Before the health care law — aka Obamacare — the American health care system was a fragmented, confusing patchwork.
After the health care law, the American health care system remains a fragmented, confusing patchwork.
And there’s no sign that’s going to change anytime soon.
I’ve been fact-checking health care for PolitiFact since 2007, and I have to remind myself all the time: We don’t have one health care system, but several.
The biggest chunk of Americans get health coverage at work, through some sort of employer-provided plan. Next up is Medicare for people over age 65, along with Medicaid for the poor and other forms of government-provided health care insurance. A few people — about 6 percent of us — go out and buy health care insurance on our own, in what’s known as the individual market. It’s that relatively small chunk that has been getting cancellation notices in recent weeks, because the current plans don’t meet new standards for comprehensive coverage.
What does this mean for your reporting?
It means you have a bunch of different people to think about as you prepare your reports. People who get insurance at work, for example, may not know what’s it’s like to buy on your own. Younger people may not understand how Medicare works. Then there are veterans; the VA health care system is unlike any other. And the list goes on.
The 2010 health care law didn’t try to change the basic contours of these systems. Instead, it sought to bring the uninsured into the existing framework. Plus, it pushes and prods the health care industry toward more efficiency with tons of smaller changes and fixes.
Confusing? You bet.
So what’s a journalist to do when fact-checking claims about the health care system?
1. Call out the most ridiculous claims. The health care law does not turn the U.S. system into one like Canada or Britain. Muslims are not exempt. There are no death panels. Congress is not exempt from Obamacare, despite some members of Congress saying they are. PolitiFact has fact-checked more distorted claims about the health care law than any other piece of legislation. We published a list of 16 myths, rounding up the most absurd claims.
2. Embrace nuance. Calling out the worst of the falsehoods isn’t too hard, but other claims are trickier. Promoters of the law in particular can be a little rosy in their assessments. At PolitiFact, we found 10 things Obamacare supporters say that aren’t entirely true.
Obama said that if you liked your health care you can keep it, and the cancellation notices that have gone out to people in the individual market directly contradict his statement.
But Obama wasn’t entirely off-base, either. It was a way of letting people know that his plan wasn’t a single-payer, Canadian-style proposal. People who get their insurance through work, for example, get to keep their plans to the same extent that they did before the health care law — that is, they’re subject to changes their employers decide to make. People on Medicare are left alone, for the most part. We get regular criticism whenever we rate a statement Half True, but in a complicated world, it’s often the right call.
The health care law touched almost every part of the health care system, in ways both major and minor. It’s hard to make sweeping generalizations.
3. Look to nonpartisan sources, and talk to both sides of the partisans. We’re always looking to respected, independent sources on the health care law. When it comes to cost and economic impact, we look to the Congressional Budget Office for its regular reports and forecasts. The Congressional Research Service, an official government agency, publishes more topical reports that often find their way to the Internet. (Frustratingly, these reports are not public records.) Outside of government, the nonprofit Kaiser Family Foundation is a treasure trove of unbiased information and research.
Keep in mind, though, the people who know the details of the health care law often have strong opinions about it. We like to interview experts on one side of the debate and then run their line of thinking by the experts on the other side. That way, you find the areas where there truly is common agreement, and where the arguments are strong or weak. (If you’re looking for ideas on sources, we list our sources on the right-hand rail of each fact-check.)
4. Welcome reader reaction. Everybody needs health care, so everybody usually has opinions about health care. Brace yourself for hate mail: Because the health law is so politically polarized, passions run high. But we also get lots of good tips and feedback from readers who let us know when we haven’t considered all the angles. Readers who are willing to share their experiences  can be a rich source of interesting stories.
Angie Drobnic Holan is the editor of PolitiFact. She has been covering federal health care policy since 2007. She will be our guest at noon, ET, on Wednesday through Poynter’s News University. Learn more and sign up now.
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Training: Covering the Affordable Care Act – free, on-demand NewsU Poynter Conversation
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