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.”
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.
Why insurers care about the medical-loss ratio
The Wall Street Journal’s Avery Johnson explains the significance of the “medical-loss ratio,” a single metric within the reform bill that holds great significance for the insurance industry.
The ratio, known to wonks as the MLR, signifies the percentage of premiums insurers use for medical costs versus the amount that goes to paying administrative overhead. For individual and small-business plans, it’s set at 85 percent medical to 15 percent administrative. For larger businesses, the magic medical number is 80. Those who don’t meet the threshold would be forced to pay rebates to customers.
At present, the key issue seems to be subsidiaries. Major insurers have hundreds of them each, and while the insurer could meet the requirements if all subsidiaries were averaged together, they won’t be able to hit the numbers at every single subsidiary. Current draft documents, Johnson reports, seem to imply that each subsidiary would be judged separately, a practice which insurers say might force them to stop providing insurance in certain high-risk areas.
Applying uniform numbers to the segmented, fragmented insurance industry could prove tricky. Johnson looked at the numbers.
UnitedHealth, for instance, has about 392 subsidiaries, according to Goldman Sachs health-care analyst Matthew Borsch. Its average MLR for individual policies is 69%, dragged down by a 63% ratio at its dominant Golden Rule subsidiary, according to a report by Goldman Sachs that examined state insurance filings. The Minnetonka, Minn., insurer could owe about $280 million in rebates in 2012, Mr. Borsch estimates, based on his reading of the methodology in the health care law.
The rules will be set by the National Association of Insurance Commissioners, a coalition of state insurance regulators. They’re hoping to have recommendations ready for HHS by the end of this month.
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.
What we’re reading: OSHA, reform and a new site
Filed under: Government, Health care reform, Health journalism, Member news, Nursing
These are busy times for AHCJ (getting ready for Health Journalism 2010!) but we want to take a moment to share some of what we’re reading:
OMBWatch: OSHA Proposal Cuts Workers’ Right to Know about Chemical Risks
PLoS ONE: The Unbearable Lightness of Health Science Reporting: A Week Examining Italian Print Media
FairWarning.org launches: New site to investigate health, safety and corporate conduct issues was founded by former Los Angeles Times reporters.
Poynter’s Al Tompkins has an interview with ProPublica’s Charles Ornstein (also president of AHCJ’s board of directors) about investigating nurses and regulatory boards.
Health care reform: What’s next? Reporters Jim Landers, Washington correspondent for The Dallas Morning News, and Noam Levey, health policy reporter for the Los Angeles Times/Tribune Washington Bureau, have advice on how to cover the local angles of health reform. Suggestions from other reporters will be added soon.
Reporter finds conflict in N.Y. reform effort
Filed under: Conflicts of interest, Health care reform
A Syracuse University professor charged with reforming health insurance reimbursements gave up her position on an insurance company’s board on Friday after James T. Mulder, a reporter with The (Syracuse, N.Y.) Post-Standard, started looking into her ties.
Deborah Freund, a health economist and professor at Syracuse University, is overseeing a project intended to reform the health insurance system and eliminate conflicts of interest.
However, she has been on the board of Excellus since 2004 and received more than $61,000 from the health insurance company last year.
Freund oversees “FAIR Health Inc., a New York City-based nonprofit that is supposed to come up with a new, fair reimbursement system that will be used by insurers nationwide.” The project is funded by settlements from 13 insurers that used reimbursement data that rigged the system “to benefit insurers at the expense of consumers and doctors.”
At a news conference last year, [state Attorney General Andrew] Cuomo said the FAIR Health project will bring “ … transparency, accountability and fairness to a broken reimbursement system …”
Despite earlier statements from Excellus, the university and Cuomo’s office that Freund’s board position did not post a conflict of interest, a view not shared by consumer advocates, the professor resigned from the board Friday afternoon after Mulder spend several days looking into the situation.
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.
- Obama’s proposal
- Republican ideas included in Obama’s proposal
- Solutions to health care from the GOP
- Bipartisan meeting
Health care bill moves forward
Following the Senate vote on the health care bill, reporters have rushed to cover the latest developments. Here is just a bit of the coverage:
Ricardo Alonso-Zaldivar and Erica Warner of The Associated Press have a point-by-point comparison of the Senate and House health care bills. Werner also has an interesting look at the winners and losers in the bill, including the residents of Libby, Mont., many of whom suffer from asbestos-related illnesses from a now-closed mineral mining operation.
On The Wall Street Journal’s health blog, Jacob Goldstein reports on the Congressional Budget Office’s estimates on the Senate bill with the “public option lite” - with private plans overseen by a government agency.
Reuters’ Donna Smith offers an overview of the Senate health care bill in a Q&A format.
Scott Hensley of NPR’s Shots blog notes the weekend’s key development that led to the bill moving forward and he looks ahead to reconciliation.
In a piece that appears in USA Today, Phil Galewitz of Kaiser Health News points out that mandates, such as requiring all Americans to have health insurance, do not guarantee compliance. His article explains the mandate and the penalties for those who choose to go uninsured.
In the Los Angeles Times, Kim Geiger and James Oliphant also look at the mandate: why its in the bill, how it can cover people with expensive illnesses and “age rating.”
Plenty more coverage is emerging by the minute. Here is the bill.
Pay for the person - not the procedures
When people talk about health reform it’s often shorthand for covering the uninsured. But improving access without tackling costs is a recipe for a fiscal crackup.
Just take a look at Massachusetts, a pioneer in universal coverage, where the cost of medical care is growing at more than 8 percent a year. Ballooning subsidies for coverage of the poor are one problem. Another is heavy use of high-priced hospital care.
The Boston Globe reports on the recommendations of a state commission to pay doctors and hospitals a set amount for each person’s care for a year. (Read the report here.)
Some might call it capitation redux. The payment approach, once popular with managed care, aims to curb incentives for doctors and hospitals to do more to get paid more. Previous attempts at capitation were too stingy and inflexible and remain worries this time around, critics say.
On the national front, the cost of health reform is moving to the fore, galvanizing opposition to the plans advanced in Congress. The Washington Post reports that the head of the Congressional Budget Office “delivered a devastating assessment” of the fiscal consequences of the proposals because they don’t do enough contain the fast-growing costs of government health programs.
Where’s the money for health reform?
If there ever was a time to remind health journalists to follow the money, it’s now.
President Obama is back in campaign mode, barnstorming the country to win support for health-care reform. The details and fate of the overhaul remain uncertain, but it’s clear any steps toward universal coverage will mean big bucks — at least $1 trillion over 10 years.
How to pay the bill without increasing the federal deficit, as Obama has pledged? A combination of tax hikes and cost cuts.
Team Obama is already planning for reductions in payments to hospitals, private insurers and drugmakers. For more details, see the video below and the White House blog’s post on Obama’s weekly radio address.
But the real action is looming over how to get more cash into the health system. A federal tax on employer-sponsored health benefits, opposed by Obama during his run for president, is under serious consideration in the Senate, the Washington Post reports.
That approach, supported by some economists as a way to manage health costs, could be political suicide. “Taxing benefits would be a disaster,” Democratic pollster Celinda Lake tells the Post. “You have no idea how strongly this is going to backfire if we do it.”
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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
