In Texas, where the state has not expanded Medicaid and continues to hold the highest uninsured rate in the country, the consequences for residents with chronic health conditions can be devastating. That’s what Public Health Watch reporter Kim Krisberg set out to show in her story on Texans with epilepsy who lack health insurance — part of the outlet’s ongoing “Uninsured in America” series.
For this “How I Did It,” Krisberg talked about the challenges of finding data, the importance of narrative reporting and the strategies she uses to build trust with uninsured patients. She also shared her advice for other health journalists covering the intersection of chronic illness, poverty and health policy.
This interview has been edited for brevity and clarity.
How did you find data for this story, especially around uninsured Texans living with epilepsy?
We weren’t able to find out exactly how many Texans with epilepsy are uninsured — those numbers are really hard to come by. But based on what we know about this population — higher unemployment and low incomes — combined with the fact that Texas has not expanded Medicaid and has the highest uninsured rate in the country, we could make an educated guess that the rate is relatively high.
You can also look at research from the 40 states that have expanded Medicaid and see the difference over time. After about a decade of data, however, it’s clear that when people with chronic conditions like epilepsy gain health insurance, their health outcomes improve.
So while granular data was hard to find, we were able to rely on related indicators and on state-funded programs like the Texas Epilepsy Program, which provides some insight into how many uninsured Texans with epilepsy are getting help.
You centered the story around Lynda Smith, a woman with epilepsy who lost her access to Medicaid when she moved to Texas. How did you find her and decide how to balance her personal story with policy reporting?
That balance between human stories and policy context has been central to our “Uninsured in America” project. The goal from the beginning was to humanize what it means to live without health insurance.
I found Lynda through one of the free seizure clinics run by the Epilepsy Foundation Central & South Texas. These clinics serve uninsured Texans with epilepsy, so they’re an important safety net. By spending time with providers and staff there, I built trust. Once they knew my intentions and the kind of stories I tell, they connected me with patients who were willing to share their experiences.
There can be a lot of stigma attached to being uninsured. That’s why it’s so important to take your time, build relationships and report with empathy. I still check in with Lynda — I spoke with her recently about how she’s doing. That ongoing relationship is really at the heart of this kind of reporting.
You mentioned that much of the Medicaid expansion coverage tends to focus on politics. How did you approach the story differently?
Exactly — in states like Texas, the debate can feel repetitive: Will they expand Medicaid or not? But the policy discussion often overshadows the human cost of inaction.
In our reporting, we tried to flip that. Instead of leading with lawmakers, we started with communities. What does it mean for someone in a small Texas town to live without coverage for years? What happens when they can’t afford medication or care for a chronic condition?
By shifting focus from political debate to lived experience, we found that there are real opportunity costs to not expanding Medicaid — people are getting sicker, and local safety nets are stretched thin. That’s where the real story is.
What advice would you give other journalists covering insurance gaps and chronic conditions in their own states?
One way to start is by looking at these issues through a disease lens. Ask: What is it like to manage diabetes, heart disease, or epilepsy without insurance? Chronic illness is where the consequences of policy become visible — and it’s also where the stories resonate most.
We’re also watching upcoming policy changes, like new Medicaid work requirements, that could have huge impacts on people with disabilities or chronic conditions. There’s a lot of room for local journalists to explore what those changes mean in their own communities.
What data sources or organizations do you rely on most for this kind of reporting?
I’ll admit — I’m not a data journalist by training! But I collaborate with data reporters. For story leads, I often start with the County Health Rankings to get a sense of the local health landscape — things like provider shortages, hospital closures, or even transportation gaps.
Other good resources include Congressional Health District dashboards and data showing how many physicians accept Medicaid in your area. That last one is crucial — having insurance doesn’t guarantee access to care.
And, of course, nonprofits and community health centers are important sources too. Organizations like the Epilepsy Foundation and federally qualified health centers (FQHCs) are often the best connectors to uninsured patients. They’re deeply embedded in their communities and can offer both data and human insight.
Any final piece of advice for health reporters?
Don’t drop the story once it’s published. Follow up. These relationships and stories evolve — and staying in touch helps you tell a fuller story over time.
It’s also fairer to your sources and your readers. We owe it to them to keep showing up, not just parachuting in for a single piece. In our newsroom, having a running series like “Uninsured in America” helps us sustain that commitment. I know it can be difficult for some reporters to convince their editors to keep a story going. But, that continuity makes for stronger, more impactful journalism.
