Tip Sheets

Lessons learned from Massachusetts: Covering the impact of health reform on a local level

By Karen Brown, WFCR Public Radio, Amherst, Mass.


State officials, insurance executives and policy experts are the obvious places to start on many issues. But to learn what's happening in the trenches, make frequent phone calls or visits to:

  • Community health centers, which are often the places that coordinate sign-ups for the new health programs. They see who's falling through the cracks and why. They can often also put you in touch with consumers to tell their own stories.

  • Primary care doctors. They can talk about waiting lists and complex insurance rules and what their patients are frustrated or happy about.

  • Young invincibles. Men in their twenties remain one of the least insured group, because they just don't think they'll need insurance - even the subsidized kind. Find out who's trying to circumvent the insurance mandate, and why.

  • Gatherings of "middle income" earners, like artists or acupuncturists, for instance - groups that are likely to be most affected by new programs designed for people up to 3 or 4 times the poverty level. Some will be delighted because they've finally been given access to affordable insurance, and some will have fallen through the cracks.

  • Consumer advocates can be very helpful sources, but don't rely exclusively on those groups for examples of "real people." They are often hand-picked to make a certain point (which may be a good one, but still....) Why not approach people in the video store...or supermarket...or local park. Everyone is affected by health insurance, and you'll get a good cross section of experiences.


You may be surprised to learn how many cracks there are in new programs, however well designed – and those cracks help inform public opinion. In Massachusetts, for instance: if your employer offers health insurance but the premium is too high for you to afford, you're not eligible for a state subsidy (even if your salary is otherwise low enough to qualify.) Also, there's a fairly large population of people who make too much to qualify for a subsidy but too little to comfortably afford private insurance. Those are the people who feel hardest hit by the insurance mandate – and many of them are quite vocal.


Ask people to describe their individual experiences dealing with an insurance exchange or government programs. Sometimes you'll find trends, other times you'll find exceptions to the rule, but either way you'll learn a lot about what informs public opinion. For example, stories about being kept on hold for hours and then being given conflicting information from different offices, or being told you qualify for coverage only to receive a letter of denial in the mail – these are the things that define success or failure from the consumer perspective.


There are always plenty – and each one makes for a good story. For example, in Massachusetts, the shortage of primary care doctors got worse after more people got health insurance. And more fly-by-night insurers started to prey on confused consumers who knew they were required to buy health insurance but didn't realize those health plans had to meet certain standards. Advocates will point out that unintended consequences do not negate all the good that comes out of reforms – and that's a fair point – so make sure you put it all in context.


Expanding health coverage costs a lot of money. What are state and local governments giving up to pay for that? In Massachusetts, in order to avoid limiting state-funded benefits or capping enrollment, the state has had to take money out of the outreach and education budget (which funded health outreach organizations), out of Medicaid reimbursement rates to doctors and hospitals (affecting the bottom line of safety net institutions) and out of the health care subsidy for legal immigrants (which led to a lesser health plan for one group of people.)


There is a difference between "access to insurance" and "access to care." For instance, many more people in Massachusetts now have coverage but that doesn't mean they're always getting the care they need, at a price they can afford, in a timely fashion. Also be aware that "reform" means different things to different people. In Mass, state-subsidized health coverage was greatly expanded, but the payment system stayed essentially the same. Explain those distinctions frequently, because even though health journalists know the jargon and the politics like the back of their hands, most consumers are still confused.


Since health reform is such a politicized issue, including at the state level, it's hard to report on the nitty gritty without having to carefully navigate political allegiances. It's common to be accused of anti-reform bias when reporting on consumer complaints – and conversely, to be accused of acting as a government mouthpiece when reporting on people happy with the way things have changed.