Health care signups pick up but still below expectations

Health and Human Services Secretary Kathleen Sebelius testifies on Capitol Hill in Washington Wednesday before the House Energy and Commerce Committee hearing on the implementation failures of the Affordable Care Act. .   (AP Photo/Susan Walsh)
Health and Human Services Secretary Kathleen Sebelius testifies on Capitol Hill in Washington Wednesday before the House Energy and Commerce Committee hearing on the implementation failures of the Affordable Care Act. . (AP Photo/Susan Walsh)

With time running short, the nation’s health care rolls still aren’t filling up fast enough.

New sign-up numbers Wednesday showed progress for President Barack Obama’s health care law, but not enough to guarantee that Americans who want and need coverage by Jan. 1 will be able to get it. Crunch time is now, as people face a Dec. 23 deadline to sign up if they are to have coverage by New Year’s.

That means more trouble for the White House, too, after months of repairing a dysfunctional enrollment website. Next year could start with a new round of political recriminations over the Affordable Care Act, “Obamacare” to its opponents.

The Health and Human Services Department reported that 364,682 people had signed up for private coverage under the law as of Nov. 30. That is more than three times the October figure but still less than one-third of the 1.2 million that officials had projected would enroll nationwide by the end of November. The administration’s overall goal was to sign up 7 million people by next March 31, when open enrollment ends.

Secretary Kathleen Sebelius assured Congress on Wednesday that “we are seeing very, very positive trends” now that HealthCare.gov is working reasonably well. She also announced that she’d asked the department’s inspector general for an independent investigation into contracting and management factors that contributed to the technology failure.

Yet the revamped federal website serving 36 states continues to have issues, and some states running their own sites also face problems. Oregon had signed up only 44 people as of Nov. 30.

That’s created stress and uncertainty not only for the uninsured but also for other people who now have insurance but are seeking to avoid an interruption in coverage in January.

Those who are trying to preserve their coverage include some of the more than 4 million people whose individual plans were canceled because they didn’t measure up under the law — as well as hundreds of thousands who are in federal and state programs for people with serious health problems, from cancer to heart disease to AIDS.

“Unless there is a proactive attempt to enroll these groups, you are likely to see a significant number of people whose coverage will lapse in January,” said Dan Mendelson, CEO of Avalere Health, a market analysis firm following the rollout. “That might not be a big deal, because they might not get sick, but some of them will.”

Democratic lawmakers say they are relieved the website is finally working, but some are not convinced the turnaround is complete.

“How confident I am? I’m hoping that we’re moving in the right direction,” said Rep. Eliot Engel, D-N.Y., after Wednesday’s Energy and Commerce Committee hearing. “And if we find the day has come and we find that it’s not what we had hoped, then I think there should be changes.” The law should be fixed, not repealed, he said.

Sebelius said at least 1.9 million people appear to be waiting just offstage to sign up. They’ve been found eligible to enroll but haven’t yet picked a plan.

If they’re all procrastinators who rush forward on Dec. 23, the website would be overwhelmed. It can only handle 50,000 people at a time.

The administration report found a total of 137,204 people enrolled in the states served by the federal HealthCare.gov by the end of November, up from 26,794 in October. The 14 states running their own websites enrolled 227,478 people, up from 79,391 in October.

California, which is running its own program, led the nation, with 107,087 sign-ups. New York, also running its own market, had 45,513.

Among states with federally run markets, Florida was the leader with 17,908 sign-ups. Texas, which has a bigger share of its population uninsured than any other state, had 14,038.

Nationally, an additional 803,077 people have been determined to be eligible for Medicaid, the safety-net program shaping up as the health overhaul’s early success story. That’s about double the number for October. Nonetheless, state Medicaid directors are reporting accuracy problems with information on prospective enrollees that the federal government is sending them.

Obama’s law uses a two-track approach to expand coverage for the uninsured. Middle-class people who don’t have access to job-based insurance can buy government-subsidized private plans. Low-income people are steered to an expanded version of Medicaid in states accepting it, though not all do. The website is supposed to be the portal to both kinds of coverage.

The administration had spent $677 million on website technology through the end of October, aiming for smoother operations, but with results still well short of perfection.

