The Sentinel has done some local reports on the health law, but, Janney acknowledges, “there is no way that I would have had the time to delve in and do the reporting for this project had I not had the help from our parent company.”

Partnerships and pickups

When that sort of backing is not forthcoming, help is also available from the nonprofit world.

Perhaps the most respected independent source for healthcare journalists is the Kaiser Family Foundation, which offers a wealth of web resources, media-ready experts, and its own news service.

Partnerships between Kaiser Health News and local news organizations have produced some of the better ACA stories in the Midwest—including pieces from the St. Louis Post-Dispatch on Missouri’s Medicaid coverage gap and Iowa Public Radio on the difficulties faced by rural patients in signing up for the exchanges.

For newsrooms that don’t enjoy such a direct relationship, Kaiser is a fount of ACA-related story ideas: on enrollment numbers, Medicaid expansion, doctor shortages, coverage “churning,” workplace health incentives, accountable care organizations, and quality-care measures, to name a few.

“This is a revolution that’s underway in the US,” says John Fairhall, editor in chief for Kaiser Health News, “and you can localize every aspect of it.”

In addition to Kaiser, a spate of nonprofit health news services have cropped up at the state level, including Georgia Health News, Health News Florida, and Reporting on Health (California), as well as Kentucky Health News, which is published by Cross’s Institute for Rural Journalism, and the Kansas Health Institute news service.

The KHI news service was formed in 2006, in direct response to the health news coverage gap in the Sunflower State, according to managing editor Shields.

“Most of the news outlets in the state were generally reliant on what they were getting from the wires, and there was very little effort to localize it,” Shields says.

The growth of nonprofit journalism may not be “a cure-all for a lack of mainstream coverage in smaller communities, but it’s one answer,” he adds.

Indeed, KHI and other nonprofits have produced some of the best recent coverage in the region—much of which can be lifted wholesale by community papers. “We’ve been on the front page of all the smaller dailies and weeklies in the state at various times,” says Shields. Fairhall and Cross emphasize that stories from their outlets can be picked up for free, too—“just credit and link,” Fairhall says.

Ultimately, though, relying on statewide or national news services is a stopgap fix for the rural health coverage gap. Successful local news organizations have unique relationships with their readers—it’s the marriage of that local understanding and outside resources that can deliver essential coverage.

“I used to be a rural newspaper manager,” Cross says. “I know what papers go through. I know how tough it is. I just want them to raise their sights a bit.

“From time to time, there are really big issues they need to tackle, and if there ever was one, it’s the Patient Protection and Affordable Care Act.”

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Deron Lee is CJR's correspondent for Iowa, Missouri, Kansas, and Nebraska. A writer and copy editor who has spent seven years with the National Journal Group, he has also contributed to The Hotline and the Lawrence Journal-World. He lives in the Kansas City area. Follow him on Twitter at @deron_lee.