Tag Archives: obama

Election 2012: What do we know about the fate of health reform?

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.

Joanne Kenen, AHCJ’s health reform topic leader, earlier discussed five potential outcomes of the election. Given what we now know about the results, here is Kenen’s wisdom on what to expect in terms of “Obamacare.”

Barack ObamaPresident Obama has won re-election; the Senate remains Democratic and the House remains Republican.

Obamacare survives. It will be implemented in 2014 – probably not without bumps and challenges, so you will have plenty to write about. But the fighting won’t be over.

There are at least two legal challenges to the law out there (not counting the lawsuits over contraception policy – but that’s a peripheral issue and wouldn’t bring down the whole law). Republicans, as this CQ/Roll Call story suggests, won’t just drop their argument that people can’t get subsidies through federal exchanges (in states that don’t run their own exchanges).

The Affordable Care Act will get tied into all the fighting to come over the fiscal cliff, entitlement reform, tax reform, the sequester and of course that looming debt ceiling limit. There are many ways that the GOP could still try to weaken or dismantle parts of the health law, including attempts to delay it, repeal specific pieces of it, or roll back some of the subsidies. But repeal is off the table.

My Oct. 26 story is behind a paywall. Julie Rovner at NPR also took a look at this. Mary Agnes Carey at Kaiser Health News looked at how various pieces of the law could change under different scenarios.

Joanne Kenen (@JoanneKenen) is AHCJ’s health reform topic leader. If you have questions or suggestions for future resources, please send them to joanne@healthjournalism.org.

AHCJ Webcast

What does the election mean for senior health?

Tune in Thursday, Nov. 8, at 1 p.m. ET.

Now we need to make sense of the election’s results for our readers, viewers and listeners.

This AHCJ webcast will examine one big piece of the puzzle: what this election’s outcome means for seniors on Medicare, older adults who receive long-term care services from Medicaid and other programs that serve our elderly population.

A blue ribbon panel of experts will offer their thoughts and analysis during this event. Join us for a lively discussion and ask the questions that matter to you and your audience. The experts are:

  • Joseph Antos, Wilson H. Taylor Scholar in Health Care and Retirement Policy, American Enterprise Institute
  • Karen Davis, president, The Commonwealth Fund
  • John Rother, president and chief executive officer, National Coalition on Health Care
  • Moderator: Judith Graham, health care journalist and AHCJ topic leader on aging

A quick Obamacare election recap – or ‘precap’

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.

So the election is finally here. What do we know about the fate of “Obamacare?”

As I write this on Sunday, Nov. 4 – not much. But here are the four main  scenarios to think about. When we know the results, we’ll explore more in depth.

Joanne Kenen

Joanne Kenen (@JoanneKenen) is AHCJ’s health reform topic leader. If you have questions or suggestions for future resources, please send them to joanne@healthjournalism.org.

At this writing, the presidential race is considered very close (with each side predicting that its guy will win.) The conventional wisdom is that the Senate is likely – not certainly, but likely – to remain in Democratic hands. But we’ll look at what would happen if the Republicans pull out a narrow win.

All the scenarios I write about here assume that the House remains Republican – that’s pretty much a given. Should the entire politicoscenti be wrong about that (highly unlikely) and it goes Democratic, that would mean more support for President Barack Obama’s health law, if he’s re-elected, and more obstacles to repeal if Mitt Romney wins. But, I repeat, it’s unlikely.

So read through the other four scenarios – and I put the most interesting and least understood last. Continue reading

Resources break down candidates’ views on health care, what matters to voters

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 are two more resources before the presidential debate and the final weeks of trying to untangle the health policy claims in the campaign. Both come from the Journal of the American Medical Association (and neither require a password).

Core Topics
Health Reform
Aging
Oral Health
Other Topics

The first is a straightforward two-page essay summing up Obama vs. Romney on the health law/private insurance, Medicaid and Medicare. It’s by Aaron E. Carroll, who is a physician and policy expert, and   Austin B. Frakt, a health care economist. (Both are part of The Incidental Economist blog, which I like a lot – and it’s searchable!)

