Cat Duffy

Author ››› Cat Duffy
  • The AHCA Is Even Worse Than You've Read

    ››› ››› CAT DUFFY

    A Media Matters study of four major newspapers’ coverage of the American Health Care Act (AHCA) after it was passed by the Republican-led House found a serious lack of reporting on detrimental effects of the bill. Analysis of the coverage revealed a dearth of reporting on the AHCA’s negative impact on access to mental health care and substance abuse treatment, women’s health care, special education funding, services for the elderly, and funding for rural hospitals.

  • The Wall Street Journal Forgot High-Risk Pools’ History Of Failure

    Blog ››› ››› CAT DUFFY

    The Wall Street Journal published a misleading editorial about the Republican Party’s American Health Care Act (AHCA), pushing the false claim that high-risk pools “will ensure everyone can get the care they need” and that they “are a fairer and more equitable solution” than existing patient protections enshrined by the Affordable Care Act (ACA).However, high-risk pools have a long history of failure and the current AHCA legislation would leave a funding shortfall of billions of dollars for these high-risk pools, thereby limiting accessibility. Multiple Republicans have also admitted that the legislation would not protect those with pre-existing conditions.

    The GOP released an amendment to its extremely unpopular health care bill, authored by Rep. Tom MacArthur (R-NJ), that weakened the ACA’s patient protections in an attempt to lure the right-wing Freedom Caucus into supporting the AHCA. In particular, the amendment included provisions to allow states to apply for waivers that would allow them to eliminate the ACA’s mandated protections for individuals with pre-existing conditions and the essential health benefits (EHBs) package in exchange for setting up high-risk pools.

    The Wall Street Journal’s editorial board claimed to “explain how the GOP reform would work in practice” given that “insurance coverage for pre-existing health conditions can be confusing.” The article presented high-risk pools as the solution to pre-existing conditions coverage, the salve to “pre-existing conditions panic” and claimed that the “GOP plan will ensure everyone can get the care they need”:

    Why might a Governor prefer such an arrangement over the ObamaCare status quo? Well, the law’s price controls are a raw deal for most consumers, which leads to a cycle of rising premiums and falling enrollment. Average premiums rose by 40% or more in 11 states this year, and insurance markets in states like Tennessee, Kentucky and Minnesota are in crisis.

    [...]

    High-risk pools are a fairer and more equitable solution to this social problem, rather than hiding the cost by forcing other people to pay premiums that are artificially higher than the value of the product. The waivers also include protections for people who renew continuous coverage from major premium increases if they become ill.

    Liberals are inflating the pre-existing conditions panic with images of patients pushed out to sea on ice floes, but the GOP plan will ensure everyone can get the care they need. Republicans can win this argument, but first they need to join the debate and explain their ideas.

    High-risk pools are not new -- they existed in 35 states prior to the ACA. History shows they represent an incredibly flawed approach to providing coverage for the most vulnerable because they are chronically underfunded, outrageously expensive, and they provide insufficient access to care.

    High-risk pools are almost never sufficiently funded because they cost an exorbitant amount to administer. High-risk pools flip the normal logic of insurance pools -- which spreads risk throughout the pool between healthy and sick individuals -- and instead consolidates all the costliest individuals in one pool. While this might reduce costs for healthy individuals, who are no longer grouped with chronically ill individuals, the high-risk pool requires an incredible amount of funding in order to function as viable health insurance. New estimates from the Center for American Progress show that the $130 billion of risk pool financing included in the AHCA is woefully insufficient to properly cover these individuals and, in fact, “would leave a $20 billion shortfall annually.” This underfunding is typical of high-risk pool proposals as history shows they almost always cost more than the funding allocated, and within the pools, coverage becomes exceedingly expensive. As MSNBC medical contributor Dr. John Torres explained in a May 2 interview, given the high number of individuals with a pre-existing condition -- nearly half of all Americans, and roughly 86 percent of people aged 55 to 64 -- average premiums could cost over $25,000 a year.

