Sarah Gantz has been fascinated with Maryland’s Medicare waiver since the Baltimore Business Journal hired her to write about health care more than two and a half years ago. She describes the policy as “the lifeblood of Maryland’s $15 billion hospital industry.”
Maryland is the only state with an “all-payer” hospital system – a system in which every health plan and every payer pays about the same rate to a given hospital for a given procedure or treatment. That includes Medicare, under a waiver from the federal government. A commission sets the costs and there’s a lot less cost-shifting in the system if everyone is playing by the same rules.
Despite its importance, Gantz says that most people write it off as a wonky hospital rule that doesn’t affect them. With help from the AHCJ Reporting Fellowship on Health Care Performance, Gantz set out to explain why the policy is worth taking the time to understand. In this piece for AHCJ, she tells our readers what she learned and how she turned wonky policy into stories about real people.
By now you have heard of “Dentalgate.” The administration, twice, released ACA enrollment numbers this fall that included nearly 400,000 dental plans, alongside the regular health insurance plans. That made it sound like more than 7 million people were covered in the state and federal exchanges.
That’s wrong. Depending on which date you used, there were either about 6.9 million (as of mid-August) or 6.7 million (October).
You know the politics too: The GOP said it was “deception;” the Department of Health and Human Services said, “Oops.” There will be a hearing on the Hill on Dec. 9 when CMS chief Marilyn Tavenner will testify before the House Oversight committee.
But what do we know about where the numbers come from, or what they say about attrition from the 8 million who signed up for coverage by the middle of April? Continue reading
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.
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.
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.”
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.
California journalist Randy Dotinga has written several pieces about his own efforts to obtain health insurance. His “long-running tale of woe” features several twists and turns but it isn’t that unusual in the grim world of 21st-century health insurance in the United States.
Since 2000, I’ve been jilted by a grand total of seven insurance companies. The eighth — the one covering me now — comes courtesy of Obamacare and looks like it might actually stick around for a while. Expensive? Yes. A relief? Absolutely.
What is unusual is for a journalist who covers health and medicine to be so open about his own experiences. In an article for AHCJ, he offers journalists some tips on how to do the same.
We’re closing in on the start of the ACA’s second open enrollment season. Both Kevin Counihan, the new HealthCare.gov “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
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.
Photo: Margot Sanger-KatzJournalists at a Sept. 18 Washington, D.C., chapter meeting heard from Tom Scully, a former CMS administrator; Stephen Zuckerman, a senior fellow at the Urban Institute; and Marilyn Werber Serafini, a former journalist now with the Alliance for Health Reform.
Open enrollment is coming again. And with millions of new people signing up for health insurance and renewing their plans come opportunities for new stories about how the Affordable Care Act is working.
Stephen Zuckerman, a senior fellow at the Urban Institute and Tom Scully, a former administrator at the Centers for Medicare and Medicaid Services who now works as a private equity investor, spoke to an AHCJ chapter meeting in Washington, D.C. about the possible stories ahead.
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