‘Main Street’ informed, skeptical on health reform
In her blog on CJR.org, AHCJ Immediate Past President Trudy Lieberman updates what is becoming an annual franchise: Her summer man-on-the-street column gauging popular opinion on health reform. Just like last year, Lieberman found her subjects on the streets of Columbia, Mo., a town that’s about as close to the (population) center of the United States as you can get.
The common thread? Missourians were pretty sure health care reform wasn’t all it was cracked up to be, but still weren’t willing to vote “yes” in the state’s referendum on opting out of the individual mandate.
Lieberman added a concrete dimension to her main street opinions by prying details on income and expenses from her sources, numbers and ideas which she then used to link their stories to the larger themes surrounding reform implementation.
Keep an eye out for part two of the column, which should be coming soon.
Article looks at evidence behind back surgery
Filed under: Conflicts of interest, Health care reform, Hot Health Headline
In the Star Tribune, Janet Moore seeks to counter aggressive spinal surgery with equally aggressive journalism. It’s a comprehensive take on a subject which journalists have been hammering away at piecemeal for some time now. Her anecdotes are strong, and her numbers doubly so. For example:
Photo by planetc1 via Flickr
Four out of five Americans will suffer from disabling back pain during their lifetimes, according to the National Institutes of Health. Spending on back care soared between 1997 and 2005, reaching $86 billion — just shy of what Americans spent battling cancer.
As those numbers have multiplied, so have questions about the more aggressive forms of back treatment. A 2008 study in the Journal of the American Medical Association, for example, noted that the increase in back-care spending occurred “without evidence of corresponding improvement” in patients’ health.
As Moore points out, this is a debate that will continue as health reform is implemented because the new legislation will “require doctors and hospitals to demonstrate that their services are cost-effective. In that vein, the New England HealthCare Institute estimates the United States could save roughly $1 billion a year by eliminating unnecessary back surgeries.”
Minnesota is home to Medtronic, a leading maker of devices used in spinal surgery. Medtronic has consultation arrangements with a number of doctors and some experts question whether that relationship has an effect on how many spinal surgeries are done. The head of the Association for Ethics in Spine Surgery, says these financial incentives create demand for certain brands of product.
It’s a lengthy piece, and the numbers are just one component. The whole package is definitely worth a read.
Related
Report examines health reform implementation
Filed under: Health care reform, Health policy, Hot Health Headline
A special report just released by The American Prospect looks at the implementation of health care reform. For the wide-angle view, read Paul Starr’s road map of where the battle lines will be drawn in the implementation effort.
AHCJ members Joanne Kenen, Jonathan Cohn and Rebecca Ruiz contributed to the 12-part report. Cohn discussed the construction and implementation of insurance rules, Kenen looked at Connecticut’s push for a local public option and piecemeal reform implementation in individual states.
Other elements include:
- Keith Wailoo’s evaluation of the pain management reform components of the bill, which amount to the promise that “we’ll look into it and maybe throw a little grant money in that direction.”
- Maria Abascal examines how reform will impact immigrants, legal and illegal alike. Legal immigrants, which make up a substantial portion of the nation’s uninsured, stand to benefit — as long as they can prove citizenship. Illegal immigrants don’t.
- Harold Pollack looks at health reform’s massive blind spot, the period between now and January 2014. Stopgap measures won’t be adequate for the majority of the uninsured, and Pollack pushes for an accelerated timetable.
Related
A briefing from the Alliance for Health Reform, cosponsored by the Robert Wood Johnson Foundation, looks at “50 Ways to Implement Health Reform: State Challenges and Federal Assistance.”
How reform will affect America, group by group
Filed under: Health care reform, Health policy, Hot Health Headline, Studies
In Health Affairs (AHCJ members get free access), economist Joseph Newhouse considers how health care reform will affect four major groups. They’re summarized below.
- Uninsured or on Medicaid or CHIP (30 percent)
- Insured individually or through a small business (10 percent)
- Insured through a mid-size or large business (45 percent)
- Recipient of Medicare (15 percent)
Medicaid expansion and broader subsidies are “major gains.”
This group will undergo the most change, with the individual mandate expanding their ranks to as much as 50 million people (16 percent of Americans). Health reform should “repair” this now-broken sector of the market.
A wash, as an insurance tax is balanced out by a reduced need to cover uncompensated care for the uninsured.
Complicated. The doughnut hole will close, but future financing sources are murky. Newhouse goes pretty deep into just how murky.
His conclusion is relatively upbeat. Newhouse writes that while reform “addressed many issues in health care financing, it left many others unresolved.” The system will need to be revised and updated throughout the foreseeable future, Newhouse writes, and effective implementation will “require persistence for many years to come.”