“Fundamentally,” they write, “the candidates disagree on the role of government as the guarantor of affordable access to health insurance, as evidenced by their plans for private insurance markets, Medicare, and Medicaid.”  They also note the two candidates have different starting points for policy – Obama prioritized covering more people, and Romney stresses cutting federal spending on health.

The second is an infographic from the Kaiser Family Foundation, part of its Visualizing Health Policy collaboration with the journal.  It shows how voters rank health care as a campaign issue this year, which health issues are most salient and how Americans perceive Obama and Romney on these issues. It includes historical contact for the past five elections (back to Bill Clinton in 1992). Cost, as you may guess, is key. I particularly liked this chart, which showed how issues rose and fell with voters every four years. (Moral values beat out economy/jobs for the top spot in 2004. Health care placed 5th and last that year – after terrorism and Iraq.)

Joanne Kenen (@JoanneKenen) is AHCJ’s health reform topic leader. If you have questions or suggestions for future resources, please send them to joanne@healthjournalism.org.

Americans unprepared to pay for long-term care

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism, and he has blogged for Covering Health ever since.

In the Chicago Tribune, Deborah Shelton examines how unprepared Americans are to pay for their own long-term care needs as they age. Long-term care tends to slip under the radar because, as one of Shelton’s sources told her, “People buy insurance for their life because they know they are going to die, for their car because they know that can get in an accident and for their health because they know they can get sick, but people don’t tend to buy insurance because they think they are going to need someone to help them take a bath.”

faces-of-aging-largeLong-term care encompasses everything from nursing home fees to in-home assistance with everyday routines. It all comes with a price tag; Medicare only covers a limited amount and Medicaid programs apply only to those below certain economic thresholds. That leaves the middle class, who can’t afford the services but don’t really qualify for Medicaid, in the lurch, Shelton writes.

Most people assume Medicare will pay the bills, but the program covers long-term care only under certain conditions and for a limited time. While Medicaid covers long-term care, beneficiaries have to be poor or willing to “spend down” their assets to be eligible. Private insurance can be expensive and excludes applicants with serious medical problems.

As a result, many families pay out of pocket until they exhaust their resources and then turn to Medicaid.

The Affordable Care Act attempted to fill in the blanks, but long-term care provisions of that reform plan withered under intense cost pressure.

An initiative that would have incorporated long-term care into the Obama administration’s health reform plan was scrapped in October after actuaries determined that it would not be financially self-sustainable over the long haul. The Community Living Assistance Services and Supports Act would have created a voluntary, self-funded, employer-based insurance option to help people save for long-term care.

Related

Journalism organizations offer data government blocked from public

Jeff Porter

About Jeff Porter

Jeff Porter is the special projects director for AHCJ and plays a lead role in planning conferences, workshops and other training events. He also leads the organization's data collection and data instruction efforts.

Another development in the protest by three key journalism groups to the Obama administration’s decision to block public access to a public database of physician discipline and malpractice: Now, Investigative Reporters and Editors, working with the Association of Health Care Journalists and the Society of Professional Journalists, has posted the data for download, free to the public.

The data are posted for the entire U.S. in the original text format with documentation. IRE has also made available state-by-state Excel spreadsheet files.

On Thursday, the groups sent a letter protesting the decision to pull offline a the Public Use File of the National Practitioner Data Bank. The government has made this file available online for years, and reporters have used it to call attention to lax oversight of physicians across the country.

The public version of the database does not identify physicians by name or address, but it does provide other useful information about hospital sanctions, malpractice payouts and state disciplinary actions against every doctor in the country.

