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Remaking Health Care

This column explores how health reform is changing the ways in which we pay for and deliver health care in the U.S. It also highlights the ways in which our current system is falling short on measures of coverage, access and affordability. On any given week, that could mean a look at how Republican plans to repeal Obamacare could reshape the individual insurance market, how the safety net system is adapting to new financial pressures, or how the trend of doctors and hospitals merging into ever-larger entities is driving up costs. We also explore health care costs and whether the Affordable Care Act or its successor plans can live up to the promise to rein them in. Throughout, we keep watch on how the goals of health reform intersect with the shaping power of markets and human behavior. Contributors include veteran health journalist Trudy Lieberman and independent health journalist Kellie Schmitt, with occasional contributions from independent journalists such as Susan Abram and Sara Stewart.

Picture of Judy  Silber

At the Native American Health Center in East Oakland, health reform has pushed clinic staff to experiment with new ways of delivering care. But changes in the way care is reimbursed and increased competition for patients still leaves clinic leaders nervous about longterm survival.

Picture of Kellie  Schmitt

Geographic boundaries can have a big impact on health insurance options, particularly for people living in rural regions. Rural residents tend to fare better on premiums and choices when their area is grouped with an urban neighbor.

Picture of Judy  Silber

At La Clínica de la Raza in Northern California, the surge of new Medicaid enrollees has made it difficult for the clinic to meet the demand for care. But the need to make the most of limited resources has also led the organization to adopt new innovations, such as the "morning huddle."

Picture of Kellie  Schmitt

As Medicare makes a big push towards paying providers based on value rather than volume over the next few years, Accountable Care Organizations will be expected to start making good on their promise to cut costs and improve quality of care. But so far, their track record has been rather mixed.

Picture of Judy  Silber

For La Clínica de la Raza, long a source of care for a diverse Oakland community, the ACA has increased the clinic's share of insured patients. But financial pressures are still a constant reality, and the problem will worsen dramatically if federal funding isn't renewed.

Picture of Kellie  Schmitt

In some states, reimbursements are so low that doctors say they lose money when they see Medicaid patients. And that can make it harder for patients to see their doctor — a recent study found that higher rates improve access to care.

Picture of Judy  Silber

Sign-ups for insurance on the federal and state health exchanges end in less than a month, and the state's push to enroll more Latinos appears to be paying off. Meanwhile, safety net providers such as Clinica Sierra Vista are focused on both signing up and retaining patients.

Picture of Kellie  Schmitt

A key goal of health reform has been to get insured individuals to seek out primary care rather than the ER. In the Bay Area, safety net systems are trying new approaches to funnel more patients into primary care, including putting nurses in firehouses.

Picture of Judy  Silber

As a federal "funding bump" expires, the payments California doctors receive for seeing Medicaid patients are dramatically decreasing. At the same time, the state is imposing a 10 percent fee cut that was approved in 2011 but is just now taking effect.

Picture of Kellie  Schmitt

The ACA expanded insurance coverage, but many children throughout the country are still not receiving important health care benefits. The extent of the coverage exclusions varies widely depending upon which state a child calls home.

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