Author Archives: Joanne Kenen

Joanne Kenen

About Joanne Kenen

Joanne Kenen, (@JoanneKenen) the health editor at Politico, is AHCJ’s topic leader on health reform and curates related material at She welcomes questions and suggestions on health reform resources and tip sheets at

Breaking down court rulings on Affordable Care Act subsidies

supreme-courtEven for those of us who cover the Affordable Care Act (ACA) more or less full time, July 22 was a pretty zany day. Here’s a recap and some resources to help you going forward.

First an appeals court in Washington, D.C., ruled, 2-1 that people can’t continue to get subsidies in the federal exchanges – just on the state exchanges. Only it didn’t move to enforce that ruling – which would cut off millions receiving subsidies – because the three judges on that panel knew they didn’t necessarily have the last word. There are more legal fights to come in the case, known as Halbig v. Burwell. (It was v. Sebelius but the name was updated.)

Then, less than three hours later, another appeals court – also a panel of three judges – in Richmond, Va., issued the exact opposite ruling. They said, 3-0, that the subsidies in the federal exchange were fine. Well, maybe not fine – they thought the law was ambiguous. But even with the ambiguity, they said that the IRS had the right to interpret the law to allow the subsidies in the federal exchange. That case is known as King v. Burwell. (The IRS set the rules for the subsidies, which take the form of premium tax credits.)

The question in very simple terms is this: Did the ACA allow the subsidies through the federal exchanges? The plaintiffs argue no – and cite a specific section of the law that refers to subsidies for people enrolled “through an Exchange established by the State.” They say it’s clear as day – the subsidies are tied to state exchanges. The administration and its supporters say that’s far too narrow and literal an interpretation. The whole law is designed to expand coverage and the federal exchanges are meant to stand in when the states don’t stand up exchanges.

Now what? Continue reading

Health costs, journalism and transparency: One site opening door to price data

clearhealthcomHere’s a resource for health care costs – and a creative journalistic model of crowdsourcing, data collection, mapping, reporting and blogging. was started by former New York Times reporter and editor Jeanne Pinder. She received start-up funding from foundations (Tow-Knight Center for Entrepreneurial Journalism at CUNY and others listed on the website) and ClearHealthCosts now has a team of reporters and data wranglers chipping away at some of the difficult questions that patients need answered: How much is this treatment going to cost me? Can I find a better price?

It’s about shedding light on a health care cost and payment system that, to use Pinder’s word, is “opaque.” Some of what they are doing is specific to a half-dozen cities; other projects are building out nationally.

The data collected by ClearHealthCosts focuses on elective or at least nonemergency procedures such as imaging, dental work, vasectomy, walk-in clinics, screening (mammograms and colonoscopy) and blood tests. Much of the data is crowdsourced, and focused on New York area, including northern New Jersey and other suburbs; the San Francisco and Los Angeles areas; and Houston, Dallas-Fort Worth, Austin and San Antonio in Texas.

A recent grant from the John S. and James L. Knight Foundation via its Prototype Fund will let ClearHealthCosts collaborate with KQED in San Francisco and KPCC/Southern California Public Radio in Los Angeles to crowdsource Califoria prices. Earlier, Pinder’s team did a crowdsourcing partnership with the Brian Lehrer Show at WNYC public radio in which hundreds of women shared mammogram payment information, and their thoughts. It led to a series of blog posts including here and here. Continue reading

Early trends emerge following Medicaid expansion

Image by Colin Dunn via flickr.

Image by Colin Dunn via flickr.

A couple of stories have begun to trickle out from states about the impact of Medicaid expansion on hospitals.

This one from the Arizona Daily Star by Stephanie Innes, for instance, reports that uncompensated care dropped by a third in the first four months of 2014 from the prior year – a pretty significant number. The hospitals in that period wrote off $170 million in 2014, versus $246 million from Jan through April in 2013.

She uses data from the state’s hospital industry to report on uncompensated care (both bad debt and uncompensated care) and the hospitals’ bottom line.

“The Arizona hospital report shows the average operating margin of Arizona hospitals has gone up from 4 percent in 2013 to the current rate of 5.2 percent — a signal to some health experts that the Affordable Care Act will be a net positive for hospitals’ bottom lines,” she wrote. Continue reading

Documents yield true cost of Illinois’ PR campaign for insurance coverage

Carla K. Johnson

Carla K. Johnson

When Illinois awarded a $33 million contract to a high-priced PR firm to promote insurance coverage under the Affordable Care Act, Carla Johnson began filing open records requests under the state’s Freedom of Information law.

