I finally found the right person to tell the story of uninsured moms in South Dakota. Then it almost fell apart.

Published on
April 12, 2023

Pregnant and postpartum people put up with a lot to grow, deliver and raise new humans, and health care systems in the U.S. charged with taking care of everyone often fall short. Since becoming a mother, I have encountered health system failures and have grown more sensitive to them as a health reporter for the PBS NewsHour. That awareness guided my research when I developed my pitch for the Center for Health Journalism’s National Fellowship.  

When I prepared my pitch in spring 2022, the U.S. Supreme Court’s draft decision in Dobbs v. Jackson had just leaked. Fear and anger charged the debate over the need to protect abortion rights. Several states and Republican lawmakers, including those in South Dakota, had said they would ban or severely restrict abortion if Roe v. Wade fell. South Dakota also planned to hold a contentious referendum over Medicaid expansion, scheduled in November 2022 — the state was one of a dozen that had not offered greater access to health care coverage under the Affordable Care Act. I was drawn to the tension of that political moment: The state was forbidding people from getting an abortion while at the same time raising barriers to health care, even for people who were pregnant and wanted to do what was best for themselves and their pregnancy but did not have enough money to do so.  

But earning people’s trust to tell those stories took time. For months, I looked up email addresses, made cold calls and left messages that went unanswered. Policy experts were easy to find and interview. Providers on the ground were difficult to schedule due to staggering demands for their services (South Dakota had been losing reproductive health professionals like much of the rural U.S.). But once I got OB-GYNs and nurse practitioners on the phone, the interviews flowed like water from a busted hydrant. They needed to speak and be heard. 

Each health care provider offered names of patients who I might contact. I knew I needed to find a patient who was pregnant, functionally uninsured and whose household earned too much money to qualify for Medicaid under normal circumstances — someone who was in a stressful bind. I hoped their personal stories would breathe life into what might otherwise feel like dry, distanced policy analysis. I received dozens of names, and I kept them in a spreadsheet where I organized all my sources (tip of the hat to ProPublica’s Kat McGrory and her fellowship project management session). Initially, I texted potential subjects. Then, I followed up with a call and left a voicemail if they did not pick up.  

Most people did not text or call me back. It was frustrating (especially as the fellowship’s deadline approached), but I understood. Years ago, I sat on the office couch of Gwen Ifill, the legendary journalist who left us all too soon. Early one morning, I sought her advice after I had tried so hard to reach a source, I needed for a story I really believed in. I could not grasp what I was doing wrong. Then, after patiently listening to my complaints, Gwen said, “It’s not in her interest to share her story right now.” 

As always, Gwen was right. Her words gave me peace because at the end of the day, the interview process is not about me. It is about the person who holds the story I seek, not me. And that is OK. 

As a journalist, I am moved when people trust me with their stories. It is humbling, and you can tell when someone makes that decision for the first time. They are usually putting their reputations on the line. Some people cry as the words tumble out. Others talk nonstop, as if they cannot release their story and its weight fast enough. Those moments feel sacred, and I work to remain sensitive to the privilege of my job by honoring these people’s bravery and vulnerability. I tell them their stories will help others because I believe in the power of storytelling.  

Eventually, I found a patient willing to talk to me. Then another, and another. Some were willing to meet me in person, and have their photos taken. We talked about potential settings and environmental portraits. I found a local photographer and booked tickets to fly from Washington, D.C., to Rapid City, South Dakota.  

Then, hours before I was set to meet with a key patient whose story dramatically illustrated the story’s whole premise, I received a frantic text message from her. She was upset and scared. She had received a huge bill from a hospital tied to her newborn son’s birth. She was healing from childbirth, having trouble sleeping and had to return to work. She did not know how she would ever pay these bills, and said she wanted to back out of the interview until everything got sorted out.  

I took a deep breath before I responded to her text. This was about her life, not mine. The stakes were high, and she had everything to lose. I told her I was sorry this was happening, and that it made sense to feel so stressed. I walked through the story’s timeline. I told her that her story was powerful, could help others, but that I only wanted to share it on her terms.  

For three days, I heard nothing from her.  

I reached back out to her health care provider, who had recommended I contact her (with the patient’s permission). This was a provider the patient had known and trusted for years and who had earned the trust of her community. The provider agreed to talk to the patient on my behalf and see if she might be able to ease any fears or answer any questions the patient might have.  

Then, with less than 24 hours left in South Dakota, I reached out one more time. The patient texted me: “Okay I’ll meet u.” 

At a stop light, I hastily searched for the gas station near her mother’s house and got directions (I am an imperfect human, please do not text while driving). When I arrived, she was waiting for me in the parking lot, her infant son sleeping in her arms. Although initially guarded, she immediately started talking. Soon, she smiled, nervously laughed and spoke candidly about how she feared financial ruin due to an unforeseen life-threatening health issue she developed late in pregnancy. She had worked so hard to be fiscally cautious. But that complication led to a huge medical bill that stressed her out, even as she was learning how to be a mother — all because she earned too much money to qualify for Medicaid but too little to afford her own health insurance.  

Her story was deeply human and vulnerable. She never had to share it with me and took a risk in doing so. As a journalist, I am thankful to be able to hear people’s stories, ask questions and use stories to stitch together the pieces that connect us to each other.