Health Reform Story Ideas for 2012

Reporters have an unprecedented opportunity this year to chronicle a historic battle in the unfolding story of federal health reform. Yet getting the story right will depend on mastering the details.

The Affordable Care Act represents the most significant expansion of health care since the creation of Medicaid and Medicare in the 1960s, yet its effectiveness largely will be determined by hundreds of administrative and policy decisions made at the state level, said panelists at a health care reform briefing for journalists yesterday at the University of Southern California.

 The U.S. Supreme Court is expected to rule on constitutional issues by June. Meanwhile, individual states are making decisions every day that either advance or attempt to thwart the law’s aims – offering an ongoing source of stories to enterprising local health reporters.

The Alliance for Health Care Reform panel, co-sponsored by our USC Annenberg School of Journalism program and the Association of Health Care Journalists, featured Walter Zelman of California State University-Los Angeles and Daniel Zingale of the California Endowment – architects of earlier efforts at federal and state health reform. Panelists also included Ed Howard, Alliance for Health Care Reform CEO, Deborah Crowe, a health business reporter at the Los Angeles Business Journal, and Anthony Wright, head of Health Access, a Sacramento-based advocacy group.

Here are some of the ideas they shared and questions they raised:

• Health care exchanges: How should health care exchanges be designed to encourage competition and fair pricing and make it possible for consumers to get reliable information on competing plans? By regulating pricing and participation by insurance plans? By serving as a clearinghouse? It’s a question that’s been debated since Stanford University’s Alain Enthoven came up with the concept of “managed competition” in 1978, said Zelman, and a good topic for a discussion with local experts. Will pitfalls that dogged earlier reform efforts undermine the Affordable Care Act? Exchanges will fail if they don’t serve a broad enough pool of patients in their state and instead become repositories for the sickest, one panelist said. And, in rewiring health reform, regulators need to use all their smarts to combat the power of those who are deeply invested in the status quo – a fragmented and inefficient fee-for-service system.

• The peculiar political history of the individual mandate: Who supports or opposes the individual mandate in your community? Traditional conservative and liberal divisions break down, as illustrated by a backbiting exchange in the Florida Republican Primary debate. Originally, the Heritage Foundation supported the idea; President Obama opposed it as he tilted left of Hillary Clinton in the Democratic primary. Now, most conservatives are scrambling to distance themselves from the mandate (with the exception of Mitt Romney, who offered a spirited defense in Florida).

• Prevention and Families: It’s easy to get caught up in all the political jockeying but don’t forget that health care reform is about improving the circumstances for America’s families, says Zingale. Framing stories around the people who will benefit or lose could be more fruitful than focusing so intently on the political horse race. On a related note, says Wright, there are many stories to be done on the benefits that already are available in California because of its speedier implementation of the ACA. For example: Nationally, insurers are no longer allowed to deny coverage to children with pre-existing coverage. California has taken an extra step, limiting how much can be charged for children based on their health status. Individual counties in California also are expanding Medicaid benefits to adults well before a 2014 federal mandate, providing insurance and “medical homes” to those who meet the income criteria. Wright says approximately 250,000 Californians are covered now through these plans and he expects to see 500,000 covered by the end of 2012.

• Follow the Money:  Business journalist Deborah Crowe advocates “following the money” for health reform story ideas. She’s interested in the jockeying for position as insurers, doctors and hospitals decide what they needed to do to come out on top in a post-health reform world. One notable example: the accountable care organization. She anticipates the doctor groups will start to form alliances with hospitals in ways that resemble HMOs like Kaiser Permanente. They will have new incentives for best practices, such as higher reimbursement rates for services. How can they coordinate their efforts without running afoul of anti-trust regulations? You can also check now to see how local employers and plans define “essential benefits” in anticipation of a minimum package of benefits required under the ACA.

Here are some additional resources for your reporting:

• The California HealthCare Foundation tracks health reform implementation in California.

• The National Conference of State Legislatures keeps a close watch on implementation and issues affecting health reform.

• Kaiser Family Foundation offers a multitude of resources and briefing papers on health reform.

• The Commonwealth Fund has created a special portal to track health reform issues as well.