Tip sheets

Journalists and experts have written about covering health reform and presented discussions on the topic at AHCJ conferences and workshops. This is a collection of the most useful and relevant tips. Click the title of the tip sheet that interests you and you will be asked to login because these are available exclusively to AHCJ members.

Affordable Care Act (ACA)

Consumers and the ACA


Electronic medical records

Employers and the ACA

Health care costs

Health care workforce

Health exchanges/marketplaces

Health Journalism 2011: Health reform presentations

Health Journalism 2010: Health reform presentations

Health reform resources for reporters

High-risk insurance pools


Immigrants and the ACA



Rural health

Supreme Court

Affordable Care Act (ACA)

What reporters should watch for during this year’s open enrollment 

November 2018
Affordable Care Act's open enrollment for calendar year 2019 began Nov. 1 and runs until Dec. 15, 2018, at Healthcare.gov or most state exchanges, although a few states have different sign-up periods.

As noted in a recent story for Washington Examiner, the Trump administration has instituted new regulations and changes for customers to navigate as they shop for health plans over the next several weeks. So keep these seven things in mind when reporting on open enrollment in your community.

Keep these points in mind when covering the tax bill’s impact on health care

December 2017
The House and the Senate both have passed tax bills which have provisions that will deeply affect health care, ranging from repeal of the individual mandate to repeal of a tax credit meant to help businesses comply with the Americans with Disabilities Act. Since the bills are not identical, the final legislation must first be negotiated in a conference committee. Not all the provisions will survive, although the final bill most likely will more closely resemble the Senate version, which includes repeal Affordable Care Act’s individual mandate. Learn more about the health provisions at stake.

How to assess health care innovation centers popping up in your region

October 2017
It seems like every week there's a new press release about a new health innovation center opening up shop.

Since passage of the Affordable Care Act in 2010, which emphasized the transition from patient volume to value, innovation centers have been popping up all over the country. Becker's Hospital Review has identified at least 50 hospitals with innovation programs.

What you should know about new HHS rules on state control of health plans

Louise NorrisJune 2017
Before the Affordable Care Act, health insurance regulation in the individual market largely was managed by the states. The ACA saw a shift to a greater federal role. Now under the Trump administration, some responsibilities are going back to the states. In this tip sheet, Louise Norris explains the new responsibilities. One significant area is network adequacy – whether a plan has enough doctors, hospitals and other providers to meet the needs of beneficiaries. The other area is drug formulary non-discrimination – did the plan design its drug formulary or marketing to discriminate against people with high-cost health needs?

How ACA repeal could impact mental health care

February 2017
The Affordable Care Act (ACA) led to the biggest expansion in mental health services in several decades, helping to close long-standing gaps in access and coverage for as many as 60 million people.

President Donald Trump promises to gut the federal law, which would include its substantial protections for people with mental conditions. Health care advocates warn that repealing the ACA would have a severe effect on the 43.6 million people living in the United States with a psychiatric illness and the 21.5 million with a substance abuse disorder, according to a 2014 government survey.

In this tip sheet, Sarah Ferris runs down the key ways in which repealing the ACA could affect people with mental illnesses or addictions. These are some important issues to consider when reporting about repeal and replacement efforts.

How Congressional Republicans plan to gut the ACA

U.S. CapitolJanuary 2017
Republicans in Congress aim to vote to repeal the Affordable Care Act in the first 100 days of Donald Trump’s presidency.

Even with Trump in the White House, the GOP won’t be able to get a full repeal of the ACA through the narrowly divided Senate. Instead, Republicans will use a legislative tactic called reconciliation, which will enable them to push massive budget-related bills through the Senate without the threat of a Democratic filibuster.

Sarah Ferris has prepared a guide to some of the bewildering D.C. budget lingo and process for this to take place.

Suggestions on writing accurately about rising premiums

November 2016
Health insurance premiums obviously are going up – and we’re all, appropriately, writing about it. Affordability is a political issue, affordability is a consumer issue, and affordability is an economic sustainability issue.

But we need to do it accurately, not sloppily. Here are a few quick suggestions:

Five things to know about ACA enrollment challenges for ‘young invincibles’

October 2016
The “young invincibles” live up to their name. They don’t think they’ll get sick or hurt, and so they take bigger risks than most people, including the risk of going without health insurance. Because of this, they have posed a challenge for insurers and the Obama administration.

