Category Archives: Government

Revisit how high-risk insurance pools are working in your state

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.

It’s a good time to take a look at the high-risk pools.

There are two basic kinds of high-risk pools – about 35 states have some form of high-risk pools that predate the Affordable Care Act, and all states have Pre-Existing Condition Insurance Pools created by the federal law.

Let’s look at the “PCIPs” first. (Here’s a federal website that explains them.)

Some states administer these “PCIPs” themselves, and some let the federal government run them. “Red” states tended to hand it to the feds, “blue” states tended to run it themselves but there were enough exceptions in both directions to make this less political than the fight over the state-run health insurance exchanges going online in 2014.  Here’s a map.

These pools were supposed to be temporary — a bridge to get some uninsured people to 2014. They never were going to cover everyone and they never were going to be cheap for these individuals, despite the $5 billion in federal subsidies. Enrollment in states was slow and uneven, but after tweaks by the Department of Health and Human Services to the premium structure and more outreach, it picked up a bit. The pools were meant to provide a degree of help to people with serious and expensive medical conditions who hadn’t been able to get insurance for at least six months.  It was not meant to be a permanent or comprehensive solution. According to HHS, about 100,000 people are covered.

But some of those people were very expensive to cover. By early this year, federal officials suspended enrollment. (In February for the federally administered ones, in early March for the states.) They wanted to make sure that the $5 billion didn’t run out. People who are in the pools will continue to be covered but new people can’t come in. In January, the PCIP pools will close and the people in them can be covered in the regular state exchanges like everyone else. Continue reading

After 5-year FOIA fight, documents show ties between researchers, officials in Lyme wars

Pia Christensen

About Pia Christensen

Pia Christensen (@AHCJ_Pia) is the managing editor/online services for AHCJ. She manages the content and development of healthjournalism.org, coordinates social media efforts of AHCJ and assists with the editing and production of association guides, programs and newsletters.

Documents obtained after a long FOIA battle reveal “behind-the-scenes maneuvers and long-standing connections between the scientists’ group and government officials” in the debate over whether Lyme disease can be chronic.

The debate, and the fight for the documents, are detailed by Mary Beth Pfeiffer in the Poughkeepsie (N.Y.) Journal and by documentary film maker Kris Newby on IRE’s Transparency Watch blog.

In 2007, in doing research for a film, Newby requested emails and resumes pertaining to three employees at the Center for Disease Control and Prevention. She writes that “For five years the agency strung me along with frivolous denials, mysterious delays, shifting explanations and false promises. In essence, the delays became an illegal, off-the-books FOIA denial.” Her account of how the CDC handled – or didn’t handle  her request is alarming.

Newby, whose film had been completed, provided the 3,000 pages of documents to Pfeiffer.

The documents show close connections between the government officials who set disease policy and researchers who have received government funds and written treatment guidelines. “As a result, physicians and scientists with opposing views on Lyme disease believe they have been marginalized in the debate.” This graphic provides a good overview of the connections and issues.

Medicare data shows dangerous prescribing habits, lack of oversight

Pia Christensen

About Pia Christensen

Pia Christensen (@AHCJ_Pia) is the managing editor/online services for AHCJ. She manages the content and development of healthjournalism.org, coordinates social media efforts of AHCJ and assists with the editing and production of association guides, programs and newsletters.

ProPublica’s Tracy Weber, Charles Ornstein and Jennifer LaFleur, in an analysis of Medicare prescription records, found that “some doctors and other health professionals across the country prescribe large quantities of drugs that are potentially harmful, disorienting or addictive,” with no attempt by the federal government to monitor or deter the practices.

“… officials at the Centers for Medicare and Medicaid Services say the job of monitoring prescribing falls to the private health plans that administer the program, not the government.”

Continue reading

Reclassification impacts access to health care for millions of rural older adults

Liz Seegert

About Liz Seegert

Liz Seegert (@lseegert), AHCJ’s topic leader on aging, is writing blog posts, editing tip sheets and articles and gathering resources to help our members cover the many issues around our aging society. If you have questions or suggestions for future resources on the topic, please send them to liz@healthjournalism.org.

Telemedicine equipment

Photo by Kevin Souza via Flickr

Back in January, the FCC announced $400 million in funding for creating and expanding rural broadband networks to support telemedicine in medically underserved regions.

