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

A look at how states are addressing balance billing abuses

service-invoiceWe’ve all read about patients who were careful to choose an in-network doctor or hospital but still ended up with some care provided out of network – and unanticipated bills.

One of the most memorable accounts was in Elisabeth Rosenthal’s “Paying Till It Hurts” New York Times series, when she recounted the story of the patient who – unbeknownst to him – had an out-of-network assistant surgeon alongside his carefully selected in-network surgeon. The assistant submitted a $117,000 bill. Continue reading

Things to keep in mind about the King v. Burwell SCOTUS ruling

  • The court ruled that the subsidies were integral to the functioning of insurance markets under the ACA, and that Congress constructed the law with that in mind. The Court did not use an alternative legal argument to uphold the subsidies – saying that the law was ambiguous but the executive branch (in this case the IRS) had the right to interpret it so that subsidies are available in both state and federal exchanges. This is not a minor distinction – that latter interpretation (used by one of the lower courts) would have meant that a future administration could come in and change the subsidy policy. The 6-3 court ruling bars a future administration from doing so. (A future Congress could still change the law regarding subsidies but a future administration couldn’t just flip a switch and stop them.) Continue reading

Things to keep in mind as we anticipate the King v. Burwell ruling

Photo by dbking via Flickr

Photo by dbking via Flickr

We’ve put up a tip sheet and written about the King v. Burwell case, but now that the ruling is imminent, we wanted to bring one more good one-stop-shopping resource to your attention and share a few tips.

The Alliance for Health Reform has issued a very good four-page tool kit – links to background articles, think tank papers, issue briefs and lots of sources. One caveat – it says that 7.5 million are subsidized in the affected states but the most recent government numbers are 6.4 million.

Other things to remember

There are 37 states using (with Hawaii, soon 38). But the reason you keep reading that 34 states are affected is that 34 are federal exchanges. Continue reading

Health care delivery reform and what it means in the delivery room

Courtesy of Neel Shah, M.D.

Courtesy of Neel Shah, M.D.Health reformers are grappling with how to bring down the high rate of cesarean section deliveries in the United States. The U.S. isn’t the only country in the world overusing the procedure, but it does have one of the highest rates.

I recently heard Neel Shah, M.D., an obstetrician at Beth Israel Deaconess Medical Center, the founder of Costs of Care, and associate faculty at Ariadne Labs (more about all of that here) speak about health care quality and delivering babies.

We’ve all heard about unnecessary cesarean sections (and elective induced early births, although that’s a related but not identical set of challenges). Many of us tend to think of it as a doctor-centered issue. Some doctors perform more C-sections than others and there are a host of reasons, ranging from how and where they were trained to how they assess and tolerate maternal risk to time management and financial considerations.

But Shah challenged me to think of unnecessary C-sections as a hospital management or system engineering problem – not just a problem created by individual doctors. Continue reading

Another report casts skeptical eye on patient satisfaction surveys

Photo" PINKÉ via Flickr

Photo” PINKÉ via Flickr

After we posted in May on issues concerning hospital patient satisfaction surveys, the Hastings Center, a Garrison, N.Y., research institute focusing on bioethics, published its own skeptical report. The full text requires a purchase, but the abstract raises some of the same questions we addressed and brings up a few more.

“The current institutional focus on patient satisfaction and on surveys designed to assess this could eventually compromise the quality of health care while simultaneously raising its cost,” authors Alexandra Junewicz and Stuart Youngner write in Patient-Satisfaction Surveys on a Scale of 0 to 10: Improving Health Care, or Leading It Astray?

Their main worries: Continue reading

Return to McAllen illustrates changes ACA has brought to health care system

Photo: Peter Dutton via Flickr

Photo: Peter Dutton via Flickr

In June 2009, Atul Gawande wrote an influential New Yorker article, about the community of McAllen, Texas, which has some of the highest per-capita Medicare costs in the nation. At the time, “The Cost Conundrum” had a significant impact on the national debate over the legislation that would become the Affordable Care Act – not so much on the health insurance coverage aspects but about wasteful spending and flawed incentives built into our payment system.

McAllen was awash in waste, fraud and abuse, with millions spent on care of little to no value to the patient. The spending could not be blamed on socio-economic factors because nearby El Paso was a very similar community, but with half the per capita Medicare costs, and same or better outcomes. Gawande wrote this about McAllen: Continue reading

What that recent emergency department survey didn’t tell us

emergency-roomEarlier this month many of us received a news release from the American College of Emergency Physicians about a survey that indicates emergency department visits are rising along with coverage expansion under the Affordable Care Act. This was happening even though one important goal of the health law is to connect people with primary care physicians so they wouldn’t feel compelled to go to the ED for primary care.

While many of us ignored the release or, at most, wrote a brief; some large news outlets did give the survey big play, even linking the increase to expanded Medicaid coverage. The tone of that coverage, at least in a few pieces I saw, was that this was a negative development. Continue reading

The ACA and patient satisfaction: Does it improve care?

Alexandra Robbins

Alexandra Robbins

The ACA made many changes to Medicare. One of them involves linking part of hospital pay to patient satisfaction.

In an Atlantic magazine essay adapted from her new book, “The Nurses: A Year of Secrets, Drama, and Miracles With the Heroes of the Hospital,” Alexandra Robbins argues that hospitals are missing the point: the way hospitals are defining, measuring and achieving patient “satisfaction” is not advancing the quality of care.

Robbins overstates that the amount of Medicare payments tied to patient satisfaction and understates the role of outcomes (more on Medicare’s Hospital Value-Based Purchasing later). But her essay is provocative and worth thinking about for those of you who cover the hospital industry or your local hospitals, and how they are changing under the Affordable Care Act. Continue reading

Conference panel generates ACA resources, story ideas #ahcj15

Anyone who is moderating a session at an AHCJ conference is lucky to have AHCJ board member, Associated Press medical writer, and Twitter extraordinaire Carla K. Johnson (@CarlaKJohnson) in the audience. Here, she’s Storified her Twitter stream from the session “Politics, Policy and People: ACA report card.”

Our speakers were David Blumenthal, M.D., president of The Commonwealth Fund; Mollyann Brodie, Ph.D., senior vice president for executive operations, Kaiser Family Foundation (she oversees its polling); and Lanhee Chen, Ph.D., David and Diane Steffy research fellow, Hoover Institution. On Twitter, they are @DavidBlumenthal, @mollybrodie and @lanheechen. Continue reading

Reporters offer state, local story ideas for covering ACA #ahcj15

The first day of Health Journalism 2015 featured a session “The ACA: Will it survive? And how to cover it now” with Kaiser Health News’s Julie Appleby and Vox’s Sarah Kliff. Their major themes included:

Julie Appleby & Sarah Kliff

Julie Appleby & Sarah Kliff

  • The King v. Burwell Supreme Court case over federal subsidies
  • What’s next in Congress?
  • Exchanges
  • Medicaid
  • And – the topic that got by far the most attention from the crowd – narrow networks.

Here are some of their highlights and story suggestions, with an emphasis on stories that state and local reporters can tackle. (Here are Kliff’s slides.) Continue reading