Pot Legalization Effort Defies Stereotypes

It’s time for government officials to accept reality and legalize the recreational use of marijuana.

While taking my daughter to a punk-rock concert a few years ago, I noticed something even more fascinating than fellow concert-goers’ hairdos and intricate tattoos. It involved some common behavior.

Many people stood outside the venue, puffing cigarettes. When the doors opened, everyone — with no exception — put out their smokes before filing inside. But smoking didn’t stop. As the lights went down, clouds of marijuana smoke rose up across the hall.

Tobacco is a legal but regulated product, so when authorities announced that no tobacco is allowed, people complied. Recreational marijuana use is not legal, so people smoked it as soon as they felt safe from being caught. It’s already illegal, so why follow rules?

Public debates over marijuana use may become more common as supporters of legalization gather signatures for a November 2014 initiative. In 2010, a similar measure (Proposition 19) did respectably, but lost by 7 points. A new poll shows 60-percent of likely voters supporting legalization.

Such efforts have long had a “Cheech and Chong” stigma, and this particular initiative is viewed by some as an overly broad long shot. But supporters of the concept are increasingly focused on issues that are mainstream and wonkish — i.e., increasing government revenues, stretching law-enforcement resources and protecting the environment.

They often point out what the story above illustrates: People behave more responsibly when they are free to do something — and when that something is taxed and regulated rather than pushed into the shadows.

“Medical marijuana is nothing more than a land-use issue to me,” said Max Del Real, a lobbyist who represents medical-marijuana shops. “How do we regulate, tax them and move on?” He has lobbied San Diego to adopt an ordinance similar to the one in Sacramento, which raises $2.5 million a year in taxes from 39 legal dispensaries.

Dispensaries are allowed under California’s Proposition 215, but enforcement varies by locality. Many cities, including San Diego for the time being, use land-use restrictions to ban dispensaries.

Counties recognize different limits on how much “medicine” a patient may have. The feds have cracked down on dispensaries in California, but recently told Colorado and Washington officials that they will allow their legalization laws to proceed. It’s a mixed-up mess.

As a result, many cannabis growers operate in the shadows, paying no taxes, following no rules and despoiling the environment. Del Real opposes legalization, but prefers a regulatory framework that gives cities a tax incentive to be more rational in their medical-marijuana policies.

Humboldt County, 200 miles north of San Francisco, is Ground Zero in the debate. The redwood-forested county has the perfect climate for growing marijuana, and a political climate that’s amenable to it, too.

Mikal Jakabul, whose documentary film, “One Good Year,” chronicled the lives of some Humboldt growers, told me it would be hard to find a jury that would convict anyone for marijuana cultivation given how socially acceptable and economically beneficial it is locally. So the industry flourishes.

Humboldt’s District Attorney Paul Gallegos favors decriminalization, even as he points to ill effects of marijuana. “We should use our criminal justice system not to punish people for doing things we don’t like, but for things they are doing that are wrong, … like killing and robbing people,” he said in an interview Tuesday. Current laws “reward the wicked and punish the innocent,” he added.

Ironically, Humboldt residents voted overwhelmingly against legalization in 2010, for reasons that might have to do with protecting a homegrown industry from outside competition.

Jubal favors legalization in general but fears the current initiative would lure out-of-town marijuana “miners,” who clear-cut forests, poison water supplies and drive out local growers. Protections for family farms must be “hard-written” into any initiative, he said.

But Nate Bradley, a former Wheat land police officer who represents Law Enforcement Against Prohibition, said it would be easier to crack down on misbehavior by growers if they were regulated like other businesses. And he complains that the war on marijuana diverts police resources from more serious matters.

With widespread agreement on the failure of current policies, it may only be a matter of time before California officials acknowledge politically what those concert-goers understood inherently — legalizing a product may be the best way to control its use.

Chicago Health Commissione Ban on E-Cigarette

All of this, city officials assure, is aimed at protecting children. Chicago Health Commissioner Dr. Bechara Choucair told the Sun-Times that it's not enough that “we’ve seen a decrease [in youth smoking], then a plateau. We really need to break that plateau.” Choucair hopes to stamp out youth use of both cigarettes and e-cigarettes.

Erika Sward, vice president of the American Lung Association, voiced approval for Chicago's planned ban, saying, "We don't want to have people now exposed to e-cigarette second-hand emissions until we know more about them."

But can government officials actually convince people to stop smoking cigarettes while also preventing them from utilizing alternatives? Reason's Jacob Sullum has extensively covered e-cigarette issues and has noted that e-cigarettes are not a gateway to tobacco use, rather, “because e-cigarettes more closely simulate the experience of smoking than nicotine gum, patches, or inhalers do, they may be more effective in helping smokers quit.” Likewise, addressing concerns about safety, he has pointed out that “the health hazards of vaping pale beside those of smoking,” so the decrease in tobacco use that has coincided with the rise of e-cigarette use in young people “might signal successful harm reduction.”

Other cities considering e-cigarette restrictions include New York City, Oklahoma City, and Beverly Hills.

ReasonTV's Tracy Oppenheimer addressed a number of e-cigarette issues in the video below:

E-Cigarette Ban Proposed in Chicago

E-Cigarette Ban Proposed in Chicago

Chicago is on its way to becoming the first major U.S. city to ban electronic cigarette use in public and to place other regulations on the product.

In December, the city council will vote on a proposal to amend and expand a current tobacco ordinance. Backed by Mayor Ram Emanuel and aldermen Will Burns and Ed Burke, this measure would ban the sale of e-cigarettes to minors, require retailers to gain a license to sell e-cigarette products, force them to sell these products behind the counter, and – despite the fact that e-cigarettes contain no tobacco – apply the same public prohibitions to them as tobacco products.

The Chicago Sun-Times explains that this means “adults would be prohibited from that smoking e-cigarettes in virtually all of indoor Chicago except private homes and vehicles, hotel rooms designated for smoking and at least 10 feet away from building entrances.” If it passes, the ordinance will take effect in January 2014.

Beverly Hills City Council May Blanket Ban E-Cigarettes Tonight

Beverly Hills City Council has an urgent matter at hand! At tonight’s meeting, the council will consider an “interim urgency ordinance” that will declare a “moratorium of the establishment and further operation of any electronic cigarette retailer.” Remarkably, they are giving retailers two weeks notice:

 "In order to allow retailers to amortize any investment in e-cigarettes made before the adoption of the ordinance, retailers who purchased e-cigarettes for resale prior to the date of adoption of the ordinance will be able to continue to sell such cigarettes for a period of two weeks after the adoption of the ordinance. Selling e-cigarettes beyond the two weeks is a misdemeanor and is punishable by a fine not to exceed $1,000 or imprisonment for up to six months, or both."

Along with the suggested moratorium on vape shops, there is a separate agenda item that will extend all present smoking regulations to electronic cigarettes. Read the rest of the proposed ordinance here.

Proponents of e-cigarettes fear that rash, local legislation like this will set a precedent that will severly impact the industry as a whole. For all the reasons that e-cigarettes shouldn't be regulated, watch E-Cigarettes: Second-hand Smoke, Vaping, and the Price of FDA Regulations.

Arbiters of Taste

Menthol cigarette ban

The Family Smoking Prevention and Tobacco Control Act of 2009, which gave the Food and Drug Administration (FDA) regulatory authority over tobacco products, banned almost all varieties of flavored cigarettes. The one exception was menthol cigarettes, which account for about a third of the U.S. market. A June report suggests that the FDA may be preparing to close that loophole.

