Reprinted with the permission of the Columbia Journalism Review
It's fair to say there has been coverage of the new health insurance shopping exchanges. From California and Oregon came spin, spin, spin about low rates and no rate shock (that notion that the rates insurers will charge will be so high consumers won't be able to afford them). From Ohio came spin, spin, spin about stratospheric rates that the public had better prepare for. From Maine we heard there probably would be only two insurers selling in the exchange. In Mississippi, Reuters tells us there will be just one, a small company called Magnolia Health Plan that most people outside the state have never heard of.
Eric Whitney, a reporter for Colorado Public Radio, who's done a good job of following the state's exchange all year, has brought us the latest from the Rockies. Colorado's insurance commissioner is keeping mum about the direction of rates that will be offered by 749 insurance plans in the fall. He worries that prices insurers will be asking will be misinterpreted. Perhaps, though, he doesn't want to go out on a limb the way officials in California and Ohio did. But at some point the uninsured in Colorado will need to know what's going on.
And what about New York--the state that got kudos from Obamacare supporters because Gov. Andrew Cuomo did an end run around Republicans in the state legislature and established the exchange by executive order; the state that will have some 615,000 people insured through its exchange, one of the largest in the country; the state that already has a lot of experience with the kinds of reforms Obamacare calls for? In short, we don't know much, and it's time the media pressed Albany much harder to tell us something useful. Given how politics in the statehouse works, I know that's hard, but still". If insurance departments and exchange officials refuse to talk, tell your readers. The workings of Obamacare were supposed to be open, we were told.
The very few stories there have been in the mainstream press lately have not exactly been reassuring about the state's progress. Patti Singer, the health reporter at Rochester's Democrat and Chronicle, reported over a month ago that Trilby de Jung, a staff attorney at the Empire Justice Center, said, "It's all abstract. There's no phone number to call, no software app for your computer. It's like it's hard to explain Costco when the building hasn't been built." Jane Lerner at the The Journal News reported , "a lot of information isn't there. How much will the policies cost? What benefits will be covered? Who is eligible, and how do you sign up?" Good questions, all. Danielle Holahan, deputy director of the New York Health Benefit Exchange, did not say how many insurers had applied to offer policies, but, Lerner reported, she said she was "pleased" with the response--whatever that meant.
So the news peg in New York may be the secrecy of state officials setting up the state's exchange, a point Harris Meyer ably made in his fine piece about the New York exchange published in early June in Health Affairs. Meyer noted some of the sources he consulted found: "Having the exchange within the executive branch rather than under an independent public authority has led to less transparency and public engagement." He quoted Elizabeth Benjamin, a vice president of the Community Service Society in New York City, whose organization will be on the front lines when enrollment begins October 1. Said Benjamin:
Press outreach and external affairs are very tightly controlled. It's not that we don't trust them, but people are feeling nervous that we haven't had a public stakeholder meeting since last November. The state feels a little bunkered in. To get people trained as navigators by the time of open enrollment seems unlikely.
Meyer checked in with Donna Frescatore, a Cuomo health policy adviser, former state Medicaid director, and now executive director of the exchange. Frescatore acknowledged, "There are a lot of very interested folks rightfully asking us good questions." I wanted to ask a few myself, but the state didn't make Fresctore or anyone else from the exchange available for an interview. That lack of transparency thing.
In Colorado, the tight-lipped insurance commissioner, Jim Riesberg, did make a point relevant to our business. He said The New York Times, The Wall Street Journal, and the local media had contacted him "and they all want to talk about rates." Yes, rates--in proper perspective without the gloss of political spin--are important and certainly will be as we head toward implementation day. But there's much more.
In a post I wrote at the end of March, I outlined five crucial questions to guide reporters covering their local exchanges. After seeing some of the initial coverage, those questions are more crucial than ever. Forget the spin from either side. Forget that standard bit about older people paying less--in absolute dollars they will pay more. Forget the prognostications about young people taking a hike--we won't know that for months. Instead, it's best to zoom in on the following:
Will policies be affordable? Forget that stuff about whether rates will be higher or lower than last year. They are not the same policies. The real issue is whether people can afford to buy the better policies that offer the most protection, and how families will make trade-offs between coverage and affordability.
Who influences the exchange boards? Which stakeholders are governing the board and how have their decisions affected ordinary shoppers?
Which policies can be sold? Can every Tom, Dick, and Harry sell policies on the exchange, or will there be oversight in an attempt to make sure only the best products will reach consumers? What does too few policies mean--and, too many?
Do networks have enough doctors and hospitals? We know carriers are narrowing their networks of doctors and hospitals to compete on price. The theory is that if a few providers give substantial discounts to the insurers, carriers can then offer cheap premiums, setting up another tradeoff between going to a doctor you like and affordability.
How will the exchange sell its policies? An important one! If the exchange takes a laissez-faire approach toward outreach and education, or it has been tardy training navigators and assisters who are supposed to enroll people, heaven only knows what kind of help shoppers will get.