How I did it

Learn from these journalists how they have covered various aspects of health care related to insurance. They provide valuable tips and sources and explain how they got past the challenges to explain the complex issues to their audiences.

Reporting on junk health insurance plans

June 2021

Early in May, ProPublica health care reporter Jenny Deam wrote about the financial ruin that often results when unknowing consumers enroll in short-term health insurance plans. Her article of more than 3,000 words, “He Bought Health Insurance for Emergencies. Then He Fell Into a $33,601 Trap,” is an excellent example for any journalist looking to cover the complex world of health insurance plans that do not comply with the requirements of the Affordable Care Act (ACA), otherwise known as Obamacare.

Maya Miller, an engagement reporter with ProPublica’s Local Reporting Network, also contributed.

How to report on the ‘financial toxicity’ even Medicare cancer patients can face 

Kate Yandell

May 2021

A recent Cancer Today magazine feature I wrote on the financial difficulties faced by many Medicare beneficiaries with cancer, Learning Medicare’s ABCDs, began its life in 2018 as a failed idea for a brief web explainer.

When I started as an editor at Cancer Today, I tended to think of financial toxicity as the province of people under 65 who were not eligible for Medicare. However, the median age for a cancer diagnosis is 66, and by early 2018, I had noticed in the literature and social media exchanges that some cancer patients on Medicare also were reporting financial troubles.

Award-winning journalist shows what European countries can teach the U.S. about containing opioid crisis 

Taylor Knopf

August 2020
In 2018, Taylor Knopf used time while she was on a personal vacation to report on successful harm reduction methods Europeans use to support people who use drugs.

She had written about the opioid crisis in North Carolina and found that the drug-related death and disease statistics were grim. Meanwhile, European countries experienced a heroin epidemic a few decades ago and Paris recently opened a drug consumption room (or safe injection site).

Read about how Knopf reported and produced a six-part series called “Lessons from Abroad” on successful harm reduction methods.

For some patients, high health costs and inadequate insurance are financially toxic

December 2019
Two years ago, Liz Kowalczyk rotated onto the Boston Globe Spotlight team to participate in a project about race. Her role was to document segregation in the city’s health care system. During the investigation, she grew interested in writing about another type of inequality in Boston medicine: How money, and the lack of it, affects patients and their care.

As it turns out, the issue has many twists and turns.

How a doctor’s tip and a Facebook algorithm led to an award-winning series

July 2019
This is the story of how a doctor’s tip, with help from a Facebook algorithm, led to an award-winning series about a nationwide network of diabetes clinics that some experts called a scam. The story does not end well for the network’s founder, G. Ford Gilbert, who goes to federal prison in August.

How reporter Cheryl Clark learned about Trina is probably what happens to a lot of journalists who stumble onto a great story. The path might be circuitous and require a lot of patience and curiosity.

Decoding upcoding: Reporter finds manipulation of patient condition severity in ER bills 

July 2019
Jenny Deam, who specializes in reporting on the business of health at the Houston Chronicle, has been digging into health care costs – and she’s found a trove of information in billing codes. When she saw that what insurers were paying for ER charges was going up significantly even though the overall number of insured patient visits was remaining steady, she suspected that the severity of the patient conditions was being “upcoded” which meant more revenue to the hospital.

Here are her tips on how you can obtain bills, and understand facility fees and “upcoding.”

High-profile interview leads to a five-part series on mental health parity 

May 2019
After a lucky, hurricane-related break, reporter Yen Duong scored a half-hour interview with Patrick J. Kennedy, the former congressman from Rhode Island and mental health advocate.

That interview led to a series of stories about mental health parity – treating mental health on par with physical health. She scoured complaint records in North Carolina and was able to interview several patients and providers, though she found that insurance companies were reluctant to speak on the record.

Reporting on surprise medical bills

October 2018
Kaiser Health News and NPR have been collaborating on a series called Bill of the Month – including a particularly powerful  piece by KHN’s Chad Terhune about an insured high school teacher hit with a $108,951 bill after a heart attack at age 44.

