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Chronicling America’s uninsured and their gut-wrenching decisions Date: 02/05/19


John Tozzi

By John Tozzi

The people with the most at stake in America’s health-care debate often have the smallest voice in it.

A year ago, my editor came to me with an assignment intended to change that: Find people who had decided they could no longer afford medical insurance. Follow them for a year. And show our readers how the affordability crisis in U.S. health care shaped their lives.

Unlike the insurance companies, drugmakers, doctors and hospitals that we cover, these people didn’t have lobbyists, lawyers or PR firms to advance their interests. They were on their own.

And though they numbered in the millions, it wasn’t always simple to find them.

I started by reaching out to people on social media who posted about being uninsured, asking if they would consider sharing their stories. I also called patient advocates, health-focused nonprofits, insurance brokers, small-business groups, and direct-pay doctors who don’t take insurance coverage.

This last group, an active community of hundreds of physicians, circulated my request to patients and connected me with dozens of people who had opted out of health insurance and wanted to talk about it.

Our initial plan was to find about a dozen households to track. I spent most of January recruiting possible candidates and doing initial interviews. I asked people if they were willing to share details about their finances and their health. Many, to my surprise, said yes.

We tried to find people from communities all over the U.S., in different economic circumstances, ages, family situations and political persuasions. We were surprised at how many people going without insurance were financially well-off — people too wealthy for subsidies but not rich enough that the costs didn’t matter. A North Carolina couple who made more than $127,000 a year, comfortably in the top fifth by income, decided to forego coverage that would have cost them $1,800 a month.

We picked a handful of these examples for our first piece, published in late March, which framed the premise of the project: As health insurance premiums and deductibles increased, Americans were making difficult tradeoffs about whether to buy coverage or chance going without. We called the project “Risking It.”

We also invited readers to share their stories through a survey we published. Over the course of the year we heard from more than 5,000 people, many of whom gave rich accounts of their lives and said they were open to being contacted by Bloomberg News.

While we stayed in touch with the initial group of a dozen, the survey widened the project’s reach. My colleagues and I called and emailed hundreds of people, logging our calls and interviews in a shared database that expanded the universe of stories we could tell.

I had long been curious about people who had insurance but faced bankruptcy due to medical charges their plans didn’t cover. Despite spending hours reading bankruptcy court filings and cold-calling attorneys, I hadn’t found anyone who could tell that story.

Then a Virginia woman responded to our survey with precisely that experience. She became the central anecdote in our next piece. The growth of high-deductible plans, combined with the deterioration of Americans’ household balance sheets, meant that health insurance offered less financial protection just when people needed it most.

It was a story we could see in data. But anchoring it with a real example of a family ruined financially, despite their costly medical insurance, made the numbers resonate with readers.

The dollars-and-cents details that people shared were also essential to making this project succeed. We needed them to open their books to us, and to verify what they told us with evidence — medical bills, letters from insurers, family budgets, tax returns. Health insurance is complicated. People’s recollections about premiums, deductibles and other costs often didn’t quite match what their documents said.

Interviewing people in person was also important to verify their stories and make them vivid on the page. My colleague Aziza Kasumov went to Dallas to meet the Maldonados, a middle-class family of four squeezed off their medical plan one-by-one as costs ratcheted higher.

In June I sat at Lindsie Bergevin’s kitchen table in Boise, surrounded by stacks of paperwork. She and her husband Chris talked about the tradeoffs they made and the risk they were taking, dropping insurance even as they planned to have a second child.

Conversations like that happen at kitchen tables across America every night. I’m grateful that our subjects let me — and our readers — sit in with them.

The project only succeeded with the vision and support of senior editors and others throughout Bloomberg’s newsroom. Illustrators and graphics journalists made the stories come alive visually. Software developers built the survey tool that fed our database of leads. Bloomberg journalists promoted the story on television, radio, and social media.

My colleagues and I approached hundreds of people for this project. I did more than 80 interviews, sometimes talking to people several times over the year, hearing how their health problems and financial struggles evolved. There was something powerful in listening to these stories over and over again, and humbling in how eager people were to share them. They wanted to be heard.

John Tozzi is a health care reporter for Bloomberg News in New York. He was a 2016-17 Knight-Bagehot Fellow at Columbia University.