‘Millions of People Will Lose Their Coverage Under Whatever Comes Out’

Janine Jackson interviewed Trudy Lieberman about covering Trumpcare for the June 16, 2017, episode of CounterSpin. This is a lightly edited transcript.

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Janine Jackson: As we record this show on June 14, Democratic senators are saying they have no idea what’s in the healthcare bill that Senate Republicans have been crafting secretly for weeks. Said Missouri Democrat Claire McCaskill:

There’s a group of guys in a back room somewhere that are making these decisions…. We’re not even going to have a hearing on a bill that impacts one-sixth of our economy.

“We’re not stupid,” a Senate GOP aide reportedly told Axios when asked why Republicans weren’t releasing a draft of their bill.

Neither will the public see a draft of the bill, which conservative senators hope to rush to the floor for a vote. And the reason for that, a senior Senate GOP aide reportedly said, “We aren’t stupid.”

The cynicism is so frank as to be disarming—the aide of course suggesting that if people knew what was in the bill, their outrage might hinder its prospects. This about legislation that will affect millions of people’s lives.

Well, right now, we can ask how a press corps whose usual tendency is to track what powerful people say and do should represent the public in this instance, in which we are being deliberately kept in the dark. But there’s a bigger question, too: What role could journalists play in making people harder to bamboozle when it comes to policies and programs affecting their healthcare?

Trudy Lieberman is a long-time contributing editor to the Columbia Journalism Review. She’s also a contributing editor at Remaking Health Care, based at the Center for Health Journalism at USC. She joins us now by phone from New York. Welcome back to CounterSpin, Trudy Lieberman.

Trudy Lieberman: Thank you.

Trudy Lieberman: “The public is thirsting for more information…. What they want to know is how these changes are going to affect them.”

JJ: Let’s start with the remarkable present moment: no hearings, no amendments, no expert testimony, no input from stakeholders, no negotiations, and the secrecy is completely conscious and strategic. Well, there’s more than one thing going on here, of course, but as a reporter, how do you inform the public about healthcare legislation when this is the process?

TL: Well, this question was asked at a panel that I was speaking at Friday in Cincinnati, and another reporter from the Louisville paper and I were addressing this very question, and there was a room of about 50 journalists, and they asked that very question. And what we came up with was sort of a work-around, because the Senate is pretty hell-bent on keeping whatever they’re doing a secret, because they know the public isn’t going to like it. And they are fearful of what happened after the House bill passed, which was a lot of loud blowback at their town hall meetings. So they don’t want a reprise of that.

So what’s a journalist to do here? One thing that I would suggest — I suggest this to journalists, but also the public can kind of start thinking about healthcare in this way as well—think about the big chunks that are going to comprise this new bill, this new legislation, whatever you want to call it, that is likely to emerge sometime this summer, because there are big chunks.

There is Medicaid, obviously: Who’s going to be hurt under that, and it’s going to be a whole lot of people, maybe 11 million people who will lose their coverage, ok? It’s going to affect a lot of people.

There’s the pre-existing conditions requirements, that insurers have to take everybody. [Eliminating] that’s going to hurt a whole lot of people, particularly those who are older, because they have health problems as people age.

And there are other big chunks. There are, of course, the taxes that some of the businesses that have been taxed under the Obamacare legislation are desperately trying to get rid of.

There’s also anything that’s likely to happen to Medicare. Some of the ACA changes shored up the hospital trust fund and had it last a little bit longer, but what’s going to happen to that?

There is also what’s going to happen to premiums and to insurance rates. I think that’s a big question.

What’s going to happen if your state opts out of all the consumer protections, like no lifetime limits on benefits, which is one of the Obamacare protections, or letting your young adults stay on your health insurance policy?

So if you think about it in terms of these big-picture chunks, and then what we told reporters to do is make a list, and then put what they know about what’s under those chunks in the House-passed bill.

JJ: Right.

TL: And then the bet is that the Senate bill is going to be changed, but maybe not a lot. The thrust is probably going to be very similar. A lot of people are going to lose their insurance. There may be some tax cuts, we’re not sure about that yet. Older people are going to have a harder time paying for insurance, because of the way they want to change the rating requirements, the premiums.

So if you think about that, and then put what we don’t know about the Senate bill, [then] when we do know more about the Senate bill, we can kind of fill in the blanks.

And the Senate bill is not going to be the end of it. This bill will go to a conference committee sometime this summer, or perhaps in the fall, when Congress resumes in September. So we’re really not done yet. So I think we have to report what we know.

And by kind of organizing it in that kind of a framework, I think it would be helpful for reporters to think of it that way. And they can organize their stories accordingly, knowing that it’s OK to report that we don’t know everything, but these things could happen, and these people are likely to be helped or hurt.

