Key Issues Small Businesses Will Face in 2014 - Health-Care Worries

From The Wall Street Journal:

Earlier this year, small-business employers were given a one-year reprieve from the health-care law's employer mandate, which requires businesses with 50 or more full-time equivalent workers to offer health insurance or pay a penalty.

The bad news: Other changes that go into effect next year are likely to boost costs for many of these employers.

Starting in 2014, all Americans will be required to carry health insurance, or face a penalty. As a result, many uninsured workers will likely be prompted to enroll in their employers' plans for the first time, boosting the overall cost of the plans.

Because insurers will no longer be able to set premiums for small-group plans based on industry, or the health or gender of its staff, many are expecting premiums to rise for employers in industries with lots of young, healthy workers. Meanwhile, moderate rate increases are expected for companies with older and sicker employees, and in higher-risk industries.

As a result of technical glitches in the government's online marketplace for coverage, known as the Small Business Health Options Program, or SHOP, small businesses with 50 or fewer workers won't be able to buy plans on the site until November. The one-year delay is significant because the exchanges were meant to attract more participants, boost competition among insurers and lower premiums. However, premiums for small-group plans might not decline as expected.

Another change slated for next year: Insurance companies will be required to pay a new annual fee, which the Congressional Budget Office and insurance-industry experts say will largely be passed on, in the form of higher premiums, to small businesses and consumers who buy their own policies.

Three ominous signs for Democrats heading into the 2014 midterm year

From The Washington Post:

With just days until the 2014 midterm election year is officially upon us, there are fresh signs of trouble for congressional Democrats.

A trio of findings spells bad news for Democrats in a new CNN/ORC International poll released Thursday: The generic ballot test has broken sharply toward Republicans, voter enthusiasm for Democrats is lower than it is on the GOP side, and President Obama is shaping up as an albatross for candidates who support him.

Let’s take a closer look at each one starting with the generic ballot test.

Republicans have opened up a 49 to 44 percent lead over Democrats on the question of which party’s candidate for Congress voters would choose in their district. That’s a sharp reversal from October, when Democrats led Republicans 50 percent to 42 percent.

The movement on the generic ballot — which tends to tilt toward Democrats in the first place — seems to be explained by the disastrous rollout of Obamacare that dominated much of the fall. What’s clear is that the advantage Democrats seized in the wake of the October government shutdown that badly damaged the GOP’s image has now been wiped out — and then some.

While the GOP’s five-point advantage is wider than other recent polls, which show a tighter race — the most recent Washington Post-ABC News poll shows Democrats with a two-point lead — what’s clear in all the surveys is that voters are tilting toward Republicans. And for a Democratic caucus that needs to pick up 17 seats to win back the majority, that’s disturbing news.

So is their relative dearth of voter enthusiasm. Thirty-six percent of Republican voters say they are very or extremely enthusiastic about voting for Congress. Just 22 percent of Democratic voters say the same thing.

Not only are Democrats making a long-shot push to win back the House majority, they are trying to preserve their Senate majority by preventing Republicans from picking up six seats. If voter enthusiasm is anything like it is now next fall, Senate Democrats could be in for some serious turnout woes.

Making matters worse for Democrats, it appears that the party’s leader is in no position to serve as a strong campaign surrogate at this point either. Fifty-five percent of voters in the CNN poll say they would be more likely to vote for a candidate who opposes Obama, compared to 40 percent who say they would be more likely to vote for a candidate who supports the president.

As we saw with the dramatic shift in the generic ballot between October and December, attitudes can change in a hurry. And its far too soon to declare an emergency for Democrats in 2014.

But headed into a new year, these are hardly the signs the party wants to see.

Saudis Pledge $3 Billion to Support Lebanon's Army - Grant Seeks to Bolster Armed Forces Against Iranian-Backed Hezbollah; Saudi Arabia sees itself as a patron of Lebanon's Sunni Muslims. Saudi Arabia also backs rebels in Syria, while Iran and Hezbollah support Syrian President Bashar al-Assad; Saudi Arabia and Egypt don't mess around with regard to letting you know where you stand.

From The Wall Street Journal:

Saudi Arabia pledged $3 billion to bolster Lebanon's armed forces, in a challenge to the Iranian-allied Hezbollah militia's decadeslong status as Lebanon's main power broker and security force.

Lebanese President Michel Sleiman revealed the Saudi gift on Lebanese national television Sunday, calling it the largest aid package ever to the country's defense bodies. The Saudi pledge compares with Lebanon's 2012 defense budget, which the Stockholm International Peace Research Institute put at $1.7 billion.

Lebanon would use the Saudi grant to buy "newer and more modern weapons," from France, said Mr. Sleiman, an independent who has become increasingly critical of Hezbollah. It followed what he called "decades of unsuccessful efforts" to build a credible Lebanese national defense force.

 

As a direct challenge to Hezbollah, the Saudi gift—and the Lebanese president's acceptance—has potential to change the balance of power in Lebanon and the region. It also threatens to raise sectarian and political tensions further in a region already made volatile by the three-year, heavily sectarian civil war next door in Syria.

 

The Saudi move was announced hours after thousands of Lebanese turned out for the funerals of former cabinet minister Mohamad Chatah and some of the other victims killed Friday in a bombing in downtown Beirut. The bomb was believed to have targeted Mr. Chatah, an outspoken critic of Hezbollah's dominance of Lebanese affairs and security. No group has claimed responsibility.

 

Saudi Arabia on Friday responded to the assassination by calling for Lebanon to build up the government and armed forces "to stop this tampering with the security of Lebanon and the Lebanese."

 

Saudi Arabia sees itself as a patron of Lebanon's Sunni Muslims. Saudi Arabia also backs rebels in Syria, while Iran and Hezbollah support Syrian President Bashar al-Assad.

 

Saudi Arabia increasingly is using massive cash infusions to support allies around the region. This year, the kingdom bequeathed billions of dollars to Egypt after the Egyptian military helped force out a government allied with the Muslim Brotherhood, a Sunni Muslim political faction that, like Iran, Hezbollah and Syria, stands as a rival of Saudi Arabia.

 

Saudi Arabia's $3 billion grant to Lebanon surpasses the $1 billion in U.S. assistance to Lebanon's armed forces since 2006, when Washington resumed military aid after a long hiatus.

 

Patients Cram In Tests Before Health-Law Start - Some Top Hospitals and Experts Are Left Out of 2014 Plans Under Health Law

From The Wall Street Journal:

 

Thousands of people are cramming in tests, elective procedures and specialist visits before year's end, seeking out top research hospitals and physician groups that will be left out of some 2014 insurance plans under the new health law, health-care providers say.

Many insurers offering plans under the law are slimming down their networks of doctors and hospitals in a bid to lower the cost of policies, which begin coverage Wednesday.

Health insurers are especially focused on paring academic teaching and research hospitals from their networks because they generally charge more than community hospitals for similar services.

Ben Rosenthal, a 57-year-old freelance market researcher in Los Angeles, rushed to squeeze in a lung exam the day after Christmas. His new insurance plan under the health law won't cover care at Ronald Reagan UCLA Medical Center in Los Angeles, where he was referred under his current plan.

"I was forced to get it done this year," said Mr. Rosenthal, who said waiting would have required him to get a new referral for another facility.

The Obama administration said Sunday that more than 1.1 million people signed up for private insurance plans through HealthCare.gov by Dec. 24. Combined with numbers from Washington, D.C., and 14 states that run their own exchanges—including California, which said Dec. 23 it had more than 400,000 enrollees in private plans—that suggests a nationwide total of roughly two million people so far.

 

That is short of an administration estimate made before the Oct. 1 rollout of the health-care website that more than three million people would enroll in private plans through the exchanges by year-end. Enrollments accelerated recently, with more than 1.6 million signing up from the end of November to Dec. 23.

 

About half of Americans are covered by insurance provided by employers, according to the nonpartisan Kaiser Family Foundation.

