‘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.
Health IT moves forward, regulation doesn’t
Filed under: Government, Health policy, Hot Health Headline
Fred Schulte and Emma Schwartz report that while the Obama administration plans to create a digital medical file for every American by 2014, “the administration has established no national mandatory monitoring procedure for the new devices and software. That no process exists to report and track errors, pinpoint their causes and prevent them from recurring is largely the result of two decades of resistance by the technology industry, a review of government records and interviews by the Huffington Post Investigative Fund shows.”
Major HIT malfunctions continue – they focus on one of 10 hospitals in the Trinity Health System in the upper Midwest – and nobody has a grip on their location or frequency. Meanwhile, the administration has issued regulations for HIT implementation that make no mention of safety and quality standards, standards the FDA has been considering for some time.
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.
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.
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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.
PEJ: Reform coverage centered on politics
Filed under: Government, Health care reform, Health journalism
Six basic facts about how the media handled coverage of health care reform have been distilled from a study of more than 5,500 health care stories in the mainstream media from June 2009 through March 2010.
A new report from the Pew Research Center’s Project for Excellence in Journalism finds that coverage was dominated by the politics of the debate and there was far less coverage of how the health care system works. Some other findings:
First, health care coverage followed a roller coaster trajectory, spiking dramatically at times and plunging at other points. And the media platforms best suited for ideological debate proved to be especially interested in the subject—particularly the liberal talk media. In the war of words over health care, however, the opposition seems to have prevailed, as their terms and ideas showed up far more often than the key ideas of supporters of the Democrats’ reform plans. The media also seemed to focus far more on the politics and the passions that drove the debate than the health care system it was trying to reform.
Finally, President Obama’s presence as a key figure in health care coverage vacillated markedly over the 10 months studied, lending credence to the idea that he did, at times, lose control of the narrative.
The report’s conclusion tells us that, in the heat of the battle, when politics became most partisan, the media focused on those aspects rather than the system. It points out that while some outlets did good work, “the public seemed consistently confused by the health care debate and had a difficult time sorting out fact from fiction.”
Feds want to fight food deserts
Filed under: Health policy, Hot Health Headline, Public health
The Detroit News‘ Nathan Hurst reports from D.C. on the Healthy Food Financing Initiative, proposed legislation that would commit between $400 million and $1 billion dollars to “building and improving stores where access to fresh food is limited.”
It’s modeled on a Pennsylvania program which provided start-up costs to grocery stores that promised to offer fresh food in low-to-moderate-income areas which didn’t yet have adequate access to such things. Detroit is the sort of city that would benefit most from a boost in urban groceries, Hurst writes.
Photo by paige_eliz via FlickrCarr said the prospect of federal subsidies to increase the number of grocery stores could be a boon to a city where large areas for years have had limited access to fresh produce and meats. In 2003, a University of Michigan study showed Detroit could easily support 41 large supermarkets — which measure more than 40,000 square feet — but at the time had only five with more than 20,000 square feet, and at least two of those have closed since the study was done.
How do these food deserts emerge in the first place? The Cincinnati Enquirer’s Laura Baverman explains by looking into that city’s shrinking grocery selection. Baverman explores several contributing factors, including a lack of the huge lots preferred by big box stores, booming suburbs and struggling independent stores, but in the end she comes back to brutal economic reality:
“You don’t get the sales levels in the inner city that you do out in the suburbs,” said Matt Casey, president of Matthew P. Casey & Associates, a New Jersey-based grocery industry consultant. “You tend to have a lower-income customer base, so they’re not spending as much. They don’t make the impulse buy.”
Related
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.
Mental health parity law implementation evolves
Filed under: Government, Health care reform, Hot Health Headline
Writing for Kaiser Health News and The Washington Post, Sandra Boodman considers the effect that the American mental health parity law has had since it went into effect on Jan. 1.
The law applies to about 140 million Americans, Boodman writes, most of whom are insured by employers with more than 50 employees. For qualifying groups, “Higher deductibles, steeper co-pays and other restrictions are no longer allowed for mental health and substance abuse treatment.” It doesn’t apply to individual policies and doesn’t require employers to offer mental health coverage of any kind.
There are still questions about the implementation of the law, many of which are addressed in the Obama administration’s implementation plan (PDF), which should take effect on July 1.
Officials of key business and insurance industry groups said they were displeased that the regulations were “more expansive” than they believe lawmakers intended. Mental health advocates applauded the rules, which they said would help ensure that Americans battling schizophrenia, for example, receive the same level of care provided to those facing leukemia.
Federal officials estimate that complying with the law will increase premiums nationwide by four-tenths of 1 percent, or about $25.6 billion over 10 years. Employers are free to drop mental health and substance abuse coverage and are allowed to manage claims to determine if treatment is medically necessary, just as they do now for physical ailments, but the standards can no longer be more stringent. Plans are also allowed to exclude treatment for certain illnesses, such as eating disorders, as long as state law does not mandate coverage. There is also an escape hatch: Plans that can prove that their costs increased by more than 2 percent in the first year can file for an exemption.
Fortunately, it looks like that sort of cost increase will be rare, based on research that shows similar rules improved access without increasing cost.
For some background on the mental health parity law, check out MIWatch.org.
Health care summit streaming live
President Barack Obama is hosting a bipartisan meeting to discuss health care reform. The meeting, from 10 a.m. until 4 p.m. is being streamed live.
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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
