Another thread running through coverage: Who’s left out. Karen Garloch of the Charlotte Observer wrote mini-profiles of people in caught in Medicaid’s coverage “gap”—an area of overall press neglect, as we’ve noted. In fact, much of the coverage from other outlets in our sample used people anecdotes to illustrate the points they were making. Reuters presented dueling anecdotes to illustrate that “major hurdles remain” for the law: a newly-insured waitress and healthcare reform advocate in Georgia who was “scared constantly” when she didn’t have insurance, and a 57-year-old woman in North Carolina who lost her employer insurance last year and worries that an out-of-pocket maximum of $5,000 on the new policy will put her medicines out of reach. The interview with the waitress, Reuters disclosed, was arranged by Consumers Union, which it described as “a public advocacy group that sees Obamacare as a benefit to consumers.” The office of Rep. Renee Ellmers, a North Carolina Republican and Obamacare opponent, helped arrange the interview with the second woman, Reuters noted. We were pleased to see these disclosures—which we’ve been calling on reporters to make. They provided context for readers to understand what these women were saying.
One big omission I noted in my scan of coverage was the failure of some outlets to place the actual number of sign-ups in the larger picture, such as how many will continue to be uninsured and how many were uninsured when the law was passed. Bloomberg was one exception, noting, “The CBO, which estimates that 45 million Americans will be uninsured this year despite the law, says that the number will only shrink as far as 31 million by 2024, the 11th year of expanded coverage.” Numbers such as these help audiences assess how well the law is doing its intended job—insuring many more Americans.
As the next phase of Obamacare unfolds, here are some areas for journos to investigate:
• Will patients be able to afford their care? Affordability of care and affordability of insurance are big ones to watch. Obamacare cements in place The Great Cost Shift from insurers and employers to patients, which has been in the making for more than a decade now. The Democrats talk about adding a “copper” plan to the coverage already offered on the exchanges. Presumably, these “copper” plans will cover less than the “bronze” plans which cover only 60% of a person’s medical expenses. That would shove even more cost onto the policyholders. Whether this gets legislative traction is something for reporters to watch.
• Do people whose incomes are just over the line and not eligible for subsidies or those eligible for reduced cost sharing (available for people whose incomes are below 250 percent of poverty or $59,625 for a family of four) understand what’s happening? Will there be a backlash? Obamacare further bakes in the inequalities that exist in the US healthcare system. The law makes these inqualities more transparent with the different options offered on the exchanges.
• Will hospitals, the biggest source of costs in the system, continue on their march to greater market power with little regulation? As hospitals and insurers duke it out, patients may pay the price.
• Will states or the federal government fix the consumer hassles people are discovering with their new policies? Who do they complain to? What if they’re caught in the middle of a dispute, as patients in New Jersey were?
Perhaps the biggest question of all to keep in mind is what kind of healthcare system do we want and who is it for?
How to measure Obamacare success