahead in six months toward bomb-making capability? That’s certainly possible. But they would make such a breakout with more chance of a U.S. military strike than before.

Kissinger set the right test when he told me in 2006 that “Iran has to take a decision whether it wants to be a nation or a cause.” This agreement, negotiated in secret with the erstwhile “Great Satan,” looks like the beginning of a long turn away from revolutionary isolation to an Iranian nation that is engaged with the West in a security framework for this volatile region. Iran may think it can play the candle at both ends — destabilize the region even as it negotiates with the United States. But that isn’t likely to work. This is a fork in the road; Iran may try to go both directions at once, but if the United States and Israel are vigilant, it won’t succeed.

The deal reached last weekend is fragile. It can be reversed; it can be finagled at the edges; it can mask secret activities. In most agreements, the rubric is “trust but verify.” In this case, make it mistrust and verify.

But it’s a beginning of a process that could make the world less dangerous. Obama, the covert commander in chief, showed once again that he acts most effectively out of sight.

Iran: Administration officials think they have bought time; they think they have retained leverage; and they believe the power of moderates could grow within Iran as the process unfolds.

Gerald Seib writes in The Wall Street Journal:

Getting to step one with Iran was hard enough. It took years of fits and starts, a long period of secret negotiations and an Iranian leader bringing a new tone to produce the preliminary and temporary deal struck over the weekend to freeze much of Iran's nuclear program in return for limited sanctions relief.
So, given the difficulties in reaching this point, why do Obama administration officials think they can take the next, even bigger step: completion within the next six months of a permanent and comprehensive deal that reins in Iran's nuclear program permanently?
Basically, there are three reasons: Administration officials think they have bought time; they think they have retained leverage; and they believe the power of moderates could grow within Iran as the process unfolds.
Skeptics—in Congress, Israel and Saudi Arabia—doubt each of those premises. But those reasons form the basis for hope that the six-month deal struck over the weekend can turn into something lasting that gives the world assurances Iran won't be able to build nuclear weapons and that provides Iran permanent relief from international economic sanctions.
Consider the three premises:

The West has acquired the most precious resource needed to strike a broad deal, which is time. For more than a decade, the world has feared that Iran might simply use negotiations to buy time to continue work on its nuclear program. The new deal, U.S. officials say, reverses that: Nuclear advances are frozen, creating time and space for negotiations without fear that talking equals nuclear program by the Iranians.

Were we not to reach this type of agreement, six months from now Iran could make significant progress in increasing its stockpiles" of enriched uranium, says one senior administration aide. "That is the outcome that we prevent with this agreement, by halting the progress of the program and rolling it back."
Israel and critics in Congress, however, don't consider that much of an achievement. They complain that little of Iran's progress in stockpiling centrifuges that can enrich uranium is rolled back, meaning the nuclear program is frozen at a fairly advanced level and can resume from there if and when negotiations break down.

The U.S. and its allies still have plenty of leverage. Administration officials contend that the sanctions relief Iran receives over the next six months is limited enough that the international community can continue to exert significant pressure.
Iran will be allowed to bring home $4.2 billion of revenue from oil sales and generate perhaps an additional $1 billion from petrochemical exports under the sanctions relief. It also will begin to bring in auto parts to revive its troubled auto industry and resume gold and precious-metals trade.
But U.S. officials insist that the core of the international economic sanctions imposed on Iran—which limit oil sales and restrict the country's access to the international banking system—will remain in place. In this view, that means Tehran's incentive to abide by the preliminary deal and make concessions to get a long-term deal will remain high.

In particular, officials argue, Iran actually will lose more revenue from oil-sales proceeds that it won't be allowed to bring home over the next six months than it will gain from the limited relief. "So just looking at oil revenue alone, Iran will actually be worse off at the end of this six-month deal than it is today," one official says.

Israeli officials argue, though, that this misses the broader point: The international stigma of doing business with Iran has faded, and that will steadily and inevitably erode the economic barriers over time.

The power of moderates could grow as the process continues. This is both one of the most intriguing and most contentious possibilities.

The key to the preliminary deal was the election of Hasan Rouhani as Iran's new president in June. U.S. officials consider Mr. Rouhani a moderating force within Iran's power structure—and, more important, think he has been given a mandate from supreme religious leader Ayatollah Ali Khamenei to begin repairing Iran's ties with the outside world.

One reason to strike a preliminary deal now, in the eyes of U.S. and European officials, is to test that proposition and to see whether a bit of diplomatic success now can allow Mr. Rouhani and like-minded forces within Iran to gather strength internally to go further.

If that proves to be the case, the U.S. might, as President Barack Obama said over the weekend, begin to "chip away" at other problems, including Iranian support for terrorism, for the Hezbollah extremist group and for Syrian leader Bashar al-Assad.

