We can probably forgive Secretary of Health and Human Services Kathleen Sebelius for spinning tomorrow’s debut of Obamacare in the best possible way for the administration. That’s her job. But spinning doesn’t cut it with journalists–or, shouldn’t. That’s why Politico deserves a shout-out for its coverage of the HHS conference call with reporters last week.
When the administration released rates last Tuesday showing premiums in states where the federal government will run the exchanges, the announcement, Politico reported, came with “one big catch: the report doesn’t actually reveal very much about what most people will pay.”
Politico’s Brett Norman and Jason Millman wrote:
The administration put the best face on the health insurance premiums, emphasizing that the rates have come in lower than expected in the 36 states where the feds will run part or all of the exchanges. That part of the report gives them a snappy answer to the widespread predictions of ‘rate shock’ by critics of Obamacare. But it was a far cry from full disclosure.
What did the administration say? According to Norman and Millman, “the carefully selected numbers the administration did produce generally undercut the more dire projections that have been made.” Like state insurance commissioners, Sebelius was eager to tell the world that insurers were selling cheapie insurance to young healthy adults, which Politico noted was the group “expected to suffer most under Obamacare’s market reforms,” but who actually “would not be bankrupted.” But what about older, sicker people who need to shop in the exchanges until they are eligible for Medicare? They are the ones who will see premiums of $600, $700, maybe more each month, especially if they forgo the cheaper policies and buy ones that offer more benefits (which they may need). They are the ones who will pay three times more than the 27-year-olds trotted out in press conferences, and a lot more if they live in high-cost areas of their state. They are the ones the administration doesn’t mention.
And, Politico got it! Norman and Millman ran through a bunch of examples of bargain basement premiums in several states, noting that both the state-run and the federal government’s exchanges showed the same thing–low rates for bronze level plans that cover 60 percent of someone’s medical costs. Then they pointed out the glaring omission. “What the report fails to say is what the health plans in the federal exchanges would cost anybody else–i.e., the majority of Americans.”
One freelance reporter who was on the call told me “all the talk was about cheap premiums,” adding that even though HHS official Gary Cohen mentioned the concept of “actuarial value” which, of course, is the technical jargon for the amount of coverage provided by the bronze, silver, gold, and platinum plans–i.e., the silver provides 70 percent and so on–she told me reporters didn’t follow-up. She wanted to ask a question about cost-sharing–the high deductibles, coinsurance and copayments that many low-cost plans require consumers to pay–and whether that deters people from accessing medical services, especially treatment for alcohol and substance abuse. But she was not called on.
Ah, cherry picking the facts! The press bit in with their stories, for the most part following what HHS officials wanted them to write. The low-premium narrative reigned supreme with its threads about the good deals for young adults and upbeat quotes from HHS officials. In my scan of other press accounts, there was hardly a nod to the question raised by Politico–what about the premiums everyone else will pay? In Alabama, the Montgomery Advertiser not only passed along the HHS spin, but got the whole rate thing wrong. The paper gave some examples of low premiums in Alabama, reporting they are “lower-than-average for current plans in the state”–and made that point in some way three times in the piece. Apparently, the fact that new rates in the exchanges cannot be compared to last year’s individual market rates hadn’t yet reached Alabama. The paper noted:
Prices on the exchanges will vary, depending on age, but HHS reported that Alabamians will tend to pay less in the exchanges than they would with current plans.
Elsewhere, Fox Business, which substantially picked up a Reuters story, failed to pick up the question Politico posed and to discuss high cost-sharing, which will be the norm for many policies. The Cleveland Plain Dealer quoted Sebelius saying, “we are excited to see that rates in the Ohio marketplace are even lower than originally projected,” and reported that “premiums would vary considerably between different markets”–an interesting fact, but hardly useful to the millions of shoppers who need to make a choice in the next few months.
Exchange shoppers must make comparisons all right, but that isn’t one of them. Insurance prices have always varied by state, and what consumers need to know is 1) how rates vary in their own states for the same coverage, and 2) how the rates vary for different coverage and whether it’s worthwhile to pay higher premiums for better coverage. That’s what the next round of stories should focus on.
Tomorrow is D-Day, and the exchanges will be the big story. In examining the premiums that will be on each state’s website, reporters will see for themselves what everybody else will pay for insurance. Maybe the ongoing game of spin the rates will finally be over. The message from the administration and Obamacare cheerleaders has been the Affordable Care Act will bring cheap insurance. It will for some, but not for others. It would be great for the media to forget about waving the pom-poms and instead use their megaphones to tell people what they can actually expect, and how to make the tough decisions about choosing a policy.
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Related content:
Untangling Obamacare: The affordability puzzle
Untangling Obamacare: Shopping the insurance exchanges
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.