Category Archives: Health care reform

Looking at the people behind the Kentucky insurance 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.

Image by pds209 via flickr.

Image by pds209 via flickr.

Kentucky has gotten a lot of attention for the largely unexpected success of its health insurance exchange.

The Washington Post’s Stephanie McCrummen has looked at another aspect of the Kentucky story: Who is getting covered and what is that going to mean?

Her first feature was published Nov. 23 (when most of us were focused on the final week of the “tech surge” to fix HealthCare.gov). She followed up in February. McCrummen looked at the faces behind the numbers – and asked questions about the numbers.

Her stories took her to Breathitt County in the foothills of Appalachia, one of the poorest and unhealthiest counties in the U.S with high rates of diabetes and heart disease. She focused on Courtney Lively, who is a human link between being covered and not being covered. Lively works at a clinic near a fast food joint, helping people get coverage, some for the first time. Among those walking through her office door were “cashiers from the IGA grocery, clerks from the dollar store, workers from the lock factory, call-center agents, laid-off coal miners, KFC cooks, Chinese green-card holders in town to teach Appalachian students.”

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A deeper look at the employer mandate and the work week

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.

The employer mandate was pushed back for 2014 and is being phased in more gradually in 2015-16. What portion of the workforce does this affect?

And what’s going on with that “30-hour” work week? That’s how the Affordable Care Act defines full time, and the GOP has legislation (likely to pass the House in early March – far less likely in the Democratic-led Senate) that would change the definition to the more standard 40-hour week.

As we’ve pointed out before, you hear a lot of talk about how the Affordable Care Act will hurt small business. But if you report those claims, be careful of the definitions. Small businesses with fewer than 50 full time equivalent (FTE) workers are and have always been exempt from the employer mandate. They can, if they wish, get coverage through the new (but still fairly underdeveloped) SHOP exchanges. But whether they choose to and how much they contribute to their workers’ coverage is up to them. Continue reading

Questions remain despite latest ACA enrollment numbers, projections

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.

The latest ACA enrollment report (and the CBO projection that 6 million people would sign up for exchange coverage by March 31) is a classic half-full, half empty scenario.

Half full because the 3.3 million selecting exchange plans is a way better number than what many expected last fall when the sign-up portals were not working. Remember when only about 100,000 had chosen a plan in the state and federal marketplaces in October?

Half empty because 3.3 million may be on track to 6 million – but 6 million is less than the 7 million that the administration earlier had embraced as a goal. And 6 million or 7 million (plus another 8 million in Medicaid and CHIP) still leaves millions of people uninsured. Continue reading

Blame game: Obamacare becomes scapegoat for all that’s wrong with health care

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.

obamaBlame it on Obamacare.

That’s what you hear, over and over again. Anything in the health care system that someone doesn’t like, it’s Obamacare.

Sam Baker of the National Journal took a look at some of the things people are blaming on Obamacare – high deductibles, narrow networks, employers cutting benefits – and reminds us that they were already part of the health care landscape, before the Affordable Care Act. He writes:

Welcome to the Obamacare era. Continue reading

CMS: Interim ACO, bundled payment savings top $488 million

Liz Seegert

About Liz Seegert

Liz Seegert (@lseegert), is AHCJ’s topic editor on aging. Her work has appeared in Kaiser Health News, The Atlantic.com, New America Media, AARP.com, Practical Diabetology, Home Care Technology report and on HealthStyles Radio (WBAI-FM, NYC). She is a senior fellow at the Center for Health, Media & Policy at Hunter College, NYC, and a co-produces HealthStyles for WBAI-FM/Pacifica Radio.

The Centers for Medicare & Medicaid Services (CMS) released interim financial results for its various ACO and bundled payment initiatives today which show savings in excess of $488 million.* These included cost savings analyses for Medicare Accountable Care Organizations, Pioneer ACOs, the Physician Group Practice demonstration and expanded participation in the Bundled Payments for Care Improvement Initiative. Many of those programs are discussed in detail in the AHCJ tip sheet “Latest innovations in Medicare.”

“These innovative programs are showing encouraging initial results, while providing valuable lessons as we strive to improve our nation’s health care delivery system,” HHS Secretary Kathleen Sebelius said in a statement. “Today’s findings demonstrate that organizations of various sizes and structures across the country are working with their physicians and engaging with patients to better coordinate and deliver high quality care while reducing expenditure growth.”

CMS said that In their first 12 months, nearly half (54 out of 114) of the ACOs that started program operations in 2012 already had lower expenditures than projected. Of the 54 ACOs that exceeded their benchmarks in the first year, 29 generated shared savings totaling more than $126 million. These ACOs generated a total of $128 million in net savings for the Medicare Trust Funds. Medicare shares in any ACO savings generated from lowering the growth in health costs while meeting high quality care standards.

