We are working to gather raw data for your own analysis and to pinpoint trustworthy outside sources of data, analysis and summaries that you can use in your reporting. Below are data sources that can assist you in covering health reform.
Potential Roe v. Wade decision highlights wide variation in regulations regarding health coverage of abortion
A report from healthinsurance.org shows that the Affordable Care Act did not mandate or ban health insurance coverage for abortion. But states passed various rules and regulations regarding abortion coverage so that by 2022, 25 states banned or restricted health plans from covering abortion offered through health plans available in the ACA marketplaces. All but two of those states (Louisiana and Tennessee) allow coverage in cases in which a life is endangered. Many states also have exceptions permitting coverage of abortion services in cases of rape, incest or other circumstances, the report shows.
Scope of Practice and Medicaid: State Flexibility to Cover Advanced Practice Care
A report issued in May 2022 from the National Health Law Program explains how state Medicaid programs could expand the number of licensed health care practitioners (not including physicians) who could provide more care and services to patients in a wider array of settings, including retail pharmacies or small outpatient clinics.
More African Americans have gained health insurance
since the Affordable Care Act (ACA) became effective in 2014, and the percentage of African Americans who have no health insurance dropped sharply since then, according to reporting in The Washington Post from Akilah Johnson. But that progress depends largely on where people live, she added. Nearly one million African American adults would become eligible for medical insurance if 12 holdout states expanded Medicaid eligibility under the ACA, according to a report from the federal Department of Health and Human Services on Feb. 22, she noted.
New data shows medical debt disproportionately affects the most vulnerable populations.
A report from the Georgetown University Center for Health Insurance Reform shows that unpaid medical bills are among the largest contributors to personal debt in the United States. The report also shows that about half of all Americans are in medical debt and about 20% of Americans have medical debt in collections. Not only is medical debt the leading cause of consumer bankruptcy, but new data also shows such debt disproportionately affects people of color and people with lower incomes, underscoring the need for more comprehensive consumer protections, the report added.
The U.S. Department of Justice filed a civil lawsuit on Feb. 24
along with the Minnesota and New York Attorneys General to stop UnitedHealth Group’s plan to acquire Change Healthcare, a revenue cycle management company that helps health systems and health care providers to maximize revenue. The lawsuit alleges that the proposed $13 billion transaction would harm consumers by limiting competition in commercial health insurance markets and in the market for the technology that health insurers use to process claims.
Medicare agency redesigns direct contracting program
in favor of accountable care organizations. The federal Centers for Medicare and Medicaid Services said on Feb. 24 that it would replace its global and professional directly contracting programs with provider-led accountable care organizations starting next year. At Modern Healthcare, Maya Goldman reported that the new model of care delivery would be called the ACO Realizing Equity, Access, and Community Health Model (ACO REACH) and would include new health equity requirements, changes to risk adjustment and additional risk-scoring criteria.
The first public option health plan struggles to gain traction
As prospects decline for a single-payer Medicare for All program, health reform advocates turned to a government-designed insurance plan that could compete with private insurance plans, according to Markian Hawryluk’s reporting for Kaiser Health News. A public option could increase health care access by making a lower-cost plan available to consumers, but a public option plan has faced political opposition. Washington state is in its second year of offering the nation's first public option health insurance plan, but state officials have learned that they must require hospitals to do so, he wrote.
2020 MLR Rebates by State
based on MLR reports filed through Oct. 21, 2021. The federal Centers for Medicare and Medicaid Services issued a report showing how many Americans would receive payments from health insurers under the Affordable Care Act’s medical loss ratio calculations. The report also shows how many and how much these consumers would get in each state. Almost 10 million consumers would get an average of $205 each for a total of about $10 billion from insurers.
All-Time High: 13.6 Million People Signed Up for Health Coverage on the ACA Insurance Marketplaces
On Dec 22, 2021, the federal Centers for Medicare and Medicaid Services reported that a record 13.6 million were enrolled in health insurance coverage for 2022 through HealthCare.gov and the ACA’s state-based marketplaces. Under the American Rescue Plan (ARP) Act, 92% of enrollees who signed up outside of the state-based marketplaces will get premium tax credits in 2022, making coverage more affordable, the report noted.
