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One series leads to another for Georgia journalist looking into Medicaid expansion under the ACA Date: 10/14/15

Misty Williams

By Misty Williams

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.

The series focused on how the state’s decision not to expand Medicaid under Obamacare affected the lives of Georgians who would have benefitted from the expansion, as well as the implications for the state’s economy.

As a part of the series, I hoped to include a story on the effect of expansion from the health care providers’ perspective, including a special focus on our state’s struggling rural hospitals. It quickly became clear, however, that many of these facilities were in a financial crisis and facing closure. This issue was so significant that I felt it deserved to be explored more in-depth, which was beyond the scope of my series. As a result, the series focusing consumers led to a second series looking at struggling rural hospitals.

How to help these hospitals had become an issue debated among Georgia lawmakers, health care providers and consumer advocates. That spring, Gov. Nathan Deal created a committee to explore possible solutions to the crisis.

Our coverage in the Atlanta Journal-Constitution tends to focus on the metro Atlanta region, home to our largest readership. But my editors and I believed that the issues faced by rural hospitals affect so many Georgians – nearly one in 10 – that it was important for us to cover it thoroughly. The closure of rural hospitals also puts pressure on larger, regional hospitals and has a substantial impact on employment and economic development statewide.

My reporting on Medicaid expansion had created a solid reporting foundation on the issue. But as the AJC’s only health care reporter, I found it difficult to carve out the time needed to delve deep into the issue until August.

What I found was astonishing.

Eight rural hospitals have closed in Georgia since 2001, and my reporting revealed that dozens more are hemorrhaging money.

As part of this project, I analyzed five years of the most recent financial data of Georgia’s 61 remaining rural hospitals. The hospitals report the data to the Georgia Department of Community Health as part of a yearly hospital survey to determine which ones lost or made money in that period. I then gave each hospital an opportunity to review the numbers.

Interestingly, 14 of the hospitals said the numbers – which the hospitals themselves had provided – were inaccurate. Most of those hospitals said their losses were overstated and didn’t include revenue from other non-hospital service lines, such as nursing homes and primary care clinics. But even after adding in the additional revenue, 7 of the 14 acknowledged that they still lost money.

In addition to the data analysis, I traveled nearly 1,000 miles around rural Georgia to interview residents, hospital executives, state legislators, county officials, business owners and other Georgians affected by the crisis rural hospitals face.

A critical part of what I do as a health care reporter is to connect how complex health care policy issues affect ordinary people. I always aim to find individuals willing to share their stories. When they do, they help our readers better understand how policy and the decisions of their elected leaders have a tangible effect on their lives.

On my trip throughout the countryside, I talked with dozens of people, including the owner of a bed and breakfast who spoke of how her local hospital saved her life after she had a heart attack.

Perhaps, the most dramatic story was that of Pam Renshaw of Folkston, Ga. Renshaw had been injured in a four-wheeler accident less than two months after the Folkston hospital shuttered its doors. Suffering burns over nearly half her body, Renshaw couldn’t get to a hospital for almost two hours because of the local facility’s closure.

With the help of one of our fantastic AJC photographers, we told Renshaw’s story through photos and video. I also identified other hospitals and individuals to photograph during my week-long reporting trip in the state.

Our online producers created a statewide interactive map showing which hospitals have closed, which are still exist and the location of ambulances and air ambulances, which together gave a comprehensive view of health care coverage in rural regions.

Ultimately, I wrote three stories examining the rural hospital crisis in our state – looking at the effect on Georgia’s citizens, its health care system and the economy. The series resulted in tens of thousands of page views, and the Renshaw video is one of top videos at MyAJC.com so far this year.

The biggest challenge for me as a reporter was finding the time to research and write the series. During the time, I also was covering Ebola news at Atlanta’s Emory University, the second open enrollment of the ACA’s Health Insurance Marketplace and other issues.

After the first first series (paywall) finally ran starting on Jan. 3, 2015, I did a second series of stories looking at another Southern state’s different decision about Medicaid. As part of this package, I focused on the impact of decision by Arkansas to expand Medicaid on its rural hospitals.

Rural hospitals continue to be an ongoing issue I cover. Currently, Georgia is working to develop a telemedicine-heavy system to help cover some of the gaps left by the closures of hospitals. Here are links to some of the work that was published:

Coverage gap

Day one: Left behind by Obamacare, and the state

Gallery one: Gallery: Left behind by Obamacare, and the state

Day two: Medicaid expansion: dollar waster or moral imperative?

Gallery two: Gallery: Medicaid in Georgia

Interactive: Interactive: Medicaid coverage gaps

Rural hospitals

Day one: The emergency at Georgia's rural hospitals

Day two: Rural hospitals: this patient may not make it

Day three: Failing rural hospitals turn to taxpayers

Map: Code red: The decline of Georgia's rural hospitals

Misty Williams covers health care for the Atlanta Journal-Constitution (@ajchealthcare).