Journalism in the Heartland

A shout out to the Kansas City Star and the Salina (Kan.) Journal

Good journalism doesn’t just grow on the right and left coasts. Two papers in America’s middle show that good reporting is still possible in this Age of Decline. So we offer another kudos to the Kansas City Star for further exploration of the individual mandate—the requirement that every man, woman, and child in America must carry health insurance. Either they get it from an employer or government program, or buy it from a commercial insurer like Blue Cross. Although it’s almost certain to appear in any final legislation, most Americans still don’t know very much about the mandate.

Word is slowly seeping out, thanks to the Star and a few other outlets. In early September, Campaign Desk praised the paper for a story about the mandate. We did, however, note that the story could have dug more deeply into the subsidy question—namely, who would be entitled to receive government help, and who would have to shoulder the added costs of buying coverage on their own.

This time, the paper did just that. As part of its ongoing series examining key questions in the health care debate, the Star ran a Q and A about the individual mandate. The paper told people more about how the subsidies would work and how they would be paid for. And it leveled with Medicare beneficiaries, at least briefly, when it reported that the Senate plan “calculates savings in Medicare by lowering costs—which would almost certainly mean reductions in benefits, lower reimbursement rates to doctors and hospitals, or both.” The paper also examined the track record of health insurance mandates in Massachusetts, Switzerland, and the Netherlands, reporting:

Massachusetts has had to continually increase the fines—now more than triple what they were originally—to goad people to buy insurance.
The Star noted that compliance was greater in Europe than it was in Massachusetts, and that some experts say the compliance rate may be lower in the U.S. because of cultural differences. We encourage the Star to keep following the mandate as it winds through Congress, and to keep its readers abreast of the age rating question—how much more older people will have to pay in the individual market than their younger, healthier conterparts. This is not the time for editors to say “we’ve already done that story.”

Kudos to the Salina Journal and reporter Duane Schrag for showing that the government’s “more data, more transparency” mantra needs more critical scrutiny. Schrag stumbled on to an important story about the Centers for Medicare and Medicaid Services (CMS), the federal watchdog for the Medicare program and the country’s nursing homes. They may not be doing much watching.

After a colleague at the paper wrote about a local nursing home that was closing its doors instead of spending $100,000 to upgrade its sprinkler system, Schrag checked the government’s much ballyhooed site, Nursing Home Compare, which is supposed to give consumers information about bad facilities. Theoretically, consumers would in turn avoid those facilities, which would then disappear.

But the database showed that the local nursing home had no fire code violations in recent years. What gives here, Schrag wanted to know. After all, the state fire marshal had confirmed that the nursing home had been given a deadline to correct sprinkler system deficiencies.

What began next was an odyssey through bureaucrat speak—otherwise known as a government stall job. Yes, the very same government that says it’s for increased transparency. Initially, Schrag called CMS and got vague explanations about why the fire code deficiency did not appear in Nursing Home Compare. He wasn’t persuaded and continued to dig. He called the Kansas Department of Aging and found fire inspection reports showing deficiencies at the nursing home before it closed. That information was supposed to be keyed into a CMS-managed database using a system called Aspen.

Schrag then went back to CMS and demanded more answers. He said the only reason he got an explanation from CMS was because he had obtained hard copies of reports and on-the-record statements from the fire marshal’s office. Said Schrag:

I think it would be hard to exaggerate how squishy CMS was in its responses. I was given many answers that kinda, sorta explained it but really did not.

In the end, it turned out to be a software bug, and Schrag, being charitable, said that he believed that CMS officials might not have been aware of the problem. But “if they were,” he noted, “their capacity for obfuscation is formidable.”

There’s a moral in this tale: Don’t take all that government consumer data at face value. I criticized the usefulness of Nursing Home Compare in investigations done a few years ago for Consumer Reports. Now Schrag gives us more reasons to be skeptical.

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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.