 

The success of the new policies—and the marketplaces that sell them—depends in large part on how consumers react to the new networks, which are often more restrictive than the range of providers available in many current plans. More plans sold on the exchanges also require patients to obtain referrals to see specialists or receive insurer authorization before costly procedures.

 

Mr. Rosenthal's new plan from Blue Shield of California, for example, doesn't include UCLA's flagship teaching hospital, Ronald Reagan, or any facilities with which it is associated.

 

The health maintenance organizations of the 1990s, which were widely credited with holding down health costs then, encountered a broad consumer backlash over their restrictions on what doctors or facilities customers could use. But insurers say they believe things will be different this time because consumers care more about price than the range of doctors and facilities they can use.

 

Some 70% of new plans under the health law offer relatively narrow networks compared with many current plans, according to a recent McKinsey & Co. report.

 

"For exchange plans, it's about affordability and getting to a lower price point," said Juan Davila, an executive vice president at Blue Shield of California, which dropped about 40% of its physicians who didn't agree to lower rates for the new plans.

 

Many hospitals are part of broader health systems containing other hospitals, stand-alone clinics and physician groups. The exclusion of a single teaching hospital doesn't always mean that a health plan blocks visits to associated facilities or physicians. But health systems typically negotiate systemwide contracts with insurers.

 

The recognition by some consumers that their new plans won't always cover the facilities or doctors they want is triggering the boomlet in last-minute procedures, say health-care providers.

 

UT Southwestern Medical Center in Dallas has seen requests for complicated imaging tests and colonoscopies rise in recent weeks, said Bruce Meyer, an executive vice president. Barnes-Jewish Hospital in St. Louis has seen "dozens" of patients push up elective orthopedic surgeries, a spokeswoman said. Cedars-Sinai Health System, a top teaching hospital excluded from most exchange plans in the Los Angeles market, said it has fielded thousands of calls from people concerned about losing access and wanting to schedule elective procedures before Dec. 31.

 

"We have seen a big spike in December," said Thomas M. Priselac, chief executive of Cedars-Sinai Health System.

 

Some specialist groups also are seeing higher-than-normal volume this month. Illinois Gastroenterology Group, a team of 40 physicians, has seen "hundreds" of accelerated requests for colonoscopies in December due to concerns over access and higher deductibles in 2014, said Lawrence Kosinski, a managing partner.

 

Not all leading research hospitals say they have noticed a jump in patients moving up procedures to this year. Others, like University of Chicago Medical Center or UAB Hospital in Birmingham, Ala., aren't able to distinguish yet the reasons why certain patients have opted for an elective surgery. In addition, demand for some elective procedures normally rises late in the year in part because more patients have satisfied plan deductibles by then.

 

People can buy plans on the exchanges that offer coverage at a vast network of hospitals. But they cost significantly more, according to the McKinsey report, which analyzed markets where one insurer sold both broad and limited plans. The more-comprehensive coverage carried a median price increase of 26% compared with the slimmed-down alternatives.

 

"Not everyone can get a 50-inch flat screen. You might have to get a 32-inch. There will be segments of the population who can't afford to buy coverage to go to [every hospital]," said Paul Mango, a McKinsey director.

 

Still, consumers buying limited health insurance on the exchanges may not realize how restricted their access is, said Joanne Conroy, chief health care officer of the Association of American Medical Colleges, a nonprofit representing nearly 400 teaching hospitals and health systems. "We have a lot of people who aren't sick yet, don't need any procedures and will have a rude awakening when they realize they don't have access to the providers they want," Ms. Conroy said.

 

Daniel M. Adair, an orthopedic surgeon in Springfield, Ill., said one of his patients late last month moved up reconstructive knee surgery, even though the knee was in relatively good condition, on the chance it may encounter trouble in 2014.

 

The patient "told me, 'I don't know what's going to happen starting Jan. 1, so I might as well do this now,' " Dr. Adair said.

Finding the Good in an Uninspiring Year

Peggy Noonan writes in The Wall Street Journal:

The past year was not the most satisfying politically, not the most exalted or inspiring. Republicans suffered an unforced error with the shutdown. The Democrats suffered for insisting ObamaCare be implemented on schedule, as planned, which immediately revealed . . . it hadn't been planned, was in fact fatally flawed, a bad law. This in turn damaged progressivism itself, at least as it is currently practiced.

On the upside for both parties: Republicans proved to be right on the health-care law and have room now to be right on other things. Democrats could, if they choose, see their position this way: They're taking a drubbing on ObamaCare but the very catastrophe of that program has highlighted the fact that they kind of won the argument on the need to do something big on health care. People aren't saying, "Get rid of ObamaCare and then do nothing," they're saying, "Repeal it and replace it with . . . something!"

Democrats are so concussed they've barely noticed that people do want health-care help, and it will probably have to be national in scope. Looking at it this way, Democrats have won a 30-year argument. They should wake up, get out from under the albatross of ObamaCare, and start trying to create something that will work. With Republicans, who now have new credibility on the issue.

Progress is always possible. The world is full of surprise.

Beneath health law’s botched rollout is basic benefit for millions of uninsured Americans

From The Washington Post:

Getting Americans health insurance is at the heart of the health law, the most significant change in health-care policy since the 1965 creation of Medicare, the federal program for the elderly, and Medicaid, the federal-state program for the poor and disabled. Such a dramatic expansion in coverage had eluded presidents, including Republican Richard Nixon and Democrat Bill Clinton, for decades.

This core mission has sometimes been obscured by the political and legal disputes that have dogged and, in important ways, altered the law. Strong research links having health insurance and being healthy. Having a health plan does not guarantee that a good doctor is within reach when a patient needs one. But insurance matters.

Various studies have found that children without insurance are less likely to get immunized or treated for a sore throat or even a ruptured appendix. Adults without coverage are less likely to get mammograms or prostate exams. If they have high blood pressure or diabetes, it is more likely to be out of control. If they have a stroke, it is more likely to leave lasting damage. The Institute of Medicine has said there’s “a chasm” between the health needs of uninsured people and their access to effective care — a gap that “results in needless illness, suffering and even death.”

In health-care economics, it is considered rational to provide coverage, so that people can readily get small medical problems taken care of before they become big, expensive, pent-up medical problems. But the gallbladder surgery Peterson is about to have and the unforeseen ailments that Munstock’s physical on Thursday could unearth also illustrate a risk for the health plans that have been signing up new patients under the law: Unless those plans also attract new customers who are young, healthy and inexpensive to insure, the rush of people like Peterson and Munstock is going to freight the new system with costs that are too heavy. Insurance rates could go up. Plans could drop out. Will it happen? No one knows.

That is the macro view. The micro view, for people who have been waiting for insurance for years, is financial protection. Hospitals frequently charge uninsured people two to four times what health insurers and government programs pay for hospital services, according to a 2007 Health Affairs study.

In the years since Medicare and Medicaid were created, there have been smaller expansions in government health-care coverage — public insurance for children of the working class, the addition of drug benefits to Medicare.

Still, nearly 48 million Americans were uninsured as of 2012, according to the most recent official figures — 11 million more than at the turn of the century, or almost one in every six people. More than 6.5 million children are uninsured.

The law wasn’t designed to help everyone who is uninsured. But it is likely to cover a big chunk — 32 million people, according to estimates from the Congressional Budget Office about the time Obama signed the 2,000-page legislation into law.

How many people will take up the offer remains to be seen. The CBO has estimated that 7 million will sign up for private plans by the end of the first annual open enrollment period on March 31, while another 9 million will enroll in an expanded Medicaid program or in the Children’s Health Insurance Program.

But with insurers canceling health plans that fail to meet new benefit standards for millions of individuals, and many Americans finding it difficult this past fall to use HealthCare.gov, it will be hard to know if the ranks of the uninsured will go up or down right away, health experts say. Starting next year, the law requires that most Americans have health insurance or risk a fine.

The creators of the law envisioned that about half the people who gain insurance would enroll in private health plans, the other half in Medicaid. The Supreme Court sliced into the second goal, ruling that states could opt out of the expansion, something that has occurred in many states led by Republicans.

