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Challenges abound in reporting on ACA rollout in Indian country

Challenges abound in reporting on ACA rollout in Indian country

Picture of SE Ruckman
A high school football team in the Navajo Nation community of Fort Defiance, Arizona.
A high school football team in the Navajo Nation community of Fort Defiance, Arizona.

When I pitched my series on the Affordable Care Act (ACA) in Indian country, I sensed that this medical system overhaul would either somehow leave American Indians out of the loop or affect them in ways that probably had not been accounted for when the new law was being drafted. I was not wrong. I found out that ACA enrollment numbers for Indians were inconclusive, that some Indians were not filing their optional exemptions from the ACA due to unemployment, and that creative efforts were being undertaken across Indian country to help enroll Indians in federal health insurance.

At first, I just wanted to know how many Indians were enrolled in insurance through the ACA. But as I rolled up my sleeves, I soon realized two main things: First, there was no aggregate number on Indian enrollment from any source. Second, I realized that I was on the journalistic equivalent of Alaskan tundra. None of my searches uncovered any useful references on how Indians were faring under the ACA.

The existing stories I found hit the high points on health care and Indians — mainly the idea that Indians already had the Indian Health Service (IHS), for which Congress allocates roughly $4 billion annually. As I set out to write this series, I realized I would have to make my own building blocks on the subject.

The series was a trial and error experience for me. The things I thought were shoe-ins (for sources or comments or art) often were busts. I thought covering 17 tribes on a beat earlier in my career would make this series a piece of cake. It wasn’t. I didn’t want to center on Oklahoma (although my initial roadmap outlined mostly tribes in the state). I realized I would have to think nationally.

I went after the biggest names in Indian health care advocacy first. I called the National Congress of American Indians (NCAI), and the National Indian Health Board (NIHB). I left messages and sent e-mails for requests for input that I thought would rain back upon me like spring showers. After several weeks and many unanswered emails later, I realized I had no takers. Fluttery panic began to set in.

I needed sources. I needed numbers. I needed cooperation. A chance phone call to the press contact at NIHB pointed me to the larger metropolitan areas in the country that made Indian health care their business. Armed with new names and contract information, I began anew. I zeroed in on key metro areas like Sacramento, Calif., Portland, Ore., and Denver, Colo. My hope was temporarily renewed.

And so it went. In my series, virtually every source that produced useful information for me came about in a serendipitous manner. For example, I had contacted a nonprofit that specialized in targeting childhood obesity and promoting healthier lifestyles in Indian country. The director was someone who I met while covering tribes for a metro daily. She did my series one of its biggest favors by forwarding an email to her mail group. And like a spring rainstorm, it began to sprinkle with notes from folks in Indian country who could provide information or who knew of folks doing extraordinary things with ACA recruiting.

Here are a couple points of advice to reporters working on similar projects:

Don’t be afraid of failure. If the door doesn’t open, then look for another portal rather than trying to force your way in. This helped me the most. I wanted to go to Denver for an on-site interview but I had no funds or support to go. I was beating my head against the wall. I decided that I would go with what did work and not take it so personally. Calm settled on me.

At one of my first jobs at a small town daily, the editor told us to "go out and beat the bushes." I still take that small bit of advice to heart. When I ran into dead-ends or no call-backs, I sought out sources online that I thought might have something to say. For instance, I wrote ACA consultant Jonathan Gruber for 14 straight days with a request for comment on whether ACA would meet the needs of small groups like American Indians. I didn’t give up. He did get back to me and politely declined, but I realized that perseverance gives its own kind of comfort. I followed due diligence trying to get the best sources.

Listen to what a talkative source is saying. In the case of Ursula Knoki-Wilson in Chinle, Ariz., she was telling me in her strong regional dialect that the ACA had something to offer that far corner of the Navajo reservation. Her insights were exciting and fulfilling (I still wish I could convey her specific vernacular to my readers).

As for the response to my stories, several Indian news outlets had reprinted my stories, including the American Health Exchange;; Cleveland American Indian Movement; Native American Encyclopedia; Tulalip Tribal News and the White Sky Services. And they were also earmarked on the Indian version of a national news website,, a portal that tribal decision-makers visit regularly. I was satisfied that my ACA reporting was being read by others.

In hindsight, I can say that I would have done so many things differently. But after realizing that I had little previous work on this specific subject to lean on, I relaxed. I wanted Indian or mainstream writers to follow after my project — to improve it or expand on a particular angle. That’s what good journalism does — it inspires other journalists to think and lets ideas germinate. Then others go out and push the story farther. I’ve done that before myself. It’s part of the process and completes the information cycle. I also got a certain degree of satisfaction in knowing Indians' experience with the ACA is coming to light.

Photo by Donovan Shortey via Flickr.


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