The Stimulus Bill and Universal Coverage

Just as the deal was being struck on the stimulus package, the News Hour on PBS aired a segment about people who had lost their jobs and could not afford to continue their health insurance under COBRA, the program that allows them to keep their coverage for awhile. As these kinds of stories go, the piece was workmanlike and predictable enough. When asked what she had to give up, one woman replied “All the Christmas presents I used to get for everybody.”

If anything, the segment’s underlying theme was that Medicaid can be helpful and there’s no shame in applying for it. “Had any of you ever in your lives needed to ask the government for help before?” inquired correspondent Betty Ann Bowser. “It was always them, never me. This is my first time that I asked for help,” one man replied. Bowser then asked: “And what did it feel like going into that office to apply for Medicaid?” The man said he “didn’t feel bad at all.”

At the end, PBS anchor Judy Woodruff noted “for the record” that the stimulus package included more federal aid to states to help pay increasing Medicaid costs. She said the bill would “provide a federal subsidy to help some laid-off workers purchase health insurance through the COBRA program, but the subsidy would be smaller than initially proposed.” That was it. No mention of how much the subsidy would be, or how much it might have been if the lobbyists had not gotten in the way. No mention of how the people featured might have fared under the two proposals in the House version that didn’t make the final cut. No mention of what all this might mean for universal coverage. Obama and other pols have said they wanted to build on the public/private insurance arrangements we already have, and some experts had thought the House expansions might have been one way to start construction. The PBS segment would have been much more informative if it had talked more about all this and less about people who couldn’t buy Christmas gifts.

To refresh your memory: The House bill would have allowed workers laid off because of the recession to obtain Medicaid coverage until 2011, without having to meet Medicaid’s usual requirements for income and assets. (Recipients can’t have much of either.) This provision would have helped workers from small businesses (fewer than twenty employees) who don’t qualify for COBRA. Under the House plan, workers age 55 to 64 or those who had been at the job at least ten years could have stayed on COBRA, paying all the premiums themselves until they became eligible for Medicare. That might have been the beginning of guaranteed coverage for a group of older workers who often have a tough time buying on their own in the private market, where insurers slam the door if applicants have health problems. People in this age group often do.

PBS was not alone, however, in missing the mark. We in the media tend toward fanfare and exuberance when reporting on a final legislative product—a celebration, if you will, of the difficult feat of passing a law. But often these “wrap-ups” fail to mention what got left behind in the back rooms where the deals with lobbyists were made, let alone the significance of these omissions to the public. The stimulus bill was no exception.

The AP, for instance, issued one story that simply said “the Obama plan offers a 60 percent subsidy to help unemployed people pay health insurance premiums under the COBRA program…” Another story, written by an AP special correspondent a day later, reported that the legislation “provides billions of dollars to aid victims of the recession through unemployment benefits, food stamps, medical care, job retraining and more.”

To those who hadn’t been closely following the twists and turns in the legislative process, this must have made it seem like help with insurance coverage was on the way for everyone who had lost a job. Several days before the House and Senate reached agreement, the AP issued a story that actually focused on all the insurance expansion proposals on the table. But by the time a final bill emerged, ‘what might have been’ was old news.

In health care, old news does matter, because so much of the reform action takes place in the back rooms where lobbyists hold sway. In its wrap-up, The New York Times explained the surviving COBRA subsidy—the government will pay 65 percent of the cost of premiums for up to nine months after being laid off. It also reported:

Negotiators dropped a significant provision of the House bill that would have given states a new option to provide Medicaid for the unemployed, with the entire cost borne by the federal government.

The paper of record did not record that the COBRA extensions for older workers were gone.

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.