In this How I Did It essay, Terhune gives many detailed and specific hints on how to identify, verify, and report on these bills. 

How Tarbell dug through layers of complexity to explain why drug prices are so high

Randy Barrett

August 2018
The complexity of the drug supply chain in the United States is truly daunting and a significant factor in why many medications have become so expensive. Since its founding in 2017, Tarbell has studied the problem. When reporters couldn’t find a clear diagram of how the system works, they created an interactive version, with an emphasis on how each player takes a cut in a system that protects and perpetuates high prices. The diagram was one result of a three-month investigation into the high cost of drug prices by Randy Barrett and Marilyn Serafini, with Tarbell founder Wendell Potter serving as editor.

Reporting on surprise medical bills leads Mississippi hospital to change its ER billing policy 

Anna Wolfe

June 2018
Batson Children’s Hospital has been charging patients thousands of dollars in unreasonable emergency room facility fees that do not match the level of care received. The hospital is part of the University of Mississippi Medical Center, the only academic medical center in the state.

As a result of complaints from patients and Anna Wolfe's reporting for the Jackson, Miss., Clarion Ledger on how these high charges are calculated, the hospital changed its billing policies to make the charges more fair. 

Explaining complex world of pharmacy benefit managers led to series for this data journalist

Katie Wedell

May 2018
Even though prescription drug prices had become a hot topic by late 2016 with public outrage aimed at Mylan and other drug makers for price hikes, telling the complicated story of the industry forces that control those prices was a hard sell to my editors at the Dayton Daily News. How do you convince someone a story is necessary when they don’t understand the first thing about the topic?

Katie Wedell began looking into drug prices because of a tip about clawbacks – a practice in which pharmacies charge a customer the full copay even if the drug costs much less, and the pharmacy benefit managers “claw back” the rest. Under the contracts pharmacies have with PBMs, neither side can disclose the actual amounts pharmacies pay and PBMs receive.

Using data, reporter shows how for-profit hospitals provide much less charity care than nonprofits

April 2018
In December, Pennsylvania published a new definition of charity care that requires hospitals to notify patients of their eligibility for such care, even if the hospital determined eligibility without the patient’s cooperation. Sean D. Hamill, a reporter for the Pittsburgh Post-Gazette, explained that the new definition is important because hospitals previously used presumptive eligibility, a practice that helped drive up spending on charity care at Pennsylvania hospitals over 10 years because hospitals were shifting patients’ unpaid accounts from bad debt to charity care.

Editor details the challenges of covering genetic testing companies that make dubious claims

November 2017
In December 2016, Charles Piller, the west coast editor for Stat, reported that a genetic test to identify patients who could be prone to addiction lacked a firm scientific basis. The article raised important questions about the Proove Opioid Risk test from Proove Biosciences in Irvine, Calif.

It was the first of four articles about Proove that Piller wrote over eight months that questioned the validity of the test and the company’s marketing practices. In this Q&A, Piller explains how he did the stories and how he and Stat reacted to charges that the reporting was inaccurate.

News brief became catalyst for series on mental health, solitary confinement 

July 2017
Taylor Knopf once assumed that the use of solitary confinement was necessary and reserved for the worst of the worst. But after a year of covering North Carolina’s use of solitary confinement and the fate of mentally ill inmates, she discovered that on any given day, one of every seven prisoners was in solitary confinement in North Carolina. Many were put in solitary as a disciplinary action for infractions as minor as spitting or cursing.

Here she shares what she learned while reporting a two-part series about one man who embodied the reality of the broken mental health and criminal justice systems.

State budget cuts had adverse effects on patient care, leading to hospital’s decertification

September 2016
Last December, Megan Hart was reading the local newspaper before heading to her first day of work at KHI News Service when she came across a few paragraphs about a public notice stating one of Kansas’ two state psychiatric hospitals would lose Medicare payments within a month.

Hart recognized that there was likely more to the story because it's rare for the Centers for Medicare & Medicaid Services to ‘decertify’ a facility or cut payments.

