Answering the big questions about insurance exchanges, states to watch

We write a lot on this blog about state developments, the exchanges and Medicaid expansion, as that’s a huge part of the local health policy beat. Here’s a helpful detailed guide to covering exchanges from CJR’s  Second Opinion.

It suggests Five Big Questions and gives some advice on how to think about each of them

  • Will policies be affordable
  • Who influences the exchange boards?
  • Which policies can be sold?
  • Do the networks have enough doctors and hospitals?
  • How will the exchange sell its policies?

And it includes this basic advice:

For starters, look beyond the easy sources – those academics and think tank experts always eager to dish out a quote. In fact, don’t even worry about quotes at this point. The trick is to understand what’s going on, who are the players and their special interests, what are the nuts and bolts of how these exchanges work. And then: What big questions need to be addressed. Therein lie your stories.

The exchanges are a local, ongoing story, and the best sources will be the ones on the ground in your state. That means advocacy groups, local foundations, local stakeholders like insurance brokers and agents, medical societies, hospital associations, the head of the local exchange board, the staff at the exchange board, insurance regulators, consulting actuaries, and insurance companies (whose websites can be helpful even when their PR folks are not). In other words, good coverage of the biggest health story in decades requires old-fashioned reporting—schmoozing, cultivating sources, reading reports and testimony, even attending meetings of your local exchange board. That’s how you’ll find the dots to connect.

I would add that California is a good state for you to watch to see how some of these questions get asked, and answered. California is ahead of many states in setting up the exchange; they are already thinking about marketing and messaging and outreach, officials (including those who favor the Affordable Care Act) are having frank public conversations about affordability, and there is a lot of good reporting coming out of the state.  CJR’s Second Opinion also has been tracking Connecticut’s exchange pretty closely.

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