This may be the biggest test of all—and the area where Israeli and Saudi officials, who fear the character of the regime is unchanged, are most skeptical.

Monday, November 25, 2013

Companies Prepare to Pass More Health Costs to Workers - Firms Brace for Influx of Participants in Insurance Plans Who Had Earlier Opted Out

From The Wall Street Journal:

Companies are bracing for an influx of participants in their insurance plans due to the health-care overhaul, adding to pressure to shift more of the cost of coverage to employees.

Many employers are betting that the Affordable Care Act's requirement that all Americans have health insurance starting in 2014 will bring more people into their plans who have previously opted out. That, along with other rising expenses, is prompting companies to raise workers' premium contributions, steer them toward high-deductible plans and charge them more to cover family members.
The changes as companies roll out their health plans for 2014 aren't solely the result of the ACA. Employers have been pushing more of the cost of providing health insurance on to their workers for years, and firms that aren't booking much sales growth due to the sluggish economy are under heavy pressure to keep expenses down.
Some are dealing with rising expenses by making employees pick up a bigger share of the premiums for coverage of family members. Employees this year are responsible for an average 18% of the cost of individual coverage, but 29% of the cost of family coverage, according to a survey of employee health plans by the Kaiser Family Foundation and the Health Research & Educational Trust.

Between 15% and 20% of eligible workers nationwide tend to skip insurance, benefits consultants say.

A quirk of the Affordable Care Act could make it more appealing for companies to raise rates for family coverage than for individuals, said Vivian Ho, a Rice University health-care economist.

Starting in 2015, companies employing 50 or more people must offer affordable health-care coverage to anyone working 30 hours a week or more.

But affordability is measured using the cost of individual coverage, capping the cost at 9.5% of income, Ms. Ho said.

Raising family rates could help companies recoup costs without running afoul of that limit, she said. Starting now, instead of next year, would allow a more gradual change.
Health-care cost growth has slowed in recent years, and benefits consultants expect an increase of about 5% for 2014, below recent averages. The ACA isn't expected to raise health-care costs significantly for most companies in 2014 either.
The employer mandate was postponed until 2015, and other major provisions have already largely kicked in, including a requirement to cover children as old as 26, ending lifetime limits on coverage, and covering preventive care without out-of-pocket charges.
But for industries dependent on hourly workers, including retailers and hospitality companies whose young and low-wage workers more often opt out of coverage, the individual mandate may have an effect.
The problem isn't per-person costs—indeed, companies' average costs could fall with an influx of the younger, generally healthier workers who had previously tended to opt out. But adding more enrollees will nonetheless raise a company's total costs.

Obama's Race for the Cure - The President's second term may hinge on how fast his health care reform can recover

Nancy Gibbs writes pens a keeper in TIME:

A good President needs a big comfort zone. He should be able to treat enemies as opportunities, appear authentic in joy and grief, stay cool under the hot lights. But humility doesn't come naturally to those who decide they are qualified to run the free world. So the sign that the Obama presidency had reached a turning point came not when his poll numbers sank or his allies shuddered or the commentariat went hunting for the right degree of debacle to compare to the rollout of Obamacare.

It happened when he started apologizing. In triplicate. For not knowing what was going on in his own Administration. For failing to prevent his signature achievement from detonating in prime time. For not telling the whole truth when he promised people that Obamacare would not touch them without permission: "If you like your health care plan, you can keep your health care plan."

Obama's supporters can decry a "feeding frenzy," but this is a critical moment for a President whose agenda for a second term amounted to little more than being not as lame as the other guy. The HealthCare.gov website may or may not get fixed on deadline, the senior staff may be booted and rebooted, but it is already too late to avoid a pageant of media scrutiny, Republican merriment, a rebuke even from Bill Clinton and a host of existential questions: Can this policy be saved? What is left of Obama's second term if it is consumed by fixing an unpopular policy from the first? How could a White House appear so confident and incompetent at the same time? Precious time and political capital had already been spent explaining revelations of spying at home and abroad, a sudden reversal of policy toward Syria, a divisive battle over negotiations with Iran and a rolling budget battle that has slowed the recovery and shaken consumer confidence. Already embattled, the West Wing team failed to prevent or prepare the President for the health care brawl and instead made multiple public and private assurances that all was on track. That left Obama sounding like a disappointed fan in a bad bleacher seat watching his presidency be pummeled at a distance. "I think we have to ask ourselves some hard questions inside the White House," he admits.

