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

Experts weigh in on covering the SCOTUS challenge

Photo: Seth Borenstein, Associated Press/New York UniversityPhil Galewitz, of Kaiser Health News; Tom Goldstein, an attorney and founder of SCOTUSblog; Christine Eibner, a senior economist at Rand Corp.; and Thomas Miller, a fellow at the American Enterprise Institute (left to right) discussed how to cover Burwell vs. King Supreme Court Case during a chapter event at the NYU Washington, D.C., Center on Feb. 18.

Photo: Seth Borenstein, Associated Press/New York UniversityPhil Galewitz, of Kaiser Health News; Tom Goldstein, an attorney and founder of SCOTUSblog; Christine Eibner, a senior economist at Rand Corp.; and Thomas Miller, a fellow at the American Enterprise Institute (left to right) discussed how to cover King v. Burwell at the NYU Washington, D.C., Center on Feb. 18.

The Washington, D.C., chapter of the Association of Health Care Journalists had a session last week about the upcoming King v. Burwell case that will go before the Supreme Court challenging whether the Affordable Care Act subsidies can flow through the federal exchanges.

More than 30 people attended the event at New York University’s D.C. campus, including some students and faculty, and it was mentioned in Politico Pulse. Seth Borenstein, a science writer for The Associated Press and adjunct professor, helped organize and co-host the session. Kaiser Health News reporter Phil Galewitz, who leads the D.C. chapter, and Margot Sanger-Katz, a health writer with The New York Times, spoke to students after the event about how journalists have covered the Affordable Care Act.

A ruling for King would affect people in 34 states. Three other states – Nevada, New Mexico and Oregon – are using technology but are running enough of their own exchange to be a sort of hybrid. Briefs for both sides filed in the case agree that it will affect 34 states, not 37.

We’re assembling a tip sheet with more resources on the case, but here are some highlights from the event. Continue reading

Even with ACA, ‘insured’ doesn’t necessarily mean ‘accessible’

water-wordle-transparencyElisabeth Rosenthal’s latest piece on the craziness of our health care pricing looks at affordability of health care for people covered by the Affordable Care Act.

For people purchasing insurance, premiums are only part of the cost, although they are what many consumers focus on when they choose a plan. There are also deductibles, co-pays, and different rules for in-network and out-of-network care. For people covered by ACA exchange plans, costs can mount, big time, and it can be very confusing for patients to figure out what they are being or will be charged. Continue reading

What a reporter learned following primary care residents

We’ve posted a new tip sheet and a new “How I did it” piece that may yield some story ideas for reporters.

In her “How I did it” essay, Karen Brown describes how she tracked a group of primary care residents for a year of their training – a year in which two of the three she chose to focus on ultimately decided not to go into primary care after all.

“Their decisions may have been disappointing for the field, but they did make for a more compelling story. I was able to use their personal dilemmas, unfolding in real time, to illustrate the crisis in primary care,” she writes. Brown had an AHCJ fellowship to do her project, but she gives advice on how to embark on a similar project  – without a fellowship – in your community.

In the tip sheet, Lola Butcher explains the 340B drug program, which requires pharmaceutical companies to sell discounted drugs to eligible health care organizations that serve a lot of poor people. The drugs are for outpatient use.

But the program has continued to grow, prompting questions about its cost and purpose. “Like all good controversies,” Butcher writes, “this one has enthusiastic advocates and wild-eyed opponents, and it’s easy to get snagged by the passion of the partisans.”

Both feature projects were funded with AHCJ Reporting Fellowships in Health Care Performance.

A sampling of perspectives on Brill’s take on health reform

I’m sure a lot of you have Steven Brill’s “America’s Bitter Pill” on your bedside table by now – I’m not going to try to recap it here.

But I did want to share a few links to some of the more thoughtful (or provocative) articles and reviews, representing critics on both the left and right. I also wanted to draw your attention to another recent book providing a conservative perspective on health reform. Continue reading

Reporting on how, why hospital superusers account for bulk of health-care spending

Tim Darragh

Tim Darragh

Tim Darragh has written a “How I did It“ essay on his yearlong project looking at a community-wide effort to reduce hospitalization and ER use among a group of “superusers,” people who have complex medical conditions and use a whole lot of very expensive health care. Many have multiple medical problems, often including mental illness or other behavioral issues. We also wrote about his work a few weeks ago.

Darragh looked at a specific program financed under the Affordable Care Act in the Allentown, Pa., area. (He was at The Morning Call at the time. He recently moved to New Jersey Advance Media, which publishes The Star-Ledger and But hospitals and health care systems across the country are looking at ways to reduce avoidable hospitalizations and rehospitalizations; the incentives are part of the ACA, and insurers are also demanding this to reduce costs. Addressing these patients’ needs before they become a crisis that lands them in the ER isn’t just a money-saver. It’s also better health. Continue reading

Reviewing patterns in marketplace insurance pools

Photo by Thomas Hawk via

Photo by Thomas Hawk via

Back when states were deciding whether to run their own exchanges or let the feds do it, they also had to make a lot of decisions about how their exchanges would operate.

