Lessons learned from covering the ACA rollout in Texas

As we approached the deadline for the second enrollment period under the Affordable Care Act, a KUT listener emailed us a while back asking for guidance, since his daughter needs health insurance. He wrote that he had heard my Affordable Care Act stories, and needed help filling out the application for his daughter to get a health insurance plan on the federal exchange. He told us his daughter lives in a town near Houston. I live in Austin, and yet here he was reaching out to me. Getting that email reminded me once again how difficult navigating health insurance on the exchange is for many people in Texas, and also how important our work is as reporters in fulfilling a public service.

I chose to cover stories about the Affordable Care Act in Texas for my National Health Journalism Fellowship project, particularly the unusual effects of the ACA’s implementation in the state, without focusing on the politics that consume so much of the discussion around the health care law. Instead, I looked at three consequences of the law:

1) Traditional health insurance remains out of reach for many in Texas – about 1 million adults fall in the coverage gap. Many of these people are looking for low costs and convenience when it comes to their medical care. So, companies like Walmart have opened “Care Clinics” in states that haven’t expanded Medicaid eligibility under the Affordable Care Act, including the biggest one — Texas. I focused this story on some statewide trends in retail health care, why Walmart had chosen Texas as one of the states for its new clinics (South Carolina and Georgia are the other two), and the concerns from physicians about how these retail clinics disrupt the patient-physician relationship.

2) For my second story, I looked at what happens when the safety-net hospital in Austin receives Latina cancer patients who recover from cancer, but still have diabetes or other health ailments after surviving — and no health insurance. Money provided by the federal government under the ACA to Seton hospital in Austin has enabled them to hire a nurse navigator that directs Latinas to the federal health insurance marketplace, if they’re in Texas lawfully. Otherwise, the navigator finds other resources so they don’t end up in the ER again. But I also wanted to look at this issue from a national perspective, and spoke to a nonprofit in Washington, D.C., called Hispanic Access. It has a helpline that helps uninsured Spanish speakers get medical care, even if they’re in the U.S. unlawfully.

3) My last story was about Blue Cross Blue Shield of Texas and the city of Austin spending a lot more money this year to insure more Latinos during the 2015 enrollment period under the Affordable Care Act. Latino enrollment lagged last year, so efforts have tried to change that. This story aired on NPR’s Morning Edition, which was such a rewarding way to finish my fellowship.

I learned many lessons over the course of the six months reporting my stories:

• Call as many people as you can in your community who could be potential sources and find out what’s new, what’s unusual, what fresh angles they might be observing. Even if you think you know the story in advance, it will likely change as you talk to more people. You might find a hidden gem by just starting from scratch.

• Make sure you have a good camera with you every time you go out to report. When I reported my final story on Blue Cross Blue Shield, I drove more than an hour to San Antonio with a camera, but had forgotten the lens at home. That might seem ridiculous, and it was, but it happens, so make sure to check and double check you have all of your equipment. I ended up having to use my iPhone’s camera.

• If you don’t already work for one, pitch your story to a national outlet and be persistent!

• When I began the process of contacting Walmart, I gave myself plenty of time before my deadline. I knew that getting inside this massive corporation that usually dislikes media coverage would be tough. I recommend smiling, sending kind emails, being very open about your story, and yet consistently following up when you’re not hearing back. I eventually got access to the inside of the health clinic and the director who staffs the nurse practitioners, both of which is unusual. Thanks to that access, I could pitch the story to WBUR and NPR’s Here & Now, which aired it.

• If you choose to organize a community engagement panel, think about including diverse voices, especially minorities who don’t often get to speak up about the topic. I should have had someone on my panel who works with Latinos — or someone who can talk about his or her own struggles getting health insurance —to make the panel more diverse, rather than only traditional experts (lawmakers, professors and advocates).

• I recommend, if you work in radio, airing multiple promos beforehand, as we did. You really need to remind people to come. Also, have another colleague from your newsroom volunteer to help at the event. We gave out index cards on which people could write questions for the panel members. My colleague brought those to me and during the Q&A portion, I could read the questions. That way we didn’t risk one person taking much more time than another to ask a question.

Lastly, you’re your own best advocate for your work. Push your newsroom to tweet your stories, post them on Facebook, and make sure to include people you interview in your tweets so they will share the link with their own followers. Don’t be shy — these are challenging stories that you should feel proud of and should be heard and read widely so that you can help inform your readers and listeners.