Health care journalists need to cover the AHCA from the ground up

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LAST WEEK, Vox’s Congressional reporter Jeff Stein posted photos of the front pages of the Los Angeles Times, The Washington Post, The New York Times and the Wall Street Journal to Twitter. “Nothing about GOP health bill today on the front pages of any of 4 of America’s most influential newspapers,” he tweeted. He followed with another photo, from CNN.com, where he counted 24 headlines. Only one—”Closed-door drama of GOP health care talks”—referred to the AHCA.

The previous day, Stein had posted an image of a line graph that showed surges in coverage of the American Health Care Act. He observed two upticks in coverage, tied to the House’s first AHCA vote in March and its second, successful vote in May.

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Stein’s posts underscore a major challenge facing resource-strapped health care journalists: how best to cover a critical piece of legislation that remains, in many ways, a moving target.

Many health care journalists outside the Beltway may be tempted to follow the lead of Washington reporters, who are closer to the daily tick-tock of policy discussions. However, for local and regional reporters, health care journalism is also particular to the evolving health needs of the communities they cover. What Washington journalists report is not necessarily what audiences in the rest of the country want—or need—to know.

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NEWSROOMS AROUND THE COUNTRY have received letters calling for clarity on the AHCA’s impact. Editors at several newspapers recently told CJR that they receive more letters raising concerns or questions about health care than any other topic. The Joplin Globe, the lone daily newspaper in southwest Missouri’s Jasper County, recently published a letter from a resident who traveled to Springfield to discuss her community’s specific concerns:

If passed in its current form, and if Missouri opts out of it (which history indicates is very likely), it would leave thousands of Missourians who currently have access to health care without it. Missourians with pre-existing conditions would be thrown into inadequately funded high-risk pools, which would mean they’d end up with no means to pay for health care (no insurance). And for some of us who rely on life-saving treatments, no insurance coverage could mean premature death.

The concerns and personal narratives those letters contain can yield important local and regional stories. I received a letter from a woman in Michigan whose 89-year-old mother lives in an assisted living facility. Medicaid pays for about half of all nursing home stays in the country, as well as some home- and community-based services provided under special waivers. If the federal government rolls back the Affordable Care Act and cuts funding to the states, there’s likely to be less money for long-term care.

The woman described her concern that neither she nor her mother could afford to sustain her mother’s care. I’ve heard about the same problem—the necessity of long-term care against the affordability of it—more than once from readers.

The New York Times recently published an op-ed by three professors—two specialists in health policy and one in economics—about the same long-term care problem:

Imagine your mother needs to move into a nursing home. It’s going to cost her almost $100,000 a year. Very few people have private insurance to cover this. Your mother will most likely run out her savings until she qualifies for Medicaid.

The op-ed begins to differentiate the groups that Medicaid cuts would impact—a first step towards localizing coverage. “Much focus has rightly been placed on the enormous damage this would do to lower-income families and youth,” the authors write. “But what has been largely missing from public discussion is the radical implications that such cuts would have for older and disabled Americans.”

Those implications are also missing from many news stories: There’s virtually no reporting on how America lacks a program to pay for long-term care.

 

HEALTH COVERAGE THAT MERELY TRACKS the Beltway drama of the AHCA risks overlooking the diverse and nuanced health needs of cities and counties. As they watch DC from a distance, more health reporters need to scrutinize their own communities’ needs, and use local concerns to shape their coverage.

Last week, 50 reporters from 18 states attended a rural health workshop sponsored by the Association of Health Care Journalists. At the event, Laura Ungar, a longtime health reporter for the Louisville Courier-Journal and USA Today, spoke about her coverage of disparate cancer rates in American communities. A source at the Center for Disease Control and Prevention told Ungar that “every state and locality has different resources available.” At the event, Ungar told reporters that cultural factors also contribute to health issues that differ across communities: During her reporting, Ungar found a 50-year-old woman who hadn’t had a Pap smear since her last child was born. Another, who was 55, “has had only one Pap smear in her life,” wrote Ungar.

Ungar told reporters that she sees four forces contributing to poor health outcomes in rural communities: poverty, health behaviors, access to services and providers, and political will.

She also mentioned a few stories in which she examined how those forces work in specific communities. For instance, in Floyd County, Kentucky, Ungar anticipated what might happen if the state’s progress in providing unprecedented access to one of the nation’s poorest and most vulnerable communities disappears. Her story is a template for other community-focused reporters to use in states where governors seek to change Medicaid programs before larger changes trickle down from the GOP health legislation.

Ungar spoke at a panel called “Finding Rural Health Stories,” for which I was also a panelist. At the end of our discussion, a reporter in the audience asked raised the persistent, and perhaps inevitable, question: how to cover the American Health Care Act without knowing its finer details.

Here’s what we suggested: List each major component of the American Health Care Act. (Need a few? Start with Medicaid, rules governing pre-existing conditions, subsidies for buying Obamacare policies, state high-risk pools, taxes, insurance rates.) Then, for each component, list what you know is proposed under the House bill. Find the people in your community who those proposals will affect and, as the AHCA legislation evolves, track the evolving impact for your community.

A community’s health needs are as distinct as a fingerprint. Knowing their whorls will help reporters trace the impact of the AHCA down the road.

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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.