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Journalists have to make big choices when writing about their own health drama Date: 09/19/14

Editor’s note: This article refers to the following stories written by Randy Dotinga and published by Kaiser Health News in 2012, 2013, and 2014: Taking a Risk to Secure Health Insurance, My Other Pre-Existing Condition: Unstable Insurance, and Solo Coverage for $430 a Month? For This Enrollee, It's a Deal.

By Randy Dotinga

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.

I first started telling my story in 2012 after meeting a Kaiser Health News editor at the AHCJ conference. Might she be interested in the fact that I would have to go without health insurance for six months in order to get better and less expensive coverage? She was interested indeed, and my first story appeared, Taking a Risk to Secure Health Insurance.

The story began like this: “When it comes to medicine, I usually do as I'm told. Take a pill? Sure. Blood test? Absolutely. Surgery? If you think so, doc. But I’ve been acting against medical advice since January, and I'll keep on ignoring it until July. Let me explain.”

I'd go on to write another story, My Other Pre-Existing Condition: Unstable Insurance, for Kaiser Health News about my struggles as a person on the individual market with one of those dreaded pre-existing conditions. This year, I followed up with a blog post, Solo Coverage for $430 a Month? For This Enrollee, It's a Deal. These two pieces were reprinted by Voice of San Diego, a nonprofit watchdog journalism site where I've been a correspondent for six years.

Here are some tips on writing about your own health situation:

1. Make the Call about Your Privacy

In order to write about my own experiences as a hard-to-insure American, I had to open up about a pre-existing condition (a heart that does the Macarena), the treatment for it (fairly inexpensive pills) and the reason why insurers would care (because it boosts the risk of stroke).

Few journalists are used to telling readers, viewers or listeners about their health problems. If you have a medical condition, give serious thought to what you want people to know about it and try to draw a line that preserves your own sense of privacy. A brief glimpse is often sufficient to give your audience what it needs to know.

2. Watch What Appears Between the Lines

If you’re writing about health insurance, you may reveal more about yourself and your family than you intend.

One of my stories includes a detail about whether I was eligible for a federal subsidy to help me buy health insurance. If they were up on such things, savvy readers could have figured out whether I made above or below a certain amount of money each year.

As far as I know, nobody did the math, and it’s not clear how it would have mattered if they did. Then again, I’m a single guy, and spouses and children may want some information to remain private.

3. Prepare for the Personal to Become Public

When I mentioned my decision to go coverage-free to staffers at the California Managed Risk Medical Insurance Board, the idea did not go over well. A spokeswoman told me that the agency wouldn’t cooperate with me on a story if I planned to embolden other people to make the same decision: Going without coverage “is not something that we would encourage.”

I went ahead with the story anyway. If anyone was emboldened, I never heard about it.

The personal and professional became intertwined again when I wrote a Kaiser Health News story last year that mentioned how a mix-up had temporarily cancelled my stop-gap coverage through Obamacare. An employee with the U.S. Department of Health & Human Services read the story and called me out of the blue, saying she would fix the problem in a few keystrokes. She did just that, saving me from having to spend more time navigating the federal government bureaucracy.

Who knew writing stories about my insurance drama would benefit my own mental health?

For more information on the more than 32 million Americans who remain insured see these resources:

In 2014, approximately 10 million Americans aged 18 to 64 gained health insurance coverage under the Affordable Care Act. By adding this number of Americans to the insurance rolls nationwide, the percentage of those uninsured in the same age group dropped from a high of 21.0 percent in September 2013 to 16.3 percent by March 31, 2014, and the rate remained stable through June, according to an analysis published in the New England Journal of Medicine July 23.

While this news is good for those who gained insurance, the uninsured are still with us in large numbers. In the same article, the authors reported that the 2014 U.S. Census estimated that there were 198 million adults 18 to 64 years of age, meaning there are 32.274 million Americans 18 to 64 years of age who are uninsured. Being uninsured means they have to pay out of their own pockets, accept charity care or forgo health care services altogether.

A report in June from the Urban Institute, Navigating the Marketplace: How Uninsured Adults Have Been Looking for Coverage, showed that 71.8 percent of the adults who remain uninsured cited financial barriers as a reason for not getting health insurance coverage either from Medicaid or on the federal or state marketplace.

In July, the Urban Institute reported on who remain uninsured in a report, Who Are the Remaining Uninsured as of June 2014? The uninsured are diverse in health status, race and ethnicity, and gender, the report said. Even though the uninsured tend to be less well educated and likely are unmarried, just under two thirds of them (61 percent) had incomes above 400 percent of the federal poverty level and 51.7 percent were employed, the institute reported.

Each of these more than 32 million Americans likely has a story to tell about how difficult it is to be uninsured in the United States today.

Randy Dotinga is an independent writer based in San Diego and president of the American Society of Journalists & Authors (asja.org). A former newspaper staff reporter, he has been a full-time freelancer for 15 years. He writes about health and medicine for Kaiser Health News, WebMD, (Long Island) Newsday, HealthDay News Service and other outlets. In addition, he reports on local news for Voice of San Diego (a non-profit investigative news outlet) and reviews books for The Christian Science Monitor.