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Journalists and experts have written about covering insurance 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 may be asked to login because some are available exclusively to AHCJ members.

Featured tip sheets

Covering health insurance? You’ll want to tap these sources on a regular basis

May 2018
Covering health insurance markets can be a daunting task. Insurance itself can be extremely complicated, especially when writing about it for the first time. Also, health insurers have complex structures. The largest insurers are for-profit, and their financial data are relatively easy to find and sift through.

However, many other insurers are private or not-for-profit, or they are part of a health system, all of which makes reporting on their financial data more difficult. On top of all these complications, each state regulates health insurers differently. For journalists covering this beat, here are some resources Bob Herman uses regularly.

Look for additional tip sheets based on subject:

Costs: Patients and providers

Medical homes


Mental health, addiction and insurance




Small business


Costs: Patients and providers

So which is it? Providers develop wide variety of definitions for population health

June 2017
One of the main ideas behind the Affordable Care Act was the concept that physician practices, hospitals, accountable care organizations and other groups of providers would deliver population health. But since Congress passed the act in 2010, defining how population health is delivered has been challenging.

The terms population health and population health management have become ubiquitous among health care providers, wrote Tamara Rosin, a reporter for Becker’s Hospital Review. But, she added, “Despite their prevalence, the industry has yet to decide on a single definition of ‘population health.’” She was reporting on a panel discussion that Becker’s sponsored on the topic and included in her article definitions of the term from five hospital executives.

Legal reporters explain how to cover medical funding companies that prey on patients

Jessica Dye

Alison Frankel

August 2016
For many reasons, the health insurance system leaves some consumers unable to cover the full cost of care. When that happens, some patients turn to medical funding companies to help them pay their bills. Often, physicians and other providers will refer their patients to medical funders who pay the providers and then collect from these patients. The problem, as journalists Alison Frankel and Jessica Dye learned last year, is that consumers sometimes suffer when dealing with unscrupulous medical funding companies. 

As they reported last year, “In the little known world of medical lending, financiers invest in operations to remove pelvic implants from women suing device makers — and reap an inflated share of the payouts when cases settle.”

In their investigations for Reuters, they reported how these investors profit by financing care for desperate patients and how business groups called for a probe of medical funders.

For this tip sheet, we asked Frankel and Dye for advice on how journalists could cover this story.

Skepticism is one key to reporting on pharmacogenetic tests

Beth Daley

June 2016
The area of pharmacogentics, or how genes affect a person's response to drugs, is a fastest-growing commercial segments of genetics. The basic science behind them is sound and decades old. It involves identifying how a patient responds to medicine, and so helps physicians avoid bad reactions and figure out what dose is best for each individual. Today, clinical laboratories are selling hundreds of these tests to patients and doctors without substantive trials, independent validation or solid proof that they actually are accurate or even useful to patients. Among the fast-growing areas for these tests are psychiatry and in assessing how patients respond to opioids.

When writing about how these tests work, skepticism is in order. These tests are highly complex and their algorithms are proprietary. Reporter Beth Daley offers advice on what to look for in your reporting.

Financial incentives for physicians may not be working as expected

March 2016
One premise behind the formation of accountable care organizations is that physicians and other health care providers would have financial incentives to deliver high quality care at lower costs. But research is indicting that the financial incentive may not be sufficient to foster improvements in care.

In other words, physicians don’t earn enough from the financial incentives to focus on improving quality of care. For journalists this point is important because health insurers and health systems often claim that by establishing new payment arrangements, physicians and other providers will be paid more for quality and quality scores will rise.

The question journalists can ask now is this: Are physicians and providers being paid enough for focusing on quality of care to make a difference in patient outcomes?

How to use the Health Care Pricing Project to take a deeper look into hospital cost variations 

February 2016
Writing about a new report from the Health Care Pricing Project (HCCP), Dan Gorenstein made the case that researchers now have compelling data showing that hospital consolidations drive up prices. Coverage of the HCPP report by Gorenstein and others raises an interesting question: Do we finally have game-changing data on hospital price variation?