Republicans have called for Sebelius to resign and some Democrats have urged Obama to fire those responsible for problems, but the White House has given no indication of a house-cleaning. Sebelius’ request for an inspector general probe is a sign that there is more explaining to be done.

She seemed to be pointing a finger at the Medicare agency, which is part of her department and oversees Obama’s coverage expansion.

In addition to the inspector general review, Sebelius said she has ordered the Centers for Medicare and Medicaid Services to hire a new “chief risk officer” to make sure technology programs work as advertised. Like other major federal operations, the Medicare agency already has several senior tech executives.

HealthCare.gov went live Oct. 1, and consumers immediately got bogged down. A two-month program of fixes directed by White House troubleshooter Jeffrey Zients made the site more workable, resolving hundreds of software glitches and adding computer equipment to handle peak demand.

Zients also concluded that the technical problems were compounded by inadequate oversight and coordination.
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Copyright  © 2013 Capitol Hill Blue

Copyright  © 2013 The Associated Press  All Rights Reserved.

Mixed reviews for updated Obamacare web site

Unidentified client tries to sign up for Obamacare in Miami (AP/Pat Carter)
Unidentified client tries to sign up for Obamacare in Miami (AP/Pat Carter)

Counselors helping people use the federal government’s online health exchange are giving mixed reviews to the updated site, with some zipping through the application process while others are facing the same old sputters and even crashes.

The Obama administration had promised a vastly improved shopping experience on healthcare.gov by the end of November, and this is the first week for users to test the updated site.

Brokers and online assisters in Utah said Monday that three of every four people successfully signed up for health coverage on the online within an hour of logging in. A state official overseeing North Dakota’s navigators said he had noticed improvements in the site, as did organizations helping people sign up in parts of Alabama and Wisconsin.

But staffers at an organization in South Florida and a hospital group with locations in Iowa and Illinois said they saw no major improvements from the federal website, which 36 states are relying on.

Amanda Crowell, director of revenue cycle for UnityPoint Health-Trinity, which has four hospitals in Iowa and Illinois, said Monday that the organization’s 15 enrollment counselors did not see a marked improvement on the site.

“We had very high hopes for today, but those hopes were very much quashed,” said Crowell.

More than 1 million people visited the site Monday and 380,000 browsed the site by noon Tuesday. Thanks to the technology fixes, response times had dropped to 1 second and error rates were under 1 percent, according to figures from the Centers for Medicare and Medicaid Services.

“The system has been stable all day,” CMS communications director Julie Bataille said Tuesday, stressing they were still continually updating the site.

But Compuware Corp., which has been monitoring the site on thousands of personal computers around the country, said several states still had response times of more than 8 seconds Tuesday morning. Wisconsin’s average response time is over 18 seconds, according to the company.

Still, Michael Smith, a vice president for Compuware Corp., says the site’s operations have improved significantly. Their data shows 26 states had unacceptable response times in late October. He said the government is likely measuring response times from a data center with ultra-fast Internet speeds that are not reflective of real-world conditions on user’s regular computers.

Roberta Vann, a certified application counselor at the Hamilton Health Center, in Harrisburg, Pennsylvania, said the site worked well for her Monday morning but she became frustrated later when the site went down.

“You can get to a point, but it does not allow you to select any plans, you can’t get eligibility (information). It stops there,” she said. “The thought of it working as well as it was didn’t last long.”

In South Florida, John Foley and his team of navigators were only able to successfully enroll one of a handful of return applicants who came to their office before glitches started, including wonky estimates for subsidy eligibility. He worried about how they would fare with the roughly 50 other appointments scheduled later in the week.

Although frustrated, most were not deterred, he said.

“These are people that have policies going away, who have health problems. These are people that are going to be very persistent,” said Foley, an attorney and certified counselor for Legal Aid Society of Palm Beach County.

Despite the Obama administration’s team of technicians working around the clock, it’s not clear if the site will be able to handle the surge of applicants expected by the Dec. 23 deadline to enroll for coverage starting at the beginning of the year. Many navigators also say they’re concerned the bad publicity plaguing the troubled website will prevent people from giving the system another try.

