The health care beat can be confusing and jargon-filled. It encompasses many large institutions, including federal and state governments, insurers, and pharmaceutical companies. Policy debates on topics like drug costs and single-payer health care can be fraught with misunderstandings and misconceptions. Joanne Kenen, POLITICO Pro’s executive health care editor, has written about health care and health policy since 1994. Journalist’s Resource spoke to Kenen to help clarify common areas of confusion in health care reporting. Here are seven tips to inform your coverage of current health care debates:
- Do not confuse actual drug costs with out-of-pocket drug costs.
Policymakers and consumers alike are concerned with the cost of prescription drugs. But Kenen advised that not all cost-cutting policies will actually bring down overall drug costs. A policy that reduces out-of-pocket costs – what you pay at the drug store – may benefit patients with high cost diseases but it does not necessarily change the amount the pharmaceutical manufacturer receives. “That cost ends up being distributed elsewhere,” Kenen said. “It might go into our insurance premiums, and we’re all paying an extra dollar or two dollars or whatever. But it’s not actually bringing down the cost of the drug.”
“Be clear, point out, be explicit,” Kenen advised. “Lowering what the patient’s paying right now, it is not addressing the trajectory of drug price spending in America. Just point out — it’s not a value judgment.”
- “Medicare for All” and “single-payer” health care are not well defined terms. Be aware of shifting definitions as you cover policy debates.
Broadly speaking, the terms “Medicare for All” and “single-payer health care” refer to government financed health plans, and the terms are often used interchangeably. Sometimes people use them as a synonym for “universal coverage.” Remember though, that while universal coverage might be the goal of these plans, there are many ways to achieve that. And the terms right now are not clearly defined – leaving lots of room for misunderstanding – and political mischaracterization.
“This is an emerging political debate,” Kenen said. “There is not yet a consensus on a common definition of what a single-payer and/or ‘Medicare for All’ means.” Be specific when referencing these terms – what would the system look like? What is its objective – universal public insurance coverage, universal coverage offered by both private and public insurers, or something else?
Medicare itself, Kenen noted, “is not a pure single-payer system.” The government is the main payer, but patients and private insurers also contribute. For example, Medicare Advantage, which is about a third of Medicare, is run by private insurers. People purchase Medigap, a supplementary policy to make up for shortfalls in Medicare coverage, and that’s also private insurance.
Kenen added that government-financed, single-payer health care systems can vary substantially in practice. For example, she contrasted Britain’s government-financed and government-run National Health Service with other European countries such as Germany that have largely government-financed systems but don’t have state-run health care systems.
So it’s best not to make assumptions about what single-payer and “Medicare for All” might look like. “Just know there’s no common language of single-payer,” Kenen said. “It lacks definition and as you report on it, be careful, because all people are not talking about the same thing. But many of them think … their definition is the operating definition.”
- Be skeptical when states say they’re going to do single-payer systems.
Kenen noted that state attempts at single-payer in Vermont, California and Colorado have failed. Beyond issues of popular support, money poses a big challenge. Kenen said that even if a state endorses a single-payer system, it still has to figure out how to pay for it. And states will need waivers from the federal government to pool the money they receive for federally funded programs, such as Medicare and Medicaid, into one central fund to use for the new system, which Kenen suggested would be unlikely to happen under Republican leadership.
- Don’t blame everything on Obamacare, even if politicians do.
Kenen said that many of the negative trends associated with the Affordable Care Act (a.k.a. “Obamacare”), such as higher deductibles, bigger copays and higher costs, were trending before the ACA, and were not caused by it. “The trend toward higher deductibles is because businesses are trying to keep down their costs, it’s not because there’s an Obamacare law,” she said.
Kenen explained that the number of people covered by employer-sponsored insurance is an order of magnitude larger than those covered by insurance purchased on the ACA exchanges. Trends blamed on Obamacare, Kenen said, are “responding to way bigger imperatives, of rising health care costs, a population with a high burden of chronic diseases like obesity … the mental health crisis in America, and the fact that … we clearly did not get our arms around health care inflation in America for the long haul.”
- Explain to audiences that Medicare is not going bankrupt.