Red, blue states move in opposite directions in a new era of single-party control

Dan Balz writes in The Washington Post:

Political polarization has ushered in a new era in state government, where single-party control of the levers of power has produced competing Americas. One is grounded in principles of lean and limited government and on traditional values; the other is built on a belief in the essential role of government and on tenets of cultural liberalism.

These opposing visions have been a staple of national elections, and in a divided Washington, this polarization has resulted in gridlock and dysfunction. But today, three-quarters of the states — more than at any time in recent memory — are controlled by either Republicans or Democrats. Elected officials in these states are moving unencumbered to enact their party’s agenda.

Republican states have pursued economic and fiscal strategies built around lower taxes, deeper spending cuts and less regulation. They have declined to set up state health-insurance exchanges to implement President Obama’s Affordable Care Act. They have clashed with labor unions. On social issues, they have moved to restrict abortion rights or to enact voter-identification laws, in the name of ballot integrity, that critics say hamper access to voting for the poor and minorities.

Blue states have also been forced to cut spending, given the budgetary pressures caused by the recession. But rather than cutting more deeply, a number of them also have raised taxes to pay for education or infrastructure. They have backed the president on the main elements of his health-care law. The social-issue agenda in blue states includes legalizing same-sex marriages, providing easier access to voting and, in a handful of cases, imposing more restrictions on guns.

The values that underpin these governing strategies reflect contrasting political visions, and the differences can be seen in stark terms in the states. In a red state such as Texas, government exists mostly to get out of the way of the private sector while holding to traditional social values. In blue states such as California and Maryland, government takes more from taxpayers, particularly the wealthy, to spend on domestic priorities while advancing a cultural agenda that reflects the country’s growing diversity.

The alternative models on display in the states have triggered a competition for bragging rights about which would be better for the nation as a whole — a debate that is likely to intensify nationally in forthcoming elections.

Louisiana Gov. Bobby Jindal (R), coming off a year as chairman of the Republican Governors Association, has been a tireless proselytizer for his party’s conservative approach. Red states, he said, are “doing better economically, they’re doing better with credit ratings, they’re doing better with people moving into their states. . . . I’ll sit here all day and talk to you about how Republican policies and Republican-led states are doing better.”

Illinois Gov. Pat Quinn (D), who has moved Illinois in a progressive direction, countered that the Republican model threatens to leave too many people behind. “We’re not Pottersville, and we don’t intend to be Pottersville,” he said in a reference to the mean-spirited and miserly villain in the movie “It’s a Wonderful Life.” “There is a choice between a Bedford Falls that cares about your neighbor and the scorched-earth, don’t-care-about-your-neighbor policy of Mr. Potter.”

Single-party control

Today, 37 of the 50 states are under unified party control. Republicans hold the governorship and majorities in both chambers of the legislature in 23 states; Democrats have full control in 14 states. In 12 states, power is divided between Republicans and Democrats. (The other state, Nebraska, has a nonpartisan, unicameral legislature, although the governor is a Republican and the legislature is conservative.)

Justin Phillips, a political scientist at Columbia University who has written extensively about state government, said the degree of unified party control in the states is greater than at any time in more than half a century.

“This allows governors to behave very differently than they do under divided control,” Phillips said. Acknowledging that the parties long have had different philosophies about how to govern, he added: “The difference between what Democrats want and what Republicans want is growing. With unified party control, they don’t have to compromise.”

The National Governors Association once was an arena where governors of both parties came together to find consensus. But Ray Scheppach, who spent three decades as the organization’s executive director, said the governors’ partisan organizations — the Republican Governors Association and the Democratic Governors Association — now dominate, producing a sea change in the way states are being governed.

“They used to be governors first and Democrats or Republicans second,” Scheppach said. “Now they’re Democrats and Republicans first and governors second. In my mind, that’s a huge change.”

Widespread unified control in the states represents a significant shift over a period of three decades. After the 1980 elections, 24 states were under unified control. A decade later it was 20, and after the 2000 election it was only 21. Since then the states have been moving toward more unified control, with the biggest changes taking place in the past half-dozen years as partisan lines have hardened and split-ticket voting has declined across the country.

Control in the states today is more closely aligned with voting patterns in presidential elections than in the days when conservative Democrats dominated state and local elections in the South and moderate Republicans held greater sway in the North.

Karl Kurtz, a political scientist at the National Conference of State Legislatures, noted in an article published this year that Republicans control both houses of the legislatures in 22 of the 24 states carried by Mitt Romney in 2012 and that Democrats hold majorities in 18 of the 26 states won by Obama.

The eight Obama states that have full or partial Republican control are or recently have been presidential battlegrounds. These are Florida, Iowa, Michigan, New Hampshire, Ohio, Pennsylvania, Virginia and Wisconsin.

Two decades ago, when politics were not as polarized, governors were more inclined to work cooperatively with legislators of the other party, in part as an acknowledgment of the disparate views of the entire citizenry of their states.

“This picture of Republican-controlled states doing exactly the opposite of what Democratic-controlled states do on these issues is relatively recent,” Kurtz said. “Even in past generations, even when they had the hammer, when they had unified government, when they might have had a supermajority or veto-proof majority control, I think there was more of a tendency to negotiate with the minority than there is today.”

The risk is that with unified control, governors and their like-minded legislators push beyond the views of their citizenry, particularly in states where public opinion is more evenly divided.

Phillips and Columbia colleague Jeffrey R. Lax argued in a paper published in the American Journal of Political Science that elected officials in states with unified control can overshoot public opinion. “The net result is that state policy is far more polarized than public preferences,” they wrote.

The most obvious example of this is Wisconsin, a state Democrats have carried in every presidential election since 1988 (although several of those outcomes were among the closest in the nation). After his election as governor in 2010, Republican Scott Walker, with the backing of a GOP-controlled legislature, moved swiftly to implement a conservative agenda that included significant restrictions on collective-bargaining rights for most state workers.

The policies sparked widespread protests and ultimately a recall election in 2012 that Walker survived. The state remains deeply polarized, and Walker, a prospective 2016 presidential candidate, remains firm in his convictions, with a new book titled “Unintimidated.”

In Ohio, which Obama carried in 2008 and 2012, Republican Gov. John Kasich and his legislature triggered a similar backlash over changes in public employees’ collective bargaining and over voting laws. Ohio voters repealed restrictions on collective bargaining for public employee unions a year after Kasich’s election. Later, faced with another threat of a citizen veto, the legislature rolled back some voting-law restrictions.

Going separate ways

In many more states, however, citizens are being governed by a philosophy and a set of policies that conform more closely to public opinion within their borders. That has accelerated the trend toward more-partisan governing, and as Ronald Brownstein and Stephanie Czekalinski wrote this year in National Journal, it is sometimes “straining the boundaries of federalism.”

Over the past three years, Obama’s Affordable Care Act has been the most ideologically divisive issue across the country. The law envisioned that the states would establish marketplaces, or exchanges, to facilitate the purchase of health insurance.

But 27 states opted not to do so in any way, throwing responsibility on the federal government. All have Republican governors, Republican legislatures or both. Of the states that took full responsibility for an exchange, two-thirds are under unified Democratic control and almost all the rest have divided government. (There are seven states in partnership with the federal government.)

The law also expanded access to Medicaid, with the federal government providing the states with more than 90 percent of the funding over the first nine years. Democratic-led states leaped at the opportunity, but 23 states have declined — three-quarters of them under unified Republican control when the decisions were made.

Some Republican governors have bucked that trend. Eight states with Republican governors or unified Republican control have decided to enter into the expanded Medicaid program.

The latest to join was Iowa, where Republican Gov. Terry Bran­stad worked with leaders in both parties in a divided legislature. Earlier, in Ohio, Kasich had to overcome resistance from Republican legislators. He found a route around the legislature that put his state in the program, arguing that it was good for the state and its low-income residents.