At another time, the national dismay might be less of a concern. But we've reached the point where voters boo whichever party is center stage. Faith in the federal government is at its lowest point ever. When the Republicans diverted the nation's attention with the government shutdown, their approval numbers tanked. Now that the spotlight is on the President and the Democrats, theirs are falling fast; in a Washington Post/ABC News poll, 57% now say they oppose the Affordable Care Act (ACA). Obama's popularity has hit an all-time low as for the first time he faces disapproval not just of his performance but also of his personal credibility. Trust was the lotion that let him pursue policies people didn't necessarily like, because they liked him.

"Everything hangs in the balance," says Brookings Institution senior fellow William Galston, a key policy adviser in the Clinton Administration, who argues that Obama cannot change the topic and shouldn't even if he could. "The ACA is the signature achievement of his Administration and one of the biggest promissory notes ever handed the American people. It is not only his moral obligation to deliver on that promise but an absolute political necessity. Nothing else is going to be feasible until he rights the ship. It's just as simple as that."

Broken Promises

The rituals of presidential contrition are fixed and formal: confess the sin, express regret, make amends and, if necessary, perform a human sacrifice, preferably on a fairly high-ranking human. In his extraordinary Nov. 14 press conference and in private meetings, Obama has admitted how badly the launch has gone, how ignorant he was of the website problems, how much trouble he has caused fellow Democrats and how little confidence he has that everything will be working properly soon. He feels bad for the people getting insurance-cancellation notices who can't even go online to see if they qualify for a better policy. His verb of choice is fumbling; he fumbled the health care rollout.

But all reforms have winners and losers; throwing people off cheap, no-frills plans is central to making the Affordable Care Act work. This is not a fumble--it's a core feature. Some people will have to buy more coverage than they want or need to offset the older and sicker people who cost insurers more. Everyone in Washington knew this, so the policy's defenders are reduced to arguing that people should have realized Obama was sugarcoating things when he sold the policy as a way to cover a majority of the country's 48 million uninsured without inconveniencing anyone else.

Yet there is policy and there is politics, and the backlash was so fierce among Democrats that Obama had to reverse course, even if his backpedaling was likely to cause further fumbles down the field. He announced that the canceled policies could be extended for one more year, but that assumes insurers and state regulators go along. Experts warned that his fix could drive premiums up and cost taxpayers more if the government has to reimburse insurers for unexpected losses. State insurance commissioners argued that the President's reversal just added more chaos and complexity to an already complex system. "It's going to make pricing for next year a problem," says Kansas insurance commissioner Sandy Praeger. "When there's uncertainty, plans will take the conservative route and have higher premiums than perhaps they need."

And this may be just the beginning of the damage control. Recent policy cancellations affected a tiny proportion of people compared with those who were reassured by another presidential promise: "If you like your doctor, you will be able to keep your doctor." Obama has dropped that from his script as insurers from Indiana to California cut the number of in-network doctors and hospitals in order to hold premiums down. He also once said the law wouldn't affect people who get coverage through their employers, but already some workers are losing their coverage or seeing their out-of-pocket expenses rise in the face of policy changes. "There is no doubt that Obamacare is going to cost more for small businesses," says David Hogberg, a senior fellow at the National Center for Public Policy Research. A recent poll by Public Opinion Strategies found that 28% of businesses with 40 to 500 employees plan to drop health care coverage by 2015 because of "sticker shock," Hogberg says. "When you start forcing insurers to cover various benefits, that's inevitably going to increase the costs."

In any given year, there is a huge amount of change and churn in the marketplace; individual policies have typically turned over 70% a year as people discovered just how skimpy they were. Many may find better or cheaper plans if they can eventually penetrate HealthCare.gov But the problem for the White House is that every change that people don't like will now be blamed on the law, even those that would have happened anyway. Meanwhile, those parts of the law that are working as planned or even better--kids staying on their parents' policies till they are 26, lower rehospitalization rates, the fact that vastly more people are getting insurance than losing it--get lost in the noise. Republicans are free to both denounce the policy and then decry how poorly it's working: "This dangerous assault on personal freedom doesn't even work!" goes the war cry that Republicans will repeat into the 2014 elections.

What Went Wrong?

As a candidate, Obama disdained the game of politics, a self-conscious contrast to all the tireless political athletes named Clinton. He would rise above the small government--vs.--Big Government debate by rolling out Smart Government, an E-Z Pass lane to the future. He ran more as magician than manager: "I'm not an operating officer," he said during the 2008 primaries. "Some in this debate around experience seem to think the job of the President is to go in and run some bureaucracy. Well, that's not my job. My job is to set a vision of 'Here's where the bureaucracy needs to go.'" To which Hillary Clinton responded, "I think it's important that we have a President who understands that you have to run the government."