Federal health officials acknowledged the website is still a work in progress. They’ve also acknowledged the importance of fixing back-end problems as insurers struggle to process applications because of incomplete or inaccurate data. Even when consumers think they’ve gone through the whole process, their information may not get to the insurer without problems.

In less than an hour Monday, Starla Redmon, 58, of Paris, Ill., was able to successfully get into a health plan with help from an enrollment counselor. Redmon, who juggles two part-time jobs and has been uninsured for four years, said she was surprised the website worked so well after hearing reports about its problems.

“Everything she typed in, it went through,” said Redmon, who chose a bronze plan and will pay about $75 a month after a tax credit. “It was the cheapest plan I could go with.”

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Contributing to this report were Associated Press writers Carla K. Johnson in Chicago; Chris Tomlinson in Austin, Texas; Catherine Lucey in Des Moines, Iowa; Peter Jackson in Harrisburg, Pa.; Scott Bauer in Madison, Wis.; James MacPherson in Bismarck, N.D.; Brady McCombs in Salt Lake City; and Phillip Rawls in Montgomery, Ala.

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Follow Kelli Kennedy on Twitter at twitter.com/kkennedyAP

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A critical week for Obamcare’s troubled web site

Working the website. (Reuters)
Working the website. (Reuters)

President Barack Obama and his HealthCare.gov website face another critical test starting this week, as Americans who have been unable to enroll in health coverage under Obamacare rush to a site that continues to face challenges.

A day after the administration said it met its weekend deadline for making HealthCare.gov operate smoothly for most users, networks of volunteer organizations are expected to resume enrollment activities after a long U.S. Thanksgiving holiday weekend, many of them with backlogs of would-be applicants waiting for access.

While saying HealthCare.gov had improved, Obama adviser Jeffrey Zients also warned that peak traffic volumes during the coming weeks could overwhelm it as consumers scramble to sign up before a December 23 deadline for coverage that begins January 1.

Enroll America, the nonprofit group that serves as a flagship for private sector enrollment efforts under Obama’s landmark healthcare law, said it planned to launch a new “Coverage is Coming” push, with more than 1,000 events over the next three weeks ranging from commemorations of World AIDS Day to community health summits and holiday toy drives, according to Enroll America spokesman Justin Nisly.

AIDS Alabama, a statewide non-profit organization that received a federal grant to help people enroll, had been relying largely on paper applications to sign people up until last week, when they noticed major improvement in the website, said Lauren Banks, the organization’s director of policy and advocacy.

One glitch the organization came across last week involved apparently incorrect information about tax subsidies, Banks said. For example, she said, people who appeared to be eligible for subsidies given their income levels were told they did not qualify.

Banks said the organization planned a radio campaign as part of a push to get people enrolled by December 23 so they could have coverage starting next year.

“We really are going to push super-hard the next 23 days to get people enrolled for the January 1st deadline,” Banks said.

The White House, which plans to hold public education events about the healthcare law throughout December, will hold a Youth Summit on Wednesday to help drive outreach and enrollment over the remaining four-month enrollment period.

The number who need coverage starting January 1 could include millions of uninsured Americans with preexisting health conditions and others who have been notified that their current health plans will expire at year-end because they do not meet Obamacare’s standards for benefits and consumer protection.

Zients said on Sunday a five-week emergency “tech surge” had doubled the capacity of the online health insurance portal that is crucial to helping people shop for insurance plans, while making it more responsive and less prone to errors.

STILL SCRAMBLING

The administration said the effort’s key improvement was to increase HealthCare.gov’s capacity to 50,000 simultaneous users, which would allow the site to handle a minimum of 800,000 users per day.

Officials acknowledged however that the site may not operate smoothly for some visitors even when the capacity has not been exceeded, and said they were still scrambling to repair and install functions at the crucial “back end” of the system that are needed to finalize enrollments with insurers.

“The real challenges remain, and that’s downstream,” said Rick Howard, research director for the technology consultant Gartner. “The real error rate will be in the billing transactions and how accurate the billing information is and how accurate the premium calculation is.”

Craig Garthwaite, a health economist at Northwestern University’s Kellogg School of Management, said Sunday’s announcement represented “dramatic progress,” but that the fixes mainly brought the website to “the baseline of what we need the site to be able to do.”

