Esophageal cancer screening could lead to runaway health costs
Filed under: Conflicts of interest, Health care reform, Hot Health Headline, Public health
Reuters’ Frederik Joelving reports that a new, easier method of taking biopsies to detect esophogeal cancer, called TSA, has opened a up a whole new profit center for folks pushing cancer screening, despite the fact that, as Joelving writes, “there is no research showing that routine screening for esophageal cancer lowers the risk of dying from the disease. Specialist medical groups recommend against it, as does the American Cancer Society.”
Joelving’s report focuses on one physician, Dr. Jonathan Aviv, who has peddled the screening with particular vigor, recommending it for anyone over age 50. Here he is with talk show host Dr. Mehmet Oz:
Folks in the know are not nearly as impressed as the TV doctor.
While the cost of TNE is lower on a per-patient basis than traditional endoscopy, critics say testing millions of people would needlessly add billions of dollars to the already bloated U.S. national health bill and lead to lifelong follow-up testing for many people who would never get the disease.
“You are going to end up hurting a lot of people, and it’s not clear to me you’re going to help very many,” says Dr. Otis Brawley, chief medical officer of the American Cancer Society and author of “How We Do Harm: A Doctor Breaks Ranks About Being Sick in America.” “The simple, ‘Let’s find it early, let’s not pay any attention to the potential for harm’ – that same thought process is what started prostate cancer screening.”
Joelving even goes so far as to compare the test’s business potential to PSA, the well-known antigen screening for prostate cancer that costs the American health system at least $3 billion a year, and which one of its discoverers described as resulting in “a hugely expensive public health disaster.”
And, speaking of conflicts of interest, Joelving found Aviv has plenty.
At different times over the past decade, he was a paid consultant to three companies that make or sell TNE scopes and related equipment: Minneapolis-based Medtronic Inc, Pentax — now known as KayPentax, based in Montvale, New Jersey – and Vision-Sciences Inc, of Orangeburg, New York. Aviv says he is no longer a paid consultant to any of the companies, though he owns several thousand shares in Vision-Sciences and uses its equipment. The company’s systems cost between $30,000 and $60,000.
Watch the AHCJ Health Reform Core Topic pages for an upcoming feature by Joelving about how he reported this story. For more about screenings and comparative effectiveness research, see our recent article by Rochelle Sharp.
Experts share challenges of setting up state insurance exchanges
Setting up a state insurance exchange is a complicated endeavor – made more so by the bitter politics of health reform and the uncertainty over the Supreme Court ruling. Some states, like Maryland, are proceeding with enthusiasm. Others are fighting the health law in court – but quietly doing some of the ground work for an exchange anyway. Other states say they just aren’t going to set one up, no way, no how – meaning the federal government is supposed to be ready to step in with a backup exchange plan.
At the panel on state exchanges at Health Journalism 2012, we heard from two experts – Maryland Health Secretary Josh Sharfstein, who is coordinating his state’s exchange efforts as the head of its exchange board, and Heather Howard, the director of the State Health Reform Assistance Network, based in Princeton. (For her snapshot maps of where states stand in exchange development as of April 2012, click here.)
One point Sharfstein made: Even in a state as committed to reform as Maryland, setting up the exchange is no simple task. Much of the challenge arises from updating and revamping – and adding – to the state’s information technology capacities. When exchange builders talk about IT, they aren’t referring to the electronic health records you’ve been hearing about. This is a system to help people shop in the exchanges, (for individual or small group coverage), figure out whether they belong in Medicaid, CHIP or the exchange and, if in the exchange, whether they qualify for federal subsidies – and how much. It’s not just the very poor who qualify, there are subsidies available on a sliding scale up to 400 percent of poverty, currently around $90,000 for a family of four. These complex IT systems will also have to deal with what happens if people’s income changes – whether the subsidies rise, or whether they have to give some of it back. If it doesn’t sound easy – it’s not.
“On the topographical map of anxiety, this is a skyscraper,” Sharfstein said of the IT challenge.
