Kentucky’s Courier-Journal led the way in reporting on Republican Gov. Matt Bevin’s push to fundamentally change the state’s Medicaid program through a waiver request that would implement draconian policies to cut coverage and hurt vulnerable communities. The Courier-Journal’s coverage of the Medicaid waiver highlights some best practices -- such as discussing specific policy impacts and citing local experts and people affected by the proposal -- thus providing a model newspapers in other states with similar proposed changes to Medicaid should emulate.

In June 2016, Bevin released a Medicaid waiver proposal called Kentucky HEALTH, which included a series of draconian policies that would gut the state’s existing Medicaid program. Bevin’s waiver has been soundly criticized by experts who emphasize that it would create barriers to obtaining coverage, decrease the use of key preventive services, and harm the overall health of Kentucky’s Medicaid population. Work requirements in particular have been criticized as poor-shaming, since the majority of Medicaid recipients come from working homes and such a policy has never been approved in the entire history of the program.

However, the election of President Donald Trump and the installation of new leadership at the Department of Health and Human Services mean a new openness to previously rejected policies like work requirements. This shift has spurred a couple other Republican-led states -- Wisconsin and Florida -- to explore the possibility of obtaining waivers so they can include policies like mandatory drug testing and work requirements, a trend that could negatively impact Medicaid beneficiaries across the country.

The Courier-Journal’s coverage of Bevin’s proposal models the best practices for state-level reporting on attempts to impose cruel restrictions on Medicaid programs -- a model that other outlets should adopt as more state legislatures attempt to enact radical reforms. Here’s what The Courier-Journal did correctly, and the one thing the paper could have improved on:

1. Discuss Specific Policies Within Medicaid Waiver Proposals And Outline Their Impact On Local Public Health Issues

The Courier-Journal consistently reported on the specific policies Bevin included in his Kentucky HEALTH proposal, not just generalities about the waiver, and highlighted the impact these changes would have on the citizens of Kentucky. A Media Matters study of the paper’s coverage showed that the majority of its reporting clearly outlined the major policies included in Kentucky HEALTH such as the requirement that “most ‘able-bodied working age’ adults … put in up to 20 hours a week working” or volunteering, the provision to “charge premiums for coverage that is now largely free,” and the elimination of “dental and vision benefits from basic Medicaid coverage.”

Additionally, The Courier-Journal analyzed how the specific policies would impact Kentucky’s Medicaid beneficiaries. Reporting highlighted the impact the waiver would have on the detection of diabetes -- a huge public health issue in Kentucky -- and the negative impacts on public health of eliminating dental and vision benefits.

2. Include Information On Public Hearings And Information Sessions -- Opportunities For Citizens To Make Their Voice Heard On Medicaid Proposals

The Courier-Journal consistently included information on the timing and location of public hearings and other opportunities for citizens to express their views. After Bevin revealed his Kentucky HEALTH proposal, there was a public comment process, in which Kentucky’s Department for Medicaid Services held a series of public hearings and accepted comments from residents. The Courier-Journal outlined how to get more information on the proposal and public hearings, including the dates, times, and locations. As the backlash over the GOP’s American Health Care Act illustrated, when people show up it forces politicians to listen.

3. Seek Out Testimony From Local Experts And Individuals Impacted By The Medicaid Proposals

The Courier-Journal bolstered its comprehensive reporting by citing local experts and interviewing individuals who would be impacted by Bevin’s proposal. The Courier-Journal received comments from health care experts like Bill Wagner, the executive director of Family Health Centers, and public health advocates like Sheila Schuster and Emily Beauregard of Kentucky Voices for Health. Articles cited feedback from Kentucky doctors and health care organizations that identified the grave public health problems posed by Bevin’s proposed changes.

The newspaper also contextualized its reporting by including testimony from individuals who had personal experience with Kentucky’s Medicaid program or would be impacted by the proposal. This type of reporting humanizes public policy debates and provides concrete examples of the consequences of such drastic changes.

4. Contextualize Proposed Changes To The State’s Existing Medicaid Program

The Courier-Journal consistently included information on the massive gains in health care coverage achieved by the ACA-facilitated Kentucky Medicaid expansion in its reporting on Bevin’s proposal, which is essential to properly contextualize the policy discussion. Medicaid expansion in Kentucky dramatically increased access to health care for vulnerable communities, aided in the fight against the opioid epidemic, and improved public health through increased use of preventive services. It is important for newspapers to ground their reporting on potential changes to Medicaid in the context of how Medicaid expansion affected public health -- particularly given the false claims propagated by Bevin and his officials about Medicaid’s stability.

But There’s Still Room For Improvement -- Outlets Must Clarify When Proposals Address Nonexistent Problems

The Courier-Journal set the gold standard for reporting on state-based attempts to gut Medicaid programs in Kentucky, but there is still room for improvement. The paper largely failed to note that Bevin’s proposed work requirement is a solution in search of a problem. Work requirements operate under the false assumption that programs like Medicaid undermine individual work ethic when in reality, the majority of Kentuckians who gained insurance under the Medicaid expansion were low-wage workers. The Kaiser Family Foundation noted that, nationwide, “nearly 8 in 10” Medicaid-enrolled adults “live in working families, and a majority are working themselves.” Only two of the newspaper’s articles mentioned that the majority of the state’s Medicaid beneficiaries have jobs.

Right-wing media and politicians like Bevin often demonize Medicaid and push work requirements as a mechanism for fostering personal responsibility and forcing people to have “skin in the game.” Similarly, Wisconsin just released a waiver proposal that would institute mandatory drug testing for Medicaid beneficiaries, which reinforces stigmatizing stereotypes rather than helping actual substance abusers. It is incumbent on news outlets to contextualize proposals to change Medicaid by identifying the actual problems they purport to solve -- and noting when they’re merely right-wing fictions.

Graphics by Sarah Wasko.