Advancing the healthcare story with consumer coverage

Two Midwestern dailies offer good models for local reporting

The Obamacare story is getting a bit ripe about now—we all know about the botched federal website, we’ve been through outrage and factchecks on the policy cancellation angle, and the national press is already telling us what the next round of political fights is going to look like.

But as I’ve been preaching since mid-summer, this is also a plain, old-fashioned consumer story. And this week, a couple daily papers in the Midwest offered some useful consumer coverage that’s worth noting.

Web tools for window shoppers

Steve Koff, Washington bureau chief for the Cleveland Plain Dealer, has been doing fine reporting on the health law for awhile now. On Wednesday, he came up with a consumer piece that tackled a consumer question that’s obvious, but has actually been hard to answer: What’s the best way to get information about how much policies will cost on Ohio’s new exchange?

Koff’s article starts with a point that echoes what we found recently after helping one woman shop for insurance: might be the place to buy insurance (once you can manage to create an account), but it’s probably not where you want to start shopping. If you haven’t registered, you can only get estimated premiums—and though they’re rough figures, they may be wrong. It may show policy options you’re not actually eligible for. And the site offers window-shoppers no links to the nitty-gritty stuff—deductibles, coinsurance, and doctor networks—you need to begin any serious consideration of policies.

Fortunately, Koff was able to suggest some better, though not perfect, alternatives. The free, privately-run site Health Sherpa delivers accurate, subsidy-adjusted premium prices that reflect consumers’ age, location, and income—though it doesn’t offer actual policy details, and the adjustment for smokers doesn’t quite work. (Koff has a good explanation for why that’s a hard problem for sites like this one to solve. You might say this is another one of those mostly unreported aspects of the Affordable Care Act that is now becoming known.) Several online calculators, including one from Kaiser and a couple from Ohio insurers, can help readers figure out whether they’re eligible for subsidies. An online brokerage was most complete of all, even including accurate smokers’ rates—except it only featured two of the seven subsidy-eligible insurers in the Plain Dealer’s Northeast Ohio market.

In other words, even if you know where to find the right tools, shopping for insurance on the individual market isn’t likely to be a low-hassle, one-stop excursion. Still, Koff’s piece did readers a service by pointing out what the right tools are. The article ends by flagging another estimating tool, created by The Plain Dealer’s Rich Exner, and urging readers to “come back and tell us about the results.” Crowdsourcing on this one is a pretty good idea!

Dealing with deductible shock

Over in Michigan, meanwhile, Detroit Free Press medical writer Robin Erb took a stab at explaining one of the undercovered facets of the ACA—not so-called “rate shock,” but “high deductible shock.” Employers and insurers have been shifting more costs to consumers for the last few years, so this isn’t strictly an Obamacare story. But it’s coming into focus now as pricing information about the new policies comes out, and many of the people shopping for insurance on the individual market—especially those who were fortunate enough to have coverage before—aren’t happy campers.

The core facts in Erb’s piece are that most of the 14 lower-premium “bronze” plans in the Freep’s region have deductibles of $5,000 or more for an individual, and $10-12,000 for a family. (A chart offers details on each plan’s deductible.) And at least according to HealthPocket—another one of those private sites that’s offering information on the new marketplace—deductibles for bronze policies nationwide are 26 percent higher than those for current policies. Erb interviews a local insurance broker who dubs these prices a reality check, and adds, “Most people for years didn’t know how much health insurance costs.” That includes Michigan workers, such as public retirees, who have gotten used to nearly-full coverage insurance that may not available to them anymore.

There were some opportunities for this story to be stronger. Erb speculates that the high deductibles might be driving low enrollment numbers; maybe, but it’s likely a combination of factors, and enrollment has been stronger in states with functioning websites. I also wish Erb would have gone into more detail on how out-of-pocket expenses are incurred and what counts against the annual cap—and noted that consumer costs could even potentially be much higher in 2014, when some plans will have separate caps on medical and drug benefits. The piece could have looked into what’s happening across the insurance marketplace—is cost-sharing increasing for auto workers, who once had the crème de la crème of health coverage? And I wondered about an anecdote featuring a former police officer: Was he old enough for Medicare, or had he taken early retirement?

Still, her article presents a good outline for others to follow. And it sketches out some strategies cost-sensitive consumers might consider—such as exploring whether subsidies will help them afford a “silver” or better plan, which will mean lower costs when they need to see the doctor; or even getting separate individual plans rather than a family plan, depending on what expenses you anticipate. That won’t make health insurance any less complex, but it might help some shoppers.

Related content:

Tales from Obamacare’s trenches

An Obamacare reality check from reporters on the ground

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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. Tags: , , , , ,