At the very least, a President has to run his most important initiative. As recently as Oct. 1, Obama vowed that shopping for health insurance would be as easy as comparing flights or flat-screen prices online. Then when it wasn't, the Administration explained that the program was just so popular, the site couldn't handle all that enthusiasm. Only too late did it become clear that no one with any experience launching a startup or managing the immensely complex task of integrating systems had ownership of the project. "The President has never surrounded himself with people who have deep experience in managing government, who really know how to make it work," observes Elaine Kamarck, a former Clinton adviser who now leads the Center for Effective Public Management at Brookings. "I don't agree with [James] Baker or Dick Cheney's politics, but they knew how to use the system to get things done. There's been no real equivalent in the Obama Administration."

So how could Obama not have known this? "I was not informed directly that the website would not be working the way it was supposed to," the President finally explained in his press conference. Had he known, he said, "I wouldn't be going out saying, 'Boy, this is going to be great.' I'm accused of a lot of things, but I don't think I'm stupid enough to go around saying this is going to be like shopping on Amazon or Travelocity a week before the website opens if I thought that it wasn't going to work."

But that answer just raised more profound questions. Everyone understands that a project of this size can face technical challenges. But what kind of White House leaves its boss that exposed? And what kind of boss lets that happen? By last summer, people should have been running around the West Wing with their hair on fire. In late March, consultants from McKinsey & Co. gave senior officials a 14-slide presentation detailing risks in the system, including indecision and a lack of adequate testing; the President was briefed on their recommendations. In April, Senate Finance Committee chairman Max Baucus warned that the Administration wasn't doing enough to explain and promote the new law. "I just tell ya, I just see a huge train wreck coming down," Baucus told Health and Human Services Secretary Kathleen Sebelius. In July, Henry Chao, deputy chief information officer of the Centers for Medicare and Medicaid Services, also worried that the website was going to be a disaster. "I just need to feel more confident they are not going to crash the plane at takeoff," he told a colleague in an internal memo. All the while, Obama's top aides said publicly and privately that they had the project in hand, managing it all with daily meetings from the West Wing. The White House's no-drama ethos had insulated Obama and his aides from reality.

Can He Fix It?

The President says he's got "one more campaign" in him, and that's getting health care reform right. Earlier this year, Obama recruited his campaign opinion-research guru David Simas as a senior adviser on selling health care reform. Simas understood that of all government policies, those affecting health care are the most personal, to the point where no one really thinks about them as public policy. And so it could not be more different from a presidential campaign. "When people go to vote, they are not making these potentially life-altering decisions about their kid or their mom or their dad or themselves," Simas told Time back in June. "Health care is personal. We are sending them to a place where they have to make a decision to buy something. It's completely--completely--different."

But Simas was confident. "I believe this is an instance where good policy makes great politics, because this is going to be meaningful and tangible to people," he said. "People have been asking, What do I get from Obamacare? Millions of people are about to find out."

And so they have. Democrats admit they're now in a hole; if the midterm elections were held tomorrow, they'd lose. Which is hugely frustrating for them, since the most ambitious parts of the law--the expansion of Medicaid benefits, the end to discrimination against people with pre-existing conditions, the coverage of adult children--have little to do with the individual-insurance market at the center of the current storm. They note that both the original Medicare law in 1965 and the prescription-drug expansion under George W. Bush had rocky rollouts and that they always assumed the ACA would need to be refined over time. But Republicans in Congress have no interest in revision, only repeal.

Obama aides insist that the focus right now is on fixing the site rather than assigning blame. "When the website is working better and all of that, the politics are going to be fine," says one senior White House official. "If your contractor at your house screws something up, you tell them to fix it, you don't go hire new contractors. We could do public stoning of the people the political class thought were responsible for this in the middle of the street, and if the website didn't work in two weeks none of that would matter." Meanwhile, Henry Chao was on the Hill explaining to lawmakers that 30% to 40% of the system was still being built.

Some Democrats insist that they have a year to get this right and that they can frame the elections in November 2014 as being about Republicans' continued efforts to undermine the health care law. But that smacks of spin, and the blows could keep on coming: if the website is not fixed by the next deadline, Nov. 30 of this year; if more people find their premiums going up in January; if by March 31, the individual-mandate enrollment deadline, insurers find their risk pools stacked with old, sick people. "Democrats in the midterms are [in trouble] if they don't get their act together and get this running effectively," says one party operative working on 2014 races. "The bigger problem than the substance of the health care debate, which candidates individually should be able to neutralize, is a Democratic Party that seems incompetent, dithering and weak."
But there is a larger problem for the country if Obamacare's ills metastasize. The glee of the law's opponents masks the reality that failure would leave behind: a country that pays too much and gets too little from its health care system, whose costs, at nearly 18% of GDP, limit America's ability to grow and invest and compete globally. Compared with other developed countries, the U.S. has more uninsured, fewer doctors per capita and lower life expectancies.