Officials are working to correct errors in the consumer enrollment data sent to insurers and have not built in several necessary functions, including one that will enable the government to pay federal subsidies to insurers on behalf of low-income enrollees. Without those functions working properly, HealthCare.gov and websites for 14 state-run marketplaces could have difficulty operating in 2014.

Even so, officials said, the site is dramatically better than when it was launched on October 1. It was overwhelmed by users in a debacle that fueled Republicans’ complaints about the Democratic president’s healthcare overhaul and threatened to make his signature domestic achievement a drag on Democrats heading into the 2014 elections.

The Zients team’s success could mark a more upbeat chapter for the Patient Protection and Affordable Care Act, also known as Obamacare. The law is designed to help provide coverage to millions of uninsured and under-insured Americans.

Longer-term questions remain about whether the program will be able to enroll the estimated 7 million people it needs by the end of March to be financially viable, including millions of healthy, young enrollees who are needed to keep the program’s costs in check.

“The issue is really the management capacity of the Obama administration,” said Robert Blendon, a Harvard expert on healthcare and public opinion. “If the website really is still working a week from now, it’ll make people feel at least they have the capacity to turn things around and move ahead.”

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Presumption: HealthCare.gov is on the mend

The beleaguered health insurance website has had periods of down times as as the government tries to fix the problems. (AP Photo/Jon Elswick)
The beleaguered health insurance website has had periods of down times as as the government tries to fix the problems. (AP Photo/Jon Elswick)

Computer crashes should be giving way to insurance coverage — if the government’s diagnosis of its health care website is correct.

The Health and Human Services Department released a progress report Sunday on its effort get the troubled HealthCare.gov website on the mend. Administration officials said the worst of the online glitches, bugs and delays may be over.

“The bottom line — HealthCare.gov on Dec. 1 is night and day from where it was on Oct. 1,” said Jeff Zients, the White House’s troubleshooter tasked with making the website function properly.

Yet officials acknowledged more work remains on the website, which made its national debut two months ago with hundreds of software flaws, inadequate equipment and inefficient management. Federal workers and private contractors have undertaken an intense reworking of the system, but some users might still encounter trouble.

How many problems are left? That’s the question consumers and lawmakers alike will be eying before the next crucial deadline: Dec. 23.

That date is likely to be the first big test of the repaired website, as consumers rush to meet the deadline so their coverage can kick in on the first of the year.

“There’s not really any way to verify from the outside that the vast majority of people who want to enroll can now do so, but we’ll find out at least anecdotally over the coming days if the system can handle the traffic and provide a smooth experience for people trying to sign up,” said Larry Levitt, a senior adviser at the Kaiser Family Foundation.

But, he added, HealthCare.gov is clearly working better than when it first went online. Its challenge now is to convince users who were frustrated during their first visit to give it another chance.

HealthCare.gov was envisioned as the principal place for people in 36 states to buy insurance under President Barack Obama’s health care law. But its first few weeks were an embarrassment for the administration and its allies.

Obama made Dec. 1 a self-imposed deadline to fix several significant problems and the administration organized a conference call with reporters Sunday to boast that 400 technical problems had been resolved. Officials, however, declined to say how many items remain on the to-do list.

Even with the repairs in place, the site still won’t be able to do everything the administration wants, and companion sites for small businesses and Spanish speakers have been delayed. Questions remain about the stability of the site and the quality of the data it delivers to insurers.

Obama promised a few weeks ago that HealthCare.gov “will work much better on Nov. 30, Dec. 1, than it worked certainly on Oct. 1.” But, in trying to lower expectations, he said he could not guarantee that “100 percent of the people 100 percent of the time going on this website will have a perfectly seamless, smooth experience.”

Obama rightly predicted errors would remain. The department reported the website was up and running 95 percent of the time last week — meaning a 1-in-20 chance remains of encountering a broken website. The government also estimated that pages crashed at a rate less than once every 100 clicks.

But the administration gave itself a passing grade for meeting its goal of allowing 50,000 people to log onto the website at one time and more than 800,000 people to shop for insurance coverage each day.

