Series explains Health Policy through people’s stories


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The Tennessean recently ran a six-part series by Tom Wilemon, who was a 2012-13 AHCJ Regional Health Journalism Fellow, showing the faces of the Affordable Care Act.

The series, accompanied by video, a set of helpful fact boxes, and an invitation to email Wilemon with questions about the law, broke down the jargon and, as Wilemon wrote, showed “what the law means for a young invincible, a part-time job juggler, a 50-something, an entrepreneur, a poverty worker and an immigrant.” (I confess that initially I read that as a “juggler” not a “job juggler” and was hoping for the first article on “Obamacare goes to the circus,” but alas, I had just read it too quickly.)

The unifying theme was that the Tennessee population – like much of the country – was just not quite sure what this Health Policy law could offer them (other than political fighting). And that they needed help.

As he wrote in the overview:

The countdown is on until the Affordable Care Act’s mandates take effect.

It’s a law intended to bring health coverage to uninsured Americans, including about 900,000 in Tennessee. They range from healthy young people who think they don’t need coverage to desperate 50-somethings with pre-existing conditions who can’t get a policy.

However, few people understand exactly what the law means for them, even though three months from now they can start signing up to buy coverage on a federal insurance exchange.

The pieces were short and clear but conveyed a lot of information: I was particularly struck by the simple vivid opening sentences that brought the various segments of the population to life and zeroed in on their concerns.

The “young invincible:” “Paul Simpson is a bartender smart enough to not talk politics.”

The job juggler:  “Cindy Selph works long hours and odd hours whenever she can, doing multiple jobs. She’s a caregiver, helping families tend to the needs of senior citizens for more than 20 years. It’s a career without a steady employer or insurance coverage.”

The self-employed (with pre-existing conditions):Lisa McCauley decided to be her own boss, a career decision that meant stepping out from under the coverage umbrella offered by an employer.”

People with pre-existing conditions: “Angela Woods worked at Opryland for 33 years before she got downsized last year. She now works for a small business that does not offer health coverage.”

A Pastor left in the lurch: “The Christian path for the Rev. Joel Perales is one of poverty.” He and his wife, who works part time, would qualify for expanded Medicaid – but Tennessee hasn’t expanded. So they are left out.”

Immigrants: “When Haseen Ahmed hears the phrase Affordable Care Act, he associates it with telephone calls from salespeople.´

Overall I thought Wilemon did an admirable job in breaking down a complicated law in a way his readers – in a state where opposition to the health law runs high – can understand. He used the vignettes to explain age-rating, ”metal tier” (bronze through platinum health plans in the exchanges) subsidies, coverage of people with pre-existing conditions, and what happens to the poorest in states that opt out of Medicaid (a topic that many of us have written about but it’s still not widely understood). If you are struggling with how to break this all down for your readers, narrative versus straight exposition, it’s a good model.

There was one error: People can get subsidies in bronze plans—not just in silver or higher. In my emails about this with Wilemon what seems to have tripped him up was that the subsidies are “tied” to the silver plans. And that’s jargon you will come across a lot and unfortunately his sources didn’t step back and clarify adequately. “Tied” in this case means that the subsidies will be calculated based on the silver plans – the price of the second-lowest cost silver plan to be more precise. The premium subsidy can be applied to any of the metal tiers but not to the catastrophic plan. (There are other rules about cost-sharing – help paying co-pays, etc. – but that’s separate from the premiums.) The lesson here is that if you are relying on very technical issue briefs and very wonky sources, keep looking for a more consumer-friendly website and talk to more sources.

My only other quibbles – and they are only quibbles because I and others at AHCJ liked this series:

When doing a series like this, it’s helpful to do a little more to correct or contextualize mistatements or speculation by the people quoted. For instance, the bartender Wilemon interviewed says he doesn’t know much about the law and then speculated about paying $100 a month. Is that accurate? Would it be more or less? What kind of subsidies might he get? (There are several online subsidy calculators that can help you with this, including one from the Kaiser Family Foundation)

The immigrant piece left a few things unclear – and the immigrant he profiled is a naturalized US citizen so he’s treated like any other U.S. citizen, regardless of birth place. That means he isn’t the best illustration of how “immigrants” will fare – he’s not in the “immigrant” category anymore for health insurance purposes, he’s a citizen. Legal immigrants can get exchange coverage but may have a wait for Medicaid, undocumented immigrants can’t get anything under ACA, not even on their own dime. See this AHCJ tip sheet.

There were a few little places where the stats and the narratives were a mismatch. When talking about a bartender in his early 30s, Wilemon gave uninsurance rates for people 18-25, although this person was outside that bracket. In addressing the plight of the pastor and his wife, he gave Medicaid income cutoffs for a family of three, not the two that he was writing about (if they have a child or children, he didn’t mention). Those are really tiny things but I was reading more closely than a normal audience.

Overall I think this is a useful model for those of you struggling with how to break this all down for your readers, a good balance between narrative and straight exposition.

And I thought this quote, from the home care worker, really summed up what a lot of Americans feel and what we are still up against as we try to report on the far-reaching legislation:

“I know very little to nothing about the Affordable Care Act outside the negative things I’ve heard on the news,” Selph said. “I have honestly heard nothing good. I have not done a lot of homework. To me, it appears that it is bigger than I am. No matter what I do, it’s not going to make a difference. So I’ve just sort of waited for the hammer to fall — and to see what that means.”

Here are some tip sheets to help you explain to your readers, listeners and viewers how the Affordable Care Act might affect them:

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