Cigarette Sin-Tax Hike Could Boost Black Markets

The FDA, which is seeking public comment on how it should regulate menthol, found no evidence that menthol brands such as Kool and Newport are any more toxic than other cigarettes, but it worried that the cool, minty flavor makes them more appealing to beginning smokers and harder to give up. Menthol cigarettes are especially popular among teenaged smokers, 40 percent of whom prefer them (compared to 30 percent of adults), and among black smokers. The FDA cited evidence that menthol smokers are more strongly attached to their habit: They are more likely to light up within five minutes of waking and less likely to quit smoking.

Which States Will Legalize Pot Next?

Which States Will Legalize Pot Next?

Smoking jointChmee2With the governments of Colorado and Washington in the process of implementing voter-driven measures that legalized pot, the big question is: Who's next? Rob Kampia, the executive director of the Marijuana Policy Project, explains why these states could be the next to legalize marijuana.

Alaska. "I think the next state to legalize will be Alaska, through a ballot initiative we're running in August 2014. The polling's good. It's a cheap state. You can do it."

Rhode Island. "Through state legislature, I think the first state is going to be Rhode Island. Almost everyone in the legislature is extremely liberal. And the Marijuana Policy Project's bill is already halfway to passing."

California, Nevada, Maine, Arizona, or Massachusetts. "You're going to see a whole bunch of states voting on legalization initiatives in 2016-all on the same day. What we saw with medical marijuana is that the ballot initiatives came first. Then state legislatures started passing the bills. And then Congress started getting interested, but of course not passing anything. I think you'll see the same thing with legalization. We're now at 52 percent support for legalization. That's a higher level of support than for most politicians."

Pot Smokers to Denver City Council: Stay Off the Porch

The latest version of Denver's rules for marijuana consumption eliminates the widely derided "smell test," which would have made pot smoking illegal when other people can smell it, even if you do it on your own property. It also omits a ban on mere possession in parks, which Councilwoman Susan Shepherd worried would deter marijuana consumers from walking and biking. And although it still covers marijuana consumption "in any outdoor location" where it is "clearly observable from a public place," it exempts consumption on "private residential property" by owners, tenants, or guests. But The Denver Post reports that at least six out of 13 city council members still want to ban marijuana consumption in front yards, and there may yet be a seventh vote:

Charlie Brown, a swing vote, said he is conflicted. He has been a staunch property-rights proponent but understands the problem [Councilwoman Jeanne] Robb is trying to resolve.

"I don't want to see a bunch of pot parties on front yards," he said. "The city's image is at stake. I'm torn between [that concern and] my stance that a man's front yard is his castle."

Mason Tvert, who co-managed the campaign for marijuana legalization in Colorado, tells Westword that Robb's proposed amendment is approved, he could end up with no place to legally smoke pot:

They are still trying to prohibit the use of marijuana by adults on private property. It's currently legal for adults to consume alcohol or smoke cigarettes on their porches or balconies, so we fail to understand why it should be illegal to use a far less harmful substance there....

I don't have a private backyard; the backyard is a common area. And if my building were to decide people can't use marijuana inside their units, for whatever reason, I wouldn't have anywhere I could legally use marijuana as an adult.

Aspen recently approved marijuana regulations that do not restrict consumption on private property. According to The Aspen Times, that means "it is OK for people to smoke in the comfort of their own yards, fenced or not, as well as their balconies, rooftops and patios." How come?  "At this point," the Times says, "the city doesn’t believe the pot users, whether locals or visitors, will get out of hand."

Update: Last night the Denver City Council gave initial approval to a bill that includes Robb's amendment, which prohibits marijuana consumption "in any outdoor location on private residential property" where it is "clearly observable from a public street, highway or sidewalk." Brown voted against the amendment, saying, "I can't support it. I believe in individual private property rights." It nevertheless got the requisite seven votes. Another vote is scheduled for next Monday.

Feds Raid Colo. Pot Dispensaries

Feds Raid Colo. Pot Dispensaries

Federal agents raided an unknown number of marijuana dispensaries and growing sites in Colorado Thursday, confiscating piles of marijuana plants and cartons of cannabis-infused drinks just weeks before the state allows recreational marijuana retailers to open their doors.

The raids, conducted on a snowy morning, were the first in Colorado since the U.S. Department of Justice said in August that it wouldn't interfere with state marijuana laws as long as the states keep the drug away from children, the black market and federal property.

The U.S. Attorney's Office in Denver said the federal action "comports with the Department's recent guidance" but would not elaborate. The U.S. Attorney's Office said authorities were executing sealed search and seizure warrants and wouldn't disclose how many businesses are being targeted or what they're being investigated for.

Sates that will legalize pot

Which of those concerns triggered today's raids? Walsh's office won't say, at least not yet. "Although we cannot at this time discuss the substance of this pending investigation," Dorschner said in a written statement, "there are strong indications that more than one of the eight federal prosecution priorities identified in the Department of Justice's August guidance memo are potentially implicated."

The raids come just six weeks before Colorado's state-licensed pot shops are scheduled to start selling marijuana for recreational use. But industry leaders seem to be viewing their competitors' legal troubles with equanimity. "Really, I see enforcement actions happening as a sign our industry is maturing and this program is working," Mike Elliott, president of the Medical Marijuana Industry Group (MMIG), told the Post, although he did add that "it's important to remember people are innocent until proven guilty." MMIG board member Andy Williams, who runs Denver's Medicine Man dispensary, appeared pleased as well. "I want the bad actors gone, quite honestly," he said.

Mason Tvert, who co-managed Colorado's legalization campaign and now works for the Marijuana Policy Project, was a bit more wary. "The Justice Department said it would respect states' rights to regulate marijuana, and that it would not go after businesses as long as they are complying with state laws," he said. "We hope they are sticking to their word and not interfering with any state-regulated, law-abiding businesses." Rob Corry, a Denver attorney and marijuana activist, told the Post: "The DOJ needs to explain in a logical fashion why they are picking and choosing, going after only some of these entities when every one of them selling marijuana is running afoul of the federal law."

These raids are an unusually aggressive move by Walsh, who until now had mostly contented himself with shutting down dispensaries he deemed too close to schools by sending them threatening letters. But the Justice Department's new policy regarding state-legal marijuana businesses leaves a lot of leeway for prosecutorial discretion. If I were a dispensary owner planning to get into the newly legal recreational market, I would pay careful attention to Walsh's explanation, assuming he ever offers one, of exactly how businesses such as VIP Cannabis crossed the Justice Department's faintly marked red lines.

Medical Marijuana Raids in Colorado Raise Questions About Federal Forbearance

Federal agents, assisted by local police, staged the biggest crackdown on marijuana dispensaries in Colorado since the state legalized cannabis for medical use in 2000. The Denver Post reports that the raids hit more than a dozen dispensaries in the Denver area, plus businesses in Boulder and elsewhere.