Governors of both parties often cite the same priorities when they talk about their agendas: job creation, education, transportation and health care. But policies have differed, particularly as they have addressed budgetary pressures during the slow recovery after the 2008 recession.

Tax policy is one area that often has divided Republicans and Democrats. The American Legislative Exchange Council, a conservative group that has offered legislative models for lawmakers, cites 18 states as having cut taxes this year. All but two have Republican governors, and those two — Arkansas and Montana — have Republican legislatures.

Democratic governors have gone in the other direction. Maryland, under Gov. Martin O’Malley, raised taxes on the wealthy. California Gov. Jerry Brown won voter approval last year for a major tax increase on the rich.

On education, Republican-led states have pushed for charter schools and more choice for parents in lieu of ever-greater spending. They say their blue-state colleagues are too constrained by the power of teachers unions to be as bold in their efforts. Democrats say Republicans have been too willing to squeeze funding for schools.

The minimum wage is another point of divergence. California, Connecticut, New Jersey, New York and Rhode Island have increases pending. In New Jersey, where Democrats control the legislature, voters in November approved a constitutional amendment increasing the state minimum wage. Republican Gov. Chris Christie opposed the amendment.

Red and blue states also have gone in different directions with labor relations, with red-state governors and legislatures moving to restrict collective-bargaining rights for public employee unions and others approving right-to-work legislation.

Michigan is a state synonymous with union power and one that has consistently voted for Democratic presidential nominees since 1988. But the GOP-controlled legislature last year approved a right-to-work law. When Republican Gov. Rick Snyder signed it, he said: “I don’t view this as anti-union at all. I believe this is pro-worker.”

Pensions have strained the budgets of most governors. Red-state governors have trumpeted their efforts to revamp public employee pension and benefit packages, but blue-state governors have been forced to act as well, despite ties to organized labor.

According to analysts at both Morningstar and Moody’s, there is no clear red-blue pattern to the problems states face on the pension front or to actions taken to solve those problems.

Illinois had perhaps the most severe pension problem in the country and seemed politically incapable of dealing with it. But Quinn and the legislature reached agreement recently on what Moody’s called “the largest reform package” in the country. If fully implemented, the analysis said, the deal would substantially reduce a problem that had resulted in five credit downgrades for the state.

Culture wars continue

Social issues have produced an even starker dividing line between red and blue states.

Abortion wars in Texas drew national attention this summer when state Sen. Wendy Davis (D) filibustered against a bill to restrict abortions after 20 weeks of pregnancy. The filibuster helped launch Davis to a candidacy for governor in 2014. But in conservative Texas, she and her allies ultimately failed to block enactment of the bill, which was championed by Gov. Rick Perry (R) and the GOP-controlled legislature.

Texas was hardly alone among red states in moving to restrict abortion rights. Elizabeth Nash of the Guttmacher Institute, which tracks abortion issues across the country, said that in 2013 there were 64 restrictions approved in the states. Of those, 53 were in states where Republicans control both the legislature and the governor’s office. Ten came in states where the Republicans have partial control of the government.

“In general, if there is Republican control, then abortion restrictions are on the table and able to be enacted,” she wrote in an e-mail. “When Democrats are in charge then abortion restrictions are not very likely.” Nash noted that California was the only state to approve expanded access to abortion services.

The Supreme Court gave same-sex marriage a boost this summer in a pair of rulings but stopped short of legalizing such unions across the country. That has left the issue to the states, where action follows a distinct red-blue pattern.

Same-sex marriage is now legal in 17 states and the District of Columbia. Where it has become legal by popular vote or action by a state legislature, Democrats control the levers of government.

In some other states, the courts have moved to sanction such unions. In recent weeks, same-sex marriages became legal in two more states — New Mexico, where control of government is divided, and Utah, long a Republican stronghold. In both cases, the change came from court rulings.

There have been political repercussions in two other states with divided control of government after courts stepped in to legalize such unions.

After the Iowa Supreme Court acted in 2009, its ruling triggered a major political reaction. Voters subsequently removed three judges who had supported the ruling. A fourth survived his election in 2012.

In New Jersey, the issue produced a different reaction. Same-sex marriages became legal there in October by court action. Christie opposed the change, but with Election Day only a few weeks off, he chose not to buck public opinion and withdrew the state’s appeal to the court action.

Public opinion has shifted dramatically on this issue, but some red states are still moving to put prohibitions in their constitutions. North Carolina, which has been a presidential battleground in the past two elections but where a Republican governor and legislature have moved decidedly to the right, approved such an amendment in the spring.

Many other states have such prohibitions written into their constitutions, and they are likely to become the next front in the culture war over same-sex marriage.

The mass shooting last December at Sandy Hook Elementary School in Newtown, Conn., sparked calls for new gun-control legislation, nationally and in the states. Obama’s gun initiative died in the Senate early this year, but new restrictions were enacted in eight states, seven where Democrats have unified control.

“I’ve been involved with state legislation for 18 years now,” said Brian Malte, senior national policy director at the Brady Campaign to Prevent Gun Violence. “2013 was by far the most successful year in terms of us passing proactive gun legislation.”

Andrew Arulanandam, director of public affairs at the National Rifle Association, said the pattern is fairly clear on gun legislation. Where control is divided or where Republicans hold power, “we were able to advance our agenda,” he said. Even in some blue states, the NRA was successful in defeating proposed restrictions.

Colorado passed new gun restrictions after the Sandy Hook killings and an earlier mass shooting in a suburban Denver movie theater. But the legislature’s action produced a backlash from pro-gun groups and citizens, resulting in the recall of two Democratic state senators, including state Senate President John Morse. A third who faced a possible recall resigned.

Voting laws have become another red-blue battleground. There are two trends visible in the states. Red states have moved to enact a series of restrictive laws, including those requiring ID cards to vote as well as laws that cut back on early voting.

“That trend has been almost exclusively in states that are red, where the legislature and the governorship are Republican,” said Wendy Weiser, director of the Democracy Program at the Brennan Center for Justice.

A countertrend has developed in blue and some red states, with legislators moving to make access to voting easier, through things such as online registration.

The red-blue hard sell

The debate over which approach works better is being fought with claims and counter claims, all buttressed with batteries of statistics: the number of jobs created, the rate of job creation, changes in median income, poverty rates or the percentage of the population without health insurance.

Some analysts who have studied the contrasting performances of states say government policy is only one factor and perhaps not as significant as a state’s history and culture. Michigan’s long economic decline came during periods of both Democratic and Republican governorships, for example.

California rose under Democrats and Republicans before it hit budgetary and economic turbulence.

“It has almost nothing to do with any individual administration,” said Tyler Cowen, an economics professor at George Mason University. “I think of history as the number one factor. State government is significant but secondary.”

Still, Republicans have been more vocal about what they see as the superiority of their philosophy.

Louisiana’s Jindal says that, on average, unemployment is about a point lower in Republican-led states than in Democratic-led states. Of the 10 states with the lowest unemployment rates in November, five have unified Republican control, three are controlled by Democrats, one is divided and one, Nebraska, has a unicameral legislature. Of the 10 states with the highest unemployment rates, four are in unified Republican hands, two are under the control of Democrats and four are divided.

Among the 17 states that the Bureau of Labor Statistics says had statistically significant declines in unemployment over the past year, eight are controlled by Republicans, seven are controlled by Democrats and two have divided government. Two of the top three performers — North Carolina and Florida — are under GOP control while the other — New Jersey — has a Republican governor. In these 17 improving states, California’s unemployment rate, at 8.5 percent,was the highest.

Presented with some of those realities, Jindal said there are fairer measures of success than the unemployment rates. He cited overall job growth and, crucially, how businesses rank the states. He and other Republican governors point to Texas as the nation’s leader in job creation since the 2008 recession, and they credit low-tax, low-regulatory policies for the successes.

Jerry Nickelsburg, a professor at UCLA’s Anderson School of Management, said Texas’s success is clear. But he questioned whether the same model is successful in other states. “Texas does really well with GDP growth,” he said. “But then go to other low-tax, low-wage, weak-union states and you really don’t find them doing quite so well.”

