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2014: The Health Care Year in Review

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ICYMI, 2014 was not just any old year in health care. The problem isn’t finding historic events to note, it’s pruning the list. Here’s a crack at some things that we at The Commonwealth Fund thought worth calling out.
2. *Uninsured rate drops:* For the first time in modern U.S. history, the uninsurance rate fell precipitously–‒from 20 percent to 15 percent among adults ages 19 to 64 by the end of the first open enrollment period for the Affordable Care Act’s health insurance marketplaces. An estimated 10 million fewer Americans were uninsured. The appetite for affordable health insurance was strong enough to get past the flawed rollout of the federal marketplace website. And, based on preliminary figures for the still-open second enrollment period, the uninsured rate seems likely to plunge even further before 2014 recedes into memory.

6. *Spending slowdown continues:* We learned more in 2014 about a no-less-historic event unfolding on the spending side of the health ledger: expenditures grew more slowly than at any time since Medicare was passed 50 years ago. Medicare spending alone is $1,200 less per beneficiary per year than predicted just four years ago. While economists scratch their heads over the “why,” some Americans (but not yet all) are seeing the benefits through lower premiums and substantially lower government deficits. The challenge now is how to ensure the slowdown continues.

10. *Republicans gain control of the U.S. Congress and more:* The election results are in: Republicans will begin 2015 with firm control over both houses of Congress, 31 governorships, and an advantage of more than 800 members in state legislatures around the country. Whether divided government at the federal level will lead to an armistice over health reform, or intensified trench warfare, is anyone’s guess. Full repeal of the Affordable Care Act (ACA) is unlikely as long as President Obama remains in the White House, but look for more targeted attacks—possibly through the budget reconciliation process—to gain some traction. At the state level, Republican control will likely mean slower-than-expected expansion of Medicaid eligibility.

14. *Supreme Court takes up an ACA challenge:* In November, the Supreme Court took up a case winding its way through the lower courts that asserts the ACA restricted insurance subsidies only to those states that establish their own marketplaces. The potential ramifications of King v. Burwell, likely to be ruled on next June, are enormous, as a decision for the plaintiffs would have profound effects on the affordability and availability of individual insurance coverage and the functioning of insurance markets. In any 2015 round-up, the Supreme Court’s decision will either be a footnote or the lead.

18. *Sovaldi draws attention to specialty drug prices:* For more than a decade spending on pharmaceuticals has been slowing, but a narrow slice of the market known as “specialty” drugs threatens to reverse that trend. In 2014, this phenomenon found its poster compound: Sovaldi, touted as a miracle cure for hepatitis C, and priced at $84,000 per course. While many patients will benefit, payers and the public are starting to balk. The question: how many more “miracle cures” can our health system afford?

22. *Ebola is a wake-up call on global health security:* Despite the media frenzy, the experts seem to have been right about Ebola. With a little remedial work, the U.S. health system is capable of swiftly managing an Ebola outbreak. However, the outbreak has served the useful purpose of drawing attention to world health security. One looming threat is chikungunya—a mosquito-borne disease that, thanks to climate change and increased global travel, has made its way to the U.S. from more tropical climes. Extraordinarily painful, chikungunya may pose a greater threat to Americans’ well-being than Ebola, and is emblematic of new disease threats the U.S. will face in the 21st century.

26. *Delivery system reform gathers steam:* More than 600 public and private accountable care organizations (ACOs) dot the landscape, covering an estimated 20 million Americans. The percent of private health insurance payments that are “value-based” jumped from 11 percent to 40 percent in the past year, according to one study. (Both ACOs and value-based payments are part of an effort to encourage higher-quality care and lower costs through increased provider accountability for cost and quality.) Efforts to reduce hospital-acquired conditions saved 50,000 lives and $12 billion since 2010. These individual events don’t remake the health system, but could be leading indicators of major structural reform in cost and quality management.

30. *Wiring of the health system continues:* Five years after the passage of the HITECH Act, $25.4 billion in incentive payments have forever changed the world of health IT. Eighty percent of eligible professionals and 98 percent of eligible hospitals have qualified for these payments by adopting electronic health records. While some providers continue to struggle with the transition and interoperability remains a challenge, an infusion of investment capital in health IT innovations and consumer interest suggest that a potentially transformative digital revolution is now under way in the health care system.
Don’t expect 2015 to be any more tranquil than 2014. For health care reformers, the old adage of “be careful what you wish for” comes to mind. Hang on to your hat, happy holidays, and have a great new year.

Written with David Squires. Reported by Huffington Post 13 hours ago.

ACA Drives Uncompensated Care Lower -- Benefit to Hospitals

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NEW YORK--(BUSINESS WIRE)--The health insurance expansion elements of the Affordable Care Act (ACA), particularly Medicaid expansion provisions, have significantly reduced the financial burden of providing care for uninsured individuals beginning in 2014, according to Fitch Ratings. Since the end of 2013, bad debt expense as a percentage of revenues has dropped by an average of 166 bps for six for-profit hospitals (FPH). This has benefitted revenue growth and earnings in the hospital sector. Re Reported by Business Wire 13 hours ago.

Colorado health insurance exchange enrolled nearly 114,000 by Dec. 31

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The state health insurance exchange reported Tuesday that 113,864 Coloradans signed up for a 2015 medical plan between Nov. Reported by Denver Post 12 hours ago.

Grubercare

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MIT economist Jonathan Gruber has distinguished himself in recent weeks by his astonishingly candid comments about President Obama's health care legislation, "The Affordable Care Act": reliance on the "stupidity" of the American public to secure enactment, the overall intent and scope of the law, and the extent to which federal subsidies were not intended for low-income people who secured coverage on the federal government exchanges (as opposed to state-sponsored exchanges where the law is clear that such individual subsidies are in order).

Then he took it all back and issued a major "mea culpa" during his testimony before the House Oversight and Government Reform Committee. In his earlier video appearances, however, Professor Gruber had depicted himself as a major architect of Obamacare. Now he tries to come off as a petit fonctionnaire -- albeit one who reportedly (he won't disclose the full sum) received hundreds of thousands of dollars in consulting fees for his work.

Professor Gruber's earlier candor is decidedly welcome -- not only among the policy experts and the lawyers challenging Obamacare's federal-exchange subsidies in the U.S. Supreme Court, but also, I suspect, among the stable of TV and online comedians whose living depends on reality being stranger than fiction.

But what I had not appreciated until I revisited Professor Gruber's videos is the extent to which he also appears to have played a major behind-the-scenes role in Senator Barack Obama's 2008 presidential election. Professor Gruber told his audience that "quite frankly" when Senator Obama was running for president, he knew that the "American public doesn't actually care that much about the uninsured." What Americans really care about first and foremost, he averred, is cost -- namely, the cost of their own insurance. So all that campaign talk about extending coverage to 40 million or so uninsured Americans was just feel-good pabulum to motivate what people like Rush Limbaugh like to call "low-information voters." It's the stupidity, stupid.

Professor Gruber's video remarks reminded me of one of President Barack Obama's first public events to promote health-care-reform legislation. On March 5, 2009, the President hosted a White House health-care summit. I was privileged to be among the invited guests and was impressed by what Barack Obama said on that occasion, not even seven weeks into his first term. The president launched the event with remarks in the East Room, and his opening statement made clear his priorities: he said that we had to get health-care costs under control first before we could expand access to the uninsured.

