The Headlines Tell Us Everything

The Congressional Budget Office weighs in on premiums

The release of the Congressional Budget Office’s report this week predicting how health reform might affect insurance premiums dished up something for everyone. Premiums could go up; they could go down; they could stay the same—and by the way, CBO’s predictions wouldn’t come true for another six or seven years. By then, the insurance industry could turn upside down; a cancer cure could spark tons of costly new technology; maybe the sky will fall in. Who really knows?

Certainly not the media, which seemed to be baffled about what, exactly, the CBO report was saying. Pity the poor news consumer who could have been totally confused by the divergent headlines.

“No Big Cost Rise in U.S. Premiums Is Seen in Study,” proclaimed the hed on a New York Times story. The Mercury News ran the Times story, but with this headline: “CBO says Senate health bill may cut cost for many.” USA Today saw it this way: “Report predicts level premiums for those insured through work.” The Atlantic went with this headline on its Politics blog: “CBO: Premiums Would Increase…And Cost Less.”

The Wall Street Journal described the report this way: “Some Health Premiums to Rise.” The NewsHour topped its online story with this headline: “CBO: Senate Bill Would Raise Some Premiums, Lower Others.” The PR Newswire ran a statement from the Blue Cross and Blue Shield Association with this: “CBO Confirms That Premiums Will Increase Under the Senate Healthcare Reform Bill.” The Web site picked up that story, same hed and all. The American Spectator’s blog used this hed: “CBO: Senate Health Care Bill Would Raise Premiums 10-13 Percent.”

So what exactly did the CBO say?

• The average premiums for each person covered in the new individual market would be about ten to thirteen percent higher in 2016 than they would be if current laws were to stay in effect. Average premiums for single people would be about $5,800 and $15,200 for families, compared with $5,500 and $13,100 under current law. Half of the people in that market would get subsidies to help pay those premiums—so their premiums would be lower. The rest would not, and their premiums would be higher—perhaps much higher.

• For employers with fewer than fifty workers, average premiums could increase one percent or decrease two percent. A few people whose employers would get a tax credit might see more of a reduction.

• For employers with more than fifty employees, average premiums might not change much, and could even be three percent lower.

• Premiums for family policies in both employer markets would still be in the $20,000 per year range, roughly the same price tag that causes panic among human resource managers today.

• The CBO hedged on its assessment of how premiums would actually affect families: “As in the nongroup market, the effects on the premiums paid by some people for coverage provided through their employer could vary significantly from the average effects on premiums, particularly in the small group market.” In other words, they could be higher, or they could be lower. No one knows for sure.

There you have it: The currently uninsured who will be required to buy coverage will face significant increases in the premiums they will pay; half of the new customers buying these individual market policies won’t qualify for government help; those over the line would pay more. Ironically, this is the group in whose interests the health reform battle has been fought, and arguably need just as much help paying for health insurance. If many of these folks could afford insurance now—at today’s price levels—they would have already bought it. Subsidies don’t change the underlying cost of the policies. Costs are just shifted to taxpayers, many of whom will get nothing from reform.

For the most part, the media stories with their wildly divergent headlines got the requisite quotes from politicians. Evan Bayh told The New York Times: “This study indicates that, for most Americans, the bill will have a modestly positive impact on their premium costs.” Mitch McConnell told the Journal: “A bill that’s being sold as a way to reduce costs actually drives them up.” But rather than padding their stories with political quotes, the press needed to look under the skin of the CBO report. The Journal, to its credit, did say that the report “painted a more complicated and uncertain picture” than the Democrats and the White House were presenting.

There wasn’t a lot of discussion about some of the CBO’s assumptions, and the important context that accompanied them. For example, the CBO said that its calculations for the individual market “reflects the expectation that many people would opt for a plan that was more expensive than the reference plan, to obtain either a higher amount of coverage or other valued features.” That hasn’t happened in Massachusetts, where nearly half the people who have bought a policy through the Connector shopping service chose the least expensive policies.

Nor did the CBO look at the increased spending on medical care that might occur when millions of new customers come to the health care system, using services that add to total medical expenditures. The CBO said it couldn’t precisely quantify those effects, but speculated that the impact on premiums “would probably be small.” Many experts say that adding thousands to the Massachusetts insurance rolls helped raise the price of care in the state. As Boston University health policy expert Alan Sager told Campaign Desk: “If we cover more people with no offsetting cost controls, we can expect Massachusetts health care to be even costlier than in 2004.”

There wasn’t much probing about what’s likely to happen to premiums before 2014, when the law will probably take effect. It’s a safe bet that they will rise. They are already back in the double digits for many employers—both large and small. I have to swallow an eleven percent increase this year for my own coverage from a retiree group plan. A memo sent to the staff at the Children’s Aid Society in New York noted that one of its carriers imposed a 21.9 percent increase, which will cost the nonprofit an extra $545,000 in 2010. Another insurer slapped the Society with a 12.6 percent increase. Who knows what will happen in 2011, 2012, and 2013, as the cost of care continues to rise?

And where was the reminder that Obama pledged that his health plan would lower premiums by an average of $2500 for a typical family? The CBO report certainly didn’t support that claim. Reporters need to add context like this if they want to help tell the real story about insurance premiums and health reform.

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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.