Covering health insurance in a less-populated state can be a significant challenge for journalists because most often, there’s not enough enrollment data to support robust reporting on trends that affect consumers.
Katheryn Houghton learned this lesson when working as a daily news reporter for the Bozeman Daily Chronicle in Montana. In May, she left the Chronicle and now works as a freelance health care journalist in Missoula.
In a new How I Did It piece, Houghton explains how she got a tip late last year that five Montana hospitals were settling a lawsuit with their employees over how much the workers had paid for health insurance. That tip led to a three-month reporting effort that culminated with this story (and awesome headline) on Jan. 26: “‘An earthquake’: the deal that changed Montana’s insurance market.”
The hospital employees filed the lawsuit in 2017, alleging that the hospitals made a deal in 2011 with Blue Cross and Blue Shield of Montana, the state’s largest health insurer. That deal changed the state’s commercial health insurance market in a way that favored the hospitals and BCBS of Montana, causing the employees’ to pay more for their employer-sponsored health insurance than they would have otherwise, the lawsuit alleged.
When she’s explaining many of the details behind the lawsuit and the settlement, Houghton provides a guide for other journalists covering health insurance competition. For reporters working in less-populated areas, her work could be particularly useful. Consider that Big Sky Country, as it’s called, is the fourth-largest state in terms of land mass, and its 1.03 million residents give it a rank of 48 among the 50 states in terms of population density.
As a result, Houghton explains, reporting on Montana’s health industry is like covering a small town. “Most who remembered the deal and had theories about its effects on the health insurance market still work in the business and wouldn’t talk on the record,” she writes. Many sources spoke to her on background.
Lacking on-the-record quotes meant Houghton needed to rely more than usual on health insurance market data to tell the story. There, she hit her first wall. “State officials couldn’t say what the deal meant for Montanans and didn’t have data to show whether it changed the balance of power among the state’s insurers,” she adds.
When covering health insurers, one source journalists may find useful is the American Medical Association’s Division of Economic and Health Policy Research, which analyzes competition in health insurance markets. In March, we used AMA data on the market in Georgia, for example. See this blog post, “How to monitor the effects of insurance mergers.”
So what does the AMA say about Montana’s health insurance market? As Houghton learned, there’s not much data. The AMA’s most recent (2019) report, “Competition in Health Insurance, A comprehensive study of U.S. markets,” says it does not have enrollment data on health maintenance organizations for Alaska, Montana, Nebraska, Wyoming or for 152 metropolitan statistical areas because each of those areas had fewer than 5,000 reported enrollees in HMOs.
Instead, Houghton used data from the Kaiser Family Foundation on the market share of commercial insurers. The KFF data showed that BCBS of Montana grew its share of the commercial market in the year after the 2011 deal and then retained that position in some areas of the market.
But, as her sources noted, most Montanans have employer-sponsored insurance (ESI) for their health care coverage. More than half of all Americans have ESI because most employers are self-insured (which is also called self-funded). Being self-insured allows employers to keep all the profits a health insurer would get, and cover all losses too.
For ESI enrollment data, Houghton turned to the National Association of Insurance Commissioners. “The NAIC’s database includes the number of people each insurance company covers and has a category titled ‘uninsured plans’ that represents those who have insurance through self-funded, employer-sponsored health plans,” Houghton explains. Also, she includes a pdf showing the NAIC’s Montana market data.
Houghton’s reporting is instructive for all these reasons, but also, as she explains, there was another benefit: tips from health care and health insurance sources on other unreported issues worth covering.