As a lifelong Republican who supported Senator John McCain in the 2008 election, I thought: this new president has it exactly correct. I can support enthusiastically what he is saying. I know very few people who do not favor expanding Americans' access to health care -- especially when it comes to the millions of uninsured Americans -- but if you expand access on top of a structurally flawed system, you will only make matters much worse. Costs will continue to rise, thereby creating additional budgetary havoc that will only jeopardize the overall viability and long-term sustainability of the entire system. Better to fix the structure first, change the incentives away from costlier fee-for-service, volume-over-value reimbursements, and then expand access once the entire system is financially secure.

But that's not what happened.

Shortly after his March 5 opening salvo, President Obama outsourced the legislation to Congressional Democrats Harry Reid, Nancy Pelosi and Max Baucus. What has never been explained is why the president did not work in a bipartisan way with Senators Ron Wyden (D-OR) and Bob Bennett (R-UT) who, months before Obama was elected, had already drafted and scored a comprehensive health-care bill, "The Healthy Americans Act," that also enjoyed more than a dozen Democratic and Republican co-sponsors. After all, during his 2008 campaign, Senator Obama had pledged to transform Washington's hyper-partisanship. An excellent way to make good on this commitment would have been to launch his signature domestic-policy initiative with genuine, pre-existing bipartisan support.

Now we learn from Professor Gruber's candid disclosures that the Obamacare legislation was mostly about expanding access to the uninsured and really not about trying to restructure the system to reduce costs. Here's what Professor Gruber actually said:

"What the American public cares about is costs. And that's why even though the bill that they [sic] made is 90 percent health insurance coverage and 10 percent about cost control, all you hear people talk about is cost control."

It turns out that all of the talk about restructuring the system to control costs was simply a dodge. Tell the American public (they're "stupid," don't forget, with a maximum attention span of 140 keystrokes) what they want to hear, and then do whatever the hell you bloody well want.

Americans tend to appreciate candor. Being too clever by half is not an established American trait. It is not terribly surprising, therefore, that the president's current approval rating is exceptionally low, and that his credibility in international matters has been questioned around the globe -- by friends as well as foes.

The American people, after all, may not be as stupid as some people think.

Charles Kolb served as Deputy Assistant to the President for Domestic Policy from 1990-1992 in the George H.W. Bush White House. He was president of the French-American Foundation--United States from 2012-2014 and president of the Committee for Economic Development from 1997-2012. Reported by Huffington Post 11 hours ago.

2015: A Year of Great Opportunity for Progressives

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Watching the Republicans glory in their new majority in the Senate and expanded majority in the House is hard to take for progressive Democrats. Democrats have dug ourselves a deep hole, and the country will suffer as the most conservative political party in American history controls the Congress. What very few people (especially progressive activists) understand, though, is that it is in moments like this when really important victories can be won.

America's political history is full of examples. Decisive defeat in an election doesn't automatically spell doom to the side either in the short run or long run in terms of policy fights. The election of hard pro-slavery President James Buchanan followed by the Dred Scott Supreme Court decision was the pinnacle of slave power, where it looked like all political power had been stripped from the abolitionist movement, yet less than a decade later, slavery was outlawed for all time. William McKinley's decisive 1900 defeat of William Jennings Bryan looked like the end of populist hopes and dreams, yet within a few years much of the populist agenda was starting to be enacted. It was a bitter disappointment when Nixon pulled out an incredibly close win against liberal stalwart Humphrey, but in Nixon's first term OSHA and the EPA were founded, the Clean Air and Clean Water Acts were passed, and the first affirmative action programs were put in place.

And here are some questions about more recent times: when were the only 2 minimum wage increases between 1980 and 2007? 1990, after the devastating win by GHW Bush in 1988, and 1996, after the Republicans swept into power in the 1994 elections. When was the tax reform bill essentially written by the strongest progressive tax group (Citizens for Tax Justice) in the country passed? 1986, after the Reagan landslide in 1984. When was the landmark bill providing health insurance to children passed? 1997, when Gingrich was Speaker. When was the only progressive legislation on corporate corruption (Sarbanes-Oxley) passed since 1980? 2002, after the 2nd Bush won the first time and with Tom DeLay the most powerful man in the House. When did the President's top priority legislation, Social Security privatization, never even come up for a vote in spite of the Republicans having control of both Houses of Congress in the aftermath of 2 bad elections for the Democrats? 2005, after both Bush and several new GOP Senators won.

It is time for progressives to stop thinking only defensively (although defensive battles can be great wins as well, like the Social Security fight against Bush), and start thinking about what we can win. While it is true that the Republican party keeps getting further and further to the right, making it hard to pass good legislation, let me give some examples of some of the ways we can fight and win progressive victories over the next 2 years:

It is time for progressives to stop thinking only defensively (although defensive battles can be great wins as well, like the Social Security fight against Bush), and start thinking about what we can win. While it is true that the Republican party keeps getting further and further to the right, making it hard to pass good legislation, let me give some examples of some of the ways we can fight and win progressive victories over the next 2 years:

1. Obama still has the power of executive action. He began to use this power in earnest over the last 2 years on immigration, climate change, Cuba, and wages paid to workers for federal contractors, but there is far more he can do, and progressives should push him to do more and bigger things. One example: on the wage front, Obama did a couple of good things over the last year but he could do so much more. He raised the minimum wage paid to workers for those companies who contract for the federal government, but only to $10.10 - there is no reason it can't be higher, and indexed for inflation. He could do something on the overtime wage issue. He could push federal contractors to do more to give their workers bargaining rights. He could force contractors to simply obey labor laws, like the USDA wanted to do a few years ago but was forced to back off by the White House. Treasury could tighten regulations and step up enforcement on the big Wall Street banks (and could even throw a few bankers in jail for the very real crimes they have committed). On environment, on trade, on procurement and contracting, on many other issues, the administration could deliver some big and important progressive victories in the next 2 years.
2. The Obama administration should not play only on defense in the next two years on the federal budget. McConnell famously promised the Koch brothers he would attach all kinds of riders to budget bills if he became the Majority Leader, and he will try. But Obama should play some offense too. In the Clinton years, we won some big fights with the Republicans in the budgeting process, including the Children's Health Insurance Program, by playing hardball. Given that it is Republicans that will always get blamed for government shutdowns (voters have figured out that they are the anti-government party), Obama can play hardball again.

3. McConnell is promising a more open amendment process. Let's hold him to his word and take advantage of it. A more open amendment process is how Teddy Kennedy pushed through the minimum wage increase in 1996. Not a single legislator claimed to like the sweetheart deal for Wall Street speculators a Citi lobbyist snuck into the last budget bill- we should offer an amendment to strip it when it comes to the floor. Progressives have the high political ground on most economic issues, with big majorities favoring our positions- let's take advantage of that fact in the amendment process.

4. In spite of the fact Democratic candidates were losing big in 2014, we won a lot of good things in the ballot initiative process. Let's build on that success and use that process to win more strong progressive victories on key economic, social, and environmental issues.

5. Make an example out of the defensive fights we have to fight. When George W Bush was beaten badly on Social Security privatization, it hurt him badly in the 2006 election, and it changed the politics of the issue in a big way. When the truly awful Trans-Pacific Partnership is being debated, let's do the same thing. We can win on this issue with a good strategy because a lot of Republicans don't like handing over so much power to the administration, and by waging an aggressive campaign, we can make future Democratic Presidents very nervous about battles over pro-big business trade bills.

