Spinning the Supreme Court’s healthcare decision

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In the days before and after the Supreme Court’s decision, spin doctors were hard at work peddling their experts, positions, and takes on what might happen, and then what did happen and what might happen next. This is all to be expected, but the scope and the volume of the spin was extraordinary.

“I have never seen so many lawyers and experts ready to comment,” said Allan Ripp, whose company, Allan Ripp Public Relations Inc., represents law firms and other healthcare stakeholders. “I’ve never seen a piece of news generate this much media responsive messaging. Anyone, aside from entertainment lawyers, had something to say. It was a quotable or teachable moment.” One of Ripp’s clients, the Washington-based law firm Arent Fox, with its big-gun health lawyers, wasn’t about to let that moment pass. It practiced its tweets beforehand, Ripp said, searching for the perfect succinct message that fit the speed and limitations of Twitter.

Judging from the steady stream of email that showed up in my own inbox, groups and individuals ranging from key stakeholders to those you wouldn’t ordinarily think of as health care heavyweights—from the Ms. Foundation for Women to a Catholic theologian to an Eye Institute in India—weighed in. Health stakeholders, of course, were the loudest voices. The CEO of the Oregon Health Co-Op, which will offer insurance in the state’s insurance exchange, hailed the court’s decision as “great news for Oregonians.” The Pennsylvania Health Access Network sent a release aimed at state legislators, arguing that although  “the constitutional debate is over, it’s time for the Pennsylvania General Assembly to stop stalling and start making these historic reforms real for us.” A flack for the Association of American Physicians and Surgeons, meanwhile, offered up what she called “Healthcare Bill Physician Experts” who could speak about the decision. The National Physicians Alliance, a nonpartisan, nonprofit research and education organization supportive of the Affordable Care Act (ACA), advised reporters that some 40 experts representing different medical specialties were available. Universities offered experts on constitutional law, health policy, and the ACA’s impact on vulnerable citizens.

The National Senior Citizens Law Center and the National Committee to Preserve Social Security & Medicare wanted reporters to know that seniors’ benefits were safe, and that they would continue to get free wellness visits, as well as cheaper drugs if their expenses hit Medicare’s donut hole, where there has historically been no coverage; the ACA will help close the hole. But Allsup, a nationwide firm that helps individuals, employers, and insurance companies comply with Medicare and Social Security Disability regulations, predicted that seniors and people with disabilities may still face financial hurdles obtaining care even with the ACA. The Medicare Rights Center in New York City said seniors could look forward to increased solvency for Medicare’s Hospital Trust Fund for another eight years.

Two of the biggest and most important stakeholders to watch in the coming months—the National Federation of Independent Business (NFIB), which was one of the plaintiffs in the Supreme Court case, and the National Retail Federation (NRF), which represents merchants across America—got their messages out too. Forty-four journalists, representing such outlets as The Orange County Register, ABC News, and the Knoxville News Sentinel took part in a conference call sponsored by the NFIB, even though the group had to switch times so it wouldn’t conflict with a similar call from another organization. Jean Card, the NFIB’s vice president of media and communications, told me the number of reporters on the call may have been a record for the NFIB.

Many emails had strong ideological undertones, naturally. From the Physicans for a National Health Program, which supports single-payer health care, came the message that the Affordable Care Act “will not remedy the US health crisis.” The American Action Forum, a right of center policy institute, told journalists in its press release that the “Affordable Care Act just got more unaffordable” and offered some numbers to bolster its contention. The Pioneer Institute, a policy research group that supports limited government and knows a lot about the workings of the Massachusetts law, had its own conference call to offer its analysis.

Did these messages score a bull’s eye with the press? “I saw a few Twitter postings that suggested the media was being swamped with items promoting health reform experts,” said Warren Robak, deputy director of media relations for the RAND Corp. the California-based think tank. One of them may have been Politico reporter Jason Millman, who, a few days before the decision, tweeted, “I can deal with ‘expert’ emails on SCOTUS/ACA but don’t call me to pitch me an expert.”

My own—decidedly non-scientific—sampling of coverage indicates that reporters did use experts’ remarks in their stories. Whether such commentary got picked up appeared to depend on the importance of the organization and reporters’ familiarity with them.

Did all this spinning have an effect on stories? Maybe.

“We got our message out, and the result speaks for itself,” said Stephen Schatz, senior director of media relations for the National Retail Federation, which was not pleased with the court’s decision because the law “wrongly focuses more on penalizing employers and the private sector than reducing health costs.” The NRF held conference calls with its member businesses and state associations, which in turn spoke to journalists. For example, the head of the New Jersey Retail Merchants Association, told NorthJersey.com, the website of The Record. “All this is going to do is penalize employers.”.

The NFIB collected 730 clips mentioning the organization—another record for an outfit that usually gets about 100 for any particular announcement, Card said. Most outlets in that clip collection noted the NFIB’s disappointment with the ruling. New York Attorney General Eric Schneiderman issued a statement promising that “over one million uninsured New Yorkers will soon have access to affordable coverage” and that his office “stands ready to enforce the Affordable Care Act.” The media jumped on that one, with several outlets in New York and elsewhere noting Schneiderman’s comments, along with reaction from other state officials.

The media, however, seemed less interested in what lesser-known commentators had to say. For example, Nancy Dallavalle, a theologian from Fairfield University in Fairfield, Connecticut, got just a couple of hits—one in the Boston Herald.com and one in Orlando Sentinel.com, which picked up her press release quote verbatim.

There’s nothing wrong, of course, with all this flackery, given the scope and drama surrounding the Supreme Court decision and the health reform law itself. And buried in many of these messages were nuggets of good story ideas for sharp-eyed reporters to pursue, which are far more important than the great tsunami of reaction quotes that washed over the media.

For me, the most useful PR message came from the actuarial firm Milliman, which pointed journos in a number of crucial directions. Milliman works with insurance companies, and expansion of private insurance is the sine qua non of the Affordable Care Act.

Its press release identified ten strategic considerations, useful not only for the firm’s clients but for reporters who want to do a bang-up job covering the ACA going forward. Milliman flagged such questions as these: What will be employers’ role in insuring early retirees? What kind of cost shifting from one payer to another will still occur? What will happen to Medicaid and all its complexity? And how will insurers deal with the costs associated with insuring a lot of very sick people, since the law requires them to take patients with preexisting conditions. “The cost problem persists,” the release warned. “What can be done about it?”  That’s a big one for us journalists to work on.

Also seen in Columbia Journalism Review