Health Care Flashpoints, Part II

The individual mandate—when journalism becomes a lobbying tool

Over the next few months, health reform will succeed or fail based on a few major flashpoints that will shape any new program, including the financing of health insurance and access to medical care itself. This is the second of a series of occasional posts that will explore these flashpoints, and how the media is explaining them to the public. The entire series is archived here.

At the end of May, a good story on NPR’s All Things Considered told of a Massachusetts auto mechanic who has refused to purchase health insurance, in defiance of the state’s mandate. Gary Cloutier says his business has gone down 40 percent in the past year, so he has chosen to pay a tax penalty rather than purchase insurance. He says he doesn’t have the money for coverage, even though the state says his $40,000 salary is large enough to afford an unsubsidized policy. “You’re forcing something down my throat and then penalizing me because I can’t afford it,” he complains.

We were pleased to see NPR explore a generally unexplored aspect of the Massachusetts reform law—those residents who are not complying with the mandate—and pick up on a point Campaign Desk made earlier in its ongoing series, “Health Reform Lessons from Massachusetts.” In the second installment, we noted that, despite the hype from the state’s health reform cheerleaders, only 37 percent of those affected by the law (that is, those who had to buy or change coverage) supported the individual mandate—a figure much lower than the 69 percent who generally supported the law. NPR observed that: “The problems with public acceptance in Massachusetts, a relatively wealthy state, could be even more daunting if an insurance mandate were stretched across the nation.”

Yes it could, and the press, which has become hyper-fixated on the public plan option, has virtually ignored any discussion of the mandate. A new poll from the respected Employee Benefit Research Institute (EBRI) found that while 68 percent of respondents support an individual mandate, only 22 percent support fines to enforce it. It would seem that people aren’t too keen on paying fines for not buying health coverage.

But rather than spark media interest in the truth about the Massachusetts mandate, we fear the story has morphed into a lobbying tool for the advocacy group Consumer Watchdog, which issued an e-mail this week with the intriguing subject line: “Meet Health Reform’s ‘Joe The Plumber.’” The message urged recipients to watch a short, “frightening” video distributed by Kaiser Health News if they “want to see what mandatory health insurance looks like without a public alternative to for-profit insurers.” The video shows Gary Cloutier rambling on about why he doesn’t buy mandated coverage. He doesn’t mention a public plan.

Consumer Watchdog is leveraging the individual mandate’s potential pitfalls to build momentum for the kind of public plan the advocacy group prefers. Perhaps that’s a decent strategy for advocacy, but it confuses the public about what’s actually at stake with either a public plan or the individual mandate.

It’s time for the media to ask the hard questions about an individual mandate. Los Angeles Times reporter Lisa Girion tackled the individual mandate this week, but her story was a garden variety, “why-to” story about how and why insurance companies will gain from all the new customers the mandate will add to their books. We’ll probably see more of those. OK. But now we need “how-to” stories that explain what a mandate will mean for all those millions forced to buy coverage.

To its credit, Consumer Watchdog began to ask some questions awhile back. Here are a few we suggest to get the conversation going:

• To whom will the mandate apply? Who will be exempt and how will they pay for their care?

• How onerous will the penalties be, and who will they hit hardest—a $45,000 worker who doesn’t think he can shell out ten grand to cover his family, or a $100,000 worker who wants to use his money for college tuition?

• How large will the subsidies be—enough to buy comprehensive benefits, or just a bare bones, high-deductible plan that can leave people underinsured?

• Can insurance companies charge whatever they want for premiums, or will there be rate caps and regulation?

• Will older people pay more for their coverage than younger people will pay?

• Even if insurers must offer policies to sick people, which may be the deal they’ve stuck with Congress, can they still “waiver out” or exclude coverage for a particular condition that poses a high claims expense? Would that mean people would have to buy a policy that may not cover the very condition they have, or face a penalty?

Campaign Desk will have more as the debate heats up and interest groups weigh in.

Has America ever needed a media watchdog more than now? Help us by joining CJR today.

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.