When Los Angeles Times reporter Lisa Girion and health policy consultant Peter Harbage talk about health reform and health insurance, the result is an exceedingly well-informed discussion with lots of concrete story ideas for journalists.

Last week, Girion, (who has written about her work on insurance rescissions for ReportingonHealth) and Harbage teamed up to share their insights with The California Endowment Health Journalism Fellows.

“The health reform debate is driven in part by the moral argument (that everyone should be insured), but it’s also much more of an economic argument now than it has been in the past,” Harbage said. “After a bill is passed – that’s when the real work is going to start. In 2010, what kind of impact are we going to see after passing a bill? There’s a lot more to come in the health debate.”

Harbage suggested journalists consider the following angles as they continue to cover health reform:

1. Provider accountability. While hospitals and doctors already must report some quality measures to receive federal reimbursement for care, they are trying to avoid any further measure to determine how they’re doing and how they’re managing treatment, Harbage said.

2. Making it happen at the state level. How are cash-strapped states like California going to implement health reform? If more people will be on Medicaid programs like Medi-Cal, how will states afford their share?

3. Impact on business. Many stories have focused on the individual mandate, but will businesses get the subsidies they need to make health insurance affordable to employees?

4. New experiments. The federal government will be trying many new experiments to contain costs and reimburse doctors and hospitals. How will those play out?

5. What about undocumented immigrants? “We really are in the process of creating a system where if you’re here legally, you’re going to have health insurance, and everything else won’t. What does it mean as a society if we’re going to create such a bright line distinction between insured residents and uninsured people who are not here legally?”

Lisa Girion, whose highly-praised work on insurance rescissions has led to lawsuits against insurers and significant legislative reforms, described how her coverage started with just one story of a man whose insurance was yanked when he got sick. When she got an enormous response from readers with similar stories, she knew she was onto something.

“The lesson for me was that I’m going to put a little thing in the paper (that I might have rejected before, because now the stories will come to you” via email and online comments, Girion said.

Girion suggested that as the details of health reform unfold, journalists will want to examine how insurance companies find ways to remain profitable.

“The name of the game for insurance companies always will be avoiding risk, taking money in and paying out less of it than any of their competitors. I think they’ll design a product to fulfill the letter of the law but appeals to people who are healthier and younger,” she said.

“This whole idea of denying care is going to be a big issue: what’s “medically necessary” and who will get to decide that? For anybody who covers health care in America – this is an issue we really need to be on guard for.”