How to avoid mistakes in covering the Affordable Care Act

If there’s one thing everyone can agree on about Obamacare, it’s that the law is complicated. Really complicated — especially for a reporter trying to write about it on a deadline.

I’ve spent the past four years writing about the Affordable Care Act for two different newspapers. To this day, I still run into provisions that are new to me and face the challenge of trying to understand them fast enough to turn around a blog post later that day.

Unfortunately, covering the health law is unlikely to get easier anytime soon. As the new marketplaces roll out, and readers begin researching their options, they will no doubt have lots of questions about how it all works. Here are five of the common mistakes that I’ve made before, have seen others stumble on and hope you can avoid.

1. Not keeping the size of the overhaul in perspective. The Affordable Care Act is, without a doubt, the most significant insurance expansion since Medicaid and Medicare became law in 1965. At the same time, it will only impact a small sliver of the American population. Just 7 percent of the population — or 24 million Americans — are expected to use the health insurance marketplaces by 2023. An additional 13 million people will gain access to Medicaid through the health law’s expansion of the public program.

The vast majority of Americans will continue to get health insurance the same way they do right now, either through their employer or public insurance programs. When readers ask me how the health care law will affect them, and they currently have coverage through their employer, the answer can often be pretty simple: It won’t.

2. Comparing premiums from before and after the health care law. The health care law will dramatically upend the individual insurance market beginning Jan. 1. That makes comparing premiums from before the health law to those offered afterwards a bit like comparing apples to oranges — or even apples to steak.

Here’s why: The health care law makes four big changes to the individual insurance market. First, it requires health insurance plans to cover all subscribers regardless of whether they have any pre-existing health conditions. This will likely increase premiums, as insurers will have to accept sick patients who, right now, they reject.

Second, it dramatically restricts the factors that insurance plans can use to determine the size of premiums that a subscriber will pay. Right now, they can use hundreds of different elements of an individual’s health. Starting in 2014, they can only use three factors: age, location and tobacco use. This change will likely increase premiums for the young and healthy, but decrease them for the old and sick.

Third, insurance companies are required to cover 10 categories of benefits, like maternity care and hospital visits. Known as the “essential health benefits,” this set of health care services is generally thought to be more robust than what individual market plans cover now. This policy will probably nudge up premiums just a bit.

Fourth and lastly, the health law includes subsidies for low- or middle-income people to purchase health insurance. This will likely decrease premiums, as it provides financial help for those buying their own coverage.

Taken together, these suite of four changes make the insurance market of tomorrow different than what exists right now. It’s one where insurers have to take all consumers — and will have to provide a larger suite of benefits. Many shoppers will get financial help. This makes the market very different than what exists right now, and any comparisons between premiums of the past and future extremely difficult.

3. Just focusing on the premiums when other cost-sharing matters a lot for affordability. Premiums are an easy metric when it comes to judging health care costs. They are the most stable form of payment in a health plan, the one piece where the price stays the same from month-to-month. That probably explains why they’re most often used to examine how expensive a health plan would be for consumers.

Leaving out other forms of cost-sharing, though, doesn’t give consumers the full picture of what they might actually pay. When discussing health insurance costs, three other factors could help give readers a fuller picture. The first is the deductible, which is the amount consumers owe until their health plan begins to pay. In some cases, the deductibles on the exchanges are pretty high, upwards of $6,000 for an individual policy.

The second element that can help consumers understand the cost of their health plans is the co-payment, the fixed amount that the subscriber pays when they take a trip to the doctor. Lastly, there is co-insurance, when the subscriber pays a certain percentage of a the cost of a doctor trip.

These concepts don’t squeeze easily into a one-sentence comparisons of health insurance plans. But they do help readers get a better understanding of how much health insurance costs under the Affordable Care Act — and helps them avoid the potential sticker shock of higher costs after committing to a certain premium.

4. Leaving out medical trends that pre-dated the Affordable Care Act. There are lots of changes happening in the healthcare industry, some of it due to the health law and some to completely independent factors. Tying everything to the health overhaul is easy to do, but also avoidable.

The best way to dodge this mistake is to look at how health care trends were evolving before the health care law took effect, and see if they have changed since. One great example in this space is the growth of health care costs, which has recently begun to slow. That could seem like a product of the health care law until you notice that the health cost slowdown began in 2009, while Congress was still debating whether to pass the Affordable Care Act. It’s helpful to do the same kind of research on premiums and narrow insurance networks, to get a sense of what began as part of the health law and what predated it.