Their HealthCare Connect program links urban medical centers and rural clinics, providing real-time consults with immediate access to a patient’s electronic medical records. Since adults 65 and older comprise roughly 14.4 percent of rural residents, this would appear to be an ideal use of technology to contain costs, facilitate care and improve preventive services.

However, last month, the U.S. Office of Management and Budget reclassified Metropolitan Statistical area delineations and moving 97 counties from rural to metropolitan designation. That eliminates Medicare reimbursement for telemedicine services in those areas. Yet just the day before, these same seniors were eligible, avoiding long-distance travel for consults or even basic health check ups. Continue reading

New tip sheet breaks down how ACA applies to immigrants

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.

We’ve posted a tip sheet from the National Immigration Law Center on how the Affordable Care Act affects immigrants. They let us put their guide on the  site with one request – that we include their website and suggest that you check their site if you write on this topic in case there are updates.

There’s no sense in repeating what you can find on the tip sheet (undocumented immigrants don’t get covered, documented ones do under  the circumstances described – generally, they can go in the exchanges with subsidies if they qualify but still face a wait to get into Medicaid). But it is worth addressing the nexis between the health law and the current debate over helping immigrants become documented.

The bill will go through changes before it passes – IF it passes (a big question mark, particularly in the House). But the key message from our perspective as health reporters: Given what’s been said so far by Democrats and Republicans alike, it is highly unlikely that undocumented immigrants will get health benefits WHILE they are going through what looks to be a multi-year process of becoming documented. However, once they are documented they will be treated like the rest of the documented immigrant population.

Keep caveats in mind when writing about climbing premiums, health reform

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.

Climbing premiums

Photo by sbluerock via Flickr

Insurers are beginning to file their rate requests and, naturally, they are beginning to generate headlines as well as more political fodder. 

My impression is that the rate hikes (particularly for younger people) are getting way bigger attention than the rate decreases (particularly for older people). That’s partly because runaway costs are a better headline – and fit into a political narrative we’re all hearing.

It’s also because the price increases for younger, healthier people is a serious policy concern. If younger people don’t sign up for the exchanges, and only older sicker people do, the costs will keep rising and fewer people will get covered. That is precisely the opposite of what the Affordable Care Act is supposed to achieve.

But there are several caveats – and I explained several of them in an earlier post. The biggest ones to remember: these are “sticker” prices. Many, if not most, people in the exchange – millions of Americans – will be eligible for subsidies in the form of tax credits. These will be available on a sliding scale to individuals and families up to 400 percent of the federal poverty level. Continue reading

Drugs remain on market despite fraudulent research; FDA withholds information

Pia Christensen

About Pia Christensen

Pia Christensen (@AHCJ_Pia) is the managing editor/online services for AHCJ. She manages the content and development of healthjournalism.org, coordinates social media efforts of AHCJ and assists with the editing and production of association guides, programs and newsletters.

Despite concluding that a drug research lab’s violations “were so ‘egregious,’ and pervasive that studies conducted there between April 2005 and August 2009 might be worthless,” the FDA didn’t pull the drugs tested there from the market, according to a ProPublica piece by Rob Garver and Charles Seife.

pills

Photo by Grumpy-Puddin via Flickr

The FDA is refusing to release information about those drugs, saying that “We believe that this did not rise to the level where the public should be notified.”

A statement from the agency said, “The issue is not a lack of transparency but rather the difficulty of explaining why the problems we identified at Cetero, which on their face would appear to be highly significant in terms of patient risk, fortunately were not.” Continue reading

Journalists call on USDA to release food stamp information

Felice J. Freyer & Irene Wielawski

About Felice J. Freyer & Irene Wielawski

Felice J. Freyer and Irene Wielawski are co-chairs of AHCJ's Right to Know Committee and members of AHCJ's board of directors.

The Association of Health Care Journalists, along with six other journalism and open-government groups, has called on the U.S. Department of Agriculture to release to the public vital information about the multibillion-dollar food stamps program.

Currently, the USDA refuses to reveal how much money individual retailers make from the Supplemental Nutrition Assistance Program, better known as food stamps. Additionally, the USDA does not disclose which products are purchased with SNAP dollars or how much is spent on each product, in aggregate.

