Making health policy visible...on the radio
My project involved parachuting in to two unfamiliar states for a week each to compare them to my home state of Colorado’s approach to the Affordable Care Act.
Democratic governors and legislatures in Colorado have enthusiastically embraced the law. That puts it the minority of states. Most are either trying to forge compromises with the Obama administration or resisting the ACA outright.
That means, whether low- and middle-income people actually receive substantial new benefits the law offers depends on where they live.
Showing the law actually creating new opportunities in Colorado would be easy. I knew there would be many colorful examples of how ample government and foundation funding was being leveraged to lure customers into Colorado's exchange and sign them up.
Showing the law not working in a state that's resisting it would be tougher. Florida seemed like a good place to try.
I wanted to apply what I learned from Sarah Varney, who shared her story-gathering strategy with our fellowship group. In her piece on Texas' Rio Grande Valley for NPR, Sarah made the place she was reporting on a character in her story. Her great advice was: Telling people an interesting story about a unique place and the people in it creates space to “sneak in” some significant health policy reporting. Sarah's efficient use of sound elements and evocative writing is a model for conjuring images in listeners' minds.
Picking the location to profile involved learning about Census Bureau Public Use Microdata Area (PUMA) maps. They display data at the sub-county level and can be manipulated to overlay income and insurance status. The maps showed me Florida's epicenters of greatest need. Those where there are a lot of uninsured people, who also earn little enough to qualify for new tax credits to buy private coverage, or to get newly-expanded Medicaid via the ACA.
Florida's map proved a target rich environment.
I ultimately chose the Panhandle because my editors wanted the unexpected. No one would be surprised to hear that conservative Florida leaders were resisting efforts to deliver new benefits to English-challenged migrant communities in Miami. More neglected is rural Florida, where many communities rank among the most economically disadvantaged in the state. Enrollment advocates called it the most difficult to reach part of Florida, in part because people there are largely hostile to Obamacare.
I looked for local events in several Florida hotspot PUMAs, and when I found the “World's Largest Free Fish Fry,” I knew I'd be going to Perry, and would probably get some great tape. I was not disappointed. The parade down Main Street really helped set the scene. People likely to qualify for ACA benefits, but who hated the law and President Obama, were not hard to find.
It was also important to portray that many Floridians disagree with state leaders' decisions to thwart the federal health law. I visited an African-American church in Jacksonville, where the pastor invited volunteers from Enroll America to Sunday services to help congregants sign up.
I also spent a full day at a community clinic in the small Panhandle town of Freeport, talking to patients. They told me about their health needs and what they thought about Obamacare. Only the most powerful patient narrative made it into the story, a woman who spoke emotionally about not being able to get coverage because Florida declined the ACA's Medicaid expansion.
The fish fry, the church and the clinic gave me three “scenes” to build my story around, and to illustrate what the law is not doing that it is in other states. That was plenty to bring to life North Florida as a character in the piece.
Reporting this story taught me, again, that all health care is local, and reminded me that that can also be the beat's biggest asset. There are places that are distinct for what they look like on paper – percent uninsured, poverty rate, race and ethnicity – and places that have distinct personalities. Finding places that are both are key helping listeners understand what health policy does, and why it matters.
Image by A. Germain via Flickr