An Obamacare reality check from reporters on the ground

The Bergen Record and Cleveland Plain Dealer serve up some fresh coverage

The deeply troubled state of has been the big healthcare story of the month. It’s also a lesson in why reporters need to be wary of government spin. In the runup to Obamacare’s big debut on Oct. 1, top federal officials were full of claims about how the site would set a new standard for government service. Coverage that passed along the hype risked being misleading—even deceptive.

That’s a lesson that applies to other elements of the law, too. The public debate over Obamacare has featured lots of oversimplified claims about its benefits against overwrought denunciations of “socialized medicine.” The task for reporters is to get past the spin and hype and explain the real trade-offs the bill makes throughout the insurance system.

The fact that actual prices and policies are becoming available now—at least, if you’re not shopping on—makes that task more feasible, and some reporters are beginning to dig deeper. Two fine daily newspaper reporters recently shared their articles, and their observations about reporting on the law, with me. Their comments are instructive for others following the continuing saga of the Affordable Care Act.

Lindy Washburn visits people in a bread line. Even in early October, when problems with the federal website were just becoming apparent, Health and Human Services Secretary Kathleen Sebelius was talking up other “pathways” to get potential customers through the individual market. Washburn, a health reporter for The Record in northern New Jersey, checked out one of those pathways—and what she found hardly matched the hype.

Washburn sent me a note describing what she found when she stood in a bread line near a New Jersey trailer park where representatives of Enroll America, a private group aimed at helping the government enroll seven million Americans by the end of March, were trying to instruct people in the finer points of health insurance. Though the Enroll America workers were pitching Obamacare, they couldn’t actually sign up people, Washburn said. Instead, they were referring them to “navigators” who could help them enroll—in effect, adding another step in a complicated process.

“I could see seeds of resentment building up,” Washburn told me. “There were the old, young, deaf, half-blind, on scooters, undocumented, unwired, Spanish-speaking, angry, grateful, the gamut. I heard a fair amount of anger and skepticism about ‘more government programs’”—a cynicism Washburn believes might have been the result of Hurricane Sandy and Gov. Chris Christie’s missed deadline for housing assistance. The refrain seemed to be, “we’re signing up for this and that and nothing ever happens,” Washburn said. People with kids seemed the most interested in insurance—but the children were probably already eligible for coverage under Medicaid, if the family had known about it. “I was hoping to get somebody to say something about their feelings about limited networks of hospitals in the plans, but that was like advanced calculus for people still in elementary school,” Washburn told me.

“All the buzz is about the website,” she added. But standing with people who need insurance was “such a reality check.” There are only 35 to 40 navigators to help the estimated 900,000 New Jerseyans eligible for coverage on the exchanges. “When you see the intensive effort needed to get everyone enrolled, it makes me wonder how this will work,” Washburn said.

Washburn did write an Oct. 20 piece about those narrow networks, relying more on industry officials than people-on-the-street. The article, “Cheapest Obamacare plans greatly limit choices,” took a careful and comprehensive look at how limited some of the provider networks are in New Jersey, and provided some new insights into the trade-offs exchange shoppers face.

There’s a newcomer in New Jersey, Health Republic —one of the new co-ops that was not cut off at the pass in the New Year’s Eve budget deal—that offers a uniform level of coverage across its entire hospital network, and changes higher premiums in turn. Other insurers, like Horizon Blue Cross Blue Shield, offer lower-cost plans and then funnel patients into just two “preferred” hospitals. If a patient needs to go to another hospital, they can—but they’ll end up paying much of the bill. Despite the potential for large costs down the line, one broker predicted the lower-end policies would be popular. “It’s all about premiums,” he told Washburn. “For the premium dollars it’s going to save, heck, yeah!”

But that may not be the case for everyone. In an email to Washburn, a 58-year-old woman said she had to buy her own coverage when her company stopped insuring its workers. Now she pays $447 per month for a Horizon policy. Her new monthly premium will be $695, which is not affordable, she said. Neither were the premiums of Horizon’s two competitors. Horizon’s bronze plan, she explained, had a $2,500 deductible and 50 percent coinsurance. “Who in their right mind would want to waste almost $700/month on this?”

This reminded me of another piece Washburn wrote that received a CJR laurel. She told what happened to a 58-year-old woman named Frances Giordano, whose life descended into chaos when her medical expenses for treating lung cancer were more than she could afford even with a good job and insurance that came with modest copayments. Even with limits on out-of-pocket spending—-a provision delayed until 2015—I wrote that there will be others like Giordano. Washburn’s update shows why.

Steve Koff takes a microscope to premiums for small employers. Small employers were supposed to get a break under the Affordable Care Act. Let’s face it, they have had a tough time paying for worker coverage, because their small employee pool was insufficient to spread the risk of insuring those who got sick. The result: employers in this pickle paid hefty premiums.

Koff, Washington bureau chief for the Cleveland Plain Dealer, looked at the new reality in Ohio and found that “until things stabilize, [the Affordable Care Act] is going to mean a lot of price hikes for small businesses.”

Or to be more precise: the minority of small businesses whose employees are at high risk of substantial medical expenses will pay quite a bit less, and other companies will pay more. That’s because many of the traditional factors that have been used to calculate premiums are outlawed come January 1. They include making women (or their employers) pay more and easing the disparities between what older and younger people pay. Welcome to the world of redistribution that’s in the ACA—something that, as I have pointed out, is not well understood and was almost never discussed in the sales job for Obamacare.

Koff illustrated how this redistribution is happening in the small employer market. “Medical risk is gone,” Mike Troyan, the owner of a benefits brokerage agency, tells him Well, yes, it is—or at least sharply reduced.. A broad sharing of the risk is one of the aims of Obamacare, and it is the key ingredient that makes health systems work for the benefit of everyone in other countries. This risk pooling is also what makes it possible to insure large numbers of old, sick people in Medicare for a reasonable cost. Koff tried to explain some of that in this reporting, ending with this question: “If it all comes together—if the ACA’s current technical glitches are overcome and the pricing works out for at least some—-will next year’s pain for others be worth it, or at least fairer?”

In a note to me, Koff said that his piece actually ended up “a bit more he-said, she said than I would prefer.” It wasn’t even the story he set out to do: He had started to compare actual premiums and that other stuff you need to really know if one plan is better than another, like deductibles and coinsurance. But the new SHOP exchanges that many small businesses are eligible to buy in are not yet operational. “The federal site was cumbersome and didn’t have as much information as you need to compare,” he told me, adding it was “impossible” to do so on insurance company websites because of how time-consuming the process is.

Still, he delivered a thoughtful and nuanced look that largely got past the spin and examined the trade-offs the law makes. Wanted: more reports from the field like these.

Related content:

A laurel to The Record

Exchange Watch: Ohio insurance redux

Open wide: the fine print

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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: , , , , ,