By PAMELA YIP
NEW YORK —- Journalists covering health care boosted their knowledge of the Affordable Care Act (ACA), thanks to top experts in the health care field, who spoke to 17 journalists during a Jan. 17-18 symposium sponsored by the Society of American Business Editors and Writers and the Commonwealth Fund.
The event was held at Reuters headquarters at 3 Times Square. Commonwealth awarded a grant to SABEW to develop the fellowship, which focused on implementation of the ACA, state-based health insurance exchanges, Medicare reform, Medicaid, health care payment innovation and reform, healthcare data, healthcare bundling and business insurance plans for employees.
SABEW and Commonwealth have teamed up before to offer specialized education in health care reporting. It is the fifth such grant the Commonwealth Fund has awarded to SABEW, which has conducted a dozen open workshops and other activities on the business of healthcare under Commonwealth’s sponsorship since 2007.
A full recap of the symposium is available here.
Here are highlights from the program:
CHALLENGES FACING HEALTH CARE REFORM
Health care reform wasn’t inevitable, said Sherry Glied, professor of health policy and management at Columbia University and a former Obama Administration official.
In fact, four presidents, going back as far as Harry S. Truman, have talked about it.
She said no one thought health care reform was going to happen and called the Affordable Care Act “the biggest change in healthcare policy ever.”
Glied said after the ACA takes full effect in 2014, most people will keep their current health insurance plan, while maybe 2 percent of the population will buy health coverage because of the individual mandate.
“Most people who are uninsured will buy health insurance because they will be able to afford it,” said Glied, who was assistant secretary for planning and evaluation at the U.S. Department of Health and Human Services from July 2010 through August 2012.
Under the ACA, individuals who purchase insurance after Jan. 1, 2014 through an exchange will be eligible for subsidies for health insurance premiums and cost-sharing depending on their income.
STATE OF THE STATES
Katie Keith, Sarah Dash and Kevin Lucia of the Georgetown University Health Policy Institute’s Center on Health Insurance Reforms focused on the progress states are making in establishing exchanges through which individuals and small businesses can purchase health insurance.
They said to date, implementation of the ACA has been “fairly mixed, with significant variation in”:
For example, Virginia has passed legislation creating a new article in its insurance code that included the early market reforms as new statutory requirements.
North Dakota passed legislation directing its commissioner to “administer and enforce” the ACA.
Health insurance marketplaces aren’t a new idea, Dash said.
“Many states had established or considered some form of marketplace, especially for small businesses but no common platform for success,” she said. “Establishment of health insurance marketplaces has never been attempted on such a large scale, with implications for real people.”
Key issues for consumers are:
States and the federal government have a long way to go, but there’s progress on crucial exchange decisions and milestones, said the Georgetown experts.
SPREADING THE WORD TO AMERICA
A key challenge is informing consumers of how the ACA will benefit them, said Rachel Klein, executive director of Enroll America, a nonpartisan organization whose mission is to ensure that all Americans have health coverage.
The group is working on a major campaign to inform consumers of the ACA. Open enrollment begins in October.
“It really creates a brand new marketplace for health coverage,” Klein said. “People get that they need insurance and they feel bad that they’re uninsured. But the reason they don’t have coverage is because they can’t afford it.”
Two-thirds of the uninsured live in 12 states: California, Texas, Florida, New York, Georgia, Illinois, North Carolina, Ohio, Pennsylvania, New Jersey, Michigan and Arizona.
“The majority of uninsured Americans don’t know the health reform law will help them,” Klein said.
One of the messages Enroll America wants to convey to consumers is that “the insurance marketplace has changed and that you will find something that will meet your needs and that there is help with the cost of it,” she said.
SMALL BUSINESS: DEALING WITH THE ACA
A key group that will be affected by the ACA is small business.
Beginning in 2014, the ACA will impose financial penalties on certain employers which don’t provide health insurance coverage and, in some cases, on employers who do provide coverage.
Businesses with 50 or more full-time employees or full-time equivalent employees face potential employer mandate penalties.
If a business doesn’t provide insurance and if at least one employee receives federal insurance subsidies in the exchange, the business will pay penalties.
“Most businesses aren’t going to be subject to this,” said Ben Geyerhahn, director of special projects for the Small Business Majority, an advocacy group for small business.
About 96 percent of small businesses have fewer than 50 employees, he said.
Health care costs comprise a major part of the operating expenses of small businesses, Geyerhahn he said.
“It’s the top 3 or top 4 of your line items every month,” he said.
Geyerhahn doesn’t see evidence of small business owners restructuring their companies to get around the ACA’s so-called employer mandate.
“For the most part owners whom I know aren’t thinking to themselves, ‘I really don’t want to get bigger. I don’t want to grow my business — which is the thing I wake up every morning thinking about’ — because of health care,” Geyerhahn said. “They may start to think about, ‘How do I manage this process?’ A lot them complain, but none are like, ‘I’m going to cut five jobs.’”
The best way that journalists can serve small business readers is to provide straightforward, accurate information on the ACA, he said.
“Businesses are at a point where they really need to make decisions,” Geyerhahn said. “This should not be the kind of reporting that’s about, ‘this is what everybody thinks the policy is.’ We know what the policy is.”
Reporters can alleviate the fear that small business owners have of, “Oh, my gosh, what am I going to do?” he said.
“The simplest thing is to say, if you’re smaller than, 50 you have no mandate,” Geyerhahn said. “There’s no negative here for you. There’s only upside.”
