With the announcement late last week that eight million people had signed up for Obamacare, it seemed for a while a new wave of spin was upon us. From the president himself came this: Republicans “can’t bring themselves to admit that the Affordable Care Act is working.” And from Republican House leader John Boehner (via spokesperson) came this: “The White House continues to obscure the full impact of Obamacare.” What’s a reporter to do? Serve up the standard he said/she said mix by repeating the president’s proclamation that eight million sign-ups equals success, and then quote Republican naysayers sticking to their talking points? Simply point out the holes in the White House numbers—lay out what we still don’t know, a point made by much of the media coverage? Or, move on and plow new ground in anticipation of the next open enrollment this fall?
My vote is to use the plow and stake out the consumer and business stories that I’ve argued have often been eclipsed by the politics of the moment. Parsing last week’s coverage gave me some specific ideas of where reporters might dig now.
Who’s dropping coverage? The eight million sign-ups is not likely to be the real number, but finding out who’s scrapping their coverage will get us closer to an actual count. For me, the real jumping off point came from a story last week by Katie Kerwin McCrimmon, who writes for Health News Colorado. In a detailed piece discussing how the state’s exchange was about to tax policyholders to pay half of its operating expenses, McCrimmon reported that Cammie Blais, the exchange chief financial officer, estimates that as many as 20 percent of Colorado’s 124,000 enrollees had dropped their insurance for a variety of reasons, including nonpayment—a revelation important in other states. Up to now, we’ve had insurers estimating that 15 to 20 percent of enrollees had not paid their premiums, but now there’s a hard number from an exchange showing not only those who didn’t pay premiums but also those who dropped for other reasons.
Why are enrollees changing their minds? In the push to get enrollees to sign on the dotted line, sales pitches from the White House and its allies may have overpromised. In the days before the deadline, for example, Organizing for Action, a group that sprang from the president’s reelection campaign network, tweeted like crazy. One example: “For Jake, $15 a month on health care fits into his budget.” But, what did Jake have to pay out-of-pocket? Probably a lot! That wasn’t part of OFA’s sales pitch, which had the flavor of those shoddy sales practices that once drove state attorneys general nuts but now seem perfectly acceptable in the context of selling Obamacare. When people find out they aren’t getting what they bargained for and must pay high amounts of cost-sharing, buyer’s remorse can set in, and they junk their coverage. Reporters should find some of these people and talk to them. It’s a good way to advance the story of The Great Cost Shift.
Will those who signed up stay with their plans next open enrollment? A Gallup poll released last week found that 78 percent of the newly insured had incomes less than $60,000. That’s the group most likely to be pinched financially when they have to cough up an insurance premium, even a relatively small one. A few days before enrollment closed, I visited a navigator in Denver who was signing up Latino residents. She pointed to a $149 premium from one of the carriers, and told me “even this is too much for our families.” Many families view insurance as an expendable budget item when money is tight.
The president himself said premiums will go up as they inevitably do each year because the cost of medical care keeps rising. But instead of passing along speculation about how much—-double digit hikes or teeny ones—-why not go out and look at how families decide whether or not insurance fits into their budgets. Follow a family like I’ve done with Jeremy Devor in Salem, Illinois. And while you’re on this track, it’s a good time to examine how adequate the tax subsidies will be in the next few years, something few politicians want to discuss.