Jeff Dorschner, a spokesman for John Walsh, the U.S. attorney for Colorado, said the operation "comports with the Department's recent guidance regarding marijuana enforcement matters." The August 29 memo to which Dorschner refers indicated that the feds would not interfere with marijuana businesses that comply with state law unless their activities implicated one or more of these eight "enforcement priorities": 1) "preventing the distribution of marijuana to minors," 2) "preventing the diversion of marijuana from states where it is legal under state law in some form to other states," 3) "preventing drugged driving and the exacerbation of other adverse public health consequences associated with marijuana use," 4) "preventing the growing of marijuana on public lands," 5) "preventing marijuana possession or use on federal property," 6) "preventing revenue from the sale of marijuana from going to criminal enterprises," 7) "preventing violence and the use of firearms in the cultivation and distribution of marijuana," and 8) "preventing state-authorized marijuana activity from being used as a cover or pretext for the trafficking of other illegal drugs."

American Lung Association, Cancer Society Oppose Tobacco Surcharges in Obamacare

ObamaCare may have backfired in its goal of making smoking so expensive that users quit, public health experts say, as sky-high insurance premiums force smokers to drop coverage altogether and lose smoking cessation programs along with it.

"Tobacco surcharges are not proven to help tobacco users quit and there are major concerns that they will prevent people from getting health care coverage," the American Lung Association's Jennifer Singleterry said.

Online Obamacare Enrollment for Small Business Delayed. Again.

Not that it's a huge frigging surprise, but small business online enrollment in Affordable Care Act-compliant health insurance, which was already delayed from October 1 until December 1, will be pushed back a full year, until November of 2014. Like a floundering big budget movie production announcing just before the Fourth of July weekend that a few scenes have to be reshot, so the resulting mess should be hitting screens...eventually, the Obama administration rolled out this particular turkey the day before Thanksgiving.

According to David Morgan at Reuters:

The Obama administration on Wednesday announced a one-year delay in online health insurance enrollment for small businesses with 50 or fewer full-time workers that could qualify for subsidized coverage under Obamacare.

It was the latest in a series of delays that have diminished the scope President Barack Obama's landmark healthcare law, the Patient Protection and Affordable Care Act. The administration has faced implementation challenges before and since the troubled October 1 rollout of the federal website HealthCare.gov.

Robert Pear of the New York Times, perhaps growing a bit justifiably cynical, points out, "The announcement of the delay, just before Thanksgiving, is reminiscent of the way the White House announced, just before the Independence Day weekend, a one-year delay in the requirement for larger employers to offer health insurance to employees."

Actually, if you go to the small business section of Healthcare.gov, the site tantalizingly announces that "The SHOP Marketplace is open for business!" Not so much. If you click on "apply" you're prompted to pick your state, before being instructed, "You enroll in SHOP coverage directly through an agent, broker, or insurance company."

That's helpful.

No matter how it's done, expect a good bit of insurance shopping to become necessary, since the Department of Health and Human Services itself estimated in 2010 that 49 to 80 percent of small employer (under 100 workers) plans, which cover 43 million people, would lose their grandfathered status. That would require the sort of cancellation notifications that have raised so many eyebrows, and blood pressures, in recent weeks among individuals. Unless the president once more unilaterally orders the temporary suspension of the requirements of the law that he himself championed.

ADHD Diagnoses on the Increase in the US

A new study reveals that the number of children in 2011-12 diagnosed with ADHD is 2 million higher in the US, compared with 2003-04. Additionally, 1 million more American children are taking medication for the disorder than previously.

The study was conducted by the Centers for Disease Control and Prevention (CDC) and is published in the Journal of the American Academy of Child and Adolescent Psychiatry.

Using data from the 2011-2012 National Survey of Children's Health (NSCH), researchers calculated estimates of the number of children in the US between the ages of 4 and 17, whose parents reported their receipt of a diagnosis for attention-deficit hyperactivity disorder (ADHD) from a health care provider.

Vermont Announces Security Breach on Healthcare Exchange

It Begins: Vermont Announces Security Breach on Healthcare Exchange

Officials overseeing the Vermont Health Connect website confirmed Friday there was a security breach on the system last month in which one user got improper access to another user’s Social Security number and other data.

A report from state to federal officials overseeing the health insurance exchanges set up under the Affordable Care Act said a consumer reported the incident with the Vermont Health Connect website on Oct. 17

Health Costs Threaten to Bust California's Budget

California’s recent announcement that it had balanced its budget for the first time since the 2007-08 fiscal year received broad coverage. Yet next to nothing has been said about the change in the state’s spending priorities over that six-year period.

Despite a 30 percent increase in the top income tax rate, higher sales taxes and fees, and greater total revenue, the state is spending less on education, transportation, courts, welfare and parks than it was six years ago. The reason: State spending on health care, employee compensation and benefits, interest, and prisons is greater than it was six years ago.

White House Meets with Health Care Groups About Obamacare

White House Meets with Health Care Groups About Obamacare

The Obama administration is seeking to coordinate a press strategy with the healthcare stakeholders who were invited to the White House on Tuesday to discuss the implementation of the Affordable Care Act.

The Hill obtained an email sent by a White House official on Monday night with suggestions on how the healthcare officials should deal with the media.

The email, written by a senior communications White House official, states, “I wanted to propose some ideas for how we suggest handling press inquiries around tomorrow’s meeting and make sure we’re all on the same page heading into tomorrow."

The White House informed the participants that it wouldn’t release their names or the names of their organizations ahead of time, but asked if they’d be comfortable if a summary of the meeting were released to the media afterwards.

Experts Predict 80 Million Employer Health Plans May Be Canceled

Experts Predict 80 Million Employer Health Plans May Be Canceled

Almost 80 million people with employer health plans could find their coverage canceled because they are not compliant with ObamaCare, several experts predicted.

Their losses would be in addition to the millions who found their individual coverage cancelled for the same reason.

Stan Veuger of the American Enterprise Institute said that in addition to the individual cancellations, "at least half the people on employer plans would by 2014 start losing plans as well." There are approximately 157 million employer health care policy holders.

White House Still Trying to Spin Obamacare

White House Still Trying to Spin Obamacare, EU Wants Spying Protection, Judge to Rule on Detroit Bankruptcy: P.M. Links

 A lovely celebration of complete economic failure memories Nd Realizing the national news media is no longer cooperating with positive coverage about the Obamacare rollout, the Obama Administration is turning to local news media instead. They are also working to coordinate a media strategy with health care groups. They still seem to think that the their messaging is the problem, don’t they?
  
The European Union is seeking stronger protection against U.S. surveillance and the right to sue if their data is abused. Ha ha ha! Like Americans can currently sue if their data is abused.
  
A judge will rule on Dec. 3 whether to allow Detroit to declare bankruptcy.
  
A federal judge will allow a lesbian couple in Illinois to get married ahead of the actual day their new recognition law takes effect because one of the women is terminally ill.
   
Following the negotiations in Iran, Obama is now asking for the release a former FBI agent who disappeared there in 2007.
   
The Obama Administration is calling for a crackdown on political campaigning by tax-exempt non-profit groups. So Organizing for Action is closing its doors when?

Higher Premiums Approved for Preserved NC Health Care Plans

Higher Premiums Approved for Preserved NC Health Care Plans
 
The state Insurance Department has approved — as expected — the higher premium rates proposed by Blue Cross Blue Shield of N.C. that allow customers to keep one of four plans that were to end as part of implementing the Affordable Care Act.

Commissioner Wayne Goodwin said the department approved rate increases of 16.4 percent for Blue Advantage plans, an average 22 percent for Blue Value plans, and 23.6 percent for Blue Saver and Blue Options HSA plans.

