DETROIT, MI — Healthcare reporters are in a tricky spot. They may understand that covering the Affordable Care Act’s insurance exchanges is essentially a consumer story at this point. But the story is so politicized, it’s difficult for those on the frontlines to navigate the fog.
Alex Nixon, a business reporter who covers the healthcare beat for the Pittsburgh Tribune-Review, said that he’s working to keep coverage focused on what the law does, who it affects, and who it doesn’t affect. “But the stories that seem to be gaining traction are the ones that seem to be politically motivated and affect a small group of people, [such as] canceled plans [and] rate shock,” he said. (CJR’s own Trudy Lieberman has written about the healthcare stories “sucking up so much of the media’s attention of late,” and who such stories leave out.)
“Navigating the politics of Obamacare is certainly one of the biggest challenges in covering this story. I’m trying to stay out of the politics, but it’s very difficult,” Nixon said.
Sarah Jane Tribble, a journalist with Cleveland public radio WCPN, echoed that point. “I do not face any pressure from the editors here to turn the stories into political stories. But I do think that the sources often try to do that.”
Tribble and Nixon discussed this during a recent online roundtable that CJR’s United States Project convened with reporters to candidly discuss the possibilities and pitfalls of chronicling the ACA. Also in the “room” were Steve Koff, Washington DC bureau chief for the Cleveland Plain Dealer; Ben Sutherly, Columbus Dispatch reporter; Trudy Lieberman of CJR; and myself. Our hope is that this will be the first of an occasional series of online conversations about best practices for healthcare reporting.
In this inaugural chat, sourcing for stories emerged as one of the top concerns for healthcare reporters. It’s no surprise that groups both for and against Obamacare’s implementation are working overtime to supply reporters around the country with sources friendly to their side. Families USA and Enroll America are private groups aimed at helping the government enroll millions of Americans for health insurance; they are also serving as reporter-ready anecdote banks supporting the ACA’s implementation (meet, among others, “Steve W.” from New York who was “able to purchase a comprehensive plan for $207 a month…The entire process took less than an hour …and the choices were transparent.”) Meanwhile, for example, Senate Republicans are collecting and sharing anecdotes about the “real-life”—read: negative—“consequences of Obamacare.”
Nixon, of the Pittsburgh Tribune-Review, said that Enroll America reached out to offer up people “who’ve had really great experiences signing up for coverage and are paying very small monthly premiums because of subsidies.” But, Nixon added, “Is that the general experience? Tracking down real people who’ve had experience and aren’t politically motivated has been the biggest challenge so far.”
Tribble, of WCPN, did a piece in September on Enroll America’s first venture into Cleveland. But she said that while she wants to keep track of their recruitment efforts for reporting purposes, “I’m finding the folks they offer up [as sources] to be unique as opposed to representing the masses—so to speak.” That is, even if the sources provided can attest to an authentically positive experience with the exchanges, Tribble has a reporter’s natural skepticism when this is presented as a uniform experience.
But finding more representative stories from people who have signed up for the exchanges is tough. As Tribble pointed out, in states like Ohio, relatively few signed up by the end of November. (Ohio rejected the option of a state-run exchange, so residents relied on Healthcare.gov, which had well-documented glitches for the first months of its roll-out.). At the same time, Tribble said, no one is keeping a comprehensive running tally of enrollees. “Some insurers have [a tally] ready, others say they don’t,” she said.
So what’s a fair-minded—and time-strapped—journalist to do to find local voices that don’t have an agenda?
For starters, there are opportunities to bring fresh takes on the anecdote banks, as Tribble did with her Enroll America story. Another example is a piece from October by Lindy Washburn, a health reporter for The Record in northern New Jersey, which Trudy Lieberman hat-tipped here at CJR. Washburn went out with Enroll America’s workers, joining them as they went down a bread line near a New Jersey trailer park and tried to explain the exchanges to people. According to Lieberman, Washburn spoke to many people on her own, choosing them at random, which “may be the key” for an original, not orchestrated, take.
