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Showing health care reform’s impact on lower-income home health workers Date: 08/15/17


Shefali Luthra

By Shefali Luthra

When my editor called me into her office to discuss an assignment on home health workers, she had one piece of advice. If this story – sparked by a press release that crossed another editor’s desk – were to work, it had to be a “people story.” I needed characters who were compelling and sympathetic, who had stories that a reader could easily follow. I found them, and the piece, "Workers Who Give Care To The Homebound Often Can’t Afford To Get Their Own," ran this spring.

The original pitch to Kaiser Health News focused mainly on the low wages and high uninsured rates for home health workers who care for the elderly and disabled. At the time the U.S. House of Representatives had just begun discussing the American Health Care Act, its replacement plan for the 2010 health care law passed under former President Barack Obama. (Since then, efforts to pass a similar bill failed in the Senate, and a bipartisan committee from both chambers is discussing more incremental reforms.)

That context put a fresh angle on an issue that rarely gets media attention. For years, home health workers have faced poor wages and low rates of insurance. However, based on their income bracket – and the fact that home health agencies often don’t provide employees with coverage – the odds seemed good they have benefited from the Affordable Care Act. The new question: What impact would repeal of the law have, and why did this matter – both for vulnerable populations and the health system at large?

This kind of project is my favorite. Health policy seems abstract and esoteric, but it affects people’s lives intimately. Illustrating that impact would be crucial for this piece to stand out, given that the media landscape is flooded with other types of stories about Congress’ repeal-and-replace efforts.

The press release was a starting point. I called the worker organizer behind the press release, figuring she might know how to contact workers who could speak about whether they had gotten coverage under the health law, how they had used it, and what it would mean if affordable coverage disappeared. She provided a list of contacts involved with domestic worker unions. That’s was how I met Celeste Thompson.

Thompson is from Montana, a Medicaid expansion state. Since she did not have regular Internet access, we coordinated mostly by text messaging. If I could work around her unpredictable hours, she was more than willing be interviewed over the phone.

We discussed her history of cancer, her poor vision and how obtaining health coverage had changed her personal and professional life. Because she earned so little, under the expansion she qualified for Medicaid.

Thompson had not had an eye exam in years, and one crucial detail she shared was how health coverage enabled her to obtain new glasses. Since she needed to be able to read pill bottle labels for her clients, if she could not care for her eyes the consequences were far-reaching. Celeste’s experience was the type of anecdote that can show the public – not just advocates and industry insiders – the real impact of the larger health care debate.

What remained – filling in the gaps with policy, statistics and analysis – was easy. Such sources are the bread-and-butter of effective health care reporting, and qualified experts abound in Washington. The only other challenge arose when, as we were editing this story, GOP in the House plans to repeal the ACA appeared to collapse, though that chamber later was able to pass a bill.

Policymakers continue to tout health care reform as a top priority, showing that the issue, and its potential impact for someone like Thompson, remained newsworthy. Though efforts in Congress to pass repeal-and-reform legislation have been sidelined for now, we still need continued robust reporting on the debate and the potential consequences of various reform options.

Working to find human faces, whether through social media or organizations such as unions and advocacy groups, can be challenging and time-consuming, but the results make all the difference.

Shefali Luthra (@shefalil) has reported for Kaiser Health News (KHN) in Washington, D.C. since 2014. Her work focuses on health policy, access to care and public health concerns, and has appeared in The New York Times, The Washington Post, NPR and CNN Health. Before joining KHN, she spent two summers interning at The Texas Tribune.