The fact that hospital mergers drive up prices is certainly not new. But the HCPP researchers used newly released data from three large health insurers — Aetna, Humana, and UnitedHealthcare — and they controlled for factors that hospital administrators usually cite when explaining why their facilities charge more than others. It was, as Gorenstein described in his Marketplace article, “an unprecedented look at medical costs nationwide.”

Little-known loophole in health insurance plans leaves some without coverage

January 2016
At first, a story by Roni Caryn Rabin for The New York Times seemed like another article about a shooting gone wrong.

But reading the full story showed there was much more to it, involving a little-known loophole in health insurance plans that leaves some health plan members without coverage or recourse.

The story shows that journalists might find a number of stories if they look into whether health insurers routinely deny coverage to victims of violent crimes if the insurers believe the victims are at fault.

How Chicago journalist used data to show how population and insurance shifts affect hospital vacancy

The traditional sense of a hospital is fading.

Advances in technology, changes in how doctors and hospitals are paid, and a big push toward outpatient care mean patients aren’t spending as much time in hospital beds as they used to. In Chicago in particular, huge population shifts have gutted many minority communities anchored by hospitals.

The result? A lot of empty beds. I found quite the increase in vacancy rates while analyzing state records and interviewing dozens of people for my project, Running on Empty, which included this database that readers could search for information on every hospital in Illinois.

Tips on finding patients, consumers to be sources for your stories

For nearly two years, Lisa Zamosky has been writing a weekly health care column for the Los Angeles Times that features the personal story of one consumer dealing with the issue she is writing about.

She says that finding a consumer each week remains, by far, her greatest challenge. While she wishes she had a brilliant, simplified process for finding the right person, she says that, "In all honesty, it can be an ugly, stressful ride right up until deadline." 

But she says things do almost always work out, and each week she finds someone to talk with her for the story. Here she shares some of her strategies to find patients and consumers for her stories.

Angles, resources to consider when covering insurance discrimination

For journalists covering insurance discrimination, the HIV cases offer important lessons about how insurers have used pharmacy benefit pricing strategies to shift the cost of medications to members. Health policy researchers and patient advocates contend that these pricing policies, including one called adverse tiering, are discriminatory.Health insurers focus so closely on the cost of care that they sometimes face charges that they discriminate against members with chronic costly conditions. Over the past year, patient advocates have complained to state and federal regulators that health insurers have failed to provide adequate insurance coverage to patients with cancer, HIV, mental health conditions and other illnesses (pdf).

This tip sheet explains issues and resources journalists will find valuable when covering pharmacy benefit discrimination cases.

How Pittsburgh reporter localized the price variation story

When the Blue Cross Blue Shield Association published a report in January 2015 about the wide variation in the cost of hip and knee surgery nationwide, it was a national story. Many journalists treated it that way.

But the report also offered journalists a way to localize the story because it offered so much detail on individual insurance markets. One good example came from journalist Bill Toland of the Pittsburgh Post-Gazette (@btoland_pg) who wrote about how the city’s hospitals ranked versus hospitals in other markets.

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.

Tracking doctors' fees: An important angle to pursue when hospitals acquire physician groups

May 2015
In an excellent article for The New York Times’ Upshot blog, Margot Sanger-Katz explained what happens when a hospital or health system buys a physician’s group. As she points out, doctors’ fees often rise sharply when hospitals acquire doctors’ practices.

In her reporting, Sanger-Katz provides a good example of how payment strategies cause hospitals to buy physician groups. 

Find out why the discrepancy exists, learn about the proposal to eliminate it and find out where hospital and physician groups stand on the recommendation.

Lisa Chedekel
Lisa Chedekel

For hospital infection rate story, Connecticut journalist cites the good with the bad

December 2014
Lisa Chedekel’s article on infection rates in Connecticut could serve as a template for any health care journalist writing about hospital infections.

Her story, “Half of State Hospitals Exceed Infection Rates New Data Show,” is important because hospitals with the worst infection rates in 2012 and 2013 will lose 1 percent of their Medicare reimbursements in fiscal 2015. It’s also important because she names 11 of Connecticut’s 30 hospitals that will likely be penalized.