Young, healthy Americans are a crucial demographic to the success of the Affordable Care Act. Their participation in Obamacare exchanges is important to help balance out the cost of older enrollees more likely to get sick and need medical care more often.

Selling insurance across state lines: What reporters need to know

April 2016
Republicans talking about their ideas for replacing the Affordable Care Act often propose selling health insurance “across state lines.” The general thrust of the idea is to boost competition in state insurance markets by providing consumers a wider array of plans from which to choose.

How is this proposal for interstate insurance sales different than what currently exists in the marketplace, where the nation’s largest health insurers (Aetna, United HealthCare, etc.) already sell policies in multiple states? And what evidence do we have about whether the idea would be successful? What has happened in the handful of states that have already tried it? What effect would it have on the uninsured?

Rachana Pradhan covers a few things you need to know.

Congress votes to give states more say in defining the small group insurance market

October 2015
In 2016, the definition of “small business” or “small group” market was supposed to change under the Affordable Care Act. Instead of covering businesses with up to 50 workers, the small group market would encompass businesses with up to 100.

But in a rare bipartisan move on ACA-related legislation this week, the House of Representatives, followed by the Senate, swiftly and quietly voted to make this change optional for states as part of what has become known as the Protecting Affordable Coverage for Employees Act (PACE). The House voted on September 29 and the Senate on October 1.

How to gauge ‘success’ at the Center for Medicare and Medicaid Innovation

August 2015
One agency created by the Affordable Care Act is the Center for Medicare & Medicaid Innovation (CMMI). As the name implies, its task is to innovate: trying new ways of delivering health care and testing new incentives and payment models. Some ideas are likely, even expected, to fail. Others may lead to new ways of delivering higher quality care for less money.

CMMI also is supposed to help spread new ideas so they’ll take root in the real world. The U.S. Department of Health and Human Serviceshas the authority to expand approaches that reduce spending – and halt those that do not. This is a more flexible approach than officials had with “demonstration projects” prior to the ACA.

Acronyms, health care and the poor: Understanding hospital safety net payments

July 2015
The months-long controversy between Florida and the federal Medicaid program over funding for hospitals and clinics that serve uninsured low-income people drew attention to these uncompensated care pools. In Florida the arrangement is called the Low-Income Pool – better known as “LIP” (a gift to headline writers).

So what are these payments? And how do they differ from a Disproportionate Share Hospital (DSH) arrangement?

At least nine states, including Florida, have some kind of Medicaid waiver arrangement with the federal government that involves payments to safety net hospitals and, in at least some states, community health centers.

Affordable Care Act: What is 'premium support?'

April 2011
"Premium support" is one of those quintessential Washington phrases. What on earth does it mean?

It's in the news now because House Budget chairman Paul Ryan wants to turn Medicare into a "premium support" program. It's not a totally new idea – House Republicans, including former Speaker Newt Gingrich and former House Ways and Means chairman Bill Thomas, had somewhat similar ideas that began circulating in the mid-1990s. But the Ryan idea is starker - or bolder, depending on your perspective.

AHCJ's health reform topic leader Joanne Kenen explains what it really means and points members to some resources to help sort it out for readers, listeners and viewers.

Health Coverage under the Affordable Care Act

April 2011
Timothy Stoltzfus Jost, of Washington and Lee University, compiled this tip sheet for the Health Journalism 2011 panel "Health insurance: Changes that are coming fast." It outlines how coverage will be expanded, the five categories of coverage, plan requirements as well as pros and cons, and information about enforcement of the Affordable Care Act.

Lessons learned from Massachusetts: Covering the impact of health reform on a local level

April 2011
Tips from Karen Brown, of WFCR Public Radio in Amherst, Mass., compiled for the Health Journalism 2011 panel "What we've learned from the Massachusetts experiment." Brown suggests the people you should be talking to and how to find the stories your audience will appreciate.

Affordable Care Act: The politics of health care, year two

March 2011
The Affordable Care Act just hit the one-year mark, but that's not likely to change the political dynamic in D.C. and many state capitals. Indeed, it may intensify as the 2012 campaign approaches. Following the complex legislative and budgetary procedures in Congress from a distance can be daunting. Here's a brief guide to some of what's unfolding and likely to unfold in the next year or two.

