March 24

Next Monday is March 31, the deadline for people in the individual market to sign up for health insurance without incurring the fine they’ll have to pay when they file their taxes a year from now. There’s going to be a wave of stories in the news about the Affordable Care Act as this deadline approaches, and if the pattern we’ve seen over the last few years holds, there will be some informed and informative coverage, mixed in with a whole lot of crappy coverage written by journalists who don’t know very much about the law and what its effects are.

So I thought it might be worthwhile to take this opportunity to lay out some things we ought to see in the reporting not only this week, but as we move into the next phase of the law’s evolution.

Here’s some of what, in a perfect world, we’d get out of this period of health-care coverage:

A clear explanation of what’s happening now and why. Why do we have this deadline? It’s pretty simple. One thing everyone wanted out of health-care reform was an end to the cruelty of “preexisting conditions,” in which insurance companies deny you coverage because you’ve been sick or injured before. The ACA outlawed those denials. But you can’t just have people waiting to get sick before they sign up for insurance, so the law not only included an individual mandate, it also said that if you don’t sign up by this date, you’ll have to wait until the next open enrollment period in the fall (there are plenty of exceptions, like if you change jobs, have a baby, etc.). But lots of people still don’t understand this. It only takes a moment to explain, and reporters need to keep explaining it.

A follow-up on those cancellations. For a while there, as far as reporters were concerned, there were no Americans whose plight was more urgent than the people who had bought coverage on the individual market and got letters from their insurance companies saying their existing plans no longer existed (and trying to push them into far more expensive plans). One after another of these “victims” was profiled in the national news, reports that almost never bothered to investigate what these people’s other options were and whether there might be better and/or cheaper plans available to them. So let’s follow up! What happened to these people? Did they wind up doing better than they thought they would? Are they unhappy with the insurance they wound up with? This is a great time to find out. Which leads to…

Reporting on both the good and bad that reflects reality. Tragedies are usually considered more newsworthy than triumphs, but accurate reporting demands that we look at both the good and bad effects of this law. So far there has been only a tiny amount of reporting about people who have benefited from the ACA, such as those newly insured under Medicaid, or people with preexisting conditions who can now get covered. Let’s hear all those stories, and even if it’s difficult to get a precise accounting of the relative proportions of people who wound up better off vs. people who wound up worse off, the coverage should at least attempt to reflect the broad reality. It should also reflect that nearly all of those made worse off are dealing with something unpleasant but not catastrophic — like higher premiums — while many of those made better off have had their situations completely transformed, often in literally life-saving ways.

A close look at the Medicaid expansion. The expansion of Medicaid has been reported in large part as a political struggle between the Obama administration and Republican governors, which it certainly is. But we could sure use some reporting on the rest of the story. This is arguably the most significant part of the ACA; millions of people have already enrolled in Medicaid, and millions more are likely to be added in the next few years. How have their lives been changed? How are state Medicaid agencies handling the new workload? What about medical providers? Where is it working well, and where are there problems? The answers to those questions can help us understand what the policy challenges of the coming years are going to be.

A view beyond the exchanges and the individual mandate. Because so much attention has been paid to the issue of the individual market, we’ve forgotten that the ACA contained a lot of other provisions attempting to improve aspects of the health care system. So can we tell yet how they’re working? For instance, there were incentives for Medicare providers to move from a fee-for-service model that encourages as many procedures as possible to a model that encourages treatment of the whole person and keeps patients healthier. Is that having an impact? What does it tell us about the future of American medicine? How is the transition to electronic records (which actually began with the 2009 Recovery Act) going? What about all the many pilot studies and experiments the ACA funded? Are there any of them that are showing promise, and what about the ones that have gone bust?

This is just a start — we could probably come up with a dozen other recommendations for how coverage of the ACA could be improved. And I’m not naïve enough to believe that the chances of great coverage emerging are particularly high. One of the things that happens at a moment like this is that a bunch of reporters from other beats (like politics) are suddenly assigned to do stories about health care, without time to learn a lot about the subject they just fall back on reporting it through conventional wisdom and the frame of what they already know. But the evolution of the Affordable Care Act is going to be an important story for years. So it’s worth at least trying to make the coverage of that story better than what we’ve seen so far.