    Despite The Wall Street Journal’s claims, high-risk pools provide dramatically insufficient coverage and states that have attempted high-risk pools have needed to impose limits on the types of coverage offered and on how individuals could access coverage given the cost. Kaiser Health News’ Julie Rovner detailed the history of high-risk pools in her “Sounds Like A Good Idea?” video series, noting that empirically, “pools got so expensive for states that they had to impose waiting lists for coverage.” Previous high-risk pools also imposed limitations on access to care, often “refus[ing] to pay for services associated with a patient’s pre-existing conditions in the first months of their enrollment.” The Physicians for a National Health Program denounced the GOP’s high-risk pool push, explaining that plans in these pools historically “offered much less than optimal coverage, often with annual and lifetime limits, coverage gaps, and very high premiums and deductibles.”

    The problematic history of high-risk pools highlights just one of the many negative aspects of the MacArthur amendment which is why most major health care groups including the American Medical Association, the AARP, the American Hospital Association and America’s Essential Hospitals, and many others have come out against the bill.

    Even conservatives recognize that high-risk pools won’t work. Rep. Billy Long (R-MO) declared that he would vote “no” on the AHCA because “the MacArthur amendment strips away any guarantee that pre-existing conditions would be covered and affordable.” During WHTC Morning News, Rep. Fred Upton (R-MI) said that he “supported the practice of not allowing pre-existing illnesses to be discriminated against from the very get go” and that the MacArthur amendment “torpedoes that,” which is the reason he “cannot support this bill.” When questioned by MSNBC’s Ali Velshi about whether or not pre-existing conditions are covered by the AHCA, conservative pundit Rick Tyler admitted “they’re not.”

  • Cable Morning Shows Fail To Discuss Implications Of Disastrous New Amendment To Republican Health Bill

    After News Broke, Networks Mentioned Amendment A Total Of Three Times, And None Discussed Impact

    ››› ››› CAT DUFFY

    Cable morning shows devoted scant coverage to the Republicans' new health care amendment, failing in particular to explain that the proposed amendment's allowance for states to opt out of protections for pre-existing conditions, preventative services, and essential health benefits (EHBs) could mean substantial increases in premiums for everyone and millions of Americans losing access to health care.

  • This Kentucky Paper Shows How To Cover Draconian Medicaid Changes Across The U.S.

    Blog ››› ››› CAT DUFFY

    Kentucky’s Courier-Journal led the way in reporting on Republican Gov. Matt Bevin’s push to fundamentally change the state’s Medicaid program through a waiver request that would implement draconian policies to cut coverage and hurt vulnerable communities. The Courier-Journal’s coverage of the Medicaid waiver highlights some best practices -- such as discussing specific policy impacts and citing local experts and people affected by the proposal -- thus providing a model newspapers in other states with similar proposed changes to Medicaid should emulate.

    In June 2016, Bevin released a Medicaid waiver proposal called Kentucky HEALTH, which included a series of draconian policies that would gut the state’s existing Medicaid program. Bevin’s waiver has been soundly criticized by experts who emphasize that it would create barriers to obtaining coverage, decrease the use of key preventive services, and harm the overall health of Kentucky’s Medicaid population. Work requirements in particular have been criticized as poor-shaming, since the majority of Medicaid recipients come from working homes and such a policy has never been approved in the entire history of the program.

    However, the election of President Donald Trump and the installation of new leadership at the Department of Health and Human Services mean a new openness to previously rejected policies like work requirements. This shift has spurred a couple other Republican-led states -- Wisconsin and Florida -- to explore the possibility of obtaining waivers so they can include policies like mandatory drug testing and work requirements, a trend that could negatively impact Medicaid beneficiaries across the country.

    The Courier-Journal’s coverage of Bevin’s proposal models the best practices for state-level reporting on attempts to impose cruel restrictions on Medicaid programs -- a model that other outlets should adopt as more state legislatures attempt to enact radical reforms. Here’s what The Courier-Journal did correctly, and the one thing the paper could have improved on:

    1. Discuss Specific Policies Within Medicaid Waiver Proposals And Outline Their Impact On Local Public Health Issues

    The Courier-Journal consistently reported on the specific policies Bevin included in his Kentucky HEALTH proposal, not just generalities about the waiver, and highlighted the impact these changes would have on the citizens of Kentucky. A Media Matters study of the paper’s coverage showed that the majority of its reporting clearly outlined the major policies included in Kentucky HEALTH such as the requirement that “most ‘able-bodied working age’ adults … put in up to 20 hours a week working” or volunteering, the provision to “charge premiums for coverage that is now largely free,” and the elimination of “dental and vision benefits from basic Medicaid coverage.”