My advice to my fellow progressives: don't feel sorry for yourselves as the republicans bask in their victories this week, and stop focusing 100% of the time on playing defense. We can win some important fights in the next 2 years, we just need to craft a strong strategy and go execute it. Reported by Huffington Post 11 hours ago.

How to Get on the Working Mother 100 Best Companies List: 9 Tips for a Better Application

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The application for Working Mother's annual "100 Best Companies" list is out -- if your company wants to try for this list, you have until mid-March to answer the 500 questions, write your essay, and get your entry in. It's a lot of work, but it's for a big reward. As I wrote in my last post, getting on the Working Mother 100 Best Companies list can boost recruitment and retention of talented employees, and is a public relations coup for your company. Even if you don't get on the list, many of my clients tell me the application process, itself, is a significant learning experience.

So how do you get on the list? I wrote about the actual process in my last post. Now comes the tougher question: what does it take to actually get on the list? Well, for starters, you need strong policies and programs promoting women's advancement and work-life balance for all employees. Then you need to be able to demonstrate that employees actually use these programs and policies -- and (ideally) that senior leadership and managers at all levels encourage that use.

But you need something more than all this. You also have to be able to convey this information in the most strategic way possible. You need to be able to tell your story. I've been helping companies write successful applications for this and other best company lists for years. Here are some of my top tips for putting together the strongest possible application:
1. Think Positive. If you can honestly say "yes" in answer to an application question, say it. If there are some caveats, that's what the written comments sections are for. In other words, better "yes" with caveats, than "no" with exceptions.
4. Think Broad. Every company has its own names for things. If you've got a program that involves pairing employees with other employees who act as resources and coaches, you've got a mentoring program -- no matter what you happen to call it. Don't be so literal-minded that you miss out on opportunities to strut your stuff.
7. Think Narrow. A program confined to one of your work sites or a single department is better than no program at all. And even an incremental improvement in one of your benefits or programs shows that you are working in the right direction. (The folks at Working Mother aren't going to be hunting up your answers to last year's questions, though -- so if there's been an improvement, make sure to mention it in the essay.)
10. Think Specific. The dynamics are in the details. Exactly how does a program work? What does it cost employees, if anything, and what specifically do they get for that? If it's a back-up child care program, how many days do they get, can they use more than those days by paying on their own, does it include in-home as well as center-based care, is it available to all employees, are providers vetted... etc?
13. Think General. The details to include are the ones that demonstrate how and why a program works. But don't get carried away and start throwing in every last bit of legalese in your policy. If your health insurance covers domestic partners, it's enough to say that -- perhaps clarifying whether that includes opposite- as well as same-sex domestic partners -- without going into detail about how employees are asked to document their relationship. Not only does such detail add unnecessary underbrush to what should be a clear, clean story but it wastes some of the precious 2,500 words you have to tell it.
16. Think Nerdy. Crunch those numbers -- leaving too many answers blank on the Working Mother application is one of the greatest mistakes you can make. If you haven't actually tracked usage of a particular flex-work option or vacation policy, make some educated guesses. This sort of "guestimating" is perfectly acceptable to the Working Mother judges, as long as it passes what they call the "red face" test -- if you wouldn't be embarrassed to see your numbers quoted publicly, go ahead and use them. Remember, too, that data of all kinds is a great way to put some teeth into any claims you make in the essay.
19. Think Concise. The final essay in the Working Mother essay is limited to 2,500 words. Judges stress that you don't have to write 2,500 words -- you won't lose points for writing fewer. But if you do find yourself hitting the limits without getting in everything you want to say, take a careful look at your language. Rather than resort to Twitter-like abbreviations or jargon-y acronyms that nobody can understand, try this: get rid of over-generalized language that adds no value ("We strive to support the work-life balance of our employees in every possible way"); platitudes ("Flexible work arrangements make it easier for employees to have work-family balance); and unnecessary repetition ("We have a paid parental leave. Our paid parental leave policy provides...") Here are some more of my tips for writing to fit word limits.
22. Think Personal. Don't just talk about programs and policies. Talk about people. Tell specific stories about employees that have benefited from the programs you're describing. Add quotes. And remember that here, once again, the dynamics are in the details. An employee says she benefited from tuition assistance? Great. She benefited because she was able to use it to complete her degree, and in that way was able to get a promotion? Much, much better.
25. Think Unique. What makes your company special? What special perks do your employees have that relate directly to your industry (e.g., discounts on cars for car dealerships, or on financial planning for investment firms)? How do your programs and policies reflect your stated corporate philosophy and values? What little extras do you provide for working parents or others with family responsibilities? The Working Mother application questions are tweaked each year, often in order to incorporate benefits and policies its authors hadn't thought to add, until an applicant like you mentioned them.There are, of course, no guarantees when it comes to getting on a "100 Best Companies" list. But if you attend to the tips above, you'll be doing all you can to make your application worth the effort.Robin Hardman is a writer and work-life expert who works with companies to put together the best possible "great place to work" competition entries and creates compelling, easy-to-read benefits, HR, diversity and general-topic employee communications. Find her at www.robinhardman.com. Reported by Huffington Post 11 hours ago.

Amazing fact: Obamacare 'beyond repair,' yet brings insurance to millions

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When it comes to the Affordable Care Act, you have two choices about what to believe. You can go with objective statistics from Gallup, a respected survey organization, which indicate that the law has increased the number of Americans with health insurance by more than 10 million. Reported by L.A. Times 13 hours ago.

Collision Insurance Rates in 2015 by State Now Quoted in Real Time Online

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Collision insurance rates for car owners by state can now be examined using the updated insurer locator tool at the Quotes Pros website at http://quotespros.com/auto-insurance.html.

Los Angeles, CA (PRWEB) January 07, 2015

Add-ons to automobile insurance policies are available through some insurers to help motorists to obtain additional coverage compared to using only a liability policy. The Quotes Pros company is now allowing research to find collision insurance rates by state through its finder at http://quotespros.com/auto-insurance.html.

The real time system available to motorists in the U.S. this year now supplies access to collision add-on plans from a number of different insurance companies. The new provider list that is returned to a car owner who uses this QuotesPros.com portal to find coverage is structured by zip codes to make finding providers faster.

"The rates that are available to review come straight from top companies in the insurance industry and these providers can quote more than state minimum policies," said one Quotes Pros source.

The search capabilities that are provided to users of the insurer portal this year are not limited to only collision add-on policies. A person who is also searching for collector, broad form or full coverage policies can find rates as well as top providers when searching by zip code using the customized portal.

"Our website is now configured to present a larger group of companies in a single search to provide easier ways to explore policies available in the U.S.," said the source.

The Quotes Pros company has reconfigured its search tool for 2015 to provide more results for system users. The auto insurers that are displayed after selected in the system are now in combination with life insurance and health insurance providers at http://quotespros.com/life-insurance.html. These providers can be found through mobile or standard Internet usage.

About QuotesPros.com

The QuotesPros.com company is one American source to find and quote costs for national vehicle insurance policies in real time. New agencies are able to be searched for through the open database upgraded at the first of this year. The QuotesPros.com company offers ways to review costs for health, life, medicare, business and homeowner coverage policies that are supplied nationally. Reported by PRWeb 13 hours ago.

