Morning Jolt
. . . with Jim Geraghty December 30, 2013 This Was an Awful Year with Unmet Expectations! Fire the Coach! Happy Black Monday! Yes, today's the day that all across the country, institutions that promised their supporters and fans thrilling success, which have spent years of effort and millions upon millions of dollars, assess the performance of the past year and conclude that the fumbles, the stumbles, the bad judgments, the over-optimistic assessments, the bad planning, and the overall incompetence can no longer be tolerated, and fire the guy who's been calling the plays all year long. 
Er, no, that's not the person I meant . . . 
Um, no, not him either . . . 
No, not her either. Although it is rather striking that Sebelius has outlasted Mike Shanahan. Amanda Carpenter: "Seems like the only accountability in D.C. is in sports." Actually I meant NFL teams, but I can see why you might be thinking along those lines. The good news for Obamacare: More than a million people have signed up for private plans! Maybe even 2 million once the state exchanges report their figures! (EnrollMaven.com puts it at 1.85 million.) The bad news: That puts them at about 26 percent of their enrollment goal of 7 million, with half the enrollment period passed. Another little snag: "4 million-plus: People whose individual plans were canceled because the plans didn't measure up under the law. The government changed rules to allow substandard plans to exist for another year; it's not known how many canceled policies will be revived. Another rules change allowed cancellation victims to sign up for bare-bones catastrophic coverage." That's from the AP; other estimates put the number of newly uninsured at 5 million.
So . . . we're still ending 2013 with more people having lost their insurance than gained it.
Jonathan Cohn, usually one of the law's biggest cheerleaders, is refreshingly direct about the problems that may lie beyond the figures indicating an increased rate of applications: It doesn't tell us whether these people getting private (or public) coverage had insurance previously—or, if they had insurance, how much they were paying for it. It doesn't tell us how many of these people have actually paid premiums, which is essential for coverage to take effect. It doesn't tell us whether insurers have proper data on these people or what kind of access and protection the new coverage will give. It doesn't tell us how many of the enrollees are in relatively good health or how many are in relatively poor health—or how that mix will affect insurance prices going forward. In addition, the numbers do not appear to match the Administration's own targets. According to internal projections, later reported by the Associated Press, officials expected more than 3.3 million enrollments by year's end, with about 1.8 million of those coming through the federal website. For all of those reasons, and a few others, it's premature to say Obamacare is meeting expectations. Say, will all of these new insurance holders be able to see doctors? Preventive care is one of the essential health benefits that all insurance plans must now provide, prompting some concern that new patient volume could overburden primary care offices similar to what happened in Massachusetts in 2006, when the state's mandated health insurance law went into effect. Wait times to get an appointment at primary care physicians' offices grew significantly, and they have remained high, according to the Massachusetts Medical Society. Many offices have refused new patients. Wait, just how bad are the wait times in Massachusetts now? Pretty darn awful: The 2013 study shows wait times for new patient appointments with primary care physicians remain long in the Commonwealth, with the average time to see a family medicine physician at 39 days (down from 45 days in 2012) and the average wait time to see an internal medicine physician at 50 days (up from 44 days in 2012). The study also showed that only about half or less of primary care practices – 51% of family physicians and 45% of internists - are accepting new patients in 2013. For pediatrics – primary care for youngsters up to age 18 – the average wait time was 25 days, two days longer than last year, with 70% of pediatric practices accepting new patients, a decrease of 2% from 2012. Perhaps most significantly: "The percentage of family physicians accepting new patients has dropped 19 percent over the last seven years; the percentage of internists accepting new patients has plunged 21 percent over the last nine years; and the percentage of pediatricians accepting new patients has fallen 10 percent over the last four years." At what point does a shortage of practitioners accepting new patients amount to de facto rationing of care? More bad news: The Affordable Care Act requires insurers to cover mental health care just as they do physical care, but a new study shows only half of psychiatrists accept insurance. That means access to care for the millions of people with depression, post-traumatic stress disorder and other mental health issues may be limited to those who can pay for treatment out of their own pockets, despite the law. From 2009 to 2010, 53% of psychiatrists accepted insurance, compared with 89% of all other physicians who did, said Tara Bishop, associate professor of public health and medicine at Cornell Medical College. She looked at data from the National Center for Health Statistics and released her team's findings in The Journal of the American Medical Association. . . . nothing in the law requires psychiatrists to take insurance, and after years of low rates, administrative hassles, extra steps not required of other physicians and a plethora of patients willing to pay cash, many psychiatrists have simply opted out of insurance programs. Next time some lefty tells you how uninformed Fox News viewers are, remind them of this uncomfortable statistic: 81: Percentage of young Democrats who approve of the Affordable Care Act, according to December poll by Harvard's Institute of Politics. 58: Percentage of young Democrats who approve of "Obamacare." Ahem. "Obamacare" and the "Affordable Care Act" are the same thing.