"Therefore, I knew something serious must have happened at Osawatomie State Hospital. The issue was even more important because in eastern Kansas most people who are involuntarily committed are automatically sent to OSH. The only other state psychiatric facility covers the western part of the state, and relatively few private facilities take involuntary patients, even if the person has insurance."

Finance editor reports on how health systems replace fee-for-service with value-based payment

July 2016
When revolutionary change sweeps across an industry, innovation is among the most thrilling journalism beats.

In the health care-industry revolution prompted by the Patient Protection and Affordable Care Act in 2010 and husbanded by the Obama administration, the pioneers face a harrowing ride, with providers and payers playing the role of test pilots for a slew of new business models in the shift away from fee-for-service medicine to value-based care.

Tagging along with the pioneers to chronicle their story can be a bumpy ride, too. Health care innovators are on the cutting edge of change, often with no road map and never with historical trend data in hand. One of the oldest implements in the journalism toolbox becomes essential: finding reliable sources and trend setters who can help guide the reporting of the story through the twists and turns of an evolving marketplace.

Document management systems can help find the story in thousands of pages   

Audrey Dutton

April 2016
After a number of media companies, including my paper, the Idaho Statesman, successfully sued for court files improperly sealed during a federal trial against a local hospital system, I went home with a thumb drive full of digitized documents. A beautiful vision greeted me when I plugged the drive into my computer: hundreds of internal memos, emails, text messages, board presentations and spreadsheets.

I knew these documents held secrets. I knew they'd help our readers better understand the inner workings of health care. But I didn’t know how to organize them and make sense of hundreds of PDFs, especially without the context lawyers provide in a courtroom explaining their importance. So, the pressing question I faced was this: How would I organize these documents into a relevant story or series of stories and still have a life?

There’s not one reason why co-ops are failing; there are dozens

Adam Cancryn

March 2016
In March 2014, I scored an interview with the chief executive of a new health insurer called Maine Community Health Options.

The interview wasn't much of a "get" by any standard. MCHO was a little-known health plan that sold coverage to customers on Maine's state exchange. But it was exciting to me for one reason: MCHO was a consumer-oriented and operated plan, part of the first generation of nonprofit health insurers created by the Affordable Care Act and funded by taxpayers.

The co-op program, which consisted of 23 startups, offered an alternative to buying coverage from the traditional big insurance companies. The individual co-ops would ideally be more community-focused, friendlier and more accessible to the average consumer, and maybe even cheaper.

Rush to robotic surgery outpaces medical evidence, critics say

Richard Mark Kirkner

March 2016
I was flipping through AARP The Magazine — yeah, I’m of that age — in January 2014 when I came across a small news item on robotic surgery. I can’t even remember whether it was favorable or negative, but it piqued my curiosity because I had some background with robotic surgery. I had been editor of a trade magazine for general surgeons back in 2003, when the first surgical robots began appearing in hospitals. I had a close-up view of robotic surgery growing from novelty to standard of care.

After I saw the item, I went to PubMed and found a few studies that reported varied results with robotic surgery, particularly with its growing use in gynecology. I also was aware, from my aforementioned days with the surgeon magazine, that robotic operations cost more than conventional surgery and required quite a learning curve for the surgeon and operating room staff.

When a doctor threatened to sue this California reporter, he did what journalists do best 

Ron Shinkman

February 2016
If you’ve ever wondered what it would be like to face a lawsuit over a story you’ve written, you’ll want to read how Ron Shinkman responded when a source threatened to sue.

The editor and publisher of Payers & Providers, a newsletter in Los Angeles, Shinkman got the phone call we dread. On the line that day in March 2012 was Jeannette Martello, M.D., a plastic surgeon Shinkman had covered when the California Department of Managed Health Care enjoined her from balance billing her patients.

