Too little, too late on ‘You can keep it’

Obama knew millions might be pushed off their health plans. The press should've known, too.

I have a question for all the reporters busy asking whether Obama misled Americans with his oft-repeated line that “if you like your health plan, you can keep it”: Where have you been? You should have challenged this claim well before now. You should have been reporting that some people in the individual insurance market might receive cancellation letters—in other words, they can’t “keep it”—well before it started happening to them. That many of these folks have plans that would not meet ACA standards (typically, not enough coverage) was known all along. That, even with the Affordable Care Act, health insurance would continue to be unaffordable for some people—that, indeed, some would pay more than they do now—was known the day Obama signed the bill into law.

As Brendan Nyhan wrote yesterday for CJR, cancellation notices from insurance companies

should come as no surprise—this outcome was anticipated by health policy experts both within and outside the administration. Unfortunately, most media coverage before this week did not explain how the process was likely to play out or hold the president accountable for making promises he could never keep.

That NBC News is sounding the alarm on these things this week (“Obama administration new millions could not keep their health insurance”)—with ABC News (“Broken promise?” Forced to switch plans”), PBS News Hour (“Does it constitute a broken presidential promise?”) and many others joining in—serves as a stark reminder of how poorly the press in general has covered the Affordable Care Act from its origins in 2006 through this month’s government shutdown.

Having written more than 700 health care-related posts for CJR, and having observed the nitty-gritty of the political process that resulted in passage of the ACA and the media coverage before and after, I can say the press as a whole has muddied more often than it has clarified. And this week’s very belated focus on “you can keep it” and the affordability, now that it’s rolling out, of the Affordable Care Act are just recent examples. (Yes, there has been excellent work here and there which I do my best to point out and praise).

In an early October post, I outlined five missing threads in press coverage of Obamacare to date, shortcomings that have exacerbated the general confusion, misunderstanding, distrust, and lack of support for a law that was not wholesale reform but basically another patch on America’s patchwork health system. Perhaps the media’s number one failure has been not honestly describing to the public what the law would and would not do. Instead of explaining how and why certain provisions got into the law, and how they would work for millions of Americans, the press focused on the drama and the horserace and the inessential—for example, Will there be a public option, which had no chance of passage from the get-go. The public would have been better served had reporters used their space and airtime to describe the changes in coverage the public would actually see. When it comes to scrutinizing the policy details and explaining what they might mean for people, the press has been snoozing. (Nyhan, in his post on this topic yesterday, noted “the media’s lack of interest in policy.”) So the overhyped coverage we’re seeing this week—Breaking news! Turns out some people can’t “keep it” and the Affordable Care Act isn’t affordable for everyone!— was perhaps inevitable.

The Affordable Care Act called for policies in force when the law was passed in March 2010 to be grandfathered—meaning that people could keep them. But then, regulations from the Department of Health and Human Services interpreted the law to mean that only policies not substantially changed would be grandfathered. But if policyholders increased, say, the deductible, as many did to make their insurance cheaper as medical costs climbed, their policies would not be grandfathered. In the last few weeks, insurers have notified many such folks that their policies will be cancelled. The press generally doesn’t cover administrative agencies and the regulations they issue. Too dull and boring! Had they, they might have learned about grandfathered plans and paved the way for their audiences to understand the changes about to take place.

Earlier this spring, there were other clues that the press missed. Insurers, primarily Aetna, had begun notifying policyholders that their coverage would soon be cancelled, and they were offering early renewal for next year so policyholders could keep the old plans awhile longer. A few trade pubs picked up the story, but not the somnolent mainstream press.

During debate on the ACA and continuing to this day, the president, his staff, and health reform advocates repeatedly used the phrase “affordable, quality healthcare.” Pollsters found people wanted “affordable” care and were afraid of losing the coverage they had—good, bad, or mediocre. In an interview last week with CNN, HHS Secretary Sebelius used the term “affordable” some eight times in trying to defend’s failures. And yet, the press scarcely noticed that since the passage of the law almost four years ago, health insurance premiums for many people were becoming less affordable (let alone explain the causes of this price rise and how it meshed with the Affordable Care Act).

Back in 2009, I urged journos to report on the affordability question, noting that the 160 million Americans who get employer coverage often have to choose new policies each year. So much for keeping the coverage they liked. And the subsidies? Almost no one in the media questioned whether they would be adequate over time. I tried to spark coverage of the individual mandate to buy insurance, the penalties for not buying, and why both were necessary in the insurance scheme this political system would allow.

There will be more “surprises” in the coming weeks as Americans are able to get on the government website and shop for coverage. They will learn how limited the coverage is for cheap insurance and how costly good insurance will be. Enough sensationalistic coverage (witness NBC News presenting its story as a White House cover up). What’s needed, at this point, are good explainers and good old fashioned consumer journalism to help people navigate the exchanges. Can the media redeem itself?

Follow @USProjectCJR for more posts from this author and the rest of the United States Project team.

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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: , , , , , ,