Behind Oregon’s failed health insurance exchange is a story of spin that in some ways mirrors federal officials’ management of news about the Affordable Care Act from its passage in 2010 to the present day. For the last three years the Oregon Health Authority and Cover Oregon, the state exchange, played a PR game, hiding myriad IT and contract disputes with Oracle, their contractor; relentless bureaucratic backbiting; and bad business decisions. Gov. John Kitzhaber has claimed he didn’t know what was going on until after the exchange opened, while those tasked with building the site ignored internal warnings, shrugged off oversight reports, and misled the public, reassuring themselves and the press that all was well.
We know this now because, when problems became apparent just before the state exchange was supposed to go live on Oct. 1, reporters in the state press corps started to read between the lines of official pronouncements and began their own investigations, which cracked the story wide open. We didn’t know it sooner because, for months before that, both legislative and media watchdogs were slow to question the official spin. There are lessons for journalists in both the strong recent reporting and the weaker early coverage.
Oregon has often been hailed as a pioneer among states in healthcare reform—though past efforts have sometimes failed to live up to their billing—and the state was supposed to be a leader in this transformation, says Diane Lund-Muzikant, executive editor of The Lund Report, a Portland-based site for health professionals. This time the state had high ambitions and grand plans for a seamless, integrated online system, a model for other states where Medicaid recipients, the uninsured, and small businesses could sign up with ease.
The state got national buzz for its ambitious good-government approach, but “Oregon tried to take on too much,” Lund-Muzikant said. Unlike in some other states, there was mostly widespread support for the goal of expanding coverage. “I think people believed in the democratic ideal that people should have insurance,” said Lund-Muzikant, and the media and others were slow to question the official optimistic pronouncements.
Whether it was subtle self-censorship, the tight noose drawn around information by state officials, or just a focus on other stories, the exchange’s progress toward launch day wasn’t at the top of the news agenda throughout most of 2013. “No one had any sense we were going down the road we went on,” said Markian Hawryluk, an investigative reporter who covers health for The Bulletin, the daily paper in Bend, OR. Even Nick Budnick, an investigative health policy reporter for The Oregonian who along with his colleague, Jeff Manning, has done a stellar job covering the exchange since last fall, acknowledges he should have jumped on the story a year ago March. “I regret not doing that,” he told me. “With so many other stories to do, it’s hard to do that kind of coverage if you don’t know the story is there.”
Like the story coming from some other states, Oregon’s narrative in spring and summer of 2013 was one of good news about insurance rates. Premiums in the exchange were low—so low two carriers asked regulators’ permission to file new lower rates once they saw what their competitors were doing. Budnick covered that story in May; it was also picked up by The Washington Post, where Sarah Kliff wrote that “Oregon may be the White House’s favorite health exchange.” (Other Post pieces asked, “Can Oregon save American health care?” and “Is the future of American health care in Oregon?”)
But as the launch date neared, there were signs success was not at hand. Reporters were barred from the exchange’s “situation room,” designed to deal with bugs and crashes on opening day. The day before enrollment began, Cover Oregon officials organized a highly unusual conference call with insurance agents to warn them the exchange website would be available only for limited use and instruct agents to stop scheduling new client appointments until further notice. At The Oregonian, Budnick and Manning got suspicious. The next day came Cover Oregon’s upbeat press release, touting a “new day in health care for people across our state”—but also hinting at trouble. “We knew there would be bumps in the road as we roll out the technology and we’ve planned for them,” said Cover Oregon director Rocky King. He admitted, “We are not fully satisfied” with the part of the system that determines eligibility for tax credits—a key mechanism in the law’s promise of affordable care.