5. Comparing the exchanges to “Expedia.” This is one area where, at least in my view, even the White House has been guilty of making a mistake. They’ve told voters that buying insurance on the new marketplaces will be just as easy as buying a plane ticket on Expedia.

But health insurance policies are more complicated than plane tickets, not to mention a much more significant financial commitment. We’re talking about a commitment to spend money each month. Telling readers that such a purchase will be as easy as shopping for a trip is most likely not true, even before all the technical problems the marketplaces are now experiencing.

Part of this has to do with the act of purchasing health insurance, which requires entering in information about your family size, your age and where you live. Part of it also has to do with how the federal government designed its website. Unlike most shopping websites, requires users to create an account before browsing insurance options. That has created what many technology experts see as a bottleneck that sometimes crashes the website, and makes the shopping experience more difficult than others.

Want to learn more? Sarah Kliff, who covers health policy for the Washington Post, will be our guest at noon Eastern on Wednesday through Poynter’s News University. Learn more and sign up now.

Related: How to weave the stories of ‘real folks’ into coverage of health-care law | How reporters can localize coverage of the Affordable Care Act | 5 myths about the Affordable Health Care Act | NPR will use term ‘Obamacare’ less | News orgs rush to quote guy who said he bought Obamacare plan


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  • VenturaCapitalist

    Don’t forget DNC access to NSA and IRS data.

    And let’s take a look at how much of that $600 million turned up as bribes deposited in Barry’s Brownshirts For America bank account.

  • VenturaCapitalist

    You touch on the real reason the BarryCare website blew up… Axelrod burned out his calculator fabricating the employment numbers.

  • VenturaCapitalist

    Have you no shame?

  • RichardBlaine

    Ever get dizzy from all this spinning?

  • Michael C Stephenson

    I think if liberal journalists persist in their dishonest advocacy, they should feel some pain. I think it would be the only way to make them accountable for the damage they do.

  • Reticulator

    In Obama’s inauguration speech he said we’re all in this together. In No. 1, Sarah Kliff says we aren’t.

  • Michael C Stephenson

    I had the same thought. The ACA has dominion over a very broad swath of medical decisions irrespective of where you policy comes from.

  • TallDave

    This article should be titled “How OFA Would Cover Obamacare.”

    What an embarrassment to journalism. Never mind Obama promised premiums would fall by $2500, down the memory hole!

  • John Lampinen

    I agree that comparisons are complex, but that doesn’t mean we don’t have an obligation to analyze the results. It’s hard to analyze the federal budget too, but that doesn’t mean we don’t do it.

    Sarah’s first point that most people will not be affected by ACA is dangerously naive, so far removed from reality, that I can’t recommend this piece as accurate or constructive advice for my newsroom.

  • LibertyAboveAll

    “When readers ask me how the health care law will affect them, and they currently have coverage through their employer, the answer can often be pretty simple: It won’t.”

    Unfortunately, this is false. Numerous people I know personally – myself included – have employer sponsored health plans that have been affected negatively by the legislation. The “mistake” here is believing this line that the liberal pundits have been feeding us since the inception of the legislation. It’s just a lie.

    Then you go on to say that “comparing premiums of the past with premiums of the future is difficult – like comparing apples and oranges”. You goes on to say that this is because of the complicated bureaucracy and rules placed on private insurance companies by the new law. Well duh! That doesn’t excuse the fact that most people’s premiums are going up! It’s not apples and oranges – it’s “Here’s what I paid before, and here’s what I’m paying now!”

    You should stop defending a bogus system that’s doomed to cost us all more of our earned treasure. It’s not a good look…

  • GangstaBot3000

    She should go work at the White House like a lot of those other former “journalists”, or more accurately, fact-spinning, talking points regurgitating parrots. Don’t forget your kneepads, Sarah!