The Affordable Care Act: What to cover at the one-year mark

Covering health reformMarch 2011
The Affordable Care Act became law nearly one year ago, on March 23, 2010. The biggest provisions – the state-based exchanges and the subsidies for low and moderate income people to buy insurance – don't go into effect until 2014, but dozens of lesser known programs and provisions are already under way, and most states (including some that are fighting health reform in court) are working on implementation plans.

As the anniversary approaches, AHCJ's new health reform topic leader, Joanne Kenen, shares some topics that reporters may want to look at in their states and communities, as well as resources for covering them.

Officials, health system administrator discuss challenges, implementation of the Affordable Care Act

March 2011
Support for health reform has been complicated by political rhetoric and the general public's lack of knowledge about the Affordable Care Act, according to officials who spoke at an AHCJ Chicago chapter meeting. Hear from Chiquita Brooks-LaSure, the director of coverage policy in the Office of Health Reform in the U.S. Department of Health and Human Services, and Michael McRaith, director of the Illinois Department of Insurance, in this panel, moderated by journalist Bruce Japsen.

Consumers and the ACA

Don't stick to experts: How to find people who acquired insurance under the ACA

Shannon Muchmore
Shannon Muchmore

May 2015
Having trouble talking to “real” people about their experiences under the Affordable Care Act?

This tip sheet by Shannon Muchmore, health care reporter at the Tulsa World, gives some hints. She shares ideas on finding people, what to ask them about their insurance coverage and some story ideas, as well as some important reminders for reporters.

She also shares some of the stories she's written that include consumers' experiences and perceptions.

Joanne Kenen
Joanne Kenen

Who will help consumers understand their options?

August 2013
Navigators. In-person assisters. Volunteers.

Who are they and what do they do?

Getting people to sign up for health coverage under the Affordable Care Act will take more than a few public service ads and some brochures. So the law envisioned having “navigators” and other community organizations and trained individuals help them. Various advocacy groups also will mount volunteer efforts.

Understanding the role of these people and organizations will be important as the federal government is set to announce on Aug. 15 who will get navigator grants from a pool of $54 million. 

Health reform topic leader Joanne Kenen breaks it down and identifies some local stories that reporters should be working on.


Datasets: Reform by the Numbers

June 2014
As part of the Robert Wood Johnson Foundation’s efforts to monitor the impact of the Affordable Care Act (ACA) on coverage, utilization and affordability, the organization is working with a number of organizations to acquire and analyze timely and unique data. It has developed a website, Reform by the Numbers, which will house downloadable data, tables and graphs, in addition to policy briefs, blogs and other content that highlights key findings.

The first health insurance marketplace numbers are in: What do they tell us? 

November 2013
The Department of Health and Human Services recently reported the first set of enrollment numbers from the state and federal insurance marketplaces. There were a lot of numbers and Joanne Kenen, AHCJ's health reform topic leader breaks them down and helps reporters understanding what they do and do not tell us.

Business of Health Care: Tapping the holy grail of hospital data

October 2011
How profitable is your local hospital? How much charity care does it provide? Do doctors there implant a disproportionate number of cardiac stents? Is the ER turning a high number of ambulances? This session will show you how to answer these questions and more. Using data from California’s Office of Statewide Health Planning and Development (OSHPD), this session introduced data sets that journalists can request in other states.

Electronic medical records

Electronic medical records: Promised land or mirage?

October 2011
Electronic medical record systems have been touted for years as the way to fix health care. Proponents say electronic prescribing would warn against dangerous drug interactions and electronic access to patient medical information could reduce unnecessary procedures. States and the federal government, particuarly in the Affordable Care Act, are pursuing plans to link hospitals, doctors and patients electronically, dangling incentives for medical providers. Meanwhile, privacy problems continue to surface with information breaches such as occurred at Stanford Hospital, where data for 20,000 emergency room patients was posted on a commercial Web site, including names and diagnosis codes.

Lee Tien, senior staff attorney at the Electronic Frontier Foundation, discussed privacy and security concerns, as well as suggesting some possible story ideas for reporters.