Maryland’s O’Malley drew a different contrast between how Democrats and Republicans are governing, arguing that his state’s record holds up well when measured against red states. “The fundamental difference between most Democratic governors and most Republican governors has to do with ideology versus a more entrepreneurial approach,” he said. “Democratic governors exist in a reality-based world. We are not chained to ideology.”

Wisconsin’s Walker said the GOP’s small-government model is the surest way to economic dynamism. “You create a government that’s . . . mainly about helping government get out of the way,” he said. But he added a caveat. “I think government’s too big, too expensive, too involved in your lives,” he said. “But for the government that’s necessary, it should work. . . . That’s the challenge for Republicans.”

Perry, who is exploring a second presidential candidacy, has taken this fight into his opponents’ back yards. He has sponsored radio ads in or made forays to some Democratic-led states to encourage businesses to consider moving or expanding operations to Texas. asserting that the limited-government approach of Republicans has clear advantages over the Democrats’ model.
Illinois’s Quinn dismissed Perry as a “big talker.”

“I have read the entire book of Amos in the Old Testament,” Quinn said. “Amos was a working guy who took care of sycamore trees. One of his famous pieces of advice is, don’t afflict the poor. I think some of the policies of the governors on the other side are afflicting the poor.”

The coming national debate

California’s Brown ultimately finds all the gamesmanship tiring. “I think it’s hard to make these generalizations,” he said. “A lot of it is just boosterism when governors go around. They’re more like promoting their state to puff up their images. We [in California] have problems, and we’re solving them.”

One analyst who works closely with governors and who spoke on the condition of anonymity because he did not want to take sides in the debate, said, “I don’t know that anyone has a definitive measure to show your economic policy is better than mine.”

Perry argued that the red-blue contrasts are just what the Founding Fathers envisioned by giving states constitutional authority to chart their own destinies with economic and social policies that are tailored to their populations. “People in this very mobile society can go live where they’re most comfortable,” he said.

The next presidential campaign probably will revive the national debate about whether the country should move decisively in one direction or the other, particularly if a Republican governor becomes the party’s nominee.

But Thad Kousser, a political scientist at the University of California at San Diego, offered this caution to would-be contenders. “When a governor is running for president,” he said, “they push an ideological agenda that is tailored much more to the national primary voters in their party than it is to the average voter in the state. And they often crash and burn for that reason.”

Columbia’s Phillips said it is questionable whether there is an ideal model for the nation. “If the country had to live under one [red or blue] model, I think national politics would be as hostile, or worse, than it is today,” he said. Having divergent approaches in the states, he said, “defuses” some of the conflict at the national level. “It is what the framers of the Constitution envisioned.”

But Brown focused on one value of single-party dominance in an era of partisan divisions. “The main thing is to get stuff done,” he said. “You need a governing consensus. . . . You can’t govern as a constant bickering, debating society. Somebody must prevail over time to sustain any kind of momentum.”

That question could be at the heart of the debate in 2016. After years of gridlock, will people be prepared to move as decisively in one direction or the other in Washington as they have been in the states?

West Virginia Democrats Face an Uneasy Time

From The New York Times:

Although Democrats have owned West Virginia’s two Senate seats since the Eisenhower administration, Republicans are eyeing this state as one of their best bets as they seek to win a Senate majority next year.

An accelerating rightward tilt here was reflected recently in an awkward two-step by the Democratic nominee for an open seat, Natalie Tennant, as she distanced herself from the White House after a fund-raising trip to New York.
      

In a Sheraton ballroom, Ms. Tennant, West Virginia’s secretary of state, listened to Michelle Obama urge donors to write “a big old fat check” to her and other women running for the Senate.

      

But back home, where President Obama is deeply unpopular, Ms. Tennant’s campaign quickly sought to wriggle out of the embrace of the White House, insisting to the local news media that “what the first lady said is not an endorsement.”

      

Mr. Obama lost all 55 of West Virginia’s counties in 2012 despite a two-to-one registration edge for Democrats, who are increasingly estranged from the national party over issues like guns, immigration and environmental regulations.

      

“I think there’s a dam ready to break here,” said Chris Hansen, the campaign manager for Ms. Tennant’s opponent, Shelley Moore Capito, a Republican congresswoman in her seventh term.

      

Both Ms. Tennant and Ms. Capito seek to succeed the departing Senator Jay Rockefeller, the Standard Oil heir who came to the state in 1964 to work with the rural poor as a Vista volunteer, just a few years after John F. Kennedy cemented his presidential nomination by winning the West Virginia primary.

      

Neighboring Virginia has leaned leftward in recent years because of the growth and diversity of its Washington suburbs. But the Appalachian region of West Virginia and parts of Kentucky, Ohio, Pennsylvania and Tennessee, which had stayed faithfully Democratic even as Southern whites abandoned the party, have more recently been defecting over issues that are as much cultural as economic.

      

Many of the poorest counties in West Virginia, which are among the most dependent in the nation on food stamps, unemployment insurance and other federal benefits, voted most heavily for Mitt Romney in 2012.

      

“The state that first elected Jay Rockefeller in 1976 as governor is not the same state today,” said Lane Bailey, a former chief of staff to Mr. Rockefeller. Rural West Virginians feel culturally adrift from Washington, said Mr. Bailey, the son of a coal miner. “They are more and more angry, more and more turning inward, because they have become untrusting of a government that they feel has forgotten them.”

      

Voters have generally remained faithful to their party heritage in statewide races, choosing a Democratic governor, Earl Ray Tomblin, and senator, Joe Manchin III, in 2012. But there is uneasiness this time around, reflected in the Tennant campaign’s efforts to distance itself from the Obamas. Before Ms. Tennant stepped forward in September, more than a half-dozen prominent Democrats declined to run.

      

“Republicans will have so many pictures of Obama, it’ll be comical and laughable,” said Kent Carper, a Democrat who is the president of the Kanawha County Commission, which includes Charleston, the capital. “I would hope the state party and national party can explain to voters he is not on the ballot. If you want to vote against him, you really need to wait until he runs for school board in Illinois.”

      

In an interview, Ms. Tennant even seemed to downgrade the president’s title. “I don’t answer to Senator Obama,” she said. “I answer to the people of West Virginia.” (A spokeswoman later said that was an unintentional slip of the tongue.)

      

Democratic leaders were relieved when Ms. Tennant, who turned 46 on Wednesday, finally entered the race, and they have promised millions of dollars to help her run competitively. She is well known and popular from previous campaigns and, before entering politics, from her time as a co-anchor of “Good Morning, West Virginia” on Charleston television with her husband, Erik Wells, who is now a state senator.

 

Some also remember her from her days as the first woman to serve as the Mountaineer, the buckskin-wearing, rifle-toting mascot of West Virginia University. It was a first that made some people unhappy. “Go back to the kitchen and make babies,” Ms. Tennant recalled people yelling. She was spat on during an outing with sorority sisters.

      

“It shaped who I am today,” she said. “A lot of people ask, ‘Is she tough enough?’ West Virginians know me as someone who can stand up for what is right.”

      

After leaving her office in the State Capitol last week to pick up her 11-year-old daughter from school, Ms. Tennant sat for a quiet-voices interview in the children’s section of the main branch of Charleston’s public library, while her daughter studied for a test.

      

She framed her candidacy as a contrast with “the dysfunction that Congresswoman Capito has continued to perpetuate” in Washington, citing the government shutdown in October.

      

Ms. Capito, 60, the daughter of a former governor here, said in an interview that she had opposed the shutdown and that she voted for the recent budget compromise that Tea Party-leaning Republicans rejected.

      

“I’ve been known as someone who reaches across the aisle,” she said. She spoke by phone from her home in Charleston, where she was readying an office Christmas party for her husband, Charles, an investment manager of Wells Fargo bank.

      

Ms. Capito is well liked by leaders of both parties in a small state where most people in public life know one another. Polls show her winning up to one in three Democratic votes. “I couldn’t be elected without Democrats,” she said.