    Additionally, The Courier-Journal analyzed how the specific policies would impact Kentucky’s Medicaid beneficiaries. Reporting highlighted the impact the waiver would have on the detection of diabetes -- a huge public health issue in Kentucky -- and the negative impacts on public health of eliminating dental and vision benefits.

    2. Include Information On Public Hearings And Information Sessions -- Opportunities For Citizens To Make Their Voice Heard On Medicaid Proposals

    The Courier-Journal consistently included information on the timing and location of public hearings and other opportunities for citizens to express their views. After Bevin revealed his Kentucky HEALTH proposal, there was a public comment process, in which Kentucky’s Department for Medicaid Services held a series of public hearings and accepted comments from residents. The Courier-Journal outlined how to get more information on the proposal and public hearings, including the dates, times, and locations. As the backlash over the GOP’s American Health Care Act illustrated, when people show up it forces politicians to listen.

    3. Seek Out Testimony From Local Experts And Individuals Impacted By The Medicaid Proposals

    The Courier-Journal bolstered its comprehensive reporting by citing local experts and interviewing individuals who would be impacted by Bevin’s proposal. The Courier-Journal received comments from health care experts like Bill Wagner, the executive director of Family Health Centers, and public health advocates like Sheila Schuster and Emily Beauregard of Kentucky Voices for Health. Articles cited feedback from Kentucky doctors and health care organizations that identified the grave public health problems posed by Bevin’s proposed changes.

    The newspaper also contextualized its reporting by including testimony from individuals who had personal experience with Kentucky’s Medicaid program or would be impacted by the proposal. This type of reporting humanizes public policy debates and provides concrete examples of the consequences of such drastic changes.

    4. Contextualize Proposed Changes To The State’s Existing Medicaid Program

    The Courier-Journal consistently included information on the massive gains in health care coverage achieved by the ACA-facilitated Kentucky Medicaid expansion in its reporting on Bevin’s proposal, which is essential to properly contextualize the policy discussion. Medicaid expansion in Kentucky dramatically increased access to health care for vulnerable communities, aided in the fight against the opioid epidemic, and improved public health through increased use of preventive services. It is important for newspapers to ground their reporting on potential changes to Medicaid in the context of how Medicaid expansion affected public health -- particularly given the false claims propagated by Bevin and his officials about Medicaid’s stability.

    But There’s Still Room For Improvement -- Outlets Must Clarify When Proposals Address Nonexistent Problems

    The Courier-Journal set the gold standard for reporting on state-based attempts to gut Medicaid programs in Kentucky, but there is still room for improvement. The paper largely failed to note that Bevin’s proposed work requirement is a solution in search of a problem. Work requirements operate under the false assumption that programs like Medicaid undermine individual work ethic when in reality, the majority of Kentuckians who gained insurance under the Medicaid expansion were low-wage workers. The Kaiser Family Foundation noted that, nationwide, “nearly 8 in 10” Medicaid-enrolled adults “live in working families, and a majority are working themselves.” Only two of the newspaper’s articles mentioned that the majority of the state’s Medicaid beneficiaries have jobs.

    Right-wing media and politicians like Bevin often demonize Medicaid and push work requirements as a mechanism for fostering personal responsibility and forcing people to have “skin in the game.” Similarly, Wisconsin just released a waiver proposal that would institute mandatory drug testing for Medicaid beneficiaries, which reinforces stigmatizing stereotypes rather than helping actual substance abusers. It is incumbent on news outlets to contextualize proposals to change Medicaid by identifying the actual problems they purport to solve -- and noting when they’re merely right-wing fictions.

    Graphics by Sarah Wasko. 

  • Fox News Promotes Eric Bolling, Noted Bigot, Conspiracy Theorist, And Muppet-Hater

    ››› ››› CAT DUFFY, ZACHARY PLEAT & JARED HOLT

    In the wake of Bill O’Reilly’s departure from Fox News following an advertiser boycott stemming from sexual harassment settlements involving the prime-time host, Fox News announced a new lineup that includes giving host Eric Bolling his own show at 5 p.m. This promotion comes despite Bolling’s history of trafficking in racist stereotypes, promoting fear of Muslims in America, and engaging in conspiracy theories, including the birtherism made famous by now-President Donald Trump.

