Soon after the Affordable Care Act passed, I met with a reporter who had written some of the most important and insightful articles on the U.S. health care system that I had read anywhere. Without a doubt, her reporting helped inform the debate on reform and led to some of the consumer protections being included in the legislation.
I had just begun serving as a consumer representative to the National Association of Insurance Commissioners (NAIC), which was charged by Congress to write numerous regulations required by the new law, when I told her I was looking forward to seeing her coverage of the law’s implementation. I knew that with her depth of knowledge about the U.S. health care system, she was especially well qualified to report on how the special interests who profit from the system—including my former employers in the insurance industry—would be attempting to influence how the new regulations would be written and put in place at both the state and federal levels.
She dashed my hopes. There would be no such articles, at least not from her. She told me she had been covering health care too long and was moving on to another beat. Besides, she said, covering the regulation writing and implementation would be boring.
No argument there. It’s hard to get excited about what goes on behind the scenes to shape how any law will actually go into effect, and it’s hard to write about it in a way that will be perceived as meaningful and relevant to editors, much less to readers. But unless there is scrutiny by the media, the special interests are much more likely to succeed in shaping what is arguably the most far-reaching bill passed by Congress in decades.
I wish I could have persuaded that reporter and many others to travel to Denver a few weeks later to cover the spring meeting of the NAIC, which began just days after Congress passed the reform bill in March 2010. That was my first meeting as one of 29 NAIC consumer representatives, and I was stunned by how outnumbered we were by the special-interest lobbyists. There were more than a thousand of them there for the sole purpose of trying to protect their employers’ interests as the state insurance commissioners began their work on drafting the regulations. As for reporters, there were a few from the trade press and a couple from Politico, but as I recall not one from a big daily newspaper, a network or cable news show or even online media.
I should not have been surprised. Regrettably, much of the coverage of the debate in Congress over reform and about the bill since it was signed into law has focused on what the politicians and pundits say about it—and much of what is being said about it is not even remotely true. Add to that the fact that the Obama administration seemed not to have had a strategy to explain how the law will affect Americans. It’s little wonder then that polls continue to show that more Americans are opposed to the law than support it.
But those poll results also reflect the failure of the media to educate and inform the public about the law. It is easy to do the “he said, she said” type of reporting. It takes more time and effort to really delve into the various provisions of the law and to explain how they will affect not only consumers but also the special interests who have redeployed their lobbyists from the halls of Congress to the halls of the federal and state office buildings to try to guard their profits and incomes.
And now that the Supreme Court has ruled that the law can go forward, lobbyists and PR people for the insurance industry, which is most affected by the law, are taking their campaigns to influence how the law will be implemented to the court of public opinion. Their objective is to persuade the public, and ultimately lawmakers, that some of the most important consumer protections in the law are not in our best interests because they will result in higher premiums.
All you have to do to understand what the industry has its sights on is to read the statement by America’s Health Insurance Plans in reaction to the Supreme Court decision. AHIP took advantage of the opportunity to warn of higher premiums if Congress doesn’t change certain provisions yet to go into effect. Specifically, they are the tax on certain health plan policies that will help finance expansion of coverage; the restriction on charging older people more than three times as much as younger policyholders; and the provision calling for the development of an essential benefits package.
Just this week, AHIP’s CEO, Karen Ignagni, reiterated the industry’s concerns about these provisions during a panel discussion, sponsored by Health Affairs, at the National Press Club in Washington, D.C. What this means is that AHIP and insurers are putting on a full-court press to change the law to protect profits.
I’ve seen almost no coverage of this in the media. It leads me to believe that reporters are not paying attention or that they have either moved on to cover other things, have no time to do much of anything other than the “he said, she said” type of reporting, or find it too boring to take a closer look at what is really happening.
But I’m an optimist. I’m hopeful of seeing at least one or two reporters taking this on and doing a little investigating and writing so that readers can understand the importance and the relevance of paying attention to the way the law will be implemented in the coming months and years.
What, for example, would happen to premiums for people in their 50s if the insurers get what they want and have the age rating restriction either changed to a 5-1 ratio or eliminated entirely? It would be worth pointing out that in Massachusetts, the reform law enacted when Mitt Romney was governor prohibits insurers from charging older people more than twice as much as young people. Even with that, according to a 2009 story in the Boston Globe, many of the state’s older residents are having a hard time finding decent coverage they can afford. Many have no choice but to buy less comprehensive policies that put them at financial risk of bankruptcy if they get seriously ill or injured.
We can’t rely on either the Obama administration or the law’s critics to keep us informed about what will happen if the law is implemented as Congress intended or if it is changed to suit the special interests, like the ones I used to work for. In-depth, insightful reporting is our only hope.
This first appeared on Reporting on Health from the Annenberg School for Communication and Journalism at the University of Southern California on 7/18/2012.