New rules affect patients’ insurance appeals
Filed under: Health care reform, Health policy, Hot Health Headline
Kaiser Health News’ Phil Galewitz and Michelle Andrews have an update on health care reform implementation, pointing out that new rules will give consumers the right to appeal insurance denials, first directly to the insurer and then to review boards. The rule doesn’t break new ground in most states – only five lack such regulations, and existing plans are “grandfathered in” under the old rules – but it may bring order to a chaotic national patchwork on insurance appeals. The White House estimates that, by next year, the rules will benefit about 41 million Americans insured either through employers or through individual plans. The administration is pushing states to implement the new standards by next July.
The new regulations take effect for plan years starting Sept. 23. But they won’t automatically apply to residents in states that have existing external review laws until next July. That’s to give states time to adjust to the new standards.
If states fail to change their rules by next July, their residents will then be able to rely on the federal standards. But federal officials are still working out the details of how that would be done.
Read the HHS press release here.
AHCJ resources
- Reporting on health reform between now and 2014: 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 and transcript of this briefing and a resource list are available.
- Covering high-risk insurance pools: The federal government and states are scrambling to create temporary high-risk pools for the medically uninsurable, as one of the first provisions of the Patient Protection and Affordable Care Act to go into effect. 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. Four reporters covering the topic have shared their story tips, suggestions and resources for AHCJ members.
- Health care reform has passed: What’s next? Four journalists on the front lines offer their advice and suggestions on what needs to be covered next, how it might affect local communities and how to approach this complex topic.
Beacon programs offer hope for health IT
Filed under: Government, Health care reform, Health policy, Hot Health Headline
Emma Schwartz and Fred Schulte, the HIT specialists at the Huffington Post Investigative Fund, examine the 15 “beacon” programs involved in a $220 million federal effort designed to demonstrate how health tech can bring better treatment at a lower cost. Twelve of the programs will focus, at least in part, on diabetes in order to explore how much of an impact HIT can have on chronic (and under-treated) diseases.
For more on each program, visit this interactive map.
The grants also offer an early test of a $27 billion gamble by the Obama administration that medical records technology can achieve specific cost reductions and health improvements, critical tenets of health reform.
Hopes are high. In Mississippi, the alliance aims to reduce blood sugar levels in at least one of four patients with diabetes, increase the numbers of people who take their medications as directed and cut the cost of their care by 10 percent – all within the next three years. In Tulsa, Okla., which has the nation’s highest rate of heart disease, another group is hoping that its $12 million grant will reduce preventable hospital visits by 10 percent while saving patients and taxpayers $11 million a year.
Schwartz and Schulte write hopefully of the potential shown by the beacon programs, but temper it with cautionary tales from Florida and various auditor’s offices.
Reform may worsen ER crowding
Filed under: Health care reform, Health data, Health journalism, Health policy, Hospitals, Hot Health Headline, Member news, Studies
Associated Press medical reporter Carla K. Johnson has found that, contrary to common assumptions, emergency rooms could become even more crowded with the passage and implementation of health care reform. Popular wisdom has it that, with more access to insurance thus to primary care, folks will be less likely to go to the emergency room for minor complaints or to allow illness to progress to the point where an emergency visit is necessary. Johnson, an AHCJ board member, gives three big reasons why it’s not that simple:
- There are not (will not) be enough primary care physicians in America to deliver that preventative care.
- At present, the uninsured are no more likely to use the ER than patients with insurance coverage.
- “The biggest users of emergency rooms by far are Medicaid recipients,” Johnson writes. “And the new health insurance law will increase their ranks by about 16 million.”
ERs are crowded, Johnson writes, not only because of a lack of insurance but also because of obstacles inherent in their structure and mission, such as an aging population, more people with chronic illnesses, the closures of many ERs in the 1990s and the demand for beds for both emergency patients and patients scheduled for elective surgeries that bring more money.
AHCJ Immediate Past President Trudy Lieberman praised Johnson’s story and linked it to reporting by The Boston Globe on the impact of that state’s reform law upon emergency room use. So far, events in Massachusetts reinforce Johnson’s predictions.
The Boston Globe revisited Massachusetts’s ER conundrum last week, and reported pretty much what it did last year—that despite the state’s reform law, which mandated everyone have coverage beginning in July 2007, emergency room use is rising. Last year, the state’s Division of Health Care Finance and Policy cautioned that it was too early to draw any conclusions from the seven percent rise in ER visits between 2005 and 2007. Now the agency is saying that expanded coverage may be one reason for the 9 percent rise from 2004 to 2008. According to commissioner David Morales, many studies have shown that expanding coverage does not reduce emergency room visits. That’s because the uninsured “are not really responsible for significant ER use,” he told the Globe.
