Health reporters spend a lot of time tracking ACA litigation (especially but not exclusively the Texas lawsuit that aims to overthrow the whole statute). Here are some legal scholars who write extensively on health law, and can guide you.
Nick Bagley of the University of Michigan Law School has excellent analysis. He posts on both the health section of the TakeCare blog and Incidental Economist.
Conservative lawyer Jonathan Adler, who has fought the ACA to the Supreme Court in prior cases but thinks the legal arguments in the Texas-led anti-ACA litigation don’t add up, writes frequently for the Volokh Conspiracy.
Some websites and apps can estimate costs of various health plans in the new insurance exchanges. Some are better than others. The Kaiser Family Foundation has a calculator. Zeke Emanuel and Andrew Steinmetz wrote this op-ed describing two fairly sophisticated calculators that do a whole lot of what HealthCare.gov is supposed to do (calculating and shopping options but not all the verification that the government site has to do). One is on the website of Steve Morse. The other is called Value Penguin.
Center for Consumer Information and Insurance Oversight
National Association of Community Health Centers Community health centers are expanding, because of the health reform law and funding made available through the 2009 stimulus law. This site has information about where they are, what policy issues face them, and leads about what some of the more innovative centers are trying to do.
Consultants and Legal Groups
Many HR consultancies, investment groups, and law firms have health policy resources (reports, webcasts, etc.) that are available to reporters, often online. Here are just a few of them:
Mercer Not all the benefits and HR data is relevant to health, but some of its work on health care benefit trends and employment is useful.
Community Health Status Indicators (CHSI)
This website produces public health profiles for all 3,143 counties in the United States. Each profile includes key indicators of health outcomes, which describes the population health status of a county and factors that have the potential to influence health outcomes, such as health care access and quality, health behaviors, social factors, and the physical environment. The online application includes updated peer county groups, health status indicators, a summary comparison page, and U.S. Census tract data and indicators for sub-populations (age groups, sex, and race/ethnicity) to identify potential health disparities. In this version of CHSI, updated in March 2015, all indicators are benchmarked against those of peer counties, the median of all U.S. counties, and Healthy People 2020 targets.
For background on what a co-op is, and some examples of successful ones that predate the Affordable Care Act, see this 2009 “tool kit” from the Alliance for Health Reform. It was written before the final legislation was passed in the Senate, but is still a useful overview.
Here’ s an HHS fact sheet – it was written before the funds were cut off, but it explains the federal program that applies to those that are going ahead.
Health Affairs and RWJF have published a brief that explains in more detail about how they are set up, and the challenges they face. The brief gives a description of several of the co-ops – here are the top three on the list to give a taste of the variety. (There are more in the brief and the National Alliance of State Health Cooperatives has a full list (PDF).
Beneficiaries Dually Eligible for Medicare and Medicaid: This is a data book that is an updated, joint initiative of MACPAC and MedPAC, which advise Congress on Medicaid and Medicare respectively. It looks especially at the high-risk, high-cost population that are eligible for both Medicare and Medicaid.
Here are two resources that help you understand the arcane terms you will come across trying to understand federal budgeting and spending, including health care programs. (Example outlays, “PAY-GO”, mandatory versus discretionary spending). One is a glossary from the Congressional Budget Office (CBO). The other is a plain English guide to the federal budget from the Center for Budget and Policy Priorities.
Congressional Budget Office: The CBO is the official “scorer” – or estimator – of legislation. The website has a huge trove of data, some more technical than other.
There is a section on Selected CBO Publications Related to Health Care Legislation 2090-2010
There is a section on other health policy, including Children’s Health Insurance Program and Physician Payment.
Don’t’ be put off by the daunting title of this March 2011 CBO analysis: “Reducing the Deficit: Spending and Revenue Options.” It has good one- or two-page nonspecialist descriptions of federal programs that could be changed in the ongoing budget debate. Many changes would be felt in local communities. (This is a link to the PDF)
CBO Glossary – Not light reading but still a useful one-stop-shopping for government financial terms.
