The Second Opinion

As Republicans promise Obamacare demise, reporters attempt their own do-over

December 1, 2016

With Obamacare in play once again, it’s fair to ask: Is the press repeating the mistakes it made covering the law the first time around? By that I mean the failure to fully explain the law’s provisions back in 2009 and 2010 during the run-up to passage, brushing off early warnings in 2013 before the law’s technology-driven, near-death experience, and most recently ignoring the deteriorating financial conditions of the 23 insurance co-ops created as a cheaper alternative to the big carriers until they began to topple one by one?

The press has a chance to redeem itself this time around, but judging from some of the coverage after Trump’s post-election meeting with President Obama, redemption could be a shaky proposition. Early stories jumped on simplistic angles that characterized so much of the campaign coverage. A headline in the Wall Street Journal  proclaimed, “Donald Trump, in Exclusive Interview, Tells WSJ He Is Willing to Keep Parts of Obama Health Law – President-elect hints at possible compromise after vows to repeal the Affordable Care Act.” The Washington Post signaled a Trump policy reversal with “Here’s why Trump is already waffling on Obamacare,” an op-ed by Harvard economics professor David Cutler, who once was a senior health care adviser to the Obama presidential campaign. The New York Times weighed in with “Trump Signals Shifting Views of Health Law” and reinforced the apparent flip-flop with this pull quote, “A move away from campaign promises that hews closer to Republican policy.”  CBS seemed to be passing on the “news” as a promo for Trump’s first post-election TV interview on 60 Minutes.

There was just one problem with this “news.” It wasn’t really news.  In an interview with CNN in February, Trump said: “I want to keep pre-existing conditions.  I think we need it. I think it’s a modern age. And I think we have to have it.” Even if he had flip-flopped, the story going forward is not that a president or president-elect changes his mind. Presidents do that all the time. Obama did not support the individual mandate when he first campaigned for the office, and he used that fact in campaign ads against Hillary Clinton, who did support such a mandate in her 2008 campaign.

Going forward, the story does not lie in Trump’s imaginary flip-flop, the spill-over gotcha from the campaign, or the carefully-crafted words from GOP spinmeisters who likely will be called upon to fashion focus-group tested words to sell their brand of reform as the Democrats did for Obamacare. The election results tell us that slogans like “affordable quality health care for all” and false promises like the one about every family saving up to $2,500 a year on health insurance do come back to bite.  Reporters tasked covering the story of “repeal and replace” take heed!

What the press delivered before Obamacare’s passage “was mostly a conversation among policy wonks and Beltway political elites without letting in the people who would be most affected by the nostrums they were prescribing.” The public became the victim of a slick messaging war shaped by spin and talking points that finally backfired at the polls.

Throughout the contentious debate, we at CJR urged the media to explain the individual mandate–the requirement that almost everyone carry insurance or face monetary penalties. Many didn’t because newsmakers and politicians glossed over the mandate fearing that voters might not like it. Nor did they talk much about affordability except to pass along the rallying cry of Democrats and their supporters that the law would deliver “affordable quality healthcare for all,” which as we have seen, it has not. There was little examination of the president’s pledge, “if you like your healthcare plan, you can keep your healthcare plan,” a hollow promise at best. Americans were already being forced to switch policies often as employers continued to change carriers in search of cheaper coverage for their workers.

Sign up for CJR's daily email

In hindsight, we can argue more honest journalism and better reporting–especially about the likelihood of future high premiums–might have stalled, perhaps even eliminated, the virulent backlash that has occurred. After all, the public did like some Obamacare provisions. But as recently as late summer the media were still tone deaf, relying on spin from the law’s supporters to frame their stories. Outlet after outlet failed to recognize that half the people buying insurance in the individual insurance market where policies must be compliant with Obamacare rules, were not eligible for subsidies and would have to pay the full freight. They, too, undoubtedly expressed their displeasure at the ballot box. The Congressional Budget Office estimated that for 2017, nine million people buying individual market policies outside the shopping exchanges will get no subsidies. Neither will three million people who buy exchange policies because their incomes are too high. That leaves half the projected 24 million individual market shoppers without government help.

The  impression given by the media, though, could be best summed up by the quote given on a press call by Health and Human Services official Kathryn Martin and widely passed along by the media. “Headline rate increases do not reflect what consumers actually pay,” she told reporters. The Hill summed up the rate situation this way: “Even if premiums increased by a whopping 50 percent, most Obamacare customers would still pay $100 or less per month for coverage.” There was no mention of those who wouldn’t. Newspapers across the country left them out, too.

What exactly are the GOP’s plans for repeal and replace? They are likely to be complicated and hard to understand, especially on deadline. How they will they affect people who have come to depend on Obamacare for coverage? By that I don’t mean a laundry list of possibilities and speculation. Staccato descriptions of serious changes to people’s health insurance arrangements are of little help to anybody except reporters on deadline who need to crank out a quick story. There’s a danger, too, that coverage could fall into the Obamacare trap of policy-wonk speak, leaving readers and listeners to decipher what it all means. Or they could fall into the trap of proponents of a plan say this, and critics of it say that.

The media have already begun to produce stories about how requiring insurers to cover the sickest people must go hand in glove with the individual mandate. Others are saying the two are not tied at the hip. Who’s right? Who’s wrong? And what kind of insurance arrangement are they talking about? That, it seems, is a good place for journalists to start on their path to redemption.  Sarah Kliff writing in Vox this week shows what can be done. Her clear explanation of one direction for changing the health law is worth a read.    

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.