Waiting period affects 2 million disabled Americans
Filed under: Health care reform, Health policy, Hot Health Headline
Nearly 2 million disabled Americans “fall into a twilight with the first monthly Social Security disability payment, for they then must wait two years to become eligible for Medicare,” according to The Oregonian’s Anne Saker.
With at least 15,000 in that position in Oregon, Saker tells the story of Sue Sherman, diagnosed last year with pancreatic cancer, who discovered she must wait two years for Medicare to cover her. “Only 20 percent of pancreatic cancer patients live more than a year past diagnosis,” Saker reports.
Saker outlines the history of the waiting period, statistics about how many people in that situation go without insurance and the machinations in Washington, D.C., over the waiting period, but weaves it all into Sherman’s story, keeping a human face on the issue.
She looks at how Sherman’s illness and lack of coverage affects her family and includes an observation by Sherman’s daughter that the costs of her care will be passed on to everyone else.
As Trudy Lieberman says in her blog at CJR.org, “Her plight illustrates the traps that snare the disabled in every state.” Lieberman explains how people get caught in this waiting period and will be stuck with another waiting period with today’s launch of high-risk insurance pools.
With 2 million people affected, this is a story that should be told in every state. Lieberman wrote in 2008 about putting a human face on the proposed health reform plans. Reporters would be smart to heed that advice as they report on how the new law will be enacted.
Related
Health care reform has passed: What’s next?
July 1 marks a big day for health reform
Scott Hensley, on NPR’s Shots blog, has a nice rundown of the health care provisions that go into effect today, including the so-called tanning tax, high-risk insurance pools and the new healthcare.gov website.
For reporters writing about the tanning tax, we remind you to look carefully at the numbers and be sure to accurately report the data behind this policy decision. Much of the reporting we’ve seen cites numbers presented by the World Health Organization: “use of sunbeds before the age of 35 is associated with a 75% increase in the risk of melanoma.” But that statistic represents the relative risk, while the absolute risk – the chance of something happening – is far different. Reuters Health Editor Ivan Oransky, M.D., has written about the subject for Covering Health:
“You can see how if someone is lobbying to ban something – or, in the case of a new drug, trying to show a dramatic effect – they would probably want to use the relative risk.”
For a detailed explanation, be sure to read Oransky’s post about the statistics on tanning.
If you’re reporting on the high-risk insurance pools that go into effect today, don’t miss our tip sheet on the topic, with story tips, suggestions and resources from four experience reporters. 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.
Another tip sheet addresses what needs to be covered now that the Patient Protection and Affordable Care Act has been passed and begins to be implemented.
A recent briefing, “Reporting on health reform between now and 2014,” offers further advice and resources from some top Washington, D.C.-based journalists on implementation deadlines, how to cover local issues, Medicare reimbursement rates, what reporters should look for in their states and more.
Healthcare.gov coming July 1
Filed under: Government, Health care reform, Health journalism
KHN’s Phil Galewitz previews the July 1 launch of a federal website he says “will give consumers a list of all private and government health care plans for individuals and small businesses in their areas,” a service required by the reform bill, and one that has never before been part of the modern system.
The initial site will just provide basic information on each plan, but a planned October upgrade will include what Galewitz called “detailed cost and benefits information,” the precise nature of which is still being negotiated. Insurance groups, predictably, say that sharing all the information HHS plans to provide will just lead to confusion and higher costs. Consumer groups disagree.
Insurers including UnitedHealthcare and Aetna say HHS is going too far in planning to list certain data, such as the percent of claims that health plans deny, the rate at which they cancel policies after customers get sick and the number of times patients appeal coverage decisions. They say the data would mislead potential customers.
…
The site can “be the great equalizer so consumers can have equal access to information and be on the same playing field as insurance companies,” says Elisabeth Benjamin, co-founder of Health Care for All New York, a consumer health care coalition. “The government needs to make the information as open as possible.”
Until 2014, when stricter provisions of the reform bill go into effect and such practices are no longer permitted, the site will list only the “sticker prices” of the plans, and insurers will still be allowed to charge sicker patients more.
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Spend a week at the CDC studying public health, meeting sources. Apply for the AHCJ-CDC Health Journalism Fellowships today!
- Reporting on the intersection of health, environment
- Tip sheet: Covering cuts to Medicare reimbursements
- Briefing: Reporting on health reform between now and 2014
- Covering high-risk insurance pools: Tips for reporters
- Health care reform has passed: What's next?
- Health and education: Covering these intersecting beats
- Reporting on the business of health care
- Health reporting resources for journalists on state and local government beats
