Study offers context for reporting on health insurance exchanges
Filed under: Health care reform, Health journalism, Studies, Tools
The first tip sheet I wrote about covering health reform was pegged to the one-year mark of the Affordable Care Act. One topic I addressed was the creation of state-based health insurance exchanges, or marketplaces. I won’t rehash that here – here’s the link to the brief – but I do want to point out a useful resource that became available just a few days after we posted that first guide.
What questions do you have about health reform and how to cover it?
Joanne Kenen 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 joanne@healthjournalism.org.
It’s an in-depth look at the two states that already do have exchanges – Utah and Massachusetts. Those states help illustrate the decisions, both practical and ideological, legislators and governors must make as to how active the exchange is going to be in shaping the local insurance market and the consumer experience.
Those exchanges are of course dramatically different – Massachusetts covers a couple of hundred thousand people, and Utah covers a couple of thousand. Massachusetts was the inspiration in many ways for the national health reform, while Utah is the model for states that want to do a lot less and rely a lot more on the free market. But the study by experts at the Georgetown University Health Policy Institute and the Center for Children and Families also found those two state exchanges also had a lot more overlap than is widely assumed.
For those of you who are writing your first story on exchanges, this report isn’t the place to start. For help with the basics, check out ideas from Sarah Kliff, a Politico health care reporter, and some background from Noam Levey, health policy reporter for the Los Angeles Times. And the Alliance for Health Reform had an event last year that explained the basics (this link includes a webcast, transcript and lots of other resources to help you get started.)
For those reporters who have been tracking the state debate over the size, shape and structure of the exchange, or following the initial phases of implementing the exchange, the Georgetown study should help provide some context for concepts that you may have heard of like “active purchaser” (an exchange that can be more discriminating about which insurers get to sell policies in the exchange and which don’t versus an “open market” (open to any health plan that wants to play.) Here’s a taste:
To many, the Massachusetts and Utah exchanges represent opposite points on a continuum of what exchanges can provide for consumers and small businesses. Yet the stereotype of Massachusetts’ exchange as an “active purchaser” and the Utah Exchange as the open market model is, in the words of one observer, “a false stereotype … perpetuated by … a media that likes simple contrasts.”
So be part of a media that goes beyond simplistic contrasts … dig in.
Potter: Insurance industry taking advantage of media’s inattention to health reform
Filed under: Health care reform, Health journalism
Wendell Potter, the former insurance company public relations executive who has been critical of the industry, writes that journalists who were covering health reform have moved on and insurance companies have noticed the lack of scrutiny.
Potter, writing for the Center for Public Integrity, says some journalists consider the writing of regulations to implement the legislation boring and of little interest to the public.”
But insurance company lobbyists know the media are not paying much attention. And so they are able to influence what the regulations actually look like—and how the law will be enforced—with little scrutiny, much less awareness.
Consumer advocates tell Potter that the insurance industry is “pushing back” against rules that would give consumers clear information about their rights and would expedite appeals in urgent situations.
Those rules, which were written by the National Association of Insurance Commissioners, were scheduled to go into effect on July 1 but indications are that the Obama administration will push the implementation date back to Jan. 1, 2012, Potter says.
How can we help you cover reform and implementation?
As AHCJ’s health reform topic leader, Joanne Kenen is writing blog posts, tip sheets, articles and gathering resources to help our members cover the complex implementation of health reform. Her latest post is “Health reform battle entering a new phase.” If you have questions or suggestions for future resources on the topic, please send them to joanne@healthjournalism.org.
Coverage of insurance exchanges needs context
Filed under: Government, Health care reform, Health journalism
During the past few days, I have read quite a bit of local coverage about health insurance exchanges from about 10 different states (some “blue,” more “red.”) I was looking for good stories to hold up as an example of what’s at stake here.
New tip sheet
Affordable Care Act: The politics of health care, year two
The Affordable Care Act just hit the one-year mark, but that’s not likely to change the political dynamic in D.C. and many state capitals. Indeed, it may intensify as the 2012 campaign approaches. Following the complex legislative and budgetary procedures in Congress from a distance can be daunting. Joanne Kenen, AHCJ’s health care reform topic leader, has written a brief guide to some of what’s unfolding and likely to unfold in the next year or two.
