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

How much can Kentucky’s next governor unravel an ACA success story?

The off-year Kentucky governor’s election put the future of the Affordable Care Act into question in that state. Kentucky is the only southern state to have run its own ACA health insurance exchange, and go ahead with Medicaid expansion. And it’s been seen as a success. A half million people got covered, mostly under Medicaid. Uninsurance rates plummeted in 2014 more than in any other state – and Kentucky has more than its share of poverty and ill health.

Matt Bevin, the millionaire tea party GOP candidate, was elected on a pledge to undo most of it. Continue reading

Those who assist with health plan enrollment now have expanded roles – are they prepared?

Photo: Carol Von Canon via Flickr

One clear lesson that health law advocates have drawn during the first two enrollment seasons under the Affordable Care Act is that many, many people need help sorting through their health plan choices as they try to enroll.

Among the many ways to get that assistance is by consulting a government-funded navigator or in-person assister (IPA), who must have training in the health law and enrollment procedures. Continue reading

Finding fresh ways to report on Medicaid, changes in health care system

Photo: Phil GalewitzA recent AHCJ chapter meeting featured discussion of Medicaid and story ideas for reporters to pursue. Facing the camera, from left to right, are Rebecca Adams of CQ Roll Call, Joan Alker of the Georgetown Center for Children and Families; Cindy Mann, former head of Medicaid official; and Matt Salo, head of the National Association of Medicaid Directors.

Photo: Phil GalewitzA recent AHCJ chapter meeting featured discussion of Medicaid and story ideas for reporters to pursue. Facing the camera, from left to right, are Rebecca Adams of CQ Roll Call, Joan Alker of the Georgetown Center for Children and Families; Cindy Mann, former head of Medicaid official; and Matt Salo, head of the National Association of Medicaid Directors.

The Washington, D.C., chapter of AHCJ held an event about Medicaid in late October with Matt Salo, who leads the National Association of Medicaid Directors; Cindy Mann, who until January was the top U.S. official in charge of Medicaid at HHS and now works at Manatt, Phelps & Phillips; and Joan Alker, executive director of the Georgetown Center for Children and Families.

Here are some of their insights and story ideas that can help reporters keep this story fresh. Continue reading

Getting behind the confusion that leads some to lose their subsidized health insurance

Photo: frances1972 via Flickr

Photo: frances1972 via Flickr

We posted recently about California’s assessment of who was dropping out of the exchange, including the finding that most people leaving Covered California were getting health insurance elsewhere.

But as Abby Goodnough later reported from Yazoo City, Miss., that’s not always the reason for higher turnover in other areas. Retaining enrollees is a challenge – and affordability is one big reason. That’s true even for people whose premiums are heavily subsidized. Continue reading

Data raises questions: Is health exchange churn an affordability challenge, or the result of a new job?

Photo by Flower Factor via Flickr.

Photo by Flower Factor via Flickr.

The U.S. Department of Health and Human Services reported this fall that the number of people covered – that is, enrolled and paid up – in the ACA exchanges had dipped to 9.9 million as of June 30.

The drop off was similar to what occurred the prior year and was in keeping with expectations. Earlier in the year, 10.2 million were fully covered – and 11.7 had initially signed up but, as expected, not all had paid their premiums. Continue reading

Digging deeper into the Census’ new health insurance stats

Margot Sanger-Katz

Margot Sanger-Katz

Two fellow AHCJ core topic leaders, Susan Heavey and Joseph Burns, have looked at aspects of the recent census report that documents a sharp decline in the uninsured rate. (Susan’s look at poverty and gender is here and Joe’s overview is here).

It’s also worth taking a look at four points made by Margot Sanger-Katz in a recent New York Times Upshot post. Continue reading

Boehner’s departure won’t end attacks on the ACA

Photo: SpeakerBoehner via Flickr

Photo: SpeakerBoehner via Flickr

There’s a lot of speculation about what outgoing House Speaker John Boehner may or may not accomplish in his last weeks in office.

Ending the acrimony about the Affordable Care Act is not one of them.

Not only is the House now rapidly moving ahead with another attempt to gut key sections of the law through a budget tool known as reconciliation (which President Obama would veto), Boehner has another ACA legacy. He was pivotal in filing the House of Representatives lawsuit charging that President Obama and his administration overstepped their authority in implementing the health law. Continue reading

Congress votes to give states more say in defining small group insurance market

In 2016, the definition of “small business” or “small group” market was supposed to change under the Affordable Care Act. Instead of covering businesses with up to 50 workers, the small group market would encompass businesses with up to 100.

But in a rare bipartisan move on ACA-related legislation this week, the House of Representatives, followed by the Senate, swiftly and quietly voted to make this change optional for states as part of what has become known as the Protecting Affordable Coverage for Employees Act (PACE). The House voted on Sept. 29 and the Senate on Oct. 1. Continue reading

Health care reform may be helping close the pay gap for primary care providers

Photo by ibmphoto24 via Flickr.

Photo by ibmphoto24 via Flickr.

We don’t usually post two consecutive items by the same health care reporter on different topics. But when I was trying to double-check a link on the last item based on Bruce Japsen’s work, I stumbled on another interesting post by him. This one is about how health reform is encouraging primary physician pay to rise more quickly than that of specialists.

Japsen reports in Forbes that primary care physician compensation rose nearly 3.6 percent last year to $241,273, according to the Medical Group Management Association (MGMA), an association of physician practice administrators.

Specialists make nearly twice that much – on average $411,852 in 2014 – but their rate of increase was a lower 2.39 percent from 2013.

And the gap was even wider in the prior year. In 2012, he writes, “pay of primary care doctors, which include family physicians, internists and pediatricians (rose) more than 9 percent while specialist total compensation rose just 3.9 percent.”

Bruce Japsen

Bruce Japsen

This isn’t going to close the gap. But it clearly is telling us something about how the shift away from fee-for-service to value-based medicine is taking root. Primary care is often at the center of these new models, which emphasize coordination, prevention, management of chronic conditions, and team-based care. In addition, hospitals are hiring more primary care doctors to capture outpatient revenue – which is also part of the “value-based” picture. And there is a shortage of primary care physicians.

“It’s a buyer’s market,” Dr. Halee Fischer-Wright, a pediatrician and MGMA’s chief executive officer, was quoted as saying.  “Every system needs primary care physicians as they shift to value based care models.”

And that trend is likely to heighten amid the coming consolidation of health insurers who are pushing for more rapid transformation into value-based models.

Hospital companies see fewer unpaid bills under ACA



A recent post by Bruce Japsen at Forbes makes a quick supplement to a post we did recently highlighting how hospitals are faring in Medicaid expansion states vs. nonexpansion states.

Japsen knows a lot about the business side of the hospital industry and has written about the ACA’s impact on hospital finance. Recently he’s been paying attention to second-quarter earnings reports of publicly traded hospital companies. (As he notes, it’s the sixth quarter since ACA coverage expansion began.) Continue reading