Category Archives: Health care reform

Looking at questions that remain behind the enrollment numbers

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.

Photo by Thomas Hawk via Flickr.com.

Photo by Thomas Hawk via Flickr.com.

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

Drilling down into numbers uncovers Marketplace glitch

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.

Don Sapatkin

Ten days before the (expected) close of open enrollment, The Philadelphia Inquirer reported that the federal exchange’s window-shopping tool – the one that the administration encourages everyone to check before applying for Marketplace insurance – was using the wrong year’s poverty-level guidelines. Neither the Obama administration nor any health-care consultants or policy experts that reporter Don Sapatkin could find had noticed it and the site was corrected within hours after the story was posted.

In theory, almost anyone going on the site got slightly incorrect information for 35 days. Most seriously affected, however, were people just above the poverty line in states that have not expanded Medicaid. When they put their information into the tool, it responded: “Not eligible for help paying for coverage.” Many of them may have given up right there and not submitted the actual applications (which were using the correct poverty stats and were assessed correctly). It’s impossible to tell from the notification letter whether errors were made.

Read about how Sapatkin uncovered the error and what the response was from the Centers for Medicare and Medicaid Services.

Rural health providers alarmed by regulatory changes #ahcj14

Joe Rojas-Burke

About Joe Rojas-Burke

Joe Rojas-Burke is AHCJ’s core topic leader on the social determinants of health. To help journalists broaden the frame of health coverage to include factors such as education, income, neighborhood and social network, Rojas-Burke will hunt for resources, highlight excellent work and moderate discussions with journalists and experts. Send questions or suggestions to joe@healthjournalism.org or tweet to @rojasburke.

Attend AHCJ’s free Rural Health Journalism Workshop for a better understanding of what’s happening – or will be happening – in rural regions, and return to work with dozens of story ideas you can pursue.

Compared with city dwellers, people in rural America have higher rates of cancer, diabetes, disabling injuries, and other life-shortening health problems.

Among the less talked about aspects of the Affordable Care Act are measures intended to help reduce rural health disparities. But health professionals working in remote small towns aren’t convinced that the well-intentioned steps will bring enough relief – and do it quickly enough – to reverse problems that many fear are getting worse, such as lack of economic opportunity for rural residents, and limited access to high-quality medical clinics and hospitals.

“There’s definitely joys, but right now the change is huge. It’s going to make it hard for many of us to survive,” said Dean Bartholomew, M.D., a family medicine physician in Saratoga, Wyo., a town with 1,700 residents that is nearly an hour’s drive away from the nearest hospital. Bartholomew was among the panelists at the Health Journalism 2014 session on rural health.

Rural health difference

For Bartholomew, the joys include the rich relationships he’s been able to build with patients and the community. He’s found himself serving as the volunteer team physician for the local high school, for instance, and taking care of sick pets on occasion. Continue reading

Using data from exchanges, journalists report on the true cost of health insurance

Joseph Burns

About Joseph Burns

Joseph Burns (@jburns18), a Massachusetts-based independent journalist, is AHCJ’s topic leader on health insurance. He welcomes questions and suggestions on insurance resources and tip sheets at joseph@healthjournalism.org.

When the federal and state exchanges opened for business on Oct. 1, 2013, health care journalists found a trove of stories worth reporting on the cost of health insurance.

But they also found that simply reporting on the premiums that consumers paid was only part of the story. Consumers also had to pay deductibles at each metal level (bronze, silver, gold and platinum) and these payments varied widely.

Reporters also found that the federal subsidies for the poor added a layer of complexity to their reporting that made covering the actual cost of health insurance to be difficult and confusing. Continue reading

Hospitals rethink charity for those passing on Obamacare

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.

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

Covering ACA numbers? The semantics matter

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.

Kyle Cheney

Kyle Cheney

With big new sign-up numbers coming out of the state and federal exchanges, Politico health care reporter Kyle Cheney reports on what the numbers mean. Enrolled? Selected? Covered? The differences matter. 

Loose characterizations by allies and enemies of how many people have signed up, (more than 7 million as of April 1) have led to rampant – often verifiably incorrect – interpretations in the press. That matters.  The way news reports characterize enrollment could  tilt the national narrative about the health law in a tense election year.

There are subtle but significant differences between the number of people “signed up” for ACA plans and the number actually “enrolled.” And there’s an even greater difference,  for the short term, between the number of enrollees and the number of people who have “coverage.”

Here’s a tip sheet with some help in avoiding getting caught up in the enrollment spin.

Love ‘em or hate ‘em, narrow networks are drawing scrutiny

Joseph Burns

About Joseph Burns

Joseph Burns (@jburns18), a Massachusetts-based independent journalist, is AHCJ’s topic leader on health insurance. He welcomes questions and suggestions on insurance resources and tip sheets at joseph@healthjournalism.org.

Health insurers’ efforts to keep costs low by using narrow networks are drawing increased scrutiny.

Such oversight may be inevitable given that hospitals and physicians often complain if they are excluded from narrow networks, and sometimes consumers complain as well if their doctors or preferred hospitals are suddenly deemed to be out of network. The problem is that increased scrutiny could lead to increased regulation that limits the ability of insurers to control costs.

Earlier this month, the federal Centers for Medicare & Medicaid Services (CMS) said it would review all networks to ensure that they meet patients’ needs. Writing in The New York Times, Robert Pear reported that insurers will be required to have contracts with at least 30 percent of “essential community providers” in their service areas and that insurers must not discriminate against people with significant health needs.

The CMS action came in a letter to health plans using the federal marketplaces. In its 2015 Letter to Insurers in the Federally-facilitated Marketplaces, CMS said it wants to ensure that networks have adequate participation from hospital systems, mental health providers, oncologists, and primary care physicians. Continue reading

Site tracks, predicts state-by-state marketplace enrollments

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.

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, ACASignups.net. 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

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.

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

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.

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