Readers of Tom Wilemon’s recent stories in The Tennessean could easily conclude Tennessee has once again declared war on poor, sick people. The string of stories Wilemon has written since the beginning of the year chronicle yet another troubled chapter in the life of TennCare, the state’s Medicaid program (I wrote about TennCare’s troubles almost ten years ago). With strong support from his editors, Wilemon, a health reporter soon to join the investigative team, has done outstanding work and deserves a CJR laurel.
Like most red states, Tennessee did not expand Medicaid. The state has also made it difficult for already eligible people to apply for Medicaid, and is trying to save money by scouring the current program rolls for ways to cut services. In a piece from early October, Wilemon quotes Carol Westlake, who heads the advocacy group Tennessee Disability Coalition, summing up what’s been happening in the state:
There’s an old Indian saying: When the elephants do battle, the grass gets trampled. While you play out disputes about how the system should run in the legislature or play them out in the courts or you play them out between the state and federal governments, on the ground there are sick babies who need care.
Wilemon’s reporting on sick babies, long-term care patients who need ventilators, and thousands stuck in paperwork hell moves what might be dreary Medicaid stories laced with statistics and predictable quotes to interesting reporting at a human level. “These are incredible people stories, incredibly rich in narrative and imagery, and they will grab people’s attention,” Wilemon said in a phone interview. His editors have told him to make Medicaid stories a priority.
That he has–with people at the forefront. Earlier this month, for example, Wilemon reported on a rally at the Tennessee Capitol where some 60 people urged the governor to expand Medicaid. He didn’t lead with a quote from officialdom. Instead, he told of Michele Fardan, who was praying at the Capitol, “clutching a piece of folded paper” with the picture of her late daughter, Monika, who died this summer at age 37. Monika had no health insurance so she did not seek medical help until one day she became so weak and lethargic, her mother insisted she go to the hospital. She died the same day from a pulmonary embolism.
At the end of the piece, Wilemon did give the governor’s response. His communications director said the governor is still working on a way to fill coverage gaps in Tennessee. “How many times can you say the governor is talking about doing something?” Wilemon asked me. “He’s been talking about doing something for a year and a half. Sometimes an average person is more important than the governor or any politicians.”
Yet Medicaid in Tennessee is intensely political, and reflects the state’s assault on the Affordable Care Act. As Wilemon explained to me, “In court documents, state officials have blamed all the failures to process Medicaid applications in a timely fashion on Healthcare.gov and the Affordable Care Act.” He told me of one Tennessean reader who contacted the paper after state officials refused to answer a simple question about what the income limits and family assets are for having Medicaid pay for a nursing home stay. “He was told, ‘Because of the Affordable Care Act, we can’t answer that.’ It’s like answering what a deductible is.”
Wilemon has reported with context and humanity the main threads of the Medicaid story in Tennesee. Besides covering those caught in the coverage gap, he has shown how the state’s roadblocks make it tough for people already eligible for Medicaid to apply. For months, newborn babies went without coverage because the state refused to grant them coverage under the standard of “presumptive eligibility” called for by the Affordable Care Act. The state once used presumptive eligibility to sign up Medicaid patients, but stopped the service with the full rollout of the ACA. That’s meant thousands of people who got sick and ran up big hospital bills had no way to pay for them.
The state has changed the rules to make thousands of Tennesseans apply for Medicare through the Healthcare.gov website, a cumbersome and often unreliable pathway that has gotten them stuck for months in bureaucratic snafus and computer failures. And even people already receiving Medicaid services are vulnerable to the state’s cost-cutting measures. State officials now use a point system to ration long-term care services such that, as Wilemon reported in February, “someone could be incontinent, have problems walking, be unable to manage their medicines” and still not qualify for Medicaid-funded nursing home care.
Wilemon’s work is an example for reporters covering Medicaid in Tennessee and beyond. He helps readers see the effect of government policy on real people, but he also provides the numbers and the stats to round out the picture at the end of most stories–a good technique that doesn’t disrupt the story he wants to tell. Wilemon has also reported on the federal compliance issues in Tennessee, where feds pushed TennCare to comply with eligibility and enrollment systems and requirements, and the battle has moved to the courts. The feds have also sent compliance letters to Medicaid agencies in California, Kansas, Michigan, Missouri, and Alaska. It would be great if reporters in those states would follow up on this, and all reporters examining Medicaid in the coming months would use Wilemon’s reporting as a model.