Reviewing Obamacare coverage: Week 1

A look at the good, the not-so-good, the interesting, and the opportunities ahead

It’s been overshadowed a little bit by the shutdown in Washington, but this week marked the rollout—at long last—of the Affordable Care Act, and with it came a wave of media attention. Over the next few weeks as implementation moves along, the early glitches (hopefully) get sorted out, and people sign up for insurance, we’ll pass along our take on how the press is reporting the story and offer suggestions for advancing the coverage. Here’s our look at week one.

A shout-out. Thursday’s New York Times article by Sabrina Tavernise and Robert Gebeloff was a first-rate job explaining the great irony of Obamacare: the poorest of the currently uninsured will get no help. With a few exceptions, this irony—the fall-out from last year’s Supreme Court decision that allowed states to opt out of the law’s Medicaid expansion—has not been well-covered. An accompanying map and graphic bolstered the article with the Times’ typically strong multimedia content.

But what was most striking about Tavernise and Gebeloff’s article was its close look at how access to coverage breaks down along racial lines—the authors explained that many of the states rejecting expansion are in the South, where there are disproportionate numbers of poor African Americans and Hispanics who lack health insurance. “You got to be almost dead before you can get Medicaid in Mississippi,” said a 53-year-old former maintenance worker who has leg problems. A 45-year-old Hispanic housekeeper in Texas who supports two kids on $17,000 a year told the paper, “We came to this country and we are legal and we work really hard. Why don’t we have the same opportunities as others?” The piece underscored the persistent inequality in the U.S. health system—something that will affect in more subtle ways even the consumers who can afford coverage on the exchanges and who will be choosing among bronze, silver, gold, and platinum plans, each tier offering additional benefits at a higher cost.

Interview of the week. ABC’s late-night host Jimmy Kimmel got to the heart of the health reform backlash. It may be partly a problem of nomenclature, Kimmel learned from man-on-the-street interviews on Hollywood Boulevard. He asked whether people preferred Obamacare or the Affordable Care Act—which are one and the same, of course. Even in Hollywood, folks preferred the Affordable Care Act. One woman said she didn’t agree with the “Obamacare policy thing that’s going on.” Another added she didn’t like Obamacare, because she didn’t care for anything “that has to be forced.” Other streeters said they preferred the Affordable Care Act because it’s American to let people make their own choices, or because “it’s more affordable than Obamacare.”

Kimmel’s sharp take offered a new twist to what’s becoming a somewhat repetitive press narrative about health reform. It showed how effective Republican and conservative opponents have been at negatively branding health reform as the president’s baby (a branding that the president ultimately embraced). Remember Hillarycare and Romneycare? When you don’t like something in healthcare, demonize the pol who champions it.

Biased reporting. Fox News wins the prize for this one, for reasons Alex Koppelman explained at The New Yorker. A recent Fox special report focused on Andy and Amy Mangione, parents of two sons, who are in the market for new insurance. They seem like the perfect couple for story about Obamacare—but, as Koppelman points out, they are not. Andy comes from the health insurance industry and is now a VP for government relations (aka, a lobbyist) at the Association of Mature American Citizens, a group that presents itself as a conservative alternative to the AARP. As Koppelman writes, Fox reporter Jim Angle “does not appear to have ever disclosed Mangione’s work to his viewers or readers of a companion article on”

The Fox article left out plenty of other important points too, in the course of making its point: if the Mangiones choose to keep the policy they bought on the individual market with their current insurer, their prices are going to skyrocket—nearly tripling—in 2014. That’s true, but it’s not the whole picture. Koppelman’s New Yorker post essentially re-reports the Fox piece, and does a good job taking the reader through the choices, trade-offs, and different options that will be facing the Mangiones.

It’s complicated—maybe more complicated than it should be for many American households, and the numbers in the piece get a little tough to wade through at points. But Koppelman concludes that depending on what the family chooses, their health needs for next year, and what life brings, Obamacare might even help their bottom line—though it’ll be harder for Andy Mangione to buy the low-premium, high-risk insurance he’d selected for his healthy family. I especially liked Koppelman’s discussion of the trade-offs necessary when you buy health insurance, something I ‘ve been writing about a lot lately. Here’s his conclusion:

There’s a trade-off here, and it’s not one without complications. Families like the Mangiones, families on a budget, are being asked to pay more money up front in exchange for potential savings down the line. That’s not an easy thing, and it’s not something that Mangione wants to do. He chose to pay lower premiums, and accept a higher amount of risk down the line…. But it is a trade-off, not just a premium increase, and there are very good reasons why Obamacare was passed and why people like the Mangiones are facing issues like these. Jim Angle never bothered to mention any of them, but they’re real, and for some people like the Mangiones, they mean that life might actually be better under Obamacare.

Twitter overdose. I can’t blame Twitter devotees for getting a little tired of Day One’s seemingly minute-by-minute updates from state insurance exchanges, many of them retweeted by health reform cheerleaders. From Colorado we heard about at one point about 34,500 visitors and 1,300 accounts in the first three hours. From Nevada’s Health Link came an 11 am update with the news of 758 calls and 1,236 accounts created. Peter Lee, who heads Covered California, the state’s exchange, reported its website was getting 10,000 hits a minute. Many of the state exchanges fared better at launch than the backlogged federal exchange, but still, the stream of numbers prompted Reuter’s Sharon Begley to tweet: “Can #Obamacare exchanges please stop soliciting traffic via Twitter when their sites are ‘currently having log in issues,’ as in NY?”

Looking ahead. This brings me to what should reporters, editors, and producers be looking at next. Millions of people showing an interest in the exchanges is indeed a good omen. But even setting aside the technical problems surrounding the rollout, buying a policy is a tricky affair, so telling people to take their time, study the options, consider their needs, and seek help from qualified, neutral sources is good advice. Coverage won’t begin until January 1 (if you sign up by Dec. 15), and open enrollment ends March 31. We should let people know that a policy bought next month is as good as a policy bought today, so there’s no need to hurry. A Pennsylvania woman told me she was so eager to dump her Aetna policy she was ready to sign up on the spot after seeing that Blue Cross offered a cheaper premium. Were the coverages and the cost sharing the same? She didn’t know and didn’t seem to care. A woman in Nebraska explained how insurance agents had bombarded her after she entered some personal information on An agent from Florida advised her—incorrectly—that if she didn’t sign up quickly, her application would not be accepted. “The message was ‘if you don’t work with me on this, you’ve blown it, honey,’” she told me.

It’s also a good idea for journalists to take time and parse the numbers rolling in from the states. We won’t know for several months whether those signing up are the young healthy folks everyone wants in the pool, or the very sick who need insurance ASAP. The mix of applicants is as important as the numbers. And what are they buying—the cheaper bronze and silver plans or the ones offering better coverage? So when some exchange official announces the numbers, more questions are in order.

Related content:

Untangling Obamacare: Shopping the insurance exchanges

Untangling Obamacare: The affordability puzzle

Five threads reporters missed on Obamacare

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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: , , , , , ,