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Thursday, July 31, 2014         

NEW YORK TIMES


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In fracas on health coverage, some Democrats feel exposed

By New York Times

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CONCORD, N.H. » The awards ceremony Friday evening for New Hampshire's police forces was full of pomp (a bagpipe band in full Scottish regalia), circumstance (tales of heroism and tragedy told to standing ovations), officers in dress uniforms and a show of support from the state's full congressional delegation.

But almost as soon as all the awards had been given and the photos taken, New Hampshire's four members of Congress, three of them Democrats, were set upon by local reporters with one simmering question: What are you going to do about the faltering Affordable Care Act?

Rep. Ann McLane Kuster, the state's freshman Democrat, displayed her own exasperation over the failed rollout. "Patience is a virtue, and Americans have it in short supply," she said. "Frankly we are not well served by the politics of all this."

For Democrats across the country, the reversal of political fortunes over the past month has been head-spinning. In mid-October, as Republicans were contending with voter fury over a 16-day government shutdown, Democrats had the momentum. In polls, a growing number of voters said they wanted the party to control Congress after next year's election. Emboldened, a wave of strong recruits entered House contests. Democrats' control of the Senate seemed secure. Money was flowing.

Then the problems with the Internet-based health exchanges came into focus, followed by millions of letters from insurance companies canceling individual policies that did not meet the health law's minimum coverage requirements. Republicans found their voice. Democrats lost theirs. The polling gap closed, and Republican wallets opened. The National Republican Senatorial Committee raised $3.8 million in October, its best monthly showing of the year.

Rep. Greg Walden of Oregon, chairman of the National Republican Congressional Committee, called it "a Category 5 political hurricane."

New Hampshire may be ground zero in the political war over the Affordable Care Act, a state where the three Democratic members of the congressional delegation are under serious threat because of the fumbled rollout of the health care law. Suddenly they must balance their loyalty to the White House with the needs of an angry constituency that has had to absorb some of the worst problems with the new law.

The problems are many. The Tea Party-fueled legislature passed a law prohibiting the governor from setting up a state health insurance exchange, so the state must rely on the faulty federal government website, HealthCare.gov. So far, only 269 people have signed up for a plan that way, a total dwarfed by the number of residents whose policies have been canceled.

Ryan Williams, a Republican consultant from New Hampshire, noted that this year, 281 residents were issued permits to hunt moose. "You've got a better chance of winning the moose lottery than getting health care coverage through Barack Obama's broken website," he said.

What is worse, the federally run exchange for the state has attracted only one insurance provider, Anthem Blue Cross and Blue Shield, which touched off a furor when it excluded 10 of the state's 26 hospitals from the health plans it offers through the exchange. Residents in the north of New Hampshire may have to drive an hour to find a hospital or doctor in their network. The Democratic governor, Maggie Hassan, is locked in a fight with the Republican-controlled Senate over how or whether to expand Medicaid as part of the health law.

"If they continue to have weeks like the last two, sheesh," state Sen. Andy Sanborn, a Republican who is chairman of the Senate Commerce Committee, said over beers at his sports bar, the Draft. "I was having lunch with two of my Democratic friends and holy guacamole - not the word they used - they are in a death spiral."

Sen. Jeanne Shaheen, a Democrat and a former governor of the state who is preparing for her first Senate re-election campaign, appears to be on her heels. This month, she began a push to extend the enrollment period for health care plans offered under the new law.

"This is not about partisan politics. This should not be about partisan politics," she said. "This should be about fixing what has been a health care system in this country that for way too long has not worked."

The state's two House members, Kuster and Carol Shea-Porter, are facing combative Republican challengers and a wave of caustic attacks over the health law. Both broke rank with their leaders and the White House on Friday, voting for a Republican bill to reinstate insurance policies that had been canceled for failing to meet minimum standards set by the Affordable Care Act, and to let insurance companies enroll more people in such plans.

For Democratic leaders in Washington, the task now is to contain the panic before it turns into political chaos. Rep. Steve Israel of New York, chairman of the Democratic Congressional Campaign Committee, distributed a memo last week assuring House Democrats that a string of Republican failures - a languishing immigration overhaul, a Senate-passed bill to protect workplace rights for gays, an effort to strip food stamps from the farm bill, the continuing refusal to work with Democrats on a budget plan - would catch up to the Republican Party.

"What always amazed me is not their ability to shoot themselves in the foot but how quickly they always reload," Israel said in an interview.

The ire over the health law may be more confined than Republicans believe. California may have more close House races than any other state next year, but its state-run exchange, Covered California, is running relatively well, said Rep. Ami Bera, a freshman Democrat from the state who barely won in 2012.

Rep. John F. Tierney, D-Mass., will face off in 2014 against the same Republican who nearly beat him last year, Richard Tisei. But, Tierney said, the Massachusetts health care law has been up and running for years.

But where the law is not operating well, the heartburn is intense.

"Oh, very bad, rotten," Rep. Nick J. Rahall II, D-W.Va., a top target of the Republicans, said of how the health law was playing in his district.

Friday's 261-157 House vote on the Republican bill to reinstate canceled health plans included a roster of 39 Democrats who joined with the Republicans that read like a Who's Who of endangered incumbents and declared Senate candidates.

"Of course there's politics. Of course it's become a partisan fight, but I try not to look at it like that," said one of them, Rep. Patrick Murphy, D-Fla., who won his seat in 2012 against a Tea Party favorite, Allen West, by fewer than 2,000 votes. "I would imagine there will be more and more attacks coming for months on end."

Republicans say the travails of the health law are not about to let up. Even if the website is fixed, more shocks will follow, they predict, maybe in the form of data breaches or anger over the tax penalties in the law for those who do not sign up for medical coverage. The problems - with shrinking provider networks, limited competition, rising costs and layers of regulations - are so complex that they simply cannot be fixed, Sanborn said.

For example, Anthem dropped not only Concord's hospital from its network but also Laconia's oncologists and cardiologists. Cancer patients in Laconia who purchase health plans through the health law will have to drive past two hospitals to get their chemotherapy in Manchester, Sanborn said.

For Democrats, voting for Republican health care bills may not be a political panacea. After Friday's vote, the National Republican Congressional Committee mocked vulnerable Democrats who voted yes as political turncoats running from past votes. Shea-Porter, the New Hampshire congresswoman, said she understood that - and had no intention of playing down her support for the health law, which cost her a House seat in the 2010 wave before she won it back in 2012.

"I'm very proud that I voted for it, and I think all the kinks will be worked out," she said. "In the interim, this is what I believe in. I just have to keep working."

———

Jonathan Weisman, New York Times






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