A Twitter conversation last weekend between MSNBC’s Timothy Noah and some Washington Post reporters revealed a lot about how the consumer story of the Affordable Care Act is being covered. In short: the bar for consumer coverage is set way too low.
You can see much of the conversation in the thread here; I’ve also collected the most relevant tweets in the Storify below along with some of my own commentary:
Not to pick on the Post, which isn’t different from how most newspapers have handled this side of the healthcare story, but Noah is spot on. For months we’ve been urging the press to tell the ACA story from the vantage of those who will be shopping in the new exchanges. (And by the way, those folks probably aren’t high up the income ladder, or they’d have employer-provided coverage, but they aren’t necessarily poor. In places that have expansive Medicaid programs–or that are expanding Medicaid under Obamacare–that’s where most low-income consumers will find insurance.) That’s a very different perspective than what the usual political horserace, or even the policy wonk, coverage offers.
And to do the consumer story justice, it is a beat all right, just as Noah tweeted. That’s the only way a newsroom can offer enough depth and detail to match the complexity of this topic. The “guide to purchasing coverage” the Post‘s Sarah Kliff mentioned on Twitter is a start, but it was a basic who-what-when-where-why piece. Readers learn who can shop the exchanges, the names of insurers offering policies, and how many plans will be offered. They get a call center phone number, a link to the exchange website, and a list of languages they can get help in. And they get a few examples of sample premiums, with a note that subsidies may reduce the monthly cost.
That may be a rough guide to buying a plan on the DC exchange, but it’s not a path to intelligently shopping the exchange and evaluating policies. (The Q&A style piece published by WaPo Sept. 25 offers some additional details, and an Oct. 1 column by Michelle Singletary had some tips on navigating the bumpy exchange rollouts, but they weren’t real shopper’s guides either.) To deliver that, you’d begin by noting the all-important deductibles and coinsurance–it’s the interplay of the deductible, coinsurance, copayments, premiums, and subsidies that determine what the consumer will ultimately pay. Simply saying there are bronze, silver, gold, and platinum plans with different numbers attached doesn’t cut it, either. How do consumers make the trade-off? How can they find and make sense of the Summary of Benefits & Coverage, the disclosure statement shoppers are entitled to receive? How do they cut through the insurance company mumbo-jumbo about limited networks and tiered networks? Answers to these questions would be my minimum for serious consumer coverage, not simply listing a URL.
If news organizations are going to deliver that sort of coverage to local readers, it’ll take editors who are committed to the consumer story and devote resources to it. Of course, newsrooms have other stories to cover, and there are niche publications and websites that delve into the insurance nitty-gritty. But the White House understands that the implementation of Obamacare is a local story, and it is moving its messaging accordingly. Counterspin from the critics will surely follow. Local news outlets around the country should understand what real consumer coverage that cuts through the talking points looks like.
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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.