One question that came up is why it matters whether the state or the federal government runs the exchange. Both speakers had a long list of reasons – including making decisions (based on the specific dynamics and demographics of a given state’s insurance market)about whether to merge or keep separate the individual and small group markets, the role of brokers and navigators, conditions for a health plan for participating in the exchange (including some requirements affecting their business outside the exchange – where people can still buy policies but not get subsidies) how to finance the exchange, the type of governing board the exchange should have, and who should (or should not) serve on it. (Another big issue facing states is how to define the essential benefits package – but I’ll post separately on that soon.) In fact, the federal government has left so many decisions up to the states that it threatens to overwhelm some of the states, or create paralysis, Howard said.
Toward the end of the session, I asked how many people in the audience thought their state would be ready to run the exchange on Jan. 1, 2014. Not a whole lot of hands went up. And, logically, when I asked how many thought their state would not be ready, a whole lot of hands shot up. So I asked Howard to explain the “hybrid” that HHS has offered to create. Basically, this means that the federal government and the state will divvy up the exchange responsibilities, with the state doing what it can and the feds backstopping the rest. This is supposed to be a sort of a temporary bridge, with the state eventually assuming full responsibility. With states – and the court – in flux, no one really knows exactly how many states will end up going for this hybrid option, but some experts estimate it could be about half. It’s just too soon to know for sure.
Joanne Kenen (@JoanneKenen) is AHCJ’s health reform topic leader. If you have questions or suggestions for future resources, please send them to joanne@healthjournalism.org.Two other big state issues that I’ll post on separately soon: How the states are deciding on the essential benefits package, and what options do states have if the Supreme Court kills the mandate, but leaves most of the health law intact. Shoot me an e-mail if you see good local coverage on this so we can link to it.
Final note: here’s the best one-stop shop for information on state exchange building and some state-specific funding information is here. The National Council of State Legislatures also is a good resource.
Comprehensive series on N.C. hospitals includes national context, effects of reform
Filed under: Health care reform, Health data, Hospitals, Hot Health Headline
The (Raleigh, N.C.) News & Observer and The Charlotte (N.C.) Observer just combined forces to do a terrific five-part series on hospitals called “Prognosis: Profits.”
It’s not just a great expose/explainer/data analysis/narrative that tells readers about the state of the hospital industry in North Carolina and its national context. With lots of examples, data and sidebars that break down some complex policy ideas, it’s also a great primer for anyone who wants an easy to understand but multifaceted Hospitals 101 (without being Hospitals for Dummies). For you multimedia fans out there, it also has a video component.
In a nutshell, the series – a collaboration of investigative and health care writers - found that some of the hospitals make a ton of money and charge more than hospitals elsewhere and that the charity care many of them provide is worth less than the tax-breaks they get ostensibly for providing care to the community. And yes, it gets into many of the complexities of charity care versus community benefit versus cost-shifting versus bad debt. (We’ve written about some of that on this blog.)
They write:
During the Great Recession, their profits have stayed strong, and they’ve raised their prices. Top executives enjoy million-dollar compensation packages as they expand, buy expensive technology and build lavish facilities. Their customers buy the services before they know the cost, and they often don’t understand the bills.
And the hospitals enjoy a perk worth millions each year: They pay no income, property or sales taxes.
The series describes what it’s like to be poor and sick and have a collection agency come after what little you have to pay a big bill for a medical emergency. It describes the million-dollar plus compensation packages of hospital execs. (One got $8.7 million, including a big retirement trust payment.)
The articles blend individual patient stories with policy context and a lot of hospital financial data (which readers can search in an online database that includes total and operating margins for every hospital in the state). The fifth and final installment (as well as some of the fourth) looks at some of the solutions that have been put forth, by state legislators and patient and consumer advocates.
The series avoids one of the pitfalls that drives me crazy in some otherwise good hard-hitting reporting. It describes a problem – deeply and accessibly. But it also goes beyond looking at a snapshot of where things stand today. It connects today’s reality, today’s system, to the many underreported provisions of the Affordable Care Act that may create new tools and forces and legal and financial and cultural shifts that can bring about change – depending on the Supreme Court, the politicians, and on how much the health sector (and patients) embraces versus resists change. (That’s a sidebar in part 3.) Among the relevant elements of the health law it identifies (and the sidebar gives more specifics than I’m including here):
- Hospitals must develop financial assistance policies and the criteria for receiving the help.
- An end to the widespread practice of charging the uninsured who qualify for financial assistance more than they charge the insured
- A ban on nonprofits engaging in “extraordinary collection actions”
- A requirement that they assess community health needs every three years, and devise a plan to meet them
The series has gotten the attention of federal and state legislators. We’ll see if they stay engaged. And how that matters.
