Covering Health Reform's Rollout Locally: Ideas from California

We have a guest post today from Daniel Weintraub, a veteran California journalist and editor of HealthyCal.org, a nonprofit news site that is supported by The California Endowment, which also funds Center for Health Journalism Digital. Especially if you live in California, HealthyCal.org is worth checking out as a resource for health-related story ideas and background information. - Barbara Feder Ostrov, deputy editor, ReportingonHealth

There will be a ton of institution-driven stories on the rollout of health reform. And stories about the system, and changing it, are important.

But this is really a story about people, about people who have gone without health coverage, and in many cases care, and are now supposed to get it. Reporters should push beyond the clinic managers and directors of community based organizations. Use them as sources to find people in the community who are supposed to benefit from this bill and find out, are they?

Many will, and those will be inspiring stories. But others might find themselves with insurance coverage yet still without care, either because the public program they are in does not have enough doctors to serve them or they were able to get private insurance but only with such high co-payments that they are still reluctant to see a doctor.

Further up the economic ladder, we should see if the promise that everyone will be able to keep the doctor of their choice comes true. Until 2014, insurance companies will still be allowed to turn people away due to pre-existing conditions. These people are supposed to get coverage through the states, but will they?

Put on your watchdog hat and hold this program accountable to its goals. That's where the best stories will be.

HealthyCal.org, a nonprofit news website that cover health policy, public health and healthy communities, hopes to  lead the way in the coverage of federal health reform as it rolls out in California.

We've already been covering health reform from a policy perspective. We started with the federal debate, then followed the story as the California Legislature and Gov. Arnold Schwarzenegger hammered out the first pieces of the state's implementation: a high-risk pool for people turned down by private insurance companies and the health insurance exchange that will be at the center of the reform when it takes full effect in 2014.

There will be other policy stories too, including the new law's effect on Medi-Cal, the biggest Medicaid program in the country already and expected to grow by another 2 million people thanks to the provisions in the reform bill.

The next step will be to follow the new law into the community. We will do stories on people gaining access to coverage, whether they are adult children allowed back onto their parents' plans or employees of small businesses that are able to afford coverage for their workers now, thanks to the subsidies in the federal bill.

But for our site, the most intriguing part of the bill is a piece that has gotten fairly little attention in the mainstream media so far: prevention. The reform bill includes an unprecedented federal commitment to prevention and wellness, and we are not just talking about more vaccinations or check-ups with no out-of-pocket payments.

The bill has hundreds of millions of dollars for "transformation grants" to help local communities improve the conditions in which people live. Research shows that where you live is connected to how healthy you are and how long you live. The environment around us, not just toxic contamination but land-use patterns, the ability to walk or bike to school and work, access to parks and healthy foods, and transportation all have a bearing on our health. The disparities by neighborhood in rates of obesity, diabetes and heart disease, all preventable and costly ailments, make this clear.

The transformation grants are intended to clean up parks and streets and alleys, improve lighting, build bike paths and sidewalks, encourage grocery stores to stock more fresh food, and generally support efforts to make communities healthier places to live.

We'll be following the money as these grants move from the feds to the state and then out into the communities. HealthyCal.org will be looking for great stories on places that are struggling today, the challenges they face and what changes they make with the aid that's coming through federal health reform.

While a lot of attention has been and will be paid to the number of people gaining access to health insurance and care, if this part of the bill keeps people from needing care in the first place, it may prove to be the most important part of the law.