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Resources for covering health reform

What questions do you have about health reform and how to cover it?

Joanne KenenJoanne Kenen (@JoanneKenen) is AHCJ’s health reform topic leader. She is writing blog posts, tip sheets, articles and gathering resources to help our members cover the complex implementation of health reform. If you have questions or suggestions for future resources on the topic, please send them to

Selected blog posts, tip sheets and conference presentations to help reporters make sense of health reform for their readers, listeners and viewers.

Key concepts

We explain the important ideas you need to be able to explain to your readers, viewers and listeners when reporting on health reform.

Glossary of health reform terms

Plenty of new phrases are making their way into coverage of health reform. We help sort out what they really mean. This list will keep growing, so send us suggestions of what terms you'd like to see defined

Blog posts

Story shows how rival systems work toward accountable care

The reporting sometimes focuses so much on rules and regs that it leaves people confused about what accountable care – not just accountable care organizations – might really look like, or at least what the early steps toward creating accountable care looks like. That’s why I liked a recent story from Minnesota Public Radio, on how two rival health care systems have teamed up to try to do a better – and more cost-effective job.

CLASS Act is gone but long-term care problem remains

The ill-fated CLASS Act is gone. What’s not gone is the problem of how to provide long-term care to the millions of disabled and/or elderly people who need it – numbers that will only grow as the baby boomers age.

What, if anything, does the Affordable Care Act do to address the problem?

The law does have dozens of provisions that – depending on how well they are funded and implemented, how widely they are adopted and, quite frankly, how well some of the new care models turn out to work in the real world – can at least nibble around the edges of the long-term care needs.

Do small businesses in your area know about tax credit for offering coverage?

There’s been a fair amount of coverage about the lower-than-expected enrollment in high-risk pools created by the federal health reform law. Another available benefit – a tax cut for certain small businesses that offer coverage to workers – is also eliciting less of a response so far than the White House had anticipated.

Friday brings IOM’s report on defining essential health benefits

On Friday, Oct. 7, the Institute of Medicine plans to release its essential health benefits report – those are the benefits that plans for individuals and small businesses will have to cover per the Patient Protection and Affordable Care Act.

The benefits fall under 10 general categories including emergency services, behavioral health treatment, preventive services and chronic disease management.

There may be a bit of confusion about what IoM’s task is: It isn’t defining the benefits – it is producing some methodology that the U.S. Department of Health and Human Services can use when it defines the benefits.

Project offers road map to local health care innovations

A new, but time-limited – looks like the emails may just be going out for just for 30 days – resource has been pouring into my inbox faster than I can read it. It’s called Care about your  Care, and it’s sponsored by the Robert Wood Johnson Foundation and a bunch of other groups (about 30 in fact: find the list here).

Part of the “Care” material is very consumer oriented- That may help those of you who are trying to communicate the basics to your audience. 

But what really caught my attention about Care about your Care is that it’s a terrific road map to a lot of the innovation going on across the country, much of which hasn’t registered in the national media or in some cases even in the policy conversation.

State update and hospital workers' health

We have two unrelated topics to touch on this week.

First, just a brief reference to a recent Washington Post story that was a pretty good snapshot of the progress - and lack thereof - at the state level  toward setting up exchanges.  As writer N.C. Aizenman makes clear, the delays are partly because of politics.

The second item that may translate into a good local health reform story is a new Thomson Reuters Healthcare study (hat tip to Reuters' Deborah Sherman)  that found hospital employees, as Sherman put it, " spend 10 percent more on healthcare, consume more medical services, and are generally sicker than the rest of the U.S. workforce."

Back-to-the-beat resources on health reform

Since so many of us are in storm (or non-storm) what-are-we-going-to-do-with-all-these-batteries cleanup and back-to-school mode, I thought I'd bring some resources and interesting studies to your attention to help bring your focus back on the beat.

The first is a poll that shows how confused people still are about health reform. Another is a report on how the health reform law will affect the "doughnut hole" for Medicare drug coverage. Find out more about the recent drug shortage, who is applying to be Medicare ACOs and the latest trend in the physician workforce.

Why the mandate matters

Usually I blog about topics that that lend themselves to local coverage, that explain health reform in the context of a state or community. But I think it's worth taking a quick look at the individual mandate, or "shared responsibility," because it's so important - as politics and as policy. It's back in the news after the Aug. 12 ruling. We won't know its fate until the Supreme Court tells us, but here is why it's worth noting now.

Health reform comes with new rules for nonprofit hospitals

As this excellent recent story by M.B. Pell in The Atlanta Journal- Constitution shows, nonprofits may or may not have a healthy bottom line. They may or may not pay their top executives a lot of money. They may or may not provide really good care.

What they don't do is pay taxes. Nonprofits are supposed to be mission-driven. In exchange for serving their community, they get the tax exemption.

One little-known element of the health care reform law – which I highlighted in my first tip sheet on the anniversary of the law's passage – sets new rules for nonprofits. They are required to assess community needs, and inform patients of charity policies. Some lawmakers, notably Sen. Chuck Grassley, an Iowa Republican, want tougher rules and oversight. The goal is to make sure they are providing enough service to the community to justify the tax break.

How does the budget deal affect the Affordable Care Act?

So how does this mammoth budget-cutting deal, with its congressional "supercommittee" affect health reform?

Good question, because lots of people in Washington are asking it too.

More specific answers will become clearer in the next few weeks, but here's a first version of the road map to both the policy and the politics.

First, understand there are two different processes – and each, separately, aims at cutting more than $1 trillion over the next decade.

