Welcome to Health Reform Watch, Sarah Kliff’s regular look at how the Affordable Care Act is changing the American health-care system — and being changed by it. You can reach Sarah with questions, comments and suggestions here. Check back every Monday, Wednesday and Friday afternoon for the latest edition or sign up here to receive it straight from your inbox. Read previous columns here.
At some not-too-distant point in the past, somewhere between the ball dropping in Times Square and a polar vortex blowing through the Midwest, America got bored with Obamacare. You can see it happening in this Google graph, which shows interest in the shiny new health-care law tapering off week by week as the law became less shiny and less new.
Reporter interest has dwindled, too. Here is a graph showing all the mentions of HealthCare.gov, Affordable Care Act and Obamacare. Enrollment in the insurance plans mandated by the new law and interest in the new law appear to have an inverse relationship.
"This is the most deadly week I can remember," said Bob Blendon, a Harvard professor whose work focuses on the intersection between health policy and politics.
"There does seem to be a little respite in the Obamacare wars," Kaiser Family Foundation president Drew Altman wrote in an e-mail.
Which feels a bit weird when you think about the fact that right now -- and for the first time -- Americans are testing out the law we've spent four years, two Supreme Court cases and one presidential election fighting about (not to mention a 17-day government shutdown). The law that has divided the country since it was passed in 2010 has its very first wave of sign-ups! So why isn't that garnering more attention?
Those who have watched other insurance expansions come and go offer two theories. One is that the coverage people signed up for is, by and large, working. And it's a whole lot less exciting to write about things that work as they're supposed to than things going haywire, as was the case with HealthCare.gov's initial rollout. This is the more optimistic theory of Obamacare boredom: The law is working, thus leaving us reporters with few screw-ups to write about.
"I could be cynical and suggest that with the web site mostly fixed it’s because the press and especially cable news has less to get whipped up about (if it bleeds it leads is not just a local TV news phenomenon)," Altman wrote.
"Maybe its a good sign," said Jack Hoadley, a professor at Georgetown University who has written extensively on the rollout of Medicare Part D. "We are a week in, about three or four business days, or even more for pharmacies, which is the first place you'd expect to see problems."
Another possibility is that the problems just haven't cropped up quite yet. Another difference between this health law and the prescription drug program is volume. Hoadley estimates there were at least 10 million seniors signed up for Part D when it started; with the Affordable Care Act, there are about 6 million. And Americans tend to fill prescriptions more than they go to the doctor (nearly 4 billion prescriptions were filled in 2012), meaning there was more space for interaction with the health-care system early on.
"This is the quiet they had in World War II before Poland was invaded," Blendon said. "Everyone is saying not much is happening, and then three months later things will emerge."
Blendon, Hoadley and Altman all expect another crop of stories about the health-care law to turn up at some point soon. They need what Blendon describes as a "focusing event": some particular moment, like the launch of open enrollment on Oct. 1 or the Dec. 23 deadline for purchasing coverage.
"It has to involve people, their great successes in what they got or if they have a real problem," he said. "There will be focusing events, like when premiums start coming out next October, that will probably capture a huge amount of attention."
Right now though, there's not much to focus on. There are some people getting coverage and a subset of those people testing it out. And a trip to a doctor's office doesn't seem to hit the threshold for for front-page news.
And, ultimately, this is what success looks like for Obamacare, if and when that happens. There will be no ticker-tape parades, front-page stories or skyrocketing poll numbers. It will be people using insurance and the press focusing on other things.
KLIFF NOTES: Top health policy reads from around the Web.
If you can't go to Cedars-Sinai anymore, is that Obamacare's fault? "The assumption that giving up access to hospitals like Cedars means giving up quality care is a powerful one. And it taps into deeply held anxieties about class and status. But while we might think we know what’s good for us medically, the relationship between hospital prestige and hospital quality is a lot weaker than it may seem. Health insurance is changing for some Americans because of Obamacare, but the changes are not the catastrophe many of them think." Jonathan Cohn in the New Republic.
A new report finds flaws in digitizing health records. "Although the federal government is spending more than $22 billion to encourage hospitals and doctors to adopt electronic health records, it has failed to put safeguards in place to prevent the technology from being used for inflating costs and overbilling, according to a new report by a federal oversight agency." Reed Abelson and Julie Creswell in the New York Times.
Get ready for a side of Obamacare ads with your Olympic curling. "The Obama administration is planning an Olympic-size ad blitz to push health coverage during the winter games next month. HHS confirmed Tuesday that it has bought advertising time in markets with high rates of uninsured people to air during the Winter Olympics, which run Feb. 7-23." Kyle Cheney and James Hohmann in Politico.