This information could show which businesses benefit from the program and also inform public policy debates about obesity and its causes, the organization argues.

The USDA’s position runs contrary to President Obama’s promise of government transparency, and stands in sharp contrast with practices at other federal agencies. For example, the Temporary Assistance for Needy Families discloses where recipients used their EBT cards to withdraw cash assistance. A wealth of information is available about Medicare and Medicaid. Continue reading

Experts say new tools, tougher government oversight can reduce foodborne illnesses #ahcj13

Lacey McLaughlin

About Lacey McLaughlin

Lacey McLaughlin is a features writer at The Daytona (Fla.) Beach News-Journal. She is attending Health Journalism 2013 on an AHCJ-Healthier Beat Fellowship, which is supported by the Leona M. & Harry B. Helmsley Charitable Trust.

Placing food safety above profits, and using new regulatory power and testing techniques could help protect consumers from foodborne illnesses, three experts in food safety said today.

The experts – an executive at America’s largest organic food producer, a food safety attorney and a federal food and safety regulator – discussed the challenges of protecting consumers from illnesses such as E. coli, salmonella and listeria on a panel called, “Why is food still making us sick in the 21st century?” during Health Journalism 2013 in Boston.

Bill D. Marler, managing partner at the law firm Marler Clark, began litigating personal injury cases related to foodborne illness cases in 1993 after E.coli-contaminated meat from the fast-food chain Jack in the Box resulted in the deaths of four children and illness in hundreds of consumers. Marler said that when companies take shortcuts, or focus on profits more than food safety, it can compromise consumer safety.

“Food production is a risky business with a competitive market,” said Marler, who started the website foodsafetynews.com. “Good safety practice isn’t always on everyone’s minds because of stockholder pressures.”

But even companies that follow strict food testing procedures can’t always stop outbreaks. Earthbound Farm Senior Vice President Will Daniels said despite following strict safety guidelines, his company had to recall spinach contaminated with E. coli in 2006 after three people died and 300 became sick.

“This changed my life,” Daniels said. “There was no smoking gun, no break in our system and no deliberate contamination. The source of contamination was never proven.”

Earthbound Farm is now a leader in the food industry when it comes to safety standards. By using the newest technology, Earthbound Farms is able to test food products twice before delivering them to consumers, he said. New technology has made it possible for the products to be tested in a 12-hour time frame, whereas older methods took three to five days.

“Before, I couldn’t wait five days to test results on the raw side of the product and then again at the end of the process,” he said. “That was almost half the life of the product.”

The Food Safety Modernization Act of 2010 shifts the role of regulators from responding to outbreaks to preventing them. For the first time, the law gives the U.S. Food and Drug Administration the authority to order recalls of contaminated food. But, with 80 percent of seafood and 20 percent of vegetables imported from overseas, FDA Deputy Commissioner Michael Taylor said there are even more obstacles for ensuring safety regulations are followed.

The law “creates a mandate for companies to meet comprehensive safety standards,” Taylor said. “It also strengthens government authority to make sure those standards are being met. But to build a national integrated food-safety system, we need aggressive partnerships between state and local governments.”

Insurance co-ops faded from view but still ripe for analysis

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.

Former AHCJ president Trudy Lieberman, in a CJR “Second Opinion” post, recently pointed out a story that was largely untold– and put it in a helpful national and political context for those of you who may still tell it. That’s the “incredible shrinking insurance co-ops.”

The co-ops’ funding was slashed in the New Year’s fiscal cliff deal. With all the other economic and political aspects of the “cliff,” the co-op story was not widely reported, including in some of the states where they may have made a difference.

Why does it matter? Remember the long battle in 2009-10 over the “public option?” The Consumer Operated and Oriented Plans were the alternative – arguably a sort of consolation prize – to the public option. The co-ops were a way to have a nonprofit health plan alternative to the largely private commercial plans expected to dominate the exchanges.

Lieberman quotes John Morrison, Montana’s former insurance commissioner, now president of the National Alliance of State Health Cooperatives, as saying the co-ops were scrapped not so much to save a few billion dollars for the fiscal cliff deal but as “a gift to the insurance companies” that didn’t want to compete with them. They were expected to have been particularly useful in giving small businesses more choice in rural areas dominated by one or two health insurance carriers. Continue reading