Health Care Reform Isn’t A Simple Story


Beyond the intense focus over the deeply flawed rollout of — which, if you haven’t already, read this incredibly back-story reporting in the Washington Post — there’s been a plethora of media reports highlighting anecdotes of rate shock and insurance cancellations. This appears to be especially prevalent in regional and local news, which is understandable, perhaps, as it’s fairly common for this level of media to explore broader issues through the stories of those affected. It’s a nominally good tactic, but as Paul Waldman notes these “exemplars” are only helpful if they’re framed in the proper context.

Those stories that rising to the top of the media food chain, where people end up doing the ’rounds on national outlets, are for the most part tales of people ‘losing’ under the new health care law. One such individual, Dianne Barrett, rode the wave of a local Florida station reporting on her insurance cancellation to several Fox News appearances. Yet like several “exemplars” before, her story of rate shock after been sent a notice that her individual insurance policy was not being renewed due to the ACA is not a straightforward tale of ‘losing.’

Jonathan Cohn of the New Republic followed up with Barrett, doing something that apparently every journalist before she hit Fox News failed to do; ask her about the full context of her current plan.

The policy Barrette has today is called the Go Blue Plan 91. It is not what most people would consider real insurance. Its coverage of doctor visits and tests, such as MRI scans, consists of paying $50 and then letting Barrette pay the remaining balance. Drug coverage works more or less in the same way, only the plan pays $15 per prescription—which is enough to cover generics, but not many name-brands. And hospitalization? The plan pays nothing at all. As Wemple put it, “it’s a pray-that-you-don’t-really-get-sick ‘plan.'” Barrette doesn’t really disagree—but this plan, she says, was all she could afford. “Most everyone I talked to said they were paying thousands more to get hospital coverage,” she told me, “so I took my chances with what I have now.”

Cohn worked with her information to find plans she might be eligible for under the ACA. The cheapest, according to his work, would cost her about $50.00 more a month with much more comprehensive coverage — after subsidies from the federal government. That plan wouldn’t inoculate her from any prohibitive expenses, and there would be other options with the type of trade-offs everyone can expect when shopping for health insurance. Given the broader context for possible options, though, her response was “I would jump at it.”

Advocates of the law have repeatedly written, including myself, the ACA is not a perfect law. There are indeed a subset of folks for whom the status quo in the individual market worked quite well. As others have raised, though, they largely benefited from these policies because they’re healthy and cheap (at that moment in their lives) to cover. Also, the market excluded or marginalized those that needed health insurance the most — typically the chronically ill — which kept prices low for a fortunate minority.

As we should all be doing, Cohn emphasizes the limitations on these individual examinations. Which is sort of the point of doing these followups, right? There is a better way to contextually place anecdotes about the effects of complex policies. Reports that are gaining wide attention in the press seem to lack this nuance, which isn’t very useful for anyone tuning in see them. That is to say, don’t take these reports at face value, especially if they’re presented in a soundbite or a one-paragraph exposition of the law’s effects. The human story matters, of course, because this is the impetus behind much reform — the material betterment of human life. Yet that often isn’t as self-explanatory either. It’s important to understand that both descriptions, of the policy and the people, are necessarily a complicated story no matter your ideological leanings.


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