A sharp drop in Americans who do not have health insurance

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The percentage of adults in the USwho do not have health insurance dropped to 12.9 percent in the fourth quarter, “down significantly from 17.1 percent a year ago,” the Gallup-Healthways Well Being survey reported Wednesday. “The Affordable Care Act has accomplished one of its goals, increasing the percentage of Americans who have health insurance coverage,” Gallup-Healthways reported, based on telephone interviews conducted October through December. “The uninsured rate as measured by Gallup has dropped 4.2 points since the requirement to have health insurance or pay a fine went into effect. It will likely drop further as plans purchased during the current enrollment period take effect. ” The U.S. Dept. of Health [...] Reported by SeattlePI.com 12 hours ago.

Smart Mobility Tracking: Ford Experimenting With Big Data in a Big Brother Kind of Way

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Smart Mobility Tracking: Ford Experimenting With Big Data in a Big Brother Kind of Way Ford has a plan, nay, an ongoing effort to leverage the latest in communications and data-collection technology to make life better for you, the hapless schnook just trying to get from place to place. It’s called the “Smart Mobility” plan, and at the 2015 Consumer Electronics Show in Las Vegas, Ford CEO Mark Fields dropped some fresh news on the endeavor.

In sharing Ford’s Smart Mobility updates, Fields employed lofty language, referring to the plan as being part of a “higher purpose,” focused on “driving innovation;” he added that Ford is not just a “product” company, but a “mobility” company, too. (Which reminds us of the time when a German VW employee, who, when asked why so many of the company’s events seem to include dancers, replied with the straightest face imaginable: “Volkswagen is a mobility company, and dance is a form of mobility.”) Anyway, aside from the introduction of Sync 3, which as we’ve come to find out, is much better than the execrable MyFord Touch infotainment system, Ford is engaging in a number of mobility-oriented experiments that range from the interesting to the spooky.

Though the total number of experimental programs apparently stands at 25, the company only outlined about half of them at CES. They run the gamut from from mapping uncharted parts of Africa to remotely-piloted golf carts, and the range of projects seems just unfocused enough to seem seriously interesting. Here is a detailed account of the 11 projects Ford debuted:

Of utmost concern to privacy hounds is the project in which 200 of Ford’s employees have allowed the company to gather their driving data. Besides being something that Henry Ford would’ve approved of—or even relished, at least for his unionized employees—the experiment will be used to illuminate movement patterns that can help Ford understand how the populace generally uses vehicles. The connected world is only going to get more connected, folks, and the only way to opt out, it seems, is to drive something ancient and leave your phone at home.

But Ford’s folks aren’t the only ones under this macro-microscope. Having teamed up with HP, Ford’s tracking the usage of 100 of the tech company’s vehicles. Ford notes that it “could lead to better products and services.” And presumably, a more compliant workforce.

In London, Ford is also tracking drivers’ long-term behavior “in order to build a more personalized mobility profile.” The goal is some sort of dossier, which Ford refers to as a “”driving behavior passport,” a file that can be used in the calculation of insurance rates. Drivers would take the information from car to car and from insurance carrier to insurance carrier. Sure, a number of these propositions feel a little invasive and gross, but to us, this one feels the ickiest.

George Orwell died in London’s congested capital, so it’s only fitting that Ford’s exploring a parking-oriented, semi-benign Big Brother–style overlord. In this expedition, drivers are informed whether they’re legally parked. If they’re not, the system shows a recommended spot nearby. The system also gathers live data on traffic and allows users to feed meters via their cellular communications devices. That last part we like, by the way. London also is home to another experiment in which a fleet of Focus Electric and Fiesta EcoBoost models are thrust into an app-based car-sharing service bent on maximizing efficiency and the shortest time between deciding, “Hey, I need a car for this” and actually being in said car. Also in London, as well as in NYC, Ford is investigating an on-demand minibus service. Think of it as Mass Uber: a passenger requests a pickup and the system calculates the route the 10-passenger vehicle should take to drop everybody off in the most efficient manner. They’re calling it the “Dynamic Social Shuttle.” Of course they are.

Another crowd-tangling idea: A Dearborn, Michigan–based car swapping exercise in which you could lend your Fusion to a pickup owner and vice versa. This would be ideal for those who need an F-150 every three months, but don’t feel like taking on the bulk and fuel economy of a truck the other 361 days of the year. Not content to just fiddle with cars and minibuses, the automaker has turned its attention to the way bicycles are used. Using sensor-equipped bikes in Palo Alto, Ford wants to see how alternate modes of transportation might be used. We presume your biking habits will eventually be used to calculate your health insurance rates.

Meanwhile, in Georgia, Ford is practicing remote parking with golf carts. In cooperation with Georgia Tech, Ford’s folks are exploring parking the vehicles via a streaming LTE connection. Imagine the valet as a Predator pilot. Or imagine when thieves manage to hack the system. Try not to imagine both scenarios at once, because it’s kind of scary. Also in Georgia, Ford is using vehicle sensors already on the market—including sonar and radar—to help people find parking. The system looks for open spots as a driver cruises the streets, uploading the data to the cloud and making it available to others.

On the EV-charging front, the Blue Oval is exploring the benefits of fast-charging and looking into a partnership with a retail or fast-food chain to build out a quick-charging infrastructure. The goal is to make EVs a better choice for car-sharers by giving users a broader recharging network.

Of all the experiments Ford outlined at CES, this one is our favorite: In West Africa, Ford’s working with Riders for Health, a fleet-management group that helps get healthcare workers to remote areas. Using Ford’s OpenXC tech, they’re hoping to improve vehicle maintenance, as well as use the data collected to map remote regions where Google doesn’t happen to have goofy camera-equipped Priuses roaming about.

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· Chevrolet to Use Magic Hoodoo to Deliver Prognostic Vehicle Data to Owners
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Despite the myriad benefits conferred by connectivity, we can’t help but worry about the privacy implications of all of this. Do you want an intimate profile stored in Dearborn? Does it matter, since you’ve already got even more personal data stored in Palo Alto and Mountain View? We suppose only the end users can decide, and we’d like to think that in a time where many of these behavior-tracking technologies are ubiquitous, that there’d be a way to opt out. It’s all a little head-swim–inducing, the kind of thing that might inspire one to pick up an old BSA Gold Star, throw their phone in the sea, and go back to filing IRS forms via fax at Kinko’s. Because we still can’t bring ourselves to call the place a FedEx Office. Are we sounding like stuck-in-the-’90s Luddites? Ma! bring us our laudanum, some Ovaltine, and our Superchunk records, won’t you? Reported by Car and Driver 11 hours ago.

Health care sign-ups steady as uninsured rate hits new low

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WASHINGTON (AP) — Sign-ups under President Barack Obama's health care law grew slowly but steadily over the New Year's holiday, as the share of Americans still lacking coverage hit its lowest level in years. The Obama administration reported Wednesday that nearly 103,000 people signed up last week in the 37 states where the federal government is running online health insurance markets, bringing total enrollment for 2015 to 6.6 million in those states. [...] a new Gallup survey found that 12.9 percent of the adult population remained without coverage in the last three months of 2014, the lowest share since the pollster began daily tracking of the uninsured in 2008, before Obama took office. "The Affordable Care Act has accomplished one of its goals: increasing the percentage of Americans who have health insurance coverage," Gallup concluded. Obama's law offers subsidized private insurance to people who don't have coverage on the job, along with expanded Medicaid coverage for low-income people. Reported by SeattlePI.com 11 hours ago.