The kind of “winners and losers” framework (New York Times, 5/4/17) is “about the last thing we need in our healthcare system.”

And I particularly cautioned journalists to stop using the framework of “winners and losers.” I don’t like to see that in stories; I don’t like to see people thought about as winners and losers. That’s about the last thing we need in our healthcare system.

What we do need is to get everybody into the system, in a universal health scheme like the rest of the world has; and we’re very far from that. We’re closer, I think, than we used to be, but I think we’re kind of still far from it, because people still don’t believe they should have to pay for other people’s healthcare.

And so it’s a way we have to start reframing that issue, and thinking about—people need healthcare for life. And people who are paying in at the lower ages—sort of like our Medicare program, where younger Medicare recipients don’t have a lot of ailments, so their premiums help pay for the 85-year-olds in the program that do—there’s this cross-subsidy going on. But we don’t like to think of that in terms of general health insurance, and I think we have to move there.

So when you think about “winners and losers,” I think we’re fostering the wrong message. Furthermore, I don’t think anybody wants to be thought of as a loser, and certainly not people who are struggling mightily to understand this legislation.

JJ: Right.

TL: The other thing I would say is I think the public is thirsting for more information. I think they are not being fooled one bit about the spin and all this sort of stuff that’s going on, and much of what is being written by the national press, the horse race, sort of the inside stuff. I don’t think that’s what they care about.

I also write a rural health column that goes to community newspapers in about 20 states, and I get lots of emails from people who read these columns. And what they want to know is how these changes are going to affect them. How are changes doing away with the Medicare counseling services, that are now existing in all states, going to affect a group of people who need Medicare, love the program, but don’t really understand it?

So I think those are some of the big challenges that we have going forward. And so far, I don’t think the press has done the best job it could. When they were covering Obamacare the first time around—and I’ve been very critical of their coverage of this, and have been on record saying this—because they tended to take the spin that the proponents of Obamacare were dishing out, and not look at the real problems, that some of them have come to pass. And so the public was kind of misled and unprepared for that. And this time around, they’re dealing with a lot of inside baseball.

JJ: Yeah. Well, I have appreciated in your work—and it’s only someone who’s been covering this set of issues consistently, the way you have, who can call attention to this—is the fact that a lot of the problems that people did run into with the ACA now are being presented as: These people voted to get rid of the ACA, and weren’t they foolish, because now they’ll have fewer choices. Well, in fact, many people under the ACA really did only have one insurer choice. They weren’t fooled. You know, people are genuinely confused about what one program or another will do, but they’re not confused about their own life experience, in that sense. And so in a way the media kind of went over a lot of folks’ head, I think, on that issue.

TL: Well, I think if you went out to, say, Indiana, where I get a lot of emails from people who like what I write—which is rather interesting, coming from a very conservative state—but people don’t know. And when you can shed some light on how something’s really going to work and how it’s going to affect them, then they get it.

There was a fellow who lives in South Bend, and he had written a letter to the editor of the South Bend newspaper, and I had written a column about hospital safety. And he said, these hospitals aren’t fooling us at all with their phony ads that they put on television, and he wrote that in a letter to the editor of the paper. So he was very appreciative of my column, which is the point of this thing.

They’re not being fooled. But they’re not given the information that they need, and I think that this is a black mark on the media.

JJ: Yeah. Well, what you have emphasized over time is the need for a consumer focus. And what I hear you saying about what reporters can do now is take some information, have your target be, how will this affect taxes, how will this affect people with pre-existing conditions—have some informational targets, rather than simply scurrying around following what politicians are saying day to day, and how they’re fighting and how they’re angry. But keep your eyes on the prize. And that requires the reporters thinking of themselves from the point of view of a consumer, a member of the public.

TL: That’s exactly right. And as you may know, I’m an old consumer reporter from the old Nader days. That’s how I began my career, as the first consumer reporter at the Detroit Free Press. And so I didn’t know much more than that, except I had to learn it quickly, and putting myself in the shoes of the consumer who was buying whatever I was writing about at the time  helped me understand the process.

And healthcare is no different. Think of it as another consumer purchase that consumers have to make. And if Republicans and conservatives have their way, it’s going to become even more commodified than it is now. You know, the marketplace is supposed to work, and you’re going to get the lowest-priced doctor and whatever. Well, it’s not going to work; that’s not how healthcare works. And people need to understand that, but reporters above all need to understand the struggles that people are having trying to understand this. What is it I need to know if I were going to lose my health insurance, or I was a 55-year-old and may pay a whole lot more for it, whatever I could buy.