By comparison, the department approved for 2013 an 8.1 percent average rate increase for Blue Advantage, Blue Options HSA and Blue Saver products. The insurer had requested an average rate increase of 9.9 percent.

SCOTUS Will Hear Religious Challenges to Obamacare's Contraceptive Mandate

Today the Supreme Court agreed to hear two cases that challenge Obamacare's contraceptive mandate as a violation of religious freedom. Last year the Court upheld the requirement that individuals obtain government-approved medical coverage by treating it as an exercise of the tax power. This will be the Court's second opportunity to assess the legality of the Patient Protection and Affordable Care Act.

In one of the cases the court plans to hear, Sebelius v. Hobby Lobby Stores, David and Barbara Green, who own the Oklahoma-based chain together with their three children, argue that forcing them to provide their employees with health plans that cover certain forms of contraception violates the Religious Freedom Restoration Act (RFRA). The Greens specifically object to four kinds of contraception—Ella, Plan B, and two IUDs—that work by preventing implantation of fertilized ova, which they view as morally equivalent to abortion.

RFRA, which Congress passed almost unanimously in response to a 1990 Supreme Court decision that loosened the restraints on laws that limit religious freedom, says "government shall not substantially burden a person's exercise of religion" unless the burden is "narrowly tailored" to serve a "compelling" interest. Last June the U.S. Court of Appeals for the 10th Circuit ruled that the contraceptive mandate probably fails this test, especially since it already exempts as many as 100 million health plans, including those offered by churches and other nonprofit religious organizations. The court also noted that the Greens have no religious objection to 16 of the 20 contraceptives covered by the mandate.

The other challenge to the contraceptive rule, Conestoga Wood Specialties v. Sebelius, involves a Pennsylvania cabinet company owned by the Hahns, a Mennonite family. The Hahns, like the Greens, object to contraceptives that prevent implantation rather than fertilization. But in July the U.S. Court of Appeals for the 3rd Circuit rejected their RFRA claim, concluding that their business is not covered by the statute because it is a for-profit corporation and therefore does not qualify as a "person." The Court held that "a for-profit, secular corporation cannot engage in the exercise of religion."

The 10th Circuit rejected this distinction. "It is beyond question that associations—not just individuals—have Free Exercise rights," it said, quoting a 1984 Supreme Court decision: "An individual's freedom to speak, to worship, and to petition the government for the redress of grievances could not be vigorously protected from interference by the State unless a correlative freedom to engage in group effort toward those ends [was] also guaranteed." If people do not lose their religious freedom when they exercise it through nonprofit corporations (such as churches) or for-profit businesses that are not incorporated, the 10th Circuit asked, why should they sacrifice this right when they combine the corporate form with a profit motive? For example, "Would an incorporated kosher butcher really have no claim to challenge a regulation mandating non-kosher butchering practices?" The 10th Circuit noted that the Supreme Court, in the 2010 case Citizens United v. FEC, overturned restrictions on political speech by both commercial and nonprofit corporations, recognizing them as tools that individuals use to exercise their First Amendment rights.

Early Obamacare Advocate Goes Missing as Program Flounders

Peter Orszag is strangely silent since the reforms he wanted have been made.

Orszag was the director of the White House Office of Management and Budget for the first year and a half of the Obama administration. Other than President Obama himself, he’s the person most identified with the argument that health reform was necessary to save the government money.

“Reducing health care cost growth is the key to our fiscal future,” Orszag wrote in one White House blog post back in October of 2009. “As the President has repeatedly emphasized: Doing nothing is the surest way to fiscal failure, while reform is the best path for fiscal responsibility.”

Or, as Obama himself put it in an address to a Joint Session of Congress in September of 2009: “Our health care system is placing an unsustainable burden on taxpayers. When health care costs grow at the rate they have, it puts greater pressure on programs like Medicare and Medicaid. If we do nothing to slow these skyrocketing costs, we will eventually be spending more on Medicare and Medicaid than every other government program combined. Put simply, our health care problem is our deficit problem. Nothing else even comes close. “

President Obama is emphasizing the cost-control aspect of his health-care overhaul less these days. In his talk the other day to the Wall Street Journal CEO Council, Obama said, “With respect to the Affordable Care Act, I think people are legitimately concerned because we have a major problem with health care in this country — 41 million people without health insurance, a lot of people underinsured.”

The two sales pitches for the law — helping the uninsured, and saving the taxpayers money — are not mutually exclusive. But it’s a lot harder to go around claiming that ObamaCare is necessary to save taxpayers money when the law’s most visible signature achievement so far is a Web site on which the government spent hundreds of millions of dollars, a site that does not work.

The HealthCare.gov debacle sure makes it look like rather than saving taxpayer money, the Patient Protection and Affordable Care Act is wasting taxpayer money. It’s an impression only furthered by reports like one in today’s Boston Herald, which brings in the news that “A stunning 40 percent of the staff at the state agency that oversees the glitch-plagued, befuddling $69 million Obamacare website earn six-figure salaries.”

As a kind of fallback, Obama has resorted to arguing that somehow, the Affordable Care Act is controlling health care costs even before many of its key provisions have taken effect. “We also have seen health care costs growing at the slowest rate in 50 years. Employer-based health costs are growing at about one-third of the rate of a decade ago, and that has an impact on your bottom line,” Obama said to that same Wall Street Journal CEO Council audience.

There, Obama is trying to take credit for something that was happening before his health care law was passed. A 50-year low in growth of health spending was back in 2009 — before the Affordable Care Act was passed in 2010. As Charles Blahous points out in a commentary for Economic Policies for the 21stCentury, the effect of the health reform law, at least in the short term, has been to increase costs, not to decrease them; Blahous calls the cost reduction claim about as credible as the “if you like your plan, you can keep your plan” claim that has become a late-night laugh line.

Speaking of comedy, that’s where some of the most incisive commentary on ObamaCare is coming from these days. Bartley’s, a hamburger restaurant in Harvard Square, has added to its menu the ObamaCare burger: “Nobody knows what’s in it!...Ask the liberal sitting next to you.” (Cost: “$ Trillions.”) Even the liberal New Yorker magazine’s resident humorist, Andy Borowitz, jokes that Ayatollah Khamenei, “told reporters today his nation agreed to a deal on its nuclear program in the hopes that it would distract attention from the trouble-plagued rollout of Obamacare.”

“It’s true, we’ve resisted any deal on nukes for over three decades,” the Ayatollah said, according to the humorous dispatch in the New Yorker. “But when we saw how much trouble Obama was having with his Web site, we realized it would be uncaring of us not to try to help him out.”

As for Orszag, his usually weekly Bloomberg View column has gone on what the columnist described in an email to me as a “quick sabbatical.” His only column since October 7 was one about a housing bubble in New Zealand. Orszag, now a Citigroup executive and newly returned from a three-week trip to Asia, says he will address the issues with Healthcare.gov in a future column.

Who Will Treat Those New Medicaid Patients From the Obamacare Exchanges?

Medicaid U.S. Government Health care providers are showing a certain lack of enthusiasm about the Affordable Care Act. Because of low reimbursement and bureaucratic headaches, both state and national surveys showing physicians unenthusiastic about seeing patients who get coverage through the Obamacare exchanges. And that's for private insurance. But Healthcare.gov and the state exchanges have been more successful so far at signing people up for Medicaid than private plans—and many Medicaid patients are already having trouble finding doctors. So...Who is going to see these new Medicaid enrolls?