MACPAC – the Medicaid and CHIP Payment and Access Commission – was established when the Children's Health Insurance Program was renewed in 2009 and it was expanded in the health care law. It reviews state and federal Medicaid and CHIP access and payment policies and makes recommendations to Congress, HHS and the states. Reports are online.
Health care costs
The Health Care Cost Institute has de-identified claims data from three big health insurers, which it has been using to analyze cost trends. Here’s a link to several state-focused issue briefs on scope of practice, cancer care, telemedicine and other issues.
Consumers Union has a useful glossary of terms used during discussions of drug pricing.
White House report: Trends in health care cost growth and the role of the Affordable Care Act, November 2013 This report analyzes recent trends in health care costs, the forces driving those trends, and their likely economic benefits. It states that health care spending growth is the lowest on record and that, “while the causes of the slowdown are not yet fully understood, the evidence available to date supports several conclusions about the slowdown and the role of the ACA.”
Reference Pricing: Will Price Caps Help Contain Health Care Costs? On Nov. 18, 2013, a panel of experts addressed a new strategy employers have begun known as "reference pricing" to help reduce health care costs. Under this benefit design, employees get insurance plans that set price caps on certain services and procedures. Enrollees are allowed to use any provider. But if they use providers with fees higher than the "reference price," they must pay the difference between the reference price limit, determined by the employer or insurer, and the actual charge. The transcript and video are available here. The event was sponsored by the Alliance for Health Reform and WellPoint.
Online tool uses state, federal data to track marketplace enrollments
The federal government plans to release exchange enrollment figures once a month (here’s the first report), and they’re expected to give more demographic information (i.e. age, metal tier) in future updates. States have different timetables for releasing their statistics. To keep track of it all, the Kaiser Family Foundation has a new tool: the State Marketplace Statistics.
It has both the enrollment numbers as well as some other key stats to watch (when available):
Eligibility determinations, including how many people can enroll in a marketplace plan with financial assistance and how many qualify for Medicaid/CHIP
Zeke Emanuel and Andrew Steinmetz wrote this op-ed describing two fairly sophisticated calculators that do a whole lot of what HealthCare.gov is supposed to do (calculating and shopping options but not all the verification that the government site has to do). One is on thewebsite of Steve Morse. The other is called Value Penguin. When I plugged in the same scenarios in the two sites, I came up with fairly consistent price quotes and options for families without a subsidy. It was a little harder to compare with the subsidy. One gave actual quotes, while the other gave more general price limits with subsidies. The Kaiser Family Foundation also has a calculator that takes into account ZIP code, income, age, family size and other factors.
Health Insurance Marketplace Premiums for 2014
The HHS Office of the Assistant Secretary for Planning and Evaluation released an issue brief summarizing the health plan choices and premiums that will be available in the Health Insurance Marketplace. It contains information, current as of Sept. 18, 2013, on qualified health plans in the 36 states in which the Department of Health and Human Services will support or fully run the Health Insurance Marketplace in 2014. Plan data is in final stages but is still under review, so this information is subject to change. The analysis includes similar information that is publicly available from 11 states and the District of Columbia that are implementing their own Marketplace. Health Insurance Marketplace Premiums for 2014 Databook
Just days after the November elections, states will have to make decisions about whether they are going to run their own health insurance exchange and what that will look like. States also are grappling with decisions about the essential benefits packages and Medicaid expansion. We talk to three experts who are doing hands-on work with both “red” and “blue” states.
A recording of this webcast is now available for AHCJ members. Log in to this page to access it.
This document (PDF) from the Center for Consumer Information and Insurance Oversight gives a good precise of the role and responsibilities of the exchanges, as well as how the states and federal government may divvy up the tasks. Particularly useful is the charge on page 5 explaining the five key functions of the insurance exchange:
Eligibililty (who goes into what program, what subsidies may apply)
Financial Management and the timetable on page 15 that shows what states have to do between now and 2014.
Slashdot.org is a place to track what the self-described tech nerds are saying online about the cyber-infrastructure of the health insurance marketplaces. CAVEAT: We’re listing it here as site you might find interesting – we are not endorsing everything that’s posted on it or asserting that it’s accurate so be forewarned. It isn’t peer reviewed; it’s something that people post on, but those of you who speak tech as well as health might want to peruse it.
