Covering Health Reform: New Story Ideas From a Health Policy Expert

Last night, a group of San Francisco Bay Area health journalists got some intriguing health reform story ideas from one of California's better-known health policy experts, Marian Mulkey of the California HealthCare Foundation.  

"We're at the beginning stages of figuring out what (health reform) means," Mulkey told journalists attending a meeting of the Association of Health Care Journalists' San Francisco chapter. "As many pages as there are in the bill, there will be 10 times that many pages of regulations to make this thing a reality."

What a cheery thought. Anyway, while Mulkey's story ideas are aimed at California journalists, they're certainly relevant outside the Sunshine State:

1. The health care safety net. This is a "good news, bad news" story, Mulkey said. While community clinics are going to get a "big infusion of funds" and lots of newly covered patients, public hospitals are going to be serving those who can't get health insurance, either because they can't afford it even with subsidies or because they're not legal residents or citizens. "What's the political appetite for continuing to fund (health care) for these people?" Mulkey asked

2. The cost conundrum. Many consumers still will be insulated from knowing the true cost of their care under health reform – as will their doctors. How will that play out as health reform gets underway and what will be the effect on the cost of care?  

3. Impact on the state budget. About 2 million Californians will gain new access to Medi-Cal, the state's Medicaid plan, adding to 7 million existing recipients. Another 3.4 million will get new coverage in the private market through subsidies, changed insurance marketplace rules, and the individual mandate. The federal government is subsidizing some but not all of these costs, and for a limited time. What happens when those subsidies end?  

4. More welcoming than welfare? With more middle-class people applying to join health insurance exchanges and other government-subsidized health insurance programs, how will enrollment change? Will it be as burdensome as signing up for food stamps or welfare? Will there be efforts to make these applications easier and less stigmatizing than signing up for food stamps or welfare?

5. New patients, new Medi-Cal? Medi-Cal used to be about serving primarily moms and their kids. That will change under health reform when Medi-Cal must start to also accept far more childless women and men if they meet income and residency requirements. How will Medi-Cal change the way care is provided and the treatments and medicines that are covered?