For small business owner Eric Blinderman, the ACA is a “complete home run” for his two New York City restaurants.
“We’re under the 50 full-time employee threshold at each restaurant,” said Blinderman, who owns Mas (farmhouse) and Mas (la grillade). “One, we’re not subject to the mandatory imposition of health insurance plans at both restaurants and two, to the extent that we want to — which is what we do want — we get the benefit of the insurance exchanges.”
Starting in 2014, individuals and small businesses will be able to purchase health insurance through state-based insurance exchanges.
Exchanges will operate a Small Business Health Options Program – or SHOP – that offers small businesses and their employees a chance buy coverage.
“Come 2014, there should be some real ability to do some price competition through the exchanges, which will be a double home run for me,” Blinderman said. “It’s a huge benefit for me and my employees, whom I have a really strong vested interest in keeping happy and healthy.”
Currently, he offers health benefits to only senior managers at both restaurants. He hopes to offer health insurance to all his employees by buying coverage through the SHOP.
Blumenthal, a physician and president of The Commonwealth Fund, talked about the organization’s newly released report “Confronting Costs: Stabilizing U.S. Health Spending While Moving Toward a High Performance Health Care System.”
Blumenthal, who chaired the Commonwealth Fund Commission on a High Performance Health System, said options on confronting health care costs include:
“The first two are easier to do, but they inflict a lot of pain,” Blumenthal said. “They all involve taking something away. The alternative is to get more out of the dollars we spend.”
The commission recommended:
PAYMENT REFORM IN HEALTH CARE
The U.S. has the most expensive health care system in the world, said Stuart Guterman, executive director of the Commonwealth commission.
“We are the best in the world at spending money,” he said.
Health care spending as a percentage of U.S. gross domestic product has been climbing steadily over the past half-century, the Commonwealth commission said.
U.S. national health expenditures are projected to rise from 17.9 percent of GDP this year to 20.5 percent of GDP in 2023, he said.
Rising health spending not only puts pressure on the federal budget, but also on state and local budgets, businesses and households, Guterman said.
Expanding health care coverage and improving coordination of care among health care providers are keys to a high performance health care system, he said.
Reforming the payment system from one of fee-for-service to one that pays for value will make the system more efficient, Guterman said.
With fee for service, “as long as you get more by doing more, you’re going to do more,” he said.
A payment system that pays for value includes including more bundled payments that reward efficient care of patients, the commission said.
NORTH CAROLINA INVESTIGATION
Ames Alexander, an investigative reporter for The Charlotte Observer, talked about the five-part series his newspaper published last April with its sister paper, The News & Observer of Raleigh, that examined how North Carolina hospitals profit at the expense of patients.
The team looked at how much hospitals give back to their communities by calculating what percentage of hospitals’ budgets is devoted to charitable activities.
The newspapers examined hundreds of documents, including lawsuits, financial audits and hospital bills, as well as Medicare cost reports, IRS returns and hospital community benefit reports.
Alexander said one of the best sources for reporters is the American Hospital Directory at www.ahd.com, which provides data and statistics on more than 6,000 hospitals nationwide.
Alexander said for the series, he reached patients saddled by medical debt by pulling data on lawsuits filed against them by hospitals.
“A surprisingly large number of them were willing to talk,” he said.
REPORTER ROUNDTABLE: COVERING THE BEAT
Peter Frost of the Chicago Tribune moderated a reporters’ panel with Alex Nussbaum of Bloomberg News, Caroline Hunter of Reuters and Alexander.
Nussbaum, who covers health care for Bloomberg, said he reads lots of analyst reports and advised journalists to get to know experts at the Kaiser Family Foundation and the National Association of Insurance Commissioners, as well as health economists and health care consultants.
“You have to be careful,” Nussbaum said. “Everybody comes with an agenda, a point of view.”
One question reporters should explore is whether small insurers in their communities will survive health care reform or will they be snapped up by larger insurance companies.
Frost, who covers the business of medicine and health care for the Tribune, said reporters should keep an eye on private insurance exchanges through which employers buy health insurance and then give employees the ability to choose from a health plan. Private exchanges aren’t run by the government.
“There seems to be a lot of movement toward these private exchanges,” Frost said.
Winslow, deputy editor of health and science at The Wall Street Journal, said the health care beat is a “really rich beat” that can be covered from several angles – consumers, policy, and investing.
“I look at health care as a tent with various entry points,” he said.
One of the most exciting stories is discoveries in genomics, particularly the sequencing of a person’s DNA.
“That is producing an incredible amount of information,” Winslow said.
Biotechnology and drug companies are trying to determine how all that data can be used to develop drugs, he said.
“Most pharmaceutical companies have been chastened by the failure of some [drug] trials,” Winslow said.
CHANGES IN MEDICARE AND MEDICAID
Medicare has a revenue problem and so does Medicaid, from some states’ perspective, said E.J. Mitchell II, managing editor of the Chicago-based MedicareNewsGroup.com.
In covering Medicare stories, “follow the money,” he said.
“At some point, there will not be enough money to sustain the Medicare program,” Mitchell said. “State officials are leery that more and more of their budgets will fund health care at the expense of other programs.”
He said reporters also should at the financial bottom line vs. quality of health:
(Pam Yip, a reporter at The Dallas Morning News, attended the New York symposium. Her beat is covering health care.)
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