Hospital infections kill more people than car crashes. Here’s how to cover them better

About 75,000 people a year die from nosocomial infections - infections they contracted while in the hospital. This seems like a high number, but these infections and their costs don't get a lot of coverage. It might seem difficult to approach the issue and make the data relevant to your community, but the Columbia Journalism Review has some suggestions on how to cover hospital infections, such as utilizing the National Healthcare Safety Network from the CDC.

Miami journalist reports on the challenges in getting price transparency data in South Florida

Price transparency is supposed to be one of the keys to controlling the cost of health care. But as journalist Michael Chang reported in The Miami Herald, getting insurers to release the figures on what they pay for health care and getting providers to release the figures on what they receive for delivering care can be difficult if not impossible.

In his article, Chang reported on the struggle a consultant for a local union had in determining what Miami-Dade County paid to doctors and hospitals caring for county employees, their family members and retirees. The numbers could not be released, he reported, because data in contracts between insurers and providers are proprietary. In fact, most contracts between health plans and providers include “gag” clauses that prohibit either side from releasing price information.

Even a public employer, such as Miami-Dade County, could not get the data due to gag clauses. Chang quoted Duane Fitch, the consultant for Local 1991 of the Service Employees International Union, saying, “We really need to understand where the money is being spent in order to be insightful about benefit design changes.’’ Local 1991 represents physicians and nurses at the Jackson Health System, which is a county-owned hospital.

How a secretive panel uses data that distorts doctors' pay

Joseph Burns
Joseph Burns

September 2014
One factor that makes health care costs difficult to manage is the system the federal government and health insurers use to decide how to pay physicians for the various services they deliver. In an article in The Washington Post, “How a secretive panel uses data that distorts doctors pay,” journalists Peter Whoriskey and Dan Keating explain that a committee of the American Medical Association meets in private every year to develop values for most of the services doctors perform. The AMA is the chief lobbying group for doctors.

“Those values are required under federal law to be based on the time and intensity of the procedures. The values, in turn, determine what Medicare and most private insurers pay doctors,” Whoriskey and Keating wrote.

The problem with this secretive 31-member AMA committee called the Relative Value Update Committee (RUC) is that the AMA’s estimates of the time involved to do procedures are exaggerated by as much as 100 percent, according to an analysis by Whorisky and Keating.

Programs develop to manage most costly 1 percent of patients 

December 2013
As more health insurers begin covering the uninsured under the Affordable Care Act, they will assume the financial risk of covering the most costly patients in any health system: the 1 percent who run up the biggest bills. A recent report from the federal Agency for Healthcare Research and Quality shows that these 1 percent of patients account for 21.4 percent of all spending. Writing for Kaiser Health News and The Washington Post, Sandra G. Boodman covered this issue thoroughly and her article serves as a tip sheet for any health care journalist covering this segment of the population.

Medical homes

What is a ‘medical home’ and why is it important?

December 2017
In the past decade, thousands of U.S. primary care practices have reorganized themselves as patient-centered medical home (PCMH) practices, making medical homes the most widespread type of health care delivery and payment reform so far. The concept likely will become even more popular in the years ahead because the federal government’s Quality Payment Program included some medical home practices in its advanced alternative payment model (APM), making them eligible for incentive payments.


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.

10 things reporters should know about covering Medicare

August 2016
If it’s hard for health care journalists to keep up with Medicare’s flood of announcements about new and revised programs, imagine what it must be like for the poor consumers who actually have to use Medicare.

In fact, Medicare’s complexity has been identified in research as a significant deterrent to broader consumer use of the program’s wide range of benefits. Even though Medicare has an open enrollment period each year that basically amounts to a free “do over” for consumers, seniors can be so intimidated by the process that they just stick with what they have even if it’s inferior to other options.

With this in mind – and having spent the past two years answering reader’s Medicare questions for PBS NewsHour – here are 10 items (and, yes, this is a made-up number for the list gods) that health care journalists might like to know as they shape their plans for Medicare coverage.

Mental health, addiction and insurance

Mental health parity rule clarifies standards for treatment limits, coverage of intermediate care

Michelle Andrews

January 2014
The Mental Health Parity and Addiction Equity Act of 2008 required health plans that offer mental health and substance use disorder benefits to cover them to the same extent that they cover medical/surgical benefits. Among other things, it prohibits having treatment limits or financial coverage requirements such as copayments or deductibles that are more restrictive than a plan’s medical coverage. Interim regulations issued in 2010 clarified some issues about implementing the law.

