Covering The ACA May Be Almost As Hard As Implementing It

This Pulling It Together was adapted from a column I published earlier this week in Politico, with a new introduction added. You can read the original Politico column here.

The implementation of the ACA is news and the public will demand information about it. Journalists and news organizations have an obligation to cover this story.  As Kaiser CEO I serve as the publisher of our non-profit news service, Kaiser Health News, and also as the head of our large health policy information and analysis enterprise, so I see ACA implementation from a variety of perspectives. The ability of journalists to cover the ACA accurately and in depth will be related to our ability in the health policy community to provide facts, data, and evidence on ACA implementation in near real time, and to provide expert analysis journalists can rely on. Ultimately it will also depend on our ability to evaluate the impact of the law on coverage, access, people’s financial burdens, and overall health care spending, and to do it in a time frame that is not so slow that public and political judgment on the ACA has already been rendered. This column addresses the challenges journalists face covering the ACA, but ACA implementation confronts the health policy community with challenges that are at least as formidable as those faced by journalists. They will be the subject of another column.

Covering The ACA May Be Almost As Hard As Implementing It

President Barack Obama recently predicted “glitches and bumps” when major provisions of the Affordable Care Act are implemented next year. It is always this way. Today we think of Medicare as a popular program that is part of the fabric of American life. But my friend Joseph Califano, who helped create Medicare while working for Lyndon B. Johnson, recalls real problems during the early days of the program, including resistance to desegregating hospitals and physician reluctance to participate.

But there is at least one big difference today: Our almost instant and nonstop news cycle, the Internet and the impact of the news echo chamber on the public. As several news organizations learned during last summer’s coverage of the ACA ruling in the Supreme Court, it’s better to be right than to be first. Getting the ACA story “right” will be nearly as difficult as implementation itself. Here are four major challenges all news organizations will face. These are challenges we face too at Kaiser Health News.

1. The biggest challenge is that ACA is no longer a Washington story.

As the story moves to the states, national news organizations will need to cover the law’s implementation beyond the Beltway and explain what it means for the American people. Few national news organizations have the “eyes and ears” across the country to do this well, and regional and local news organizations do not have the on-staff health policy expertise, even if they have the local ties. This is a challenge for us at Kaiser Health News, with a staff of reporters and editors based mostly in Washington.

We are establishing partnerships with regional newspapers, NPR affiliates and others, so that together we can spot the most relevant state and local stories to report them locally and nationally through our distribution partners. Other news organizations will find their own answers.

2. Another challenge will be judgment by anecdote. Critics will feed reporters ACA horror stories and supporters will sell them success stories.

Every journalist will be able to find a bad ACA story or a good one. When does “one” person’s experience represent “many,” or “most”? The gold standard is to take examples from a statistically representative group using a scientifically valid survey, but that’s just not going to happen very often with reporters working under deadlines. Journalists will need to do interviews, check with experts, scrape together what early data exist and make judgment calls about whether the anecdote they have is an outlier or representative of broader experience.

Let’s say Bill Smith in Arkansas chains himself to the IRS building and refuses to pay his fine in protest of the law’s requirement that Americans buy health insurance, but that overall, the mandate works smoothly, as it has in Massachusetts. No doubt, Smith will be “breaking news” on your favorite cable channel. With complex stories like ACA, there is a temptation to cover only breaking news and not the broader story. These news judgments matter because powerful anecdotes stick in the public mind in ways statistics never will.

3. A third challenge is deciding what to cover.

When the “death panel” story broke, many news organizations sprang into action to fact check and debunk the claim. Cable news covered the story day after day. No doubt the repeated coverage of nonexistent death panels contributed to public anxiety about the law. Today, 40 percent of the American people still believe there are death panels in ACA. News organizations need to make their own judgments about what is important to cover and be on guard against being manipulated by the political process. The decision about what stories to cover can be even more important than how to cover them.

4. Finally, there is the “balance trap” — the pressure to present the views of the organized right and left rather than the facts.

This is a general problem for journalism today but one that is particularly relevant to ACA because views on it are so sharply divided along partisan lines. I recently moderated a panel with three top journalists from The New York Times, NPR and The Wall Street Journal. All three said that the pressure to do just this was their biggest challenge covering health reform in a hyperpartisan Washington. It is not always easy to find the facts, and sometimes issues are maddeningly gray in health policy. But often the facts are clear in statute or regulations. They are in a government report or a study from a respected organization.

Our polls show that the public remains only dimly familiar with the details of ACA, and those who stand to gain the most (the uninsured or people with pre-existing medical conditions) often know the least.

As the main elements of the law are implemented, efforts are being mounted by the federal government, states and nonprofit organizations to inform people. As important as these targeted awareness and outreach efforts will be, the news media have always been the public’s main source of health information. And while local TV news has traditionally been the public’s top source of health news, newspapers, radio, online news and cable news are closely bunched as their top sources of information about ACA. How well news organizations step up to these and other ACA coverage challenges will have a big impact on implementation of the law and public judgment about it.