Florida No. 3 for savviest health exchange customers

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Floridians fare better than consumers in most other U.S. states as far as selecting a health insurance plan through the exchanges, according to Putting Patients First. Florida came in at No. 3 on the list of states with the savviest health exchange consumers, trailing only California and Texas. Rounding out the top five after Florida were New York and Virginia. The Putting Patients First website was created by the National Health Council. The Putting Patients First calculator is a Web-based tool… Reported by bizjournals 10 hours ago.

HUFFPOST HILL - Liberté, Égalité, Louie Gohmert

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Today the United States put aside its Freedom Fries in favor of Solidarity Crepes. On that note, we forgot how lucky we are that the worst responses we get to our political satire usually involve curt emails from flacks about something being a "non item." And John Boehner kindly reminded everyone that "rubbed shoulders with white supremacists" still isn't as terrible as "helped people get health care." This is HUFFPOST HILL for Wednesday, January 7th, 2014:

*AND JUST WHAT ARE WE GOING TO DO WITH YOU, LOUIS BULLER GOHMERT JR?* Erica Werner: "House Republicans began the new Congress with old divisions on display Wednesday, bitter fallout from a failed rebellion against Speaker John Boehner. Boehner took swift action against two of the dissenters, knocking them from a key committee. But some of his allies demanded more, furious at the two dozen lawmakers who opposed the Ohioan in Tuesday's speaker vote. In the process, the GOP is starting the year with party infighting instead of a unified challenge to President Barack Obama. *'All of us think that they should have retribution,'* Boehner loyalist Devin Nunes of California said of the rebels. *'They put the conservative agenda at risk with their wanting to be on television and radio.'* The dissidents warned of their own payback if Boehner does take further steps against them. 'There's going to be a fight,' said Rep. Louie Gohmert, R-Texas, when asked what would happen if leaders retaliated against lawmakers who opposed Boehner's re-election." [Associated Press]

*DAVE BRAT HAS SOME REAL GUMPTION* - Brat smiled broadly as he posed for swearing-in photos with John Boehner right after voting against Boehner's speakership. "*The juxtaposition of the vote and the photo was a bit much for still-seething allies of the speaker, who considered the move quite brazen*," Carl Hulse reports. No kidding! [NYT]

*CBO SPANKS OBAMACARE BILL* - The Congressional Budget Office reported that the Republican bill tinkering with Obamacare's definition of full-time work would reduce the number of people with employer-sponsored health insurance, burden Medicaid, increase the number of uninsured, and jack up the deficit. The "dynamic" version of the analysis said the bill smells like flowers. [CBO.gov]

*REPUBLICANS UNFAZED* - Mike McAuliff: "Senate Majority Leader Mitch McConnell (R-Ky.) said he was not worried about the CBO findings about the deficit implications or the negative impact on full-time workers, suggesting he also knew better than the numbers crunchers' data. *Asked at his Capitol Hill news briefing Wednesday if the information gave him pause, he offered an unequivocal 'No.'* 'One of the worst things we can do is destroy the 40-hour work week, which has been a part of American culture and life for a very long time,' McConnell said, despite the findings that many more 40-hour workers would be hurt by shifting the threshold." [HuffPost]

Meanwhile, the uninsured rate keeps falling, according to surveys. Go fig.

*OBAMA ON THE CHARLIE HEBDO MASSACRE:* "The fact that this was an attack on journalists, attack on our free press, also underscores the degree to which these terrorists fear freedom -- of speech and freedom of the press. But the one thing that I'm very confident about is that the values that we share with the French people, a belief -- a universal belief in the freedom of expression, is something that can't be silenced because of the senseless violence of the few."

*HOUSE GOP NOT BACKING DOWN FROM DHS FIGHT* - Elise Foley: "After gunmen attacked a satirical French newspaper on Wednesday, House Speaker John Boehner (R-Ohio) said Republicans won't back away from a fight over immigration that risks halting funding for the U.S. Department of Homeland Security. 'I believe that the president's executive actions with regard to immigration are outside of the Constitution and outside of his powers, and *I believe that we can deal with that issue in the Department of Homeland Security bill without jeopardizing the security of our country*,' he told reporters when asked whether the Paris attacks would change the GOP's strategy on funding DHS." [HuffPost]

*DAILY DELANEY DOWNER* - Several news organizations are afraid to show Charlie Hebdo's cartoons. Fortunately, HuffPost is not one of them. [HuffPost]

Does somebody keep forwarding you this newsletter? Get your own copy. It's free! Sign up here. Send tips/stories/photos/events/fundraisers/job movement/juicy miscellanea to huffposthill@huffingtonpost.com. Follow us on Twitter - @HuffPostHill

*BOEHNER STANDS BEHIND SCALISE* - Mike McAuliff: “House Speaker John Boehner insisted he knows what's in the heart of his embattled House Republican whip, Rep. Steve Scalise, and stood behind the Louisiana Republican who has come under fire for a 2002 speech to a white supremacist group. Boehner, who said earlier that the speech to a group affiliated with David Duke was an "error of judgement," repeated that opinion Wednesday, when questions about the third-ranking Republican in the House dominated the GOP's first news conference of the new Congress. Scalise spoke to the group when he was a Louisiana state lawmaker, and Boehner suggested that it would be easy for anyone in such a circumstance to mistakenly address an organization that may have distasteful views. “ [HuffPost]

*DEMS WEIGHING KEYSTONE PIPELINE STRATEGIES* - Kate Sheppard: “*Senate Democrats who oppose the pipeline are trying to figure out what they can do to make it more difficult to pass the legislation -– or, if not, at least score a few points in the process*. ‘The first test of the 114th Congress is what kind of fight the Democratic caucus has in them,’ said a Democratic aide, speaking on background in order to be able to talk more freely. ‘Do we want to simply hand over votes to [Majority Leader Mitch] McConnell for his agenda, or do we want to show that Democratic votes need to be earned?’ Those Democrats appear to be doing their best to make the Keystone vote difficult. The Senate Energy and Natural Resources Committee had scheduled a hearing on the bill for Wednesday morning, and a markup of the bill for Thursday morning. But Minority Whip Dick Durbin (D-Ill.) objected to the hearing, noting on the Senate floor Tuesday that legislation providing for the structure of committees was not anticipated until the following day.” [HuffPost]

*DEMS TARGETING DOMA* - Eventually they’ll stop trying and in 150 years when gay marriage isn’t an issue, Congress will have to address this, like when Mississippi technically abolished slavery 150 years after the Civil War. Jen Bendery: “Democrats kicked off the new congressional session Tuesday by reintroducing legislation to repeal the federal Defense of Marriage Act, which allows states to refuse to legally recognize gay and lesbian couples married in other states.
The Supreme Court struck down a portion of DOMA last year that barred the federal government from recognizing same-sex marriages. But because the rest of the law is still in effect, states that have banned same-sex marriage are not required to recognize legal marriages performed in other states. Same-sex marriage is now legal in 36 states -- Florida joined the group on Monday -- and in the District of Columbia, while the remaining 14 states have explicitly banned it. *The bill introduced Tuesday, called the Respect for Marriage Act, repeals DOMA entirely. If it were to become law, all legally married same-sex couples would have access to federal marriage benefits and protections, even if they moved to states that haven't legalized gay marriage*. It wouldn't require states to pass marriage equality laws; it would only require that legally married same-sex couples living in those states receive the same federal benefits as other married couples.” [HuffPost]

