In reporting on health reform’s impact, hard-won lessons can ease the way

In southwest Ohio, Larry Keller is cancer free and practicing law again thanks to a life-saving surgery made possible by insurance he couldn’t get just a few years ago.

In northern Kentucky, Rachel Hill finally has her diabetes under control with prescriptions paid for by her new Medicaid coverage.

And across Ohio, Kentucky and Indiana, doctor offices and hospitals are working through the growing pains and gains ushered in by a historic increase in people who now have health care coverage.

Earlier this year, thousands of Greater Cincinnatians dug into these stories and more as WCPO unveiled five-part special report: “Pain and Gains: A Year with Obamacare.”

As a Dennis A. Hunt Fund grantee, I spent the last six months of 2014 hunting down consumer stories, analyzing government data, canvasing health care providers and pressing elected officials on the impact that health reform has had on our lives – one year into the Affordable Care Act’s most sweeping reforms. The challenges were abundant.

First, I set out to understand the consumer experience. I took to social media, asking readers to share their experiences. I culled through stories from the past and contacted a host of local clinics, doctors offices and weekend insurance enrollment help events. In the end, I had more than three times as many voices as I was able to work into the series. Still, every interview contributed to the authority in which we were able to share the local experiences and impact.

It took months to get some health care providers to open up. Immediately, I found that hospitals and health systems that typically made executives available for interviews relied more on their spokespeople or even government public relations folks to field any questions related to Medicaid expansion and impact of the ACA. I had the most success getting detailed interviews and real data from smaller providers – health clinics and county hospitals.

Larger health systems eventually were willing to share the percentage changes in uninsured, as well as the percent increase in those newly covered by Medicaid – but they held tight to the raw data. Also, few were eager to offer in-depth analysis about how the system itself and patients were impacted by the changes. Some told me initially it was too soon to gauge. After pressing – over months – I was able to gain a few deeper insights, but it took re-framing some of my questions.

Initially, I started out asking health systems: “Have you seen an influx in consumers covered by Medicaid or insurance plans sold, and can I talk to experts there about the impact of that shift?” The usual response was an email with some helpful but limited info. Eventually, to get more I reworked my questions using health-system speak: “Can you please share any detail/data on the shift of your payer mix – such as the decrease in self-pay patients to Medicaid or other insurance? How is this change impacting the system’s revenue? With regard to Medicaid reimbursement, can you lend more insight on the challenges current reimbursement levels cause for providers?”

Few health systems addressed all the questions, but the results and answers among those that did painted a telling scene of the shift afoot in health care.

All along the way, I looked for data. The challenge here was keeping up with evolving data sets. Mostly, this was data tied to the number of residents enrolled into Medicaid, those enrolled into marketplace plans, and the cost and prices tied to each. Key sources for those details and the big-picture impact included: HHS.gov, Gallup-Healthways Well-Being Index, The Robert Wood Johnson Foundation, The Office of the Assistant Secretary for Planning and Evaluation, and Washington, D.C.-based The Advisory Board Company.

The reporting results delivered an eye-opening deep dive on the local effects of an evolving, national story. Among my series’ findings:

Portions of the Tri-State region I cover have displayed a hoped-for outcome of the ACA: Fewer uninsured Americans. Still, the new coverage hasn’t come without challenges. Our series found areas in the Tri-State where consumers newly covered by Medicaid were waiting up to four months to get an appointment to see a doctor.

Big up-front savings on most plans sold through the marketplace are offset by higher costs down the road. Some consumers worry that their new insurance means costly out-of-pocket expenses they won’t be able to cover if they get sick. Others complain the plans don’t cover the doctors they need or worse: They can’t see the doctors they have without lengthy waits.

Hundreds of thousands enrolled into Medicaid, but for how long? Nearly one million Ohioans and Kentuckians are now covered by Medicaid. But big changes could hit Ohio’s newly implemented expansion, and questions linger about the long-term affordability of the move.

Providers report a mixed bag of gains and growing pains: Health care providers report record levels of newly covered patients. Still they complain that reimbursement rates from Medicaid are too low. Others worry about the impact on health care costs long term, as more consumers are pushed toward high-deductible plans. As one provider put it, “We’re seeing more and more under-insured people who can't pay the high deductibles that come with the insurance they now have.”

Health law remains a target among conservatives: Ohio and Indiana Republican congressmen have taken a lead in efforts to dismantle health reform. We gave our readers a blow-by-blow breakdown of the legislation and lawsuits that could unravel the ACA.

To keep the series alive beyond its publish date, we enlisted several approaches that had great success and impact:

Build and grow your audience: We tested the waters ahead of our special report, running a series of stories in November that gave readers a full run-down on everything they should know about enrolling into marketplace coverage or Medicaid. We kept tabs on everyone who reached out and engaged with us through social media or sent us emails with questions. Some became voices in our stories. Others were alerted when the next story ran, either through social media or direct email effort. Ahead of the special report, we ran a weeklong series in November reminding consumers of the second wave of open enrollment.

Push engagement: We asked readers to share their experiences not only with us but with lawmakers – directing them to the downloadable Podium app to follow policy makers. Also, during the November reporting effort, WCPO hosted a phone-a-thon in which volunteers with Enroll America answered more than 150 consumer questions during a three-hour event. Online, volunteers answered dozens more questions from readers. The full chat is posted here.

Report out the results: Following February’s special report, we published a quick story later that week summing up some of the reader feedback (with permission from those who shared emails) and redirected readers to the series again.

As our series pointed out, many more tests are ahead for health reform in the U.S. I am more than happy to speak with any reporter or news outlets considering ways to dig into the impact ACA policies are having their communities. Email me at lisa.bernard-kuhn@wcpo.com.

Photo above by Emily Maxwell/WCPO.