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Greg Sargent:

While the punditry has focused on Dems supposedly “running away” from the law, what is really happening is they are adopting variations of the “keep and fix” message that will be central to the Dem approach next year. Dems like Kay Hagan, Mary Landrieu, and Mark Pryor are embracing various “fixes,” but they will be attacking GOP opponents for supporting repeal. Dems remain committed to sticking with the law, which could get tougher if it continues to experience problems, but easier if it works and coverage continues to expand.

Pundits will probably see this new messaging as a kind of political “lemons to lemonade” play. And to be sure, many Dems remain nervous about what the law will do to their prospects. But the new push from Dems is also about recasting the meta-pundit debate over Obamacare — it’s an effort to persuade the commentariat that while Obamacare may be unpopular, the GOP repeal stance is a liability, too.

As 2012 illustrated, getting commentators to view the debate over a major political albatross (whether it’s the economy or Obamacare) as a “choice” rather than a “referendum” is not easy. But as 2012 also illustrated, voters don’t always view things in the same terms the pundits do.

Ron Fournier:
Rather than be the party of solutions in a gridlocked capital, appealing to a leadership-starved public, the GOP is the party of obstruction, ensuring that its putrid approval ratings nose dive apace with Obama’s.

The country needs sensible immigration reform that brings 11 million or so undocumented residents out of the shadows. No, says the GOP
The country needs to tame a massive debt that will be 100 percent of the gross domestic product by 2038 unless Congress raises revenue and trims entitlements. No, says the GOP.

The country needs fair debate and compromise around existential issues such as climate change, income inequality, and a deteriorating 20th century infrastructure. No, says the GOP.

NY Times:
Republican strategists say they intend to keep Democrats on their heels through a multilayered, sequenced assault on President Obama’s signature legislation.
More politics and policy below the fold.

In terms of how people view things, here's an important observation from NY Times in a story chronicling the continued web site woes, my bold:

Some navigators said it was hard not to feel discouraged, especially when their clients, locked out by the website, went home upset. “We have people who understandably say, ‘Well what the heck am I doing here if you can’t enroll me?’ ” said Ted Trevorrow, a navigator in Philadelphia who has not been able to enroll a single person yet. “I always want to say, ‘That’s a really good question.’ ”

Their experience remains markedly different from that in most of the 14 states that built their own exchange websites, where people are managing to sign up in much larger numbers. The remaining 36 states depend on the federal exchange.

Clients wary of the health care law can be especially intolerant of the website’s problems, Mr. Trevorrow said. “They’re incensed over the fact that the law would, as they see it, intrude on them to this degree and then not even perform,” he said.

A major issue with Obamacare:
As Americans have begun shopping for health plans on the insurance exchanges, they are discovering that insurers are restricting their choice of doctors and hospitals in order to keep costs low, and that many of the plans exclude top-rated hospitals.

The Obama administration made it a priority to keep down the cost of insurance on the exchanges, the online marketplaces that are central to the Affordable Care Act. But one way that insurers have been able to offer lower rates is by creating networks that are far smaller than what most Americans are accustomed to.

The decisions have provoked a backlash. In one closely watched case, Seattle Children’s Hospital has filed suit against Washington’s insurance commissioner after a number of insurers kept it out of their provider networks. “It is unprecedented in our market to have major insurance plans exclude Seattle Children’s,” said Sandy Melzer, senior vice president.

The result, some argue, is a two-tier system of health care: Many of the people who buy health plans on the exchanges have fewer hospitals and doctors to choose from than those with coverage through their employers.

Everything about health care insurance involves tradeoffs and you can't have it all. That's a tough lesson, but it's true with or without ACA. So do you want cheaper? Do you want to exclude the teaching and children's hospitals that treat the poor? But (from the full story) is it really unavoidable that an appendectomy at a specialty hospital costs 23K vs 14K at a community hospital? Read that with this:

USA Today:


Health care costs rose by only 1.3% a year from 2010 to 2013, a new report from the White House Council on Economic Advisers shows. That's the lowest increase in a three-year period on record. White House officials cite the 2010 Affordable Care Act as a main factor in lowering costs.

And don't forget the mental health aspects of ACA as well as refusal in some states to expand medicaid (this report on mental health coverage is from OK). Whenever things sound simple about health care, I guarantee you they are not.

Jennifer Bendery:  

A dozen state attorneys general are urging the Senate to reject an effort by Sen. Chuck Grassley (R-Iowa) to strip the D.C. Circuit Court of Appeals of three of its seats and therefore prevent President Barack Obama from filling vacant judgeships on the court.

In a Monday letter, 12 top state law enforcement officers call on senators to support the court's current 11 judgeships instead of backing Grassley's bill to shrink the court to eight seats. The attorney general of Iowa, Grassley's home state, is among those on the letter.

"There is no basis to reduce, much less slash, the number of judgeships" on the D.C. Circuit, which is a "vital, understaffed court of national importance," reads the letter. "The D.C. Circuit's caseload is unique, heavily tilted toward complex administrative law cases."

I forget when Sen. Grassley decided to become a complete political neanderthal, but his conversion is complete. Keep this move by Grassley in mind when we discuss going nuclear on filibusters, and what room there is to negotiate.


The state inspector general’s office has opened an investigation into why the son of of Virginia state Sen. R. Creigh Deeds was released from custody the day before he apparently stabbed his father and then shot himself to death.

“We’re going to investigate the circumstances that led up to Austin Deeds’s release at the expiration for the emergency custody order,” G. Douglas Bevelacqua, director of the behavior health and developmental services investigations and inspections for the Office of Inspector General...

The investigation opened as news emerged Wednesday that three hospitals near Bath County had available beds the day of Austin Deeds’s psychiatric evaluation

The mental health system in every locality has to function properly. One idea that developed after 12/14 in Newtown is to have local navigators assigned to help folks figure out the local system and how it works. There's something odd about the way it works in VA, and hopefully more light will be shed.

NPR covers a medical mystery:

How A Vitamin D Test Misdiagnosed African-Americans

By the current blood test for vitamin D, most African-Americans are deficient. That can lead to weak bones. So many doctors prescribe supplement pills to bring their levels up.

But the problem is with the test, not the patients, according to a new study. The vast majority of African-Americans have plenty of the form of vitamin D that counts — the type their cells can readily use.

The research resolves a long-standing paradox.

"The population in the United States with the best bone health happens to be the African-American population," says Dr. Ravi Thadhani, a professor of at Massachusetts General Hospital and lead author of the study. "But almost 80 percent of these individuals are defined as having vitamin D deficiency. This was perplexing."

The origin of this paradox is a fascinating tale of genes interacting with geography. More on that later.

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