The Affordable Care Act, a.k.a Obamacare, is the law of the land, and the re-election of the president ensures that its far-reaching provisions will take effect as scheduled in 2014. What does that mean for journalists? It presents an opportunity—and an obligation—to deliver the clear and thorough reporting that was missing during the debate on the Act itself.
The politicians were not helpful then. Republicans demonized Obamacare, essentially a plan hatched in conservative think tanks and road-tested by Mitt Romney in Massachusetts. The Democrats hid the football, de-emphasizing the mechanics of the law in an effort to minimize the risk that the requirement to have health insurance or face penalties might not win votes.
In the end, the media covered the law’s long, slow passage like a sporting event, without much explanation of how it would shape people’s lives. Here comes another chance.
First, it’s important for the press to explain what the ACA is, and is not. It is not a radical government take-over of medical care or a national health insurance scheme. America still has a private insurance system, one that is not universal (some 20 million Americans will be left out). And this context—private insurance, private provision of care, and a medical establishment rapidly consolidating into vast corporate entities—offers a useful frame. It helps to think about reporting in terms of healthcare’s main realms.
The medical establishment What happens here will determine how much people pay for insurance in the new government-provided healthcare exchanges that the law puts in place, or, when employers provide coverage, what those employers will pay. If doctors and hospitals demand higher prices for services, insurers will pass on the costs. Evidence is mounting that consolidation in the hospital industry is boosting prices.
It’s debatable whether the cost-containment nostrums in the Act—like accountable care organizations, or more health-information technology—will do the trick. (The Center for Public Integrity has already shown how electronic medical records may do the opposite.) Other countries have lower healthcare costs largely because their governments push back against the power of medical providers. That’s not part of Obamacare.
The insurance companies The kind of insurance sold in the new exchanges should top the what-to-cover list. Will there be zillions of offerings with tiny differences that are too hard for ordinary shoppers to decipher? Are the rules for explaining them good enough? And the biggest questions: What will consumers get for the money? Will the cheapest—and perhaps least comprehensive—plans be adequate? And for people whose income qualifies them for government subsidies under the law to help them buy insurance: Will those subsidies be sufficient?
The employers They lobbied hard to keep the job of covering 160 million workers. But if costs rise, will employers, especially small ones, stay in the game, or will they dump their employees into the exchanges?
The people The primary focus of covering the implementation of the new law should be on how it affects ordinary Americans—not in two or three-graph anecdotes, but via deep, explanatory reporting. That means sitting at the kitchen table as people figure out how to insure a family on a budget, as Boston’s WBUR so ably did earlier this year.
The Affordable Care Act is a big deal, and it’s complicated. Readers and viewers need our help to see it clearly, both for their own situations and that of the nation. Here’s our chance.The Editors are the staffers of Columbia Journalism Review.