campaign desk

Missing Persons

How will reform affect ordinary folks?
November 16, 2009

Come on now. We’ve heard enough about the political horserace of health reform—way too much of Nancy, Max, and Olympia. No doubt we’ll be overfed on the theatrics of the coming Joe and Harry Show; but that’s not where the story is.

The real story is how reform will affect millions of people who will have to live with the financial consequences of the deals made by Baucus, Pelosi, Snowe, Lieberman, and Reid—and so far we’ve blown it. As readers of Campaign Desk know, stories about how reform affects ordinary folks have been missing since the campaign. And there’s a real danger reform will pass without families knowing what’s in store for them, financially speaking.

A recent Gallup poll shows that forty-one percent of Americans believe they will be better off after reform, while forty percent think they will be worse off. The numbers drop when pollsters ask how reform will affect their own situation. Twenty-six percent say they would be better off; thirty-six percent say they would do worse; and about one-third said reform wouldn’t make much of a difference. “Americans have moved in a more negative direction on the basic issue of whether a new bill should be passed into law,” Gallup concluded.

Those numbers are something to think about. Are people basing their opinions on good media explanatory pieces, or on rhetoric from stakeholder groups using the media as their mouthpiece? “What people want is a Consumer Reports 101—how will the bill make things better for me,” says Harvard pollster Robert Blendon. “Nobody has explained why people should be thrilled by the passage of this bill.”

For the most part, there have been few stories focusing on how much people will pay for health insurance after reform–a big concern on the mind of the electorate during the campaign. It’s affordability, stupid! But for the most part, interest groups from the White House on down haven’t been keen to address that one, because for many voters health reform won’t make premiums more affordable. It might even increase them, and few pols want to expose the emperor without any clothes.

Oregon Sen. Ron Wyden is an exception. He says “this town continues to miss what is going to be the real issue—premiums, premiums premiums.” Earlier this year, he told Congressional Quarterly that “If middle class people have to pay more than they’re paying today…I don’t think that is going to pass the smell test as being affordable.” A good story, no?

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Politico journeyed into the White House’s territory last week by examining the rhetoric of the president’s campaign pledge and today’s reality, namely that the lack of serious cost controls might indeed make premiums unaffordable. It started its story this way:

Barack Obama ran for president on a promise of saving the typical family $2,500 a year in lower health care premiums. But that was then. No one in the White House is making such a pledge now.

Politico made another important point that the MSM should examine pronto—that no independent group has looked at how the bills would affect the premiums for 170 million workers with coverage from their employers. Remember, that’s the group the president said could keep what they have, since they are happy with their coverage. This is the group that is being offered policies with higher and higher deductibles and more cost-sharing.

The media have talked about affordability mostly in the context of whether the country can afford reform, not whether individuals can afford it. It’s easier for a reporter to write about humongous numbers like $900 billion or $1 trillion, and give the arguments that those sums will or won’t add to the federal deficit, than it is to spend several hours with the Joneses in Peoria finding out where in the family budget they will find $8,000 to pay for health insurance. And the advocates—reform’s uber-cheerleaders—who see victory at hand aren’t terribly eager to point out that mandatory insurance might be unaffordable after all. Making that too transparent might undermine all the work they’ve done to advance legislation this far.

Advocates, usually at the ready with families for the press to interview, don’t seem to be trotting them out to talk about affordability or the obscure indexing provisions that the Center on Budget and Policy Priorities brought to the attention of Kaiser News Service and Campaign Desk. Those provisions would cause families with modest incomes to spend a larger and larger share of it for health insurance as time goes on. It might be easier for the Joneses in Peoria to take the penalty and run.

A perspective piece published two weeks ago in the New England Journal of Medicine pointed out that the polls now show the same things that they showed during the various stages of the Clinton reform effort. The authors say that “Americans’ impressions of the legislation’s likely impact on their own situation will be the most important factor in determining the level of public support.” The polls may be similar, but one thing is different. In 1993-94, the media, which did not do a great job then explaining the Clinton plan to the public, at least ran winners and losers pieces from time to time. This year they aren’t even doing that.

It’s past time for the story to shift from Capitol Hill to Peoria. Here’s what we suggest: Go out and find the people who will experience the good and bad of reform and tell their stories. Report on what they spend now for the usual things—car and mortgage payments, food, gasoline, life and auto insurance premiums, clothing, entertainment, taxes, presents for Christmas, credit card debt, savings for college or retirement. Tell what spending five percent, ten percent, or twelve percent for health coverage will mean for other spending priorities. How will that change through the years, given what Congress currently has in mind for indexing the premiums? Find out what kinds of “affordable” insurance they can actually buy. Investigate what employers are offering this year? Will people with good health plans—the so-called Cadillacs—see their insurance turn into Edsels?

This is the Consumer Reports 101 the public needs. It’s the stuff that Ron Wyden worries about.

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.