The Affordable Care Act is reaching its climactic phase. In just over three months, starting Oct. 1, the health insurance exchanges, also known as marketplaces, will open their digital doors as the period for open enrollment begins under the ACA.
The Alliance for Health Reform, a nonpartisan group in Washington D.C., has partnered with the Association of Health Care Journalists to provide briefings to journalists across the country. Thirty-five reporters and editors from southeastern Pennsylvania and southern New Jersey gathered for a June 18 briefing hosted by The Philadelphia Inquirer. The panel of experts who addressed the crowd shared their knowledge on the changes that are to come and suggested story ideas.
Karen Pollitz, a senior fellow at the Kaiser Family Foundation, addressed the changes expected in the individual market. While small, this market is, and will continue to be, the one most affected by the changes under the ACA.
Pollitz offered some suggestions for stories, such as collecting data from existing insurance plans (current price points and what they cover, etc.) and comparing this data in the future with that of the plans from the new marketplaces. Reporters have to be careful because the new plans will be more complete than current ones and comparisons can be tricky.
She also suggested that journalists could become volunteer Certified Application Counselors and help the uninsured get through the application process.
“Become your ACA block captain,” she said. That way you can “see what kind of issues they’re coming up against, how well the system is working, or not.”
Gerald Katz, the owner of Healthcare Management Consulting and a long-time hospital consultant in Philadelphia, addressed the challenges that hospitals will face and how their systems will be forced to change under the ACA.
The biggest problem he sees hospitals facing is how to adjust their model away from volume and towards quality. He is also concerned with the decline in independent community hospitals and the ongoing corporatization of health care delivery.
“The days of the community hospital are really numbered,” Katz said, “and with that goes the focus of the hospital on its community.”
He also suggested following the problems that will arise for hospital funding when the new plans take effect in January. The president and some legislators have proposed delays in those cuts, but when they happen, the subsidies provided to the hospitals with high populations of indigent patients will be cut. And if Medicaid expansion isn’t happening, then hospitals will get the pain without the gain that the law intended.
Uwe Reinhardt, James Madison Professor of Political Economy and Professor of Economics at Princeton University, addressed the concerns of rate shock, as well as its converse, “rate joy”, that will come with the changes in insurance premiums.
“The ACA draws a line through the imbalance of cost from healthy to sick,” he explained, meaning that healthier younger people will have to pay more – rate shock – while the sicker population’s premiums will likely go down – what he describes as “rate joy. “
Another topic Reinhardt stressed was how to sell these cost spreading premiums to young people. The actions of young people will be crucial to the law’s success. If they don’t sign up, the insurance pools will not work.
Karl Stark, assistant managing editor for health and science at The Philadelphia Inquirer, suggested writing about how businesses are going to react to the ACA.
Will they cut employees or hours so that they do not have to comply with new mandates to provide insurance?
He also suggested a story on smokers, who could face dramatically higher premiums from the law. “The law gives insurers the ability to raise costs on smokers by 50 percent,” he said.
Stark also acknowledged that insurance premiums are another very big story. However, like Reinhardt, he cautioned against comparing a person in the current market to someone in a better plan in the future exchanges.
“There [will be] so many more protections built in,” he warned. So the plans aren’t truly comparable.