Health policy issues
Health Economics Briefs from Penn’s Leonard Davis Institute
How Has the Affordable Care Act Affected Work and Wages?
Turmoil in the Health Insurance Marketplaces
Insurance Coverage and Access to Care Under the Affordable Care Act
Effect of the ACA on Cost Containment
Written with reporters in mind,"The Sourcebook: Essentials of Health Policy" is useful for anyone looking for concise information on health policy issues, and experts from across the political spectrum. Chapters contain fast facts, background, tips for reporters, story ideas and experts with contact information. The book also includes an extensive glossary and ideas for TV and radio reporters.
Guide to health policy acronyms: If there's one thing health policy has in abundance, it's acronyms. So many that CMS (itself an acronym and a truncated one at that; as it stands for the Centers for Medicare and Medicaid Services) has an online acronym guide. There are hundreds of entries, alphabetically arranged. Some are quite obscure.
Health reform topic leader Joanne Kenen has compiled a list of books that journalists might find useful. She says: "Most of these books I’ve read all or part of. A few are new and I haven’t gotten to them yet, and a handful I’m relying on recommendations of others. Disclosure: I know a lot of these authors – friends, colleagues, sources, AHCJ members, even a former professor or two. Finally, there are more books aimed at explaining the new law or providing historical context than there are on how to dismantle or replace it – partly because there’s a larger crop of such books to choose from, and partly because it’s more relevant to this website. But the conservative viewpoint is represented."
“Evidence tracker” – evaluating delivery system and payment reform: The Kaiser Family Foundation has a new (as of November 2017) “Evidence Tracker” to evaluate various new delivery systems and payment models, many of which were created or encouraged under the Affordable Care Act. It includes data on Accountable Care Organizations, Medical Homes, Bundling and other models.
The New Wave of Innovation: How the Health Care System Is Reforming: This resource for journalists from The Commonwealth Fund looks at emerging innovations, providing examples from different sectors across the country, to inform journalists and others of the ways in which the system is reforming itself. It may also provide ideas for journalists who are interested in exploring the early effects of health reform and the implications for the future.
Latest innovations in Medicare: Don’t look only to Washington policymakers for strategies to control medical costs and improve care for our aging population. New pilot projects that could accomplish these goals, which are at the heart of health reform, are being tested in communities across the country. In this tip sheet, reporter Susan Jaffe provides an overview of projects sponsored by the Center for Medicare and Medicaid Innovation, directs journalists to helpful resources and supplies an extensive list of potential story ideas.
Perspectives: Options for Reforming Medicare: Experts and policymakers in Washington are considering a broad range of proposals for reforming Medicare. Below, we present perspectives from leading experts on some of the more frequently mentioned policy options. Henry Aaron is a Senior Fellow in Economic Studies at The Brookings Institution, Stuart Butler is the Director of the Heritage Foundation’s Center for Policy Innovation, and Avalere Health is a leading health care policy consulting firm.
The Commonwealth Fund's Health Reform Resource Center: Explore the provisions of the Affordable Care Act and find the latest regulations. View the timeline for the highlights of the law, or use the "Find Health Reform Provisions" tool to search for specific provisions by year, category, and/or stakeholder group.
The National Governors Association has a guide to Medicaid waivers. Many states are overhauling aspects of their Medicaid program as they try to restrain costs while expanding coverage, or as they develop community-based alternatives to nursing homes for the elderly and disabled. The NGA developed a tool kit for states going through the waiver process. The overview sections are written in ways that clearly explain the process and some of the trends at the state level.
The Kaiser Family Foundation has an issue brief that explains Medicaid waivers with particular attention to the six states that have done nontraditional Medicaid expansion.
The Galen Institute aggregates conservative, free-market oriented, reports and commentary at ObamaCareWatch.org. It also has information about policy proposals from the right, and includes an experts page with contact information.
Center on Budget Policy Priorities: CBPP is a well-respected liberal research center with a focus on state and federal fiscal policies and programs that affect low- and moderate-income families and individuals. Issues reports and blog posts on health and entitlements.