Joanne Kenen (@JoanneKenen) is AHCJ’s health reform topic leader. If you have questions or suggestions for future resources, please send them to joanne@healthjournalism.org.
Plenty of stories in how ACA could affect veterans’ health care
While preparing for a veterans health panel I moderated at the recent AHCJ conference in Atlanta, I remembered an article in the Journal of the American Medical Association that AHJC’s Pia Christensen had sent me on what the health reform law would do for veterans. It’s behind a pay wall, but AHCJ members get free access. It’s written by Kenneth Kizer, who is at the University of California, Davis, but used to run the Veterans Health Administration (better known as the VA) - which is the nation’s largest health care system – when he was under secretary for health in the Department of Veterans Affairs.
There are more than 22 million veterans and the number is obviously growing. About one-third (37 percent in 2011) were enrolled in the VA, which usually means they either have a service-connected disability and/or are low income. Most (80 percent) are covered by Medicare starting at age 65. Most have some kind of coverage or mix of coverage (private insurance, Medicaid, or TRICARE, which also covers military retirees and their dependents). Only about 7 percent - well under the national average and most states’ rates - are uninsured, which in most cases means they are poor but not poor enough to get into the VA.
Joanne Kenen (@JoanneKenen) is AHCJ’s health reform topic leader. If you have questions or suggestions for future resources, please send them to joanne@healthjournalism.org.The Affordable Care Act (assuming it survives the Supreme Court) doesn’t affect the VA per se – although one could argue that some of the VA’s initiatives on care coordination and its early adoption of electronic medical records did affect the shape of the ACA. But not affecting the VA doesn’t mean it won’t affect veterans. Kizer expects that to be a mixed blessing.
For that 7 percent who are uninsured (and for those who may be paying a lot for insurance that may or may not be comprehensive in the individual or small group markets) the coverage expansion could make a big difference. Some may qualify for the expanded Medicaid. Other will be able to get insurance, often with a federal subsidy, in the new state-based insurance exchanges. And that’s a gain.
Those options will be open, too, to some veterans who are VA eligible. This is where Kizer argues the benefits aren’t so clear cut. On one hand, it gives veterans more choices, and they may be able to get care that is more convenient and timely. The drawback, though, is the care may be more fragmented and disconnected once they venture outside the VA’s closed system of coordinated care.
“Fragmentation of care is of concern because it diminishes continuity and coordination of care, resulting in more emergency department use, hospitalizations, diagnostic interventions, and adverse events. The VA serves an especially large number of persons with chronic medical conditions or behavioral health diagnoses – populations especially vulnerable to untoward consequences resulting from fragmented care,” Kizer wrote.
There is even some data suggesting that vets who get some care in the VA and some outside are more likely to be rehospitalized and die within a year than VA-only users, although the data is limited. The new choices by expanded coverage options could also mean more veterans end up getting care outside the VA system – from doctors who may not be as well-versed in the medical problems prevalent among vets (including PTSD) or the resources available to help them. There could be some good local stories on this aspect – and on the broader issue of whether mental health providers in the community are plugged into the needs of veterans, whether or not they are eligible for the VA itself.
There are also a bunch of questions about financing – and these too are worth a local look. If more vets seek care outside the VA, will that mean that some low-volume rural VA services will be cut back? How will that affect the remaining vets who want to get those services from the VA? Will coverage expansion in general – not just for vets – lure more doctors and nurses and physical therapists etc out of the VA to meet the higher demand for health providers among the newly insured? And will the increased options for vets cost the government money? For instance, the government may be making redundant payments now – think about a vet over age 65 who gets some care in the VA and is also enrolled in a government-subsidized Medicare Advantage plan, or is a dual-eligible getting subsidized Medicare, Medicaid - and VA care. Will this kind of duplicative payments rise if vets get subsidized coverage through Medicaid or the exchange – and also draw on VA services? Is anyone in your state even thinking about this? Kizer suggests research needs to be done on this, and says Florida, Texas and California – together home to nearly one in four vets – would be good places to start.
He raises other questions about the health care work force, the safety net, the oft-neglected needs of women vets but concludes with a call to recognize that “providing health care for veterans is an ongoing cost of foreign policy foreign policy and national defense strategies and that the nation has a long-standing social contract with veterans to ensure that those who have experienced harm during military service have ready access to health care.”