Employers and the ACA

Employer plans may get whacked by GOP changes to Obamacare

Jay HancockMarch 2017
In the debate over repealing Obamacare, everybody is correctly focusing on what happens to the Medicaid expansion programs and the subsidized plans sold through the Affordable Care Act online exchanges. But there’s a potential threat to another, much bigger part of the health insurance market.

Employers are worrying that when it comes to providing affordable health insurance for their workers, the Republican cure might be worse than the disease.

Jay Hancock of Kaiser Health News explains the issues and why this is a story that reporters should be paying attention to.

Reporting on how employers might use self-insurance to sidestep ACA rules

July 2013
Self-insurance has been called an Obamacare loophole because the arrangement is immune to taxes, benefit requirements, profit limits and other rules set by the Affordable Care Act. For small businesses with young, healthy workers, it’s a way to offer coverage while avoiding premiums that build in costs for older, sicker people in the ACA’s insurance marketplaces.

But some people fear that self-insuring companies could skim too many young folks out of the small-business exchanges and insurance company costs and losses could soar, insurers could exit and the exchanges could break down.

Health care costs

Check out these resources before reporting on drug prices

Jonathan D. Rockoff

June 2016
Jonathan Rockoff, a reporter at The Wall Street Journal who covers the pharmaceutical and biotechnology industries, has done some ground-breaking work on drug prices.

A great example is "The Dysfunction in Drug Prices," reported by Rockoff and his colleagues last year. It won a 2015 Award for Excellence in Health Care Journalism for writing on the business of health and it was a finalist for the Pulitzer Prize.

Rockoff spoke about drug costs at Health Journalism 2016 in Cleveland. In an essay accompanying his AHCJ award submission, Rockoff and his co-authors wrote about the lack of a centralized database on drug prices and how they basically had to build their own. Short of that, this tip sheet suggests some ways you can find and understand the data.

340B drug pricing: Cutting through the controversy

Lola Butcher
Lola Butcher

January 2015
Debate about the government’s 340B Drug Pricing Program continues to build as the program expands. Like all good controversies, this one has enthusiastic advocates and wild-eyed opponents, and it’s easy to get snagged by the passion of the partisans.

340B is a discount program that requires pharmaceutical companies to sell outpatient drugs – both branded and generic – to eligible health care organizations at significantly reduced prices, up to half off in some cases. The program was created in 1992 to help provider organizations that serve a lot of poor people stretch their resources.

Over the years, the eligibility criteria to participate has expanded repeatedly. Currently, safety-net hospitals, children’s hospitals, critical access hospitals, federal health centers and other organizations are eligible; organizations that fall into those categories must register and enroll in the 340B program. Check here to find 340B organizations in your community.

Six things to remember when reporting on health care costs 

health care costsAugust 2014
Health care costs lack transparency and are wildly variable, not just from region to region but sometimes from block to block within the same city.

It is a complex topic, with chargemaster prices, what insurers paid and what consumers pay (if anything). Then there are the administrative rules set by Medicare and Medicaid and the negotiated rates between insurers and providers.

It's daunting, but three reporters have teamed up to offer guidance for reporting on health care costs.

Health care workforce

Changes coming to health care workforce ripe for coverage

Margot Sanger-Katz
Margot Sanger-Katz

April 2013
While employment in many industries tanked and weakly recovered, jobs in the health care sector have grown at a steady clip. But ever-growing health employment may be coming to an end, as National Journal reporter Margot Sanger-Katz learned when she reported on the health sector’s impact on the Pittsburgh economy.

Deficit reductions out of Washington will squeeze the dollars fueling health care jobs. That means cuts from Medicare and Medicaid, as well as grants from the National Institutes of Health and the Centers for Disease Control and Prevention and other agencies. The recent across-the-board budget cuts known as the sequester hit medical research and public health particularly hard. Hundreds of billions of dollars likely will be cut from future Medicare spending, cuts that come on top of Affordable Care Act reductions that already have many hospitals tightening their belts.

Sanger-Katz urges reporters to cover the health care workforce in their own communities and, in this tip sheet, she points out potential stories, asks key questions and offers some essential resources. The changing health workforce is a key part of the story of health reform, and it hasn’t yet been well told.