I did not read every single state story from the whole country so maybe I missed something great. But I did read enough to conclude that most of the stories, unfortunately, were awfully heavy on process. They described political finger pointing: Republicans say no, Democrats say yes, the state legislature equivalent of he-said, she-said . There was very little explanation to readers about what exchanges are, and what kind of decisions states have to make about them , what’s at stake or why the heck the reader should care.
In case you are tempted to say it’s too complicated to explain in a short daily story: Look at Felice Freyer’s March 31 story in The (R.I.) Providence Journal. That is a short daily story, not a big takeout. But see how much context and explanation she was able to weave in with a deft clause here and there.
Sarah Kliff, of Politico, takes a slightly different tack that is also useful. It’s not a policy story, but politics, a state roundup. She makes two good points, which might help some of you covering the politics of implementation in your own state. First, how successful the Tea Party has been in driving the state-level implementation conversation to the right, and second “a widening rift within the Republican party, between those who say states should implement the law, retaining more power as it moves forward, and others who favor completely opting out of a law they because they believe it to be unconstitutional.”
I pulled together some resources about exchanges for the tip sheet on covering the first anniversary of reform. I’ll gather some more for a future update. If you see more good articles on the exchange, let me know by sending a note to joanne@healthjournalism.org.
Pentagon reluctant to provide therapy for TBI
After a lengthy investigation, ProPublica’s T. Christian Miller and NPR’s Daniel Zwerdling found that, in their words, the “battle over science and money has made it difficult for wounded troops to get a treatment recommended by many doctors for one of the wars’ signature injuries.”
They’re writing, of course, about traumatic brain injury, a consequence of roadside bombs in Afghanistan and Iraq. Their work revolves around a method of treating TBI and rehabilitating victims that has gained wide acceptance among civilian physicians and health plans but has not been embraced by the military’s insurance provider.
During the past few decades, scientists have become increasingly persuaded that people who suffer brain injuries benefit from what is called cognitive rehabilitation therapy — a lengthy, painstaking process in which patients relearn basic life tasks such as counting, cooking or remembering directions to get home.
Many neurologists, several major insurance companies and even some medical facilities run by the Pentagon agree that the therapy can help people whose functioning has been diminished by blows to the head.
Tricare provides health insurance for about 4 million active duty and retired soldiers, and “despite pressure from Congress and the recommendations of military and civilian experts,” it still refuses to cover cognitive rehabilitation therapy for the thousands of American soldiers afflicted by TBI.
Five of the 12 largest insurers cover the therapy, and an expert panel has recommended that the military do the same.
For its part, Tricare points to an assessment it conducted that put the effectiveness of cognitive rehabilitation therapy into doubt. I’ll let Miller and Zwerdling take it from there.
An investigation by NPR and ProPublica found that internal and external reviewers of the Tricare-funded assessment criticized it as fundamentally misguided. Confidential documents obtained by NPR and ProPublica show that reviewers called the Tricare study “deeply flawed,” “unacceptable” and “dismaying.” One top scientist called the assessment a “misuse” of science designed to deny treatment for service members.
The therapy would cost $15,000 to $50,000 per soldier, and the reporters found that, in private, Pentagon officials had expressed concerns about the massive cost of providing it to every suffering soldier. A few soldiers with political connections or ultra-motivated family members have managed to get the therapy, but its essentially off limits for most folks covered by Tricare.
Finally, a quick parenthetical mention answers a question that most health reporters are asking at this point. How did they get those internal studies and documents?
HINT: It involved finding a slightly less formal way to fulfill some of their FOIA requests.
(NPR and ProPublica obtained a copy of the ECRI reports through the Freedom of Information Act. However, Tricare denied access to reviews of the reports. ProPublica and NPR have appealed the request, but obtained copies of the reports and information on the reports from sources.)
