Remember those seven tips I offered earlier this month for how to report on health insurance rate proposals? I have a couple of additions–in light of some unfortunate misreporting last week in Florida that was amplified via Twitter.
On June 24–three days before Florida’s rate filing deadline–the site Health News Florida (a regional health reporting organization designed to fill the lack of health news by more traditional outlets) published a story headlined, “No rate increase? Can it be?” The story, by Carol Gentry, began this way:
Something unprecedented may be unfolding in Florida’s individual health-insurance market: None of the nine companies that have filed their 2015 rate requests so far wants an increase.
No insurance company–including heavyweights like Florida Blue and United Healthcare–wants to raise premiums in Florida at all? Not even a smidge? Gentry herself seemed slightly unsure, as the caveats in the headline and lede showed. So, where did Gentry get this information? Florida’s Office of Insurance Regulation, where companies must file rate requests, “has put the requests online,” Gentry wrote. Gentry looked on the website and saw zeros listed as proposed increases (or, in some cases, saw decreases listed). No increases! Consumer advocates, Gentry wrote, “are cautiously optimistic that this is evidence that the Affordable Care Act is restraining prices for individuals who don’t get coverage through a group.”
The Hill picked up Gentry’s report and, in its own June 24 piece, called it “a blow to critics” of Obamacare who “predicted substantially higher premiums.” Both Gentry’s piece and The Hill‘s report (and the implicit or explicit Obamacare is working! takeaway) made the rounds on Twitter, including tweets or retweets by reporters from Kaiser Health News, ProPublica, HuffPost, The New Republic, and The Washington Post.
There were some skeptics on Twitter that day. “No premium increases, of any size, for any plan in any region of the entire state of Florida? Seems *too* low,” tweeted National Journal reporter Sam Baker. And, in a follow-up tweet: “Wouldn’t that mean every insurer in every county over-priced (kinda significantly) for this year?”
Kaiser Family Foundation’s Larry Levitt weighed in to say that the zeros Gentry saw on the OIR website may not actually mean “0% rate change,” they “may be because data is proprietary.” Levitt added that he was “holding off judgement until I can review rate filings in more detail. Their search tool is currently down for ‘maintenance.'”
When the OIR search tool came back online later that day, it came with this disclaimer: “Displayed rate changes may not fully reflect increases and decreases due to claims of trade secret.”
Turns out, skepticism was in order.
“It was too good to be true,” Health News Florida tweeted at 6pm that day, linking to Gentry’s walk-back story in which she wrote:
Some of the insurers listed “zero” instead of their real intentions in order to keep them out of the public domain, OIR’s spokesman Harvey Bennett said. It is legal for them to do that under a “trade secrets” statute, he said.
“It’s not [Gentry’s] fault, she did nothing wrong,” OIR’s Bennett told CNBC for its June 25 piece on the rate confusion. “This was the first time we were aware of the zeros there.” If true, you’d think a spokesperson for a state regulator wouldn’t want to admit that.
Florida has an “I-File” system where insurers post their rate requests directly onto the OIR website. The system apaprently was new to Gentry. She told me she had covered rate regulatory procedures for decades. “Last year when they posted rate increases, they were the actual increases,” Gentry told me. “There was no reason to think it wouldn’t be the same.” She added that she tried to talk to the health plans for her initial story but they wouldn’t talk and so she turned to a consumer advocate for help.
Gentry told me (and mentioned in her walk-back story, though notably not her initial piece) that she tried to reach someone at OIR to verify her interpretation of those zeros, but didn’t hear back and published the initial story anyway. “That was my mistake,” she told me, adding, “I had no reason to believe it was not correct.”
What about that small nagging doubt betrayed in her initial headline (“could it be?”) and lede (“may be”)? What’s that cliché about things that sound “too good to be true,” as Gentry’s walk-back headline put it? As Gentry said herself: she should have verified before she published. In her defense, Gentry isn’t the first reporter to have difficulties getting regulators to talk in a timely manner or at all (see Fred Schulte’s experience with CMS here), even to explain something basic like how a program works. When regulatory agencies don’t even want to talk about the basics, they’re opening themselves to misreporting and public suspicion.
In addition to the advice I gave two weeks ago for reporters on the rate story–not using averages, comparing like plans, comparing the same demographics, looking at formularies and narrow networks–this Florida screw up suggests two more:
Understand how your state insurance department posts and reviews rates for Obamacare policies as well as insurance sold outside the state exchanges. In Florida’s case, as we now know, carriers post their own rate requests and can use zeros to mean information is proprietary. Rate requests are never the final word on what insurers will charge–they are subject to review and approval–and reporters should never treat them as such. In Florida, reporters should approach these numbers with added caution, knowing that insurers write them in directly, apparently without OIR oversight. The rate filing process differs from state to state. Reporters need to get smart on how it works where they live.
Check to see what reports or other data insurance regulators have available on rate filings in their states. They may offer clues that could help you understand exchange policies. It turns out that Florida’s Office of Insurance Regulation has on its website a report called “For Consumers: Health Insurance Rate Changes June 2013—May 2014.” That document shows that companies in the past year have asked for some pretty substantial rate increases. The OIR told me that report did not include exchange policies and to contact the Department of Health and Human Services. The following report might be helpful there.
There’s one more thread we pulled out of this mess that is worth following. What’s the legislative backstory story behind those zeros and claims of trade secrets? Why did the state tell the OIR they can’t regulate the rates until 2016, as Gentry noted in her initial piece? Why are insurance carriers allowed this much leeway? That’s a story that Gentry and other Florida reporters need to investigate.
Trudy Lieberman is a longtime contributing editor to the Columbia Journalism Review. She is the lead writer for CJR's Covering the Health Care Fight. She also blogs for Health News Review and the Center for Health Journalism. Follow her on Twitter @Trudy_Lieberman.