  • Top Kentucky Newspapers Consistently Reported On The Substance And Impact Of Kentucky's Medicaid Waiver

    ››› ››› CAT DUFFY

    A Media Matters analysis of the top two Kentucky newspapers’ coverage of an effort to radically alter the state's Medicaid program found that while both substantively covered the changes and impacts, The Courier-Journal led the way in in-depth reporting on the impacts of a Medicaid waiver on the state. The waiver request submitted by Gov. Matt Bevin included instituting draconian policies like a work requirement and mandated monthly premiums.

  • Kansas Nightly News Fails To Educate The Public About The Medicaid Expansion 

    ››› ››› CAT DUFFY

    A Media Matters study of broadcast TV coverage in the Kansas City market found that NBC, ABC, CBS, and Fox collectively spent less than eight minutes over a 43-day period covering the state legislature’s debates over the proposal to accept the Affordable Care Act’s Medicaid expansion, which would extend coverage to more than 150,000 Kansans. 

  • The GOP Health Care Bill Actually Does What Conservatives Said Obamacare Would Do -- And Worse

    Blog ››› ››› CAT DUFFY

    Speaker of the House Paul Ryan (R-WI) scheduled the vote on the Republican health care bill, the American Health Care Act (AHCA), on the seventh anniversary of the passage of the Affordable Care Act (ACA), also known as Obamacare. Despite seven years of Republicans pledging to repeal and replace the ACA, all they’ve managed to come up with is a bill that is the manifestation of some of the worst myths and baseless critiques that right-wing media leveled against the ACA.

    The Republican Party introduced their health care bill earlier this month. The proposed legislation severely cuts Medicaid, reduces tax credits while giving a massive tax cut to the wealthy, and dramatically increases the number of uninsured Americans, effectively erasing the gains made by the ACA. While right-wing media has spent the better part of a decade demonizing the ACA, three of their biggest myths -- allegations that the ACA hurts seniors, that Democrats rammed the law through Congress, and the never-ending predictions of a “death spiral” -- are actually valid criticisms of the GOP health care law.

    The most famous right-wing media myth surrounding the ACA is the death panel -- the false allegation that the ACA created a panel of government bureaucrats that would ration health care for the elderly. PolitiFact dubbed the falsehood the “Lie of the Year” in 2009. However, right-wing media figures continued to push the myth for years. The specter of a death panel that might euthanize a grandmother fit into right-wing media’s narrative that the ACA would hurt seniors. Conservative media figures forwarded a variety of lies about how Obamacare was “sticking it to the seniors,” ranging from assertions that the ACA’s medical tax would apply to wheelchairs (it doesn’t) to false allegations that the law eviscerated Medicare by raiding its funding.

    In reality, the ACA improved senior care by reducing prescription drug costs for the elderly and extending coverage to key services. The ACA improved access to care by increasing Medicare payments for primary services and instituted crucial protections to improve the “quality and coordination of care.” The health care law also extended the solvency of Medicare by over 10 years, after which “payroll taxes and other revenue will still cover 87 percent of Medicare hospital insurance costs.”

    The AHCA, on the other hand, worsens the health care outlook for seniors. The bill loosens the age-rating protections that limit how much insurers can charge seniors, allowing them to discriminate against the elderly by charging them five times more than younger individuals. While allowing insurers to jack up premiums for the elderly, the AHCA also provides substantially less generous tax credits for purchasing health care, likely far below what would be needed to purchase comprehensive coverage. This disproportionately hurts working-class seniors. According to Vox, a 64-year-old who makes $26,500 a year will see “more than a 750 percent increase in premiums from Obamacare to the Republican bill.” As The Atlantic’s Vann Newkirk explained, “proportionally, the group of people that would see the most coverage losses under the AHCA is the population of people aged 50 and older.” And while the ACA increased Medicare’s solvency, the AHCA repeals the Medicare payroll surtax on the wealthy, which will “weaken Medicare’s financial status” by depleting its funding “three years sooner than under current law,” according to the Kaiser Family Foundation. Essentially, despite right-wing media having pushed the image of seniors as one of Obamacare’s main victims, it is actually the Republican health law that actively worsens access to health care while increasing costs for the elderly (just ask the AARP). 

