About Those Holes in Your Health Policy

As campaigns discuss the uninsured, the insured have their own problems

How ironic that the campaign has been marked by Democrats pushing for universal health insurance coverage just as the country is in the throes of a de-insurance movement. While more Americans have come to believe everyone should be covered, many of those who thought they had insurance are finding that their policies cover less and less.

Higher deductibles and co-payments and skimpier benefits have become the new coin of the realm in the insurance world, and people are writing their own checks for medical care once covered by insurance. In a front page Sunday story, The New York Times examined the new dig-deep-in-the-pocket phenomena and showed what people are up against. This is a story in which anecdotes, often overused in health care reporting, drove home the point—people, strapped for money, are paying more for medical services, and that often means going without. Shoving more costs onto the insured has serious health and financial consequences, as documented in a report issued earlier this year by the Employee Benefit Research Institute and The Commonwealth Fund.

The Times told of sixty-two-year-old Sage Holben, who lives paycheck to paycheck from her $40,000 a year job. Her union agreed to freeze wages in 2003 in a tradeoff to protect health coverage, but her coverage is slipping away anyway. She has put off eye exams crucial for good diabetes care and she doesn’t monitor her blood sugar regularly because the supplies she needs cost too much.

Whose problem is this? The same day the Times piece ran, the Chattanooga Times Free Press quoted Tennessee Congressman Lincoln Davis saying that any reform should address wellness incentives and preventive care. “When you look at Tennessee and obesity and adult-onset diabetes, we’re not being responsible for ourselves, and we can’t expect taxpayers to be,” he said. I don’t know what caused Ms. Holben’s disease and neither does the congressman. But her predicament does say something about an unwanted outcome of the de-insurance movement that the media have not touched: if taxpayers shouldn’t pay for care that diabetics need (as Davis suggests) and insurance doesn’t cover it, what is she supposed to do?

Nor have most of the media critically examined another irony of the march to de-insure America. Both the Clinton and Obama plans would force people to buy coverage from private insurers that are more than ready to sell relatively low-cost policies that come with relatively low benefits—and such high cost-sharing that formerly uninsured policyholders may end up paying potentially large medical bills out of pocket anyway. USA Today took a hard look at these bare-bones policies, which go by the technical name “limited medical benefit plans.” Mila Kofman, who is the top insurance regulator in Maine, told the paper “I don’t believe that something is better than nothing when what you have doesn’t work for you when you’re sick.”

John McCain’s plan, meanwhile, would undermine the very idea of employer-provided health insurance, and require people to seek insurance on their own in the market, where the de-insurance movement lies in wait. This too bears deep scrutiny from the press.

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Trudy Lieberman is a longtime contributing editor to the Columbia Journalism Review. She is the lead writer for The Second Opinion, CJR's healthcare desk, which is part of our United States Project on the coverage of politics and policy. She also blogs for Health News Review. Follow her on Twitter @Trudy_Lieberman.