Bad Omens for Health Care

Mixed coverage of the latest premium hikes

The big news in health care last week was, of course, that average annual premiums for family coverage through employers reached an all-time high of $15,037, a nine percent increase from last year. While the major media outlets were scrambling to make sense out of such a steep rise, I was walking the streets of Lincoln, Nebraska, hearing from people about the troubles they had keeping their families insured. One thirty-five-year-old man, eager to dump his individual policy that cost too much and covered too little, explained that he hoped to get his family on his wife’s employer plan from an optical company, but that plan had been too expensive for them, even with the company paying part of the premium. The employer is now switching to a cheaper plan, although with higher cost-sharing. Still, he thought they might sign up for it this fall. The numbers out from the Kaiser Family Foundation confirmed his pain.

The premium increases made page one of the Lincoln Journal Star. I eagerly read the piece, which was a wire story from the Los Angeles Times. I waded through lots of numbers, alongside a predictable quote from Kaiser president Drew Altman, who said that “a big premium jump is especially tough for workers. It’s really tough for workers when wages are declining in real terms.” The Times amplified Altman’s point, reporting that health benefits have grown 168 percent since 1999—more than three times the rate of earnings growth and more than four times the rate of inflation. I looked for some fact that would tell me something about medical trend—jargon for changes in health care costs—declining, as it was earlier this year. Yet the Times story indicated the trend was up.

I recalled a Wall Street Journal story in late July that reported Americans are using fewer medical services, and that a drop in usage is showing up as insurers report their financial results. “People just aren’t using health-care like they have,” said WellPoint’s chief financial officer. “The recent drop in usage could make it difficult for insurers to argue that continued price increases are necessary,” the Journal concluded. In other words, premium increases should be moderating.

That point was made by my other sources, citing the Standard & Poor’s Healthcare Economic Composite Index from earlier this year. The index had posted its lowest annual growth rate in its six-year history. I searched the LA Times story for some explanation of this. No luck, although the story said twice that experts expect health expenses to slow next year.

So I checked other coverage for some kind of explanation of the apparent decline in medical trend and the huge premium increases, starting naturally with the Wall Street Journal, which did note that the increases come “despite a continued trend toward more limited use of medical services in the U.S.” An analyst from Goldman Sachs said carriers may have been conservative in their pricing, and overshot to some degree. Altman said the premium hike could be attributed to projections that consumers would use more health care services than they did, continued increases in health care prices, insurance company profits, and to some extent the new health reform law.

A story from McClatchy’s Washington bureau reported “profits continue to pour in for insurers who are spending less for services as covered workers postpone doctor visits and other elective procedures during the economic downturn,” citing a quarterly report from the Bureau of Labor Statistics. Reed Abelson and Nina Bernstein of The New York Times also acknowledged this downward trend, but made clear that hospitals and drug makers were charging more. They built their piece on large rate increases in New York. Aetna, for example, has asked for increases ranging from 8.9 percent to 53.6 percent. One Emblem Health policyholder got notice of a 270 percent increase. Ever since health insurers asked for huge increases in California last year, Campaign Desk has been urging news outlets in other states to tackle the subject, so it was good to see Abelson and Bernstein move their story in this direction rather than repeat an outline of Kaiser’s report.

The Washington Post’s story was puzzling. Nowhere did it report that average annual premiums had now reached $15,000—a curious omission indeed. Instead, the paper focused on workers getting less coverage, with half of those working for small firms facing annual deductibles of $1000 or more for their individual policies. “Employers seem to be turning to cost-shifting as an alternative to dropping coverage outright,” the Post concluded. As proof it laced its piece with boring anecdotes—one from an employer agonizing over making its workers assume greater costs and one from a patient who had a hard time paying them.

The NewsHour presented an elliptical discussion between host Judy Woodruff and analyst Susan Dentzer, who once reported for the NewsHour. Dentzer talked some about chronic disease driving up health care spending, noting that insurance isn’t the thing that’s really pushing up the increase right now. Rather, the underlying cost of health care is the culprit. Well, yes that’s true. Dentzer did say that there’s downward pressure on health spending and on insurance, and that could be beneficial. That was as close as the NewsHour came to explaining my disconnect problem. At the end, Dentzer said: “We will have to see what happens when subsidies begin to kick in and other things take effect to broaden insurance coverage.”

Woodruff brushed this comment off with a brief “a lot of factors at play.” But Dentzer’s remark cried out for explanation. Guess what will happen when millions of newly insured people seek medical care? They will use more services, which will increase spending. And what happens when insurers must cover everyone even those at death’s doorstep? What will happen to premiums to reflect the added risk to the carriers?

In sum, the reportage emphasized different points, plucking different quotes from Altman and different details from Kaiser’s report, which, if strung together, would have provided a terrifically illuminating picture of health insurance premiums. The price of insurance is key to whether or not health reform works. It’s a continuing story that involves tons of dot connection to get it right. Reporters almost need to think like litigators who must know where every piece of the evidence is buried.

As I combed through the coverage, I recalled another stat about health insurance premiums. As the health reform debate wound down, the insurance industry issued another of its studies designed to influence the outcome. This time it was a study from the consulting firm PricewaterhouseCoopers, which found that several provisions in the legislation would help drive up the cost of insurance. Its report showed that the cost of an average family policy, then costing about $12,300, would zoom up to $15,500 in 2013 under current law and to $17,200 if all the provisions were implemented. Reform advocates and the White House attacked the study, and the media reported almost gleefully that the industry had discredited itself. Perhaps the study wasn’t so farfetched after all.

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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. Tags: , , , ,