    Another anti-Obamacare talking point featured conservative media figures decrying the allegedly undemocratic process by which Congress passed the ACA, claiming that Democrats were trying to “ram it down America’s throat.” Right-wing media took then-Speaker of the House Nancy Pelosi’s (D-CA) comment “we have to pass the bill so that you can find out what is in it” at the National Association of Counties out of context, to scandalize the health law as a secretive, closed door deal.

    Despite the rampant right-wing smears, the debate over the ACA was “one of the most transparent” in recent history, as Congress debated the legislation for over a year before it was signed into law. The full context of Pelosi’s now notorious speech reveals that her comment was about the need to have conversations about the substance of the ACA outside of the “fog of the controversy,” because negative talking points dominated the discussions of the law.

    The clear differences between the legislative processes for the ACA and the GOP health care bill lays bare right-wing media’s hypocrisy. As Politico’s Dan Diamond noted, “in 2009, Dems took 119 days between introducing [the] bill [and] taking a floor vote,” while “in 2017, [the] GOP will do it in 17 days.” The GOP has pledged to hold a vote on the bill in the House on March 23, despite the fact that the CBO has not finished scoring the substantial amendments released this week. Topher Spiro, the Center for American Progress’ Vice President for Health Policy, highlighted the hypocrisy, pointing out “Republicans *literally* have to pass the bill to find out what it does,” since it is highly likely there would be “no CBO score before the vote.” Instead of defending the democratic process they found so dear in 2009, conservative media figures portrayed the AHCA’s passage as inevitable and allowed guests to insist that the Republicans are using “regular order” to normalize the rush to pass the disastrous bill. The hypocritical treatment of these starkly contrasting legislative processes illustrates how right-wing media fealty to democratic norms only exists when it furthers their own narratives.

    The third manifestation of conservative hypocrisy on health care stems from right-wing media’s continued predictions over the last seven years about the possible collapse of the Affordable Care Act’s insurance markets into a death spiral. Conservative outlets claimed the law was in a death spiral each time premiums increased, when Aetna withdrew from the exchanges, when they alleged there weren’t enough healthy enrollees, and when some of the co-ops failed. None of these alleged death spirals were real -- in fact, the newest CBO report confirms the ACA is not collapsing and will continue to stabilize, despite claims to the contrary.

    By eliminating the individual mandate and replacing it with a much weaker “continuous coverage” requirement, the AHCA seriously risks a death spiral because it “could have the unintended consequence of discouraging healthy people from buying coverage.” Whereas the ACA’s individual mandate incentivizes purchasing insurance to avoid a penalty, under the continuous coverage requirement a healthy uninsured individual is likely to wait until they are sick to join the market, massively increasing costs. The Century Foundation outlined how the AHCA could result in a death spiral because coverage losses and cuts in financial assistance will result in few healthy enrollees. Families USA noted that the only way the AHCA creates stable markets is “by making it nearly impossible for older adults and the sick to find affordable coverage, leaving only the healthy or wealthy in the market.” While the predictions of the ACA’s demise have been greatly exaggerated, the Republican health law might actually lead to the death spiral right-wing media have long been hyping.

    The false claims right-wing media have made over time about the ACA highlight only a few of the ways in which the AHCA would devastate the American health care system. The AHCA pays for a $600 billion tax cut for the wealthy by cutting Medicaid -- the program that provides essential health care for the disabled, the elderly, and low-income communities -- by 25 percent. The newest reported proposal to eliminate the ACA’s essential health benefits package will gut access to substance abuse treatment for victims of the opioid epidemic and likely increase costs for women as insurers can drop maternity coverage. By defunding Planned Parenthood, the AHCA will deprive many low-income communities of their only safety-net health center and result in thousands of additional births per year. If the law passes -- despite the apparent cancellation of the first scheduled attempt -- the AHCA could create the apocalyptic fantasy right-wing media desperately sought to find in the ACA.

    *Image by Sarah Wasko

  • STUDY: Major North Carolina Newspapers Largely Failed To Report On The Devastating Impacts Of The GOP Health Bill

    ››› ››› CAT DUFFY

    Three of the top North Carolina newspapers largely failed to explain the major impacts of the proposed Republican health care bill, the American Health Care Act (AHCA). A Media Matters analysis of originally reported articles about the bill in the Winston-Salem Journal, The News & Observer, and The Charlotte Observer found little to no mention of its impact on women and minority communities, insufficient reporting on its impact on seniors, and minimal coverage of its hidden, massive tax breaks for the wealthy.