To offer a flavor of what he meant, Myers noted the state’s minors are the most uninsured in the country. There is a shortage of doctors and nurses, and, Myers wrote, “in any other state, the Nevada mental health system would be a scandal.” He did point to a few improvements in rates of teen pregnancy and immunizations after the state embarked on educational campaigns. But, he noted, Nevada has rarely invested in such educational endeavors, and “The Affordable Care Act isn’t in the business of changing infrastructure, of creating programs or building facilities or training healthcare providers.” So can this law, Myers asked, “merely by providing insurance, upgrade a state that could easily be named Downgrade?”
Poverty and how much healthcare the working poor can afford compound the state’s weak health report card. To drive home these points, Myers wove in an interview with Dr. Mary Guinan, who served two stints as the state’s health officer. Guinan said early in the health reform debate that Congress was not constructing a healthcare program but a health insurance program. Myers asked her if her experience dealing with the state’s “deep-seated and seemingly unsolvable healthcare problems has shown that the new health law will cure the state’s problems or contribute to easing them?” Myers wrote:
It was the only moment when the ever optimistic Guinan sounded at all discouraged. She sighed, then said, “I don’t know. I’m hoping that it will, because access to healthcare has been a terrible problem for Nevada.”
And that, dear colleagues, is the thread to follow as Obamacare continues its rollout.
The Tennessean’s unhelpful premise. With a “Navigating health reform” landing page, The Tennessean offers information for readers to help them get the gist of the new law, and uses a common approach—chunking facts into boxes. There is an “Ask A Question” box, offering health reporter Tom Wilemon’s email address. There’s a “Health Care Expenses” box, linking to a database the paper created on hospital prices. There is a “Subsidy Calculator,” a nice dollars and cents translation of how much subsidies would be worth to families with different incomes along with what their maximum out-of-pocket costs would be. And, there are two boxes detailing health reform’s “winners” and “losers.” The “winners” include people with preexisting conditions and those with incomes between $11,490 and $45,960 who qualify for subsidies. The “losers,” per the paper, are the richest who will pay more taxes and the poorest who won’t benefit from Medicaid expansion, as Time and others have reported.
After being in Canada for several weeks examining Canadian healthcare, I am struck at the inappropriateness of this “winner, loser” frame, and how it contributes to the misunderstanding of what the ACA does (calls for a modest amount of wealth redistribution) and doesn’t do (provide much equity in healthcare). The notion of “winners” and “losers” might help fuel the backlash against the law. In a post two weeks ago, I noted that the wealth redistribution the law calls for is not well understood, including by those groups who are taxed or will pay more to fund the subsidies. It’s time to ditch the inflammatory concept of “winners” and “losers,” even if it means using more words to tell a more complete story.
Deciphering the deductible trade-off. Chicago Tribune reporter Peter Frost offered a thoughtful and balanced take on the trade-offs people face when shopping in the exchanges—something we’ve been urging reporters to do. The Trib analyzed policies that insurers will be offering on the Illinois exchange and found that 21 of the 22 lowest-priced plans offered on the exchange for Cook County will carry deductibles of more than $4,000 for individuals and $8,000 for families. Frost cut through the pre-enrollment debut spin about those premium plans in the exchanges.