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At a crucial moment in California health policy, reporting beyond the capitol is key

Topics in Health: Lessons From The Field

At a crucial moment in California health policy, reporting beyond the capitol is key

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Leticia, an undocumented 53-year-old mother of three, spent months on the waitlist for a knee surgery. The untreated injury not
Leticia, an undocumented 53-year-old mother of three, spent months on the waitlist for a pro bono knee surgery. The injury not only kept her from working but required one of her adult sons to work fewer hours in order to take care of her.
(Photo: Andrew Nixon/Capital Public Radio)

When you’re covering health care in California, it’s easy to fall into a pattern. I remember 2017 as the year of “zombie” health stories, when federal efforts to defeat the Affordable Care Act died and then came back in new form — the American Health Care Act, the Graham-Cassidy bill, the “skinny repeal.” I covered each of them with a formula: scan the bill text, tune into the hearing, interview a lawmaker. I tried to become a reporting machine that could absorb the national health policy debate and spit it back out in a bite-size, reader-friendly format.

I planned to follow the same rulebook while covering California’s push to achieve universal health care. I got used to fill-in-the-blank headlines: “California Health Advocates Fight for X as Federal Government Threatens Y.”

But I was missing a crucial element: the people.

In quick-hit news coverage about health policy, it’s easy to forget the enrollees buying insurance and seeking care. I had typed the phrase a hundred times — “California’s 3.5 million remaining uninsured” — without ever pausing to ask: Who are they, anyway?

As it turns out, they’re a lot of things — undocumented workers, small business owners, exhausted parents, healthy 20-somethings. There's a story behind every uninsured Californian, and with help from the Center for Health Journalism’s "Uncovered California" news collaborative, I was able to highlight a range of personal experiences. The state’s ongoing health reform discussions were just a backdrop.

When it comes to policy pieces, editors often want you to get the nuts and bolts and move on. I’d encourage any journalist covering policy, whether it’s health, education, or the environment, to push for human-centered storytelling on the wonky stuff, even if takes a little extra time. It absolutely pays off. Here are a few pointers on how to do it:

Start with building trust

About 1.5 million of California’s remaining uninsured are undocumented immigrants. I knew from the get-go that getting these patients to speak about health insurance would be a challenge, especially given the current political climate. Fortunately, other reporters in my newsroom had developed trusted relationships with local immigration nonprofits. I reached out and explained that adding a personal story to my project would shed light on the health barriers that California’s undocumented residents face and could move the needle on policy. Once leaders in the community understood what I was doing, they often moved quickly to find a patient who had struggled to access care without insurance.

A few weeks later, I met Holandesa Lopez. She moved to California from Nicaragua 17 years ago to build a safer life for herself and her now-teenage son, but she’s battled multiple health issues and struggled to access care. When we first spoke, I took some time to explain exactly who I was and what I was doing before I asked any questions. I tried to follow best practices for immigration reporting, like making it clear that a person’s first name alone could be used, or that we could indicate in a story that someone’s name had been changed to avoid putting safety or well-being at risk. I asked people I interviewed if they needed a translator and if there was a preference for a male or a female, and where she’d be most comfortable doing the interview.

When I finally arrived at Lopez’s house, we’d spoken so many times by phone that she seemed relatively at ease with me. Within 20 minutes we were chatting about her journey to finding mental health treatment for her depression. Her narrative was a bright spot in an otherwise dry explainer piece on what county health systems do (or don’t do) to serve undocumented residents.

Show the everyday impacts

When reporters tackle a series of stories about one issue — in this case, access to affordable health care — it’s our job to keep readers and listeners engaged, no matter how many times the same issue comes up. For me, that meant going beyond repetitive narratives such as, “X doesn’t have insurance, so she can’t get Y treatment.” Instead, I tried to dig into the various ways that not having coverage impacts someone’s ability to live a full and meaningful life.

With one particular patient who was on the waitlist for a knee surgery, I learned that the untreated injury not only kept her from working, but required one of her adult sons to work fewer hours in order to take care of her. Her family’s situation sheds some light on the wider societal impacts of not insuring everyone, and speaks to the ways in which health coverage can be either a driver or a barrier for a family’s economic mobility.

On the flipside, I spoke to undocumented young adults who are about to become eligible for Medi-Cal, California’s Medicaid program, for the first time. I asked them about how getting access to care might enable them to achieve their career goals or better support their families. Then I looked into how the lack of health insurance can drive some undocumented seniors back to to their home countries for treatment, separating families at a crucial time. The result was a series of multigenerational stories that I may not have taken the time to sniff out if not for the tight focus of this collaborative.

Get the paperwork

A story about how red tape and paperwork keep people from enrolling in services can be a real snoozer, unless you get creative. I knew that 9%of eligible kids and moms on California’s Women, Infants and Children (WIC) program were not enrolled in Medi-Cal. I’d heard that the Medi-Cal enrollment process could be tricky, especially for exhausted new moms or single parents. And I knew there was a bill up for debate in the state legislature that could automatically enroll these WIC families in health insurance.

It was a wonky piece about a little paperwork loophole that, if fixed, could help a pretty small number of Californians. But that small group contained low-income mothers and young children, some of the state’s most vulnerable residents with the highest health needs. And I figured if I could tell that story effectively, we’d be going somewhere.

With help from one of the nonprofit groups supporting the bill, I met a mom who had struggled to keep her children on Medi-Cal. She said she’d try to sign them up, but then she’d forget to file a paper or there’d be a computer glitch. She couldn’t remember exactly how long her kids were without insurance, so I asked her for the paperwork. Together, we looked at insurance cards for her toddler, and were able to figure out that he was uncovered for a little over a year. She said she had spent that whole time just praying he wouldn’t get sick.

When you’re trying to understand the nuances of someone’s insurance status, it can really help to have their paperwork in front of you. I did something similar when I asked a small business owner who was insured through Covered California for a bill showing her monthly premiums. When I compared it to her yearly income, the financial strain became obvious. As a good editor once told me, “Show, don’t tell.” It entails a whole new level of fact-checking but it really pays off.

In all of these cases, firsthand accounts turned what might have been a quick-hit legislative story or a forgettable explainer piece into more meaningful journalism that hopefully taught audiences about a community they may not have known or understood. It seems like basic journalism, but it’s easy to forget these human stories in the whirlwind of daily news. For me, it’s now become a rule of thumb.

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