Understand how Supreme Court’s possible decisions will affect seniors
Older Americans have a lot at stake as the Supreme Court considers the future of the Affordable Care Act, and it behooves reporters on the aging beat to understand this slice of the health reform debate.
Howard Gleckman gave a good overview recently on his “Caring for our Parents” blog. Gleckman is a former senior correspondent at Business Week, author of the book “Caring for Our Parents,” and a resident fellow at the Urban Institute.
Here’s a look at how older adults might be affected, drawing on Gleckman’s piece and my thoughts.
Medicare. As Gleckman notes, health reform offers an important benefit to seniors: an eventual end to the dreaded “doughnut hole” – the multi-thousand dollar gap in coverage for prescription drugs, available through Medicare Part D.
If the Supreme Court strikes down only the individual mandate component of the Affordable Care Act – the requirement that everyone carry insurance or pay a penalty – there’s no reason this provision couldn’t stand, except for its expense. If, however, the Supreme Court invalidates the entire Act, this benefit may well disappear, leaving many seniors vulnerable to high medication costs.
Since adults 65 and older already have coverage through Medicare, they wouldn’t be harmed if the court overturns key provisions expanding health insurance coverage to 30 million Americans. But uninsured adults in the 55 to 64 age group would be hard hit. As Families USA noted in a report:
“While people in this age range are currently the least likely to be uninsured, they can have very serious problems finding coverage if they leave or lose their jobs: They are too young for Medicare and too old to purchase affordable coverage on their own in the private individual market. Options for coverage outside the workplace are limited.”
It’s highly unlikely that Medicare will cancel new preventive services for seniors - a popular element of health reform that became effective in January 2011. Services now provided without beneficiary cost sharing include an annual wellness exam and screenings for diabetes, cognitive impairments, high cholesterol and cancer.
Medicaid. Health reform would add up to 16 million new members to Medicaid, mostly poor children and adults under age 65. In terms of seniors, its biggest impact lies in two areas: a push to provide more long-term care services outside of institutions (see below) and a drive to better coordinate care provided to “dual eligibles” – sick, poor seniors covered by both Medicare and Medicaid.
A complete invalidation of the Affordable Care Act would hamper both initiatives by withdrawing legislative support and crucial funding. Both initiatives could survive a partial invalidation of the Act, but whether leadership for these changes would materialize is in question.
Home and Community-Based Care. For years, advocates have pressed for an expansion of long-term care services available to seniors outside of nursing homes. The Affordable Care Act recognized this and directed billions of dollars toward so-called “home and community-based services,” as Gleckman notes:
“The ACA includes important new incentives for states to expand Medicaid long-term care services for people living at home. Today, nursing homes still get the lion’s share of Medicaid long-term care dollars. Yet seniors and adults with disabilities overwhelmingly want to receive assistance at home. The ACA includes a number of new programs to expand those home and community-based programs, but all would die with the law.”
Gleckman is correct if the entire law is upended. But if only the individual mandate is rejected by the court, it’s likely this shift toward home and community-based care will persist, if only in a reduced form. The economics and preferences of aging baby boomers will require these changes to occur.
Integrated care. If health reform is torpedoed by the Supreme Court, many experts expect the government to continue testing innovative programs that improve medical care and lower costs. But several prominent Republicans have questioned the value of programs funded through the newly created Center for Medicare and Medicaid Innovation and appear poised to mount political attacks on its work.
Gleckman says that “In the long-run, perhaps the most important provisions for seniors are a far-reaching package of experiments aimed at improving the way care is delivered to people suffering from chronic disease, as nearly all seniors do. ” He predicts that these demonstration projects will end if health reform is struck down by the Supreme Court.
Other experts believe similar efforts to improve chronic care will be undertaken by the private sector if health reform fails.
Long-term care insurance. The CLASS Act, part of the health reform package, would have created the nation’s long-term care insurance program but that initiative fell by the wayside when the Obama administration decided that it was unaffordable. See AHCJ’s recent tip sheet on long-term care for more details.
Without this program, long-term care insurance will remain an unaffordable expense for many consumers, especially as insurers across the country sharply raise premiums.
