Covering Obamacare poses big challenges for journalists, from piercing government spin and deciphering GOP rhetoric to unraveling and simplifying the complexities of insurance. Today we begin a series of posts that aims to help reporters, editors, and the public understand what this law is really about and how it is being implemented.


Will insurance premiums go up, or won’t they? That was a burning question among Beltway types a few weeks back, when Health and Human Services Secretary Kathleen Sebelius admitted that some people buying insurance this fall might indeed find themselves paying higher prices for their coverage. “These folks will be moving into a really fully insured product for the first time, and so there may be a higher cost associated with getting into that market,” she said.

What an admission! During the run-up for the law, the president proclaimed families would save an average of $2,500 on their premiums, and for the last three years the administration’s line has been that the new law would lower insurance rates. Not for everybody, it seems.

Sebelius apparently spilled the beans about something most people who know insurance have said for a long time—that despite the spin from the Secretary and others with a stake in the Affordable Care Act (ACA), the rate question is tricky, and trying to shoehorn the idea of “universal” coverage into a private insurance market might indeed cause some insurance premiums to rise. This is becoming clear in the individual market, which covers some 16 million Americans.

So it’s hardly surprising that the next day, Josh Earnest, the deputy press secretary, seemed to soften her remarks, although he claimed he had not read them. “I would actually point to the results that we’re already seeing from the Affordable Care Act, which is a savings of $2.1 billion, and the analysis from the [Congressional Budget Office] that actually says, in the future, we’re gonna see rates that are lower for higher benefits.”

Huh? That one needs some explanation. For example, generally in health insurance, higher premiums buy better benefits. Was the deputy secretary saying that this has changed, that people will now pay less and get more? Was he referring to Obamacare’s minimum-benefit standards? We’re left to wonder.

And the media can be forgiven if they were confused. The Hill and The Wall Street Journal waded into the ticket of statements and anti-statements. John Harwood of The New York Times touched on rates in his “Political Memo” column Tuesday, on how thanks to the complexity of implementing it, Obamacare will continue to be a political football.

But for the most part, the media have not considered the topic of rate increases—and decreases—as front-page material. The White House line has been (and remains) that subsidies called for by the ACA will make health insurance more affordable.

Will they? For the last month, studies have raised some important red flags about the affordability of health insurance premiums.

When a study done by the actuarial firm Milliman, for the state of California, found premiums might go up 30 percent on average for high-income people who are currently insured, and who won’t qualify for federal subsidies (although there might be decreases for those with lower incomes), the White House called fears of “rate shock” overblown, saying consumers can move from expensive plans to more efficient, lower-cost plans, a point Jackie Calmes of the Times repeated two weeks ago. Efficient, lower-cost plans? That’s euphemistic shorthand for fewer benefits and more out-of-pocket expenses. Calmes didn’t get into that.

Another red flag, this one about the customer base of the state exchanges that Obamacare puts in place, each one a separate “risk pool,” as insurers put it: A month ago, the Society of Actuaries, a research and professional organization, released a study showing that when sicker people join the new risk pools—a major reason for healthcare reform—the underlying cost of their care (in insurance jargon, “claims costs”) could jump, on average, 32 percent. Those higher costs could translate into higher premiums in the individual market in states like Ohio, Wisconsin, and Indiana. Obamacare supporters questioned ties that some of the researchers had to insurance companies.

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Trudy Lieberman is a fellow at the Center for Advancing Health and 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. Follow her on Twitter @Trudy_Lieberman.