The New York Times (6/3/17) misrepresented single-payer as “an actual government takeover of healthcare.”

JJ: You talked about one of the fundamentals of healthcare being that you want to get everyone into the system, and that seems to be something that the public sort of understands automatically, even though, as we know, elites on both sides of the aisle are bent on telling folks that that’s absurd. And a recent New York Times article, not an op-ed, talked about Democrats being increasingly open to national health insurance, and they referred to it as a “government takeover of healthcare.”

And I guess what I want to ask you about is, that language isn’t just misleading about the present and about how programs work, but it also shows a kind of lack of historical understanding. Because people used to have a different kind of orientation towards the way they thought healthcare would function in a society, but that has not just changed, but been changed.

TL: Oh, I think there’s been assault on that notion of healthcare for everybody, certainly during the time of Harry Truman, but certainly before that. I think FDR even toyed with that idea.

And this really goes back to the days of the big life insurance companies in the ’20s and ’30s. There really wasn’t much of a health insurance presence in those days, until Blue Cross got organized sometime in the ’30s. But the life insurance industry objected to all of this, and that kind of stuck.

And certainly by the time we got to the ’50s, during Truman’s time, when the AMA and wives of the doctors, in all these little towns out in the US, organized bridge clubs and coffees and had a program on the evils of socialized medicine, this notion has stuck.

I’ve had students tell me, 18-, 20-year-olds, about socialized medicine. I ask them how they know about it. You know, they weren’t around in the 1950s. And for some reason, that notion and the evil of it has stuck, and that’s the reframing of the narrative that I think is necessary as we go forward, no matter what comes out of the Republican bill.

JJ: I wanted to say, you have said that what you’re looking for is for reporters to “report the hell out of” the healthcare story. And I think many people would say, well, I read a story about healthcare pretty much every day in the paper. And yet it sounds as though you still think there are a lot of concrete stories that are going missing.

I wanted to ask, just also, about timeline. When we talk about the House bill and how there was a lot of great coverage about, or a lot of probing coverage about, the impacts it would have, after it passed, I can’t help but fix on the “after” in that point. It seems like we know there’s a disconnect between what the public wants and what politicians are doing. We understand some of the reasons for that disconnect, and we know there’s a space for journalists in there. But it has to be, maybe, more proactive?

TL: I think just better reporting, more honest reporting, and putting yourself in the shoes of the people who are listening. All those people who went to hear Greg Walden’s town halls out in Oregon, they were furious with him, Democrats and Republicans. They wanted to know what was in the bill.

And we talk about something that’s missing. There are a lot of things that are missing, I want to touch on this, and one of them is the reporting of Medicaid.

We know that there are going to be millions of people who will lose their coverage under whatever comes out. These are people who were in the Medicaid expansion program that was part of the ACA, arguably the best part of the Obamacare law. People, poor people, for the first time got checkups and got access to healthcare in some of the poorest counties in America. And you have to be heartless to say that that wasn’t a good thing.

But there’s another part of Medicaid that has been absolutely missing, and that’s its role in financing a great share of the long-term care in this country. And this affects the middle class, because the middle class relies on Medicaid to pay for nursing home stays for their family members. They rely on Medicaid waivers for home care, for care in the community, like adult daycare centers and so forth, to provide some kind of care that they cannot do, and cannot afford to do.

And nobody seems to be writing about this. But the middle class has a huge stake in what happens to Medicaid, because if that program is cut, and the financing changes from an entitlement to a capped-welfare allotment, a block grant kind of arrangement, which is likely to happen—we’re not exactly sure what it’s going to be yet, but it’s not going to be an open-ended entitlement anymore—states are going to have a lot less money for long-term care services. So what’s going to happen if your family member is in a nursing home? Or you’re going to have a family member, and you’re spending down the Medicaid requirements so that family member can go in, and then find there’s no money?

It’s like one woman in Michigan wrote me and said, I’m terrified, my mother is 89 years old, she’s using up her money in an assisted living facility, she’s going to have to go on Medicaid if she goes into a nursing home. And the woman says, I have no money to pay for it and I have no siblings to help. So what’s going to happen? But that is not being addressed.

JJ: That’s the kind of story reporters could be doing, even as they can’t get politicians to answer their questions.

TL: Exactly.

JJ: We’ve been speaking with Trudy Lieberman. She’s long-time contributing editor to the Columbia Journalism Review, where she’s lead writer for The Second Opinion, CJR’s healthcare desk. It’s part of their United States Project on the coverage of politics and policy. She is also contributing editor of Remaking Health Care, at the Center for Health Journalism at USC. Trudy Lieberman, thank you so much for joining us today on CounterSpin.

TL: Thank you, Janine. It’s always a pleasure.

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