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Traveling to Tennessee for a possible preview of health insurance markets Date: 01/04/18

Erin Mershon

During her yearlong AHCJ Reporting Fellowship on Health Care Performance, Erin Mershon reported several feature stories on the impact of the Affordable Care Act in rural areas, including this story on Tennessee Farm Bureau Insurance – an established health plan that is exempt from Affordable Care Act rules and standards.

It gives some hints about what health insurance could look like under President Donald Trump’s executive order – a system that could lead to two parallel insurance markets – one where plans follow ACA rules and accept everyone, and one where the plans may be more affordable for people who are healthy but may not be available to those who are not.

By Erin Mershon

When President Donald Trump announced his executive order on association health plans – one of the first concrete actions he'd taken on Obamacare since the collapse of the Senate Republican effort to repeal the law – I knew immediately I wanted to find a more personal way to write about the otherwise relatively dry policy.

I had heard the talking points from Democrats:

• The coverage Trump was championing would be skimpy, that it wouldn't cover real health issues.

• That people with pre-existing conditions would be turned away if they tried to sign up.

And I knew the Republican points, too:

• That association health plans would mean lower premiums and more flexibility.

• That the affordability would help some of the people Obamacare had left behind.

I wanted to find real people who lived with similar health insurance plans and figure out the real story: Was it as good – or as terrible – as Washington had cracked it up to be?

Thanks to a yearlong fellowship from the Association of Health Care Journalists, supported by The Commonwealth Fund, I'd already spent a year researching rural health insurance issues. That had alerted me to this little health plan available only in Tennessee – and only because of a quirk in state law that essentially exempted the insurance company from many of Obamacare's rules and regulations. Mentors at the fellowship agreed to fund a weeklong trip to the state.

Finding my subject matter, though, turned out to be the easy part. Finding people who would speak about the plan – whether as experts or as customers – took weeks of planning ahead of my trip and during it, too. I was still making roadside calls to set up meetings as I drove between Knoxville and Nashville and down to Columbia, where the plan's headquarters are based. But I learned quickly the importance of being on the ground, close to the story I wanted to tell.

Despite all that prep work, I didn't find as many consumers who would speak about their experiences on the plan as I wanted. That's partly because I was looking for a needle in a haystack – only about 25,000 people in the state have Tennessee Farm Bureau insurance, and that figure includes children. And it may also have something to do with the way the smaller plan is designed and administered.

Because of that struggle, and in hopes of finding another way into the story, I decided midway through my trip to call a Tennessee retiree I knew was frustrated with his expensive Obamacare coverage. He didn't have a Farm Bureau plan, but I asked if he'd be willing to try to sign up for Farm Bureau insurance and let me come along. It wasn't exactly the story I wanted to tell, but it ended up working perfectly for my lead: Phil Yates was exactly the type of person Republicans wanted to help with plan's like Farm Bureau's. Yet he couldn't get access because he had diabetes – just the kind of problems Democrats warned about.

From there, the story took off: I ultimately managed to persuade the executives of Tennessee Farm Bureau Health Plans to participate and to tell their story. That was another place that the trip helped: executives there said they had decided to work with me over other national media outlets because I was in the state and ready to meet in person.

Insurance brokers were also vital in-state sources: they were much more knowledgeable and far more willing to talk about the state's health care landscape than any executive-level officials. Several congressional offices – in particular, the member of Congress who represents Columbia, where Farm Bureau is located – were also incredibly willing to help me find more in-state officials and experts willing to meet a reporter.

My takeaway, then, is twofold: travelling to report a big story is absolutely about planning, time and resources – and a bit of luck, certainly. But it also helped that I was willing to ask anyone and everyone, in D.C. or elsewhere, if they would put me in touch with someone who might understand the state's health landscape. I crammed my schedule with meetings. Then, once I was on the ground, I was flexible enough to pivot when it became clear I needed to do so.

Erin Mershon (@eemershon) is a Washington, D.C., correspondent for Stat News. She has covered health policy for Politico and Congressional Quarterly.