*MICHAEL GRIMM’S DONORS REGRET NOTHING* - Sam Stein and Paul Blumenthal: “There are sound investments. There are risky investments. And then there are investments in individuals facing public disgrace and possible prison time. Nearly 200 people made that last sort of investment in 2014. They're the folks who gave itemized donations (i.e., donations in the aggregate of more than $200) to then-Rep. Michael Grimm (R-N.Y.) even after he had been indicted on charges of tax fraud. They helped the Staten Island congressman sustain a bid for re-election even as the rest of the political world ran far away and legal threats engulfed his political future. And though he won, they watched as he turned around less than two months later, pleaded guilty to the charges and resigned from his seat. [I]n interviews this past week, none of those reached by The Huffington Post expressed animus toward Grimm for taking their donations to gain another term and then abruptly leaving office. ‘I have no such feelings of that,’ said Steve Schleider, president of Metropolitan Valuation Services. ‘Personally my feeling is that I didn't know how it was going to shake out. But it is better to have a special election now than give up the race at that point.’” [HuffPost]

*GOP REP DEFENDS CONTROVERSIAL BANK DEREGULATION* - Yoder is still putting the final touches on his Op-Ed defending his carveout for free beer flight samplers at AA meetings. Sam Levine and Zach Carter: “*Rep. Kevin Yoder (R-Kan.) has finally chosen to defend his role in passing a bill to subsidize Wall Street derivatives trades after going politically MIA when the issue exploded in mid-December*. The controversial measure eliminated a key rule from the 2010 Dodd-Frank financial reform law that prohibited banks from trading risky derivatives through subsidiaries insured by taxpayers. It was Yoder who first slipped this Wall Street perk into a $1.1 trillion must-pass spending bill, which indeed passed last month. Big banks aggressively supported the measure because such taxpayer-backed trades are more profitable for them. Its language was drafted by Citigroup lobbyists... Ultimately, the congressional leadership of both parties signed off on its inclusion in the spending legislation...In a Kansas City Star op-ed on Sunday, Yoder insisted that his measure makes banking more secure. ‘This fix actually makes banking safer -- specifically, the commodities markets for agriculture and energy producers -- while not exposing the American taxpayer to further liability,’ he wrote. Yoder is simply wrong.” [HuffPost]

*BECAUSE YOU'VE READ THIS FAR* - Here’s a child protecting a monkey

*SILICON VALLEY FIRM CLAIMS SONY EMPLOYEE(S) HELPED HACKERS* - Dana Liebelson: “A Silicon Valley cybersecurity firm is doubling down on its claim that at least one former Sony employee was involved in hacking Sony. Some former employees of the company are expressing that sentiment as well, even as the U.S. government stands by its conclusion that North Korea orchestrated the massive cyberattack. Kurt Stammberger, senior vice president at Norse, which provides cyber intelligence to customers in financial services, technology and government, *told The Huffington Post that the company remains ‘pretty confident’ that ‘at least one ex-employee was involved, probably more’ in the Sony hack*. As evidence, Stammberger said that Norse has samples of malware used in the Sony hack that existed as early as July, "completely in English with no Korean whatsoever." Sony credentials, server addresses and digital certificates were already built into the malware, he added.” [HuffPost]

*COMFORT FOOD*

- The women of “Downton Abbey” play Cards Against Humanity.

- Real life Peter Griffin

- For those in tight jeans unable to engage in creative thought, here’s a hipster band name generator.

*TWITTERAMA*

@daveweigel: Fahrenheit 451, the temperature at which takes burn RT @chrislhayes: We've reached the hot-take hour...

@dceiver: One wonders if a hypothetical TNR subscriber who, say, wakes from a year-long coma in May will notice any difference in the content quality.

@aedwardslevy: senate winter caucus:
dan coats
richard brr
jeff snowflake
former chair, olympia snowe

*Got something to add? Send tips/quotes/stories/photos/events/fundraisers/job movement/juicy miscellanea to Eliot Nelson (eliot@huffingtonpost.com) or Arthur Delaney (arthur@huffingtonpost.com). Follow us on Twitter @HuffPostHill (twitter.com/HuffPostHill). Sign up here: http://huff.to/an2k2e* Reported by Huffington Post 10 hours ago.

Local clinic provides care for low income, uninsured Utahns

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Midvale, Utah- (ABC 4 Utah) – A free volunteer clinic is offering hope to Utahns who have no where else to turn.

Anarosa Lopez is one of them.

She was diagnosed with epilepsy last year and has no health insurance.

The free services at Hope Clinic in Midvale fill a critical need in her life.

'It's very challenging, because you need to do follow up after follow up. If you don't have insurance you usually get the full cost of everything and it just tends to pile up," said Lopez.

An estimated 53,000 Utahns have no option for health insurance right now because of a gap created by the Affordable Care Act.

While state lawmakers debate Medicaid expansion Hope Clinic offers them and others internal medicine options and even some secondary services.

Things like physical therapy tips, general check ups, minor surgeries, treatment for burns and more.

The demand is nonstop.

"We see an average of 100 patients a day and if you would compare that to average clinics you would see that is quite a bit," said Co-Founder, Jane Powers.

An all volunteer team staffs the clinic two days a week.

Retired people, students and medical professionals all give of their time to open the door to those who face one closed door after the other.

Volunteers say they wouldn't want to spend their free time any other way.

"You go home knowing that you haven't held your gifts to yourself, you've given them out," said Powers.

To people like Lopez who otherwise would go without.

"Makes me feel safe and good about what I'm having done here and what I am doing with my health," said Lopez.

Volunteers at Hope Clinic support the governors Healthy Utah Plan, because they say it would open new doors to their clients.

The governor does have federal approval. Now, he's working on lawmakers here at home to get them to sign off.

It will be a big debate this upcoming session.

Hope Clinic is open for medical services every Tuesday and Wednesday.

The address is: 65 E. 6850 S. Midvale, Ut.

The phone number is: (801) 568-6700 Reported by abc4 10 hours ago.

MNsure gets extra $34M from feds for upgrades

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Minnesota's health insurance exchange is getting some extra cash from the federal government. Reported by TwinCities.com 9 hours ago.

Those Protesting Harvard Professors Have a Point

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It’s hard to see the Harvard University faculty’s fury over their health insurance as anything but comic. The school began the new year by requiring its employees to pick up a great percentage of their health care bill—a change the school partially attributed to the very Affordable Care Act many of its professors once argued for. Now those academics are pushing back, but for those of us living in the real world, the amount in dispute sounds ridiculous. From no deductible to $250 per person? This is worthy of a protest movement? When the New York Times reported on the dispute earlier this week, the Internet laughed. I did. You probably did too. Reported by Slate 7 hours ago.

Small Businesses Snub Exchanges

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Some small-business owners are snubbing health-insurance exchanges, citing limited federal tax credits and a small menu of insurance offerings in a few states. Reported by Wall Street Journal 7 hours ago.

Workers paying more for health insurance, but getting fewer benefits

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Although the Affordable Care Act has not led to soaring insurance costs, as many critics claimed it would, the law hasn't provided much relief to American workers either, according to a new study of employer-provided health benefits. Reported by ChicagoTribune 4 hours ago.

Goldman's 2015 Political Outlook: Will Congress "Audit" The Fed?