If true, it’s a dramatic improvement from the system’s first weeks, when frustrated buyers watched their computer screen freeze, the website crash and error messages multiply.

The figures — which could not be independently verified — suggest millions of Americans could turn to their laptops to shop for and buy insurance policies by Dec. 23.

The nation’s largest health insurer trade group said significant problems remain and could be a barrier for consumers signing up.

“HealthCare.gov and the overall enrollment process continue to improve, but there are significant issues that still need to be addressed,” said Karen Ignagni, president and CEO of America’s Health Insurance Plans.

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Associated Press writers Darlene Superville and Ricardo Alonso-Zaldivar contributed to this report.

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Follow Philip Elliot on Twitter: http://www.twitter.com/philiprelliott
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Copyright  © 2013 Capitol Hill Blue

Copyright  © 2013 The Associated Press  All Rights Reserved.

Is Obamacare’s web site finally up and running?

The troubled Obamacare web site (Reuters/Joe Skipper)
The troubled Obamacare web site (Reuters/Joe Skipper)

The errors are fewer, the pages load faster, and more people can log on at the same time to the government’s troubled health care website, according to Obama administration officials. Yet, like doctors overseeing a sick patient, they caution that more rehab lies ahead.

Amid all the problems with HealthCare.com, President Barack Obama set a deadline for Saturday for several significant problems to be resolved. The administration planned a conference call with reporters Sunday morning to give a status report.

The White House is hoping for a fresh start once the website is operating more smoothly and can accommodate up to 50,000 people logging on at the same time. A wave of bad publicity over the site’s failures has cast a shadow over the president’s signature domestic achievement.

Even with the repairs in place, the site still won’t be able to do everything the administration wants, and companion sites for small businesses and Spanish speakers have been delayed. Questions remain about the stability of the site and the quality of the data it delivers to insurers.

Administration officials said HealthCare.gov was “performing well” Saturday, the deadline set to have it working smoothly for the “vast majority of users,” after overnight hardware upgrades to boost server capacity. The deadline fell during a long holiday weekend when traffic to the site likely would have been slower anyway and at a level unlikely to expose new technical issues.

More hardware upgrades and software fixes planned for overnight Saturday were expected to further improve speed and reduce errors.

Obama promised a few weeks ago that HealthCare.gov “will work much better on Nov. 30, Dec. 1 than it worked certainly on Oct. 1.” But, in trying to lower expectations, he said he could not guarantee that “100 percent of the people 100 percent of the time going on this website will have a perfectly seamless, smooth experience.”

The nation’s largest health insurer trade group said significant problems remain.

Karen Ignagni, president and CEO of America’s Health Insurance Plans, said insurers have complained that enrollment data sent to them from the website include too much incorrect, duplicative, garbled or missing information. She said the problems must be cleared up to guarantee consumers the coverage they signed up for effective Jan. 1.

The first big test of the repaired website probably won’t come for another couple of weeks, when an enrollment surge is expected as consumers rush to meet a Dec. 23 deadline so their coverage can kick in on the first of the year.

Avoiding a break in coverage is particularly important for millions of people whose current individual policies were canceled because they don’t meet the standards of the health care law, as well as for a group of about 100,000 in an expiring federal program for high-risk patients.

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Associated Press writer Ricardo Alonso-Zaldivar contributed to this report.
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Copyright  © 2013 The Associated Press  All Rights Reserved.

White House claims HealthCare.gov website is on track

The beleaguered health insurance website has had periods of down times as as the government tries to fix the problems. (AP Photo/Jon Elswick)
The beleaguered health insurance website has had periods of down times as as the government tries to fix the problems. (AP Photo/Jon Elswick)

The Obama administration says it will meet its self-imposed deadline of fixing the troubled health care website so that 50,000 people can log in at the same time starting late Saturday. Yet questions remain about the stability of the site, the volume of traffic it can handle and the quality of the data it is delivering to insurers.

Round-the-clock repair work since HealthCare.gov went live on Oct. 1 has produced fewer errors, and pages are loading faster.

But the site still won’t be able to do everything the administration wanted, and companion sites for small businesses and Spanish speakers have been delayed.

