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Gollust: Local TV News Coverage of the ACA during the First Open Enrollment Provided Little Public Health SubstanceFebruary 17, 2017:
In 2014, new Medicaid and Marketplace enrollees identified news as the top source of information about health insurance options, with local television news cited more than any other news media type as their most influential information source. Despite the key role of television news media in providing information about the ACA during the time when Americans were first learning about the details of the new insurance options available to them, no one has analyzed the public health-relevant content of this coverage during the ACA's first open enrollment period.
In an article released today in the American Journal of Public Health, Dr. Sarah Gollust (University of Minnesota) and her co-authors examine the content of local TV news coverage of the Affordable Care Act (ACA) during the first ACA open enrollment period (October 1, 2013 through April 19, 2014), when 10 million Americans gained insurance. This new analysis is relevant to the work of policymakers, health policy scholars, and enrollment advocates as they seek to understand the information environment to which Americans were exposed at this historic time of widespread coverage gains.
The researchers identified a sample of1569 ACA-related television news stories broadcast during the first open enrollment period. The sample was generated using keyword searches of closed captions from local evening news broadcasts in 208 U.S. media markets. Data were collected and the content of news broadcasts coded at Wesleyan University through a partnership between the University of Minnesota and the Wesleyan Media Project, which study author Dr. Erika Franklin Fowler directs.
Results: Types of Television News Coverage
- 26.5% of the stories in the study sample focused solely on the politics of the ACA, not mentioning any information about health insurance products.
- 44.9% focused entirely on the health insurance options available through the ACA.
- 28.6% presented a mix of coverage, looking at both politics and available health insurance options.
Results: Policy-Relevant Variables
- Just 7.4% of the sample news stories mentioned Medicaid, and only 5.0% had a Medicaid focus. Stories in the politics-focused subsample were more likely to have a Medicaid focus than were stories in the insurance product-focused subsample (10.1% vs. 3.1%).
- Among the news sample that addressed health insurance products (in whole or part), about a third included some factual policy details about enrollment (e.g., mention of fines, subsidies, or how to get help enrolling) in 2013, and about 4 in 10 did so in 2014. Just 13.9% of the product-related sample provided viewers with information on where to go or a number to call to get help, and less than seven (6.9) percent of stories mentioned the availability of subsidies to make health insurance more affordable.
- Health insurance product-related news stories presented information on the number of enrollees to date about one fourth of the time, with 14.2 percent describing federal or state enrollment goals. Mentions of research or evaluation evidence about the ACA were only found in 1.8% of stories.
- A common message in product-related ACA news stories had to do with website glitches: 33.3% mentioned some type of website glitch, whether at healthcare.gov or state-based marketplace sites.
- Among sources cited in local TV news stories about the ACA, the most common were President Obama (38.9% of stories), and a White House or other federal executive agency figure (28.7%). Republican (22.3%) or Democratic (15.9%) politicians or officials were also common sources.
The authors emphasize that only half of all news coverage about the ACA focused on the health insurance products available through the law and note that key policy aspects of the ACA content were surprisingly uncommon even among these stories, with Medicaid mentioned in only seven percent of them and the availability of subsidies mentioned in only eight percent. The authors point to a dominant journalistic style that focuses on political strategy and on who is winning or losing in a given scenario. Political strategy framing was evidenced by attention to enrollment expectations and achievements and to web site problems—i.e., “wins” and “losses” for ACA proponents—over policy substance. Reliance on partisan sources further supports a focus on strategic over substantive reporting. Few news stories, the authors point out, included any public health, medical, research, or health advocacy perspectives. They argue that the framing of the law by the local media using a political strategy frame limited citizens’ exposure to the substance of ACA policy content, instead heightening the likelihood of the public perceiving the law through a politically charged lens.
The research highlighted here was supported by a grant from the Robert Wood Johnson Foundation's SHARE program, which is managed by SHADAC. Learn more about Dr. Gollust's SHARE-funded research.