Health exchanges/marketplaces

Seven ideas to cover health exchanges before the rollout

Katie McCrimmon

September 2013
In this prescient tip sheet, Katie McCrimmon, a reporter for HealthPolicySolutions.org, offers suggestions for stories that reporters should be covering and questions that need to be asked. She suggests looking at the technology, contingency plans, how states are using the grants to build exchanges and who still won't be covered once health reform is implemented. She also suggestions reporting on whether the exchanges are successful and offers some sources that she has found helpful in her reporting.

Beyond premiums: Five things to know about health care costs in the exchanges

Arielle Levin Becker

September 2013
There’s been a lot of interest lately in how much it will cost to buy a health plan through the exchanges created by the Affordable Care Act. But equally important, and often overlooked, is what those premiums will buy. In fact, many consumer advocates are worried that people buying coverage through the exchanges will choose plans based solely on premiums and buy plans with such high deductibles and co-insurance they’ll be unable to afford care. (Also important to remember: Many people buying insurance through the exchanges will be eligible for federal subsidies to discount their premiums, so when you see a premium price, it’s not necessarily what most people will pay.)

Health Journalism 2011: Health reform presentations

What you need to know about ACOs (Katherine Schneider presentation)

April 2011
Katherine A. Schneider, M.D., senior vice president of health engagement at AtlantiCare, explains the accountable care organization model and the focus on outcomes for special care centers.

Where do they go from the hospital? (Mary Naylor presentation)

April 2011
Mary Naylor, Ph.D, F.A.A.N., R.N., Marian S. Ware professor in Gerontology, University of Pennsylvania School of Nursing, offers this information on core components of the transitional care model and its relevance to the Affordable Care Act provisions.

What you need to know about accountable care organizations (Steven Lieberman presentation)

April 2011
Steven M. Lieberman, president, Lieberman Consulting; visiting scholar, Brookings Institution, offers an overview on accountable care organization goals, key innovations and challenges.

Can advance care planning help you avoid the treatment trap? (Rosemary Gibson presentation)

April 2011
Rosemary Gibson, author of "The Treatment Trap" and "Wall of Silence," offers 10 points on end-of-life care and health reform.

Future of nursing: Campaign for action (Susan Hassmiller presentation)

April 2011
Susan B. Hassmiller, R.N., Ph.D., F.A.A.N., senior adviser for nursing and director of the Initiative on the Future of Nursing at Robert Wood Johnson Foundation, offers these brief slides on the campaign for action state-by-state involvement and state-by-state access to care.

Accountable care organizations: Impact on hospitals (Lawton Robert Burns presentation)

April 2011
Lawton Robert Burns, Ph.D., M.B.A., and The James Joo-Jin Kim Professor of the Department of Health Care Management at The Wharton School, spoke on what questions to ask policymakers, doctors and hospital executives about ACOs.

Health insurance: Changes that are coming fast (Jack Burke presentation)

April 2011
Presentation by Jack Burke, F.S.A., M.A.A.A., principal and consulting actuary of Milliman, Inc., on changing insurance practices.

Covering health reform issues (Tips from Julie Appleby)

April 2011
In this tip sheet compiled for Health Journalism 2011, Julie Appleby offers a list of useful websites for covering health reform.

Health Journalism 2010: Health reform presentations

Understanding the fundamentals of health insurance & implications for reform (Tim Lee presentation)

May 2010
Actuary Tim Lee explains the underpinnings of health insurance, risk and the current system.

Will More Physicians Improve the Health of Patients? (David Goodman)

May 2010
Dr. David Goodman answers the question posed in the title of his presentation, namely "Will More Physicians Improve the Health of Patients?"

Assessing Health Reform: Is There a Looming Doctor Shortage? (Kevin Barnett presentation)

May 2010
Barnett argues for a comprehensive approach to addressing California's health care workforce needs.

Health reform resources for reporters

Questions to consider when covering health insurance reform proposals

Now that election day is only about a month away, one of the most important issues the country faces is how a new Congress and a potentially new administration will address the need for health insurance reform.

