Health-care debate is a ‘wake-up call’ for Medicaid coverage

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FROM BELTWAY PRESS REPORTS to Jimmy Kimmel’s sustained outrage, critiques of the Graham-Cassidy bill have laid bare the shortcomings of the GOP’s latest doomed effort to dismantle the Affordable Care Act. Much of the strongest coverage, however, happened at the local level, where news outlets provided some of their best reporting to date on Medicaid—the government’s largest insurance program and, in Graham-Cassidy and other GOP proposals, the target of devastating reductions.

Since the beginning of the year, many local news outlets have provided robust reporting on Medicaid, which has bolstered reader interest in the program. “In the course of the debate, it’s become clear that Medicaid has tremendous public support,” says Shannon Buckingham, vice president for communications at the Center for Budget and Policy Priorities. “There has been much more focus [on Medicaid] in this debate than I’ve ever seen in any health policy debate.”

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Such focus has traditionally been the exception, not the rule. For years, news outlets seemed largely uninterested in Medicaid, contributing to collective ignorance of what it’s like to live below the federal poverty line, as millions of Americans do.

However, the ACA’s Medicaid expansion provisions brought coverage to some 12 million new recipients—an influx whose consequences were for many newsrooms to ignore. Medicaid emerged slowly as a frame for coverage of efforts to repeal and replace the ACA, says Joan Alker, who directs Georgetown University’s Center for Children and Families. Then, says Alker, “it started to seep out” that Congress was considering “radical changes” to Medicaid’s financing structure, which had been in place for 50 years. As those changes took shape, coverage took off.

A story by an Arizona reporter about state-sponsored Medicaid forum ranked among her news site’s top stories for a week. ‘That told me we should be writing more about Medicaid. It was a wake-up call.’

In Arizona, Medicaid covers one-quarter of the state’s population. Weeks before Republican Senator John McCain voiced his decisive opposition to Graham-Cassidy, Stephanie Innes—a medical health reporter for The Arizona Daily Star, one of the state’s largest newspapers—produced a first-rate piece on how the state’s application for a Medicaid waiver would affect Arizonans. The waiver would pave the way for a five-year lifetime limit on benefits and requirements that “able-bodied” enrollees work, attend school, or get job training.

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In her story, Innes noted that most of those on Medicaid already work. She laced her story with vignettes of Arizonans like Jim Truitt, who said he’d be dead without Medicaid. Truitt, a former truck driver, relies on Medicaid for his defibrillator and heart and psoriasis medications. He’s had several strokes and, Innes reported, “looks much older than his 57 years.”

The Daily Star’s editorial board built on Innes’s reporting. Work requirements “may sound appealing,” the board wrote days later, but they “don’t jibe with reality and have the real potential to harm people who need help the most.” After McCain voiced his opposition, the editorial board urged Arizona Republican Senator Jeff Flake to do the same, and again cited Medicaid as a reason to do so.

Earlier this year, another story by Innes—about a state-sponsored Medicaid forum—ranked among the news site’s top stories for a week. “That told me we should be writing more about Medicaid,” she tells CJR. “It was a wake-up call.”

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In Phoenix, Ken Alltucker, who covers health for the Arizona Republic, says the paper has run many stories about Medicaid this year. One took as its subject the hypocrisy of state legislators, who opposed Medicaid expansion while they received more comprehensive and less costly health coverage from the state.

Last week, Alltucker reported that the block grants proposed in the Graham-Cassidy legislation would cost Arizona’s Medicaid program more than $10 billion. (Block grants usually mean less money and, by extension, benefit cuts for recipients.) Another piece detailed the concerns of those health-care providers “that have reported a significant drop in unpaid bills” since the state’s Medicaid expansion.

“People are engaged in the politics of health reform,” Alltucker says.

News outlets in Montana and Nevada highlighted for readers how the GOP’s scalpel would wound their states. In Montana, the Billings Gazette published two strong editorials objecting to efforts that would have repealed Affordable Care Act protections for the poorest Americans. When the repeal-and-replace drive began in March, the Gazette’s editorial board argued that the House legislation “aims to give Americans more choices, [but] for people below or near poverty there is no market choice they can afford.” In May, the editorial board urged the state’s Republican senator, Steve Daines, “to get on board to protect health care for all Americans, particularly the poor, elderly, and disabled.”

