In mid-February, Katie Kerwin McCrimmon wrote her 148th story for Health News Colorado, a foundation-funded niche site with a mission to provide in-depth coverage of health and health policy issues in the state. The piece, while not the most damning example of McCrimmon’s reporting, did not bring great news about Colorado’s health insurance exchange, once a poster child for the state marketplaces established under the Affordable Care Act. About 140,000 people had signed up for private health insurance through the exchange at the close of open enrollment—a number that, as McCrimmon explained using a table showing the exchange’s own projections, was “far below” the lowest official estimate of sign-ups for the full year. Even if sign-ups continue at the same monthly rate as in 2014, she noted, enrollment will fall toward the lower end of official projections. The numbers may be cause for worry because enrollment fees will finance most of the exchange operations in coming years—strong sign-up numbers are crucial for its solvency.
Until the last few weeks, McCrimmon has been all but alone in chronicling these and other concerns at the exchange. Other news outlets contributed stories now and then, but that coverage hardly rocked the boat. (Consider, for example, the Denver Post story on open enrollment signups, which totaled four paragraphs in print, six online). Ellen Daenhick, a former health exchange board member, told me that when she joined the board in 2013, a top exchange employee advised her not to talk “to that blogger Katie McCrimmon.” A look at some of McCrimmon’s tough reporting shows why.
One of McCrimmon’s 2012 pieces, as the exchange was revving up—headlined “Colorado’s exchange progressing, but IT problems loom”—has proved prophetic. As the second open enrollment period moved along in late 2014 and early this year, system glitches hampered those tasked with signing up new customers. The promise to operate lean and mean has turned out to be just a promise: In January, McCrimmon told readers the exchange was costing a lot more than anticipated and managers were asking the board for more emergency funds to cover IT cost overruns. The call center, McCrimmon wrote in November, is costing millions more than planned. Last summer, McCrimmon reported the exchange had spent nearly $7 million on a navigator network that had managed to sign up only 8,000 people for private insurance. (Many more signed up for Medicaid and the state’s children’s health plan.) And in December, McCrimmon summarized the report of a state audit that “uncovered more than $32 million in problematic spending of federal tax dollars and possible illegal use of tax money to pay for barred activities such as lobbying and marketing.” The legislature is deciding whether to authorize a new, more expansive audit, she told me.
The critical thrust of the reporting has often led to pushback, especially from Onsight Public Affairs, a Denver-based PR firm hired by the exchange. Onsight’s Curtis Hubbard, onetime editoral page editor of The Denver Post, is frequently quoted in McCrimmon’s work as the voice of the exchange—and frequently pushes back on her reporting, challenging the framing and sometimes the facts. Soon after McCrimmon’s Feb. 19 story was published, for example, Hubbard complained to Health News Colorado editor Diane Carman, Carman told me in a phone interview, wanting her to change the headline and lead of the story. “The pressure has been to edit our content just because they didn’t like it,” said Carman, who described regular “demands for corrections” as an effort to intimidate. When I put these complaints to Hubbard, he told me by email that Onsight’s “strategy has been to work with [Health News Colorado] to provide the correct information prior to publication and to reach out to correct errors when they are published.” He added that Onsight also “reach[es] out” to organizations that share Health News Colorado’s content “to alert them to what we consider errors.” (It’s worth noting that in 2013, McCrimmon wrote about the exchange’s $118,000 “PR tab” from Onsight for “advice that included discouraging members of the oversight board from talking about the exchange as it launched.”)
By McCrimmon and Carman’s count, Health News Colorado has run three corrections (here, here, and here) and two editor’s notes on her exchange reporting over four years. She describes the pushback from Onsight this way: “With every single story I wrote, they claimed there were errors or the implications were negative. They challenged every single story, so I buckled down and instead of walking away, I started covering [the exchange] more.”
Recently, other Colorado outlets have started to cover the exchange more, too. In January, Brandon Rittiman, a political reporter for KUSA, Denver’s NBC affiliate, jumped into the mix and broke important news: The exchange had cancelled policies of Coloradans that were supposed to be automatically renewed, leaving them with gaps in coverage. A design flaw in the system caused the exchange to cancel up to 3,600 plans of policyholders who had browsed other policies while logged in to the exchange. “The exchange’s overarching message was they knew about this, the system was designed this way, but they never thought it would be a problem,” Rittiman told me.
In mid-February, he uncovered another glitch, this time reporting the exchange was combining some applicants’ incomes from last year and this year, meaning many would qualify for lower subsidies than they were entitled to. Rittiman has reported the exchange doesn’t know how many people were affected, but officials insist the glitch has been fixed. “I don’t see any effort on the part of the exchange or the state to proactively help these people,” he said. “Citizens deserve to know who is responsible for the system that’s caused this latest glitch. It’s a question we still haven’t gotten an answer to.” (Rittiman has not encountered substantial pushback from the exchange, he told me.)
These are important examples of the media’s role in holding government agencies accountable, a task that has become increasingly difficult for journalists. At Health News Colorado, the reporting “has taken a lot of guts on Katie’s part. They’ve tried to undermine her reputation, but she doesn’t give up or back away,” says Carman. The editor says both she and McCrimmon are “supportive of the whole concept” of the ACA, and “it takes some discipline to go after an agency you want to see succeed. But the fact is that’s our job.” The tough reporting in Colorado stands out among the cheerleading that has defined much Obamacare coverage for too long.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.