Reporters can explore states' options for creating exchanges

Flexibility is the buzzword these days, as federal health officials coax states along the road to exchange creation.

Steve Larson, director of the Center for Consumer Information and Insurance Oversight at CMS, recently noted that states are making progress. But federal health officials recently made clear (in newly released proposed regulations) that they realize that a lot of states may need a bit of extra help. That's why "flexibility" has become such a drumbeat. Instead of "yes, we have an exchange ready to go" or "no, we aren't ready," states can pursue a middle path – they can be ready in some ways, but let the federal government step in and handle other components.

Follow up on $95 million just awarded to school-based clinics

This week the Department of Health and Human Services announced $95 million in awards to school-based clinics. These are where about 790,000 patients get their health care – sometimes including dental care. The awards announced this week (July 14) will allow for a 50 percent expansion to cover another 440,000 patients. Joanne Kenen shares some thoughts, resources and questions to help you cover these clinics and how they will be affected by health reform.

Shifts in health care delivery raise questions

Christopher Weaver at Kaiser Health News has done two stories recently on new care models driven by insurers eager to save money. Both stories lay out issues that AHCJ members can examine in their own communities, particularly regarding the influence insurers will have over health care delivery and how it differs – or does not differ – from the HMOs of the 1990s.

Two new resources for covering health reform

There are two more resources to share with you from two of health journalisms' ever-helpful friends: the Kaiser Family Foundation and the Alliance for Health Reform.

Kaiser has started posting on its site a series called "Notes on Health Insurance and Reform," while the Alliance is adding another layer to its online sourcebook, updating the reference book pages with relevant local news stories from around the country.

Is reform adequately serving people in your area with pre-existing conditions?

When the health care law passed last year, it included $5 billion for temporary insurance pools for uninsured people with pre-existing conditions. The widespread expectation was that the uninsured would rush to enroll, blowing through the $5 billion long before 2014, when the pools were supposed to shut down as national reform kicked in. Once the state exchanges are up and running, the uninsured will be able to buy coverage that way (with subsidies if they qualify based on income) and can't be turned down because of pre-existing conditions or high-risk.

News coverage should reflect that Vermont has long road ahead to single-payer system

You may have seen a lot of breathless coverage about how Vermont is poised to become the first state to have a single-payer health care system. Don't get too out of breath.

Vermont did pass legislation laying out a pathway toward - perhaps - getting to a single-payer system in 2017. And by all accounts, new governor Peter Shumlin, who ran on a single-payer platform, truly wants to get there, as do many of his supporters in and out of Vermont government. So this post isn't meant to be cynical about their intentions or sincerity. It's just that Vermont's path toward its single-payer system, Green Mountain Care, is way longer and far more unpredictable path than a lot of the overexcited news coverage suggests.

Making sense – and stories – of Medicaid

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?

Affordable Care Act: What is 'premium support?'

This quintessential Washington phrase is in the news 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. 

Meeting the challenges of explaining health reform

Health reform, to say the least, is confusing. The Kaiser Family Foundation had a great “data note” recently establishing just how little the American people know about reform.

So, how did people do? Fewer than one in 100 got all 10 questions right. Only a quarter scored seven or more right – a “C” or above if we were grading.

Why should we, as journalists, care about this non-knowledge – aside from the fact that it’s just depressing? I think it’s a two-fold challenge. Read more ...

Tip sheets

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

The Affordable Care Act: What to cover at the one-year mark, by Joanne Kenen

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

Health care reform: Litigation update 
Kenneth Jost of CQ Press and CQ Researcher outlines key cases in the battle over health reform as well as organizations involved in the litigation and experts and websites that are following the developments in this tip sheet prepared for "Health reform: Repeal, replace or implement?" at Health Journalism 2011.

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

Health Coverage under the Affordable Care Act
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
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.

Will More Physicians Improve the Health of Patients?
Conference presentation from David C. Goodman, M.D., M.S., Center for Health Policy Research at the Dartmouth Institute for Health Policy and Clinical Practice

Understanding the fundamentals of health insurance & implications for reform
Conference presentation from actuary Tim Lee

Assessing Health Reform: Is There a Looming Doctor Shortage?
Conference presentation from Kevin Barnett, Dr.P.H., M.C.P., senior investigator, Public Health Institute

Health reporting resources for journalists on state and local government beats
Tips from longtime state government reporter Nancy Cook Lauer

Health care reform has passed: What's next?
Suggestions from four reporters on how to approach the topic

Covering high-risk insurance pools
Four reporters who have covered the topic offer story tips, suggestions and resources.

More resources

Officials, health system administrator discuss challenges, implementation of the Affordable Care Act, Feb. 24, 2011 (audio available)

What’s next? Reporting on health reform between now and 2014
Transcript of a briefing co-sponsored by AHCJ and related resources

Toolkit: Fresh Ideas for Reporting on Health Reform
Story ideas, reform timelines, expert sources and resources to help you cover implementation.

'Landmark:' Behind the scenes of covering health care reform
Joanne Kenen interviews two of the authors of a book about about how the ACA evolved and how it will affect individuals, small businesses and insurers.

APHA midyear meeting: Implementing health reform - A public health approach, June 23-25, Chicago (see the meeting blog)

Caring for People Covered by Both Medicare and Medicaid: A Primer on Dually Eligible Beneficiaries, June 3, 2011; introductory session designed to inform the staff of new members of Congress both in Washington and in district or state offices about the people who receive benefits from both the Medicaid and Medicare programs (often called "dual eligibles")