“We applaud IRE for making this data available for free to the media, researchers and the public,” said Charles Ornstein, AHCJ’s president. “While the government has decided that this ‘public use file’ should no longer be public, our organizations believe that it continues to be a critical resource. I encourage reporters, even those who have never used it before, to look for stories within it now.”

Journalists have used the data for years to draw attention to troubled physicians and state inaction. Recent examples include the St. Louis Post Dispatch, the Duluth (Minn) News-Tribune and The Kansas City Star. Other examples over the years have included The Hartford (Conn.) Courant and the Raleigh, N.C., News & Observer.

The U.S. Health Resources and Services Administration threatened a reporter from The Kansas City Star with financial penalties if he proceeded to write a story about a local neurosurgeon using information he gleaned from the public version of the database on the agency’s website. The newspaper published its story anyway on Sept. 4. The doctor’s attorney complained to the agency, prompting officials to remove the database from its website on Sept. 1.

Several news outlets – The New York Times, Los Angeles Times, Reuters and the St. Louis Post-Dispatch – are following the story.

AHCJ, other journalism organizations protest removal of data from public website

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.

The Association of Health Care Journalists, joined by the Society of Professional Journalists and Investigative Reporters and Editors, sent a letter to the Obama administration today protesting its decision to pull offline a public database of physician discipline and malpractice payments.

Read the letter sent by the journalism organizations to Mary K. Wakefield, administrator of the Health Resources and Services Administration.

Stories using the NPDB

The Kansas City Star

• Doctors with histories of alleged malpractice often go undisciplined
• Obama’s HHS shuts down public access to doctor malpractice data

Duluth (Minn.) News Tribune

• AHCJ article: Duluth News Tribune exposes malpractice allegations
• As Duluth hospital reaped millions, surgeon racked up complaints
• Multiple allegations against former St. Luke’s doctor
• Ailing patients speak out about former Duluth doctor
• Wisconsin restricts former Duluth doctor’s license
• In Texas, former Duluth surgeon may be sanction-free
• Federal database of malpractice cases doesn’t make public doctors’ names, or where they practice

Propublica

States Fail to Report Disciplined Caregivers to Federal Database

St. Louis Post-Dispatch

• Reporters encounter hospital’s lack of transparency
• Tip sheet from Bernhard & Kohler on researching health professionals.
• Award entry: Who Protects the Patients?
• Serious medical errors, little public information
• Caution urged with facedown restraints
• Doctor lost hospital privileges but kept clean record
• Girl, 16, dies during restraint at an already-troubled hospital

Milwaukee Journal-Sentinel

• Dangerous Doctors
• AHCJ article: Records show ‘dangerous doctors’ rarely face discipline
• Tip sheet from Gina Barton on state oversight of health professionals

Connecticut Health Investigative Team

• Disciplined Docs Practice Freely In State

West Hawaii Today

Medical malpractice in Hawaii
Diagnosis-related claims among top reasons for suit

Public Citizen

• Hospitals avoid reporting disciplined docs: The nonprofit group released a report showing that hospitals nationwide are taking advantage of  loopholes to avoid reporting disciplined physicians to a national database.  The Miami Herald‘s John Dorscher, the Detroit Free Press‘s Patricia Anstett and the Contra Costa Times‘ Sandy Kleffman reported local versions of the story that are no longer available online.

Earlier stories about access to NPDB:

• Data Mine reports on access to practitioner data: The Center for Public Integrity focuses on the National Practitioner Databank and the lack of public access to information in the database.
• Access to list of disciplined health workers in limbo: NPR’s Joseph Shapiro looked into the status of the Healthcare Integrity and Protection Data Bank.
• Public Citizen posted an open letter to HHS Secretary Kathleen Sebelius explaining why the database is important, and details the consequences of keeping it under wraps.

AHCJ, SPJ and IRE called for the government to immediately restore access to the Public Use File of the National Practitioner Data Bank. The government has made this file available online for years, and reporters have used it to call attention to lax oversight of physicians across the country.