Final performance year-one results will be released later this year.    Continue reading

Find out if lack of health literacy keeps people from ACA benefits

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.

Wordle-health-literacyYet another study tells us how little the public knows about the Affordable Care Act, and how even the people most likely to benefit from it are often unaware. The study, from The Robert Wood Johnson Foundation and The Urban Institute, found that fewer than four in 10 uninsured adults thought they would get insurance this year. Most don’t realize they may be eligible for subsidies or expanded Medicaid.

We all know that the Affordable Care Act is complicated, and the intense political fighting about it has added to the confusion and the challenges of getting simple apolitical messages across.

But is it all about politics and messaging? How much of a role does “health literacy” – or more specifically “health insurance literacy” play? Continue reading

Mo. journalist reminds us that reform does little to improve actual delivery of care

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 reform” is the term we use to describe the changes being made to the U.S. health care system under the Affordable Care Act. But as we’re reminded from time to time, for example in a blog post by Austin Frakt earlier this month at The Incidental Economist, the ACA is more accurately defined as health insurance reform.

Jim Doyle

Jim Doyle

Certainly insurance reforms are badly needed, but these reforms alone are doing little to reform the actual delivery of care to patients. Jim Doyle, who covers the health care industry for the St. Louis Post-Dispatch, makes this point in on a series on health care access and the fraying safety net.

In a new “How I Did It” article, Doyle explains what he found when reporting from rural parts of Missouri and Arkansas is that, while the Affordable Care Act will bring changes to the health insurance marketplace in these areas, it only goes so far in helping the poor access health care services. Continue reading

Cost report full of ideas for state-level stories on 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.

cracking-the-codesWe get inundated with reports and issue papers, but every once in a while it’s a good idea to pick one up, review what you know and figure out what you have to learn.

A recent report, “Cracking the Code on Health Care Costs” from a state health cost containment commission organized by the University of Virginia’s Miller Center turned out to be useful for that purpose. It didn’t offer me any brand-spanking new huge ideas but it pulled a lot of trends and data together in one (nonpartisan) place – everything from malpractice reform to end-of-life care, and how they can be addressed at the state level.

If you are an experienced health care reporter, the state sections can still give you some story ideas. If you are a newbie, the report is a pretty good and readable overview. Read the executive summary and then follow up on areas that interest you for stories.

Here are five story ideas I came up with in just a few minutes of looking at the report – you will be able to think of dozens more that affect your community. Continue reading

Comparing U.S., Canadian health care systems

Trudy Lieberman

About Trudy Lieberman

Trudy Lieberman, a former president of AHCJ, is a contributing editor to the Columbia Journalism Review, where she blogs about health care and income security issues. She is a fellow at the Center for Advancing Health where she blogs about paying for health care. At Consumer Reports, she specialized in health care and health care financing. She has won more than 25 awards and five major fellowships.

Lieberman recently returned from a monthlong visit to Canada as a Fulbright Senior Specialist, where she lectured on the American health care system and learned much about how Canadians get their medical care. She interviewed hospital executives, physicians, academic experts, former health ministers, reporters covering health care, and ordinary citizens. Lieberman also toured hospitals and long-term care facilities. This is the first of four posts reporting on that visit.

canada-flagOne thing Americans and Canadians can agree on is that we don’t want each other’s health care systems. In truth, most Americans don’t know how Canada’s system works and Canadians don’t know much about the U.S. system.

What Americans know has come mainly from the negative talking points of politicians and others who have argued for years against national health insurance. Two decades ago The New York Times reported that Canadian women had to wait for Pap smears, a point vigorously refuted by the Canadian ambassador who shot back in a letter to the Times editor: “You, and Americans generally, are free to decide whatever health care system to choose, avoid or adapt, but the choice is not assisted by opinions unrelated to fact.”

Yes, there are waiting lists for some services – as I will explain in another post – but, no, Canadians are not coming across the border in droves to get American care.

There’s misinformation among Canadians, too. Wherever I went, Canadians told me they thought, mostly based on what they said they heard on CNN and Fox, that Obamacare meant America was getting universal health coverage like their country has.

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Star-Telegram incident is a cautionary tale about ‘Obamacare horror stories’

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.

In November, the Fort Worth Star Telegram wrote about several people who were “losing” under the Affordable Care Act. A month later it ended up having to do a pretty significant mea culpa by executive editor Jim Witt.

The flaws in the story caught the attention of health care blogger and author Maggie Mahar. Some of the accounts of people who lost their old policies and were facing stupendous prices for lousy new Obamacare policies didn’t ring true. A 26-year-old woman, even one with multiple sclerosis, wasn’t going to have to pay up to $1,800 a month for coverage that was inferior to what she had before.

So Mahar did a bit of reporting of her own. Continue reading