When it announced the underwhelming Obamacare enrollment figures (PDF) to-date on November 13, the department of Health and Human Services said that 106,185 people had "selected a Marketplace Plan," but that 396,261 persons had been "determined or assessed eligible for Medicaid/CHIP" (Children's Health Insurance Program).

That's a problem. A 2012 survey (PDF) by Jackson Healthcare, a medical staffing company, found that, while 64 percent of physicians nationally are taking new Medicaid patients, "A majority of physicians across many specialties said they could no longer afford to accept new Medicaid patients due to declining reimbursements. States where physicians were least likely to accept new Medicaid patients were New Jersey, California and Florida."

In fact, last week, the Courier-Post, a south New Jersey paper, reported that Medicaid patients in that state may be signed up for medical care, but they're having serious problems finding providers:

    Midway through her third pregnancy, Grace Ewing spotted a disturbing notice on the counter at her obstetrician’s office.

Her Advocare doctor could no longer accept the UnitedHealthcare Community Plan as of Oct. 1, since the Medicaid managed care organization terminated its contract with the provider network.

Like 25,000 other Advocare patients in New Jersey, the practice told her she would have to find a new provider — and quickly.

But it was no easy task. For the next several weeks, the 28-year-old called obstetricians listed on the managed care company’s website. She wanted to find a female doctor within a reasonable distance from her Bellmawr home, who could deliver her baby at Virtua.One office worker after another told her the same thing: “We used to accept it, but we don’t anymore.” ...

Nearly 1.3 million New Jerseyans — about 15 percent of the state’s population — are enrolled in Medicaid, most through plans administered by four managed care organizations.The number of people covered by NJ FamilyCare is expected to swell next year, as an additional 300,000 uninsured residents will be eligible for free coverage, thanks to the Affordable Care Act.

The article adds that 54 percent of doctors in the state don't take take new Medicaid patients. Not surprisingly, low reimbursement is cited as a major reason. There is already a doctor shortage before the expected influx of new Medicaid patients.

None of this should be a surprise. Physician dissatisfaction with Medicaid is not a new proble, Pharmacies, too, were refusing Medicaid patients years ago because of rock-bottom reimbursement. Soon after the Affordable Care Act passed, health experts pointed to Medicaid as a major vulnerability in the law—coverage without providers is no coverage at all.

And yet... Here we are.

It Is Now Illegal To Smoke In Your Own Home In San Rafael, California

In a unanimous decision, members of the San Rafael City Council have approved the strictest smoking ordinance in the country. Effective last week, Assembly Bill 746 bans residents of apartments, condos, duplexes, and multi-family houses from smoking cigarettes and “tobacco products” inside their homes.

Introduced by Assembly Member Marc Levine and pushed by the Smoke-Free Marin Coalition for over seven years, the ordinance applies to owners and renters in all buildings that house wall-sharing units for three or more families. The purpose is to prevent second-hand smoke from travelling through doors, windows, floorboards, crawl spaces, or ventilation systems (i.e. any conceivable opening) into neighboring units.

Levine said the bill is motivated by his desire to ensure that "Californians [can] breathe clean air in their own homes." He continued, "In apartments or condominiums, whenever a neighbor lights up, everyone in the building smokes with them."

Rebecca Woodbury, an analyst at the City Manager’s office who helped write the ordinance, explained some of the bill's specifics to ABC News. "It doesn't matter if it's owner-occupied or renter-occupied," she said. "We didn't want to discriminate. The distinguishing feature is the shared wall...I’m not aware of any ordinance that’s stronger."

The bill's proponents cited scientific evidence that shows cigarette smoke is able to travel through the ventilation systems of apartments. Some of this evidence was produced by two CDC studies, which found that roughly 45 percent of apartment dwellers claimed to have been exposed to second-hand smoke in their homes in the past year.

Some anti-smoking groups, like the American Lung Association, have expressed their support for the legislation. The President and CEO of California's division said the ordinance is "groundbreaking" and called for a state-wide ban.

The ordinance is not without its detractors, however.

A researcher at the Heartland Institute, a free-market policy think tank in Chicago, said the ban is part of a larger, disturbing trend of government encroachment on personal freedoms. As he told ABC News:

I don't like cigarettes, and I've never taken a puff. My sympathies aren't with smokers because I am one, it's because of the huge growth in laws and punishments and government restricting people more and more. Illinois' criminal code was 72 pages long in 1965; today it's more than 1,300 pages long.

Brian Augusta, of the Western Center on Law and Poverty, said that targeting multifamily units disproportionately affects low-income families and workers. According to the Sacramento Bee, Augusta said, "If smoking is an addiction, and it clearly is, are we telling people that they have to quit smoking—without support—or leave their homes?"

George Koodray, New Jersey state coordinator for Citizens Freedom Alliance and the Smoker's Club, decried the evidence linking apartment-dwelling to second-hand smoke exposure as weak. "The science for that is spurious at best," he said.

The California Apartment Association has not taken an official position on the issue, but has stated its doubts as to how the ordinance will be enforced and by whom. As it stands, AB 746 levies rule-breakers with fines but does not identify who will respond to complaints or write tickets.

Levine said that he hopes the ordinance will be "self-enforcing," but it's clear that landlords are being prodded to take up the torch. In an informational pamphlet published by the city, landlords are advised to threaten rule-breaking tenants with eviction.

Boston to Ban All Smoking in Public Parks

Boston is poised to fine anyone who smokes in its parks, including those who light up cigarettes or joints or who puff on e-cigarettes.

City councilors yesterday approved the ban, which also would apply to other property controlled by the Parks and Recreation Commission, and includes a $250 fine for each violation.

“It passed unanimously on a voice vote,” City Councilor Bill Linehan told the Herald.

Mayor Thomas M. Menino must sign the ordinance, and it must be adopted by the city Parks and Recreation Commission before it takes effect, said Nick Martin, spokesman for the Boston Health Commission.

That likely won’t be a problem, as the ban was put forward by Menino, and Martin said the ordinance was crafted by his agency, the parks commission and police officials.

Utah Lawmakers Mull Raising the Smoking Age to 21

Utah Lawmakers Mull Raising the Smoking Age to 21

Two Utah lawmakers want to raise the legal age to buy tobacco from 19 to 21, which would match the minimum age for drinking alcohol.

Statistics show that most young people become addicted to cigarettes after age 20 or 21, even though they first try smoking earlier, said Rep. Kraig Powell, R-Heber City.

"If we can make sure that we keep them away from what everybody now admits are substances with no redeeming value, then I think we'll be able to protect a lot of people from health damage and protect society from hundreds of millions of dollars in costs," he said.

Which States Will Legalize Pot Next?

Smoking joint With the governments of Colorado and Washington in the process of implementing voter-driven measures that legalized pot, the big question is: Who's next? Rob Kampia, the executive director of the Marijuana Policy Project, explains why these states could be the next to legalize marijuana.
 Alaska. "I think the next state to legalize will be Alaska, through a ballot initiative we're running in August 2014. The polling's good. It's a cheap state. You can do it."

Rhode Island. "Through state legislature, I think the first state is going to be Rhode Island. Almost everyone in the legislature is extremely liberal. And the Marijuana Policy Project's bill is already halfway to passing."

