Here’s how I tried to make the niche topic of health care access in mining towns accessible to a broader audience

There’s a story that had long nagged at me: In 2018, I traveled to Elko, Nevada as a reporter for The Nevada Independent to write about a health care problem plaguing the rural gold mining community. Miners had great health benefits and access while they were working but struggled to access care as soon as they retired. Some of them were leaving friends and family behind and moving elsewhere because of it. At the time, I wrote a story about that particular issue — but continued to mull over Elko’s health care access disparities and why they existed.

Five years later, I had an opportunity to tackle that question in a six-month reporting project, as a health care reporter at Politico. The result was a deep dive into the way health care in mining communities can be disrupted and distorted by the industry’s booms and busts, creating ripple effects that make it harder for people to access care, deepening inequities and worsening health outcomes in populations often predisposed to poor physical and mental health.

I explored this idea through three communities — Elko, of course, but also White Sulphur Springs, Montana, and Williamson, West Viriginia. Together, the towns showed the impact of mines on past, present and future on health care access and some of the unusual consequences of the fact that mining companies offer good jobs with good benefits — namely, that those benefits don’t translate into good or lasting health care access, like one would think they would.

I’ve tackled big reporting projects like this before, but I still grew a lot through this project. Here are some key takeaways from my experience. 

1. Do your homework.

I spent six months reporting out this project. But I spent several more months before that pre-reporting and pitching the story. Part of that was figuring out which mining communities to focus on. In that pre-reporting phase, I looked at mining towns in several other states, including Arizona, Idaho, Kentucky, New Mexico and Wyoming. 

I ultimately settled on the three towns featured in my story because they demonstrated a swath of existing and potential health care challenges — and because in each of those towns I found a guide or guides who could serve as central characters in the story, walking the reader through what is otherwise a fairly complex and in-the-weeds problem.

2. You have to talk to people in person.

There’s really no replacement for shoe-leather reporting. Many of the people who ended up being focal points of the story — or provided some of the best quotes — were people I wouldn’t have met unless I went to these communities in person. There’s a big difference between calling someone on the phone and saying, “Hi, I’m a Washington, D.C.-based reporter. Can I talk to you about health care access in your community?” versus, “Hi, I’m in Elko. Can you meet at a coffee shop in an hour?”

Probably the best example of that was I was in an attorney’s office in downtown Williamson with a lawyer and county commissioner. I asked him who else I ought to talk to for the story. Right then and there he rang up his cousin, who is a pharmacist, and asked if he’d be up for talking with me. 

3. Get newsroom buy-in as early as possible.

My editor was on-board with the project from the very beginning. But we also got buy-in from other key people in our newsroom — like our photo director and the folks who would do a special page layout for us — many months in advance of publication. You never know what else is on people’s plates, and our early communications made sure that the project would receive the time and attention it needed amid many competing priorities in a large newsroom 

4. You can’t include everything.

One of the biggest challenges was figuring out how to make months of reporting and more than 90 interviews on a fairly niche topic much about accessible to a broad spectrum of readers. 

Part of that was trimming a draft I initially filed that was upwards of 9,000 words down to about 6,000. I fit as much as I could in the first several grafs of the story, knowing I’d lose many readers early on in the story. I wrote a key takeaways box for the people who wanted to skim. We used photos to guide the reader along.

At the very end of the editing process, we were cutting gems of quotes and trimming single words out of the draft. But in the end, the story was stronger for it.

5. Make it make sense to your readers.

This is maybe the most important one. Most people will never be miners, nor will they live in a mining town. I write for a national audience. I had to make sure early on I defined the stakes for the reader.  

Part of it was explaining why this is important to the people I’m writing about: Miners have a higher prevalence of almost all health risk factors compared with most other manual labor workers. Those include excessive alcohol use, chewing tobacco and sleeping less than seven hours. This isn’t just about poor health care access in rural communities. It’s about health access challenges in a particularly vulnerable population. 

It was also important to define the national stakes with this story. The Biden administration has been pushing for more domestic sourcing and production of critical minerals and materials as it aims to achieve 100% carbon pollution-free energy in the next dozen years. It’s unclear how many more mines we’re going to get in the U.S., as one person told me, but we are going to get more, and these communities are going to face the kinds of challenges I lay out in the story.

Finally, it was about showing readers why this should matter to them, too. The U.S. health care system feeds off employer-sponsored health insurance to turn a profit. Those private plans generally subsidize what Medicare and Medicaid, two government insurers, pay providers. This can create imbalances in any community — as the health care system warps itself to meet the needs of people with better-paying health plans.