And if nothing changes, the other victim may have less to do with debt or disease treatments than national pride and ambition. Obama was elected on a slogan of hope and change because both were in short supply: the military exhausted by two wars, the banks failing their public trust, the U.S. Congress a comedy of dysfunction and a federal government that seemed designed to idle on the sidelines. Obama promised a return to competence and confidence and asked the nation to believe again that the government could do big things well. In the end, he got his big thing, a once-in-a-generation revision to the basic social compact, a commitment of health coverage to nearly all Americans. He has yet to prove he can do it well.

Sunday, November 24, 2013

So far so good: Arab States Show Cautious Optimism on Nuclear Deal - Saudis Voice Fears That Iran Will Press Influence in Region

From The Wall Street Journal:

Saudi Arabia maintained a pointed silence Sunday on the new nuclear pact between world powers and Saudi Arabia's top rival, Iran, while other Gulf and Arab states gave a cautious welcome to a deal hoped to ease tensions in a region bloodied by proxy battles between Shiite Iran and Sunni Arab states.

Saudi political commentators voiced persistent fears that Iran would now see itself as freed to advance on other, non-nuclear fronts against its Middle East rivals.
By early Monday in the Middle East, most of the region's Muslim powers—Turkey, Egypt, and at least four of the six wealthy Arab Gulf countries—had issued statements expressing support for the deal. The United Arab Emirates., a commerce-minded nation that traditionally has thrived on doing business with both Iran and Arab states, welcomed the deal as one it hoped would protect the region "from the tension and danger of nuclear proliferation," the emirates' council of ministers said.
However, Saudi Arabia's silence after the deal, as other Arab and Muslim states expressed guarded approval at the diplomatic effort in Geneva, emphasized abiding Saudi distrust of Iran, and suggested distrust of the new deal as well.
Arab Gulf states hope a solid deal barring Iran from developing a nuclear-weapons program "will take away competition…for an arms race" in the region, said Jamal Khashoggi, a veteran political commentator and journalist in Saudi Arabia.

In rural Kentucky, health-care debate takes back seat as the long-uninsured line up

From The Washington Post:

On the campaign trail, Senate Minority Leader Mitch McConnell was still blasting the new health-care law as unsalvageable. At the White House, President Obama was still apologizing for the botched federal Web site.

But in a state where the rollout has gone smoothly, and in a county that is one of the poorest and unhealthiest in the country, Courtney Lively has been busy signing people up: cashiers from the IGA grocery, clerks from the dollar store, workers from the lock factory, call-center agents, laid-off coal miners, KFC cooks, Chinese green-card holders in town to teach Appalachian students.

Now it was the beginning of another day, and a man Lively would list as Client 375 sat across from her in her office at a health clinic next to a Hardee’s.

“So, is that Breathitt County?” she asked Woodrow Wilson Noble as she tapped his information into a laptop Thursday morning.

“Yeah, we live on this side of the hill,” said Noble, whose family farm had gone under, who lived on food stamps and what his mother could spare, and who was about to hear whether he would have health insurance for the first time in his 60-year-old life.

This is how things are going in Kentucky: As conservatives argued that the new health-care law will wreck the economy, as liberals argued it will save billions, as many Americans raged at losing old health plans and some analysts warned that a disproportionate influx of the sick and the poor could wreck the new health-care model, Lively was telling Noble something he did not expect to hear.

“All right,” she said. “We’ve got you eligible for Medicaid.”

Places such as Breathitt County, in the Appalachian foothills of eastern Kentucky, are driving the state’s relatively high enrollment figures, which are helping to drive national enrollment figures as the federal health exchange has floundered. In a state where 15 percent of the population, about 640,000 people, are uninsured, 56,422 have signed up for new health-care coverage, with 45,622 of them enrolled in Medicaid and the rest in private health plans, according to figures released by the governor’s office Friday.

If the health-care law is having a troubled rollout across the country, Kentucky — and Breathitt County in particular — shows what can happen in a place where things are working as the law’s supporters envisioned.

One reason is that the state set up its own health-insurance exchange, sidestepping the troubled federal one. Also, Gov. Steve Beshear (D) is the only Southern governor to sign on to expanded eligibility parameters for Medicaid, the federal health-insurance program for the poor. The less technical reasons involve what Lively told Noble next.

“Okay, Woodrow, now you get to shop a little bit,” she said, explaining options he’d never had before.