As 2013 Closes, Obama Faces Hazards, Handicaps, and Unplayable Lies Andrew Malcolm transcribes the president's weekly address to the nation: That's the same spirit of giving that connects all of us during the holidays. So many people all across the country are helping out at soup kitchens, buying gifts for children in need, or organizing food or clothing drives for their neighbors. For families like ours, that service is a chance to celebrate the birth of Christ and live out what He taught us — to love our neighbors as we would ourselves; to feed the hungry and look after the sick; to be our brother's keeper and our sister's keeper. And for all of us as Americans, regardless of our faith, those are values that can drive us to be better parents and friends, better neighbors and better citizens. And here's how the president has connected with that spirit of giving in recent days: President Obama is back on the golf course at Marine Corps Base Hawaii as he enjoys his annual Christmas vacation. The president's motorcade left their rented Kailua vacation home for the Kaneohe Klipper course just after noon today. It's the fifth round of golf for the president since he arrived late on Dec. 20. The president last golfed on Thursday at the tough Koolau Golf Club. He played the Marine base course on Monday and on Dec. 21, the day after he arrived in his birth state. He's also played at the Mid-Pacific Country Club in Lanikai. Meanwhile, over in the NFL . . . Eric, a donor to NR, urges me to "acknowledge that the NFL exists outside the walls of Gotham (no, talking about New England does not count either -- do you really want to be like Peter King??) and west of the Mississippi!" He's a Broncos fan, so he's probably got his Super Bowl tickets lined up already. Peyton Manning is somehow playing the best football of his career at age 37, with his neck held together with duct tape; I only hope that his recent success convinces some company to put him in its television commercials. - Is there room on the Seattle bandwagon? Besides enjoying my visit to that city last fall, I'm impressed with how the city -- for a long time something of a professional-sports afterthought, beyond Steve Largent, the 2006 Super Bowl, Ken Griffey Jr., and Ichiro Suzuki -- has turned into the loudest and toughest place to play in the whole NFL. It's as if every fan comes to the stadium just for the chance to yell at the rest of the country to pay attention.
- Chiefs coach Andy Reid broke the hearts of Steelers fans by sitting nineteen of his twenty-two starters in Sunday's game against San Diego. The Kansas City Practice Squad actually played the Chargers to a tie at the end of regulation; once in overtime, Reid sat his backups and brought eleven hot dog vendors out of the stands to finish the game.
- How did the New Orleans Saints, who always look phenomenal when they're on national television (except when they played in Seattle) end up being just the sixth seed? I still lean towards the idea that the NFL playoffs should consist of the six best teams in each conference, or perhaps even the best twelve teams in the league, regardless of conference. As it stands now, the 12-4 Forty-Niners will be traveling to Green Bay to play the 8-7-1 Packers, who get the home field game because they won the NFC North. Meanwhile, the 11-5 Saints will travel to Philadelphia to play the 10-6 Eagles.
- How perfect is it that the Cowboys miss the playoffs by losing on the last Sunday night game of the season on a late interception . . . from a quarterback who isn't Tony Romo? Maybe it's something in the water there.
- One East Coast bit of gloating: The Miami Dolphins, competing for a playoff spot in their final two games, scored seven points, on the road at Buffalo and at home against the Jets.
ADDENDUM: Hey, who saw this coming? "Syria's failure to move part of its chemical weapons arsenal to a Mediterranean port has prompted warnings that the disarmament deal struck with the country is falling seriously behind schedule. The deadline was the first key milestone under a UN Security Council-backed deal arranged by Russia and the US that aims to wipe out all of Syria's chemical arms by the middle of 2014." Why, it's almost as if the Obama administration signed on to that deal in order to avoid getting into an unpopular war and doesn't really care what happens in Syria now!
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