The Atlanta Journal-Constitution does the Medicaid story we’ve been looking for

Taking a close look at what life is like in the "coverage gap"

Not long ago, we faulted press coverage of the Medicaid expansion debate for overlooking the personal experiences and struggles of people caught in the coverage “gap”—earning too much to qualify for Medicaid in states that turned down federal funds to expand that program, and too little to receive subsidies to buy insurance on the new exchanges.

So it’s only fair that we acknowledge The Atlanta Journal-Constitution, which on April 5 published the Medicaid story we’ve been looking for, and set an example for other news outlets on how to spotlight one of health reform’s biggest inequities. The paper deserves a CJR laurel for reminding readers there is a large group of Georgians—some 400,000 of them—who are left behind by healthcare reform. That’s more than twice the number of state residents who have signed up to purchase a policy through the new exchanges (about 177,000, through the middle of March).

The article, by reporter Misty Williams, is behind the AJC’s paywall. But for those who can read it, it’s a strong example of how to balance numbers with telling details from people’s lives. Williams opens with the predicament of 41-year-old Karen LaBar, a home care worker with no healthcare or doctor of her own and high blood pressure to treat—and an income too low to qualify for subsidies to buy a private insurance plan on the new exchange. Williams captures the inequity created the law’s design, the Supreme Court decision saying Medicaid expansion was optional, and the choice by leaders in Georgia not to expand:

A parent of three who makes $10,000 a year can’t get a tax credit. A single person who makes $46,000 a year can.

The people in the gap are young and old, healthy and ailing. They are parents and workers, black and white. They live in metro Atlanta and rural communities across Georgia. They put food on the table for their families and put off doctor visits for themselves.

The rest of the piece uses more mini-profiles to show those whom health reform has left behind. There’s Anthony Jenkins, who suffers from seizures and lost his last job because of them. He thinks a specialist would help him, but he hasn’t been able to see one in years. Jen Rafanan, a 38-year-old freelance graphics designer, hasn’t been to a doctor for two years. She makes less than $10,000 a year, and recalls waiting for hours to get 10 minutes with a doctor at a clinic for low-income patients. (Clinics may be inclined to put paying patients—including those with Medicaid cards—at the head of the queue.) Then there’s John David Vandiver, a 63-year-old self-employed laborer who hasn’t been able to work since a car accident last summer—and can’t afford care or insurance, either, until he becomes eligible for Medicare in a couple years.

Williams’ summary of the politics influencing Georgia’s decision not to expand was also illuminating. Gov. Nathan Deal, she reported, estimates expansion would cost Georgia taxpayers $2.5 billion over 10 years, though advocates for expansion argue it will be a lot less. (The vast majority of the cost would be paid for by the federal government, under the ACA.) In a statement sent to paper, Deal argues more money for Medicaid would have a “severe impact on public education” by redirecting state resources. How about the costs now to the state’s poorest residents from lack of access to care? “We don’t view somebody in poverty as somebody who also has something to lose,” Cathryn Marchman with Saint Joseph’s Mercy Care Services tells Williams.

Williams was able to devote real space to the personal experiences of poor Georgians in part because much of the discussion of policy arguments and institutional lobbying that dominates coverage of Medicare expansion went into a second long article on April 13. (It’s also paywalled.) The second article, like the policy portion of the first story, was solid and informative if not exceptional. A discussion of Deal’s insistence on switching Medicaid to a “block grant” system, which would reduce long-term funding for the program, is important—but the AJC might have pressed harder on why he wouldn’t consider other compromises, which some Republican governors have obtained from the White House. And while the series cites research on how Medicaid expansion improves poor peoples’ lives, it might also have acknowledged other research that found the connection to improved health outcomes weaker than you might expect.

But the main takeaway here is that the AJC delivered strong coverage of a type that’s been sorely lacking. Williams concludes the outlook is grim for Georgians stuck in the coverage gap, as it is for the poor in 25 other states not expanding whose legislative calendar is drawing to a close. “Politicians on both sides of he aisle—many facing re-election this year—aren’t champing at the bit to come up with alternatives to Medicaid expansion,” she reported. We hope Williams builds on her fine work and continues telling the ongoing saga of those who won’t benefit from health reform and the political forces that keep the Affordable Care Act from reaching its full potential.

Related content:

What’s missing from Medicaid coverage: actual people

Climbing the Medicaid mountain

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Trudy Lieberman is a longtime contributing editor to the Columbia Journalism Review. She is the lead writer for The Second Opinion, CJR's healthcare desk, which is part of our United States Project on the coverage of politics and policy. She also blogs for Health News Review. Follow her on Twitter @Trudy_Lieberman. Tags: , , , , ,