California, Nevada, Maine, Arizona, or Massachusetts. "You're going to see a whole bunch of states voting on legalization initiatives in 2016-all on the same day. What we saw with medical marijuana is that the ballot initiatives came first. Then state legislatures started passing the bills. And then Congress started getting interested, but of course not passing anything. I think you'll see the same thing with legalization. We're now at 52 percent support for legalization. That's a higher level of support than for most politicians."

States with Obamacare

Maryland has at least managed to get some people to the final step of the private plan enrollment process. The same can’t be said for Oregon. Not a single person has enrolled in private coverage through the state’s broken exchange, according to Reuters. The state exchange—which The Washington Post once described as “the White House’s favorite health exchange”—was delayed before the October launch, and has never gone online. And there’s no sign that it will in the foreseeable future. Reuters says that its marketplace is “out of commission and unavailable to the public indefinitely.” I suspect the White House isn’t too thrilled anymore.

These aren’t the only state-run systems that have had or still have serious problems. As The New York Times noted last week, Hawaii’s site went down on launch day, didn’t come back online for weeks, and “users continue to report problems.” Vermont’s exchange system does not yet process individual payments for insurers, which presumably complicates enrollment. Vermont’s system was built by CGI Group—the same contractor that botched the federal exchanges.

So it’s not all flowers and rainbows in the state-run exchanges. And even where things are going relatively well, there are still problems. In Washington state, for example, a pricing glitch means that about 8,000 people are finding out that they’ll be eligible for a smaller federal subsidy for their insurance than they were initially told. One of those people was a woman whom President Obama highlighted in a speech as being able to finally obtain affordable insurance. Her new, revised price is so high that she now says she expects to remain uninsured.

In other states, like Kentucky, Connecticut, and California, the demographic mix of people signing up for plans appears to skew old, which could pose longer-term problems if the insurance pools turn out to be more expensive than expected.

And that’s presuming that any of these states actually hit their enrollment targets. The Los Angeles Times reported this week that the numbers so far suggest that California is on track to meet its 2014 enrollment goals after a “sharp increase in November.”

But the enrollment numbers released for the state so far don’t actually say how many people have completed the enrollment process. An HHS report on Obamacare signups from last week counts 35,364 individuals as having “selected a Marketplace plan” in California, which means they’ve dropped it into their online shopping cart. A Los Angeles Times report from last weekend merely describes people as having “selected” health plans.

And there appear to be issues with income and subsidy verification as well. The same HHS report lists the  number of people determined “eligible to enroll in a Marketplace plan with financial assistance” as not applicable; that data is available in most of the other state-run exchanges. Last weekend’s Los Angeles Times report noted significant problems for enrollment assisters. One potential applicant told the LAT that “You can look, but you can’t use the website to do the income calculation.”

That’s what Obamacare’s state-run exchanges look like. Even where they appear to be working, it’s not clear they’re working all that well.

How Well Are Obamacare's State-Run Exchanges Actually Working?

As problems with Obamacare’s federal exchange system have continued, supporters of the health law have turned to a backup argument. Sure, the law is struggling due to technical problems, but in the states that decided to set up their own exchanges, it’s actually going reasonably well. California, in particular, is being singled out for its high enrollment numbers—numbers that some reports have said put the state on track to hit its enrollment targets.

The reality of the state-run exchanges is a little more complicated. There’s no question that the state systems are, on the whole, working better than the federally facilitated exchanges. But serious problems continue to plague a significant minority of the state-run exchanges. And even states said to be success stories may not be quite as successful as claimed.

The argument that state-run exchanges, put in place by state governments that wanted to make the law work, predates the October launch. Obama himself made a version of the argument during the last week in September, when he went to Maryland to give a speech about the law, and to tout its state-run exchange.

But Maryland is one of the states that has struggled most to get its exchange up and running. The technical troubles are significant enough that it turned to paper applications and other workarounds. But it’s not getting the sign up numbers it was hoping for. As The Washington Post reports, just 1,278 people signed up for private coverage in the state during October, and another 465 in the first week of November. Those low numbers, the Post piece notes, “raise questions about whether Maryland will achieve its enrollment target of 150,000 by the end of March.”

Federal health care website

When the troubled federal health care website came online, the key "Anonymous Shopper" function was nowhere to be found -- even though it passed a key test almost two weeks before Health Care.gov launched.

That successful test, noted in documents obtained by CNN and confirmed by a source close to the project, contradicts testimony from an Obama administration official overseeing Health Care.gov, who told lawmakers earlier this month the function was scrapped because it "failed miserably" before the October 1 launch.

Perhaps the CNN story is missing some key information. We don’t know, for example, if there was another test that did fail—one that convinced the health site’s tech team that the function wasn’t worth implementing.

But there’s some reason to think that CNN’s story is not incomplete, and that Chao, in his response, did not tell the truth. The CNN report backs up, and seems to confirm, an October report in The Wall Street Journal, which said that the federally run insurance portal “was initially going to include an option to browse before registering, but that tool was delayed.” The Journal report included an explanation for why the function was removed—an explanation that said nothing about technical failures. “An HHS spokeswoman said the agency wanted to ensure that users were aware of their eligibility for subsidies that could help pay for coverage, before they started seeing the prices of policies.”

In other words, officials didn’t want people to see the true price of the insurance premiums on offer through the exchanges, so they created a system which only allowed for plan shopping after subsidy eligibility was confirmed.

That doesn’t sound like it was simply a question of system readiness, as Chao claimed before Congress. And if Chao lied about the test results, it’s reasonable to wonder whether he also misled about the reasoning for disabling the feature.

Did a Top Obamacare Tech Official Mislead Congress About the Decision Not to Implement Obamacare's Shopping Feature?

CSPANCSPAN Did a top Obamacare tech official lie to Congress about whether or not a key Obamacare website function was delayed for political considerations?

In a congressional hearing earlier this month, Henry Chao, the Deputy IT director for the Centers for Medicare and Medicaid Services, was asked whether there were any political considerations involved in the last-minute decision to delay the “anonymous shopper” function at Obamacare’s online insurance portal, Healthcare.gov.

He responded that there were “none whatsoever.”

“I look at the facts of whether—if a system is going to be ready,” Chao said, “and of course not everything is going to be 100 percent perfect, and there are certain tolerances. But in this case it failed so miserably that we could not consciously use it.”

But that’s not what happened, according to CNN, which reports that insider documents confirm that, in fact, the feature passed a test of its functionality shortly before the October 1 launch of Healthcare.gov. From CNN's report:

Legalizing Pot

While Colorado’s legalization initiative made personal use and possession of pot legal statewide, it also let counties and municipalities to opt out of allowing pot sales. Over 100 towns and cities across Colorado have voted to ban outright or delay the opening of retail shops selling recreational pot. And it turns out that some of the counties that have banned the sale of recreational marijuana nonetheless want their share of sales taxes collected by the state. When asked whether such a position is hypocritical, a commissioner from Douglas County, which opted out of allowing pot sales, told the Denver CBS affiliate, “The answer is going to be then, why was my county not able to opt out of allowing the smoking of it at all?”

The upshot of such actions is predictable and depressing. Colorado lawmakers are banking on about $70 million a year (PDF) in taxes from pot and their Washington counterparts have projected new revenues of $1.9 billion over the first five years of legalization. There’s just no way that’s going to happen if a legal ounce of pot is double the price or more of back-alley weed. Even the most stoned pothead isn’t that easy to scam.

