‘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.
CPI: Insurers prepare $20 mil lobbying effort
On the Center for Public Integrity’s PaperTrail blog, Peter Stone reports that five of biggest insurers in America are preparing to go to the mat for round two, this time with the intertwined goals of swinging midterm elections and influencing health reform implementation regulations.
According to Stone, Aetna, Humana, United HealthCare, WellPoint and (maybe) Cigna will pool something like $20 million. Look for the new lobbying organization, probably a 501(c) (4) nonprofit, in the next few months. Television ads and a variety of other campaigns will likely follow.
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.”
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?
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.
Lundberg’s list of why health care costs are rising
While people on the streets, experts and legislators debate the causes of rising health care costs, George Lundberg, M.D., editor-at-large of MedPage Today, does no such hand wringing.
He declares that a survey of the topic that was posted by his publication missed the point and did not provide the correct answers.
Lundberg, who edited the Journal of the American Medical Association for 17 years and is a member of the Institute of Medicine, lists what he sees as the “Primary Drivers of Rising Healthcare Costs.”
Insider offers view of health innovation
Filed under: Health care reform, Health policy, Hospitals
Blogging for the Harvard Business Review, Simon Stevens (chairman of the UnitedHealth Center for Health Reform & Modernization) seeks to explain why the field of health care is so agonizingly slow to adopt innovation, whether it be 15 years and counting for e-mail communication or several generations for scurvy-preventing limes. Without spoiling Stevens well-chosen analogies and explanations, I can say he makes a case that it comes down to three factors:
- The labor intensive nature of health care
- Failure to spread organizational innovation
- Barriers to new entrants in care delivery
To Stevens’ way of thinking, there is one group positioned to overcome those barriers and push the system forward: Health plans. UnitedHealth and its competitors have the data, platforms and connections to become major change agents in the field of health care delivery, as well as the incentive to put it all to work improving outcomes and decreasing costs.
#AHCJ2010 early coverage roundup
Filed under: Government, Health care reform, Health journalism, Health policy, Hot Health Headline, Member news
Apart from the announcement of the FDA’s infusion pump regulation push, the biggest appearances out of Health Journalism 2010 in Chicago this week have been U.S. Department of of Health and Human Services Secretary Kathleen Sebelius and Thomas Frieden, director of the Centers for Disease Control and Prevention.
Landon Hall, of The Orange County Register, covered the Sebelius and Frieden appearances for AHCJ.
At Health Journalism 2010, Kathleen Sebelius talked about implementing health care reform. (Photo: Pia Christensen)Reuters’ Debra Sherman also covered both presentations.
Sebelius focused on insurers, especially those who deny coverage to those with a legal write to it, Sherman wrote. According to Sherman, “Sebelius… said to expect ‘hand-to-hand combat’ if insurers try to ‘drive patients out of plans.’”
Working from a broader perspective, New America Foundation’s Joanne Kenen wrote about how insurance fit into Sebelius’ larger task of implementing recently passed health care reform measures.
In his presentation, Frieden focused on smoking, which he called the leading preventable cause of death. Reuter’s Sherman again:
Dr. Thomas Frieden, director of the Centers for Disease Control and Prevention, said that after years of steady declines in the nation’s smoking rates, progress has stalled over the last few years and that the agency was renewing its focus.
He said government stimulus funds would be used to increase anti-smoking efforts. He said the CDC would encourage states to implement anti-smoking strategies, such as education and media campaigns, smoke-free laws and higher cigarette prices.
In other AHCJ 2010 news, Dallas Morning News reporter Robert Garrett wrote that a “siege mentality was very much on display when a trio of hospital executives spoke this morning at an Association of Health Care Journalists conflab in Chicago.”
“We’re all scared to death by health care reform,” said Advocate Health Care president and CEO Jim Skogsbergh, who runs 13 hospitals in Illinois. “We know we’re going to get paid less.”
Lieberman: Pollack wrong, reform coverage lacking
Filed under: Health care reform, Health journalism
Last week, Harold Pollack (bio), a University of Chicago professor who has been contributing to The New Republic’s The Treatment blog, recently referred to health care reform reporting as “the most careful, most thorough, and most effective reporting of any major story, ever.”
AHCJ Immediate Past President Trudy Lieberman took issue with that in a post on CJR.org.
Better coverage than the Vietnam War; the civil rights movement; the consumer movement? Really? In the case of the civil rights struggle, the press helped change the discourse; Americans began to view race in a new way, which led to the eventual passage of the Civil Rights Act. During the Vietnam War, the media effectively changed the public dialogue from a war we couldn’t lose to one we could not win. In the early days of the consumer movement, media coverage of Ralph Nader led Congress to enact significant consumer protections. Coverage of health reform has hardly risen to that level.
Lieberman writes that health care reform coverage failed because the public was inadequately educated on the finer points of reform efforts. Her evidence? That public opinion was roughly split on reform. Had reporting been better, Lieberman writes, public support levels would have been higher. She then brings up a number of issues she says were undercovered and uses examples to back them up.
For advice from Lieberman and three other journalists on the front lines on what needs to be covered next and how to approach this complex topic, see this special tip sheet.
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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