For health care journalists writing about health reform now and what might happen in 2021, it’s instructive to consider what Wendell Potter, a former public relations executive for health insurers, would suggest when covering this issue. The founder of Tarbell, a donor-funded and subscription-driven health care news site, Potter is one of the co-founders of Business Leaders for Health Care Transformation, a coalition of business leaders supporting the idea of a health care system that covers everyone with essential services regardless of income.

As a former executive for Humana and Cigna, Potter has good advice for health care journalists. During a recent telephone interview, offered a number of tips for reporters to consider.

Covering health reform resources

There are ample resources for covering health policy at the state and federal level. Here are some particularly useful ones – but they will lead you to others.

Health reform reading list

March 2012
Joanne Kenen, AHCJ's topic leader on health reform, has compiled a list of books about health reform in the United States. The list is organized by topics, such as understanding the law, politics and history, criticism of the law and value versus volume.

Three health reform issues to watch in the states (and what to write about them!)

April 2011
Politico's Sarah Kliff offers story ideas about health exchanges, insurance rate hikes, medical loss ratio waivers and points readers to some resources to help with those stories in this tip sheet from "Health reform: Repeal, replace or implement?" at Health Journalism 2011. Related article: Health Journalism 2011 panelists suggest stories about health reform implementation

Transcript: What’s next? Reporting on health reform between now and 2014

May 2010
Some top Washington, D.C.-based journalists discussed implementation deadlines, how to tie local issues to reform, Medicare reimbursement rates, what reporters should look for in their states and more. A recording of this briefing and a resource list are available. The event was co-sponsored by the Alliance for Health Reform and the Robert Wood Johnson Foundation. "What's next?" was sponsored by AHCJ, the Alliance for Health Reform and the Robert Wood Johnson Foundation.

Health reporting resources for journalists on state and local government beats

Statehouse February 2010
Health is an essential part of the beat for reporters covering state and local government, even more so as media shrinks and traditional health reporter slots go unfilled. The health sector consumes a big chunk of government budgets. And it’s what people are talking about.

The good news: There’s a wealth of government and nongovernmental organization resources to draw from on health topics.

Veteran reporter Nancy Cook Lauer has tips and an extensive list of resources for government reporters who find themselves covering the unfamiliar territory of health care.

Responses to the Supreme Court's health reform decision

Health care reform has passed: What's next?

March 2010
Advice from journalists on the front lines who have advice and suggestions on what needs to be covered next and how to approach this complex topic. Includes links to source documents, news stories, a contact list of sources and background on the health care debate.

Five common mistakes to avoid on the health policy beat

Carol Eisenberg
Carol Eisenberg

June 2013
Health policy these days is contentious, with those in favor of the Affordable Care Act saying one thing while opponents insist other things are true.

Carol Eisenberg, a senior editor at Kaiser Health News, offers some helpful tips for understanding health policy and communicating it accurately to your readers, viewers and listeners.

High-risk insurance pools

Covering high-risk insurance pools: Mike Shields

May 2010
The federal government and states are scrambling to create temporary high-risk pools for the medically uninsurable by July 1. As one of the first provisions of the Patient Protection and Affordable Care Act to go into effect, it will serve as a test case for implementation of the new law and it should be closely followed.

Apart from being a policy story, it's of great interest to all your readers, viewers or listeners who have pre-existing conditions and are struggling to find coverage.

In this tip sheet, Mike Shields, managing editor of the Kansas Health Institute News Service, shares some story ideas, suggestions and resources.


Five things to know about hospital consolidation

February 2016
Hospitals have been merging and acquiring physician practices at a breakneck pace over the last several years. Hospital representatives argue they need to join forces in order to better share resources, such as expensive IT systems, and to coordinate care in the manner that the Affordable Care Act has encouraged.

But the trend has drawn criticism from insurers, state attorneys general and federal antitrust enforcers, who warn that consolidation can also give hospitals monopoly power to drive up prices and hurt consumers.

Here are five things to know when you report on hospital mergers and efforts by antitrust officials to challenge them.

Finding the full story behind hospital mergers, consolidations

March 2015
Across the country, health systems are getting larger, gobbling up community hospitals or smaller chains. Some of this has to do with payment incentives in Obamacare, but just as much has to do with changes to Medicare, Medicaid and providers’ desire for leverage as they negotiate payments with insurance companies.

