Why it pays to stay flexible in reporting on immigrant health care policy

When I started looking into health care policies affecting immigrants late last year, it was a fascinating 
topic but one that was far from the news. I’d written about the issue once in early 2014, and my story then was filled with speculative words like “could” and “perhaps.” There wasn’t much actually happening.

But as they say, timing is everything. As I started digging into these issues this year, so did advocates and politicians across the state. Because of that, one of the greatest challenges of reporting these stories was keeping up with the constantly changing political landscape.

My first story was about differences in the medical care that poor immigrants could receive across counties in California. It set the stage for the rest of my pieces, which focused on specific counties’ programs and how some of them could change now that most of the formerly uninsured have insurance through the Affordable Care Act.

I knew that there was a bill in the state Senate that was trying to get the state to provide health care for all undocumented immigrants, but I wasn’t paying much attention to it since I was focused on my stories.

But a week after my first story published, Gov. Jerry Brown agreed to provide health care for undocumented children through Medi-Cal, California’s Medicaid program. Brown very well could’ve approved health care for all the state’s undocumented immigrants, which would’ve essentially made not just my first story irrelevant, but all of them. County-level differences in care don’t matter much when the state decides to provide coverage to all. From a reporting perspective, I was extremely lucky that things played out the way they did.

My advice for anyone covering politics, especially across several regions at once, is to be smarter than I was about planning for your stories. Before embarking on your in-depth reporting, figure out when discussions and decisions will most likely happen. Even if you don’t know exactly when these things will occur, veteran reporters or legislators can tell you what the general timeline will be for such decisions. If I had asked, I would’ve discovered that if Brown wanted to move forward with this plan this year, he would’ve had to make a choice before approving the budget, which has a hard deadline. So ask, and make a rough timeline, and set deadlines for yourself. Preferably, set them weeks before anything big could happen, so even with editing and typical reporting delays, you’ll still publish before anything changes.

A big part of keeping tabs on all these things is determining what conversations and pending decisions are happening that could affect your stories. Unfortunately for anyone interested in health care policy, especially immigrant health care policy, there are hundreds of things that could come into play at the county, state and federal levels. Before you start reporting, make a list of as many of these things as you can and monitor them. Do your research. It’s almost impossible to get a hand on everything yourself. But luckily, if you’re interested in immigrant health care policy, there are lots of smart people at the UCLA Center for Health Policy, UC Berkeley Labor Center, National Immigration Law Center, Insure the Uninsured Project, The California Endowment, Georgetown University Health Policy Institute, Latino Coalition for a Healthy California, Health Access California, California HealthCare Foundation as well as local officials who can help you figure out all the moving pieces. They certainly helped me.

And that can open doors to other stories. Because I was keeping my eye on immigrant policy issues for this series, I ended up doing a story in March about how Medi-Cal enrollment would be affected if President Obama’s executive action expanding the deferred action program were to be approved.

That being said, breaking news isn’t always a problem. As reporters, we often search for news hooks for stories, and breaking news is a timely element that falls in our lap. It adds relevance to our stories.

From the beginning, I wanted to do a story on Sacramento County, which offered health care to undocumented immigrants before 2009, but cut these services during the Recession. When I went to Sacramento in February to meet with some advocates, the movement to expand this coverage was in the early stages. As I continued reporting the story, however, the discussions became more serious, and before I knew it, the county Board of Supervisors was poised to vote on the issue, and I hadn’t published my story yet.

I had to decide to drop the story I was planning to publish next — on San Francisco’s county-run health program — and focus on this one instead. I was deviating slightly from my plan, but because of that decision, my story ended up publishing a day before the vote, and carried much more significance than it would’ve otherwise. On the day of the vote, Sacramento board chair Phil Serna referenced the article during the meeting, and then said the supervisors’ vote was of the utmost importance because, “The whole state of California is watching.” That kind of stuff is thrilling, and made me realize how important it is to be flexible. Prepare as much as you can for any changes, but the news is impossible to predict. That’s why it’s news. So if something does happen that changes your in-progress story, embrace it.

Because if you do it right — or stumble into doing it right, as I did — you’ll get caught in a wave of news that make your stories more relevant than you ever thought they would be. I planned to write about how California’s 58 counties were considering expanding health care to undocumented immigrants. In the time that I was reporting this project, the number of counties that offered this coverage jumped from 11 to 47. Talk about drastic change.

And that’s led me to more and more stories. State legislators are now talking about further expansion to adults, and more and more counties are discussing these options. I’ll be covering this issue for months, if not years to come.

The final thing I have to say about my project is less about politics than policy. Simply, it’s complicated. There are dozens, if not hundreds, of regulations that govern health care services for the poor, and even if you read all of them, you’re still not going to truly understand how these laws work.

For example, I had a map of California that showed the counties that provide coverage to undocumented immigrants and those that didn’t. It seemed simple: either you could get care, or you couldn’t. But then I talked to a woman in Riverside County, one of those that did provide coverage to such immigrants, and she said that she couldn’t get treatment for her diabetes. In general — but especially when it comes to policies for the most disadvantaged people in our communities — the story often doesn’t 
end with the text of the law. There are all kinds of barriers you can’t understand unless you talk to real people who live by these laws, whose fortunes hang on them. Either these programs accept a limited number of people, they have application fees, or a time limit for enrollment or some other kind of small print. This came up again and again. The way people interact with a policy is often far different from what a policy says. This is not groundbreaking journalism advice, but find real people. Talk to them. Follow all the ways their stories deviate from what you expected. That’s the real story.

Please reach out to me at soumya.karlamangla@latimes.com if you have any questions about health policy reporting on immigrants.

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Soumya’s stories on the remaining uninsured:

For those in California illegally, health services vary greatly by county

In reversal, Sacramento County wants to restore clinic access to immigrants

Two deals boosting healthcare to immigrants illegally in U.S. are OKd in Sacramento 35 California counties grant healthcare to immigrants in U.S. illegally

In ironic twist, S.F. is worried Obamacare could hurt its most vulnerable residents