The article was a just-the-facts brief based on a report the insurance regulator issued. With some digging, he discovered that Martello had a history of suing her own patients. In fact, Shinkman found Martello had filed 70 lawsuits in Superior and Small Claims courts in Los Angeles County against her patients. By looking through court and lien records, Shinkman uncovered many of Martello’s patients-turned-lawsuit defendants who became sources in a report he wrote for Payers & Providers.

Attempt to ‘crowdfund’ kidney surgery prompts exploration of ethical issues surrounding coverage

Jackie Farwell

February 2016
When Christine Royles painted a plea for a kidney donor on the rear window of her car, she had no idea of the ethical dilemma she was about to provoke.

As we covered the hospital’s response to the crowdsourcing effort behind her surgery, I worked with Anthony Ronzio, the news and audience director at the BDN, to sort through the medical crowdfunding editorial policy questions inherent in medical crowdfunding. In so doing, we wrestled internally with the role of media coverage in Royles’ ultimately successful search for a donor.

One series leads to another for Georgia journalist looking into Medicaid expansion under the ACA

Misty Williams

October 2015
In the spring of 2014, I began working on a series of stories spotlighting the health care “coverage gap” in Georgia amid the state’s decision not to expand Medicaid under the Affordable Care Act.

An estimated 400,000 Georgians fit into this category. They make too much money to qualify for Medicaid but not enough to be eligible for tax subsidies through the federal Health Insurance Marketplace.

How a fellowship helped one journalist cover the business of oncology

Lola Butcher

June 2015
I cover health policy and the business of health care for Oncology Times, a twice-monthly news magazine, and I started gathering string for a hazy story idea in 2010 after writing this piece on the financial problems oncology clinics were facing.

What captivated me was this paradox: Private oncology practices are being driven out of business because of Medicare payment policy, but cancer care delivered at hospital-owned practices actually costs the Medicare program more than if the same services were delivered by private practices.

If I were a staff reporter, I would have bugged my editor to give me time to dig into this topic. But, as an independent journalist, I could not justify the time needed for the just-checking-this-out interviews and to wrap my arms around a hazy topic that might not lead to anything worth publishing.

Journalist turns six months of research into eight-part series on hepatitis C epidemic

Kristin Espeland Gourlay

May 2015
While working on a documentary about opioid addiction, Kristin Espeland Gourlay, the health care reporter for Rhode Island Public Radio, discovered there was another story waiting to be covered: Hepatitis C.

New drugs had hit the market with reported cure rates of 95 percent or more, but they cost upwards of $90,000 for a full course. The arrival of these new drugs coincides with another trend: millions of baby boomers who contracted the disease decades ago are just now showing up in doctors’ offices and emergency rooms, sick with something most didn’t know they had.

Add to that a wave of new infections, spreading among younger injection drug users – people who got hooked on opioids and then turned to heroin – and you’ve got a unique moment in the history of an epidemic.

In this AHCJ article, she shares what she learned, what sources she used, as well as a list of potential story ideas. As she points out, this epidemic will impact many lives but also state budgets.

Print, radio reporters team up to expose a fraying mental health system in Idaho 

April 2015
Last fall, The Idaho Statesman newspaper and NPR member station Boise State Public Radio ran a series titled, “In Crisis,” that explored Idaho's fragmented and underfunded mental health care system. Statesman business reporter Audrey Dutton and BSPR digital content coordinator Emilie Ritter Saunders collaborated on the series, producing stories for print, radio and online.

Dutton and Saunders found that Idaho's threadbare mental health care system does not serve well the many Idahoans who need quality, timely and appropriate behavioral and mental health care.

Their work could serve as a blueprint for journalists covering this challenging story in any state. Read about how they focused on Idahoans who lack insurance, or can't find adequate services and end up getting care only in crisis. They looked at emergency room visits, involuntary commitments, jails, homeless shelters and emergency response teams of police and social workers.

Reporting on how, why hospital superusers account for bulk of health-care spending     

January 2015
Tim Darragh, when he was with The Morning Call, of Allentown, Pa., reported and wrote a four-day series of stories about a local effort to find ways to improve care and individual health while reducing expenditures for so-called “super-utilizers.” These patients constantly use expensive emergency departments for their health care needs – in many cases, poorly controlled chronic and mental health illnesses, coupled with social isolation, unhealthy living environments and poverty.