If the experience of state cigarette taxes teaches us anything, it’s that draconian levies allow black markets to flourish. After raising its per-pack tax by a dollar this year, Massachusetts is now grappling with somewhere between $74 million and $295 million in lost revenue. Most people are happy to pay taxes that they think are fair—and most people will avoid taxes they think are extortionary. Combine that with the widespread NIMBYism at work in Colorado and it’s a recipe for clutching defeat from the jaws of victory.

The past several decades haven’t been kind to the nation’s drug warriors, especially when it comes to marijuana, the only illegal drug that is used on a monthly basis by more than 1 percent of Americans. In 1996, California passed a medical marijuana law and was soon followed by 19 other states and the District of Columbia. Crime—whether drug-related or not—didn’t go up, kids didn’t start toking up in droves, the heavens didn’t fall.

Instead, a record number of people—58 percent, according to Gallup—have come to embrace pot legalization as a smart and proper idea and The Marijuana Policy Project identifies no fewer than 10 states it expects to legalize weed in the next couple of years.

It’ll be an ironic buzzkill if it ends up that folks in places such as Maine, California, and Hawaii have an easier time firing up a state-sanctioned joint and enjoying the economic and social benefits of legalization long before the trailblazing residents of Colorado and Washington.

Pot's Black Market Backlash

How prohibitionists, nanny staters, and taxpayers who voted for legalization (!) are trying to keep marijuana illegal - or at least inconvenient.
In 2012, voters in Colorado and Washington passed full-on, no-hemming-or-hawing pot legalization by large majorities. Lawmakers in each state have spent the better part of the past year figuring out how to tax and regulate their nascent commercial pot industries, which will open for business in 2014 (until then, recreational pot is only supposed to be cultivated for personal use). The spirit behind the legalization efforts in both states was that marijuana should be treated in a “manner similar to alcohol.”

Unfortunately, it’s starting to look like both states are going to treat pot in a manner similar to alcohol during Prohibition. Not only are pot taxes likely to be sky high, various sorts of restrictions on pot shops may well make it easier to buy, sell, and use black-market marijuana rather than the legal variety. That’s a bummer all around: States and municipalities will collect less revenue than expected, law-abiding residents will effectively be denied access to pot, and the crime, corruption, and violence that inevitably surrounds black markets will continue apace.

Washington’s legalization initiative, I-502, mandated a 25 percent excise tax at each of three levels of transactions: sales between producers and processors; sales between processors and retailers; and sales between retailers and customers. That’s all on top of a state sales tax of 8.75 percent. As Jacob Sullum argued at Forbes, the upshot of such a system is that weed could end up costing end users somewhere between $482 an ounce and $723 an ounce. The average price of high-quality pot at Seattle’s medical marijuana dispensaries is currently about $250 an ounce (under I-502, medicinal pot won’t be subject to taxes).

“The legal market is going to have a hard time competing with the illegal market, but a particularly hard time competing with untaxed, unregulated sort-of-legal market,” Mark Kleiman, a UCLA professor and one of the main policy consultants for the Washington’s government, told Sullum.

A similar situation is shaping up in Colorado, where voters just passed Proposition AA, which creates a 15 percent excise tax and a sales tax as high as 15 percent on pot sold in stores licensed by the state. On top of that, local municipalities can slap still more taxes on weed sales. Cities such as Boulder and Denver will start out with levies in the 3.5 percent range but can jack the rates as high as 10 percent and 15 percent.

E-Cigarettes Getting Noticed in Schools

E-Cigarettes Getting Noticed in Schools

When a teacher noticed what looked like smoke rising in her Eastern Middle School classroom one day this fall, she quickly investigated, finding an eighth-grade boy holding an e-cigarette.

The “smoke” was vapor, but for Casey B. Rouse, principal at the Silver Spring school, the episode was the first signal of what she would learn is a troubling teen trend nationally: An increasing number of students using electronic devices that simulate tobacco smoking.

E-cigarettes are beginning to show up in the hallways of the nation’s middle schools and high schools. Just as health officials have begun to debate their potential dangers and school districts have started to pay attention to them, educators are grappling with how to deal with students who are found puffing on e-cigarettes while at school.

Calorie Postings Don't Affect Consumer Choices

Mandatory Restaurant Calorie Postings Don't Affect Consumer Choices

Posting the calorie content of menu items at major fast-food chains in Philadelphia, per federal law, does not change purchasing habits or decrease the number of calories that those customers consume, researchers at NYU Langone Medical Center reported today at the Obesity Society's annual scientific meeting, held in Atlanta, Georgia. The results echo those conducted by the same researchers among low-income neighborhoods in New York City before and after calorie-labels were mandated there in July 2008.

"What we're seeing is that many consumers, particularly vulnerable groups, do not report noticing calorie labeling information and even fewer report using labeling to purchase fewer calories," says lead study author Dr. Brian Elbel, assistant professor of Population Health and Health Policy at NYU School of Medicine. "After labeling began in Philadelphia, about 10 percent of the respondents in our study said that calorie labels at fast-food chains resulted in them choosing fewer calories."

As part of an effort to encourage people to make healthier food choices, the Patient Protection and Affordable Care Act mandates that restaurant chains with 20 or more locations nationally must post the calorie content of all regular food and drink items on their menu board or printed menus.

'Keep Your Health Plan' Bill Passes House'

In a vote where Democratic leaders scrambled to minimize party defections, the House on Friday approved a Republican bill that would block the cancellation of insurance plans that don't meet the Obamacare standards.

The Keep Your Health Plan bill passed 261 to 157, with 39 Democrats ending up joining most Republicans in approving the measure.

Senior House Democratic aides already conceded that dozens of Democrats would side with Republicans in favor of the measure.

Many rank-and-file lawmakers have been feeling intense pressure to display some response to the troubled roll-out of the Affordable Care Act.

New High: 56 Percent Say it is Not Govt’s Job to Ensure Americans Have Healthcare

Just 5 years ago Gallup found only 28 percent of Americans thought government did not have the responsibility to “make sure all Americans have healthcare coverage.” However, today Gallup finds the highest number since it began asking the question—56 percent—say government does not have a responsibility to ensure all American have healthcare coverage. Even a majority (55 percent) of Independents say government does not have this responsibility.

Source: Gallup

Throughout much of the 2000s, a solid majority of Americans believed it was government’s job to ensure all Americans have healthcare coverage, hitting a high in 2006 when 69 percent agreed while 28 percent said it was not government’s responsibility. However, after 2006, Gallup measured a steady decline among those who believed government should ensure healthcare for all.

By the time Congress began debating remaking the American health care system in 2009, Americans were evenly split and remained so until 2011.

However, once actual implementation of the Affordable Care Act/Obamacare got underway, the public for the first time since Gallup began asking the question diverged against government’s role in health care. Between 2011 and 2013 the share of Americans who believe it is not government’s job to ensure healthcare coverage increased +10 points from 46 to 56 percent.

Not only the glitch-ridden roll out of the healthcare law explains this results, but partisanship also. In 2000, only a slim majority (53 percent) of Republicans believed government should not be responsible for healthcare coverage and 42 percent believe it did. Just 13 short years later, while also losing most of Congress and the presidency, 86 percent of Republicans say its not government job to ensure healthcare coverage and 12 percent say it is. These are roughly 30-point swings in roughly a decade.