 

More than in any other state, deep ties to King Coal expose Democrats’ vulnerability in West Virginia because of the national party’s stances on climate change and renewable energy. Both Ms. Tennant and Ms. Capito diverge sharply from the Obama administration on its coal policy, an issue that is often more emotional than economic in Appalachia, where jobs are being lost to cheaper natural gas as much as to environmental regulation.

      

Ms. Tennant denounced the president’s order to the Environmental Protection Agency in June to limit carbon dioxide pollution from coal-fired power plants. “I think he has not fairly looked at what’s taking place with West Virginia,” she said. “A policy like that hurts jobs for the people of this state.”

 

She dodged when asked whether she would have voted for the president’s health care law. “If I were in office in 2010, I certainly would have brought West Virginia values to it,” Ms. Tennant said. She would not say whether she would have voted yes or no.

      

Ms. Capito, for her part, called the Affordable Care Act “a huge overreach,” but declined to second-guess the decision of state officials to expand Medicaid under the law. “We are where we are now, and we have to figure out how to go forward,” she said.

      

Ms. Capito voted with Republicans in the House 94.6 percent of the time, according to the website OpenCongress.

      

Ms. Tennant said Ms. Capito supported House Republicans’ staunch opposition to raising the minimum wage. Ms. Capito countered that she voted for the last federal increase in 2007. “We need to look at ramifications of what raising the minimum wage would mean to the whole economy,” she said.

      

Mr. Carper, the county commission president, promised a tight race. “This is a small state,” he said. “When a potato spud hits the ground at a potato festival, these two women will be there. They’ll eat more ramps than anyone at the ramp festivals in July. They will be everywhere.”

In Battle Against Fraud in Free Phone Service, the Poor Might Pay the Price

From The New York Times:

From her trailer with a rusting roof on Lot 54, Donna James uses the free Samsung cellphone provided by a federal program to speak with friends who give her rides, clerks at medical offices, a caseworker, emergency dispatchers and, of course, bill collectors.

“If it weren’t for my free phone, there were a few times I wouldn’t have made it to the hospital,” said Ms. James, who is unemployed because of chronic health problems and has no other telephone or Internet connection in her home. She is among the 15.3 million people in the United States who receive the Lifeline telephone service because they meet income guidelines or are enrolled in programs like Medicaid or food stamps.
      

But the fundamental feature of the program on which Ms. James relies — 250 minutes of free wireless service a month — is at the center of a legal battle linked to a new tactic to reduce fraud in the program. The outcome could have far-reaching consequences for the telecommunications industry and for millions of impoverished Americans.

      

Alarmed by accounts of households that have more than one subsidized phone — a breach of federal guidelines — and other allegations of fraud, the Georgia Public Service Commission voted this year to make this state the first to require phone companies to collect a fee of at least $5 a month from Lifeline users.

      

As an alternative, in an effort to force the service providers to better police phone usage, the commission also said that the companies could, for the same compensation they already receive from the government, offer participants 500 minutes a month. But the companies denounced that option.

Georgia regulators made their move about three years after the Government Accountability Office reported that officials from 21 states “indicated that they were somewhat or very concerned about consumer fraud in the Lifeline program.”

      

Georgia’s mandate, which had been scheduled to take effect in January before a judge in Atlanta granted an injunction last week, prompted outrage from some advocates for the poor, and a legal challenge from a trade group that represents cellphone companies. The group argued that Georgia was circumventing federal law to set rates.

      

But the author of the regulation has argued that the fee’s benefits outweigh the risks, and that it would do much to reduce Georgia’s share of fraud in the Lifeline program, which began in 1985 and was expanded to include wireless coverage two decades later.

      

“There’s always going to be collateral damage when you’re having a war, and we’re having a war with fraud and abuse,” Commissioner H. Doug Everett told WABE Radio in October.

      

Stan Wise, one of two public service commissioners who voted against the new regulation, conceded that the Lifeline program has been rife with misconduct, but warned that the fee would be ineffective and damaging.

      

“What it really does is harm those in the most need and the ones that the program was designed to help,” Mr. Wise said. “If you have three Lifelines and it’s important to you to have the three phones, what’s $15 to you if you’re promoting fraud?”

      

The program’s troubles have received widespread attention. Aware of the criticisms, the Federal Communications Commission, which cited the potential for “a significant burden on some classes of Lifeline consumers” when it turned back a plan in 2012 to impose monthly fees across the country, has started a campaign to clean up the program, including the introduction of new national databases tracking eligibility and participation.

      

But if Georgia’s new policy can survive in court, it could be replicated elsewhere by anxious state regulators.

      

“These sorts of cases are relatively unusual,” said James B. Speta, a professor at Northwestern University who specializes in telecommunications law. “So in a second state or a third state, they will certainly look at what happened in Georgia.”

      

As the legal battle plays out, Georgia residents who have Lifeline phones are beginning to contemplate what they will do if the fee is put in effect.

      

Ms. James, who has a monthly budget of about $350, said she was likely to have to choose between her phone and one of the six prescription medications she takes every day.

      

“I’ve got medicines I’ve got to buy with $5,” said Ms. James, 47, who lives just northwest of Atlanta and said she has medical debts well into six figures after numerous hospitalizations and health issues that include chronic bronchitis and gastrointestinal ailments.

      

Others who have the Lifeline phones, including Brenda Florence, said they would immediately return them.
      

“They’re supposed to be free,” said Ms. Florence, 60, who pays for a home landline and cell service but also participates in Lifeline because she receives Medicaid benefits. “I’m going to put it in the box and mail it back.”

      

In Georgia, where nearly 721,000 people use Lifeline, the debate has also exposed a fissure among those who work to aid people in poverty.

      

At the Christian Aid Mission Partnership, which provides food and clothing to the region’s poor and sometimes hosts phone providers offering their wares, officials said they endorsed the state’s new effort to stem fraud.

      

“I think there should be some skin in the game,” said Linda Oviatt, the organization’s outreach director. But she added that she generally supported the Lifeline program because it was “a godsend” for many of her clients.

      

Other advocates for the poor, though, have been sharply critical of Georgia’s plan.

      

“The proposed fee simply serves as a penalty on the poor,” the Rainbow PUSH Coalition wrote in an October letter to commissioners. “It is, in essence, a tax being arbitrarily applied to those who can least afford it and an incursion by the P.S.C. on the free market business practices of private companies.”

      

Back on Lot 54, Ms. James, whose kitchen on a recent day was cluttered with boxed and canned foods, said she thought the debate should focus less on complex legal arguments. She merely wants to keep her aging flip phone.

      

“It’s so hard on someone who is on a fixed, fixed income,” she said. “It was just an honor to get something that is going to help me.”

As the Politics Play Out, Key Jobless Benefit Lapses

From The Wall Street Journal:

An emergency jobless-benefits program due to expire this weekend would pinch the finances of more than a million Americans, setting the stage for the what could become lawmakers' first flashpoint of the midterm election year.

While the program's end would barely dent the broader economy, the money at stake is meaningful. The federal Emergency Unemployment Compensation, launched during the middle of the recession, pays on average $300 a week to 1.3 million long-term jobless who have exhausted the roughly 26 weeks of unemployment insurance benefits most states provide. If extended, the program would transfer about $25 billion in 2014 from the government to the unemployed, the Congressional Budget Office calculates.

 

Some opponents of continuing the program say the roughly $25 billion price tag would be more effective at rehabilitating the labor market if put toward creating jobs, rather than extending a safety net. Some analysts also describe the Emergency Unemployment Compensation program as a recession-era holdover no longer needed in an economy—and labor market—that has been recovering for more than four years.

 

"This is an emergency program," said Chris Edwards, of the Cato Institute, a libertarian think tank in Washington. "The emergency has long been over."

"It is to an individual's advantage—as soon as they are unemployed—to really try to get employed again," Mr. Edwards said. "The curious thing about emergency unemployment benefits is that [they] induce people to wait to start searching for a job and that ends up kind of hurting them."