The final rules, issued in November by federal officials, spell out more specifics. Michelle Andrews, writing for Kaiser Health News, spoke with Jennifer Mathis of the Judge David L. Bazelon Center for Mental Health Law and provides some background and clarification on how the rules affect consumers.


Self-Insured Employers

Joseph Burns

September 2013
Seeking to avoid the employer mandate of the Affordable Care Act, many small employers are pursuing self-funded health insurance. Under this strategy, employers set aside enough funds to insure themselves, eliminating the traditional health insurance although these employers still use traditional insurers or health plans to enroll employees, process claims, and establish networks of providers.

Describing this strategy, one health care consultant said: “What you’ve got is basically a loophole for the small employer to get out of the ACA requirements.”

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

Jay Hancock
Jay Hancock

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.

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


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:

Covering premium rate increases for 2015? Check out these resources first

Joseph Burns
Joseph Burns

June 2014
As the nation’s health insurers file rate requests with state insurance departments, the news about health insurance premium increases is coming out almost daily now. The deadline for submitting rate requests on the marketplaces is June 27.

Premium rate review is an important story, obviously, because it begins to answer the question of what consumers will pay for insurance next year. But it’s a complex story because what health insurers propose now is not necessarily what consumers will pay next year, and, in fact, insurance rate requests are only part of the story, as Trudy Lieberman reported in the Columbia Journalism Review.

Here's some background on the process of premium rate review, as well as tools, resources and tips for doing the most nuanced and accurate reporting on this important topic.


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?

Issues to consider when covering hospital readmission penalties

November 2016
American hospitals may have some of the most advanced medical technology in the world, but they hold an unimpressive record of ensuring their patients continue to get better after they leave. Roughly one in six Medicare patients ends up back in the hospital within a month, and researchers believe a third of those readmissions may be preventable.

The federal government publishes individual hospital readmission rates on its Hospital Compare website, and Medicare is in the fifth year of cutting payments to hospitals with high rates of rehospitalizations. Public scrutiny and financial hits from the penalties are prompting many hospitals to take steps to avert so many returns.

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.

Small business

States establish SHOP marketplaces

March 2014
As of March 2014, 17 states and the District of Columbia were running their own Small Business Health Options Program (SHOP) marketplaces, according to a report from the Commonwealth Fund, State Action to Establish SHOP Marketplaces. In the remaining 33 states, the federal government is operating SHOP marketplaces. In the SHOP marketplaces, businesses with 50 or fewer employees can buy health insurance for their workers. Tax credits are available for employers with fewer than 25 employees making an average of less than $50,000, the report said. In the report, Sarah J. Dash, Kevin W. Lucia, and Amy Thomas of Georgetown University’s Center on Health Insurance Reforms explained that most states running these marketplaces are offering features that were previously unavailable, such as being able to offer employees a choice of plans and to set a predictable contribution toward their coverage.

Research by the Commonwealth Fund has shown that small business owners and their employees have often been priced out of the health insurance market, said Commonwealth Fund President David Blumenthal, M.D. Small businesses also have limited insurance options, forcing them to choose plans with high premiums and limited benefits. The SHOP marketplaces give these businesses a chance to provide a range of affordable, comprehensive insurance options to employees, he added.

This study shows that nearly all states have attracted enough competition to offer small businesses a choice of insurers and plans. The Connecticut SHOP marketplace, for example, offers 12 plans, while the SHOP exchange in the District of Columbia offers 267 plans, the report showed.


Covering health insurance? You’ll want to tap these sources on a regular basis

May 2018
Covering health insurance markets can be a daunting task. Insurance itself can be extremely complicated, especially when writing about it for the first time. Also, health insurers have complex structures. The largest insurers are for-profit, and their financial data are relatively easy to find and sift through.

However, many other insurers are private or not-for-profit, or they are part of a health system, all of which makes reporting on their financial data more difficult. On top of all these complications, each state regulates health insurers differently. For journalists covering this beat, here are some resources Bob Herman uses regularly.