There are key questions reporters ought to tackle whenever the House or Senate passes a bill. Coverage of the "doc fix" bill passed by the House last week, unfortunately, did not adequately address critical points. This is a bill that--in addition to reauthorizing the Childrens' Health Plan (CHIP) for two years and permanently fixing the way doctors are reimbursed for Medicare patients, both of

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re-posted with permission of Columbia Journalism Review

What's in it? Who does this affect short- and long-term? Who's going to pay for it (and who is not)? It should go without saying that these are among the key questions reporters ought to tackle whenever the House or Senate passes a bill. Coverage of the "doc fix" bill passed by the House last week, unfortunately, did not adequately address these critical points. This is a bill that--in addition to reauthorizing the Childrens' Health Plan (CHIP) for two years and permanently fixing the way doctors are reimbursed for Medicare patients, both of which were widely covered-- brings other far-reaching changes to Medicare. Yet reporting on the politics and maneuvering behind the bill was easier to come by than coverage that sufficiently explained the policy changes the legislation prescribes, who will pay for them, and the full range of consequences in years to come--as is too often the case. (I'm reminded of coverage of December's "Cromnibus" bill that wiped out pension benefits to union workers who were already receiving them, and of the 2013 "fiscal cliff" deal that stopped development of new co-op insurance companies to compete with the industry giants.)

The coverage this time ranged from perfunctory (this LA Times piece, for example, is stingy on what the bill really means for current and future Medicare beneficiaries) to factually incorrect (USA Today flubbed the income number at which this bill would have Medicare recipients begin paying higher Part B premiums in 2018--it's $133,000 not $85,000). As for putting this bill into a larger context? There were mostly just hints, like a line in this Wall Street Journal piece that conservatives agreed to the bill even though it adds to the deficit because "they saw an even more important prize: an effort to rein in an entitlement program." (I've written extensively on this).

So, what does the bill--which the Senate takes up again in two weeks and will likely approve--change for Medicare beneficiares? In a nutshell:

- More skin in the game for Medicare beneficiaries. Out-of-pocket costs will go up for some of them. No one eligible for Medicare in 2020 will be able to buy coverage for the Part B deductible which applies to physician and out-patient services. These changes open the door for restructuring the program and perhaps drastic cost-shifting down the road, such as high limits on out-of-pocket costs and very large deductibles. Some policymakers on both sides want Medicare to be more similar to the insurance people have on the commercial market that increasingly comes with high deductibles and much more cost sharing.

- More means-testing of Medicare premiums. All beneficiaries paid the same premiums until 2006, then Congress changed the law to make individuals with adjusted gross incomes of $85,000 ($170,000 for couples) pay more. The current bill changes the rules again so that some people already paying higher premiums will pay more. The president's budget proposal would have pushed even more seniors into the higher income pool until one quarter of all beneficiaires were paying higher premiums. Stacy Sanders, federal policy director for the advocacy group Medicare Rights Center, told me recently, "This is problematic because eventually middle class people would pay more. If the president's proposal were implemented today, beneficiaries with incomes around $45,000 in today's dollars would pay higher premiums."

The answer to the question of "who or what pays for" the House's $214 billion bill, then, is cuts to Medicare befeficiaries, to the tune of $35 billion, along with equal cuts in payments to providers, with the rest--some $140 billion--added to the deficit over the next decade. Other stakeholders like drug companies and insurers took no financial hit. (For just one piece of perspective, as Charles Ornstein reported for ProPublica on Sunday, "Medicare spent $4.5 billion last year on new, pricey medications that cure hepatits C--more than 15 times what it spent the year before on older treatments for the disease, previously undisclosed federal data shows.") How did legislators decide which stakeholders would be billed and which spared? The media did not explore this question or the question of whether making seniors pay more for their care was the only--or optimum--route to funding the "doc fix." Reporters also failed to examine the ramifications of the skin-in-the-game theory of cost control--if patients have to pay more out of pocket, they won't got to the doctor as much. (Studies by The RAND Corp. have found that although they do use fewer services, they can't discriminate between necessary and unnecessary care and that, of course, can lead to more costly care in the end.) What does this cost-shift look like in practice for affected Medicare beneficiaries? There are stories here.

This is admittedly difficult terrain to cover--it is complex, not to mention a potential turn-off for less wonky readers. But it matters to the financial future of everone who is on the program now and who will be on it some day. And there is still time for reporters to dive in on this. Congress is back in session in two weeks, and this bill is in the Senate's lap.

Authors Bio:
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 www.cjr.org. Her blogposts are at http://www.cjr.org/author/trudy-lieberman-1/
She is also a fellow at the Center for Advancing Health where she blogs about
health at http://www.preparedpatientforum.org/.   Her blog posts are at http://blog.preparedpatientforum.org/blog/category/author/trudy-lieberman/   Lieberman has had a long career at Consumer Reports specializing in
insurance, health care and health care financing.   She was also the director of the Center for
Consumer Health Choices at Consumers Union.  
She is a contributor to The Nation,
and has written a column about health and the marketplace for the Los Angeles Times.   Lieberman began her career as a consumer
writer for the Detroit Free Press
where her reporting became a model for consumer writers across the country.

She has won 26 national and
regional reporting awards and other honors, including two National Magazine
Awards, 10 National Press Club Awards, five Society of Professional Journalists
Deadline Club Awards, a John J. McCloy Fellowship to study health care in
Germany, a Joan Shorenstein Fellowship from Harvard University to study media
coverage of medical technology, an honorary doctorate of humane letters from
the University of Nebraska, and two Fulbright Fellowships---a senior scholar
award to study health care in Japan and a senior specialist award to
participate in training conferences in the United Kingdom for European health
journalists.   She is the author of five
books including Slanting the Story the Forces That Shape the News and
the Consumer Reports Guide to Health Services for Seniors, which was
named by Library Journal as one of
the best consumer health books for 2000.

Lieberman is an adjunct associate
professor of public health at City University of New York where she teaches
courses on the media's influence on public health.   She was director of the health and medical
reporting program at the Graduate School of Journalism, City University of New
York, has taught media ethics in the Science, Health and Environmental
Reporting Program at New York University, and has been an adjunct professor of
journalism at Columbia University.   In
2006, she was a Beamer-Schneider SAGES Fellow at Case Western Reserve
University where she taught courses on media ethics and the ethics of health
care delivery.   In 2007, she was
appointed the James H. Ottaway visiting journalism professor at SUNY New Paltz
where she taught a course on the media and the marketplace.   In 2011, Lieberman was named the Soderlund
Visiting Professor in the College of Journalism and Mass Communication at the
University of Nebraska where she taught public affairs reporting.

Lieberman served five years as the
president of the Association of Health Care Journalists, a professional
organization of over 1300 journalists who cover health and medicine, and
continues to serve on the board of directors as immediate past president.   She is currently a national advisory council
member of the California Health Benefits Review Program.   She has served on the board of directors for
the National Committee for Quality Assurance, the Medicare Rights Center, and
Village Care of New York.   Lieberman
appears on many panels and lectures widely on health care in the U.S.   She holds a B.S. with distinction from the
University of Nebraska and earned a certificate in business and economics
journalism from Columbia University's Graduate School of Journalism where she
was a Knight-Bagehot Fellow in 1976-77.

She can be reached at trudy.lieberman@gmail.com
and can be followed on Twitter at trudy_lieberman.