October 5, 2017

Whether you’re a beat reporter or just covering it for a day, health care is complicated. Cutting through the jargon and complexity of the system can be difficult, so reporting, economic and health experts from across the country broke it down Monday at Poynter’s “Covering Health Care Policy Changes” event in Washington, D.C.

Whether you heard the discussion in person, or live miles away, here are some takeaways for the next time you delve into health care.

Know the differences between Medicaid and Medicare and how they operate in your state.
Medicare condensed into a bumper sticker would read: “Health Care for Old People,” says Matt Salo, executive director of the National Association of Medicaid directors. Medicaid, on the other hand, is designed to help poor families and children, but regulations and implementations vary greatly by state. In Texas, for example, parents of children on Medicaid can receive benefits as well, but only if they make less than $230 a month. Many poor people don’t qualify for Medicaid, while many people who do qualify don’t realize they can apply for it.

Through federal waivers, states have the flexibility to allocate money in different ways. The Affordable Care Act attempted to expand Medicaid to poor, working-age adults, but 19 states have not expanded the program.

Learn about insurance billing, cost vs. price, and the fee-for-service model.
Private insurance prices vary greatly geographically, whereas Medicaid and Medicare are better able to control prices across regions. The gap between how much the two categories pay has widened, says health economist Stephen Zuckerman. On average, Medicaid and Medicare pay less than the cost of services while private insurance customers pay 180 percent of the cost of services they receive.

The fee-for-service model incentivizes doctors to provide a high number of services rather than a higher quality of care. Efficiency hasn’t done as much to reduce costs as economists had hoped, Zuckerman says. In the current system, it’s easier for a doctor to redo a test (and get paid for it) than it is to request it from another provider.

Know the social determinants of health and how public health programs tackle them.
Social determinants can include education, income and race, says New York City Public Health Commissioner Dr. Mary Bassett. Bassett stresses that no one chooses to live in unsafe neighborhoods with little access to good food or education. Yet, when these circumstances affect health, minority groups are often blamed for being lazy or not following doctors’ advice.

Bassett’s department works with education, urban planning and transportation agencies because a higher quality of life for families goes a long way in the health of a child. One example: The city found that paying to clean and manage pests in apartments was worth the cost because of how much it lowered absences for kids with asthma.

“Health care is not just hospitals. It’s a different way of thinking about the whole person,” says Dr. Megan Tschudy, a medical director at Johns Hopkins Hospital. In her clinic, doctors ask parents atypical questions such as, “Are you able to pay your electric bill this month?” and “How is your kid adjusting to their school?” They try to connect parents with outside resources to help them. But Tschudy admits that clinical medicine has much progress to make in integrating with public health programs.

Know which hospitals and treatment centers in your area are for-profit or nonprofit, and which are private and state-funded.
We tend to think of nonprofit hospitals as those that don’t make any money, when in reality those classifications have far more to do with tax status than income, says Dr. Mai Pham, who leads research in health care delivery and payment reform, She recommends finding out how your local hospitals are integrated with public health programs and whether they're in it for the patients or the shareholders.

Knowing a facility’s status means you can ask how much they invested in their building and equipment and what kind of returns they expect. If a new radiology center announces its arrival with billboards and television ads, it’s worth looking into its business model and asking critical questions about how it plans to help the community, Pham says.

Keep it local — but don’t be afraid to reach out.
Even if you can’t get to Washington to cover health care from Capitol Hill, you have the ability to know your state or local regulations better than anyone else. Markian Hawryluk, who writes for the Bend Bulletin in Oregon, offers this advice: Talk to local patients but don’t hesitate to reach out to national experts. In smaller communities, it can take awhile for doctors to feel the effects of new federal legislation. Hawryluk says you’d be surprised at the number of high-ranking health professionals who will field calls from local reporters.

When looking for local patients, Jenny Deam, who covers health care for The Houston Chronicle, recommends neighborhood and mommy groups on social media as a way to find sources. If you present yourself as a member of the community or a fellow parent, people will be more likely to answer your questions candidly, says Deam.

Develop sources for “dumb questions.”
Almost all state universities have public health departments. Find researchers or professors who are willing to explain medical terms and public health concepts and get in touch before you need them. Politico health care executive editor Joanne Kenen, who moderated Monday’s event, said she kept a rotating list of professionals to whom she could ask “dumb questions,” like the difference between a respirator and a ventilator (they’re the same). Although a Google search is quick, there’s no substitute for a source with a wealth of background knowledge, and building those relationships now will pay off.

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