More Than 80% Remain Uninsured Following Pandemic Layoffs
A report in November 2021 published on AffordableHealthInsurance.com, a site that helps consumers enroll in health care coverage, showed that men were more likely to remain uninsured after a layoff than women. The report also showed that 56% of Americans who were laid off during the COVID-19 pandemic lost their employer-provided health insurance and 81% of those who lost their health insurance remained uninsured into the fall of 2021, many because they could not afford health insurance, the report said. And some 59% of those who were uninsured said a medical emergency would “very likely” be devastating financially.
Misleading Marketing of Non-ACA Health Plans Continued During COVID-19 Special Enrollment Period
Journalists reporting on open enrollment for the Affordable Care Act (ACA) should warn consumers that during the ACA’s special enrollment period (from Feb. 15 through Sept. 15, 2021) that online shoppers were more likely to be referred to alternative health insurance plans that do not comply with the ACA’s requirements than to ACA-compliant plans, according to research from the Georgetown University Center for Health Insurance Reforms. The non-compliant offerings included fixed-indemnity, short-term, health care sharing ministry and other plans that were impossible to categorize based on the information the insurers provided, the report noted. Typically, the alternative plans were more expensive than coverage through the ACA marketplaces and required consumers to pay more for deductibles and coinsurance. Sales representatives for the non-compliant plans gave misleading information about alternative plans and made false statements about the cost and features of ACA-compliant plans, the report said.
Updated ACA Health Insurance Marketplace Subsidy Calculator
In October 2021, KFF published a revised ACA Health Insurance Marketplace Calculator to help consumers understand how much they would pay when buying coverage on the Affordable Care Act marketplaces for coverage in 2022. The calculator reflects increased tax credits under the American Rescue Plan Act. Open enrollment for health plans effective Jan. 1, began Nov. 1 and ends on Jan. 15 in most states. Some state-run marketplaces have different end dates. The calculator allows consumers and journalists to enter age, income, Zip code and family size to estimate eligibility for subsidies and payment and to know if they may be eligible for Medicaid.
Domestic Reference Pricing and Its Potential Role in Medicare Pharmaceutical Price Negotiations
In 2021, members of Congress considered a proposal to let Medicare negotiate lower drug prices with pharmaceutical makers. One way to do so is to use prices from other federal agencies as a reference, according to a report from the Commonwealth Fund. The federal Medicare Part D (prescription drug program for seniors) pays nearly three times what Medicaid pays and nearly double what the federal departments of Defense and Veterans Affairs pay for the same medications, the report noted. Using domestic reference pricing, Medicare would pay what defense and the VA pay for drugs, STAT reported in September.
Who Went Without Health Insurance in 2019, and Why?
In 2019, about 12% of the U.S. population under age 65 (about 30 million Americans) were not enrolled in a health insurance plan or a government health program that provides comprehensive major medical coverage, according to a report from the Congressional Budget Office. The nation’s federal programs, subsidies and other sources of coverage did not reach those people even during a strong economy and historically low unemployment, the report noted. People with low incomes were likely to be uninsured in 2019, and about two-thirds of uninsured people were eligible for some form of subsidized coverage, although the available subsidies varied on the basis of family income, access to employment-based coverage and other factors. A smaller number of uninsured people had no option for coverage except a private plan purchased at full cost. Many uninsured people do not enroll in coverage because of the cost; others may not know they are eligible for subsidized coverage or may be deterred by the complexity of enrolling. Although the majority of uninsured people could obtain coverage for 10% or less of their income, they may not view the coverage to be worth the cost, the CBO said.
How HHS Can Lower Drug Prices, Strengthen Domestic Manufacturing and Reduce Government Spending on Prescription Drugs
The American Economic Liberties Project wrote to HHS Secretary Xavier Becerra to outline four ways HHS could lower drug costs: 1) use compulsory patent licensing provisions in federal law to bring new insulin manufacturers to market and increase competition; 2) restore fair markets for independent pharmacies and purchasers by eliminating predatory fees, unfair patient steering, and anti-kickback exemptions for group purchasers; 3) enforce laws against pharmaceutical companies that have repeatedly engaged in illegal conduct to harm competition; and 4) use participation in Medicare Part D and in Medicaid to encourage competition.