President Obama highlighted in a speech as being able to finally obtain affordable insurance

So it’s not all flowers and rainbows in the state-run exchanges. And even where things are going relatively well, there are still problems. In Washington state, for example, a pricing glitch means that about 8,000 people are finding out that they’ll be eligible for a smaller federal subsidy for their insurance than they were initially told. One of those people was a woman whom President Obama highlighted in a speech as being able to finally obtain affordable insurance. Her new, revised price is so high that she now says she expects to remain uninsured.

In other states, like Kentucky, Connecticut, and California, the demographic mix of people signing up for plans appears to skew old, which could pose longer-term problems if the insurance pools turn out to be more expensive than expected.

And that’s presuming that any of these states actually hit their enrollment targets. The Los Angeles Times reported this week that the numbers so far suggest that California is on track to meet its 2014 enrollment goals after a “sharp increase in November.”

But the enrollment numbers released for the state so far don’t actually say how many people have completed the enrollment process. An HHS report on Obamacare signups from last week counts 35,364 individuals as having “selected a Marketplace plan” in California, which means they’ve dropped it into their online shopping cart. A Los Angeles Times report from last weekend merely describes people as having “selected” health plans.

And there appear to be issues with income and subsidy verification as well. The same HHS report lists the  number of people determined “eligible to enroll in a Marketplace plan with financial assistance” as not applicable; that data is available in most of the other state-run exchanges. Last weekend’s Los Angeles Times report noted significant problems for enrollment assisters. One potential applicant told the LAT that “You can look, but you can’t use the website to do the income calculation.”

That’s what Obamacare’s state-run exchanges look like. Even where they appear to be working, it’s not clear they’re working all that well.

How Well Are Obamacare's State-Run Exchanges Actually Working?

Scott Smith (SRisonS) / Foter.com / CC BY-NC-NDAs problems with Obamacare’s federal exchange system have continued, supporters of the health law have turned to a backup argument. Sure, the law is struggling due to technical problems, but in the states that decided to set up their own exchanges, it’s actually going reasonably well. California, in particular, is being singled out for its high enrollment numbers—numbers that some reports have said put the state on track to hit its enrollment targets.

The reality of the state-run exchanges is a little more complicated. There’s no question that the state systems are, on the whole, working better than the federally facilitated exchanges. But serious problems continue to plague a significant minority of the state-run exchanges. And even states said to be success stories may not be quite as successful as claimed.

The argument that state-run exchanges, put in place by state governments that wanted to make the law work, predates the October launch. Obama himself made a version of the argument during the last week in September, when he went to Maryland to give a speech about the law, and to tout its state-run exchange.

But Maryland is one of the states that has struggled most to get its exchange up and running. The technical troubles are significant enough that it turned to paper applications and other workarounds. But it’s not getting the sign up numbers it was hoping for. As The Washington Post reports, just 1,278 people signed up for private coverage in the state during October, and another 465 in the first week of November. Those low numbers, the Post piece notes, “raise questions about whether Maryland will achieve its enrollment target of 150,000 by the end of March.”

Maryland has at least managed to get some people to the final step of the private plan enrollment process. The same can’t be said for Oregon. Not a single person has enrolled in private coverage through the state’s broken exchange, according to Reuters. The state exchange—which The Washington Post once described as “the White House’s favorite health exchange”—was delayed before the October launch, and has never gone online. And there’s no sign that it will in the foreseeable future. Reuters says that its marketplace is “out of commission and unavailable to the public indefinitely.” I suspect the White House isn’t too thrilled anymore.

These aren’t the only state-run systems that have had or still have serious problems. As The New York Times noted last week, Hawaii’s site went down on launch day, didn’t come back online for weeks, and “users continue to report problems.” Vermont’s exchange system does not yet process individual payments for insurers, which presumably complicates enrollment. Vermont’s system was built by CGI Group—the same contractor that botched the federal exchanges.

Health care website

Avi Rubin, professor of Computer Science at Johns Hopkins University, pointed out (PDF), "One cannot build a system and add security later any more than you can construct a building and then add the plumbing and duct work afterwards." He then discussed the challenges faced in necessarily doing exactly that with the federal exchange.

Dr. Frederick R. Chang, Bobby B. Lyle Centennial Distinguished Chair in Cyber Security at Southern Methodist University, was similarly critical (PDF).

The fact that there is not one single place to sign up for health care coverage will lead to confusion by the public. There is the main federal site, individual state sites, as well as legitimate third party sites. As I understand it, there is no official designation or marking that a consumer can use to determine whether they are on the correct site or not. As people seek to register for health care coverage they may find that there are a dizzying array of websites to select from. When it comes to typing in information like a social security number into a web form, many people might be cautious about doing so, but given that it has do with health insurance coverage people might be more inclined to do so (particularly if they think the request is coming from a legitimate website). These two factors could combine to create a ripe circumstance for personal information to get into the wrong hands. It is difficult to estimate how much traffic these fake websites will siphon off, but it could be significant

David Kennedy, CEO and Founder of TrustedSec, cautioned (PDF) that existing reports of hacking attempts on Healthcare.gov are incomplete and that, because of poor security precautions, "in the event that the website is hacked (or already has been), the attacks would go largely unnoticed and the website would remain compromised for a long period of time." He went on to detail a series of vulnerabilities his company discovered on the site, and then alluded to others he said he was unwilling to publicly reveal.

Kennedy recommended building an entirely new Healthcare.gov website while the first one is up and running (including its flaws) and replacing the existing one when it's ready. If, instead, the already bought-and -paid-for site is taken down for a full fix, "the remediation process will span seven to twelve months at a minimum."

Fixing the exisiting site while it's being used would take even longer.

Healthcare gov is Hacker-Bait, Say Security Experts

Healthcare gov U.S. GovernmentAs it now exists, Healthcare.gov, the federal exchange for approved health plans, "creates massive opportunity for fraud, scams, deceptive trade practices, identity theft and more," Morgan Wright, CEO, Crowd Sourced Investigations, LLC told the House Science, Space, and Technology committee in a hearing held yesterday. He was only one of several cybersecurity experts who testified as to the vulnerabilities of the already infamous Website, launched October 1 as part of the rollout of Obamacare. Perhaps the only saving grace is the frequency with which Healthcare.gov crashes, dissuading people from entering information, or even making use impossible, and so sparing them the high risk of data theft.

In his testimony (PDF), Wright said:

    The first major issue is the lack of, and inability to conduct, an end to end security test on the production system. The number of contractors and absence of an apparent overall security lead indicates no one was in possession of a comprehensive, top down view of the full security posture. 3For a system dealing with what will be one of the largest collections of PII, and certain to be the target of malicious attacks and intrusions, the lack of a clearly defined and qualified security lead is inconsistent with accepted practices.

Wright pointed to a flaw involving the management of names and passwords, discovered by a private security researcher, that would have allowed hackers to take control of people's accounts. That hole has been patched, but others have been assigned a fix date of May 31, 2014—while the Website remains up and running.

    This is completely unacceptable from an industry perspective, and is in extreme contravention of security best practices. Only in the government could such a gaping hole be allowed to exist without fear of consequence. This shows a lack of understanding for the consequences to consumers and the protection of also creates massive opportunity for fraud, scams, deceptive trade practices, identity theft and more. Much of this is playing out right now.