United States Project

Reporters are caught between Obamacare and Trumpcare. How should they proceed?

March 9, 2017
Photo by Air Force Staff Sgt. Sean Martin

A few days ago, a radio host in California told me she did not understand what Republicans were trying to do to repeal and replace Obamacare. “I don’t learn much from the Sunday shows,” she said. “It’s all so much inside baseball and theatrics.” Now, the first details of the GOP’s plan—already dubbed “Trumpcare,” of course—present a familiar challenge for health care reporters: Can they push past inside baseball and instead provide clear explanations for those who will live with the consequences of whatever Congress manages to pass?

Reporters covering the Trumpcare announcement are in a rhetorical bind: They must strive to explain the particulars of the GOP’s still-vague plan to an electorate that often struggled to grasp the Affordable Care Act. There has been an unexpected backlash from conservatives in Congress and from conservative groups like the Heritage Foundation, and a number of stories have focused on the Republican opposition to Trumpcare. Russell Berman has an authoritative rundown at The Atlantic, and Jonathan Swan notes at Axios that pieces at Breitbart and Conservative Review “are beating the daylights out of the Obamacare replacement plan.”

The temptation is to report on the internecine conflict erupting in the GOP. Still, for the public, perhaps the most consequential reporting is that which will clarify the replacement plan’s impact.

Some news organizations provided fine explanations of various provisions—Vox’s coverage of how GOP tax credits would benefit high-income Americans, or McClatchy’s discussion of how older Americans will pay more for their insurance. But good explanations of “tax credits” here or “higher premiums for 60 year-olds” there don’t add up to the kind of thorough, clear, and consistent reportage required of every media outlet if journalists hope to illuminate Trumpcare for the public.

Too many outlets relied on shorthand to describe complicated concepts, which made for stories too cryptic for anyone but deep familiarity to understand. Modern Healthcare reported the GOP plan would “convert Medicaid from an open-ended entitlement to a program of capped, per-capita payments to the states.” The New York Times said insurers could sell a “leaner, less expensive package of benefits.” The AP told readers the plan “would loosen rules that Obama’s law imposed for health plans directly purchased by individuals while also scaling back insurance subsidies.”

The Texas Tribune probably confused most of its readers with this mixed up statement: “Under the new bill, federal funds used to expand Medicaid will be suspended by 2020 and people will no longer have to be on an insurance plan.” Would someone on Medicaid no longer have to be on an insurance plan? Some outlets used the word “refundable” to describe the tax credits without explaining what a refundable tax credit is. (It means that if the amount of the tax credit is greater than the amount of taxes owed, the taxpayer gets a refund of the difference.)

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News outlets conveyed information with short primers and listicles, which can be useful so long as they don’t suffer from the same shortcomings found in more narrative approaches. The Los Angeles Times offered readers a reasonable primer, “Obamacare 101,” which set highlights from the GOP bill against the Affordable Care Act for context. “Obamacare is pretty complex,” wrote Noam Levey. “So it shouldn’t be a surprise that what the GOP is proposing in its place has a few knotty details.”

Still, such stories can also be too brief and omit important connective tissue. When the LA Times reported that, “by pegging the size of the subsidy to the actual cost of health plans, the law protected consumers from big insurance increases,” I was confused. What exactly did this mean for the thousands of people who saw huge premium increases on their Obamacare policies this year? And, if those same people are confused, might they stop reading at that line?

ThinkProgress’ “6 things you should know about Trumpcare” was illuminating, if not comprehensive. It explained the consequences of various provisions in clear language. The GOP proposal “defunds Planned Parenthood and eliminates abortion coverage;” it “includes massive cuts to Medicaid, the program that provides coverage for millions of low income Americans;” it “could trigger a ‘death spiral’ in the individual insurance market.”

ThinkProgress also questioned whether the 30-percent increase in premiums for those who move in and out of the individual market and allow their coverage to lapse is great enough to entice younger, healthier people into the marketplace. That’s a question for more reporters to tackle soon.

Insurance consultant Robert Laszewski, who runs the Health Care Policy and Marketplace Review blog, says the Republican plan is not financially or politically sustainable. He told me that the Obamacare tax credits were good for people with little income, but not so generous for the middle class. With Trumpcare, it will be the opposite. “They are pretty good for the middle class,” says Laszewski, “but they are screwing the poor people.” It will be like Obamacare, Laszewski predicts. Half the people will love it and half will hate it. “It will just be a different half,” he argues.

I’ve received emails from Obamacare supporters and critics alike during the past several months. In their letters, they lamented a lack of plan choices in their counties, and said they didn’t like paying for care they didn’t want or need. Higher deductibles and rising premiums pinched family budgets and crowded out household priorities. Those undergoing treatment dreaded losing coverage and unaffordable bills.

Those concerns are a good lens for understanding how Trumpcare will or won’t address the needs of American communities, and they should be used to guide future reporting. The same stories must address not only what Republicans are selling, but also how they are selling it, using empty slogans and buzzwords like “bringing freedom and individual responsibility back to American health care.” If health care journalists can answer those concerns clearly and honestly, then their audiences will be better served than last time, and better informed for what the future might bring.

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.