Dan Goldberg
Dan Goldberg

The recent HHS announcement that Medicare would tie 30 percent of payments to alternative models, such as accountable care organizations or bundled payment arrangements by the end of 2016, and 50 percent by the end of 2018, furthered many health system executives' beliefs that the key to survival is the ability to manage population health. And that is best done with large populations. That's a big reason why we see so much consolidation, but in crowded markets, such as New York, New Jersey and California, it's only a part of the story. (In smaller markets, such as Idaho, the FTC 's view of whether a merger will create an anti-competitive environment is the most important question.)

In the February issue of Capital Magazine, I looked at New York's five large health systems and the strategies they were employing to diversify their revenue base while preparing to play in a post-ACA, value-based world.

Rules could change for 'critical access hospitals;' what reporters should know

Jenny Gold
Jenny Gold

January 2013
Critical access hospitals are supposed to be small, rural facilities that receive a higher Medicare reimbursement rate to help keep them afloat. But not all of them fit that description, and they’re not always “critical.” More than 1,300 facilities – nearly one in four acute care hospitals – have been designated as critical access, and some are neither rural nor isolated.

Recently, several proposals floating around Washington, including one from President Obama, recommend narrowing the definition to help weed out some of the spending from the program.

Jenny Gold, of Kaiser Health News, has written about critical access hospitals and offers background, questions reporters should be asking and resources to support their reporting.

Immigrants and the ACA

Immigrants and the Affordable Care Act

April 2013
This tip sheet, courtesy of the National Immigration Law Center, breaks down how the Affordable Care Act covers various groups of immigrants, including naturalized citizens, lawfully present immigrants and undocumented immigrants. It also explains how the status of immigrants will be verified.


Coronavirus is shaking up states’ coverage expansion plans

June 2020
Before the novel coronavirus pandemic, several states were looking at ways of expanding coverage – no matter what the outcome of the November election. But with the upheaval, uncertainty, and immense costs of coronavirus, much of it is on hold for now.

Here, I’ll highlight a few of the most notable states, including the status of Medicaid block grant requests.

Understanding 'partial Medicaid expansions'

December 2019
The Affordable Care Act originally included Medicaid expansion in all states, but the Supreme Court, as part of the 2012 decision upholding the constitutionality of the individual mandate, made it optional. In those early years, only a handful of Republican-led states expanded the program, but several more signed on in subsequent years, in a few cases because of a change in political leadership or because of a voter referendum.

In a new tip sheet Rachana Pradhan – who had been covering Medicaid deeply at Politico and is now moving to KHN – explains what you need to know about partial expansion. Read more about the policy, the politics, the funding – and the impact on the uninsured.

Finding fresh ways to report on the rural hospital crisis

October 2018
The United States is facing a rural hospital closure crisis. If you are a health reporter in a rural state, chances are you’ve covered some aspect of this story. In fact, one challenge with covering this crisis is how to write about it with fresh and engaging angles with impact.

Here are some lessons that Bram Sable-Smith learned while reporting a series of stories last year on the rural hospital in Pemiscot County, Mo., the state’s poorest county.

Understanding how health advocates, legislators are wrestling with Medicaid work requirements

March 2018
Republican-controlled states are taking a fresh look at the subsidized expansion of Medicaid under the Affordable Care Act following a major shift in the federal government’s stance on 1115 demonstration waivers.

The Department of Health and Human Services’ recent green light for work requirements, drug tests, premiums and other policies rejected by previous administrations is attracting the interest of states that already expanded Medicaid and are now looking to tighten restrictions on the program, as well as states that never expanded Medicaid in the first place.

But for states looking to implement the newly-allowed restrictions, many difficult questions lie ahead.  Here’s a guide to understanding some of the economic and ideological battles playing out in the states.

Is Medicaid managed care coming to your state? Keep these coverage tips in mind

January 2018
As Medicaid managed care spreads, it is important for reporters to understand how it works and where to get the information we need to do solid accountability reporting about it.

Although research is mixed about whether managed care saves money for states, programs have exploded nationwide because health plans typically are paid a fixed amount per enrollee, which helps states predict their costs for the year.

This is an important story to follow in your state. Kristen Schorsch explains six things to pay attention to.