The Poorest Children Lost Health Insurance During The Pandemic
In this report, researchers noted a flaw in a federal report on health insurance in 2020 from the U.S. Census Bureau. Researchers from the Georgetown University Health Policy Institute Center for Children and Families showed that data in this report, “Uninsured Rates for Children in Poverty Increased 2018–2020,” showed no statistically significant increase in the number of uninsured children over those years. But, the researchers added that the data from CPS count people as being uninsured only if they had no health insurance during the entire previous year. In 2020, about 8 million children (or 10.4% of all children) were uninsured for all or part of 2020, the Center for Children and Families explained. IN addition, the children in the poorest families were likely to be without insurance for some part of the year, the researchers noted. “The uninsured rate for children under the poverty line rose significantly from 7.8 percent in 2018 to 9.3 percent in 2020,” the researchers added.
ACOs earned nearly $2.3 billion in Medicare shared savings in 2020
More than two-thirds of accountable care organizations in the Medicare Shared Savings Program earned shared savings in 2020, according to a report in Modern Healthcare. Among ACOs in models with downside risk, 88% earned performance payments versus 55% of ACOs in one-sided risk models that got performance payments, the news magazine noted. In its announcement, CMS said ACOs in the shared-savings program earned almost $2.3 billion in bonuses and saved taxpayers about $1.9 billion last year, the fourth consecutive year of net savings for Medicare.
Out-of-Pocket Costs of Diagnostic Breast Imaging Services After Screening Mammography Among Commercially Insured Women From 2010 to 2017
The ACA largely eliminated out of pocket costs (OOPCs) for screening mammography, but researchers found that among commercially insured women aged 40 to 64, OOPCs for additional breast imaging evaluations and procedures after initial screening were common, nontrivial and rising. This trend coincided with the rapid rise in high-deductible health plans during the time period (2010 to 2017), the researchers noted.
Private Health Coverage: Results of Covert Testing for Selected Sales Representatives Listed on Healthcare.gov
The Government Accountability Office (GAO) reported in August 2021 that sales representatives listed on the federal healthcare.gov website can sell other types of health coverage that may cost less but may not cover all pre-existing conditions as comprehensive plans are required to do under the Affordable Care Act (ACA). After doing 31 covert tests on selected sales representatives, the GAO found none engaged in potentially deceptive marketing practices. This result contrasts with a GAO report from August 2020, Private Health Coverage: Results of Covert Testing for Selected Offerings, in which undercover agents tested the sales practices of representatives selling health plans exempt from the ACA’s rules. In these tests, sales representatives engaged in potentially deceptive practices, the GAO said. Those practices were reported to the Federal Trade Commission.
Small Share of Medicare Supplement Plans Offer Access to Dental, Vision, and Other Benefits Not Covered by Traditional Medicare
Researchers for The Commonwealth Fund found that a small and declining share (7%) of Medicare Supplement plans (also known as Medigap plans) cover only 12% of all Medigap enrollees and provided additional benefits (such as dental, vision, and hearing) not covered by traditional Medicare in 2020. Enrollment in Medigap plans is growing at more than 4% annually since 2016 and Congress is considering increasing access to these additional benefits. The researchers found the additional benefits were concentrated in only a few Medigap plans and that some 65%of Medigap enrollees who could get these benefits were enrolled in Medigap Plan G.
Higher and Faster-Growing Spending Per Medicare Advantage Enrollee Adds to Medicare's Solvency and Affordability Challenges
Medicare spending was $321 per-person higher in 2019 and growing faster per person for beneficiaries in Medicare Advantage (MA) than in traditional Medicare, according to a KFF report published in August 2021. The higher spending contributed to an estimated $7 billion in additional spending in 2019. Between 2021 and 2029, higher spending will come from growth in MA enrollment and in Medicare payments per MA enrollee, the report added. The Biden Administration supports reforming MA payments to private plans to extend the solvency of the Medicare Hospital Insurance (HI) Trust Fund and improve affordability for beneficiaries, the report said.
The Impact of the COVID-19 Pandemic and Recent Federal Policies on Small Business Health Insurance
Contrary to some predictions, small businesses’ health coverage offerings remained relatively stable during the COVID-19 pandemic, according to a report from the Urban Institute in August 2021. Over the past 20 years, the share of small employers offering comprehensive health benefits dropped from almost half to less than one-third. When costs rise, many small businesses shift to coverage exempt from Affordable Care Act rules, unsettling the market. If left unaddressed, these trends could create a more costly pool of enrollees for insurers to cover in the small-group market.