Pursuant to the law, the public version of the database does not identify physicians by name or address, but it does provide other useful information about hospital sanctions, malpractice payouts and state disciplinary actions against every doctor in the country.

As an example, the database would allow a reporter or researcher to discover that certain, unnamed physicians have been sanctioned repeatedly by their hospitals but never were disciplined by their state’s medical board. It would also be possible to find doctors with lengthy trails of malpractice who continued to enjoy clear licenses.

The groups also expressed their deep disappointment that the U.S. Health Resources and Services Administration threatened a reporter from The Kansas City Star with financial penalties if he proceeded to write a story about a local neurosurgeon using information he gleaned from the public version of the database on the agency’s website. The newspaper published its story anyway on Sept. 4. The doctor’s attorney complained to the agency, prompting officials to remove the database from its website on Sept. 1.

The government said that it had to act now because reporters were able to link information in the data bank to specific doctors, and the law prohibits the public use file from identifying doctors. A HRSA spokesman said the data bank will be offline for at least six months and may never return unless the physician privacy concerns are adequately addressed.

AHCJ President Charles Ornstein said he was puzzled by HRSA’s sudden action because reporters have used the public version of the data bank for years to assist in their reporting and learn additional details about physicians they already had been researching.

“We are troubled that the Obama administration appears to have placed the interests of physicians ahead of the safety of patients,” Ornstein said. “Attempting to intimidate a reporter from using information on a government website is a serious abuse of power.”

Stories written by reporters using the public version of the National Practitioner Data Bank have drawn attention to troubled physicians and state inaction. Recent examples include the St. Louis Post Dispatch, the Duluth (Minn) News-Tribune and the Star. Other examples over the years have included The Hartford (Conn.) Courant and the Raleigh, N.C., News & Observer.

Some of these stories have resulted in new legislation and other steps that protect patients, by increasing transparency and sometimes toughening requirements on doctors.

The groups wrote that if HRSA determines the public version of the database violates the law in any way, it should seek swift legislative changes to remedy the problem and once again make the database available.

“In one stroke, the very administration that promised greater transparency not only excludes information of obvious public value to patients across this country but threatens legal action against a reporter for using public records,” said SPJ President Hagit Limor. “This is clearly outrageous.”

IRE President Manny Garcia said, “The removal of the Public Use File – whose very name means for public use – eliminates a valuable tool for journalists whose goal is to educate and protect the public. This database has allowed reporters to uncover flaws that have toughened legislation, and without a doubt, saved the lives of patients across the country.

“We are also stunned that a public servant has the hubris to threaten a health care reporter for doing his job. HRSA should be delighted that journalists are using public information to help saves lives, but in this instance the response is: get lost or get fined.”

HHS unveils ‘National Prevention Strategy’

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism, and he has blogged for Covering Health ever since.

Today, in a live webinar and a companion piece in the New England Journal of Medicine, the Department of Health and Human Services released its “National Prevention Strategy,” a broad effort to realize the preventive care goals set forth in the Affordable Care Act. The specifics of implementation are still taking shape, but the release centered around four primary talking points:

  • The ACA seeks to “remove cost as a barrier” to “clinical preventive services,” by requiring new private plans to cover preventive services in the “strongly recommended” and “recommended” categories (examples include certain vaccines and screening procedures) with no cost to the beneficiary. Medicare will take a similar approach, and state Medicaid plans will be incentivized to do the same.
  • It promotes workplace wellness initiatives through new grants and a re-evaluation of existing programs.
  • It seeks to involve communities and local governments through community-based efforts. “Community Transformation Grants,” for example, “promise to improve nutrition, increase physical activity, promote smoking cessation and social and emotional wellness, and prioritize strategies to reduce health care disparities.”
  • It makes preventative health a federal priority through “a newly established National Prevention, Health Promotion, and Public Health Council, involving more than a dozen federal agencies,” which “will develop a prevention and health promotion strategy for the country.” It also promises a “national strategy to improve the quality of health care,” and “improved data collection on health disparities.”