U.S. Chamber of Commerce: Health care: The U.S. Chamber of Commerce, which can provide a conservative critique of health reform, has a plan to help businesses get health care costs under control, improve the quality of health care coverage and services, and expand meaningful coverage to the uninsured.
Heritage Foundation's Health Care Initiative: This conservative organization contends that health care is one of the most highly regulated sectors of the American economy and that government financing means government control, and government control means less personal freedom.
Choosing Wisely® is a campaign by the American Board of Internal Medicine to help physicians and patients engage in conversations to reduce overuse of tests and procedures, and support physician efforts to help patients make smart and effective care choices. The medical specialty societies, along with Consumer Reports, have identified tests or procedures commonly used whose necessity should be questioned and discussed. The resulting lists of "Things Physicians and Patients Should Question" provides some guidance about the need—or lack thereof—for many frequently ordered tests or treatments.
U.S. Preventive Services Taskforce: This independent panel of experts reviews scientific evidence for a broad range of clinical preventive health care services (such as screening, counseling, and preventive medications) and develops recommendations for primary care clinicians and health systems. The panel is composed of primary care providers (such as internists, pediatricians, family physicians, gynecologists/obstetricians, nurses, and health behavior specialists).
The Urban Institute and the Catalyst for Payment Reform have put out a guide to common new payment methods (capitation, bundling, global budgets etc.).
National Quality Forum: The ABCs of measuring performance. The NQF certifies quality measures. Here is an overview.
Section 1115 of the Social Security Act gives the secretary of Health and Human Services authority to approve experimental, pilot, or demonstration projects that promote the objectives of the Medicaid and CHIP programs. The waivers give States flexibility to design and improve their Medicaid and CHIP programs. See a list of waivers by state.
With states thinking about using Medicaid expansion dollars to purchase private health coverage for low income people, this paper from the Kaiser Family Foundation explores how this version of “premium” assistance works under the current law.
The Kaiser Family Foundation has an issue brief, "Aiming for Fewer Hospital U-turns: The Medicare Hospital Readmission Reduction Program," that describes the HRRP, analyzes the impact of this program on Medicare patients and hospitals, and discusses several issues that have been raised regarding its implementation. While other studies have focused primarily on penalties imposed on specific hospitals, this Issue Brief provides additional analysis on the extent to which Medicare beneficiaries stay in hospitals with relatively high penalties and national trends in beneficiary readmission rates.
Repeal and replace
The American Academy of Actuaries analyzes health insurance ideas and trends, and in early 2017 began releasing a series of nonpartisan briefs explaining and analyzing GOP ideas for ACA replacement. The first three are:
GOP Repeal and Replace plan comparisons: The Kaiser Family Foundation has created an interactive tool to compare various GOP health plans. Click here.
Ruralhealthinfo.org: The Rural Health Information Hub, based at the University of North Dakota School of Medicine and Health Sciences, has information about what rural communities are doing to improve health. They can also provide advice on resources: 800-270-1898.
Daily Yonder - Linked to a rural policy think tank, this publication tracks rural health care, the opioid crisis, and agriculture, food and nutrition policy. Read it here.
The Robert Wood Johnson Foundation has done a series of nine reports (March 2014), looking at aspects of state implementation of the ACA including the enrollment systems, insurer participation, outreach and the small business market.
State Health Insurance Exchange Websites: (updated Oct. 7, 2013) This chart, from State Refor(u)m, provides links to the web portals, where consumers can purchase coverage, as well as links to relevant agency websites containing exchange policy and consumer assistance-related information.
KFF State Health Facts: A division of the Kaiser Family Foundation, it is a boon to local reporters, providing free, easy-to-use health data for all 50 states
National Conference of State Legislatures: A bipartisan organization that serves the legislators and staffs of the states and territories. It provides summaries on state implementation of health reform, Medicaid, budgets and other health-related topics.
State Health Reform Assistance Network: A program funded by the Robert Wood Johnson Foundation helping states with technical assistance on coverage expansion under the Affordable Care Act. The network's director, Heather Howard, has contributed useful maps showing where states are on implementing exchanges and the status of funding for each state, as well as a list of resources, as of October 2012.
State Refor(u)m: An online network for health reform implementation that connects health officials from different states, and with outside experts.
