Health Journalism Workshop offers a host of health-care story ideas from officials, health-care providers, journalists

By Melissa Patrick
Kentucky Health News

Kentucky journalists were challenged by policy makers, health experts and health journalists to write about Kentucky's health issues and were presented with many story ideas at a Health Journalism Workshop sponsored by the Foundation for a Healthy Kentucky Sept. 21 in Louisville.

"Kentucky needs health reporting," said Laura Ungar, national and regional health reporter at The Courier-Journal and USA Today, adding that health reporting "can really make a difference."

A panel of health experts opened the discussion with a look at the "temperature" of health reform in the state and told journalists what they thought needed to be written about.

Sen. Julie Raque Adams, R-Louisville, chair of the Senate Health and Welfare Committee, encouraged journalists to write about the affordability of the Patient Protection and Affordable Care Act, saying "We are going to have to come up with $250 million to pay for it." She was referring to the expected cost of 5 percent of the Medicaid expansion in 2017 and 2018, which Gov. Steve Beshear says will be covered by tax revenue from the jobs created by the expansion.

Health jobs in Kentucky are growing, but hospitals are cutting jobs. Adams said reporters need to write about the effects of the PPACA and Medicaid managed care on their local hospitals, noting, "We have lost 7,000 jobs in rural hospitals."

Adams, who co-sponsored a statewide smoking ban in the Senate last session, said a smoke-free law would save Kentucky more than $2 billion a year in health-care costs. She said this was something important to report on, and  dismissed the prevailing belief in her party that the issue should be decided locally: "When you are talking about $2 billion, you are talking about a statewide issue."

Rep. Tom Burch, D-Louisville, the longest-serving member of the legislature and chair of the House Health and Welfare Committee, said journalists should report the "bigotry" involved in political discourse about "Obamacare;" the importance of preventive care to improve the health of Kentuckians; the need for more primary-care physicians; and a higher cigarette tax to discourage smoking as well as a statewide smoking ban.

"This is one of the biggest health problems we have in Kentucky," he said, "but we just kind of wink at it."

Sheila Schuster, a mental-health advocate, said the PPACA's inclusion of behavioral health as an essential health benefit, and its requirement of parity for behavioral health, are "huge" because no substance-abuse disorder treatment was regularly covered except for pregnant women and youth. But she added that getting mental health services often takes a fight, because insurance companies often question "medical necessity to get around it."

Schuster encouraged journalists to follow the data and tell the personal stories of individuals who have benefited from these behavioral health services, as well as roadblocks they have faced.

Bill Wagner, director of Louisville's Family Health Centers, a group of community clinics that serve low-income residents, said we must never forget that the reform law includes the words "patient protection" and reminded journalists that it is important to remember the "very important protections" it offers.

He noted that with only one-third of eligible Kentuckians enrolled in the subsidized private insurance plans, "the jury is still out" on the reform's affordability and suggested this would be a good story.

The financial sustainability of the reform depends on about 40 percent of the exchange policies to be purchased by those between 18 and 35, the most healthy segment of the population, according to the U.S. Department of Health and Human Services. In 2014 and 2015, this group accounted for only 28 percent of the subsidized policies sold, according to HHS data.

Wagner also said it is important for journalists to cover the race for governor and he was "very concerned" that Republican candidate Matt Bevin says he will replace the Medicaid expansion and seek a federal waiver to implement a different program, possibly like Indiana's, which requires beneficiaries to pay varying premiums and co-payments for non-preventive services and can discontinue services to those above 100 percent of the poverty level if they don't pay their premiums for six months.

Wagner suggested that reporters do a side-by-side comparison of the plans operating under waivers and Kentucky's current expansion plan.

Lack of access to care came up several times in the discussion, especially related to specialty services like psychiatrists and dentists.

Moderator Larry Tye, director of the Boston-based Health Coverage Fellowship, suggested that journalists regularly call all of the health care providers in their coverage area and ask who takes Medicaid and who does not and then print this information in their papers, noting that the calls are necessary because the licensure boards don't always have accurate or up-to-date information.

Al Cross, director of the Institute for Rural Journalism and Community Issues and associate professor at the University of Kentucky, who describes himself as the "extension agent for rural journalists," gave an overview of the PPACA in Kentucky. (Click here for the presentation.)

Cross called for journalists to use the Medicaid Dashboard, which offers county-by-county data about the ACA, to tell community specific stories about who is benefiting from it; the effects of the ACA on employment in their communities; to tell the stories about the infection rates and readmission rates at their local hospitals; to write about their community's plans, or lack there-of, for a needle exchange which must be approved by the local board of health and public officials to be implemented; and also reiterated the importance of keeping their audience informed about the gubernatorial race and each candidates views on health.

"Every news outlet should be writing about needle exchanges, especially in Appalachia, which is number one in Hepatitis C cases," Cross said.

Cross and Tye wrapped up the session with three other prominent health journalists: Ungar, Abby Goodnough, national health reporter at The New York Times, and Mary Meehan, health reporter at the Lexington Herald-Leader and current Nieman Fellow at Harvard.

They added that journalists should write about: prescription drug abuse; the unintended consequences of the reform law, like the lack of access to providers; why emergency rooms are still being over-utilized; denial of treatments by managed-care organizations; penalties that come with not signing up for health insurance; stories to help the newly insured know how to use their health insurance; and reproductive health issues.

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