Finding the stories about how the AHCA would affect Medicaid, older adults

Dan GoldbergMay 2017
Medicaid has evolved a lot in the five decades since it was signed into law. Now, the American Health Care Act would cut more than $800 billion from Medicaid over 10 years. Rightfully, there has been a lot of focus on what that would mean for low-income adults. But Medicaid also is a lifeline for roughly 6 million seniors, most of whom cannot afford Medicare’s cost-sharing requirements.

Because Medicaid is a jointly operated program, federal actions often require state reactions and state budgets provide a trove of stories. Medicaid is among any state’s most expensive, and fastest growing, programs so every governor looks for ways to contain costs.

Making sense – and stories – of Medicaid

May 2011
Medicaid doesn't get anywhere as much attention as Medicare. That's nothing new – it's been that way pretty much since the twin programs were enacted in 1965. But reporters should pay attention to Medicaid right now, for a lot of reasons:

  • It's smack in the middle of the debt/spending/entitlement debate going on in Washington.

  • It's a lynchpin for the insurance coverage expansion starting in 2014.

  • Keep in mind, too, that the federal stimulus package gave the states a lot of extra Medicaid money – and that runs out at the end of June. States know that's coming, but it doesn't mean they like it or that they are as prepared as they might be.

If it seems like the Medicaid headlines are going in several directions at once – that's because they are. Expand, contract, reinvent, blow up, save, destroy ... What's really going on?


Journalist explains why Medigap plans might be best for seniors

There’s no denying that MA plans are attractive to seniors because many of them offer multiple benefits for low monthly premiums. But the TV ads and almost all the promotional materials from the Medicare program and the insurers themselves do not mention that when enrolling in MA, seniors face a huge risk because MA plans are unlikely to provide the best coverage for seniors over time.

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.

Rural health

Finding fresh ways to report on the rural hospital crisis

The United States is facing a rural hospital closure crisis. If you are a health reporter in a rural state, chances are you’ve covered some aspect of this story. In fact, one challenge with covering this crisis is how to write about it with fresh and engaging angles with impact.

Here are some lessons that Bram Sable-Smith learned while reporting a series of stories last year on the rural hospital in Pemiscot County, Mo., the state’s poorest county.

How will rural areas fare after health reform?

June 2011
Timothy D. McBride, Ph.D., professor and associate dean for public health at Brown School of Washington University offers an abundance of information on health coverage in rural areas, payment differentials, the health status of chronic disease.

Supreme Court

Tools for understanding, explaining King v. Burwell

Joanne Kenen
Joanne Kenen

March 2015
Probably in late June, the Supreme Court will rule in King v. Burwell. The case challenges whether subsidies, in the form of tax credits, can go to people in states using the federal exchange, or only to those in the states running their own health insurance marketplaces.

After the state cases and 2012 National Federation of Independent Business case, it is the third case that poses an existential threat to the Affordable Care Act. (Hobby Lobby and other contraception-related cases wouldn’t unspool the structure of the whole ACA, only that aspect of women’s preventive health.)

This case isn’t about whether the Affordable Care Act is constitutional. (The 2012 case was.) This is about interpreting the text, and whether the language of the law allows the subsidies in the federal exchange states.

The U.S. Supreme Court and health reform: 2012

The U.S. Supreme Court
Photo by functoruser via Flickr

March 2012
On March 26, the Supreme Court starts six hours of oral arguments over three days – its longest case in years – on four separate legal questions arising from the Affordable Care Act. A decision is expected in late June. We talked to T.R. Goldman, a longtime legal journalist who has written about the case.

We asked Goldman to address five questions for journalists:

  1. Is the individual mandate’s “minimum coverage provision” that requires most people to obtain health insurance constitutional?

  2. If not – will the court strike the whole law down, or just certain sections (“severability”)?

  3. What role does Medicaid expansion play in the legal case?

  4. Can the court decide on the constitutionality of the mandate now, or under the Anti-injunction Act does it have to wait until mandate penalties are imposed in 2015?

  5. What are some tips for health reporters trying to cover this – particularly those covering from afar?

Along with his answers, we are including some links to further reading, webcasts and health and legal blogs that may be useful.

Responses to the Supreme Court's health reform decision
A quick guide to covering the Supreme Court ruling on health reform
Affordable Care Act & the Supreme Court: What you need to know