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

Why do rural hospitals close and what does it mean to communities?

 Image by Bob Harwigvia Flickr.

Image by Bob Harwig via Flickr.

Jayne O’Donnell and Laura Ungar had an interesting story recently in USA Today about rural hospital closures.

The pace of closures has picked up in the past few years; the hospitals blame readmission penalties under the ACA, inadequate federal reimbursement policies, and the mandate to switch to costly electronic health records.

It’s also clear that the problem is more widespread in the states that have not expanded Medicaid, such as Georgia and Alabama.

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What the Republican win might mean for the Affordable Care Act

Image by  ofacalifornia via flickr.

Image by ofacalifornia via flickr.

Come January, the Republicans will have big majorities in the House and the Senate – majorities they have not had since President Obama took office or since the Affordable Care Act was passed along party lines in 2010.

Now what?  Even the Republicans are figuring that out  – but here’s some of what we know.

The Senate and the House will both have ACA repeal votes. Such a vote will win overwhelmingly in the House and, in the Senate, the Republican majority is also expected to vote against the ACA (or for a procedural motion related to a straight out repeal vote) but it will still fall short of the 60 needed to clear a filibuster.

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A one-year assessment of the ACA

The New York Times recently pulled their reportorial and graphics know-how together to do a one-year assessment of the ACA.  It concludes: “After a year fully in place, the Affordable Care Act has largely succeeded in delivering on President Obama’s main promises, an analysis by a team of reporters and data researchers shows. But it has also fallen short in some ways and given rise to a powerful conservative backlash.”

Image by

Image by

The package consists of seven sections that run the gamut, with some key numbers and charts.  Overall it’s a positive but not uncritical look. The cost section is particularly nuanced, noting the challenges of narrow networks and high deductibles.

Most of these topics we’ve considered on this blog over the last few years. But the series provides a nice, compact overview and handy reference going into the second year.

Here are the seven sections covered, and the nutshell conclusion the Times provided for each.

Looking ahead to the second ACA enrollment period

Photo by jfcherry via Flickr

Photo by jfcherry via Flickr

We’re closing in on the start of the ACA’s second open enrollment season. Both Kevin Counihan, the new “CEO” within the Department of Health and Human Services, and HHS Secretary Sylvia Burwell have been speaking out a bit more about the upcoming season.

But there’s a lot they aren’t saying – or touting. Here are a few things we do – or don’t – know about what to expect by Nov. 15, the start of the three-month enrollment period: Continue reading

Tips on covering hospital mergers and acquisitions

Photo" PINKÉ via Flickr

Photo: PINKÉ via Flickr

Hospitals across the country are merging – both with other hospitals and with other health care entities such as clinics and rehab facilities. (Those are sometimes called, respectively, horizontal and vertical integration.)

The question is whether the consolidation is creating more efficiency in the health care system, as hospitals generally argue, or whether it’s creating big monopolistic health care entities that will have more clout in negotiating with insurers and thus will lead to higher, not lower, prices.

Antitrust/ mergers and acquisitions is a topic health reporters often shy away from. But it’s important and we need to pay more attention. To help you, we just posted a tip sheet, “Getting the facts on hospital mergers and acquisitions,” based on an email-interview with Barak Richman of Duke Law School, one of the foremost experts on health care antitrust law. In addition, here are a few additional resources on the topic and some recent coverage about the issue nationally and locally.

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About 115,000 could lose insurance coverage based on residency issues

Image via

Image via

We wrote earlier this month about the Sept. 5 deadline for people who had signed up for ACA coverage through the federal exchange but still had some inconsistencies in the record about their citizenship or legal residency. Here’s an update:

As of early September, the Department of Health and Human Services said 310,000 people still had status questions (down from close to a million “data-matching” cases in late May). Most did get the information in and the questions resolved. But about a third did not, and that means about 115,000 people will lose coverage at the end of this month. Continue reading

No shift to part-time work seen (yet) under ACA

Photo by Marta P via Flickr

Photo by Marta P via Flickr

Remember all those stories about people being shifted into part-time work so their employers don’t have to provide health insurance?

According to a new Urban Institute report, funded by the Robert Wood Johnson Foundation, it hasn’t happened.

If, and when, the employer mandate fully kicks in (more on that below) things could change. But the anecdotes we’ve heard about employers cutting hours because of the Affordable Care Act are just that – scattered anecdotes. (And when it does occur, it might be a result of other business conditions, not the health law). Under the ACA the definition of “full-time” work is 30 hours; anyone working 30 hours a week or more would have to be covered. The fear was that employers would cut them to, say, 28 or 29 hours, to avoid that obligation. Continue reading

Worries abound about second ACA enrollment season

healthcaregovThe second ACA enrollment season begins Nov. 15 – after the Congressional elections. While it’s hard to imagine problems worse than last year’s rollout, there’s still plenty that can go wrong.

Kevin Counihan was just named the new CEO of – a position that incorporates the old Center for Consumer Information and Insurance Oversight (CCIIO) director job at the Centers for Medicare and Medicaid Services (CMS) and also consolidates some of the responsibility for the exchange that had been scattered throughout the Department of Health and Human Services. An old hand at health care, Counihan played a role in the Massachusetts state reform before running Connecticut’s state exchange last year. (Here’s a Connecticut Mirror piece by Arielle Levin Becker about him).

After his CMS appointment, Counihan spoke to the New York Times’s Reed Abelson and gave a preview of headaches to come. It’s hard to know how many of these problems will still feel big and threatening in November, and to what extent he’s playing a “lowering expectations” game. HHS is under new management with Secretary Sylvia Burwell and the new team would clearly benefit from some headlines that say, “Hey, it didn’t melt down.”

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Thousands face Friday deadline to document citizenship, immigration status for federal marketplace

Image via

Image via

Friday is the deadline for some 350,000 people who have yet to document their citizenship/legal residency for their health insurance through the federal exchange to get the information submitted and verified or face losing insurance at the end of this month.

It would be a good time to check with health, enrollment and immigrant advocacy groups in your community to see what kind of obstacles they are facing (technical, language barriers, poor communication, confusion) and what steps they are taking to meet the deadline. The Centers for Medicare & Medicaid Services says it has been trying to reach the affected people by email, mail and telephone. Immigration advocacy groups say that the outreach has left a lot to be desired and people are having trouble getting problems sorted out. Continue reading

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.)