This is a lot to assimilate, but here’s another thought: if health reform is deep sixed by the Supreme Court, it will be many years before Congress will be willing to undertake another substantial overhaul of the health care system, Gleckman suggests. That’s a sobering thought, since older adults’ health is frequently compromised by costly, sometimes unjustified, fragmented and uncoordinated care in the system we now have.
Related: Joanne Kenen, AHCJ’s topic leader on health reform, writes that there is still plenty to watch and report on as the Supreme Court deliberates.
Judith Graham (@judith_graham), AHCJ’s topic leader on aging, is writing blog posts, editing tip sheets and articles and gathering resources to help our members cover the many issues around our aging society.
If you have questions or suggestions for future resources on the topic, please send them to judith@healthjournalism.org.
How health care price fixing works in Maryland
Filed under: Health care reform, Health data, Hospitals, Hot Health Headline
As part of her series in National Journal, Margot Sanger-Katz explains how four decades of health care price controls have held costs in Maryland from 25 percent above the national average in 1976 to 3 percent below average in 2009.
In addition to price, the state’s system has also had an impact on quality of care and on hospital access, because Maryland’s universal prices mean that inner-city hospitals won’t be lured out to more affluent suburbs as they have been in cities such as Detroit and St. Louis.
Maryland’s system is what health care economists call all-payer rate-setting. The cost-containment board looks at services and hospital needs and then selects a uniform menu of prices for all payers. In most states, prices for the same procedure vary. Some payers, usually the public ones such as Medicaid, get a steep discount, while others pay more to make up the difference. (The country’s most expensive CT scan of the head is $1,545, according to the international health-plan study.) In Maryland, Medicare, Medicaid, private insurers, and patients who pay cash all get the same bill for a CT scan. It means that bigger, more powerful hospitals can’t demand higher prices from insurers. It also means that hospitals that treat Medicaid patients don’t get bankrupted by skimpy reimbursement rates.
Sanger-Katz is writing this series as part of an AHCJ Media Fellowship on Health Performance, supported by the Commonwealth Fund.
After AHCJ protest, HHS stipulates public meetings are open to media
Filed under: Government, Health care reform, Public records
Can you imagine holding public meetings open to everyone – except reporters who want to cover them? That’s exactly what the U.S. Department of Health and Human Services did last year. But, after complaints from the Association of Health Care Journalists, HHS has agreed to make it a policy that public meetings are open to the media.
“We are hopeful this will not happen again,” said Felice Freyer, chair of AHCJ’s Right to Know Committee. “But to make sure, we will need your help.”
Here’s what happened:
In November, HHS held a series of “listening sessions” in 10 cities to gather input on an important aspect of the Affordable Care Act. These meetings were publicized among thousands of invited “stakeholders,” and anyone who heard by word of mouth could also attend.
But apparently no media advisories went out and, worse, reporters who happened to learn about the meetings were barred from attending. The meetings were not transcribed or recorded.
AHCJ learned about these meetings from Laura Newman, an independent medical journalist and blogger at Patient POV, who asked to attend and was told she could not. Alarmed that the government would bar coverage of public meetings, AHCJ wrote to every member working in the cities where the listening sessions were held (Chicago, Boston, Philadelphia, Dallas, New York, Kansas City, Atlanta, Seattle, Denver and San Francisco) to find out what they knew. Among the 26 who replied, only two knew about the meetings before they took place – Newman and another member who had not been interested in attending.
Over a period of weeks, AHCJ worked with the HHS media office to find out what had happened and to express our concerns. “By excluding the news media, HHS was essentially shutting the door on the majority of people who weren’t on the mailing list or connected with someone who was,” Freyer said. “Most people don’t go to such events, but rely on the news media to tell them what happened.”
The meetings sought input on the definition of “essential benefits,” the minimum that would be covered by plans sold on health insurance exchanges. This was a key aspect of carrying out the health care law; in the end, HHS decided to leave that question to the states.
We asked for the list of “stakeholders” who attended and any notes from the meetings, but HHS was unable to provide them. In a phone conversation last month with Freyer and AHCJ president Charles Ornstein, HHS media officials acknowledged that such meetings should be open to the media. At our request, they agreed to add this sentence to their media guidelines: “Meetings that are open to the public are, by definition, open to the media.”
Please watch out for any violations of this principle, and let us know about them.
