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 healthjournalism.org. She welcomes questions and suggestions on health reform resources and tip sheets at joanne@healthjournalism.org.

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

VA secretary addresses some of department’s challenges #ahcj15

Photo: Pia ChristensenRobert McDonald

Photo: Pia ChristensenRobert McDonald

More than 140 journalists at Health Journalism 2015 gathered early Friday to hear Veterans Affairs Secretary Robert McDonald – and to question him about VA policies, including the agency’s notorious opaqueness with reporters.

McDonald readily acknowledged that the VA has had what he called a “Kremlin-esque” mentality, and told the roomful of journalists that he was trying to change it. The VA is publishing patient access data (waiting times for appointments) on the website every two weeks, and he said he’s trying to promote a culture of openness. Continue reading

Maintaining Medicaid ‘bump’ a state-by-state endeavor

Medicaid pay rates for doctors in many states traditionally have been extremely low – so low that most physicians didn’t want to participate in the program, or take on more Medicaid patients than they already had.

Joe Moser

According to the Kaiser Family Foundation, Medicaid had paid only 59 percent of what Medicare did for primary care before that.

The Affordable Care Act raised the rates for primary care providers to be equal to Medicare pay. Medicaid had paid only 59 percent of what Medicare did for primary care before that, according to the Kaiser Family Foundation. The snag: the Medicaid “bump” lasted for only two years, until the end of 2014. And Congress has not renewed it, although there has been a bit of preliminary talk about it. Continue reading

HuffPost dives into public records on King v. Burwell

Photo by dbking via Flickr

Photo by dbking via Flickr

A key issue in King v. Burwell, the health care reform case argued before the Supreme Court in early March, is whether Congress intended to make certain subsidies available to eligible people across the country or only to those living in states that created their own health insurance exchange.

Sam Stein and colleagues at the Huffington Post filed public record requests with several key states, including some  in which prominent GOP governors did not establish exchanges. The reporters also reviewed records from the U.S. Department of Health and Human Services and more than 50,000 previously released emails from the Oklahoma governor’s office. The requests covered a period between the March 2010 passage of the Patient Protection and Affordable Care Act and August 2011, when the IRS ruled that the subsidies should be available in all states.

How much discussion did Stein find about the risk of losing subsidies? Continue reading

ACA changes on the way, CMS official says

We tend to focus on the Affordable Care Act as a law that simply gives more people health insurance – and it has.

But as we’ve noted before, the health reform law also contains all sorts of programs and provisions that aim to change how health care is delivered: how we pay, what we pay for, and how we shift from a hospital-centric acute care system to one that stresses prevention, wellness and care and management of chronic diseases. Examples can be found across the country.

At a recent AHCJ webinar, Patrick Conway, M.D., deputy administrator of the Center for Medicare and Medicaid Services, gave an overview of some of the changes underway. Conway, whose job includes oversight of the Center for Medicare and Medicaid Innovation, also announced the next big thing in Accountable Care Organizations. More on that below. Continue reading

Breaking down restaurant fees the way hospitals do

Image: WHYY’s The Pulse & Don Greenfield

Image: WHYY’s The Pulse & Don Greenfield

It’s not often that we can tell you something about health care prices and also make you laugh … but we spotted a link to this on Twitter the other day and it’s priceless (no pun intended).

You all know by now that hospital bills make little sense, and that fee for service has its … shall we say … absurdities. Continue reading

Finding the full story behind hospital mergers, consolidations

Dan Goldberg

Dan Goldberg

Across the country, health systems are getting larger, gobbling up community hospitals or smaller chains. Some of this has to do with payment incentives in Obamacare, but just as much has to do with changes to Medicare, Medicaid and providers’ desire for leverage as they negotiate payments with insurance companies.

In the February issue of Capital Magazine, reporter Dan Goldberg looked at  New York’s five large health systems and the strategies they were employing to diversify their revenue base while preparing to play in a post-ACA, value-based world.

No chief executive, whether for-profit or not, wants to lose money. So every deal they make generally has financial reasoning behind it, and every deal they don’t make usually carried some financial risk that seemed too great to bear. In this new tip sheet Goldberg shares some questions to keep in mind for reporters looking at the new business landscape.

