The Story Behind the Health Care Reform Story

Health care reform, and the ideological, political and public health battles that surrounded it, reached a fever pitch in the media by the time the legislation reached the House of Representatives in March. Many members of ReportingonHealth were watching and chronicling these events closely. Here, a cross-section of reporters discusses their experience working on these complex stories.

Mary Agnes Carey is a senior correspondent at Kaiser Health News. She wrote extensively on health care reform for KHN and made many radio and broadcast appearances, including spots on National Public Radio and PBS Newshour. Noam Levey is the Washington-based health policy reporter for the Los Angeles Times and was churning out ground-level and enterprising stories from President Obama's initial announcements last fall through the political wrangling in the spring. From the north, we have comments from André Picard, public health reporter for the Canadian national paper The Globe and Mail, who wrote about health care reform with a comparative perspective. In a Mar. 25 column, he writes: "The headlines tell us that President Barack Obama is leading a 'health-care revolution' in the United States. But if what happened is a 'revolution' then Americans have truly lost their sense of the word since 1776."

The discussion took place via email and is edited for clarity. Readers: Did you cover health care reform? What lessons did you learn? Log in and add your comments and links at the end of this post.

1. What were the biggest frustrations or difficulties in your reportage and media appearances? Were there any really great moments?

Mary Agnes Carey: The biggest frustration was trying to write a story before someone else did it! With so many smart and talented reporters on the beat, it was hard to do but I, along with my colleagues at Kaiser Health News, were first with many great stories. On appearances, you never really know what a radio host or television anchor or callers are going to ask. Preparing for those appearances takes a ton of time but it's worth it because you learn more about the bill as you prepare and explain it to callers. I was especially pleased with a live spot I did on the PBS Newshour show (below) near the end of the health care debate.

Noam Levey: It was always difficult to break through all myth-making and misrepresentations that many critics of the legislation were peddling. And, as often happens with major legislative debates, politics toward the end swamped policy, which was reflected in a lot of the coverage. But I think many newspapers actually acquitted themselves quite well, devoting considerable space to explaining complex healthcare issues at the heart of the debate in Washington. When, for example, Sarah Palin and others started talking about death panels, many news organizations moved to correct the obvious falsehood. I was personally proud of a story I snuck in toward the end that looked at New York's experience with insurance market reform as an illustration of the perils of doing piecemeal reform, as some were suggesting when the legislation seemed to falter.

I never felt that correcting the myths compromised my impartiality. But I was disappointed that so many readers – as judged by my email traffic – felt that news stories that explained the impact of the bill represented an endorsement of the legislation.

André Picard: As a journalist watching the reform "debate" occur from afar, I was frustrated by the amount of coverage afforded the political to-ing and fro-ing and the relative lack of coverage of the practical impact on people. I was also frustrated by the misrepresentation of the health system I know best, Canada's. It was portrayed, alternately, as utopian and hellish; the reality is that, like all health systems, it has good and bad points.

2. What stories and reports do you think had the most impact?

Mary Agnes Carey: Along with my co-worker Julie Appleby, I explained very early on the "firewalls" that exist in the bill that would limit enrollment in the health insurance exchanges included in the legislation. I also liked the explainers I wrote early in the health care debate about how the bill would impact Medicaid and the Children's Health Insurance Program. KHN's Consumers Guide to the health care bill (here's the latest version) has been extremely popular.

Noam Levey: The stories about the legislative process and the deal-making that went on behind closed door probably shaped public perceptions of the healthcare debate more than anything else and went a long way to explaining why so many Americans ended up resistant to the legislation, even as polls showed they supported many of the individual aspects of the bills. On the other hand, proponents of the health overhaul benefited at the end from the stories out of California about Anthem Blue Cross's proposed rate hikes, which clearly helped to rejuvenate the push for legislation in the wake of Scott Brown's victory in Massachusetts.

André Picard: To me, the most impactful moment was the culmination, the President signing the bill into law. I also found it gratifying to see politicians (despite some rhetorical excesses) speaking passionately about healthcare. In Canada we take our healthcare system for granted but, in the U.S. there were lawmakers fighting for real change.

3. What kinds of stories did you wish you could pursue and why didn't you pursue them?

Mary Agnes Carey: I was lucky that I was able to pursue the stories I wanted to write about. Looking ahead, I plan to focus my reporting on the biggest challenges ahead to implementation of the health care bill.

Noam Levey: I always wish that I could have pursued more stories that explained the legislation with concrete illustrations about what was happening on the ground and what could change. But as the legislative negotiations picked up toward the end of 2009, that became increasingly difficult because so much of my time was consumed with just trying to tell readers what lawmakers were up to.

André Picard: I cannot think of any stories that we wanted to do that we did not pursue but, then again, we covered the U.S. debate with detached bemusement. In Canada, we obsess a lot about equality of care from coast-to-coast. I would like to see a lot more coverage of regional/state differences in insurance coverage and quality of care in the U.S.