On hand at the recent NAMD 2022 Fall Conference were New York Times Investigative Journalist Sarah Kliff, Chief Washington Correspondent for Kaiser Health News and host of its podcast, “What the Health” Julie Rovner, and National Health care Correspondent for Kaiser Health News Rachana Pradhan. They discussed their areas of focus and the challenges of covering a program as large, complex, and critical to the nation’s health care infrastructure as Medicaid.
Here’s an excerpt of a few questions posited to the journalists and their responses.
How do they cover Medicaid given the breadth of the program and the number of people it serves?
“They say, ‘One state’s Medicaid program is just one state’s Medicaid program,’” Pradhan said, pointing to the individualized nature of the federal program. “But really, one state’s Medicaid program is like 50 programs rolled into one. You don’t cover it as a monolith.”
All three agreed that providing the stories of individual Medicaid members was the best way to help explain the program, but finding members willing to share their stories was an ongoing challenge. They can only meet that challenge, they said, if Medicaid programs across the country continue to be transparent and support their attempts to tell these important stories.
“Please keep talking to us,” Kliff implored the audience. “Even after decades as a health care reporter, I feel like I am constantly learning what it does… I find when it is such a big program doing so many things it is those personal stories that really helps increase understanding.”
Medicaid is continuing to take a broader view of what impacts individual health with programs across the country piloting programs around housing, post-partum coverage, food insecurity and other intersectional issues. Do you think these efforts will lead to whole health in more parts of our health care infrastructure?
“Medicaid has been ahead of this for a long time with the wrap around services it has offered,” Rovner pointed out. Long-time services like transportation helped “lead people to the realization that health care is bigger than just what happens in a doctor’s office or hospital.”
The three agreed that Medicaid has been a central point of advancing whole health principles.
“Medicaid has seemed like it has the space to experiment with these ideas more so than other parts of the health care system,” Kliff said.
Pradhan pointed out that there are “very real fiscal reasons” to recognize the intersectional nature of people’s lives and expand coverage to acknowledge all the needs to help to keep healthier.
What do you see as the politics of Medicaid?
The reporters agreed that Medicaid is “forever a political story in one way or another. This is due to factors like the state, the federal partnership that created Medicaid, its central importance to the overarching health care infrastructure of the country as well as the number of individuals who use Medicaid to access health care, the size of the budget and that budget’s importance to supporting hospitals and nursing homes in many areas of the country.
But new dynamics like the ongoing ballot initiatives seeking to expand the program in several states that elected not to expand during the initial roll out of the Affordable Care Act implementation are also important to track. Kliff and Pradhan both pointed to recent passages of this expansion in Kentucky in 2016 and in South Dakota in 2022 as examples of state’s typically trending conservative in their overall voting patterns whose voters elected to expand access to the program and the health care it provides. They pointed out that as of the November election cycle, the question of Medicaid expansion on ballots as a 100 percent success rate.
What will the big story of Medicaid be in the coming year?
Far and away, the reporters thought that the end of the public health emergency and the national “unwinding” would be “the” Medicaid story of 2023. Current estimates place the number at about 16 million for those who have the potential to lose health care in the coming year.
Also on their radar screens will be child and maternal health. In the wake of the U.S. Supreme Court’s recent decision ending the constitutional protections for abortion services, the journalists speculated how that might impact the need for Medicaid services in the area of the health of mother’s and babies because ostensibly, more women will be giving birth than might have otherwise. Currently, Medicaid pays for about half of all births in the U.S.
And finally, they agreed that workforce challenges would continue to be an issue to watch given its outsized impact on the Medicaid program. These challenges include both the recruitment of state employees hired to work within the Medicaid program as well as health care and home care workers in in home and nursing home settings.