As Massachusetts goes, so goes the nation–at least when it comes to healthcare. In 2009 and 2010, in the midst of the debate on Obamacare, I wrote a series of 10 posts examining the Bay State’s 2006 law that served as the blueprint for the Affordable Care Act. It’s time for an update. This is the second of an occasional series about Massachusetts healthcare and how the press is covering it. The first is here.
Officials were not awaiting this autopsy report, published August 26 on Medium by self-described “Big-tent Boston Republican” and software engineer Ed Lyons. In 31,000 words, Lyons aimed, he wrote, “to document all the significant events of the failed Massachusetts Health Insurance Exchange, and explain how and why it happened,” to explore “how and why our government wasted two hundred milllion dollars and harmed thousands of people.” While much of Lyons’ report–titled “The Health Connector Autopsy Report”–is spent looking at what Massachusetts officials knew about the technical problems afflicting the state’s insurance exchange website (The Health Connector) before, during and well after its launch last October (and how that differed from what they were telling the public), as well as shortcomings and mismangagement on the tech side, he also explores the media’s role in the meltdown and the question of “why did the media struggle with this story” (which is the title of a short section in the back half of the report).
Lyons quotes a post I wrote for CJR in May about Oregon reporters missing the story of that state’s failing health exchange (and then recovering with a bang), noting that when he read my post he thought, “My God. Just like here.” But there were differences. While both Oregon and Massachusetts suffered website meltdowns the day their exchanges opened for business, Oregon reporters–especially those at The Oregonian–became skeptical much sooner. Two weeks after Oregon’s website failed, Oregonian reporter Nick Budnick made 11 open records requests and began to pierce the spin from government officials. By May of this year, Budnick and his colleague had made about 90 requests. In contrast, Massachussetts reporters didn’t get their hands on important documents–showing, among other things, that officials knew three months before the launch there was “a substantial and likely risk” the website would not be ready–until months
Since last October, the malfunctions of Massachusetts’ Health Connector website have been an on-again, off-again topic with the state’s news media. For the most part, coverage has been less than penetrating, often laced with upbeat pronouncements from state officials assuring the public problems would be fixed. In November, Gov. Deval Patrick told reporters the Connector website “gets better every day,” noting the bugs and glitches are “nothing unexpected.” The media did focus on the troubles residents were having signing up and keeping coverage, and they did chronicle the backlog in handling complaints. At one point, things were so jammed up that WBUR health reporter Martha Bebinger wrote a Commonhealth blog post headlined, “Come On, Massachusetts, Get This Pregnant Woman Covered.” But the press never seemed to dig into what caused the mess in the first place or assume its legitimate watchdog role in holding government officials accountable for possibly jeopardizing the health of thousands of state residents–to say nothing of the inconveniences and frustrations they experienced.
Lyons’ “Autopsy Report,” the product of several months’ work, provides a fairly complete dissection of the Connector’s failures–plugging a big hole that the Massachusetts media should have been filling all along. I talked to Lyons recently about his report and his thoughts on the media’s “struggles” to cover the Health Connector story which, he told me, “should have been an investigative story instead of an episodic one.” What follows is a lightly edited transcript of our conversation.
Why did the media fail to do its job?
There was a lot of complacency here because [Massachusetts already] had an exchange. When the government said everything was fine, it was easier to believe them than ask questions. Coverage was scattershot, especially at the Globe [where] there were more than 20 stories about the Connector failure, and several reporters doing them. The stories shifted from health policy reporters to general interest reporters, and there didn’t seem to be a coherent, continuous narrative about what was happening. The press didn’t seem to understand the consequences of [the state] not being able to process website applications.
In many ways this was a story about technology. Did the press seek out the right experts?
No. Reporters don’t see healthcare as an information technology beat. They have to understand that healthcare is about technology, but they see…a health policy story and not a health policy and technology story.
What prompted you to write the report?
I thought the media hadn’t laid out the entire story for the public, and I thought I could add a lot of value as an IT expert who could explain the [state of the] project at various times…I was also caring for a sick friend who was getting subsidized coverage from the Connector and had to get new coverage. Instead, like the other 200,000 or so residents relying on subsidized coverage, she got stuck in the failures of the website to process applications. Those were the people who were hurt most and they needed to know why.
You disclose in your report that you are a Republican. Massachusetts is a heavily Democratic state. Did partisan politics figure into your decision to write the report?
I had no partisan motivation to write this report. I wanted this to be nonpartisan. Some players in this story had partisan reasons for not acting. Some didn’t provide oversight, perhaps because they didn’t want to join Republican criticism of the law [something I have written about before]. I care about government and believe it should work well for the people. Republicans want to eliminate government. I am not one of them. I’m not against universal health care, and I didn’t want to discredit universal insurance. I don’t want to be perceived as someone attacking the Affordable Care Act.
What kind of media attention has the report drawn?
It’s had about 3,000 hits and about 900 have come from a Boston news aggregator. I’ve done a few interviews on a Boston Herald radio show and the Boston Herald in print as well as a local neighborhood TV show.
At times in the report you seem to blame reporters (you wrote that TV news reporter Jim Braude “could have asked better questions” when he interviewed the exchange’s executive director soon after launch, and a Boston Globe reporter “should have pinned [the executive director] down” during a July 2013 interview). At other points in the report, you imply that reporters could not have known what they didn’t know/what officials weren’t telling them. Have you heard any feedback or reactions from reporters?
Not really. I emailed it around to reporters and heard nice comments from the Herald and the Springfield Republican.
In a Boston Herald radio interview, you said you hoped your report would “be a resource for anyone who wanted to pursue this further whether it’s the press, politicians or activist reformers…I hope it inspires people to do the same sort of accountability work.” Do you see any bright spots moving forward to this fall’s open enrollment?
Yes. I hope reporters begin to reframe the story from an episodic story to an ongoing story with the new website going up in November. I would like to see reporters no longer accepting officials’ words about the website without questioning them. And I have begun to see a little bit of that. The other day Felice Freyer, who covers the Connector for the Globe, tweeted about a small increase in rates for next year. I tweeted, “Well, that’s if people can actually buy insurance on the Connector this year.” She admitted in a tweet, “indeed, that remains to be seen!”
It remains to be seen, too, if reporters in Massachusetts and beyond will bring appropriate skepticism to the official pronouncements coming from state and federal exchange officials as we head toward open enrollment in November. There are already some rumblings about potential glitches with the federal website. Oregon and Massachussetts provide potent reminders for journalists: government officials will do what they always do, and journos need to push to penetrate the spin. As the Oregon reporters learned–and as Lyons points out in his “Autopsy Report”–the exchanges are a technology as well as a healthcare story. Reporters need to seek out the expertise to get this story right.
Related content:
Oregon reporters missed the story of the failing exchange–until they didn’t
Trudy Lieberman is a longtime contributing editor to the Columbia Journalism Review. She is the lead writer for CJR's Covering the Health Care Fight. She also blogs for Health News Review and the Center for Health Journalism. Follow her on Twitter @Trudy_Lieberman.