Unvaccinated COVID-19 hospitalizations cost the U.S. health system billions of dollars
Preventable hospitalizations for unvaccinated patients cost $2.3 billion in only two months: June and July 2021, according to data from the Peterson-KFF Health System Tracker.
Medicaid Expansion Reduced Uninsured Surgical Hospitalizations and Associated Catastrophic Financial Burden
Expanding eligibility for Medicaid in the states was associated with reductions in the share (6.2%) and the population rate (7.85 per 10,000) of surgical discharges among the uninsured in expansion versus nonexpansion states, according to researchers from the Duke University Medical Center and the Memorial Sloan Kettering Cancer Center. Published in Health Affairs, the research suggested that in 2019 alone, adoption of Medicaid expansion in nonexpansion states could have prevented more than 50,000 incidences of catastrophic financial burden for uninsured patients needing surgery, the authors wrote.
U.S. Out-of-Pocket Healthcare Spending Swells To $491 Billion, Up 10%
Consumer spending for out-of-pocket (OOP) health care costs will rise to an estimated $491.6 billion in 2021, a 10% increase this year over what consumers paid in 2020, according to the fifth annual report on OOP from Kalorama Information, a medical market research publisher. Annual increases in deductibles, copayments and coinsurance have pushed up OOP costs from about $250 per person in 1980 to $1,650 in 2021, the report noted. In the report, Kalorama also said that such costs are expected to rise by 9.9% through 2026 and that health plan premiums have increased at a faster rate than that of overall prices and workers’ earnings.
National Healthcare Quality and Disparities Reports
In August 2021, the federal Agency for Healthcare Research and Quality (AHRQ) published its 17th annual report on trends related to access to care, affordable care, care coordination, effective treatment, healthy living, patient safety and person-centered care. The report presents data on the quality of and access to health care and on disparities related to race and ethnicity, income and other social determinants of health.
Aligning Payments, Services, and Quality in Primary Care
This report in JAMA describes what the authors said is an optimal payment model for primary care. In May 2021, the National Academies of Sciences, Engineering, and Medicine (NASEM) reported that “primary care in the United States is fragile and weakening,” and recommended paying primary care practices through a combination of fee-for-service and capitation. The report in JAMA recommends an integrated team-based system of care in which primary care groups would get monthly payments for wellness care and chronic disease management and fees for the diagnosis and treatment of new acute illnesses.
Patterns of Use of a Price Transparency Tool for Childbirth Among Pregnant Individuals With Commercial Insurance
For a study published in JAMA Network Open in August 2021, researchers collected information on 253,606 pregnant people, of whom 131,224 (51.7%) used price-transparency tools in 2011 to 2012, and 122,382 (48.3%) used such tools in 2015 to 2016. The proportion of pregnant people I am still really struggling with Susan. Not sure what to do about it, but I often feel that she is asking me to do stuff she should be able to do herself. who sought price information before childbirth more than doubled within the first six years of availability of a price transparency tool, suggesting that price information may help people anticipate their out-of-pocket childbirth costs, the report said.
Rural Health Information Hub
The Rural Health Information Hub has data sets and chart visualizations on health status, disparities, workforce and access.
Rural-Urban Health Chartbook
See appendix for information about the underlying data sets.
Medicare Geographic Variation
CMS has posted its Geographic Variation Public Use File covering 2007-16, which reports on demographic, spending, utilization, and quality indicators for Medicare fee-for-service.
Comparing U.S. health care system with other countries
The OECD (Organization for Economic Cooperation and Development) maintains a database that enables comparisons between the U.S. and other developed countries on a range of health statistics, including the pharmaceutical market and health care quality.
Tax provisions of the ACA (January 2018)
This IRS page has links to data related to the tax provisions of the ACA for individuals, businesses, government and insurers.
Rural hospital closures
The Sheps Center at the University of North Carolina has data and tracking tools for rural hospital closures by state.
HIX Compare datasets examine every marketplace plan from 2015 to 2016
The Robert Wood Johnson Foundation has created free, machine-readable data files on all ACA plans for 2015 and 2016 – on and off exchange in the individual market, and the small group market. It’s a comprehensive look at the health plans – premiums, deductibles, co-pays, benefits, etc. – though not at the people who get covered.