  • John Smith

    Dear Colleagues: Please, please, please don’t lose sight of how many of us bet our butts that we could help keep the Obama ship afloat throughout his second term. That’s a HUGE problem. And don’t worry if you have to “shade” things just a little to make it happen – after all MSM credibility wasn’t all that strong before The One launched this website so it’s not as though we’re going to take a really big hit or anything. The Neanderthals on the Right (I guess that’s redundant usage – I need to check my AP Stylebook) will scream at some of the context included in this article but we all know that such history is important to the story. I suppose I could have included the history about not raising rates one dime, the arrogance of bureaucrats insisting that Americans NEED coverages they were not buying themselves, Mr. Obama’s misunderstood assurances about keeping “your doctor,” and – I think it was the Tea Party (wasn’t it?) claiming you could keep your plan – hey there was a deadline and the writer just didn’t have time to include all that. Beside it’s time your doctor faced some competition and had to hustle for new business! Why would you want to keep such a person anyway? I know you will follow the guidance in this article in the spirit in which it was written. Just because Poynter doesn’t make clear that Sarah Kliff is the health care robot for the Washington Post doesn’t mean they didn’t mean to mention it.

  • Madrigal Man

    I’m pretty sure these come from the subsidies fairy. Or something mysterious like that.

  • Madrigal Man

    This shill of an article left out a few other salient facts, such as; The government has seized control of 1/5 of the US economy and appointed itself sole arbiter of the proceeds. The government now controls, both directly and indirectly, the quality and access to your health care. The government now controls the access and development of pharmaceutical development and profitability. The government now collects all of your health data and monitors your lifestyle including but not limited to your mental health, sexual proclivities, prescription usage and whatever other private medical information you or your family shares with your government sourced and monitored doctor. The Constitutional Republic to which you were born has been replaced with a Socialist Commune where the working and productive members of society are enslaved by the government to provide, under threat of retaliation, for the health and care of others who may or may not be really in need or deserving. Your tax dollars are now being used to pay for other peoples elective abortions. The religious freedoms and personal liberties of long standing providers have been stripped to serve the new commune(istic) paradigm. And that’s all just the beginning.

    Two more points I would like to make, that the author of the above propaganda piece fails to provide her readers. One: The GOP and conservatives are largely in agreement with the left that we as a society can do better for those who are in need and deserving of the help. We simply believe that turning the control and power over to the government is a massive mistake. We have effectively signed ourselves and our future generations over to a nanny state, from cradle to grave, that we will likely never free ourselves from again. We are now effectively slaves of the state. They are our provider. The more we hand over to the state the less we maintain of liberty and freedom for ourselves. Which brings me to the second point.

    You do not have the right to force me to provide you a home or build you a house. You do not have the right to force me to feed you or grow your food. To require such is called slavery. To demand of my work, resources and efforts is to place me into servitude. You also do not have a right to force me to heal you or provide for your health. These things are called personal responsibilities. It is up to you to provide and prepare for yourself. Not to demand them of me or anyone else. If you need help, because you are not prepared or otherwise unable to provide for it on your own then you should “ask” for the help. That is what family, friends, churches, community groups, charities, non-profits and other NGO’s are for. And if you truly need the help and are deserving of it, you will likely get the help somewhere. Or you won’t. But either way, you don’t have the right to force others to provide it. And the government certainly shouldn’t have the right to command it.


  • Not Chicken Little

    And they wonder (some of them, those that still have some tiny bit of curiosity and integrity left to ask and investigate) why they are called “presstitutes” and the “enemedia” and why people just don’t trust them like they used to…

    “War is peace. Freedom is slavery. Ignorance is strength.” And black is white, and up is down, and Sarah is one of those telling us this…

  • Stassinopoulos Post

    Here’s a good analogy! The vaunted DNC “ground game” where ACORN cheats help unregistered Democrats vote, where Union thugs and Black Panthers legally harass voters at the poles, where illegal aliens and dead people get their votes counted multiple times, and where campaign contributions from overseas can flow directly into Obama’s pockets. Pretend all that corruption is in 500,000,000 lines of code, then empty an Port-O-Potty on the keyboard, and THEN log into

  • Stassinopoulos Post

    Also, can’t fine you (ahem… tax you…. uhhh, fine you?) if you don’t enroll. And leftwits call corporations “greedy!”

  • Cleetus

    It is fitting that the absolute greatest debacle of the last 50 years is named Obamacare, a namesake to the worst president ever. Likewise, this article on how to hide the truth by creative lying is the perfect example of how the MSM will sell their souls and lie to whatever extent is necessary to protect their god known as Obama. Pravda would be proud of you.