Still, the White House hopes a website that is at least operating more smoothly after weeks of bad publicity about its troubles will mark a fresh start for Obama and the signature domestic initiative of his presidency, as well as give him a chance to salvage a second term that has been weighed down by health care law’s rough start and other issues.

Administration officials said HealthCare.gov was “performing well” Saturday, the deadline set to have it working smoothly for the “vast majority of users,” after overnight hardware upgrades to boost server capacity. The deadline fell during a long holiday weekend when traffic to the site likely would have been slower anyway and at a level unlikely to expose new technical issues.

More hardware upgrades and software fixes were planned for overnight Saturday to further improve speed and reduce errors.

“With upgrades last night and those planned for tonight, the team is continuing its ongoing work to make HealthCare.gov work smoothly for the vast majority of users,” Julie Bataille, communications director for the Centers for Medicare and Medicaid Services, said Saturday in a blog post. CMS oversees the health care website and is a division of the Department of Health and Human Services.

Additional data on the website’s progress was to be released Sunday by Jeff Zients, the website’s chief troubleshooter.

Obama promised a few weeks ago that HealthCare.gov “will work much better on Nov. 30, Dec. 1 than it worked certainly on Oct. 1.” But, in trying to lower expectations, he said he could not guarantee that “100 percent of the people 100 percent of the time going on this website will have a perfectly seamless, smooth experience.”

The nation’s largest health insurer trade group said significant problems remain.

Karen Ignagni, president and CEO of America’s Health Insurance Plans, said insurers have complained that enrollment data sent to them from the website include too much incorrect, duplicative, garbled or missing information. She said the problems must be cleared up to guarantee consumers the coverage they signed up for effective Jan. 1.

“Until the enrollment process is working from end to end, many consumers will not be able to enroll in coverage,” Ignani said.

The first big test of the repaired website probably won’t come for another couple of weeks, when an enrollment surge is expected as consumers rush to meet a Dec. 23 deadline so their coverage can kick in on the first of the year.

Avoiding a break in coverage is particularly important for millions of people whose current individual policies were canceled because they don’t meet the standards of the health care law, as well as for a group of about 100,000 in an expiring federal program for high-risk patients.

The law requires most people who don’t have health insurance to buy coverage or pay fines.

If HealthCare.gov seizes up again at crunch time, the White House may have to yield to congressional demands for extensions or delays in key requirements of the law, such as the individual requirement to get covered. Delaying the individual mandate, in turn, could lead to higher future premiums, since healthy people would no longer have an incentive to sign up.

For the system to be successful, the administration needs large numbers of mostly younger, healthy people to buy coverage to help offset the cost of insuring older people who generally use more health care services. Federal subsidies are available to those who qualify to help lower the cost of insurance.

As a result of the website troubles, HealthCare.gov, which services 36 states, signed up just 27,000 people in October, while the 14 states that run their own websites enrolled 79,000. The total of roughly 106,000 was far off the administration’s estimate that nearly 500,000 people would enroll within the first month of the six-month enrollment period.

When the website went live on Oct. 1, it locked up right away. Consumers could not get past a balky page that required them to create accounts before moving on to the next step. The system also did not allow window shopping, which experts said was a departure from standard e-commerce practices and contributed to overloading.

Conflicting explanations were given for the decision, and contractors working on the site told lawmakers there wasn’t enough time for testing before the system went live.

The White House initially put a positive spin on the problems, saying the system was overwhelmed by unexpectedly strong interest from millions of consumers. But after Obama tapped Zients, a management consultant, to troubleshoot the situation, officials acknowledged hundreds of bugs that needed fixing.

Obama said this week that despite opposition to the law by Republicans and others, and the past two months of problems that contributed , he believes it will work out in the long run.

“I continue to believe and (I’m) absolutely convinced that at the end of the day, people are going to look back at the work we’ve done to make sure that in this country, you don’t go bankrupt when you get sick, that families have that security,” Obama told ABC News. “That is going be a legacy I am extraordinarily proud of.

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Associated Press writer Ricardo Alonso-Zaldivar contributed to this report.

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Follow Darlene Superville on Twitter: http://www.twitter.com/dsupervilleap
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