One question was whether to have a “clearinghouse” and let any health plan that met the legal requirements participate in the marketplace. The other option was to be an “active purchaser,” and to have the state exchange directly negotiate with the health plans over premiums, provider networks etc.

The rationale, for each model: Continue reading

Taking a different look at readmission metrics, penalties

One of the high-profile programs within the Affordable Care Act is the drive to reduce preventable hospital readmissions among the Medicare population. The program focuses on fee-for-service patients who came back to the hospital within 30 days. Hospitals in the third year of the program face a fine of up to 3 percent of their Medicare payments. Kaiser Health News analyzed the most recent CMS hospital data, and found more than 2,600 hospitals faced penalties in the last round and could lose $400 million.

Reducing unnecessary hospitalizations is a good idea, pretty much a slam-dunk quality move.

But is the readmissions program using the right metrics? Are hospitals that are doing all the right things cutting both readmissions and admissions – and therefore facing penalties because the proportion isn’t dropping, the readmission rate is the same share of the total admissions? Some new research suggests that may be the case. As Joanne Lynn, M.D., a geriatrician and prominent health policy researcher put it (and I’m paraphrasing), it’s the denominator, stupid. Continue reading

State waivers and the next Supreme Court ACA challenge

A recent Health Affairs blog post by Heather Howard (a familiar name to AHCJ members who have attended the panels or webcasts she’s done for us) and her colleague Galen Benshoof at the State Health Reform Assistance Network (housed at Princeton) outlined an aspect of the coming King case on exchange subsidies. The information was new to me, and may be unfamiliar to other reporters too. I’ve summarized the key points below and included story ideas at the bottom. You can read the original (more detailed) post here.

justice scales

Image by HoustondwiPhotos mp via flickr.

The Affordable Care Act (ACA) encourages state innovation in many ways, but one of the most significant is the “Wyden waivers” or the State Innovation Waivers program in section 1332 of the law. They become available in 2017, although planning can start earlier.

Some states are thinking about taking these waivers,  which include “exchanges, benefit packages, and the individual and employer mandates.” States can get all the federal money that would have gone into those provisions – hundreds of millions or even billions of dollars – but they have to provide comparable coverage and it must be affordable. HHS and Treasury have released some guidance but not a whole lot of detailed rules and instructions.

Continue reading

New tools, resources for covering health reform

We post new resources on the Health Reform section of the website every month, and encourage you to visit and explore. But we wanted to draw your attention to some that are particularly timely.

Image by  Sean via flickr.

Image by Sean via flickr.

  1. The Kaiser Family Foundation has a new tool, Mapping Marketplace Enrollment. You plug in a ZIP code and then you can see how many people are eligible for a federal exchange plan, and what proportion signed up in 2014 “within a 100,000-resident statistical-geographical area associated with the ZIP code.” It also provides demographic information, and can be used to make comparisons, including statewide.
  2. Louise Norris, a licensed broker who writes and blogs about insurance and the Affordable Care Act has done a 38-page e-book guide to Open Enrollment (Note: I’ve skimmed half of it, not read every word, but I have seen some of Norris’s work in the past.)
  3. We recently posted about closures of rural hospitals, and a reader pointed us to this recent issue brief from the Centers for Disease Control and Prevention. It looks at rural residents who are hospitalized – who goes to rural hospitals and who “bypasses” them to go to urban ones.
  4. ProPublica just launched a web app that allows consumers – and journalists – to  look up their current plan to see how premiums, deductibles and out-of-pocket costs will change next year, or compare all 2015 plans offered in an area.

Covering an ACA grant for ‘superusers’ in Pennsylvania

Photo: Chris Wong via Flickr

Photo: Chris Wong via Flickr

Most of us have heard about “super-users” – patients who are constantly in and out of the hospital, running up large bills. Most have multiple chronic diseases, are poor, and often have mental illness or substance abuse problems. Most live alone, and some are homeless.

Four communities – Lehigh Valley, Pa.; Kansas City, Mo.; San Diego and Aurora, Colo. – have received grants under the Affordable Care Act to tackle the super-user problem. (Other non-ACA-funded initiatives are also underway). Investigative reporter Tim Darragh, formerly of The Morning Call in Allentown, Pa., spent a year tracking the grant in the Lehigh Valley. The super-user innovation grants, which were issued in 2012, provide $14.3 million and (at least for Lehigh) expire in mid-2015.

Darragh, now a reporter at The Star-Ledger in New Jersey, looked at a broad range of issues in the project. He also was able to weave narrative into the policy reporting. The Morning Call recently published five pieces:

Continue reading