Healthcare-related media criticism doesn’t often go viral, or even semi-viral, but the writer Maggie Mahar scored big earlier this month with her “Anatomy of an Obamacare ‘horror story'”–a debunking of a Fort Worth Star-Telegram article about four Obamacare “losers” who, as Mahar wrote, “didn’t want to be winners.” In her post at Healthinsurance.org, Mahar showed how the tale of insurance woe one woman told the Star-Telegram didn’t stand up to basic scrutiny, and how three of the four people featured in the article were associated with the Tea Party, a relevant fact about their political perspectives which the paper hadn’t reported. Soon after, Star-Telegram executive editor Jim Witt apologized in a column, saying “we did not do our job completely and therefore let our readers down.”
It was awfully reminiscent of the Deborah Cavallaro episode last fall, in which a Los Angeles real estate agent made the national media rounds to complain about the outrage of having her policy cancelled before any journalist figured out she was eligible for a subsidy that would get her a comparable plan at a lower cost. Of course, there are also plenty of ready-made testimonials in support of the law circulating in media coverage without much sign of scrutiny. CNNMoney’s late December feature “I signed up for Obamacare!” comes to mind; the six mini-profiles read like press releases from Kathleen Sebelius’ PR shop.
Of course, Obamacare really does bring new benefits to many people. And, both by design and because of errors, it really has been leaving some people worse off, and forcing others to confront trade-offs. Reporting on the experiences of individual people can be an effective way to explore the law’s wide-ranging impact.
But that means really reporting, to learn all the important information about your subject’s Obamacare encounter–including how well they understand their choice–rather than just snagging an anecdote that will serve to prop up a thesis or support a point. Here are six questions to ask yourself before sticking someone’s experience with the Affordable Care Act in your story; if you’ve got others, please leave them in the comments section.
1. Is the anecdote focused on the point you’re trying to make? Have you done enough reporting about both this person and the broader context to know the story you’re showcasing is representative? To use an example from the olden days: an anecdote about a patient denied care by an HMO (and there were many of them) hardly meant that the universe of HMO patients didn’t get care. By the same token, not every good or bad interaction with insurers today is because of Obamacare.
2. Who’s supplying the anecdote, and what’s their mission? Ready-made stories for a press ready to use them should be suspect. In October the Robert Wood Johnson Foundation awarded a $1.1 million grant to Families USA “to expand its well-established story bank operation to produce a substantially higher volume of stories from real people about their experiences with enrollment in new health coverage.” Families USA has been a strong supporter of the health law, and its founding executive director Ron Pollack is a founder of Enroll America, a public-private group whose aim is to sign people up for Obamacare. On the other side, Republicans have set up a website to solicit stories from small businesses and individuals about the “real life consequences”–presumably, harmful ones–of Obamacare. There may be some kernels of useful material in what journalists get from these groups, but handle with care.
3. What’s meant by “affordable”? Reporting that John or Jane Doe got a cheapo premium is insufficient and potentially misleading–because there’s a good chance it comes with a high deductible and substantial cost-sharing in the form of co-pays and coinsurance. President Obama sold the law on the promise of affordable, quality healthcare, and it’s the total out-of-pocket spending that determines how affordable healthcare really is.
4. What does the person really know about the policy? To drill down into cost-sharing, it’s not enough to report that your shopper got a low co-pay to see the family doc or even a specialist. That’s not where the action is. Insurers have larded up their offerings with coinsurance of 30, 40, or 50 percent on expensive services people tend to use, like hospital outpatient and imaging services. The costs of MRIs or cataract surgery can add up. If your interview subject can’t tell you what the coinsurance is, what other important details might they be unaware of?
5. How much time did the person spend shopping? Buying insurance is tough, and good, complete information about coverage is not always easy to find. Some ACA-bashers haven’t even realized they qualified for subsidies. Meanwhile, those who quickly signed up for the cheapest policy probably don’t know much about what they bought. If the decision was a quickie, it could be a clue that a third party guided the decision–and then vetted the story before it reached the press.
6. Do you need an anecdote at all? Some stories can be told more simply and clearly and in fewer words without supplying some tale of woe or glee.
We may need to add some more questions soon. Harvard pollster Robert Blendon predicts there will be a new wave of stories, as Americans who have shopped in the exchanges start using their policies. There will be tales of people finally getting care, along with tales of frustration as people find their doctor is not in the new network or face big bills they may have to pay if they have outpatient surgery or need an MRI.
“The complexity of the law allows either side to manipulate the press cycle,” Blendon says. “Stories where a lot of people lose something will have greater impact than stories of people who just gain something.” One more point to think about when you evaluate your anecdote and place it in its proper context.
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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.