Exchange Watch: Ohio insurance redux

A shout-out to The Plain Dealer

A few weeks ago, I wrote that the Ohio press—as well as some writers for national outlets—had fallen for the spin about projected insurance rates for policies to be sold on the Ohio exchange. Steve Koff, Washington bureau chief for the Cleveland Plain Dealer, sent us a note pointing out he had written a story that challenged the state insurance department spin. And indeed he did. Koff went where other reporters didn’t go, and he did it by being skeptical and asking questions—the stuff journalists are supposed to do.

To recap: In early June, the Ohio Department of Insurance noted in a news release that “insurers expect the cost to cover health care expenses for consumers will significantly increase. Based on a report released by the Society of Actuaries earlier this year, the Department estimates this increase is an average of 88 percent.”

Boy, was that some story, and the number became lede material. The problem was that the evidence state officials gave for their concern was slim. The insurance department had blurred the lines between the costs insurers incur to provide coverage with the actual premiums they will charge, and it was basing its assertions on projected rates that the department had not finished reviewing. Moreover, while the insurance department head, Lt. Gov. Mary Taylor, told reporters the new policies sold in the exchange would have “much richer” benefits, apparently she did not make crystal-clear that the old policies were different from the new ones in important ways—making any comparison silly at best, misleading at worse. Koff got the point.

Right off the bat, Koff put Ohio’s looming rate increase in perspective. “The debate is over a relatively slim portion of the insurance market, individual policies that are sold by agents or brokers to one customer at a time,” he wrote. Only about 350,000 people out of the state’s 10 million will be affected. In other words, this hoopla over whether rates go up or down is somewhat beside the point to most residents.

He also added some context to the 88 percent increase, pointing out that even if premiums are substantially higher, some people will get subsidies to help them swing the cost. About 60 percent of those buying in the individual market will be eligible for subsidies based on their income.

Koff really sliced through the insurance department spin when he challenged some specific examples that regulators trotted out. The department cited the example of a 64-year-old non-smoking woman in Franklin County; the monthly cost for her policy would purportedly jump from $131 to $594. Left out of the comparison were some important details: when Koff pressed for more information, it turned out the current premium was based on a deductible of $25,000. No wonder the price was so low! Another low-cost current policy came with a deductible of $6,000. Most of the credulous next-day coverage didn’t press the regulators on their assumptions, but Koff’s story was a stand-out.

Koff also got right that often-reported line about how much older and younger people will pay. The law limits what older people can be charged, and reporters often frame this in a way that suggests younger folks will be soaked. But Koff wrote carefully: “Older people are still likely to be charged more than younger people because of the differences in medical claims among age groups, but the law will limit the size of those price differences.” Surprise, surprise! Older people have more illnesses and will pay premiums that reflect that fact, even if the law limits what insurers can charge.

I chatted with Koff about his story, and it’s worth passing on his advice. “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,” he said. He said he also had a philosophical discussion with insurance officials, who argued people want these high deductible policies. Really? Koff said those choosing a $6,000 deductible are either fabulously wealthy, rolling the dice, or can’t afford anything else. Either way, of course, that’s vital information to have when trying to draw meaningful comparisons.

In covering insurance, Koff added, it helps to think of your own experience. Most reporters have had experience navigating deductibles, coinsurance, and out-of-pocket costs. As the healthcare narrative shifts from a political horserace to an old-fashioned consumer story, putting yourself in the shoes of someone buying these new insurance products—and asking, what would you want to know?—will produce much better journalism.

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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: , , ,