“If you go to the doctor, all you’re going to pay is $1,” she began. “If you’re in the hospital for an extended period, you should only be billed $5. . . . If you get medicine, generics are $1 and brand is $4. . . . You can go to the dentist once a month — exams, X-rays and cleanings are covered. . . . Now for your teeth, the plan does take care of having them pulled and does take care of fillings, but not bridges, because that’s considered cosmetic.”

Now, Lively explained, Noble simply had to choose among several Medicaid health-care plans. “So basically it’s whatever insurance company you go with — the effective date is January 1st,” she said, waiting for him to pick.

“My mom gets that WellCare, and she don’t pay nothing,” Noble said finally. “I’ll take that WellCare plan. My mommy got that, and it’s good.”

Don’t Dare Call the Health Law ‘Redistribution’ - But the redistribution of wealth has always been a central feature of the law and lies at the heart of the insurance market disruptions driving political attacks this fall.

John Harwood writes in The New York Times:
“Redistribution is a loaded word that conjures up all sorts of unfairness in people’s minds,” said William M. Daley, who was Mr. Obama’s chief of staff at the time. Republicans wield it “as a hammer” against Democrats, he said, adding, “It’s a word that, in the political world, you just don’t use.”
These days the word is particularly toxic at the White House, where it has been hidden away to make the Affordable Care Act more palatable to the public and less a target for Republicans, who have long accused Democrats of seeking “socialized medicine.” But the redistribution of wealth has always been a central feature of the law and lies at the heart of the insurance market disruptions driving political attacks this fall.
“Americans want a fair and fixed insurance market,” said Jonathan Gruber, a health economist at the Massachusetts Institute of Technology who advised Mr. Obama’s team as it designed the law. “You cannot have that without some redistribution away from a small number of people.”
Mr. Obama’s advisers set out to pass the law in 2009 fully aware that fears among middle-class voters sank President Bill Clinton’s health initiative 16 years earlier. So they designed the legislation to minimize the number of people likely to be hurt.
Instead of a sweeping change to a government-run “single-payer” system favored by Democratic liberals, members of the administration sought to preserve the existing system of employer-provided health insurance while covering the uninsured through the expansion of Medicaid and changes to the individual insurance market.
They also added benefits available to any family, such as the ability of children up to age 26 to remain on their parents’ health plans.
But throughout the process, they knew that some level of redistributing wealth — creating losers as well as winners — was inescapable.
They were nonetheless acutely aware of how explosive the word could be. When Mr. Obama ran for president in 2008, Republicans tried to wound him by accusing him of waging “class warfare” to achieve wealth redistribution. That fall, the Republican presidential nominee, Senator John McCain, derided Mr. Obama as the “redistributor in chief” as he seized on Mr. Obama’s comments to an Ohio man later known as “Joe the Plumber” that he wanted to “spread the wealth around.”
Mr. Obama survived that episode and other instances when Republicans deployed old recordings of him using the word “redistribution” as evidence that he was a closet socialist. But Mr. Obama had learned a lesson.
After he took office, he cast his goal of rolling back President George W. Bush’s tax cuts for higher earners not as economic redistribution, but as the restoration of top-end rates from the Clinton years.
The Affordable Care Act was a similar semantic sidestep. The law targeted high earners, too, by raising their Medicare taxes enough to reduce their after-tax incomes by nearly 2 percent, according to the nonpartisan Tax Policy Center. That revenue helped finance coverage for those currently without insurance, who tend to have lower incomes and who in many cases will receive government subsidies to make their premiums cheaper.
And yet for those nervous about potential changes, the president promised stability. “If you like your current insurance, you will keep your current insurance,” Mr. Obama said the day he signed the legislation in March 2010, a promise he made repeatedly as the Oct. 1 opening day of the online health insurance marketplaces approached.
Hiding in plain sight behind that pledge — visible to health policy experts but not the general public — was the redistribution required to extend health coverage to those who had been either locked out or priced out of the market.
Now some of that redistribution has come clearly into view.
The law, for example, banned rate discrimination against women, which insurance companies called “gender rating” to account for their higher health costs. But that raised the relative burden borne by men. The law also limited how much more insurers can charge older Americans, who use more health care over all. But that raised the relative burden on younger people.
And the law required insurers to offer coverage to Americans with pre-existing conditions, which eased costs for less healthy people but raised prices for others who had been charged lower rates because of their good health.
“The A.C.A. is very much about redistribution, whether or not its advocates acknowledge that this is the case,” wrote Reihan Salam on the website of the conservative National Review.
Having obscured much of that vulnerability before, Mr. Obama has responded to recent political heat by apologizing — and expanding the scope of his discredited “you can keep it” promise.
Mr. Gruber of M.I.T. called redistribution a convenient tool for Republican opponents who would fight the law anyway.
In the end, America’s political culture may have made it unrealistic to expect a smooth public reception for the law, no matter how cleverly the White House modulated Mr. Obama’s language or shaped his policy to minimize the number of losers.
“The reality is, any big thing you take on, any big change, is hard to accomplish,” said David Axelrod, the president’s longtime strategist. In America, he said, “we’ve created a sense that everyone can expect to win — nobody has to sacrifice.”
At the same time, Mr. Axelrod argued that widening income inequality has, to some Americans at least, changed the meaning of redistribution. “The whole redistribution argument has shifted in the country because there’s a sense that a lot of redistribution has been to the top and not the bottom,” Mr. Axelrod said.
Still, the word is hardly a favorite of the president these days. The last time Mr. Obama used it in public, according to Federal News Service transcripts, was 18 months ago during his re-election campaign in Elyria, Ohio.
“Understand this is not a redistribution argument,” the president told his audience then. “This is not about taking from rich people to give to poor people. This is about us together making investments in our country so everybody’s got a fair shot.”