This is a new free and pretty user friendly source of price information based on an extensive (billions) set of insurance claims from commercial health insurers compiled by the Health Care Cost Institute (HCCI). You can search for a medical procedure, and get the national cost average as well as costs for your region. It also has quality and consumer information.This is a new free and pretty user friendly source of price information based on an extensive (billions) set of insurance claims from commercial health insurers compiled by the Health Care Cost Institute (HCCI). You can search for a medical procedure, and get the national cost average as well as costs for your region. It also has quality and consumer information.
The Shorenstein Center’s guide to health and science databases
The Shorenstein Center on Media, Politics and Public Policy at the Harvard Kennedy School has assembled a guide to databases, with a focus on health and public health. Their list includes both free (open source) and paid access databases. Some, like PubMed or Public Library of Science (PLoS), are well known to health journalists but others, like the Social Science Research Network or HighWire, may not be. This is a comprehensive list, with descriptions, and it’s helpful.
CMS has released Health Insurance Marketplace Public Use files giving detailed information about the marketplace: Qualified health plan -eligible, remaining uninsured population ranked by city or metropolitan area.
Utilization of products, services by Medicare beneficiaries
CMS has released a data set on Provider Utilization and Payment Data: Referring Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Public Use File. It contains information on products and services provided to Medicare beneficiaries ordered by physicians and other health care professionals.
CMS Releases County-Level Marketplace Data
CMS has released new information on Qualified Health Plan selections by county for the 37 states that use the HealthCare.gov platform (including the Federally-facilitated Marketplace, State Partnership Marketplaces and supported State-based Marketplaces) for the Marketplace open enrollment period from November 15, 2014 through February 15, 2015, including additional special enrollment period (SEP) activity reported through February 22, 2015.
The data represent the number of unique individuals who have been determined eligible to enroll in a Qualified Health Plan and had selected a Marketplace plan by February 15, 2015 (including SEP activity through February 22). CMS released the following tables:
All of the above data assets are also catalogued on Healthdata.gov
NAIC Insurance Data
The NAIC offers publicly available data in PDF form on insurers’ financial performance.
Readmissions Reduction Program
CMS has published updated data about hospital readmission rates. Under the ACA, hospitals with high rates of 30-day readmissions for Medicare patients with specified conditions are penalized. Scroll down to the end of this document for the data.
POS (Provider of Service)
This POS (Provider of Service) file contains data on health care providers that take part in Medicare, and what services they provide. It’s updated quarterly.
Nationwide data on Hospital-Associated Infections (HAIs)
Most US hospitals will never see a case of Ebola, but they face other more common – and potentially lethal – infections every day. Healthcare-Associated Infections (HAIs) are "major causes of morbidity and mortality in the United States," according to the CDC. From 2009 through 2011, the CDC tracked nosocomial infections in the HAI and Antibiotic Prevalence Use Survey, a three-phase, point-prevalence nationwide survey. Also, visit the CDC's Safe Healthcare blog for relevant medical studies and updates on infection-prevention quality in hospitals around the country.
Health of minority populations
The ACA requires federal health data collection and analysis, including demographic data aimed at better understanding disparities. The HHS Office of Minority Health has detailed reports on five racial and ethnic groups.
The RWJF DataHub
The Robert Wood Johnson Foundation's DataHub tracks state-level data and allows users to customize and visualize facts and figures on key health and health care topics. It has a broad range of data sets pertaining to health coverage, status and reform.
Use data to cover the Affordable Care Act
The Robert Wood Johnson Foundation has six databases on its "Reform by the Numbers" website that can be useful for reporters covering health care. In an exclusive briefing at an AHCJ New York chapter meeting in June 2014, the Foundation's Katherine Hempstead, Ph.D., discussed the highlights of the databases.
The databases can answer many questions, such as whether consumers are having trouble paying their sky-high deductibles or whether waiting lines are growing at doctors’ offices. Want to know how your state exchange differs from others? This data can help. Hempstead also offers ideas for stories that can be mined from the data no matter your technical abilities.
State Exchange Markets
The State Exchange Markets tool, from the Center on Budget and Policy Priorities, has a preliminary summary of policies and data collected from other research data sets and Marketplace materials as well as from information provided by state advocates and Marketplace staff.