  • TheDarkHelmet

    Everyone’s health insurance, and everyone’s healthcare will be affected by Obamacare. It changes the incentive structures in both the financing and delivery system for healthcare. Whether you buy through the ‘exchanges’ or not your insurance has already been affected, for better or worse. Also, there is absolutely no way to know how many people will be on the ‘exchanges’ by 2023. We have no idea how many companies will drop coverage, how many people will opt to pay the penalty/tax rather than buy insurance, and so forth. For that matter, we have no way of knowing whether the exchanges will ever actually function properly.

  • mickeymat

    Hey Sarah,

    How does it feel to become a perfect example (as if we needed another one) for all to see of the lengths to which drooling journalists will go to defend Obama in the face of utter and total incompetence?

  • snoocks2

    Maybe Iwo Jima?

  • snoocks2

    Think this is why the government ordered 2.6 billions rounds of hollow points last year?

  • TheDarkHelmet

    Well, it’s sort of like Except that works.

  • snoocks2

    While tryingly to neatly condense a lot of information into a small space, you neglected numerous parts of this bill – namely that the deductible for medical bills as well as pharmacy costs BOTH carry a $6,000 deductible. That’s a cost of $1,000 per month on top of the premium. Also, this bill makes pregnancy coverage and birth control mandatory for insurers. Due to the sad fact that up to 75% of low income individuals have children out of wedlock, those costs are passed on to 1/3 of the current workers in America. If the lower 47% of American workers do NOT pay taxes, and the upper 12-15% of wealthy Americans have accountants and also do not pay taxes, that leaves the remaining 38% paying the entire freight of this Democrat nightmare.

    Additionally, when cash strapped cities find they can dump their union workers onto these exchanges, all hell will, indeed, come to pass. Teachers, street cleaners, electricians and so on will find themselves also waiting in long lines to sign up for this. Tragically, if they have families – they are going to find that EACH one of their family members will have $6,000 per deductibles on their medical and pharmacy costs. A family of four will have to meet the $24,000 + $24,000 deductibles prior to their insurance paying anything!

  • Thomas Blersch

    You point out that premiums are increasing or likely to increase in #2…then in #3, call increased out-of-pocket expenses “affordable”? And in #5…don’t compare to expedia, because the design requirements for were idiotic? (“Hey, let’s design a bottleneck into our high-availability system!”)

    Those are the types of things that should be reported. You’re specifically giving sales advice, not reporting advice. This article is more accurately titled “How to Avoid Honesty in Covering the Affordable Care Act.”

  • Stassinopoulos Post

    Soetorocare is, without a doubt, the most significant government expansion since Medicaid and Medicare became law in 1965. We are increasing the power, influcence, scope, size, and reach of the Federal government. No personal, financial, or medical information should be considered off-limits anymore. The IRS, which attacked political enemies of the DNC in an egregious abuse of power, will be Obama’s collection and enforcement thugs. This is how we roll in Chicago baby!

  • londondave

    Where’s the article of the




  • Stingo

    Enron. Maddoff. Greece. Detroit. Soviet Union.

  • aelfheld

    Well, thanks for that Sarah.

    I needed to fertilise my flowerbeds before winter sets in.

  • WitOrWithout

    Thank you, Sarah. Excellent guidelines. Since the Expedia comparison isn’t accurate, perhaps journalists knowledgable about the details of the system could come up with a more useful analogy. What IS the ACA similar to? If consumers could understand the issue by seeing it in comparison to a familiar, though equally complicated, process, that would be a useful function of explanatory journalism.

  • ReasObBob

    Regarding the statement you made in point 1, “When readers ask me how the health care law will affect them, and they currently have coverage through their employer, the answer can often be pretty simple: It won’t.”
    The people who will NOT be getting subsidized insurance premiums WILL be paying for those subsidized premiums. The money for the subsidies won’t just magically materialize out of thin air or from some hidden lockbox. It has to come from somewhere. That somewhere is taxes.
    They will be affected. Their personal insurance coverage may not be affected, but they will be paying more money out of their pocket than they are now. Please be accurate and tell them that.

  • Lance Williams

    Your first point doesn’t account for surveys that show how many companies are looking to shift their coverage in the wake of the ACA.

    Companies face tax penalties by 2018 for having so-called Cadillac plans … the explosive growth of high-deductible plans, the emergence of private insurance exchanges, etc.
    While these are not mandated by the ACA, it’s naive to say that most Americans coverage won’t change. In fact, employers are using the ACA to shift their approach to covering employee health care.
    That “if you like your insurance, you get to keep it” line just isn’t true if your employee decides to take a new approach.