SCOTUS: Some things to note as we wait for a decision

By Steve Petteway, Collection of the Supreme Court of the United States (Roberts Court (2010-) - The Oyez Project) [Public domain], via Wikimedia Commons

By Steve Petteway, Collection of the Supreme Court of the United States (Roberts Court (2010-) – The Oyez Project) [Public domain], via Wikimedia Commons

On March 4 the Supreme Court heard oral arguments in King v. Burwell. A ruling is expected in late June – though it’s possible it could come earlier. The plaintiffs argue that the health insurance subsidies should only be available to people living in states running their own Affordable Care Act health insurance exchanges or marketplaces, not the 34 states using the federal exchange via HealthCare.gov. They cite four words in the text of the law “established by the state” to make this argument. The Administration says it’s clear from reading the full text of the 906 page law that subsidies were to be available in all 50 states, no matter what kind of exchange they have.

So the Supreme Court has heard the King v. Burwell challenge to the Affordable Care Act.

Now what?

Good question.

Much of the coverage suggested that the March 4 oral arguments seemed to favor the administration, particularly because Justice Anthony Kennedy, often the deciding swing vote on the court, asked some questions showing skepticism of the plaintiff’s case.

But all that tells is precisely that – he asked some questions showing skepticism. He won’t necessarily vote that way. He backed scrapping the entire statute back in 2012 and made clear at that time that he detested the law.

Oral arguments are interesting and important – but rarely decisive. If you think you know how the court will rule – well you have a 50-50 chance of being right.

A few things did come out that health journalists should note. Continue reading

When hospitals buy physician practices, patients hit with fees

Photo" PINKÉ via Flickr

Photo: PINKÉ via Flickr

WSB-Atlanta recently explored what happens when hospitals buy physician practices, which has been happening all over the Atlanta area.

Prices for patients go up.

The same physicians – in the same offices, with the same treatments – start charging more.

“Everything is exactly the same,” said cancer patient Mike Rosenberg.

Except the bill.

Sometimes it’s an “outpatient facility fee.” And sometimes it’s a “treatment room fee.”

And it’s a lot of money – sometimes thousands of dollars, not covered by insurance.

And even patients who are savvy enough to know about these fees before they get the bill have a lot of trouble finding out about them, as Erica Byfield made clear in her strong 3-minute report.


A map shows facilities owned by, operated by, or affiliated with hospitals. (Yellow: Emory, Red: WellStar, Purple: Piedmont, Blue: Gwinnett Medical, Green: Northside)

It’s not unique to Atlanta. She quotes a University of California, Berkeley, study that found that patients generally pay 10 percent more at hospital-owned practices.

Byfield doesn’t explore whether the push for hospitals to purchase practices is related to the Affordable Care Act – she just says in passing that it’s unclear how big a role the law plays.

Actually the ACA does include incentives for “vertical integration,” or having doctors and physicians part of one organization. But it’s not supposed to raise costs. It’s supposed to bring them down by improving efficiency, creating economies and encouraging care coordination. (Some of the fee problems actually stem from Medicare billing practices, not specifically the ACA.)

Last year Daniel Chang of The Miami Herald looked into integration of hospitals and physician practices – and found patients in Florida were getting hit by big fees. He wrote a “How I did” it piece for us.

If you want to look at this in your community, it’s a good story.

Advocacy groups can help you find patients. And you can just try calling yourselves and seeing if the hospitals and physician practices will talk about their policies. Only two of the big Atlanta-area hospitals were forthcoming with the Atlanta station – and they reported that, and put the policies that were shared up on the web.

Note: I periodically request that people bring good local television coverage of health care to my attention, so we’re not so print (and a dash of public radio) focused. Now I can’t remember who highlighted this one – it may have been on @charlesornstein’s Twitter feed. But please do send good work my way (joanne@healthjournalism.org), we’d like to include it.

Under­standing, explaining primary issues of King v. Burwell

Photo by dbking via Flickr

Photo by dbking via Flickr

With oral arguments in King v. Burwell scheduled for tomorrow, the Supreme Court will likely rule in late June.

The case challenges whether subsidies, in the form of tax credits, can go to people in states using the federal exchange, or only to those in the states running their own health insurance marketplaces.

After the state cases and 2012 National Federation of Independent Business case, it is the third case that poses an existential threat to the Affordable Care Act. (Hobby Lobby and other contraception-related cases wouldn’t unspool the structure of the whole ACA, only that aspect of women’s preventive health care.)

This case isn’t about whether the Affordable Care Act is constitutional. (The 2012 case was.) This is about interpreting the text, and whether the language of the law allows the subsidies in the federal exchange states.

Learn more about the landmark Supreme Court case in this new tip sheet.