Last week a story appeared on the website of the Association of Health Care Journalists that reported on a panel that the organization held in mid-June. It was for journalists in Philadelphia and southern New Jersey, and it aimed to help them better cover the inauguration of Obamacare. Good idea! Journalists, as CJR keeps reporting, need all the help they can get on a complicated assignment.
What troubled me, though, was the advice of one of the panelists, Karen Pollitz, identified as a senior fellow at the Kaiser Family Foundation (FYI, she previously was the director of the Office of Consumer Support, part of a new center at the Department of Health and Human Services set up to implement health reform). Pollitz apparently offered some good story suggestions, like comparing current insurance plans with ones sold next year by looking at price, coverage and so forth. Nothing wrong with that idea, though it’s very difficult without lots of help from actuaries, since Obamacare requirements change the policies. Comparing apples and oranges is never easy, so maybe it’s not the best comparison to make. It’s better to concentrate on comparing products people will actually buy next year, one against the other, and helping readers learn to do that.
Where she really went off track, though, was her suggestion that journalists become volunteer Certified Application Counselors and, as the website post put it, “help the uninsured get through the application process.” “‘Become your ACA block captain,’” she said. “That way you can ‘see what kind of issues they’re coming up against, how well the system is working, or not.’”
Wait a minute! You’re telling health reporters to help enroll people in order to learn what the process is all about? The AHCJ reporter covering the panel might have questioned that remark, which crossed a big line, a point made by Mark McCarty @MedDeviceMark on Twitter to AHCJ president Charlie Ornstein and me. (Full disclosure. I am a past president.) “So you’re helping reporters in an effort to help people enroll? Is that really a journalist’s job????”
It is not. That kind of volunteerism may be fine for a food critic or a cop reporter but not for a health writer. Ornstein replied, “If you read the articles, that’s not the goal at all. Better coverage is the goal.” There are other routes to better coverage than Pollitz’s advice.
Reporters covering the opening of the exchanges this fall and beyond do have to understand how insurance works and how it is priced, and also understand the sales process and be on the lookout for shady sales practices. Secretary of Health and Human Services Kathleen Sebelius has set an ambitious goal of 7 million people enrolled by the end of next March. With that kind of target, the question can be fairly asked: Will people get all the information they need to make good decisions, or will they be pressured to just buy something? It is indeed the journalists job to help people through a complicated new healthcare insurance system. But there are ways to do that without becoming a helper for the Obama administration.
So how do reporters get to that better coverage Ornstein says is the goal? As we’ve reported in the new issue of Columbia Journalism Review and on CJR.org on The Second Opinion, the implementation of Obamacare is now a consumer story, requiring good old-fashioned skills and a lot of legwork. Here are some suggestions.
Use a case study. As we show in the magazine piece, “Open Wide,” you can do a lot of explaining by working with a real live person who is trying to find the right insurance at a price they can afford, as we did with Carol, a Philadelphia woman who contacted us about her premium increase from Aetna. Through several interviews and emails, we zoomed in on her predicament and discovered she may be eligible for a policy in the Pennsylvania exchange. I will follow her, too, through the process of selecting one—as she learns the uncertainties she’ll face and tradeoffs she must make. Carol, though, will do the work and make the choice.
Interview a good actuary or professor of insurance. It’s helpful to know the nuts and bolts of insurance to understand the questions shoppers will ask. And there will be many. Background interviews are a good idea.
Visit places of enrollment. Here you can observe over several days, if you can, how navigators and assisters actually counsel shoppers. It’s the old journalistic skill of observation we’re talking about here. I suspect there will be wide variation in the quality of the counseling, but to separate the sheep from goats, you have to know what’s good advice and what’s not. A few years ago, I received a note from a Medicare counselor in Ohio urging me to tell reporters to visit their local insurance counseling offices, which help Medicare beneficiaries through the thicket of choices they must face every year. Listen to what seniors must sort through to make a choice, she said. Reporters will get an earful. It will be a similar situation for the new buyers coming into the exchanges, and the counselor’s advice is more relevant than ever.
Put yourself in the shoes of a shopper. Steve Koff, Washington bureau chief for the Cleveland Plain Dealer, sniffed out the insurance spin from the Ohio insurance director by doing just that. “I’ve covered enough of this stuff to know if you’re looking at a policy with a really, really low premium, you have to question what it is.” In other words, you get what you pay for. And that, dear colleagues, is a good place to start your reporting on the state insurance exchanges.
Follow @USProjectCJR for more posts from Trudy Lieberman and the rest of the United States Project team, including our work on healthcare issues and public health at The Second Opinion. And for Trudy’s resource guide to covering the ins and outs of buying insurance on the state exchanges, see Open Wide, from CJR’s new July/August issue.