Health and Human Services Secretary Kathleen Sebelius has emerged as the person to watch as the Obama administration scrambles to implement health reform. The health care czarina’s words and silences offer clues about the way health reform will play out for millions of Americans. The rules, the regulations, and the compromises with health care stakeholders will determine the ultimate value of the reforms. What Sebelius said during the long reform debate usually signaled what was likely to happen; when she equivocated early on about the public plan, we knew Obama was prepared to junk that option. Campaign Desk will be watching what the secretary says, with an eye toward encouraging the press to do the same.
In a speech last week at the National Press Club, Health and Human Services secretary Kathleen Sebelius said that her process for implementing the new health reform law would be understandable to consumers: “As soon as we know something, we’re going to tell you,” the AP reported. Politico noted that the secretary said her department would become a “nationwide health insurance reform help desk.” Imagine fifteen million people calling Washington to ask whether they should buy Aetna’s or WellPoint’s policy.
It was kind of a blah-blah speech, and Kent Hoover, Washington bureau chief for Bizjournals, as much as said so, telling his readers “it was not a memorable speech” that was “delivered in a flat, Midwestern monotone.” According to Hoover, though, help desks weren’t really the big news. “The most memorable moment came during the question and answer portion of the address,” he wrote, when Madame Secretary strayed off message into controversial terrain. A questioner asked if she thought the age for Medicare eligibility should be raised to seventy. It’s currently sixty-five. That’s a super important question that will affect millions of Medicare beneficiaries in the years to come, and one that journalists haven’t tackled much.
Sebelius began her answer by talking about the deficit commission which the president has appointed to recommend changes to Medicare and Social Security—the so-called entitlements that many commission members claim are causing the nation’s financial distress and must be adjusted. Hoover reported that she “came awfully close to touching the third rail of politics,” noting that the secretary said that eligibility ages and benefits under those programs “will be a topic that will be robustly debated and discussed.” She added: “I think it is very appropriate. Everything should be looked at.”
Hoover interpreted the secretary’s response this way:
That’s the right answer from a policy perspective, but it could cause political problems for her boss. A headline writer might paraphrase her response as follows: “Obama open to raising retirement age; Medicare benefits could be cut.
That is indeed what journalists on the health and social welfare beats should be finding out. What is the administration thinking? What are they signaling? Is this another way to hasten the privatization of Medicare? What does the public think, especially people in their fifties who might be affected by a delay in benefit eligibility? Eventually, they might be able to buy insurance in the Exchanges that will be set up; if they can afford it, that could hold them over until Medicare kicks in. But they are also the ones who will pay more for their coverage—perhaps a lot more. Refresher here: The new health law allows insurers to charge older people three times more for coverage than they charge a younger person.
What the public thinks is important. If the press doesn’t keep on top of this, it may be easy to slip this one through without much outcry. The National Association of Insurance Commissioners (NAIC) recently surveyed consumers to test their knowledge of insurance, not a bad thing to do considering that they are going to be called upon to navigate a very complicated marketplace. The NAIC found that forty percent of Americans do not know the age when most people become eligible for Medicare (it’s sixty-five).
One thing we know from watching politicians is that they like to avoid the controversial stuff. Believe me, touching Medicare and Social Security benefits is controversial. Since the press thrives on controversy, this is one story it should examine.
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.