“This incident illustrates how members can make a big difference by alerting us to access problems,” Ornstein said. “We’re grateful to Laura Newman for bringing this to our attention, and to all those who responded to our letter. The work of the Right to Know Committee is among AHCJ’s most important endeavors – but none of it can happen without our members’ vigilance and willingness to step forward with information.”
Still plenty to watch, report on as Supreme Court considers health reform law
I have a few quick thoughts on this week’s Supreme Court hearings and what it will mean for our coverage of health reform.
Most people in the courtroom (or people who, like me, listened to audio, read transcripts, wrote and edited a ton of copy and couldn’t avoid Jeff Toobin) ended up with the gut feeling that health reform is in deep trouble – that the court is likely to toss the individual mandate, some of the insurance provisions, and maybe a whole lot more. Maybe all of it.
Joanne Kenen (@JoanneKenen) is AHCJ’s health reform topic leader. If you have questions or suggestions for future resources, please send them to joanne@healthjournalism.org.But of course, we don’t really know what the court will do. Tough questions in public certainly let us know that all nine justices are not exactly the law’s biggest boosters. But what they will do, as they mull and debate behind closed doors, is not a sure thing. We can guess, but we don’t know. And we won’t know for about three months. (There’s a chance that it will be sooner – but traditionally big rulings come out at the end of the term. And this is a big, big ruling).
Remember the “Conventional Wisdom” was wrong before – wrong from the beginning. The CW didn’t think Obama was going to push for comprehensive health reform. The CW didn’t think he’d be able to enact health reform – particularly not after Scott Brown’s election. The conventional wisdom didn’t think there would be a fight about the mandate. Or that the mandate would end up in the Supreme Court. Or that it would be in deep, deep, deep trouble once it got there.
So what do we do for the next three months?
First of all, we are going to get spun – and the negativity about the oral arguments is going to help the anti-health law camp of spinners. (The “hey it’s hunky-dory, it’s all fine” advocacy world rings a little hollow at the moment – although they may turn out in June to be right.) Keep an eye out for that “the law is dead so let’s get real” drumbeat because if things are said often enough, in a media or political context, they can start becoming the new conventional wisdom and affecting how we report and write.
We might get pushed by editors to be more forceful about predicting the demise of the law (or the mandate) than we are comfortable with. Push back – you can certainly say there are real questions about the law’s survival. You can’t pick out hymns for its burial.
Watch your state. Are officials slowing down implementation? Not submitting grant applications for exchange planning when they were before, or not putting out bids for exchange IT teams, etc.? Are the implementers slowing down – and are the non-implementers freezing? How much catching up will they have to do if the statute is upheld – and they have to meet some exchange certification deadlines by Jan. 1, 2013.
Is the court situation affecting state politics - local, congressional, presidential. How?
Is anyone talking about state initiatives to fill in if the parts of the federal plan are punctured? For instance, if the federal mandate fails, there’s nothing to stop a state from passing its own mandate; the federal constitutional questions don’t apply. I suspect few states will do this - but I can think of a handful that might. (If this does start to bubble up in your state, please email me your coverage.)
What are the hospitals’ and insurers’ and physician groups’ contingency plans? Are delivery system reforms and innovations on hold – or is the assumption that they can either proceed without the federal law, or that the relevant sections of the law will survive
And does the public know what it wished for? It wanted health reform when it didn’t have it. Then it decided it didn’t like health reform when it got it. Do Americans really want to go back to March 22, 2010 (the day before President Obama signed it)? And do they realize they can’t; that the health system has changed? Do they understand that people who are getting benefits under the first phases of the law’s implementation could lose them? And that costs will rise, the numbers of uninsured (now somewhere around 50 million) will rise, and Congress – so polarized that it has trouble doing much more than renaming post offices these days – is not going to come swooping in with a pain-free bipartisan fix-the-problems-with-no-cost-or-dislocation make-everyone-happy solution.
Related
Webinar: Implementing health reform in the states
Affordable Care Act before the Supreme Court: What you need to know – A tip sheet by longtime legal journalist T.R. Goldman that addresses five key questions.
For ACA’s 2nd anniversary, go beyond talking points; look at delivery systems, innovations
With so much focus on the coming Supreme Court case, it’s easy to forget that next week (March 23) marks the second anniversary of the health care law.