Health Insurance Exchange (HIX) Compare
This dataset, available from the Robert Wood Johnson Foundation,provides information on benefit design and cost sharing for health plans offered in all 50 states and the District of Columbia. Specifically, the dataset includes data on premiums, network composition, deductibles, out-of-pocket limits, and copayment and coinsurance amounts.
Tracking Americans’ experiences in the health insurance marketplaces
The Commonwealth Fund has developed an interactive data set based on its research about people shopping for health coverage in the exchanges.
How health IT is changing health care
The Office of National Coordinator for Health IT has databases about providers and use of technology and public health measures.
Trends in Insurance Coverage, Source of Private Coverage Among Young Adults
This report shows that, since September 2010 – when adults aged 19–25 were able to obtain dependent private health insurance coverage through a provision of the ACA – the percentage of young adults with private insurance increased and the percentage without insurance decreased. The increase in the percentage with private insurance occurred at about the same time (January–June 2011) as a temporary increase in the percentage of privately insured young adults who had been uninsured at some time in the past 12 months. This suggests that those newly insured were previously uninsured or had a period of no insurance in the past year. After this spike, the percentage of young adults with a period of no insurance did not return to pre-2011 levels but rather declined to levels consistent with slightly older adults. The data comes from the National Health Interview Survey, 2008–2012.
Localhealthdata.org (via Washington University’s Health Communication Research Laboratory). This includes U.S. government health data, data from numerous health organizations (i.e. American Heart Association), that can be searched by locality (state, city, county) analyzed, and easily turned into charts. (Not all the underlying raw data can be downloaded, but it includes sources of the information that may be able to provide it.)
Community health status & Medicare
The Health Indicators Warehouse, was updated this fall. It now includes 174 CMS indicators with data from 2007-10 focusing on community health status. It has data on Diabetes Medicare beneficiaries, Heart attack Medicare beneficiaries, Depression Medicare beneficiaries, Federally Qualified Health Center and Rural Health Clinic visits, Asthma for Medicare beneficiaries and Hypertension for Medicare beneficiaries. For more about the data, see “Health Indicators Warehouse Updates with 4-year Estimates of CMS Medicare Data.”
County health rankings
A collaboration between the University of Wisconsin Population Health Institute and the Robert Wood Johnson Foundation, this is a rich source of data about health at the local level – and who is doing what to improve it. You can get local story ideas by tracking the grantees – who is doing what. And you can dive into a whole lot of data through several links on the site, and particularly on this page.
Then you can go even deeper with the data drill-down guide.
The site looks at national and local trends regarding mortality and premature death, health related quality of life, as well as factors such as air pollution, smoking rates, obesity and teen births.
Leapfrog Group for Patient Safety
This is a group backed by large employers that gathers safety and quality data (from voluntary surveys) and uses it to promote higher quality, safer, more efficient health care
Leapfrog has its own version of hospital safety data – searchable by hospital and by procedure. The caveat is that hospitals submit information voluntarily and hospitals must pay the group to use its designation in marketing materials, but it can still be a useful tool. See this blog post about the limitations of so-called "hospital report cards."
Nonprofit hospitals' IRS 990s
One little-known element of the health care reform law sets new rules for nonprofits. They are required to assess community needs, and inform patients of charity policies. Some legislators want tougher rules and oversight to make sure they are providing enough service to the community to justify the tax break.
A number of reporters have delved into the issue of charity care and community benefit at nonprofit hospitals by using data from their IRS 990 forms. For example:
Financial data from IRS 990 forms about nonprofit hospitals: AHCJ has obtained information on the finances of nonprofit hospitals across the country from GuideStar, which compiles and disseminates financial documents from most U.S. nonprofits. This information is from tax year 2009. AHCJ hopes to update this information annually.
The Affordable Care Act expands review of proposed insurance premium increases – but does not allow Washington to reject increases. Some states have rate-setting powers. Others merely review the rates but cannot reject them. If states don’t review the rates in the individual or small group market, the federal government can. Up to $250 million will be available to states to help beef up review. Here is a list of the states that are conducting reviews, and the states where the federal government is stepping in. (Source: CCIIO/HHS, updated Feb. 16, 2012)
Effects of Selected Major Tax Expenditures from 2013 to 2022
Sometimes during debates over health policy you hear the term "tax exclusion." That's referring to the tax breaks for health insurance that people get through their (or a family member's) employment. The exclusion – or non-taxation of that benefit – is the single largest tax expenditure in the individual income tax code. It is more than the tax breaks for mortgages on personal residences, more than the breaks for state and local taxes, or for charities. In other words, it's a big pot of money that deficit-cutters may look at, but it's also politically hard to change. The Congressional Budget Office estimates the exclusion will equal 1.8 percent of GDP between 2013 and 2022.