In addition to the four big messages, HHS officials pointed to initiatives designed to address specific, salient concerns such as smoking, obesity and the looming shortage of primary caregivers.

Presidents of AHCJ, SPJ call for more openness from Obama administration

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.

The presidents of the Association of Health Care Journalists and the Society of Professional Journalists published an op-ed in The Washington Post this morning, criticizing the lack of openness within the Obama administration and calling on officials to improve the flow of information to journalists and the public.

Charles Ornstein

Charles Ornstein

“Democrats criticized the Bush administration for not making decisions based on the best science,” wrote AHCJ’s Charles Ornstein and SPJ’s Hagit Limor. “But the Obama administration now muzzles scientists and experts within federal agencies. When they are allowed to talk about important public health issues, a chaperone often supervises every word. These constraints keep the public from learning whether decisions are science-based or politically motivated.”

AHCJ has been very active in advocating for government openness, including a recent series of meetings in Washington, D.C., with officials from the U.S. Department of Health and Human Services and its related agencies. The organization has urged the FDA to re-examine a policy that prohibits reporters from sharing embargoed materials with sources before the embargo lifts for the purpose of obtaining outside comment and context. Board members from AHCJ also have worked with state health directors to encourage dissemination of more information during public health outbreaks.

“We remain hopeful that our ongoing conversations with HHS and its agencies will help improve the current climate, which isn’t working for journalists or the public,” Ornstein said. “Our members are interested in timely, meaningful responses to their questions, additional access to scientists and health experts, and speedier responses to their Freedom of Information Act requests.”

Lieberman: Election is evidence media got reform coverage wrong

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism, and he has blogged for Covering Health ever since.

In her column on CJRorg, AHCJ Immediate Past President Trudy Lieberman writes that this week’s elections showed just how thoroughly the media missed the mark on health care reform coverage.

After the economy (62 percent), health care (19 percent) was the second most important issue to voters. And while the media (and the administration) trumpeted the benefits of health reform and “glossed over” the drawbacks, public opinion soured. The biggest oversight, Lieberman writes, was the national insurance mandate, a policy that was more Republican than Democrat.

Lieberman says it best:

If the media failed to discuss in detail the law’s less attractive points, it also missed one of the campaign’s biggest ironies. Republicans, with their repeal and replace slogans, stirred up discontent about a law that was basically built with Republican and conservative ideas. That irony escaped the media.

She doesn’t explicitly frame it as such, but Lieberman’s column leaves me with the distinct impression that with the health care debate reignited by a Republican landslide, journalists are being given a second chance to provide the public with a clear understanding of what’s going on in Washington, an impression that’s cemented with her final sentence:

Whatever happens, the U.S. health system is still its dysfunctional, fragmented, costly self, in need of repair or wholesale reform. Going forward, this is the story the media need to tell.

Understanding the administrative side of implementation

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism, and he has blogged for Covering Health ever since.

Coverage of health care reform implementation has generally focused on the issues and effects of the roll-out, rather than the arcane governmental mechanisms involved. It makes sense, of course, as “here’s how you can now get coverage despite your pre-existing condition” is significantly more relevant to most readers than “23 states miss federal 90-day deadline for creation of high-risk pools, partly because already established pools don’t always conform to reform requirements, and partly because it’s too much hassle and they’d rather let the feds do it for them.”

Service-oriented as it may be, this focus has led to a few gaps in my understanding of the administrative moving parts involved in implementation. Which is why the Robert Wood Johnson Foundation’s guide to state and federal roles in the implementation of health care reform is such a handy document. It’s worth a quick scan, if only to give all those implementation stories a little context. It’s got everything from “how informal rulemaking becomes law” (hint: it involves both “notice” and “comment”), to the aforementioned business about why some states ceded control of their high-risk pools to the federal government. And it’s only four pages long.