 

If the federal program isn't renewed, Mr. Edwards said he expects "a lot of people will make the tough decisions to take lower wages, change careers or jobs, or take a job that is less pleasant than they were hoping for."

 

Research has shown that such insurance may permit some job seekers to take more time in their searches, rather than accepting the first opportunity regardless of suitability. The benefits keep recipients—who are supposed to be looking for jobs in order to qualify—in the work force, rather than dropping out of it. Today's less-than-robust labor market—with almost three unemployed people for every opening—is particularly grim for the long-term unemployed.

 

The long-term unemployed who face expiring payments are found in every state except North Carolina, which had its extended benefits cut off earlier this year after failing to meet federal guidelines. Since extended unemployment was eliminated in the state, its jobless rate has tumbled. But much of the decline is from people dropping out of the labor force.

 

After previous downturns, going back to the 1950s, the federal government has stepped in to help the jobless with benefits. The current Emergency Unemployment Compensation program has been renewed more than 10 times since July 2008. As the national labor picture has slowly improved, the combined state and federal benefits have been dialed back, from 99 weeks to 73 today. EUC benefits last between 14 and 47 weeks, depending on factors such as a state's unemployment rate.

Los Angeles Gets Serious About Its Downtown - Property investors are luring professionals by turning abandoned buildings into stores, bars and apartments

From The Wall Street Journal:

For decades, "downtown L.A." was a just a punch line in this sprawling city famous for having no real center. Largely ignored by residents—except for office workers who cleared out at 5 p.m.—many of the district's store fronts and theaters were vacant. Its best-known neighborhood was Skid Row.

Now, downtown Los Angeles is in the midst of a transformation that's no joke.

In the last 14 years, its residential population has jumped to 52,000 from 19,000, after a city ordinance allowed historic and underused properties to be converted into housing. Abandoned buildings have been transformed into luxury lofts.

In the last five years, more than 450 new businesses have opened downtown, according to the Downtown Center Business Improvement District, a coalition of business owners and residents. Many of them are the city's hippest new restaurants and boutiques. Over 5,000 apartment units are under construction. Investors from Israel, Canada and South Korea have commercial or residential projects in the works.

Downtown neighborhoods are making a comeback in many cities, including Toronto, Detroit and Providence, R.I., where investors have snapped up bargains and turned vacant buildings into lofts and shops aimed at young professionals who want to live where they work.

Good news: Government Pulls in Reins On Disability Judges

From The Wall Street Journal:

The Social Security Administration, smarting from recent scandals, this weekend is set to tighten its grip on 1,500 administrative law judges to ensure that disability benefits are awarded consistently and to rein in fraud in the program.

The agency is rewriting the job descriptions of its judicial corps, allowing officials more latitude to crack down on judges who are awarding disability benefits outside the norm.

 

The changes are among a number of revisions the SSA has adopted in the wake of a several recent scandals, including the arrest of more than 70 people in Puerto Rico and a separate criminal investigation into a former judge in West Virginia. Both affairs raised questions in Congress about how much fraud might be in the disability adjudication system.

 

The Social Security Disability Insurance program, funded by payroll taxes, pays monthly benefits—often until someone receives retirement benefits in their 60s—for people who can no longer work because of physical or mental health problems.

 

During the recent economic downturn, the program grew quickly and now has close to 11 million beneficiaries. It has grown so fast, in fact, that it is projected to exhaust the reserves in its trust fund by 2016, which could force all beneficiaries to see an immediate cut in their payments.

Immigration-Bill Pressure Backfires - Overhaul Backers Target Majority Whip, but Tactic Provokes Response From Opponents

From The Wall Street Journal:

Supporters of an immigration overhaul, looking for allies in the Republican-led House, concluded months ago that a top prospect would be Majority Whip Kevin McCarthy.

His California district is 37% Hispanic. It is dominated by big farms that rely on immigrant labor. Mr. McCarthy has strong ties to Silicon Valley, where companies are eager for more high-tech visas. His perch as No. 3 House Republican gives him a voice in leadership and sway over what legislation comes to the floor.

 

But an aggressive campaign to win his support appears to have backfired. People who have talked to him say Mr. McCarthy is less inclined to support an overhaul after protests at his district office by overhaul backers that, in turn, provoked counter-protests and TV ads from opponents of the legislation.

 

People familiar with House GOP discussions say that Mr. McCarthy hasn't used his leadership position to press for moving immigration bills through the House, which adjourned for the year without taking any votes on immigration.

 

In an interview, Mr. McCarthy said pressure from overhaul advocates was counterproductive. "If they continue their tactics, it's less likely they're helpful in solving the problem,'' he said. "They are less likely to have my ear."

 

The difficulty in winning over Mr. McCarthy, with his immigrant-dependent district, shows the steep challenge that immigration activists face as they push the House to pass legislation resisted by powerful voices in the Republican Party.

 

Activists have staged protests around the country, gone for weeks without food, organized prayer vigils and pressed their case in meetings with top Republicans. Pleas have come from immigrants, priests, CEOs, police officers and Republican donors. So far, none of it has worked.

 

In the interview, Mr. McCarthy said he would like the House to vote on immigration legislation next year. But he hasn't laid out a plan for doing so.

 

Mr. McCarthy's reluctance to take a leading role on immigration comes as other GOP leaders are giving mixed signals about whether legislation will move forward. House Speaker John Boehner said in November that Republicans would develop "principles" to guide legislation, a step many read as a delay tactic. But he also recently hired a well-respected immigration-policy expert for his staff. Some lawmakers say that with a number of incumbents now facing primary challenges, prospects for legislation will rise once the bulk of the primary elections are completed in the spring.

 

Mr. McCarthy sends mixed messages about his own views. He says the border must be secured before anything else and, like many House Republicans, he doesn't support the Senate provision that would allow many illegal-immigrant adults to gain citizenship.

 

At the same time, he supports most other elements of the Senate's comprehensive bill, at least in broad strokes, including a guest-worker program and more visas for high-skilled engineers. He also supports a path to citizenship for people brought to the U.S. illegally as children, and legal status for many other illegal immigrants.

 

At the start of 2013, attention focused on the Senate, where a bipartisan group was writing and then moving legislation. But advocates of the bill knew the tougher lift was the Republican-controlled House, and they began to identify potential allies. They put Mr. McCarthy at the top of the list.

 

"No one has the combination of power in the House and a district with as much at stake in the immigration legislation as Kevin McCarthy," said Giev Kashkooli, vice president of the United Farm Workers, whose national headquarters sit in Mr. McCarthy's Bakersfield-area district.

 

The labor union and other advocates staged a series of events aimed at pressuring Mr. McCarthy. In June and July, they held rallies outside his district office. In August, 15 people marched 285 miles over 21 days from Sacramento in a "pilgrimage" to his office. In October, area growers and the union delivered more than 8,000 postcards and letters to his office.

 

Then, in November, 13 women occupied his district office and refused to leave until Mr. McCarthy met with them. And in December, the union staged an 11-day campaign with daily events outside Mr. McCarthy's office. Mr. McCarthy's staff, citing disruptions, kept the doors locked.

 

The activism provoked a response from opponents of an overhaul. The Bakersfield Tea Party began staging counter-protests and pressed their case in meetings with Mr. McCarthy. "We would go out there with our own signs saying we did not support amnesty for illegal behavior," said Alfred Hernandez, the group's administrator.

 

A group called Californians for Population Stabilization aired ads charging that Mr. McCarthy wants to make it easier for foreigners to take American jobs.

 

The group Numbers USA, which calls for limits on immigration, also grew concerned that Mr. McCarthy might support legislation it considered to be amnesty for people who had illegally entered the country. It directed its members to phone and message Mr. McCarthy's offices, and to drop by his office with material making their case, said Roy Beck, the group's CEO. "We did react on McCarthy, because he's truly in play," he said.

 

People close to Mr. McCarthy say the conflicting pressures made him wary of getting involved with the issue at all. In the interview, Mr. McCarthy focused on the pressure from pro-immigration forces, saying they had protested at his house, confronted him at the grocery store and made it impossible for his staff to work because the protests were so loud.