EBRI (the Employer Benefit Research Institute) puts out data briefs ad summaries, but they often contain links to government databases that you can break down yourself.
For instance, here from the EBRI Databook provides an on overview/introducti on to employee benefits (including but not limited to health care). For those of you who are not comfortable with the data, it’s all summarized in this 10 page introductory chapter,w ith links that take you to other briefs. For those of you who want to dive more deeply into some of the federal data bases, there are links and date is a available in both PDF and Excel tables. For instance here are the “age pyramids” showing how the population is aging, and the relative sizes of older and younger cohorts. It’s also broken down by region, so, for instance you can look at the sunbelt versus the rust belt.
The chapter also provides links to lots of tables on employment trends – including women of childbearing age, veterans and the disabled.
Health care expenditures and utilization
The Agency for Healthcare Research and Quality offers data about medical expenditures, health care costs and utilization, broken down by state and by payer. There's also data about health care disparities and state snapshots.
The Medical Expenditure Panel Survey (MEPS) gives details on what health services Americans use, how frequently, what they cost, and how they are paid for. The U.S. Agency for Healthcare Quality and Research compiles data and sends out summaries, with data broken down by state. See Statistical Brief #329: State Differences in the Cost of Job-Related Health Insurance, 2010. The MEPS website has updated 2010 health insurance data by state.
Here are some highlights from the agency’s News and Numbers (July 2011) about state differences in the cost of job-related health insurance:
Hospital and provider utilization from the Kaiser Family Foundation: This tool includes data about hospitals, nursing homes, federally qualified health and rural health centers, physicians, non-physician providers and health care employment. See how the indicators compare across the states. Results will be shown as a table, map, or trend graph as available.
Inpatient and outpatient services, utilization and cost
CMS has released a lot of data on inpatient and outpatient services, utilization and cost. Here are some links to the data and some links to tools to help you use and visualize it.
Health care costs
We often try to provide databases that you can download. While this doesn’t quite fall into that category, The Wall Street Journal did create an interactive map with charts and tables that give you state-by-state information on health care costs.
Essential health benefits
In 2014, all health plans, in and out of the exchanges, will have to offer "essential benefits," or a minimal, reliable comprehensive level of coverage. This chart illustrates the basic categories of coverage, although plans can offer more, and consumers will have choices and tradeoffs. The ACA law itself does not define the essential benefits; HHS will, with advice from the Institute of Medicine and other sources.
Improving hospital quality
Health reform includes lots of initiatives to improve hospital quality and bring down Medicare costs. Here’s one area that some experts want to address. This chart from the Agency for Health Research and Quality (AHRQ) shows that the number of hospital stays principally for septicemia (sometimes colloquially called “blood poisoning) more than doubled between 2000 and 2009 (337,100 to 836,000 admissions) – making it the sixth most common reason for hospitalization in 2009. The most common reason (one out of five hospitalizations) was because of a complication from a device, implant, or graft. The in-hospital death rate was 16 percent in 2009 – more than eight times as high as for all other hospital stays.
Evaluate the quality of hospitals in your area
Graphic via OpenHeatMap
AHCJ offers hospital mortality and readmission data, which will allow you to tell your audience whether a hospital's rates are in line with national averages, significantly better or significantly worse. A special AHCJ webinar provided an introduction to this data, including ideas on how to use the data in your own area.
The federal survey that reflects patients' perspectives of hospital care has been updated on the AHCJ website. The spreadsheets that AHCJ offers allow you to analyze the top-rated hospitals — or lowest-rated hospitals — in your area.
The Commonwealth Fund’s Health System Data Center breaks down lots of state and local data, and includes searchable data on child health and long-term care.
These files are PDFs of charts, not downloadable Excel files (although their communications shop can probably help if you are looking for something specific). But there are queries you can fill in, and the site will generate specific charts and comparisons for you.
