On March 4 the Supreme Court heard oral arguments in King v. Burwell. A ruling is expected in late June – though it’s possible it could come earlier. The plaintiffs argue that the health insurance subsidies should only be available to people living in states running their own Affordable Care Act health insurance exchanges or marketplaces, not the 34 states using the federal exchange via HealthCare.gov. They cite four words in the text of the law “established by the state” to make this argument. The Administration says it’s clear from reading the full text of the 906 page law that subsidies were to be available in all 50 states, no matter what kind of exchange they have.
By Steve Petteway, Collection of the Supreme Court of the United States (Roberts Court (2010-) – The Oyez Project) [Public domain], via Wikimedia Commons
So the Supreme Court has heard the King v. Burwell challenge to the Affordable Care Act.
Much of the coverage suggested that the March 4 oral arguments seemed to favor the administration, particularly because Justice Anthony Kennedy, often the deciding swing vote on the court, asked some questions showing skepticism of the plaintiff’s case.
But all that tells is precisely that – he asked some questions showing skepticism. He won’t necessarily vote that way. He backed scrapping the entire statute back in 2012 and made clear at that time that he detested the law.
Oral arguments are interesting and important – but rarely decisive. If you think you know how the court will rule – well you have a 50-50 chance of being right.
A few things did come out that health journalists should note. Continue reading
Photo: Len Bruzzese/AHCJ
Louis W. Sullivan, who spoke to Health Journalism 2014 attendees about his just-released autobiography, has won an NAACP Image Award for the book.
Sullivan, the founding dean of the Morehouse School of Medicine – the first predominantly black medical school – served as secretary of the U.S. Department of Health and Human Services under President George H.W. Bush from 1989-93. Continue reading
Independent journalist Lola Butcher reports that debate about the government’s 340B Drug Pricing Program continues to build as the program expands.
“Like all good controversies, this one has enthusiastic advocates and wild-eyed opponents, and it’s easy to get snagged by the passion of the partisans,” she writes in a new tip sheet. Continue reading
Photo: Abby via Flickr
Health journalists received a few lessons in economics during a discussion last week on some alarming drug trends – largely the result of a broken market – that are threatening patient care and undermining the U.S. health care system.
At a New York City chapter event, Phil Zweig, a longtime financial journalist who also runs a group called Physicians Against Drug Shortages, spoke about the scarcity of generic drugs in hospitals and clinics – a problem that has persisted for years. Hospital group purchasing organizations (GPOs), which are not regulated and essentially negotiate supply purchases for hospitals, have the ability to charge market share to the highest bidder. Zweig said they can do this because the safe harbor provision in the 1987 Medicare anti-kickback law excluded GPOs from criminal prosecution for taking kickbacks from suppliers.
“The more you can pay to a GPO, the more market share you get,” Zweig said.
Because of the exclusive contracts that GPOs award, the number of competitors in the market shrinks, which has led to a shortage of generic prescription drugs – everything from sterile injectables to chemotherapy agents. Continue reading
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:
Imagine the outcry if patients with cancer or any other chronic condition lacked standard, appropriate care. Such ill treatment would not be tolerated.
Yet the U.S. health care system routinely fails to provide basic care to Americans with mental illness, says Patrick J. Kennedy, a former congressman from Rhode Island and co-founder of One Mind, an organization seeking new treatments for neurologic and psychiatric diseases of the brain.
For a series of articles in USA Today, Liz Szabo quoted Kennedy on mental health care in America: “The failure to provide treatment and supportive services to people with mental illness – both in the community and in hospitals – has overburdened emergency rooms, crowded state and local jails and left untreated patients to fend for themselves on city streets.”
The burden of inadequate mental health care falls on individuals and families, but also on emergency rooms, hospitals, jails and other institutions, making this topic well worth the rich and deep coverage Szabo and other journalists have committed to it. Such coverage is important, as reporters have found in Colorado, Idaho, Oklahoma, and Wisconsin, and it can be rewarding because it forces journalists to confront and explain some most challenging health care issues in our society. Continue reading
Noam Levey, who received a 2013 AHCJ Reporting Fellowship on Health Care Performance, recently reported on health care spending in Mozambique for the Los Angeles Times. In the piece, Levey pointed out that Mozambique’s economy is booming – but in contrast, its health care spending is lagging.
The decision to limit health resources had an especially profound effect in remote areas of Mozambique. Levey reported from Chokwe, a rural town about 100 miles north of the coastal capital of Maputo, and described a newborn baby boy who stopped breathing shortly after his birth, just before sunset.
Nurses were able to revive him with a ventilator and a suction machine. But if he had been born only two hours later, he would have died – limited resources mean the ward is staffed only until 7 p.m.
Megan Sandel, M.D., M.P.H., an expert on the impact of housing on child health, says journalists would do well to broaden the conversation about health care to include questions about social support – especially support for safe, affordable and stable housing.
Sandel has contributed a tip sheet that includes key stories to pursue and critical insights on the housing-as-health-care trend.
Find out why housing has an enormous impact on educational attainment and economic stability, how unequal enforcement of health and safety codes creates disparities and what the three essential elements of healthy housing are. See the tip sheet now.
Photo: Carla K. Johnson
Chicago Tribune reporter Julie Deardorff chats with health writer Evelyn Cunico at the May 12 event in Chicago.
The American health care system wastes an estimated $750 billion a year, according to the Institute of Medicine. At a recent AHCJ chapter event in Chicago, four panelists discussed one source of that waste: unnecessary tests and procedures.
Moderated and organized by AHCJ member Kevin B. O’Reilly, senior editor of CAP Today, the panel looked at the issue through the lenses of doctors, journalists, health system executives and academics.
Holly Humphrey, M.D., dean for medical education at the University of Chicago Pritzker School of Medicine and vice chair of the American Board of Internal Medicine Foundation’s board of trustees, discussed the foundation’s Choosing Wisely campaign. Continue reading
Photo by Truthout.org via flickr.
So many health care strategies are aimed at controlling costs that we may be missing the point about value. The trouble inherent in focusing on low cost is that it does not necessarily equal better care.
This point is one health policy experts are starting to deliver to the federal Centers for Medicare & Medicaid Services and to other health care payers, such as managed care companies and health insurers. Focusing on low-cost strategies may be doing a disservice to patients and health plan members, they say.
Writing in The Hill newspaper on April 22, Kenneth Thorpe, Ph.D., chair of the Department of Health Policy & Management in the Rollins School of Public Health at Emory University, criticized a recent proposal from the Medicare Payment Advisory Commission, which advises Congress, on using the “least costly alternative” when making policy decisions. Doing so puts patients into a “one-size-fits-all” model of care delivery, he explained.