Don’t expect too much hoopla from the White House, which is reluctant to look as though it’s trying to influence the Supreme Court. You probably will get the usual onslaught of emails (”Hey, have you heard the one about young adults staying on their parents’ health plan until age 26?”) from HHS and the advocacy groups will step up their game in building support for a law that remains quite unpopular. House Democratic whip Steny Hoyer got a jump start with the first “health reform is working” anniversary release, so that gives you a taste of what you will find in your inbox.
As of this writing, neither Speaker John Boehner nor Senate Republican leader Mitch McConnell have updated their websites with an anniversary missive, but both are likely to, and both sites have ample background on why they oppose the law. The House will probably vote on a measure to repeal the Medicare Independent Payment Advisory Board (IPAB) around the time of the anniversary, and that will let them showcase their arguments about government takeovers, rationing, harming Medicare etc. Groups like your local chapter of the National Federation of Independent Business (which is a party to the lawsuit against the law) may be good anti-ACA sources.
The federal site, HealthCare.gov will give you an overview of what’s in the law, what’s gone into effect and what’s ahead.
Both the Kaiser Family Foundation and the Commonwealth Fund have good timelines. They overlap, of course, but they aren’t identical.
There are many, many polls on health care and although they differ in details, the gist is: The health law is unpopular and opinions largely split along party lines. And there is, as we’ve noted here many times in the past, a truly striking disconnect because even while the law is unpopular, people really like the individual provisions (except the individual mandate which even many Democrats oppose.)
As you all know, people are really, really confused about what’s in the law and what’s not. And in one of my favorite recent tidbits (h/t Sarah Kliff) 14 percent of those surveyed in a recent Kaiser poll thought it had already been overturned by the Supreme Court and is no longer law. Another 28 percent weren’t sure.
One element often overlooked is the shorthand reporters and pollsters often use. We talk about “the individual mandate” or the “requirement that people by insurance.” What would happen if we wrote “the individual mandate – which is accompanied by subsides on a sliding scale for low-income and middle-class people up to 400 percent of the federal poverty level.” (And 400 percent of FPL is currently around $92,000 for a family of four.)
To get past the warring talking points, many of the resources we assembled last year for the first anniversary remain relevant and helpful.
One of the stories that might be intriguing to tackle is whether people who are experiencing some of the benefits or being affected by some of the new programs understand that they are in fact part of the health care law, not just some sort of benefit manna descending from health care heaven (wherever that is).
Another would be to look at some of the delivery system reforms or pilot programs that have gone into effect. They don’t get enough attention. Some may fail. Others may turn out to improve quality without saving money. And some may fulfill the promise for improving quality while saving money. Be careful of drawing conclusions too soon – for many of these it’s just too soon to know.
One place to find some innovators – the CMS Partnership for Patients Initiative and the Care Transitions program – both of which have attracted a great deal of hospital and health plan interest.
Another is the CMS Innovation Advisors – several dozen clinicians and policy experts tasked with testing good ideas and then spreading those that work.
Joanne Kenen (@JoanneKenen) is AHCJ’s health reform topic leader. If you have questions or suggestions for future resources, please send them to joanne@healthjournalism.org.
AHRQ details spending on health care
Filed under: Aging, Children, Conflicts of interest, Government, Health care reform, Public health, Public records, Studies, Tools
Among recent releases from the Agency for Healthcare Research and Quality, its data on who’s spending what on health care stands out as particularly useful to a broad audience. It has already inspired posts, graphics and stories around the web, and even journalists who don’t plan to use the data directly can get useful context from these secondary pieces.
Thanks are due to AHCJ member Eileen Beal, a Cleveland-based independent journalist, and MedCity News’ Veronica Combs for pointing us to a handy guide to the AHRQ data.
American Medical News’ Doug Trapp uses the AHRQ data to create a profile of America’s heaviest health care consumers. For the record, he reports that they’d most likely be white, female and privately insured.
They are the costliest 1% of patients in the U.S. Caring for them accounts for more than 20% of what the nation spends on all of its health care. In contrast, the least costly half of all patients are associated with only 3% of total health spending, according to an Agency for Healthcare Research and Quality analysis of spending data from 2008 and 2009 released in January.
Finally, we have the AHRQ statistical brief itself. It’s quite accessible, and reporters will find its references section to be a hyperlinked gold mine of handy numbers and research reports.
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