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

More on understanding – and unearthing – health care costs

The post we did on Clear Health Costs got a lot of positive reaction so we asked the team involved in a John S. and James L. Knight Foundation-funded project involving two California public radio stations and the cost-tracking group to tell you more about it in their own words.

In the tip sheet, Lisa Aliferis of KQED, Rebecca Plevin from SCPR and Jeanne Pinder of clearhealthcosts.comgive you a glimpse under thehood of health care costs. “Health care costs both lack transparency and are wildly variable, not just from region to region but sometimes from block to block within the same city,” they begin.

They explain a few basics: what you pay, what insurers pay, what providers are paid, and what almost no one (except some of the uninsured) pays – the Chargemaster price.  Even if you can’t build a data collection project, you can write about the variability in your community. “Put a human face on these dollar figures. Talk to people who have felt burned by the cost of a medical procedure, or confused by a huge bill. “ You might be able to find a handful of people who have had the same procedure in the same place – or the same procedure at two facilities just blocks apart in a city, or in adjacent counties in a more rural setting – and find how their experiences differed.

The “How I Did It” article by Lisa Pickoff-White, senior news interactive producer, KQED; Joel Withrow, product manager, KPCC/SCPR; and Pinder is more nitty-gritty. Your organization may not be able to do something on this scale, but it’s still worth a read to see how they approached it, what worked, and what tools they used (not just on the technical side – see the bottom of the post for other project management and collaboration tools). Facing an eight-week deadline they had to coordinate a far-flung team of journalists, data crunchers and developers scattered in Los Angeles, San Francisco, New York, Bialystok, Kiev and Tahiti. (yes, Ukraine and Tahiti.)

How to understand 2015 exchange plan insurance rate changes

Image by 401(K) 2012 via Flickr

Image by 401(K) 2012 via Flickr

It’s rate increase season, and as we head into the second ACA enrollment season, it’s hard to understand why some rates are going up, some down – sometimes in the same place.

Also, some of the rates we’re hearing about are proposals. Depending on how much regulatory oomph state insurance officials have, the rates may change.

This post give you some ideas on what to watch for and how to think about rate increases in individual states, and what questions to ask the health plans and the regulators in your state. Remember that even in states using the federal exchange,, state insurance officials still have a role.

The Alliance for Health Reform (an invaluable resource on this issue) recently held a briefing on rate changes. The full briefing (webcast, transcript, background materials, source list) can be found online here.  A recent Health Affairs blog post by Christopher Koller and Sabrina Corlette provides another important resource.

Here are some key points outlined in these two resources: Continue reading

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