How to use health equity data to cover access to COVID‑19 rapid tests

Victoria Knight

When the Biden Administration rolled out two COVID-19 rapid tests programs in mid-January, Kaiser Health News reporters Victoria Knight and Hannah Recht were separately researching the initiatives, including one that allowed Americans to get free tests through the U.S. Postal Service. Their reporting included interviewing experts and gathering U.S. Census Bureau data about health equity measures such as home-based internet subscription rates. 

The behind-the-scenes reporting illustrates how some stories are rooted in social media serendipity and collaboration. In this “How I Did It,” Knight and Recht explain how the article came together and why the data they compiled suggested that millions of Americans — mainly Black, Hispanic and Native American, and Alaska Native people — could face significant challenges in getting the rapid tests. (The following conversation was edited for clarity and brevity.)

So how did you identify this story?

Recht: We were both looking at this topic from different angles. Victoria was looking into the USPS test rollout and had tried ordering tests for herself in a multifamily household and didn’t have any luck. I was separately, at the same time, looking at the insurance reimbursement programs. Both programs were being implemented right around the same time on the same week. 

So, I was looking at Cigna and Blue Cross and a number of these insurance reimbursement programs and realized right away that they were just incredibly cumbersome. A lot of them were mailed or faxed in these very complicated forms in English only. And similarly, the USPS program was available in English, Spanish, and Chinese eventually, but not other languages, and had some other challenges. 

How did you identify three categories of people who may have difficulty getting the tests, like people who live in multifamily households, those with limited internet access or no internet access, and non-English speakers?

Knight: I live in a group house in D.C. and have four roommates, and then we have a basement apartment below us, and two guys live in it. And so, the guys ordered the test first. Then I tried to order the test and got an error message. I texted them, and I was like, ‘Hey, did you order the test?’ And they had. I tweeted about it, and a bunch of people responded to my tweet and said, ‘I'm experiencing the same thing’ or ‘I'm experiencing something similar with error messages.’ And it was other people in other housing situations. 

Recht: These are all common barriers in pretty much any facet of our health care system. We see the same things time and time again. [These] things are difficult for people who don't speak English or don't have internet access. The sort of household size is not as typical, but it was important here. So, we were looking at how programs are set up and what the barriers are along the way. 

For insurance reimbursement, having a bank account is one of those where many, if not all of the companies that I looked at, if they said how they would refund you, they were going to send you a check in the mail or a direct deposit. But if you don't have a bank account — which a significant amount of people in this country don't — that’s another barrier. 

In the story, there is a paragraph that talks about social media posts from people who were having trouble getting tests if they lived in multifamily households or in homes where there were multiple people like you, Victoria. Can you offer additional insight into this?

Knight: I just tweeted, and a lot of people responded to me, and it also somehow got to a new Bloomberg News story that Hannah sent me. So, I had a lot of people messaging me or commenting on it. And then, on my Twitter feed that day, there were other people talking about issues as well. I didn’t search or do a hashtag or anything [like that].

The information from the multifamily households and other information you include in the story is from the census. What tips can you offer reporters who aren't looking at data sets from the census?

Recht: So, most of the data in this story is from the Census Bureau, a bit isn’t. One example is the banking data from the FDIC, the Federal Deposit Insurance Corporation, another federal agency. So, this just comes from a PDF report that came out a couple of years ago. So, you know, no complicated data analysis is needed.

I think there's more data out there than people might think. That data point is something that pretty much every editor who looked at this story commented on like, ‘Wow, I didn't realize this was so common’ or ‘That's a great data point.’ But to me, it's something I had just seen before. I sort of knew it was out there. But it's something that people aren't necessarily thinking about that often. 

My advice would be to see if there is data. A quick Google search can go a long way. And if you're not finding anything, then see who the experts are in that area and try talking to them. But for this, data was pretty readily available. 

I will say that the internet subscription data point also is something where the Census Bureau published a report a couple of years ago that had numbers by race and ethnicity, but they didn't include a number for Native Americans. They have the highest rate of not having internet subscriptions, and I thought it was incredibly important to include that, so I ran a custom analysis on my own. And that's something that a non-data reporter would find a little bit out of their skill set. But that is something where perhaps working with a researcher [would be important]. 

When I hear internet access, I think a lot of people don't immediately think of access to a smartphone. So how important do you think it is to give that context? And do we have solid data on internet access on smartphones? 

Recht: That did come up when we were working on this. That's also something that the Census Bureau asks. And so, there are a number of questions that I looked at. And it's especially interesting because you could order your tests from the USPS on a smartphone. Now the insurance reimbursement programs, they're pretty much impossible to do on a phone. So that's what I want with the [home-based] internet subscription. 

So, yes, smartphone access is an important component, and there are millions of people in this country who don't have computers, don't have internet at home, but you have smartphones. 

What were, if any, challenges that you faced in reporting this story? 

Recht On my end, I reached out to probably eight insurance companies and got responses from two of them, I think? I bugged some of them multiple times, and just got no response. I would have loved to have comments or answers from more than just a couple of the top insurers. 

Certainly, [gathering] data on deadline has its pros and cons. I ran my analysis of the internet subscription data point because I thought it was so important to have that Native American subgroup in there. And the only way that I could do it is if I ran it myself. I extensively searched to see if anybody else had done that before with Reason data with the groups that I was interested in and it just wasn't there. So that's something that I did on a tight deadline made possible by the fact that I've done similar work before. So, it wasn't like starting from scratch was using a different data point, but similar to working with the same survey that I've worked with before. But that was certainly a challenge during that kind of data work on deadline, but I think it was worth it. 

Knight: Yeah, I think Hannah's data really made the story. I was the one doing more of the interviews with the experts, so I had to cold call them. I wanted to find someone who knew [more] about health equity, and so one of my coworkers gave me the phone number of an expert I’d never talked to. So, cold calling is always fun. But trying to do that quickly and get those interviews was a little bit of a challenge, but it turned out fine. 

I think the other thing was getting the White House to respond to me. So, I have a contact in the White House and he'll usually respond to me, but he sometimes can just take forever. In this situation, he really wanted to give us a response on whether the website was going to be made more accessible. But he needed more time. And I was like, we don't have a lot of time. So, it was a little bit of negotiation with him. 

Victoria Knight is a reporter at Kaiser Health News and covers Congress and a wide range of health care issues from Washington. She is KHN’s lead reporter working with PolitiFact to check the claims of politicians, advocates, and companies on health care. Hannah Recht is a data reporter and covers health care by assembling databases, digging through documents, analyzing data, and talking to people

Leave a Reply