Under Trump, health reporters confront an information blockade

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Washington Post healthcare reporter Paige Winfield Cunningham recently raised a few serious questions about how the Trump administration planned to manage Obamacare’s fall enrollment season. “The six-week sign-up period will be the first handled exclusively by an administration that’s hostile to the Affordable Care Act,” Cunningham wrote, “and one that hoped by now to see Congress pass legislation unraveling much of the law.”

Any reporter might have asked the questions Cunningham put to the Department of Health and Human Services, some of which she published in her daily Health 202 column:

Will the government contact current enrollees to alert them that sign-ups will last just 45 days, about half as long as in the past three years? Will HHS run call centers for consumers who need help as they look for plans? Will the HealthCare.gov computer system be adjusted to accommodate a possible crush of shoppers given the shorter sign-up period? And how will automatic enrollment be handled?

HHS offered no answers, although a spokesperson for the department’s communications staff did provide Cunningham with a statement: “As open enrollment approaches, we are evaluating how best to serve the American people who access coverage on HealthCare.gov.” Even that statement did not stand for long, reported Cunningham:

An hour later, the spokeswoman, Jane Norris, requested that the statement be withdrawn, saying that she did not have permission to release it. When I asked her again for detailed answers, neither she nor anyone else at HHS responded further.

“Nobody at HHS ever reaches out to me,” Cunningham told CJR during an interview. “More times than not, they don’t respond to emails asking for information.” On the day we spoke, Cunningham asked a spokesperson from the Centers for Medicare and Medicaid Services (CMS) to have coffee. The official said she’d like to, but would have to get back to her. She never did.

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Cunningham’s troubles reflect the challenge many health reporters are up against as enrollment season approaches. Journalists from mainstream news outlets as well as trade publications are frustrated—by a lack of information from Trump administration health agencies, by their insufficient responses to those questions that do get answers, and by demands from HHS officials to change stories that have already been published. In light of the Trump administration’s plans to cut advertising and programs like local navigator groups that promote enrollment in the Affordable Care Act, such silence can carry devastating consequences for many Americans.

Complaints about access to government sources are nothing new. Journalists squawked about lack of access under the Obama administration, which promised to be the “most transparent” in US history. “The public information model is dead,” a public information officer employed by a federal agency that dealt with science and health told CJR. That model “has now been replaced by a highly message-controlled environment.”

Still, a lot can change in two years.

“Things have gotten worse in the Trump administration,” says Charles Ornstein, a senior reporter at ProPublica. “There’s an outward vitriol from this administration that’s different from previous administrations.”

Dan Diamond, who writes Politico’s health newsletter, shared several instances of unanswered questions with CJR. In one instance, Diamond asked Alleigh Marre, the recently departed national spokesperson for Health and Human Services, to confirm that HHS still sees a link between climate change and risks to American health. Marre didn’t respond.

“My experience,” says Diamond, “has not been great.”

Harris Meyer, a senior reporter for Modern Healthcare, says he always wants to give agencies a chance to respond. But “it’s basically impossible to get an interview with a CMS staffer,” he says. While officials “seem to be fairly responsive to emails, they don’t seem willing or able to provide an interview with the appropriate staffer.” That goes for positive coverage, like this story from Modern Healthcare that placed HHS Secretary Tom Price atop the publication’s annual list of the “50 Most Influential Physician Executives.” Meyer tried for two weeks to snag an interview with Price before he gave up.

Matt Wynn, data reporter for MedPage Today, went public with his troubles prying loose the data underlying a series of maps CMS sent out this summer. One map published in early June identified counties without insurers selling policies on healthcare.gov this fall, and a news release announced “at least 35,000 active Exchange participants live in counties projected to be without coverage in 2018.” Wynn asked CMS to see the numbers supporting those conclusions.

I shot an email to the media relations office in the department, asking for the data behind the map.

About an hour later I got a response. No further information would be shared at this time, wrote Shelby Venson-Smith, a public affairs specialist. Adding insult to injury, the non-response was not to be used as a direct quote, the email said.

In his story, Wynn suggested that he had called Venson-Smith “on a bad day.” Wynn believes that line prompted Venson-Smith to contact his editor.

“It became clear she just didn’t like the insinuation that she was having a bad day,” says Wynn, who spoke with Venson-Smith about their exchange and then updated his story to attribute her “bad day” to CMS. “The point wasn’t specific to her, anyway, so I had no problem changing that.”

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In updating his story, Wynn also cut the description of CMS’ “non-response,” though perhaps that point is still clear enough to some readers. During his reporting, Wynn followed up with CMS and requested the map data once more. “Again, there was no further information to be had,” wrote Wynn. “Again, I was forbidden from quoting the email itself.”

Kathryn Foxhall, a freelance writer who works with the Society of Professional Journalists on freedom of information issues, protested the matter to Jane Norris, the same press contact that The Washington Post’s Cunningham had interacted with. In an email to Foxhall, Norris replied that CMS would not be sharing their data publicly because insurers hadn’t finalized their agreements. (Though, apparently, those agreements were final enough for CMS to put out its maps.) The email said the agency would provide the public “a complete picture” of the insurers prior to open enrollment on November 1. Furthermore, said Norris, “It would be greatly appreciated if you would respect the decision of our office and consider this matter tabled until we get closer to this time-frame.

