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General News    H2'ed 4/25/13

Medicare Uncovered: Figuring out the president's plan

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Message Trudy Lieberman
Re-Published with the permission of Columbia Journalism Review where it originally appeared on April 16, 2013

An Associated Press story offers more fog than sunshine

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You have to give the AP an A for effort, for at least trying to tell its huge audience about one aspect of the president's major Medicare proposal. But when it comes to judging the quality of the AP's story , a grade of C minus might be more appropriate. The piece conveys the nub of the president's plan to raise premiums for some Medicare services but that's about it. Not much context. The piece loses people in a fog of numbers that obscure rather than clarify.

The AP's lede was straightforward enough, reporting the gist of remarks from a government official--in this case the Health and Human Services Secretary, Kathleen Sebelius, who on Friday began filling in the blanks of Obama's plan to make some seniors pay higher premiums for their Part B and Part D Medicare benefits. (These cover doctors' visits, outpatient services, lab tests, and prescription drugs.)

President Barack Obama's plan to raise Medicare premiums for upper-income seniors would create five new income brackets to squeeze more revenue for the government from the top tiers of retirees, the administration revealed Friday.

Being straightforward, though, is not the same as being clear. One problem is that many readers wouldn't have clue about what the devil five new "income brackets" mean or would do. Not until the eighth graph do we learn that there are four income brackets already, and there will be nine in 2017, so that what Obama is doing is expanding the number of existing brackets.

In typical newspaper fashion, before readers learn about these brackets, the AP gives them some big picture context, but hardly any little picture context that would help explain the lede.

Readers do learn that this is about making richer people pay more for their benefits, and that it would raise $50 billion over 10 years instead of the $28 billion it reported was a "comparable number last year." They also learn that Obama's plan would "freeze adjustments for inflation until one in four Medicare recipients were paying the higher charges"--whatever that means. Readers will likely have no clue. The AP also tells readers that currently, one in 20 already pay higher premiums than what most people pay. And that the president's proposals are controversial. The story also does give a dollars and cents example--a retiree making $85,000 would pay about $168 a month instead of $146.90 under current law, numbers the AP got from a table released by the administration.

When and if readers make it down into the story, they get this graph that had me scratching my head.

The top income step--currently more than $214,000--would be lowered to $196,000. And individuals in the new top tier would pay 90 percent of the cost of their outpatient coverage, compared to 80 percent currently.

Here's a case where newspaper shorthand didn't do readers any favors. What follows is some of the fleshed out context that AP reporters and others may want to consider for future stories.

As we've reported , beginning in 2007 about 5 percent of all Medicare beneficiaries started to pay an income-related premium for their Part B benefits. (That term, "income-related," is often used interchangeably with "means-tested," which generally refers to giving lower benefits to people with higher incomes, or, in the context of premiums, to make richer people pay more. Before that year, everyone on Medicare paid the same premium, which was calculated to cover 25 percent of the costs of providing those benefits. The government paid the rest.

Since 2007, individuals with incomes greater than $85,000 and families with incomes above $170,000 pay a premium that is 35, 50, 65, or 80 percent of the Part B cost-- depending on their income bracket--instead of 25 percent, which is what those with lower incomes still pay. These are the four current brackets. If the president's proposal becomes law, five more brackets are to be folded in within that income scale, except that the premiums for seniors at the very highest incomes will be calculated so they cover 90 percent of the cost of Part B benefits, not 80 percent.

The day after the AP story ran, a second piece moved on its wires, and unfortunately its explanation of the proposed change wasn't much clearer than the first. This story, however, brought a real live Medicare beneficiary into the coverage. It showed how a retired city worker in Albuquerque, who is not rich, would be affected by Obama's plan. Tricia Neuman, a vice president of the Kaiser Family Foundation, told the AP: "Over time the higher premiums will affect people who by today's standards are considered middle-income. At some point, it raises questions about whether [Medicare] premiums will continue to be affordable."

Now we're getting somewhere. That's the kind of context the story needs.

How the AP covers Medicare is important, since the wire service may be the only way people in places like Lincoln, NE or Everett, WA. get the dope on what the politicians are considering for them. We hope AP editors and reporters take the extra steps to make their stories crystal clear and connect the dots, both regarding Medicare proposals and regarding others changes in other programs that will affect their readers' pocketbooks and lives.

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Trudy Lieberman, a journalist for more than 40 years, is a contributing editor to the Columbia Journalism Review where she blogs about health care and retirement at Her blogposts are at She is also a fellow at the Center for Advancing Health where she blogs about health at (more...)
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