The Nevada Independent, a nonprofit online news and opinion site that launched in January, jumped right into the Medicaid story. As soon as the site was live, reporter Megan Messerly took on Medicaid’s complexities and published clear explainers  along with coverage of the state’s explosive Medicaid politics. (Nevada Republican Senator Dean Heller sponsored the Graham-Cassidy legislation, and Republican Governor Brian Sandoval vetoed a bill that would have allowed some Nevadans to buy into Medicaid coverage.)

In South Carolina, people have the stereotype there’s so many Medicaid recipients defrauding the system. The reality is provider fraud is more rampant.

A July story by Messerly combined thumbnail sketches of Nevadans who depend on Medicaid with a short history of the program. Another detailed the challenges of finding care amid the state’s chronic doctor shortage. “Things that a middle-aged middle income, able-bodied patient might take for granted—finding a provider online, calling to make an appointment and driving oneself to the doctor—aren’t always easy for the Medicaid population made up of children, the disabled, seniors and low-income individuals,” Messerly wrote. Her engaging reporting on a tough topic probably gave some readers a better understanding of Medicaid than they’d ever had.

Reporters in states that chose not to expand Medicaid under the Affordable Care Act have done their share of good reporting, too. Reporters Audrey Dutton and Cynthia Sewell merged their coverage of Medicaid politics with the tale of Kristyn Herbert, who has cerebral palsy. Medicaid helps Herbert cover the cost of a full-time personal assistant, which enables Herbert to live in her own apartment instead of a costly nursing facility. “I would rather go live under a bridge than a nursing home,” Herbert told the paper. In July, Herbert joined other state residents at the office of Republican Senator Mike Crapo where, Herbert said, “I asked Sen. Crapo if he cuts Medicaid if I could live with him.”

In South Carolina, which did not expand Medicaid, the Charleston Post and Courier has covered the issue for several years. Lauren Sausser says South Carolinians have come to rely on the paper as a source for health news.

“The paper has always prioritized health coverage,” says Sausser. Medicaid, which covers one-fifth of the state’s population, is crucial to her coverage. Last year, she followed a man named Jim Connor who was dying from cancer, and whose care was delayed because he was uninsured and ineligible for Medicaid under South Carolina’s rules. More recently, Sausser distilled the 140-page Graham-Cassidy proposal into 10 questions, which she answered for readers.

Those able to do good stories on poverty and Medicaid are more experienced reporters. And there are fewer of us.

Sausser has also reported on instances of Medicaid fraud in her state. “In South Carolina, people have the stereotype there’s so many Medicaid recipients defrauding the system,” Sausser tells CJR. “The reality is provider fraud is more rampant.”

Will local journalists’ nascent interest in reporting on Medicaid continue if the GOP’s repeal-and-replace crusade vanishes into legislative obscurity? Dean Olsen, the statehouse reporter for the State Journal-Register in Illinois, knows the topic well and has done his own good reporting this year, particularly on how Medicaid changes would affect Illinois providers. As Olsen sees it, there are two strikes against sustained strong coverage of Medicaid: The public doesn’t truly realize the prevalence of poverty, and the news business does not enable such coverage as it should. Poverty and Medicaid aren’t going to be covered on TV, Olsen tells CJR; instead, it’s a story for local newspapers, where such coverage might be easily overlooked. It takes time to learn how Medicaid works, read the studies, and understand its regulations.

“Those able to do good stories on poverty and Medicaid are more experienced reporters,” says Olsen. “And there are fewer of us.”

CJR’s health care reporting is sponsored in part by a grant from the Commonwealth Fund.

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Trudy Lieberman is a longtime contributing editor to the Columbia Journalism Review. She is the lead writer for CJR's Covering the Health Care Fight. She also blogs for Health News Review and the Center for Health Journalism. Follow her on Twitter @Trudy_Lieberman.