Noam Levey, Washington health reporter for the LA Times, also had a run-in with Norris, who asked him to retract information included in a piece last spring about potential rate hikes. Levey reported the administration had offered to continue paying the ACA’s cost-sharing subsidies in exchange for insurer support of repeal legislation.

Once the story was out, the department demanded language about the quid pro quo be taken out, Levey told CJR. The offending words stayed, but the paper updated the story to include a comment from Norris, who called the Times’ account of the meeting where the deal was apparently discussed “completely false.”  

The experiences of reporters like Wynn and Levey are instructive for journalists covering federal health policy. Even when HHS and CMS share relatively little information with reporters and the public, they retain a great deal of control over what little they give out.

While HHS press officials decline to answer reporters’ questions in satisfying detail,  they seem to have plenty to say in their news releases and email blasts, which disparage the health law and sound more like campaign propaganda and GOP talking points than routine communications from a federal agency. The Obama administration was not shy about using the same PR tools to boost the ACA. But messages from HHS now feel substantively different, perhaps because they are aimed at denigrating a law they have a legal responsibility to administer.

An August 21 email blast sent by HHS to select reporters charged that the Affordable Care Act “failed to create a thriving, competitive market.” The email pointed out that Obamacare’s Enrollment Assistance Program had spent more than $1,500 for each one of the 14,500 people it signed up, numbers attributed to reporting by the Washington Free Beacon. There was no consideration for how such support might have helped healthcare shoppers understand complicated insurance options—just the implication that the money spent to help thousands of enrollees wasn’t worth it.

News releases that accompanied the county maps published this summer threw darts at the Affordable Care Act, too—again repeating a familiar theme from the Trump administration. “This is yet another failing report card for the Exchanges,” noted CMS Administrator Seema Verma in one release. In another, Verma said the decline in insurer participation left consumers with “fewer and fewer insurance options,” and she was “deeply concerned about the crisis situation facing the individual market in many states across the nation.” Later releases took on a softer tone but still claimed that millions of participants would have only one choice and “may not be able to receive the coverage they need.”  

How reliable is the information the public gets from HHS and CMS? I asked Charles Gaba, the Michigan-based freelance web developer and founder of ACASignups, which has tracked Obamacare enrollment since 2013 and has criticized number crunchers in both the Obama and Trump administrations. “A lot of what they say is misleading, questionable, or in some cases outright wrong,” says Gaba about the Trump administration numbers. For example, a June email from HHS with the subject line “Failing for years…” sent to some reporters asks them to consider “this important market update”—that “average premiums are up 105 percent across the country — an increase of nearly $3,000—since 2013.”

But as Gaba has pointed out, that number is misleading. The calculation includes only 39 states, notes Gaba. (When the other 11 are added, the number drops to 84 percent.) Gaba says it would have been “absurdly easy” to obtain data for the other 11 if the agency “had wanted to present a fuller picture.”

The “105 percent” increase also doesn’t consider tax credits, which reduce premiums for half the buyers in the individual market. And policies sold in 2013 were not the same as those sold for 2017. While the older policies excluded people with preexisting conditions, newer policies did include them, as the ACA requires.

CJR asked HHS about its media communications. This is what the agency said in response:

HHS aims to respond in a timely manner to reporter inquiries. We do make policy experts available to the media and we contact reporters as often as necessary to provide additional context and to seek connections if information reported is inaccurate.

On average, we do about 6,000-7,000 media interviews across the dept. each year, which could be about 500-600 interviews every month. Some months are even higher and some may be lower depending on what is happening that month. Calendar year 2017 is consistent with previous years.

The response also includes a link to HHS’ media policy.

What can health-care reporters do when they are denied information? There are workarounds, of course. But, while useful, workarounds effectively give agencies a pass and allow them to continue their information blockades. Reporters have always relied on experts from universities, think tanks, foundations, or businesses to explain complicated stuff. USA Today health reporter Jayne O’Donnell called on researchers at the Robert Wood Johnson Foundation to help create a map and story that showed the number of counties likely to have only one Obamacare insurer. “The best stories are ones from disgruntled employees. They’re not coming from official channels,” O’Donnell tells CJR. Finding those employees, however, grows harder with each successive administration that cuts off direct access to its experts.

HHS and CMS are powerful agencies that could decide the future of critical programs like Medicaid and Medicare, the Obamacare insurance marketplaces, and whether or not hospitals are considered safe. But when agency press officials avoid interviews and refuse to answer questions, it’s hard to present their positions fairly and understand whose side they are on. Government agencies are supposed to be objective about industry practices under their jurisdiction. But if reporters cannot get honest information about the industries they regulate, where can they go? Outside experts may not be unbiased sources. They may be trying to sell a book, or pursuing a promotion through quotes in the news media. It’s easy to overlook those biases when a reporter needs a comment on deadline.

I see one administration learning from the last and building on the last administration’s restrictions,” says Foxhall. “I don’t see the administrations ever stopping what they are doing, unless we as journalists pull out all stops and call it the censorship that it is.” There’s been reluctance to do that on the part of journalism professional groups and news outlets themselves.

Foxhall says some journalists are unwilling to fight back for the information they want. “When all the accounting is done,” she says, “we’re more responsible for this than they are.”

CJR’s health care reporting is sponsored in part by a grant from the Commonwealth Fund.

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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.