Please, ABC, Tell Us What This Story Is About

Another Obama flip-flop? Or just a plan that insurers will support?

A Dart to for a muddled mess of a story that may be interesting to Beltway health cognoscenti, but is confusing as the devil to the man (or woman) on the street. The story, entitled “Obama Health Plan Could Go In Clinton’s Direction,” seems to say that Barack Obama now supports an individual mandate for health care. During the primaries, Obama repeatedly said that he would not require people (except children) to have insurance, and blasted Clinton for supporting an individual mandate. On Friday, ABC reported that, at a National Journal health policy forum last week, Obama spokesperson Dr. Kavita Patel said that the senator “is willing to consider any sort of proposal that would bring together, not just the insurance industry but…the consumers themselves.”

Patel also told ABC News: “He has not said he is opposed to it. He has voiced his disagreement with having that be a part of his health-care plan last year. But he is not opposed to the idea itself.” There was no evidence the reporter pinned her down. However, the revelation sent the Obama camp scrambling to cover its tracks.

In the same post (in what ABC called an UPDATE), a campaign spokesman said that Obama “does not have plans to change his health care plan, which will achieve universal coverage.” Ah, there was that term again. “Universal.” Again, this raises the question of how Obama will achieve universal coverage without a mandate—an unlikely prospect unless there’s divine intervention.

What’s the real story? Who knows, but it didn’t take long for, a blog of the Republican National Committee to seize on the flip flop.

Okay, maybe readers who studied the ABC post long enough could understand the discrepancies in Obama’s position. But they probably had a hard time following another thread of the story. I did, and I know the subject pretty well. ABC dove into a murky discussion of insurance-speak on the mandate vs. no mandate question, citing an unnamed insurance industry leader’s suggestion that the industry would oppose Obama’s current plan because he has not explicitly tied a mandate to “guaranteed issue” policies, which would be available to everyone regardless of their health status.

The story didn’t say why this is important (basically, everyone must be covered so that there are enough premiums from healthy people going into the pot to pay for those who are sick.) Nor did it even get the term right, defining guaranteed issue as “the industry’s term for requiring patients to be covered without regard to pre-existing conditions.” Actually, it is legislation that requires insurers to offer guaranteed issue policies. In other words, they have to guarantee a policy to all comers. The term doesn’t mean that patients have to buy anything, it just means they can.

Instead of a clear explanation, we got this unclear quote from industry uber-spokeswoman Karen Ignani: “We’ve had the conversation about…guaranteed issue. But we are prepared to have that conversation in the insurance industry if the politicians are ready to stand up and say we are going to get everyone in.” Then, four graphs later, ABC speculates that Obama’s chances for insurance industry support might improve if he were to endorse a mandate.

Then, out of the blue, comes more speculation and a completely new thought: “Community rating, however, might still be a stumbling block.” The story quoted Richard Kirsch, head of a liberal health care coalition called Health Care for America Now, who said the group would accept an individual mandate only if the industry accepts both guaranteed issue and a system of community rating. The story’s explanation of community rating was way too brief to be anything but confusing. (For the record, community rating is a pricing technique in which everyone in a community—either a group of people between particular ages or those living in a particular geographic area—pay the same rate. It doesn’t matter whether they are sick or well. That used to be the way the old Blue Cross Blue Shield plans kept insurance premiums low before commercial insurers realized they could make big bucks by “experience” rating; that is, charging according to how sick a particular group of policyholders was.)

By this time readers would be lost in a tangle of insurance jargon. But the story moved on with a final thought: The industry isn’t supporting community rating at this time. Without more explanation, why would readers care?

ABC might have been trying to stir up a scoop about an Obama flip-flop, or some controversy about the industry. But it failed to do what the press needs to do more than ever—explain both the meaning of the candidates’ health care concepts and the way those concepts relate to their intended audiences? If anything, the piece shows that we can’t rely on the candidates—or the insurance industry—for that.

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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.