Eventually Johnson, a medical writer for The Associated Press, filed 10 FOIA requests while reporting on how public money was spent to promote the health law.

She says the “88-page contract, obtained through a records request, contained clues about other existing documents, such as monthly detailed explanations of invoices and a ‘work plan’ required by the contract.” She continued filing requests until she had enough documentation to detect some trends.

Read more about how Johnson reported the story, what she learned and tips for other reporters.

Using data to report on health reform

We posted some data tools from the Robert Wood Johnson Foundation for the health reform beat and AHCJ’s New York chapter recently got to hear about them in more detail with some help from RWJF. If you’ve done stories using this data, we’d love to see them and learn about how you used the data. Send them to

Charles Ornstein Storyfied the meeting and we have this guide for you from RWJF. Continue reading

Helping newly insured consumers understand the system

roadmapHealth reporters: Do you understand everything about your health insurance?

I didn’t think so.

Now imagine the struggles of newly insured people who don’t write about health care for a living – and who may not have had insurance for years and who may not speak English as a first language. Deductibles? Cost share? Copay? Narrow networks? Catastrophic caps?

Continue reading

Bringing local, national perspectives to report on ACA in rural Kentucky

Laura Ungar

Kentucky, a southern state implementing the ACA, has gotten a fair amount of media attention and we’ve highlighted some of the coverage.

But, in impoverished rural areas that stood to gain the most from the greater access to care that the ACA promised, many residents remained fiercely opposed to the law and the president who pushed it.

Against this backdrop, a team from USA Today and The (Louisville, Ky.) Courier-Journal decided to launch an in-depth examination of how the law is beginning to play out in Appalachian Kentucky.

In an article for AHCJ, Courier-Journal medical writer Laura Ungar writes about how the team tackled the issue, combining local and national perspective and expertise. Read more.

How one reporter strikes balance between policy, politics

Image by Scott Cresswell via flickr.

Image by Scott Cresswell via flickr.

Given the recent discussion on the AHCJ discussion list and elsewhere about the right balance between covering the politics of the Affordable Care Act versus  the policy of the ACA, I thought it would be a great time to showcase a reporter who does both.

David Ramsey of the Arkansas Times has been all over the story of Arkansas’ “private option” Medicaid expansion. That’s definitely been a political story – Arkansas legislators have slugged it out for two sessions and it’s going to happen again next year, with the fate of Medicaid expansion always on the line.  But Ramsey (@arkdavey) recently did a long and readable piece on the faces of Arkansas health care expansion.  He matched the politics, the policy and the people. And he did more than present their faces. He captured their voices. Continue reading

Costs keep going up for small businesses insuring their employees

Ideastream’s  Sarah Jane Tribble took a look at how small businesses that voluntarily cover their workers could be in for some premium shocks.

She focused on Paul Siperke, co-owner of Fat Head’s, a Cleveland brew club. It’s  a small business and, with fewer than 50 employees, there is no requirement to cover workers. But the owners do voluntarily.

And the costs keep rising – sometimes double digits, sometimes only as little as 3 percent.This year, Tribble reported, rates soared by 20 percent under the ACA, even though most of the workers are young and healthy.

She explains why: Continue reading

Similar health reform terms, but very different concepts

Essential health benefits include maternity and newborn care.

Photo: David Castillo Dominici via 
Essential health benefits include maternity and newborn care.

We’ve had a few members wonder whether “essential coverage” and “essential benefits” are one and the same.

They aren’t – and we’ve done a tip sheet to explain the difference in more detail.

But here’s the quick version:

If someone has minimum essential coverage it means he or she has a health plan that complies with the individual mandate. It means that there will be no penalty when 2014 taxes are filed. A lot of health plans qualify, including the exchange plans, most plans in the individual and small group market, employer-based health plans, Medicare, Medicaid.

Limited plans such as workers’ compensation or dental-only plans do not qualify as mandate-meeting minimum essential coverage.

Essential health benefits are the 10 categories of benefit s – hospitalization, prescription drugs, maternity care, etc. – that the exchange plans and the ACA-compliant off-exchange plans must cover. (After the brouhaha about plan cancellations, the administration gave states the option of extending the noncompliant plans for a few more years. They can be minimum essential coverage – but they don’t have essential health benefits.)

See the tip sheet for more explanation.