State Health Policy Options: This is a new (Oct 2012) website from the National Governors Association on state options for health reform. It includes names (but not contact info) of key state officials, as well as policy resources on cost and coverage, exchange creation, and delivery system reforms such a medical homes.
As you follow the legal fight over whether ACA subsidies can flow through the federal exchanges, or only the state exchanges, these reports from Avalere and RWJF/Urban Institute will help you understand who would be affected. And SCOTUSblog.org can keep you up on the progress of the cases. Use the search box at the top of the site and click on “blog.”
Tax aspects of the ACA
This IRS chart shows how employers have to report pre-tax health benefits on W-2 forms. The idea, part of the health law, is to show employees more clearly the value of their health benefits.
This is the first tax season that people have to address their health insurance coverage status on their returns. Here are two resources to help you understand it: This IRS document updates – in consumer-friendly language – the tax pieces of the ACA that individuals need to be aware of. Also, the Wall Street Journal has a summary of ACA implications for 2014 taxes.
The Internal Revenue Service has released guidance on the tax provisions included in the Affordable Care Act, such as the Premium Tax Credit and the requirement to report the cost of coverage under an employer-sponsored group health plan on an employee’s Form W-2.
State attorneys general Martha Coakley (Mass.) and Ken Cuccinelli (Va.) debated the Affordable Healthcare Act as a prelude to the Supreme Court’s consideration of the law. National Press Club's "Newsmakers" series hosted the event. The attorneys general addressed several facets of the Supreme Court case, including the health care mandate, the tax basis, the general welfare aspect, expansion of Medicaid, severability, the law’s provisions and other areas.
GAO report: Expert Views on Approaches to Encourage Voluntary Enrollment
America’s Health Insurance Plans (AHIP), the main insurance industry trade group, outlines its views, and summarizes state experiments, at its “The Link” website.
AHCJ has tip sheets, blog posts and a webinar on the topic:
Webcast: To assist reporters across the country who will need to localize the decision and what it means for their states and local communities, AHCJ hosted a one-hour online roundtable of experts to offer you suggestions on stories you can pursue right away and in the weeks ahead.
CMS FAQ on Value-Based Purchasing
This 32-page FAQ goes into a great deal of detail about changes in Medicare hospital payments, and expectations of hospitals under the Affordable Care Act.
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.
On the preliminary campaign trail, Republicans vying for their party's president nomination attack Massachusetts' near universal coverage – which was created under then-Republican Gov. Mitt Romney and state Democrats, including the late Sen. Edward Kennedy. In Washington, Republicans are seeking to repeal the national health law that was in part based on the Massachusetts model, while also pushing to turn Medicaid into a block grant, saying they don't have enough flexibility to control costs and innovate. Romney's successor, Democrat Deval Patrick, testified June 23 before the Senate Finance Committee hearing on health entitlements. He addressed all of the above – stressing that his state was able to become a trailblazer within the current parameters on flexiblity.
Three movies about health care – overtreatment, undertreatment, cost, quality, the uninsured, the underinsured, the safety nets – are being launched. Some are being shown in community settings like medical schools – might be a good story to go to one of the screenings and see how it’s received and what people say. “Escape Fire”looks at military medicine too – maybe explore how its message pertains to veteran’s care where you live.
“Money and Medicine,” shot at UCLA Medical Center in Los Angeles and Intermountain Medical Center in Utah, airs on PBS stations starting Sept. 25. (Dates may vary in other communities.)
“The Waiting Room” goes inside a safety net, Oakland’s Highland Hospital, and it premieres Sept 26 in New York.
“Escape Fire” has held a bunch of medical school screenings and goes into wider release next week.
If you are covering comparative effectiveness research, trying to assess the validity of providers’ claims about treatments, procedures, drugs, “breakthroughs,” vitamins, alternative medicines, counterclaims of skeptical insurers or other payers (including public payers like state Medicaid programs) a local medical “arms race,” or patient-centered decision-making (“should I have treatment A or treatment B”), the databases and podcasts in the Cochrane Library can guide you to reviews of the clinical and/or economic evidence. More detail on how to use it.