Let the game begin! The game of spin the rates, that is. It’s a game that pulled the media in last summer, too, as some state officials around the country were touting projected low health insurance premiums for exchange shoppers—or just-right “Goldilocks” rates—while others were blaming Obamacare for anticipated rate increases. It’s that time of year again, when insurance companies file rate requests with state insurance departments—that is, propose what they’d like to charge for the policies they’ll sell on the exchanges from November through February. These numbers, in other words, are preliminary, subject to state and sometimes federal review and approval, but you wouldn’t necessarily know that by the certainty and simplicity with which stakeholders spin them and reporters cover them (Rates increase! Blame Obamacare! Or, Rates up less than expected! Obamacare is working!). Missing in this sort of treatment, among other things, is a sense of the big picture: these initial rates don’t necessarily tell us much about what health insurance will cost individual consumers in the coming year.
So, how should reporters cover these rate pronouncements? I offer 7 suggestions further along in this post. But first, it’s instructive to take a quick look at some recent coverage. Compare, for example, two recent efforts from Ohio, where at the end of May the Department of Insurance revealed preliminarly rate filings for next year. In a May 29 piece, the Cincinnati Enquirer stuck largely with official pronouncements, reporting an expected “13 percent rise in the average premium,” according to state officials, and quoting Lt. Gov. Mary Taylor, no fan of Obamacare, who called it “bad news” for families and businesses. “It’s what we expected and it’s what the research we did in advance predicted would happen,” Taylor said. But instead of delving into the whats and whys of the expected average increase—and the caveats around the number itself—reporter Lisa Bernard-Kuhn allowed spin to take over. “The filing details spurred other Obamacare opponents to chime in,” Bernard-Kuhn wrote, offering a quote from Ohio Sen. Rob Portman who repeated the GOP mantra, “Obamacare is not working.” She did note that studies from the Kaiser Family Foundation and others show that double-digit increases pre-date Obamacare. But overall, there wasn’t much in the way of context or explanation to help readers put the rate pronouncements in perspective. (A June 2 Associated Press piece from Vermont followed a similar path, reporting that two carriers in the state increased rates, although the piece did note that “no one can predict” what final rates will actually look like.)
By contrast, on May 30, the Cleveland Plain Dealer’s Washington Bureau Chief Steve Koff (who ably covered Ohio’s rate story last year) offered a robust, reported piece that looked at the games insurance officials can play with averages. Koff reviewed the newly filed rate requests, talked to insurers, and “found that average rates for the biggest and most popular insurers…are not rising as much as the average that [Lt. Gov.] Taylor cited.” In other words, these rate pronouncements should come with context and caveats, and it’s up to reporters to supply that. Koff did.
Premium prices are based on the ages of those expected to buy and on insurers’ expectations of the health care costs the enrollees will incur. It is too early to know how that will work out in 2014, yet the state statutory deadline for initial 2015 rate filings was last week. “So all they have now are trends and guesses,” said J.B. Silvers, a health-care finance professor at Case Western Reserve University.
And, further along:
Every price in the filings comes with caveats. The Ohio Department of Insurance must approve the requested rates, and that will not happen for several months. The US Department of Health and Human Services must then sign off, although it typically will agree with Ohio’s judgment since the state must follow ACA rules and guidelines for insurance underwriting and pricing…Also, every insurer provides an average, but the averages are based on both higher and lower premiums for specific policies.
To “fill in some additional blanks,” Koff also did a useful Q&A-style explainer on June 2. This was good, thorough work, and Koff was not alone in that kind of reporting. The Arizona Republic’s Ken Alltucker used news of rate increases in Arizona to examine the competitive landscape in June 2 story, and gave a nod to other factors that go into pricing—narrow provider networks, coinsurance, and deductibles—each of which could be a story in itself.
Rate proposals will continue to trickle out in other states in the weeks to come. These numbers are, again, but a small piece of broader, more important question— what will health coverage really cost consumers? Here are 7 tips for reporters following this story.