This is big; this is historic; great job everyone involed: Major Powers Reach Deal With Iran To Freeze Nuclear Program

From The New York Times:

GENEVA—The U.S. and five other world powers struck a historic accord with Iran on Sunday, agreeing to ease part of an economic stranglehold in exchange for steps to cap Tehran's nuclear program and ensure the Islamist government doesn't rush to develop atomic weapons.

The agreement calls for Iran to stop its production of near-weapons grade nuclear fuel—which is uranium enriched to 20% purity—and for the removal of Tehran's stockpile of the fissile material, estimated to be nearly enough to produce one nuclear bomb.
Iran, in return, will gain relief from Western economic sanctions that U.S. officials believe will provide between $6 billion and $7 billion in badly needed foreign exchange for Tehran over the next half-year.
The agreement reached in Geneva is an interim deal for about six months that will allow international powers to try to strike a permanent accord, an effort experts said would be the true test of Iran's new government, headed by revitalization-minded President Hasan Rouhani.
President Barack Obama called the agreement "an important first step toward a comprehensive solution" of the Iranian nuclear dilemma and credited his administration's push for diplomacy and its adoption of stern economic sanctions for "a new path toward a world that is more secure."
"The first step that we have taken today marks the most significant and tangible progress that we have made with Iran since I took office," he said, adding that the next steps "won't be easy."
While U.S. officials argued the deal will roll back Iran's nuclear program, critics of the diplomacy are likely to seize on key Western concessions, including a signal that Washington ultimately will agree to accept Iran's enrichment of uranium and would leave open for now the future of Tehran's plutonium-producing reactor in Arak.
The first-stage deal also takes no steps to force Iran to ship out or destroy the roughly 19,000 centrifuge machines it has amassed to produce nuclear fuel.
U.S. lawmakers and key American allies have said Iran will only abandon its nuclear program if international pressure is increased.
"This deal appears to provide the world's leading sponsor of terrorism with billions of dollars in exchange for cometic concessions," said Sen. Mark Kirk (R., Ill.) a leading proponents of increasing sanctions on Iran during the talks.
Israel, which has been a sharp opponent of U.S. efforts to negotiate with Iran, was quick to criticize the development.
"This is a bad agreement. It gives Iran exactly what it wants: both substantial easing of sanctions and preservation of the most substantial parts of its nuclear program,'' said a statement from Prime Minister Benjamin Netanyahu's office on Sunday.
The deal was completed during three exhaustive negotiating sessions over the past month in Geneva involving Iran and the five permanent members of the United Nations Security Council and Germany, a diplomatic bloc called the P5+1.
U.S. Secretary of State John Kerry and the foreign ministers of the other members of the P5+1 states traveled to the Swiss lakeside city over the weekend to push through the final agreement—their second such visit in two weeks.
American and Iranian officials called the deal a potential turning point in Tehran's relations with the international community and an important "first step" in ending the decadelong standoff over Iran's nuclear program.
"The agreement creates the time and space for a comprehensive solution," said Catherine Ashton, the European Union's foreign policy chief, who leads the P5+1.
U.S. and European officials said the six months that the interim agreement covers will be used to forge a broader accord that permanently ends the threat posed by Tehran's nuclear work. Iranian officials stressed this week that the nuclear program only had civilian uses.
France played a major role in the negotiations, with Foreign Minister Laurent Fabius insisting publicly during a previous round of talks two weeks ago that a draft agreement being discussed wasn't strong enough.
In a statement early Sunday, Mr. Fabius acknowledged the discussions were long and difficult but said the Geneva accord "amounts to a first major step" to resolve the nuclear dispute.
Mr. Fabius said the deal includes strict oversight of Iran's commitments and that "we will have to be vigilant on their implementation."
Speaking to reporters after the deal was signed, U.K. Foreign Secretary William Hague confirmed Iran would win sanctions relief under the accord affecting its gold and precious metals trade, its petrochemicals sector and including the unfreezing of assets by U.S. officials.
American, European and Iranian officials described on Saturday a testy three days of talks that were needed to forge the final deal.
The question of what to do with Iran's heavy water reactor nearing completion in the city of Arak nearly killed an agreement in the later stages of the diplomacy, said these officials.