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Goldman's 2015 Political Outlook: Will Congress Audit The Fed? The 114th Congress formally convened yesterday. In what follows, Goldman Sachs presents its views on some of the *central questions regarding the political and policy outlook for the coming year*. In general, they continue to expect more substantive legislative activity to occur in 2015 than occurred in 2014, and in a few cases--trade agreements, a highway bill--these proposals could become law. Goldman expects most of the deadlines Congress faces over the coming year to result in only limited uncertainty, though *the debt limit increase that will be necessary later in 2015 is the main potential exception*.

*1. How does the agenda for 2015 differ from 2014?*

The legislative outlook for 2015 resembles the outlook for 2014 in many ways, but we expect more legislation to reach the President’s desk and, in a few cases, policy changes to actually become law. Like 2014, we expect debate on a number of broad reforms, particularly immigration policy and tax reform. However, immigration reform looks just as difficult as it did last year; major changes to tax policy are more likely but still a long shot. Congress also faces a number of deadlines this year, just as it did last year (a calendar of selected deadlines and events is shown in Exhibit 1).* In many cases Congress will likely simply kick the can by temporarily extending these deadlines, though the prospects for enacting longer-term policy measures in some areas (e.g., Medicare physician payments or the highway bill) look slightly brighter in 2015 than they were in 2014.* Finally, just as in 2014 policy changes through executive actions look likely to continue, with implementation of the President’s recently announced executive action on immigration likely by mid-year, additional changes likely to be announced in the run-up to the State of the Union Address later this month, and substantial regulations on carbon emissions, overtime pay, and higher education expected over the course of the year.
 

In other ways, the political agenda has changed more significantly from last year. First, there is a fair chance that Congress could pass some form of “trade promotion authority” and legislation to ratify the Trans-Pacific Partnership trade agreement with Japan and other Pacific Rim countries. Second, narrow changes in other more controversial areas look more realistic than they have over the last few years, though major revisions still look unlikely. For example, substantive changes to the ACA and the Dodd-Frank Act were included in the omnibus spending bill enacted in December 2014, and *at least one additional change to the ACA—repeal of the tax on medical devices—looks likely to pass early in 2015*.

*2. How will the shift to Republican control of Congress change the policy debate?*

*The source of political uncertainty is likely to shift from the House to the Senate and, in some cases, from Congress to the White House.* Since Republicans took control of Congress in 2011, most major legislative agreements have followed a similar path: the House passes legislation with only Republican votes, the Senate passes compromise legislation with some support from both parties, and that Senate legislation then passes the House, often by a very narrow margin and often at the last minute. The wider margin of control in the House is likely to provide Republican leaders in that chamber a bit more flexibility in passing legislation with Republican votes without having to reach across the aisle for Democratic support as they have often had to do on major fiscal matters. With 54 seats in the Senate, Republican leaders will still need to compromise with Democrats on most issues to reach the 60 votes usually needed to pass most legislation. Nevertheless, Republicans will control the legislative calendar, which will lead to some legislation that the White House opposes reaching the President's desk. The upshot will be a greater focus on the Senate, and a greater focus on whether the President will sign or veto various measures.

*3. What effect will lower energy prices have on policy?*

*Energy supply policies will probably get less attention, while energy taxation might get more, but changes on either front are likely to be modest. *The sharp decline in oil prices looks likely to reduce some of the political pressure on lawmakers to address energy supply issues. The most immediate issue on that front is approval of the Keystone pipeline: over the next two to three weeks the Senate is likely to vote on, and will probably pass, legislation to approve construction of the pipeline from Canada to the US. The House is expected to take up the measure this month as well, potentially putting it on the President’s desk by month-end. However, public support for the project has dipped slightly—though a majority still favors it—and the Obama Administration may feel less pressure to approve the pipeline than it once did. The upshot is that while Congress looks more likely to pass a bill, the President looks less likely to sign it.

*Lower prices could give a boost to other policy changes.* First, cheaper gasoline undoubtedly raises the probability that the $0.18/gallon tax will be increased for the first time since 1993, though at this point the likelihood still appears to be fairly low. While some Republican lawmakers appear to be less opposed to this particular tax increase than most others, few have actually supported it. And while lower gasoline prices create additional room in households’ transportation budgets with which to absorb a tax increase, the $0.12/gallon increase that would be needed to bring federal highway-related revenues into line with federal highway spending would still amount to a tax increase of about $16 billion per year. Some proponents of a gas tax increase, like Sens. Corker (R-TN) and Murphy (D-CT), have proposed to offset the tax increase with tax cuts elsewhere, but in light of the political sensitivities around gasoline prices, this nuance may not make much of a difference in generating support for an increase. At this point, we don’t expect an increase in the federal gasoline tax to become law, but we do expect to hear much more about the issue ahead of May 2015, when the current extension of the highway program expires.

*Second, a repeal of the oil export ban looks likely to move up the agenda in 2015, as lawmakers face rising (though at a slower pace than previously expected) domestic crude production while consumers face lower prices at the pump and become less focused on energy issues. *At this point the most likely outcome seems to be incremental loosening of the ban through approval of lightly processed oil condensates for export—rather than crude itself—but this will be an issue that bears watching.

*4. How will lower deficits affect fiscal decision making?*

*Congress is likely to focus more on small changes to spending plans than on long-term fiscal reforms.* Once the President has sent a budget proposal to Congress in February, Congressional Republicans will start work on their own budget proposals covering the next ten years. In addition to spending and revenue targets, these "budget resolutions" may also include instructions to various congressional committees to raise or cut spending or revenues. If Republican leaders choose to include these instructions in their budget blueprints, the so-called "reconciliation" legislation they produce would be immune to procedural obstacles and could pass both chambers of Congress with a simple majority, rather than the 60 votes usually required for passage in the Senate. In theory, this would allow Republicans to present the President with significant fiscal policy legislation on entitlement reform, tax reform, or the debt limit.* However, House and Senate Republicans have yet to agree on a single approach and may have difficulty doing so, in light of the fact that House Republicans have typically passed budgets that target cuts to entitlement programs, which some senators are unlikely to want to vote for.* With only 54 Republican votes in the Senate, there will be few Republican votes to spare and there is a clear possibility that the congressional budget process for targeting broader fiscal reforms will stop before it really even starts.

If so, this would leave Republican leaders to focus on more incremental changes, such as *further changes to sequestration. *The agreement to avert sequestration that then-House Budget Committee Chair Ryan (R-WI) and Senate Budget Committee Chair Murray (D-WA) reached in late 2013 lasts only through September 30, 2015. Unlike the onset of sequestration in 2013 that caused a reduction in absolute terms, the caps in 2016 would hold spending roughly flat in nominal terms, excluding emergency spending on overseas military operations. Both the White House and congressional Republicans propose defense spending above the caps, but disagree on how to offset the budgetary effects of doing so. *With a rise in geopolitical tensions and less pressure to enact further broad deficit reduction measures, any additional savings that can be generated through incremental policy changes could be used to modestly increase defense spending from its projected level in 2016.*

*5. Will Congress be able to enact tax reform?*

We continue to expect tax reform--particularly business tax reform--to become a more central focus of the political debate over the coming year though we see only a 25% chance that any type of reform is enacted into law in 2015. The disagreements are well known: how much to tax upper-income individuals, how to treat foreign corporate income, and which tax preferences should be eliminated. However, forward movement continues. Sen. Orrin Hatch, who will take over as Chairman of the tax-writing Senate Finance Committee in January, laid out some principles for tax reform in a report released December 11, and Rep. Paul Ryan, who will become House Ways and Means Chairman in January, recently indicated that he would be open to enacting tax reform only for business, after previously signaling that corporate and individual reforms would need to be considered together. President Obama has indicated that he expects informal discussions on reform to begin prior to the January 20 State of the Union Address, and it seems likely that some additional discussion of tax reform will be included in the budget the president submits to Congress in early February. That said, congressional Republicans have yet to agree on a unified approach on the issue, including whether any funds from reform can be diverted to infrastructure spending, as the President (and retiring Republican Ways and Means Chairman Dave Camp) have proposed.