The Medicare trust fund, or the Hospital Insurance (HI) Trust Fund, is commonly known as Part A of Medicare. It pays Medicare hospital bills, and actuaries point out that it is due to run out of money by 2026 if Congress does nothing. But, Kenen noted, “Medicare A, the trust fund, has been on the road to bankruptcy many times in the past. Congress always acts.” And there are other parts to Medicare – Part B, which pays for doctors, for instance, and Part D, which pays for drugs. They are financed separately – and they aren’t going “broke.”
“It’s a problem, but it does not mean that Medicare will suddenly cease to exist in 2026,” she added, referring to the hospital fund. “The rest of Medicare is not going broke; their premiums come in, general government funds come in and people contribute to their care.”
And it’s not all bad news, cost-wise. Kenen also noted that while Medicare spending is rising in accordance with the growing share of older Americans, Medicare spending per capita has slowed dramatically over the past few years.
- Don’t confuse having health insurance with having coverage for the necessary care.
When the Affordable Care Act went into effect, it became illegal for insurers to deny people coverage or charge them higher premiums if they had pre-existing conditions. Republicans promise that their proposals to repeal and replace the Affordable Care Act will continue to cover people with pre-existing conditions. However, Kenen explained that some of these proposals don’t guarantee a basic benefit package. “Insurers might have to cover a pregnant woman or a cancer patient or a person with an addiction, but not necessarily have to cover prenatal care or chemotherapy or rehab,” she said. “Be careful in equating insurance with access to the actual care that we think of when we think of insurance.”
- Report the skinny on skinny plans – what they are, and why they’re being offered.
Skinny plans are high deductible, low premium plans that offer minimal coverage.
“If you’re young and healthy and stay healthy, you can save money,” Kenen said. “But if you get sick … including mental illness, an addiction or an accident, these plans just don’t cover that much, so you’re on the hook for the cost. Your net cost is not going to be cheaper.”
It’s also important to know why these plans are being offered. Many people who purchase coverage through the ACA exchanges receive government subsidies determined on the basis of their income. But some people are only lightly subsidized, and some don’t get any subsidies at all. And , insurance premiums can be extremely expensive.
“Insurance is expensive if you don’t have a subsidy from the government or you don’t have health care from your employer … Supporters of Obamacare need to understand it’s expensive, it’s hard to pay for,” Kenen said. “The Trump administration is addressing a perceived need, even if advocates are correctly worried about the people who opt for these plans being underinsured rather than insured, whether they know it or not.”
But this ignores the root issue of health care in the United States, according to Kenen.
“Again, the issue is that it’s not about shifting costs, it’s about addressing costs,” she said. “Ultimately, we have not gotten a handle on health care costs in America.”
Kenen recommended the following policy-related resources for reporters on the health care beat:
- The Alliance for Health Policy, a non-partisan nonprofit think tank that has resources including a sourcebook, glossary and toolkits with information about health policy topics in the news.
- University of Southern California’s Center for Health Reporting — an independent news organization that focuses on problems with health care and possible solutions.
- The Association for Health Care Journalists, which has a blog, tip sheets, and more.
- Health Affairs and the Kaiser Family Foundation for health policy research.
- Government agencies and sites to keep in mind include the Department of Health and Human Services, Centers For Medicare and Medicaid Services, Internal Revenue Service, gov, and the Congressional Budget Office.
- For more on single-payer and “Medicare for All,” Kenen suggested reading Paul Demko’s “What We Don’t Know About Bernie’s Favorite Healthcare Idea,” published by POLITICO; Elisabeth Rosenthal and Shefali Luthra’s “Politicians Hop Aboard ‘Medicare-For-All’ Train, Destination Unknown,” published in the New York Times and Kaiser Health News; Jonathan Cohn’s “If You Don’t Believe Single Payer Can Work, See How They Do It In Taiwan,” in the Huffington Post; and Joshua Holland’s “Medicare-for-All Isn’t the Solution for Universal Health Care,” in the Nation.
- For more on Medicare costs Kenen recommended research from Altarum, a think tank that works with government insurance programs, and Melinda Buntin, a health care economist at Vanderbilt University.