A few days ago I stopped by a medical clinic in Greenwich Village; the waiting room was abuzz with talk about health reform. How would the health law affect you, I asked Jane Stark, a medical secretary at the office. “I have to honestly say I don’t know,” she said. But she had been following the debate—pretty closely, too. “I was disappointed with Democratic senators because I felt they were protecting insurance companies making sure they can make a profit,” she said. “But can’t it be less profit?”
A patient waiting for a shingles shot was having trouble sorting out whether he was getting the $300 injection from an in-network or out-of-network doctor. If he waited for the in-network doctor to come in later in the afternoon, his bill would be cheaper; if he got the shot from an out-of network doc in the same office, he would be on the hook for the entire amount. As I listened to the conversation, I realized this kind of hassle would still be with us when health reform takes effect. For most Americans, not much will change.
So what will change? For months, Campaign Desk has been urging the media to parse the legislation as it progressed, and answer the “what’s-in-it-for me” question. Yet those stories were missing. Debra Kaufman, a California freelancer for entertainment publications, told me that a friend of hers had asked his friends, through Facebook, to each read fifty pages of the bill and then explain them for everyone else. Kaufman said he believed there was no place he could go for non-partisan information on health reform. Was it that the pols weren’t saying much about all those details, or were editors taking a wait-and-see position before subjecting their audiences to points that might not survive the final vote? It doesn’t matter now.
I dare say there’s a thirst for such information. Ian, a commenter on one of my blog posts this week, said that one of the best pieces about what’s in the bill was an interactive graphic from The New York Times. “Too bad it didn’t come along until after the bill was passed,” he lamented. The Times also published, in its print edition, hypothetical scenarios showing how insured and uninsured people would fare under the new law. To its credit, the paper published a similar story while the legislation was being debated. We have long urged media outlets to do the same.
After the law’s passage, the press was awash with what’s-in-it-for-me stories of varying caliber, sometimes geared toward specific audiences. Thomson Reuters zoomed in on the effects on Medicare beneficiaries—how the bill achieves Medicare savings, whether it cuts benefits, and so on. BusinessWeek went for the tax angle, describing how the bill would mean higher Medicare taxes for wealthy people, among other things. CNN explained some of the provisions affecting businesses.
In general, information imparted by the press—in what we hope will be just the first round of explanatory journalism about the law—has tended to fall into four categories: The Wrong; The Incomplete; The Vague; and The Speculative. Here are some examples of each.
The Wrong: The Star-Ledger ran a piece called “Health care plan has hearty list of taxes,” but then botched the details of the excise tax on the so-called Cadillac plans. The tax begins in 2018, not 2013, and affects those whose premiums exceed $10,200 for individuals and $27,500 for families, not $8,500 and $23,000, as the story reported.
The Incomplete: A Q-and-A by Kaiser News Service explained what would happen to peoples’ premiums, saying that the answer was hard to predict, and subject to much debate. Indeed it is. Kaiser reported that “sick people might face lower premiums than otherwise,” because insurers could no longer charge sick people more for coverage, and that older people could still be charged more than younger ones. Healthier people might pay more. “But the gap couldn’t be as large,” the story said. This left me puzzled. It was unclear what “the gap” was, and what they were comparing it to.
The insurers got a safeguard in the bill. They can charge older people three times more than a younger one for the same coverage in the same geographic area—a kind of proxy for medical underwriting, which will be prohibited. Why not level with readers and tell them just how much more they may pay? The more details the better, especially since most people don’t know much about the law.
The Vague: An early piece from McClatchy’s Washington bureau is an example of a less-than-helpful consumer story. It consisted of a bunch of points, staccato style. “Would require most employers to provide coverage or face penalties.” But what penalties? Are they the same for big and small businesses? Which ones get a tax credit? “Would provide subsidies for families earning up to 400 percent of poverty level, currently about $88,000 a year, to purchase health insurance.” But how much of a subsidy? What will families still pay out-of-pocket? Can they still afford coverage? You get the picture. Not a lot of meat here.
The Speculative: The Christian Science Monitor gave it the old college try with its “Health care reform bill 101” series, a brief overview of different aspects of the law. One story concerned the rules for preexisting conditions:
Insurers will no longer be able to exclude children with preexisting conditions from being covered by their family policy. For current policies, that means insurers will have to rescind preexisting-condition exclusions.
I wondered about the latter phrase, and wanted to know the source. It may be true, but that statement cried out for attribution. So I contacted a top official at one of the state insurance departments, who knows her stuff. “The law does not say the carrier has to let your kid in; there’s nothing specific about that,” she said. “I think the reporter was reading something into some of the talking points.” She explained that the Secretary of Health and Human Services may have the authority to do that, when all the rules and regs are written: “A lot of the details and interpretation will be left to HHS.”
And that’s precisely the point. Much of the law and how it will work will be determined by regulations written by the federal and state agencies. And here is where the press comes in. Even as the health story shifts to the legal challenges to the bill and the politics of the midterm elections, reporters must stay on top of the “what’s-in-it-for me” story. All those pesky, regulatory details, where the special interest lobbyists have a big say, can determine whether the law fails or succeeds—and what happens to consumers as a result.
Trudy Lieberman is a longtime contributing editor to the Columbia Journalism Review. She is the lead writer for CJR's Covering the Health Care Fight. She also blogs for Health News Review and the Center for Health Journalism. Follow her on Twitter @Trudy_Lieberman.