6. Will Congress finally agree on immigration reform?

Immigration policy changes will take effect mid-year as a result of the President's executive actions on "deferred action" for unauthorized immigrants, but enactment of broader immigration reform legislation continues to look unlikely. The first test will come ahead of February 27, when funding expires for the Department of Homeland Security (DHS), which is charged with implementing most of the President's recently announced policy changes (the spending bill enacted last month funded all other agencies through September 30, 2015). Some congressional Republicans have proposed adding immigration-related legislation--increasing border security, for instance--to the upcoming spending bill. However, it is unclear whether such a bill would have sufficient support to pass in Congress, and it is even less likely to survive a presidential veto.

*7. Will Congress make changes to the Affordable Care Act?*

*Changes to the Affordable Care Act (ACA) look likely, but they will probably be limited to policies that do not fundamentally change the program. *The spending bill enacted in late 2014, for example, included a provision to restrict funding for one of the risk-sharing policies used to incentivize insurance companies to offer plans through the federal health exchanges. While a fairly minor change, it was nevertheless notable because so few substantive changes to the coverage provisions of the law had been made until then. Our expectation is that more changes will be enacted in 2015. The most likely is a repeal of the tax on medical equipment, which President Obama seems likely to agree to since it has little to do with the broader coverage expansion under the ACA and already enjoys a veto-proof level of support in the Senate. Legislation to apply the mandate on employers to provide health insurance only to employees who work 40 or more hours per week, rather than the 30 under current law, is also likely to come up for a vote in the House in the next few weeks as well, though there appears to be only limited support among congressional Democrats for such a change.

*A harder to quantify risk is the possibility that the Supreme Court could invalidate some of the subsidies provided through the Affordable Care Act. *The court has granted review of one of several cases (King. v. Burwell) challenging the legality of subsidies provided through federally-operated insurance exchanges. If the court rules in favor of the challengers to the law, enrollees in the 34 states that rely on federal exchanges would no longer be eligible for subsidies until states established their own exchanges. The Supreme Court’s prior ruling on the law in 2012 created a bifurcated system by allowing states to opt out of the Medicaid expansion, and a ruling against the current interpretation of the law could potentially have a similar effect on insurance subsidies through the exchanges. *The court is expected to rule by June 2015.* If the court restricts federal subsidies, some states may respond by establishing their own exchanges. However, some of the states that have opted out of the optional expansion of Medicaid under the law would probably also opt out of establishing their own exchanges. This prospect has led Congressional Republicans to begin work on their own proposal to replace the existing law in the event the court rules against the Administration.

*8. Will international trade agreements be approved?*

Trade Promotion Authority (TPA) and the Trans-Pacific Partnership (TPP) *appear less likely to us to be enacted this year than public rhetoric would suggest.* While it's a close call and finalization and passage of the TPP this year in Congress is still clearly possible, it also faces clear obstacles. First, while most congressional Republicans in principle support TPA--also known as "fast-track" authority, this allows Congress to approve but not modify trade agreements negotiated by the White House--the prospects for House passage are uncertain in light of sparse Democratic support and pockets of Republican opposition (to put the issue in perspective, Republicans barely managed to enact the last TPA law in 2002, and that involved granting additional power to a president from their own party). TPP still faces two important challenges as well. First, outstanding issues must still be settled, primarily the unresolved disagreements between the US and Japan related to the trade in autos and agriculture. Second, if the negotiations are not concluded in 1H 2015, a vote in Congress would probably not occur until September or later, when the upcoming 2016 presidential election season begins to make political compromises more difficult. That said, if the TPP negotiation itself can be concluded this year, implementation is likely to occur eventually (even if it is delayed until after the upcoming presidential election).

*9. When will the debt limit hit and how disruptive will that debate be?*

*The debt limit is likely to become binding between August and October and, while we expect Congress to raise it, this deadline poses the greatest potential for disruption, in our view.* Republican leaders in both chambers have signaled that they hope to avoid another series of fiscal showdowns like those that occurred in 2011 or 2013. In 2015, the only two significant fiscal deadlines that look likely to be relevant to broader financial markets are (1) expiration of federal spending authority at the end of FY2015 on September 30 and (2) the exhaustion of the bookkeeping maneuvers known as "extraordinary measures" that the Treasury will use to continue borrowing past March 16, when the debt limit is reinstated. It seems unlikely to us that another shutdown would occur in 2015, with memories of the 2013 shutdown still fairly fresh. Regarding the debt limit, the main risk in our view is not that Congress would intentionally block a debt limit increase, but rather that markets become uncertain about when and how the increase is enacted, in light of the changed composition of Congress and the possibility that congressional Republicans use a different process to raise the debt limit this time--the budget "reconciliation" process, for example--than they have in the past.* That said, we expect the final outcome to be the same as the previous debates: spending authority will be extended, and the debt limit will be raised.*

*10. Will Congress enact legislation affecting Federal Reserve policy?*

*Legislation to "audit" Fed monetary policy decisions is likely to pass the House again in 2015, but enactment looks less likely. *Last year, the House of Representatives passed by a vote of 333-92 legislation to repeal the prohibition on the Government Accountability Office (GAO) on auditing Federal Reserve monetary policy deliberations or transactions with foreign governments and central banks (GAO already has authority to audit other aspects of Fed activities). That bill would have required an audit of Fed monetary policy deliberations within 12 months of enactment, and would have made it possible for members of Congress to request additional audits in the future. The legislation passed in the previous Congress as well, but has never come up for a vote in the Senate, where it has tended to have less support: a majority of House members, mainly Republicans, were co-sponsors of the bill in the House, while only about 32 of 100 senators have their name on the legislation. While the bill would presumably win support from some additional senators, it is less clear whether it would have the support of 60 senators typically needed to pass, or 67 senators needed to overcome a presidential veto. That said, the issue looks likely to get a more thorough airing in 2015. Incoming Senate Majority Leader McConnell (R-KY) is a co-sponsor of Sen. Rand Paul's (R-KY) bill, and Senate Banking Committee Chairman Richard Shelby (R-AL), while not an official sponsor of the Paul bill has signaled support for greater Fed oversight. *While there is a clear possibility that Fed audit legislation could reach the President's desk, it appears much less likely that Congress would enact the more involved legislation introduced last year that would require the Fed to explain to Congress its deviation from the Taylor rule after each meeting.*

 

Source: Goldman Sachs Reported by Zero Hedge 6 hours ago.

House to Peg 40 Hours as Full-Time Workweek

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The House is expected to move to loosen the rules for when employers must offer workers health insurance by changing the health law’s definition of a full-time worker. Reported by Wall Street Journal 4 hours ago.
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