Your community might not have a federally-funded pilot program to address super-utilizers as Allentown has. But your community has superusers and it has similarities with Allentown that you can explore in your own reporting. Read about how Darragh approached the reporting and key issues he found.

Reporting on why a huge nonprofit with a healthy endowment would sue an uninsured patient

January 2015
Houston journalist Dianna Wray found that one of the largest nonprofit hospitals in Texas was not functioning as nonprofit. Instead, it was suing the people it was established to help: the poor and uninsured.

She first heard about Memorial Hermann Hospital's practice of suing uninsured patients when a local lawyer who specializes in health care lawsuits contacted her about a case he was undertaking on behalf of Ignacio Alaniz.

In January 2012, Alaniz was rushed to Memorial Hermann in the Texas Medical Center after he was run over by his own car. He had emergency surgery and was in the hospital for weeks. He also didn’t have health insurance. He'd been vaguely assured by hospital personnel that the hospital would work something out under its charity arm, but his medical bills were more than $400,000 by the time he was released. Then Memorial Hermann, the largest nonprofit medical system in Houston, sued him for failing to pay the bill.

Figuring out the politics of patient harm

December 2014
Patient safety is a critically important topic for health care journalists. Yet collecting the data needed to report on it thoroughly can be frustratingly difficult, as  former journalist Michael L. Millenson discovered when he and colleagues embarked on an effort to analyze patient safety by congressional district.

“In health care, cooking up answers to what look like simple questions can quickly get complicated,” he writes. Surprisingly, it was difficult just to determine how to define the term “hospital” because there are so many different types of hospitals. Just distinguishing a local hospital’s performance from that of another hospital miles away was challenging because multiple hospitals owned by one system may share a provider billing number, he explains. 

In this “How I did it” article, Millenson explains the challenges of collecting and reporting the data needed to compare one congressional district against others.

Hospital consolidation in Yakima, Wash.

October 2014
When my editor and I first discussed the idea of a hospital consolidation project, I felt my eyes glaze over at the thought of all the spreadsheets and 990 forms I would have to sift through. Consolidation is a largely financial decision, so I assumed that numbers would provide the driving force for the story.

Instead, I found that while the numbers do add weight to hospitals’ claims of desperation, the bulk of the story lay elsewhere.

Here’s the gist of it: In Yakima, Wash., the one remaining independent, nonprofit community hospital announced a year ago that it’s looking for someone to partner with to stave off financial uncertainty in the future. It reached out to several larger Seattle organizations, but only one is still engaged in talks.

Journalists have to make big choices when writing about their own health drama

September 2014
I’m paying $430 a month for health insurance for just myself now, and it’s totally awesome. And yes, I’m grading on a curve.

Since the year 2000, I’ve been jilted by a grand total of seven insurance companies. The eighth—the one covering me now—comes courtesy of Obamacare and looks like it might actually stick around for a while. Expensive? Yes. A relief? Absolutely.

My long-running tale of woe, which features several twists and turns and a dose of irony, isn’t that unusual in the grim world of 21st-century health insurance in the United States. What’s unusual is for a journalist who covers health and medicine to be so open about his own experiences.

Undocumented immigrants struggle for access to health care

June 2014
When the Affordable Care Act passed in 2010, there was a lot of talk about who would be covered under the legislation. Medicaid would expand in some states and more individuals would have private insurance coverage. But there were a few groups that were exempt from the requirement to purchase insurance including Indian tribal members, individuals eligible to opt out because of religious beliefs, and undocumented immigrants.

In fact, undocumented immigrants were ineligible for both of the main provisions of the law meant to extend coverage to 32 million Americans, the Medicaid expansion and the state insurance exchanges. Tammy Worth investigated how the law would affect care for this population as well as the providers who treat them. 

