I phoned Harvard pollster Robert Blendon for his take on the question of how we should cover success. It’s tricky, he said, but it’s also straightforward—amid all the goalpost-shifting and overpromising, the core purpose of the Affordable Care Act was to offer more people insurance coverage. That’s like using the all-important metric if you’re covering a medical study: Did the study achieve its end point, its goal?
The number to focus on, Blendon said, is “the share of uninsured in your state who were uninsured prior to January 1 and who have signed up for a policy through the exchange and actually paid the premium. As for Medicaid, the magic number in any state is how many new enrollees are in the program. It doesn’t matter whether sign-ups come from people previously eligible who’ve come out of the woodwork to enroll or from those who gained coverage under the expansion.”
If these numbers are going up in a big way, it’s a win for the law at a fundamental level (though there are important questions about narrow networks, out-of-pocket costs, stability of the plans on offer, and more). If they aren’t, it’s a loss. It’s really a simple calculation. Getting good numbers is the hard part. And since we still have only the most preliminary numbers, in most cases it’s hard to say with any confidence what they mean. The people expressing confidence are the partisans and advocates, many of whom have their minds made up before they see the numbers.
What can reporters do now? Call out those too-quick judgments, and show what they leave out. Get educated about the smarter predictions of long-term success or doom, and check back on how they’re holding up when important signposts pass. Talk to as many ordinary people like Gina as possible, insured and uninsured, about their experience with the law. And clue in readers and viewers that the story is far from over.