The Second Opinion

How a reporter forged her own path covering healthcare in South Carolina

June 9, 2016

Medicaid is not a topic most reporters—even health reporters—flock to. It’s a complex subject and the program serves mostly poor people, hardly the news demographic of choice.

But Lauren Sausser of The Post and Courier in Charleston, South Carolina, has discovered that Medicaid—which directly affects about one in five of the state’s residents—can be a treasure trove of stories. The 32-year-old Sausser is carving an important niche for herself on the healthcare beat, backed by a paper that still has a full-fledged, four-page health section once a week and recently appointed her editor of the section.

“Her abilities and strengths have led us to where we are with health coverage,” said Mitch Pugh, The Post and Courier’s executive editor. “She has opened our eyes in the newsroom about what healthcare journalism can be.”

Sausser didn’t come to the P&C with a health wonk background. After working at several other news outlets, she and her husband wanted to move back to South Carolina, and she applied at the paper, which had no openings. “I was pretty aggressive,” she said. “I told them I would take the first job that opened up.” The health beat was the first, and she landed the job in early 2013.

The summer before that, the Supreme Court had ruled that the federal government could not require states to expand their Medicaid programs as part of the Affordable Care Act—the feds could provide funds to pay for most of the expansion, but the choice was up to state lawmakers. That decision prompted legislative debates around the country, and made Medicaid a big focus for reporters, for a time.

Many of those reporters have since moved on, but in South Carolina, where state officials refused to expand the program, Sausser has continued to follow the story closely. In one eye-catching article from January, she told the tale of Jim Connor, a pizza deliveryman earning $50 to $75 a week who had been diagnosed with esophageal cancer. With no employer insurance, no access to refunds to make insurance affordable, and no Medicaid help, Connor was one of 123,000 South Carolinians in the so-called “coverage gap,” she wrote. He had been left to depend on hospital charity—and so his tumor had gone untreated for months. In May, Sausser revisited Connor’s story: Workers at the state Medicaid agency hadn’t been able to help him, but they had accepted his paperwork. Then they mistakenly shared his personal information with another applicant.

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Sausser has covered other stories about patients who fall through the gaps in healthcare reform, too. But she has also written about backlogs in processing Medicaid applications, about how the state has monitored social media to gather customer feedback, about the uneven implementation of the Healthy Outcomes Plan, the state’s alternative to Medicaid expansion, and more. The steady attention to the program’s operations makes her coverage stand out.

“There are so many negative stereotypes of patients who need Medicaid that I think some people don’t care about the program as much as they should,” Sausser told me. But the program is clearly important: It serves more than one million South Carolinians, about 600,000 of them children, and involves billions in annual spending. The chance to own the Medicaid beat also meshed with Sausser’s reporting ambitions. “I wanted to be the go-to reporter for sources who wanted some subject covered,” she said.

Her reporting is strong, in part, because she has taken—and been given—the time to really learn the subject. That’s something that impressed Tony Keck, the state’s former director of Health and Human Services, who is now a senior vice president for a hospital system in Tennessee. “She was interested not only in the story of the moment but how healthcare worked, and we often talked about non-specific issues, whether it was healthcare or Medicaid,” he said. Sausser’s coverage hasn’t shied away from exploring shortfalls in state policy, and her coverage tends to highlight people who are personally affected. But, Keck said, she “had a way to tell the story and put in the context of how and why decisions were being made.”

That’s not to say that Sausser only covers Medicaid—far from it. Her recent stories have covered a new nursing program, local lead levels, “superbugs” in area hospitals, and the response to the Zika virus. As more data about hospital performance becomes available, Pugh, the paper’s editor, says she has figured out which rankings are useful, and how to put them in context.

Those stories don’t always put hospitals in the best light.  “There was some pushback at first,” Pugh said. “It was clearly not the kind of reporting our hospitals were used to. They figured out who she was, and it has been an adjustment process.”

Sausser has been a key part of some big investigative projects, too. In March 2015, she and Doug Pardue shared a byline on “Cradle of Shame,” about the scary infant mortality rates in the state’s rural areas. Later in the year she wrote “Warehousing our Children,” about hidden abuse of foster children in group homes. The idea for that series, which won a first-place award in its category from the Association of Health Care Journalists this spring, came from a Medicaid source, she said.

Though she’s worked to become fluent in health policy, one of the lessons in Sausser’s coverage is that the best stories spring from the grassroots, from the experiences of ordinary people struggling to get better healthcare. On her computer screen are Post-its with phone numbers for the state Medicaid agency and the Obamacare marketplace, to pass on to readers who ask for help. She says her colleagues call her “Dr. Sausser” or “Insurance Agent Sausser.” It’s those kinds of calls that turn into first-rate journalism.

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.