Analysis looks at which consumers get better deal in health insurance exchanges

March 2014
When writing about health insurance premiums under the Affordable Care Act, MaryJo Webster and Chris Snowbeck at the St. Paul Pioneer Press found significant premium disparities among rates in the Twin Cities, Rochester, Minn., and nearby western Wisconsin.

These discrepancies raised two big questions: Do such disparities exist throughout the entire United States? If so, who gets the better deal – consumers in the Twin Cities with low premiums and little chance of getting federal tax credits, or consumers in the higher-cost places who benefit from the subsidies?

Movement away from fee-for-service reimbursements has begun

February 2014
Among health plan executives, there’s a lot of talk about moving from volume to value. But identifying what this expression means in practice can be challenging because health plans all define value differently and they are developing ways to deliver more value to their employer and consumer customers.

Despite the challenges, some payers and providers are in fact shifting away from volume-based payments, commonly known as fee for service, and adopting value-based payment methods, as René Letourneau, a senior finance editor with HealthLeaders Media, reported in a recent cover story, Restructuring Reimbursements. Letourneau explained that the risk of not being paid 15 percent of their contracted reimbursement rates if they do not meet certain outcome measures appears to be motivating hospitals to find ways to deliver better care. Here’s Letourneau’s explanation of how she reported this story.

Finding compelling stories about a fraying safety net in a fast-changing insurance marketplace

January 2014
Jim Doyle, who covers the health care industry for the St. Louis Post-Dispatch, has been working on an ongoing multi-part series on health care access and the fraying safety net. What he found when he traveled around rural parts of Missouri and Arkansas is that, while the Affordable Care Act will bring changes in the health insurance marketplace to these area, it only goes so far in helping the poor get access to care. “If you report on rural hospitals, you'll soon recognize the parallels between the health care disparities the poor face in rural areas and in the inner cities and that health insurance reform only goes so far, causing many safety-net organizations to struggle,” he writes. Of particular interest to health care journalists is Doyle’s impressive list of resources he uses to inform his reporting and his willingness to tap a wide variety of sources for his work.

'Critical access' designation may be in danger for hospitals in your area

November 2013
In rural areas, the federal Centers for Medicare & Medicaid Services designates more than 1,300 hospitals as being “critical access hospitals.” These facilities get higher reimbursements to ensure that Americans outside of cities and suburbs can get the care they need without having to travel too far. In August, a report from the Office of Inspector General of the federal Department of Health and Human Services recommended that many of these facilities be decertified.

When he learned of the report, David Wahlberg, a health/medicine reporter for the Wisconsin State Journal, interviewed administrators at critical access hospitals in Wisconsin and found that the administrators believed closing these hospitals would have a detrimental effect on care for Medicare patients. The issue of payment for these facilities is important in every state, but particularly in Wisconsin, which has 58 critical access hospitals. Wahlberg also found that, while critical access hospitals will not be decertified soon, they could be in the future.

Wahlberg points out some important issues journalists should be looking into that involve patient care, the local economy and screenings and care for more vulnerable populations.

Reporter finds surprising stance on smokers’ surcharge

August 2013
Stephanie O’Neill, a health care reporter for Southern California Public Radio, tells the back story of her report on why California – a state that has taken the lead in combatting tobacco – had second thoughts about whether to charge smokers higher insurance premiums as permitted under the Affordable Care Act. It’s a topic you can explore with legislators, insurers and public health advocates in your state.

Poor oversight of Medicaid managed care programs takes toll on patients

August 2013
When Kaiser Health News hired Jenni Bergal as a freelance contractor, she was given only one assignment: Write about Medicaid managed care. It’s an important topic, with millions more people expected to be enrolled as Medicaid expands under the Affordable Care Act starting next year.

She set out to find out how well the states are overseeing and monitoring the quality of care provided by the managed care plans they contract with, and how states compare with each other. In this article for AHCJ, she explains the challenges in doing so. She also reminds us that even policy stories are about people and shows us how problems in one state's managed care program have affected its residents.