Court ruling opens door for reporting on new law
Filed under: Health care reform, Health journalism, Health policy
Melissa Preddy of the Donald W. Reynolds National Center for Business Journalism followed up on Monday’s court ruling that part of the federal health care reform law is unconstitutional.
Photo by dbking via Flickr
Preddy puts the ruling in perspective and includes background about other lawsuits in the works. She also offers a number of story ideas to help reporters explain how the new law will affect their audience as well as some interesting stories to look at when planning your coverage.
Preddy even shares how her premiums have increased and how her insurer shared the news with her - the company attributed the higher costs to the mandates of the health care law.
For lots more ideas from journalists on the front lines, be sure to see these AHCJ resources:
- What’s next? Reporting on health reform between now and 2014
- Covering high-risk insurance pools: Tips for reporters
- Health care reform has passed: What’s next?
Value-based plans use disincentives, not denials
Filed under: Health care reform, Hot Health Headline
Michelle Andrews at Kaiser Health News is exploring value-based health insurance plans, a growing field that bases its reimbursement rates on how effective it believes certain treatments are. Under these models, for example, things like cholesterol-lowering drugs and help with weight management are provided free, while things like MRIs and back surgery come with hundreds of dollars in added penalties. In other words, instead of denying treatments of dubious efficacy, they keep them available but ask the patient to shoulder more of the burden.
The principle behind it is a familiar one.
A landmark 1982 study showed that as out-of-pocket costs rise, consumers spend less on health care services. But they scrimp not just on care that’s ineffective or unnecessary but also on care that they need, treatment that’s highly effective at addressing their condition.
To help us understand the system, Andrews profiles a recent large-scale implementation in Oregon. She focuses on the disincentives, or “sticks.”
In October, 155,000 Oregon public education employees and their dependents began to experience this stick approach. Their plans already offer carrots: free preventive care and low-cost or free generic drugs for chronic conditions. But starting in October members will be charged an extra $500 if they get services that the state Educators Benefit Board has determined are overused or “preference sensitive” to patient choice, including spinal surgery, knee and shoulder arthroscopy, hip and knee replacement and upper endoscopy exams. Patients will pay an extra $100 for advanced imaging tests and sleep studies.
…
People are willing to compromise, says Marge Ginsburg, executive director of the Center for Healthcare Decisions, a Sacramento-based nonprofit that studies how consumers make health care choices. They’re open to “the idea that yes, it’s still available to you, but it’s going to cost you more,” she says.Outright denials, on the other hand, don’t sit so well. “People are really unhappy if you draw a line in the sand.”
Lieberman: Election is evidence media got reform coverage wrong
Filed under: Health care reform, Health journalism
In her column on CJRorg, AHCJ Immediate Past President Trudy Lieberman writes that this week’s elections showed just how thoroughly the media missed the mark on health care reform coverage.
After the economy (62 percent), health care (19 percent) was the second most important issue to voters. And while the media (and the administration) trumpeted the benefits of health reform and “glossed over” the drawbacks, public opinion soured. The biggest oversight, Lieberman writes, was the national insurance mandate, a policy that was more Republican than Democrat.
Lieberman says it best:
If the media failed to discuss in detail the law’s less attractive points, it also missed one of the campaign’s biggest ironies. Republicans, with their repeal and replace slogans, stirred up discontent about a law that was basically built with Republican and conservative ideas. That irony escaped the media.
She doesn’t explicitly frame it as such, but Lieberman’s column leaves me with the distinct impression that with the health care debate reignited by a Republican landslide, journalists are being given a second chance to provide the public with a clear understanding of what’s going on in Washington, an impression that’s cemented with her final sentence:
Whatever happens, the U.S. health system is still its dysfunctional, fragmented, costly self, in need of repair or wholesale reform. Going forward, this is the story the media need to tell.
Report cards and rankings for 227 HMOs
Filed under: Health care reform, Health data, Tools
The National Committee for Quality Assurance, a nonprofit health plan accreditation organization, has unleashed its annual ranking of private health insurance plans, which have also been published in Consumer Reports. As present, the list only contains health management organizations.