Small business tax credit
The Affordable Care Act provides a temporary tax credit for small employers – defined as having 25 full-time workers or the equivalent – with average wages less than $50,000. But not many know about it, or that they may be eligible, according to the survey. The White House has estimated that up to 4 million small businesses may be eligible for credits, which are meant to defray part of the insurance costs
This Kaiser Family Foundation report on employer health benefits found that 29 percent of firms with fewer than 50 employees that offer health coverage tried to find out if they were eligible, and 65 percent did not. Of small businesses that did not offer insurance, half said they were aware of the tax credit and 48 percent said they did not know about it. Of those that were aware, only 13 percent said the availability of a credit had not led them to consider whether to start offering insurance to their workers. Read more: Do small businesses in your area know about tax credit for offering coverage?
According to the federal Agency for Healthcare Research and Quality, fewer than one out of three physicians in direct patient care are in primary care – family physicians, general practitioners, general internists, pediatricians and geriatricians. (The primary care count is lower than the numbers cited by the AMA, and the AHRQ fact sheet explains why).
Americans made nearly 956 million visits to office-based physicians in 2008. Just over half – 51.3 percent – were to primary care physicians.
The number of nurse practitioners and physicians assistants has risen, but it may come as a surprise to learn that the AHRQ-commissioned research found that just over half (52 percent ) of the 106,073 nurse practitioners and just 43 percent of the 70,383 physician assistants were practicing primary care. The rest were in specialty settings.
Data files from the National Center for Health Statistics
The National Center for Health Statistics offers downloadable public-use data files through the Centers for Disease Control and Prevention's FTP file server. Data sets, documentation and questionnaires from NCHS surveys and data collection systems are available.
Community Health Data Initiative
The U.S. Department of Health and Human Services and the Institute of Medicine launched this initiative to help consumers and communities get more value out of the nation's wealth of health data. It includes a number of web tools, reports and downloadable data.
HHS provides a CMS resource on historic, current, and projected data on Medicare and Medicaid – enrollment, spending, use. It also has data on budget, administrative and operating costs, providers and suppliers.
A statistical supplement offers a wealth of Medicare and Medicaid spending data. HHS says it includes “charts and tables showing health expenditures for the entire U.S. population, characteristics of the covered populations, use of services, and expenditures under these programs.”
Medicare Beneficiaries’ Use of Telehealth in 2020
Report examining changes in Medicare beneficiaries’ use of telehealth in 2020 during the COVID-19 public health emergency. In-person visits dropped while telehealth visits increased 63-fold.
CMS Chronic Conditions Dashboard
This lets you compile data on prevalence of 15 common chronic conditions – including depression -- how much they costs, who they affects, and state by state burdens.
RWJF Data Hub
This is a user friendly RWJF data hub that you can explore and customize under the following six areas:
While the AHCJ website has data available on Medicare and Medicare, here’s a menu-driven search tool that can help you search and navigate more government health data. It will retrieve data sets or statistical reports.
Hospital readmission rates
In April 2013, the Agency for Health Care Research and Quality released updated data on 30-day hospital readmission rates for 2010. They are available by procedure (PDF file, 198 KB; HTML) and by diagnosis (PDF file, 319 KB; HTML). An infographic, 30-Day Readmission Rates to U.S. Hospitals, 2010, is available in PDF, JPEG and text formats. Related: Reporters can use hospital readmission data to explore key issues
Tip sheets on analyzing health data
Finding patterns and trends in health data: Pivot tables in spreadsheets
Excel pivot tables are a powerful way to organize, interpret and manipulate numerical data. In this tip sheet, reporters will learn the skills necessary to apply these tables in real-world situations, including analyzing the Nursing Home Compare data.
Intro to investigating health data using spreadsheets
This tutorial will give you a jumpstart on using spreadsheets to investigate health data. While it's important to remember that a spreadsheet can give you a lead but can't replace your news judgment, this will help you navigate around spreadsheets, understand some basic references and learn some good practices in dealing with data.
Updated hospital data allows reporters to identify ongoing problems
The Centers for Medicare and Medicaid Services has been reporting patient survival rates for hospitals across the United States for four years now and hospital readmission rates for three. While some journalists may have a been-there-done-that reaction to yet another round of data, the latest release has important information for your readers, viewers and listeners. After several years, a surprising number of hospitals can't seem to improve – and an elite group has been able to maintain their excellence.
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