France was pushing for a complete dismantling of the reactor on the grounds that there exists no nonmilitary rational for building the facility. The U.S. government shared this position
Under the deal, Iran agreed to significantly increase inspections of Arak by the U.N.'s nuclear watchdog, the International Atomic Energy Agency and agree not to start the facility or lead it with nuclear fuel.
Iran also agreed to cap its enrichment of uranium to levels only usable as fuel for a reactor, which is a purity of 3.5% to 5%. Iran committed to maintaining its total stockpile of the low-enriched nuclear fuel at its current level, which is around six tons, during the six-month period.
Iran and the P5+1 also forged a compromise over the issue that over the past few days looked as though it could squelch a deal—Tehran's demand that the international community accept its "right" to continue producing nuclear fuel domestically.
Tehran cites the U.N.'s nuclear Nonproliferation Treaty as affording every signatory that legal right to enrich uranium, provided it is used for civilian purposes. Successive U.S. administrations have denied this right exists and have supported multiple U.N. Security Council resolutions requiring Tehran to suspend its enrichment activities.
In a compromise, the P5+1 agreed to a text that says Iran will enjoy all the rights of treaty signatories, provided Iran satisfies all of the IAEA's questions about the alleged military dimensions of Iran's program. But the U.S. and its partners won't be forced to formally accept that Iran will be allowed to enrich.
Still, the compromise is seen as a victory for Iran, which has campaigned for a decade on this issue. U.S. officials on Saturday acknowledged that Iran will likely be allowed to maintain some enrichment capacity on its soil as part of a final deal.
"We're interested in exploring how Iran might end up with a limited and tightly controlled facility to enrich," said a senior U.S. official.
Iranian Foreign Minister Javad Zarif touted the deal as vindicating Tehran's position. "Iran enjoys that right and its important to recognize that right. This recognition is there," Mr. Zarif told reporters. "We believe that to be our right."
U.S. officials said the agreement will provide sanctions relief of between $6 billion to $7 billion over the next six months, a number far below estimates made by critics of the agreement, including the government of Israel. The Obama administration also stressed that any easing of the sanctions could be quickly reversed if Iran is found not complying with the agreement.
U.S. officials said the P5+1 immediately will begin helping Iran repatriate about $4.2 billion in oil revenues that it hasn't been able to access overseas as a result of the sanctions. Iran is estimated to have $50 billion in these revenues overseas, which its government has been unable to access. The funds will be returned to Iran in monthly installments of $600 million.
The agreement also calls for the U.S. and European Union to ease the ban on Iran's trade in petrochemicals, precious metals, automobiles and airplane spare parts. U.S. and European officials said they didn't believe that such commerce could derive more than a few billion dollars in revenues for Tehran over the next six months. But they said some of the trade—such as access to airline parts—is critical to Iran, which has increasingly found its jetliners grounded due to safety concerns.
U.S. officials stressed that the sanctions relief will still be dwarfed by the revenues Iran is still losing out due to the pervasive sanctions that remain in place.
These diplomats estimated that Iran still is likely to lose around $25 billion over the six months to the U.S. and European embargo against oil purchases. They also believed Tehran will continue to find itself unable to repatriate the earnings from the oil its does sell in Asia and the Middle East, due to sanctions. One official said Iran was likely to find itself unable to access another $14 billion to $16 billion in oil earnings over the next six months.
"The pressure of the sanctions will continue to grow," said a second American official involved in the Geneva talks.
U.S. and Iranian officials both said the agreement had potentially profound implications for global security and stability in the Middle East.
Before Mr. Rouhani's August inauguration, diplomatic engagement between Washington and Tehran was largely frozen, as it had been since the 1979 Islamic revolution. Over the past three months, however, Mr. Obama has held a phone conversation with President Rouhani, and Secretary of State John Kerry and Mr. Zarif have held hours of negotiations in Geneva.
"I think this is potentially a significant moment," Mr. Kerry said following the negotiations. "But I'm not going to say this is an end unto itself."
Mr. Rouhani tweeted after the agreement was signed Sunday: "We are confident that the agreement between Iran and the West will have a positive impact on other regional and global issues."