Shout-outs to the Kansas City Star and Kaiser News Service

For starting to fill in the blanks on health reform

For months we on Campaign Desk have been urging the media to pull back the reins at health care’s Kentucky Derby and start reporting on details instead of political intrigue. CJR’s town hall meetings have revealed that men (and women) on the street don’t have the vaguest notion of what all the Washington jabber means for them. So we were pleased when two old-fashioned print stories came our way that begin to tell people where they might fit into the insurance schemes that Congress concocts.

The Kansas City Star tackled the individual mandate, the central feature of reform bills that would require all Americans (with few exceptions) to carry health insurance one way or another. As part of a series examining key questions in the debate, the Star discussed the rationale for the mandate: requiring everyone to have insurance will force young, healthy people to buy coverage; insurers would cover sick people if everyone has to have a policy in order to spread the risk; mandating coverage will keep people from buying insurance only when they need it, which, of course, messes up company profits.

The story, by Diane Stafford, raised questions that need to be asked over and over before this thing is settled. What if people don’t buy the coverage? What about enforcement? Truman Medical Center CEO John Bluford told the paper: “I have difficulty understanding how we’d police the mandate. It’s near impossible. People will game the system.” And what about the penalties—which, for some, will amount to a tax increase for not complying with the mandate? The paper told its readers:

Legislative proposals call for penalizing individuals who don’t buy health insurance by fining them. Suggested penalties would take the form of an income tax penalty, either as a flat fee or a percentage of individuals’ adjusted gross incomes.

This raises another question. Will it be cheaper for someone to take a penalty and still go bare? One bill calls for a tax penalty of $750 per person.

I do have a quibble with the Star: the article didn’t say much about the subsidies that people will need if they have to buy their own insurance. The paper said there would be public subsidies for those who couldn’t afford insurance, and added that “complicated formulas would set those subsidy levels based on household incomes.” That newspaper shorthand doesn’t help people understand what help they might get, or whether that financial assistance will still leave them vulnerable to medical bankruptcy. Simply put, that language is too skimpy.

We hope the Star and other news outlets that will surely cover this topic in the next few months will check out the piece by the Kaiser News Service. The story, by KNS staff writer Jordan Rau, pulled out another strand of the individual mandate—how much will people have to pay for the required coverage? The answer is probably a lot. Rau got his hands on some cost estimates from the House Ways and Means Committee, which revealed that, under the House bill, even those people receiving government subsidies could still end up spending 20 percent or more of their annual incomes on premiums, deductibles, and coinsurance.

Rau reported that the financial burden could “grow substantially” if Congress devotes less money to subsidies, which could happen given all the pressure to mind the federal purse strings. Wow, I said to myself. Does that mean reform won’t bring much relief, and will subject folks to the perils of underinsurance? Elisabeth Arenales, director of the health program at the Colorado Center on Law & Policy, told KNS that people with high co-payments or high out-of-pocket expenses are virtually in the same position as those without insurance. In one of CJR’s town hall meetings, a woman made the same point.

Rau’s story addressed the affordability question—another hot button that the media need to push harder:

There is no consensus about how much people can afford to pay out of their pockets on health care before costs impinge on other core areas of their lives.

That will be the issue in the coming weeks, along with the question of who will be left out. “For those who thought there was going to be broad coverage, I just don’t see that as in the cards,” said Joseph Antos, a health economist at the American Enterprise Institute. “It’s too expensive and there’s going to have to be some paring back of that expectation.” And that leads to another question: Just what was the goal of health reform anyway?

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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.