The Second Opinion

After five years of strong work, a Colorado nonprofit ran out of money at the wrong time

January 5, 2016

The year 2016 is shaping up as a big one for health policy in Colorado. In the fall, regulators shut down the state’s nonprofit insurance co-op, leaving some 80,000 residents to find other coverage. Many of those people were left to shop for new plans on the state’s insurance exchange, which has been slated for an expanded audit after an initial review a year ago found serious concerns. Most significant of all, state residents will vote in the fall on a plan to create a new single-payer universal healthcare system, funded by about $25 billion in taxes. The debate over the referendum is likely to be one of the major political stories in the state all year. 

But one of the state’s best sources for health news won’t be around to cover it. In October, Health News Colorado, one of the many nonprofit news services that sprouted around the country over the last decade, closed its doors. The site’s leading supporter, the Colorado Health Foundation, had changed its grant-making priorities, and editor Diane Carman was unable to raise enough money from other sources to keep the operation alive. 

Though other outlets will cover the big stories, the demise of Health News Colorado leaves the state’s most dedicated readers without an important source of comprehensive, aggressive coverage of the insurance exchange and other health policy news. The site’s experience, meanwhile, highlights both the promise and the pitfalls of foundation-backed nonprofit journalism.

Health News Colorado launched in 2010, and it was always dependent on support from the Colorado Health Foundation, which provided $500,000 over the years, or about half the site’s budget. The goal in supporting the news outlets was to increase coverage of health policy news and “broaden the audience” for it, Amy Latham, the foundation’s vice president of philanthropy, told me. It’s a pattern we saw in several places around the country, as the debate over the Affordable Care Act sparked a surge of interest just as newspapers were undergoing wrenching job losses.

With the money, Health News Colorado did deliver increased coverage—including some gutsy work from reporter Katie McCrimmon about struggles at the state’s health insurance exchange that angered state officials and often brought uncomfortable pushback. As I wrote last year, the site’s skeptical reporting stood out from the cheerleading that has marked too much Obamacare coverage around the country. And it was apparently finding an audience. Carman told the Colorado-based media writer Jason Salzman that the site’s stories “were routinely getting 20,000 or 25,000 hits.”

It was clear some time ago, though, that that coverage was on shaky footing. Shortly after making its second grant to Health News, the foundation gave Carman a heads-up that funding was not likely to be renewed again. The decision was part of a “strategy refresh” that included a shift away from supporting nonprofit news. Another startup, the I-News Network, also lost its funding from the foundation, but a merger with Rocky Mountain PBS in 2013 avoided a difficult situation, said Laura Frank, the outlet’s president and general manager for news. And a foundation grant to support health coverage at Colorado Public Radio is scheduled to end next year, Latham said. (Support for Health News and a handful of other journalism projects never amounted to more than a fraction of the foundation’s giving, which has topped $97 million in a single year. The foundation’s giving priorities are healthcare services, health coverage, and healthy living; it also provides support to the advocacy group Healthier Colorado.)

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Another local foundation that was a smaller supporter of Health News also reduced and then ended its funding as part of a strategy shift, Carman said.

The foundation-backed public radio project operates in partnership with Kaiser Health News, and it produces some policy coverage, like this piece comparing the failure of Colorado’s co-op with the apparent success of one in Connecticut. There’s other health coverage in the state, too. Both The Denver Post and KUSA, a Denver TV station, have reported on concerns over the proliferation around the state of costly freestanding emergency rooms, for example, and both have followed developments at the exchange, from the latest enrollment numbers to a typo that sent customers to a phone sex line. The Post’s investigations desk has turned out a number of health-related projects, including coverage of care for inmates and problems with a new VA hospital. When the failing co-op cut off payments to brokers, the Post covered the story, and Frank told me her outlet is working on a major package about infant mortality.

Still, the tenacious, detail-oriented coverage of the day-to-day operations of the state’s health agencies that Health News Colorado provided will be missed.

“Nobody does it now as regularly, reliably, or as comprehensively,” said T.R. Reid, a former Washington Post reporter who is now spearheading the campaign to enact universal health coverage in the state. “It’s a loss. Is anybody going to fill that gap?”

The site’s trajectory highlights some of the challenges faced by nonprofit sites more broadly, especially those with a niche focus. As both for-profit and nonprofit outlets struggle to identify new revenue sources, foundations can provide essential support. But in many places, the list of local foundations that might support journalism is not especially deep. When one or two change directions, it can be hard to recover.

Latham, of the Colorado Health Foundation, said that when the foundation supports a project, it always asks about sustainability. “We can’t make promises of funding in perpetuity,” she said. 

Health News had tried to develop a broader funding base, Carman told me. Her initial vision included a job-listing service and public media-style sponsorships. But regulations at Colorado University’s Denver School of Public Affairs, where they were based, prevented those approaches, she said. “One after another the options disappeared, and we were left with foundation funding solely.”

Carman also had talks with Kaiser officials about bringing the Colorado site under their umbrella. There was mutual interest, but she needed to secure two years of funding from local sources. Even without the Health Foundation money, she had some commitments—but ultimately, not enough. 

Carman is now doing media relations consulting. When I spoke with McCrimmon, the reporter, late last year, she was doing PR on a short-term contract for the non-profit Nurse-Family Partnership. Health News Colorado had folded just about the same time as the state’s insurance co-op, she noted. “It really killed me not to do the story.”

In 2010, when Health News launched, “it was a fertile period for nonprofit journalism and there was lots of experimentation and a great deal of optimism that we could make this work,” Carman said. For five years, they did. And even if it wasn’t sustainable in the end, Carman believes they had an impact.

“I think we really did succeed in our mission to increase public awareness and discussion,” she told me. “We did it by creating a competitive environment where other media felt compelled to cover health policy more intensively.”

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.