Only the top four providers received the full five points in consumer satisfaction, treatment and prevention. New England providers took top honors this year, with Harvard Pilgrim taking first (Massachusetts and Maine) and third (New Hampshire), and Tufts Associated coming in second. Florida’s Capital Health plan came in fourth.
In addition to the list, NCQA released a detailed report card for each HMO (241-page PDF). There, plans are rated for specific satisfaction measures, diseases and patient groups.
Look for similar rankings of Medicare and Medicaid plans to come out in the next month or so.
Mass. reform, cost-cutting crush safety net hospital
Filed under: Government, Health care reform, Health policy, Hospitals
Boston Medical Center has been pushed to the financial brink by a mix of politics, economics and expanded health coverage. In Boston Magazine, Eileen McNamara examines the forces that are dragging down the commonwealth’s largest safety net hospital, in the process painting a cautionary tale of what happens when universal health care and cost-cutting collide. If it keeps eating through its financial reserves at the current rate, the hospital will become insolvent next year.
Photo by Wade Roush via Flickr
BMC is in a unique position, thanks to a legal mandate (not shared by its wealthier, Harvard-affiliated competitors) that it “consistently provide excellent and accessible health care services to all in need of care, regardless of status or ability to pay,” McNamara writes. In return, the state is supposed to compensate for its disproportionate load of low-income patients. Instead, the state’s clamping down on Medicare reimbursement.
BMC is locked in a battle with the Patrick administration over dramatic cuts in how the state pays for treating the poor. Barring a last-minute settlement, a Suffolk Superior Court hearing on September 29 will consider the state’s motion to dismiss a BMC lawsuit that challenges Massachusetts’ reimbursement rate. (The state currently pays the hospital 64 cents for every dollar it spends on patients with Medicaid.)
BMC says the new reimbursement formula violates state and federal law, and will sound the death knell for the state’s largest safety-net hospital. The commonwealth says it has the power to set any rate it wants; if BMC finds the payments inadequate, it can simply stop taking Medicaid patients. The state’s argument might have some merit in the case of doctors being free to choose their patients, but it’s a ludicrous posture to adopt toward an inner-city hospital that is required — by state law — to serve all comers.
On MedpageToday, Kevin “@kevinMD” Pho, who trained at BMC, pulls no punches as he riffs on McNamara’s article.
Universal coverage makes great headlines, helps get politicians elected, and, to be fair, is something that needed happen. But doing so without adequately addressing its cost is going to bankrupt hospitals, especially inner-city ones like BMC. That will hurt the Medicaid and Medicare patients dependent on them.
And that’s a goddamn shame.
HHS publishes insurance prices, Consumer Reports explains reform
Filed under: Government, Health care reform, Health policy
The first big wave of health care reform implementation has brought with it a mini-boom in consumer-oriented explainer sites and publications. You may remember the Kaiser Family Foundation’s Health Reform Source from our implementation coverage. In the days since, it’s been joined by offerings from Consumer Reports and the federal government, among others.
Since its launch this summer, Healthcare.gov has slowly evolved, adding explainers, tools and a Spanish-language version. Now, it has officially entered the meat-and-potatoes, utility-belt phase with an insurance search tool that includes detailed pricing and coverage information (press release). According to USA Today’s Alison Young, the tool indexes 4,400 plans from 225 insurers, and will be updated monthly.
And while it caters to consumers with things like monthly premiums, out-of-pocket costs and deductibles, the tool also includes some great data points for reporters, including covered services, percent of applications denied in the past three months, and percent of applicants charged more than the base price. One caveat: All the information is hidden behind a little search wizard, and you’ll have to enter demographic information and click a few tabs before you get to the good stuff.
And finally, as an antidote to the sometimes bureaucratic HHS site, the Consumers Union guide to the first six months of health care reform (Six-page PDF) is heavy on bullet points and easy-to-understand, categorical statements like “Sick children can’t be denied coverage” and “Preventive health care and screenings covered.”
Each major topic area is broken down into four key elements: “What’s New?”; “You may benefit if you”; “What you get”; and “The fine print.” The last subheading is where the guide really shines, as it briefly details exactly how an insurer can slip out of that particular provision.
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