 

"I can't go anywhere in the community without being protested," he said. "I don't see how that is productive."

Health-Insurance Deadlines Keep Slipping - Last-minute influx of enrollees prompt the Obama administration and some states to keep the rolls open for Jan. 1 coverage.

From The Wall Street Journal:

A last-minute rush of customers helped new health-insurance exchanges boost enrollment this week, and many states extended deadlines to accommodate stragglers.

 

But officials acknowledged they had a long way to go to make a big dent in the number of uninsured people and attract the younger, healthier customers needed to make the economics of the new marketplaces work.

 

Americans hustled to sign up for government health-insurance plans this week to have their coverage kick in by Jan. 1.

 

The shifting deadlines illustrated the concern about giving people a chance to enroll after technology problems made the federal HealthCare.gov site and some state sites virtually unusable in the weeks after they opened Oct. 1. The federal site serves 36 states, while 14 states are running their own exchanges.

 

Initially the administration set a Dec. 15 deadline for those who wanted coverage taking effect Jan. 1. It later moved the deadline to Monday, and when that date arrived, gave an additional day as a "fail-safe" for those who faced snafus.

 

As darkness fell on Christmas Eve, the federal HealthCare.gov site posted a further modification, saying people who "might have run into delays" and missed the deadline should contact a call center. "We still may be able to help you get covered as soon as January 1," it said.

 

A Department of Health and Human Services spokeswoman, Joanne Peters, said the call centers "are doing casework on an individual basis."

 

Many of the states running their own exchanges have announced similar delays. California set a new deadline of Friday at 8 p.m. local time for people who didn't finish filling out their applications, telling them to contact a call center. Massachusetts, Minnesota and Rhode Island said residents could sign up as late as New Year's Eve for coverage starting the next day.

 

The changes put more pressure on health insurers to get paperwork in order so people who have signed up for coverage can actually use it.

 

State figures suggest many people procrastinated in buying coverage. Colorado had more enrollees Monday than in the entire month of October, said Patty Fontneau, head of the state's health-insurance exchange. "We had underestimated the number who would wait until the last minute," she said.

 

Other states reported a similar rush. Nearly a third of the 65,472 people who signed up for private health plans in Washington state through Monday did so in the final four days. Connecticut recorded 6,700 enrollees on Monday, double the previous single-day high. HealthCare.gov received two million visits on Monday, federal officials said.

 

The totals showed a wide divergence, with technology troubles leaving states such as Maryland, Minnesota and Oregon far behind similarly sized states. Those states have replaced their health-exchange directors and Maryland brought in a new contractor that also is working to repair the federal website.

 

President Barack Obama said on Dec. 20 that more than a million people nationwide had signed up for private coverage through the health-insurance exchanges, and the state numbers suggested the end-of-year total might approach two million.

 

Still, that would fall well short of the more than three million enrollees in private coverage the Obama administration foresaw in one early projection.

 

The mix of enrollees is also a potential problem for the Affordable Care Act, also known as Obamacare, because insurers need younger customers to balance the costs of those who are older and tend to be sicker. In one typical example, Rhode Island reported that 40% of its new enrollees were between 55 and 64 years old, while only 8% were between 18 and 25.

 

"This is the start of a longer process," said Ms. Fontneau, the Colorado exchange director. "We are planning a significant push in the coming months to reach out to people who are younger and healthier."

 

Colorado has more than 700,000 uninsured people, according to an estimate by the Kaiser Family Foundation, a nonpartisan health-care think tank, and so far 42,771 people in the state have signed up for private coverage.

 

The federal and state websites are designed to offer coverage for those who don't have health insurance through their employer or a government program such as Medicare. Starting in 2014, most Americans who fail to carry health insurance will have to pay a tax penalty, which starts at $95 or 1% of taxable income in 2014 and rises in subsequent years. Enrollment for 2014 plans will continue through March 31.

You knew it was coming: Sign-Up Period Extended Again for Health Plan - Sweeping exercise of executive power and "pattern of circumventing Congress in the creation of new major standards, exceptions or outright nullifications.”

From The New York Times:

The Obama administration said Tuesday that it would provide more time for people to complete their applications for health insurance if they could show that they missed the deadline because of problems with the federal health care website.

The move was the latest in a series of deadline changes, exemptions and clarifications that have confused insurers and many Americans and opened the administration to increasing criticism from Republicans who have opposed the Affordable Care Act from the start and have repeatedly tried to overturn it.
      

It was not clear on Tuesday how many people would be affected, or how consumers would prove that website errors had prevented them from signing up by the deadline on Tuesday night.

      

The announcement itself was vague, saying only that if website problems had prevented any consumers from enrolling, they might qualify for what the government has called “a special enrollment period.” The administration did not say how long that would last. Nor did it define what website errors might be involved.

      

Republicans said the announcement — coming a day after the federal website recorded more than two million visits — showed that President Obama was desperate to increase enrollment, widely seen as a measure of the success of the health care law.

      

For their part, administration officials said the move was a common-sense response to heavy traffic on the website, which they cited as evidence of a huge need for more affordable insurance. Some 48 million Americans are uninsured. Many could qualify for subsidized coverage under the Affordable Care Act.

      

Tara McGuinness, a White House spokeswoman, said the administration was not providing “a blanket extension,” but was offering to provide “assistance to individuals on a case-by-case basis.”

      

And Kurt DelBene, the new troubleshooter for the site, said it was performing well. “With the highest volumes we have seen to date, response time is fast, and the error rate is low,” he said.

      

The move did not mollify insurers who have grown concerned as new problems have erupted since the rollout on Oct. 1 and are worried about how they will be able to provide coverage for everyone who wants it by Jan. 1, when that coverage is supposed to go into effect.

      

“The goal posts keep moving,” William G. Schiffbauer, a lawyer who represents insurance companies, said Tuesday evening. “That raises questions about whether insurers can collect premiums in a timely manner to pay claims from doctors and hospitals.”

      

“The latest step creates confusion for consumers and insurers,” he added.

      

Insurers said that Tuesday’s action, combined with several recent unexpected shifts in federal rules and policy, made it harder for them to predict the number and characteristics of new subscribers. That, in turn, makes it harder for them to predict their costs and complicates efforts to set prices for their products.

      

In general, insurance companies say they need substantial numbers of healthy people to balance the financial risks of covering older Americans who require more medical care.

      

The open enrollment period continues to March 31. People who select health plans on the federal exchange starting Wednesday and continuing through Jan. 15 will generally be entitled to coverage that takes effect on Feb. 1, provided they pay their share of the first month’s premium before then.
      

The new offer to consumers who have had trouble with the website followed the last-minute surge of interest among people seeking coverage, and the administration hailed what it described as “amazing interest” in new health insurance options.

      

The original deadline for coverage starting Jan. 1 was Dec. 15. On Nov. 22, the deadline was extended to Dec. 23. On Monday, the White House provided a 24-hour grace period, to 11:59 p.m. on Tuesday.

      

Then on Tuesday, in a bid to ensure coverage for all who want it, the administration provided details of the “special enrollment period” for some people — but not all — who miss the deadline.

      

“If you weren’t able to enroll in an insurance plan by Dec. 23 because of problems you had using HealthCare.gov, you still may be able to get coverage that starts Jan. 1,” the administration told visitors to the website in a message posted on the health insurance blog at HealthCare.gov. The message also highlighted the assistance available to shoppers.

      

“Couldn’t enroll by December 23?” it said. “We can still help you get covered.”

 

“Even though we have passed the December 23 enrollment deadline for coverage starting January 1, we don’t want you to miss out if you’ve been trying to enroll,” the administration said. “Sometimes despite your best efforts, you might have run into delays caused by heavy traffic to HealthCare.gov, maintenance periods or other issues with our systems that prevented you from finishing the process on time. If this happened to you, don’t worry — we still may be able to help you get covered as soon as January 1.”