To find people with direct experience with the exchanges, reporters might also tap into adjuncts, freelancers, and contractors—groups that are disproportionately applying for insurance right now. (I’m one of them, actually). “Try to find their unions and places they hang out and you’ll find people who want/need insurance on the exchanges or from Medicaid expansion,” said WCPN’s Tribble. It may be effective to reach out, for example, to the Freelancers Union, National Writers Union, and the New Faculty Majority to connect with local members, in addition to the adjunct and lecturer unions at local colleges. Local construction firms might also point reporters toward contractors they regularly work with, some of whom may have stories to share about their experiences on the exchanges.
Of course, there’s no substitute for feet-on-the-street. It sounds like an obvious point, but overextended reporters might plan on carving out more space for it. Lieberman said what she’s doing for her work on CJR’s The Second Opinion is “asking people on the street if I can talk to them and use their stories. Or I ask friends who have relatives or who are shopping [the exchanges] themselves. The sister of my hairdresser who lives in Nebraska has shopped the exchange for me and provided me with great stuff.”
“I think we as journalists as a whole have lost the art of hanging out with ordinary folks—in bars, unions, at the food bank, wherever,” Lieberman said. “Maybe I am old school, but that’s where we get the best stories and learn what people really think. That is invaluable as we do our work.”
But reporters need more than stories of individuals signing up for the exchanges. Other sources worth pursuing are insurance brokers and even the insurers themselves. They are not free from conflicts of interest, but given that their interests are more commercial than political, they offer a perspective that is not hooked to a partisan script. Insurers “can be the best sources,” said Lieberman, “because they know how the products work.” As the Columbus Dispatch’s Ben Sutherly noted, it is “possible that some health plans that are getting their debut through the marketplace in your state may be more willing to talk [because] they want the exposure.”
Still, many insurers may be cagey, because, as Nixon said about Pennsylvania insurers, “I think they’re afraid of sounding negative about the website, which could hurt their enrollment.”
That’s a point that can be pushed, however. For her November piece about a Pennsylvania woman who went shopping on the exchange, Lieberman did not get a response to her calls from Independence Blue, an insurer. But after publishing her article, Lieberman said, “I have them talking to me now because they screwed up and put out the name of flak who was on maternity leave and obviously didn’t return my calls.
“My advice,” she added, is for reporters to “just keep pushing them, tell them you want to be sure to get the story right, need help to do that—that sort of thing. Sometimes it works.”
More accessible, and worth cultivating as sources, are agents and brokers. The Plain Dealer’s Steve Koff (whose “fine reporting on the health law” was recently highlighted on CJR) said that they have been great sources for him. He did, however, note that they’re not fail-proof: one broker, he said, “gave me such bad information that by the time I was done, the White House and Ohio’s very partisan lieutenant governor were in rare agreement that it was bad info.”
Insurance navigators who, per the ACA, help people sign up for coverage, are another possible source. The Tribune-Review’s Nixon reported that navigators in the Pittsburgh area have been “very wary of talking to me so far.” But Lieberman said that the navigator story is good because “we need to find out if they are really working”—whether there are enough of them, what are they being used for, who’s getting the money, if there are quotas, and so on. The story is particularly interesting in light of the fanfare that US Secretary of Health & Human Services Kathleen Sebelius made in August when she gave out $67 million in grants to navigators.
Grounding stories in a mix of sources, then, is critical for getting past the push-and-shove of politics that is coming at healthcare reporters from all sides. “[B]ecause of the political inclinations or suspicions or whatever of readers, I think reporters can best be of service by trying to get past that with as many factual and service-oriented stories as possible,” said the Plain Dealer’s Koff. “The ACA is the law, and we need to help people understand what that means.”
And that, as those on the beat well know, is a task that is as challenging as it is essential.
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