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

Looking at questions that remain behind the enrollment numbers

Photo by Thomas Hawk via

Photo by Thomas Hawk via

We put up a tip sheet the other day on how to interpret sign-up vs enrollment numbers. This piece by Carol Ostrom of The Seattle Times asks a lot of good questions as she looked at enrollment in her state.

Washington does a better job than many states in separating who paid versus who signed up, but there are other essential questions about enrollment. Who gained coverage? Who switched coverage? How many people’s plans were cancelled? Did they end up in the exchange or in another private plan? How do they feel about it a few months into the new system?

And how do we measure the success of the law?  Especially given its cost. Continue reading

Hospitals rethink charity for those passing on Obamacare

columbiahospitalThe basic calculation uninsured people had to make this first open enrollment season in the ACA is whether to  get covered – or take the risks of going without health insurance and pay a penalty (unless they are exempt.)

After all, some of them probably figure, they have managed to get discounted or charity care in the past. Why should that change?

It might.

Some hospitals are pondering changes in their policies about how to treat the uninsured, according to an interesting article by Melanie Evans that appears in Modern Healthcare.

The changes they are thinking about won’t affect emergency care; under the Emergency Medical Treatment & Labor Act (EMTALA) hospitals have to stabilize someone coming in with an emergency. But it does affect what they may charge people for care, and how and when they provide non-urgent care.

Continue reading

Site tracks, predicts state-by-state marketplace enrollments

Here’s a fun – and helpful – site for tracking enrollment and trying to get a sense of where it’s heading.

Charles Gaba – aka the ACASignups guy – runs a great website called, of course, He isn’t doing the doing the elaborate modeling and forecasting of Nate Silver during campaigns – and he isn’t really comfortable with the comparisons. But it’s still the closest thing we have to a state-by-state real-time Affordable Care Act enrollment tracker.

Here’s the graph, which is part of the site but not the whole site. Here’s his nine-state track of how many people who signed up in an exchange plan have paid their premium – about 81 percent, though it’s not a full national picture. Continue reading

Find out if a ‘deductible’ is really a deductible

One of the “simple” aspects of health insurance is – naturally – not always so simple.

There’s been a lot of talk about high deductibles in marketplace plans – higher than what most of us pay if we have insurance through a job. And since it’s often misrepresented or misunderstood by some of the people out there either praising or (more often) condemning the Affordable Care Act because of the deductibles, it’s important to understand them so you know what questions to ask.

The simple standard definition of a deductible – what you have to spend out of pocket before insurance kicks in – is sometimes too simple. In some health plans, yes, the deductible is indeed that clear cut. Insurance doesn’t pay a penny until you pay X dollars out of pocket. But many of us get those complicated EoBs (explanation of benefits) that allocate some of our own out-of-pocket payment toward a copay, some toward the deductible – and still cover the service before that deductible is fully met. There may also be tiers or different deductible requirements depending whether the care is in or out of network, or whether it’s primary versus specialist care.

So, here are a few other things to remember when you write about the new coverage options and what they are or are not costing people. (Caveat: Some of the information comes in this post comes from educational material from the Department of Health and Human Services.)

Explore causes of regional variations in premiums

blurred-us-mapWe’ve had some discussion on AHCJ’s electronic discussion list and I’ve gotten some emails about why insurance rates or premiums vary regionally. Also, people wondered what happens to someone if they enroll in one of the ACA insurance exchanges and later move to another part of the country.

Let’s start with the second question, which is simpler. Yes, if you move, you can get a new health plan on the exchange. You’d get a special enrollment period, which is also what happens if you change jobs (in a way that affects coverage), have a child, get married, etc.

The regional variations are more complicated. It’s not as simple as labor costs in New York being higher than those in Arkansas.

Competition is a big factor. The highest prices aren’t necessar Continue reading

Looking at the people behind the Kentucky insurance numbers

Image by pds209 via flickr.

Image by pds209 via flickr.

Kentucky has gotten a lot of attention for the largely unexpected success of its health insurance exchange.

The Washington Post’s Stephanie McCrummen has looked at another aspect of the Kentucky story: Who is getting covered and what is that going to mean?

Her first feature was published Nov. 23 (when most of us were focused on the final week of the “tech surge” to fix She followed up in February. McCrummen looked at the faces behind the numbers – and asked questions about the numbers.

Her stories took her to Breathitt County in the foothills of Appalachia, one of the poorest and unhealthiest counties in the U.S with high rates of diabetes and heart disease. She focused on Courtney Lively, who is a human link between being covered and not being covered. Lively works at a clinic near a fast food joint, helping people get coverage, some for the first time. Among those walking through her office door were “cashiers from the IGA grocery, clerks from the dollar store, workers from the lock factory, call-center agents, laid-off coal miners, KFC cooks, Chinese green-card holders in town to teach Appalachian students.”

Continue reading

A deeper look at the employer mandate and the work week

The employer mandate was pushed back for 2014 and is being phased in more gradually in 2015-16. What portion of the workforce does this affect?

And what’s going on with that “30-hour” work week? That’s how the Affordable Care Act defines full time, and the GOP has legislation (likely to pass the House in early March – far less likely in the Democratic-led Senate) that would change the definition to the more standard 40-hour week.

As we’ve pointed out before, you hear a lot of talk about how the Affordable Care Act will hurt small business. But if you report those claims, be careful of the definitions. Small businesses with fewer than 50 full time equivalent (FTE) workers are and have always been exempt from the employer mandate. They can, if they wish, get coverage through the new (but still fairly underdeveloped) SHOP exchanges. But whether they choose to and how much they contribute to their workers’ coverage is up to them. Continue reading

Questions remain despite latest ACA enrollment numbers, projections

The latest ACA enrollment report (and the CBO projection that 6 million people would sign up for exchange coverage by March 31) is a classic half-full, half empty scenario.

Half full because the 3.3 million selecting exchange plans is a way better number than what many expected last fall when the sign-up portals were not working. Remember when only about 100,000 had chosen a plan in the state and federal marketplaces in October?

Half empty because 3.3 million may be on track to 6 million – but 6 million is less than the 7 million that the administration earlier had embraced as a goal. And 6 million or 7 million (plus another 8 million in Medicaid and CHIP) still leaves millions of people uninsured. Continue reading

Blame game: Obamacare becomes scapegoat for all that’s wrong with health care

obamaBlame it on Obamacare.

That’s what you hear, over and over again. Anything in the health care system that someone doesn’t like, it’s Obamacare.

Sam Baker of the National Journal took a look at some of the things people are blaming on Obamacare – high deductibles, narrow networks, employers cutting benefits – and reminds us that they were already part of the health care landscape, before the Affordable Care Act. He writes:

Welcome to the Obamacare era. Continue reading

Find out if lack of health literacy keeps people from ACA benefits

Wordle-health-literacyYet another study tells us how little the public knows about the Affordable Care Act, and how even the people most likely to benefit from it are often unaware. The study, from The Robert Wood Johnson Foundation and The Urban Institute, found that fewer than four in 10 uninsured adults thought they would get insurance this year. Most don’t realize they may be eligible for subsidies or expanded Medicaid.

We all know that the Affordable Care Act is complicated, and the intense political fighting about it has added to the confusion and the challenges of getting simple apolitical messages across.

But is it all about politics and messaging? How much of a role does “health literacy” – or more specifically “health insurance literacy” play? Continue reading