Sarah Wasko / Media Matters

Evening news coverage in several crucial local television markets failed to adequately convey the ramifications of the so-called “Graham-Cassidy” health care plan, the latest Republican attempt to repeal the Affordable Care Act (ACA). A majority of local news coverage last week in the selected markets focused on GOP attempts to wrangle support for the pending legislation with few, if any, significant mentions of how the bill would affect residents.

Media Matters analyzed local television coverage of the Graham-Cassidy bill between September 18 and 22 in five major markets represented by Republican senators -- Lisa Murkowski (R-AK), John McCain (R-AZ), Susan Collins (R-ME), Rob Portman (R-OH), and Shelley Moore Capito (R-WV) -- who, at the time, had not yet committed their votes for or against the legislation (McCain and Collins have since said they could not support the legislation). According to this analysis, local affiliates of ABC, CBS, Fox Broadcasting, and NBC in the selected markets aired a total of 43 segments about the legislation during their evening newscasts, but much of the coverage involved little substance:

• The loss of ACA guarantees for coverage of essential health benefits (EHBs) was mentioned zero times.
• Graham-Cassidy proposals specifically targeting Planned Parenthood were mentioned just three times, while the legislation’s disproportionate impact on women was mentioned just once.
• The disproportionate impact of Graham-Cassidy on low-income Americans was mentioned just three times.
• Predicted insurance premium spikes resulting from Graham-Cassidy were mentioned just two times.
• Projected insurance coverage losses for millions of Americans were mentioned just seven times.
• The loss of ACA protections for Americans with pre-existing health conditions was mentioned just nine times.
• Projected cuts and restrictions to the Medicaid program were mentioned just 19 times across 43 segments.

Dangerous Medicaid cuts, insurance losses underreported

Of the 43 total segments across all five markets, just 19 -- roughly 44 percent -- mentioned that  the Graham-Cassidy proposal to convert Medicaid funding into federal block grants while rolling back the ACA’s expansion of the program would result in significant benefit cuts for millions of Americans. According to a September 20 analysis from the Center on Budget and Policy Priorities (CBPP), the steep cuts Graham-Cassidy would make to Medicaid in 2027 make the bill “likely [to] be even more damaging” than simply repealing the ACA in full would.

According to a January 2017 report from the Congressional Budget Office (CBO), completely repealing the ACA’s individual insurance mandate, its expansion of Medicaid, and its provision of tax credits for individual insurance market customers would result in 32 million fewer people having insurance by 2026. Graham-Cassidy promises to do all three, which is why a September 20 analysis from the Center for American Progress predicted insurance losses of 32 million by 2026 should the bill become law. Unfortunately, this staggering reversal of Obama-era insurance gains was mentioned only seven times by qualifying local news coverage -- roughly 16 percent of segments.

Loss of protections for pre-existing conditions, essential health benefits

Of the 43 segments included in this analysis, just nine -- roughly 21 percent -- mentioned that  the Graham-Cassidy proposal would weaken ACA protections serving millions of Americans living with pre-existing health conditions. As Larry Levitt of the Kaiser Family Foundation (KFF) explained to Axios, though Graham-Cassidy does not completely repeal ACA rules regarding pre-existing conditions, “they might end up only existing on paper.” The bill would replace ACA protections against charging higher premiums to customers with existing medical problems with language that professors told PolitiFact is " vague and subject to broad interpretation.” A new draft of the bill issued over the weekend includes even more “weakened protections for people with pre-existing conditions,” wrote Los Angeles Times columnist Michael Hiltzik. As Hiltzik explained, the previous draft “would have allowed states to apply for a waiver of federal rules” regarding individuals with pre-existing conditions, while the newest draft “doesn’t even require a waiver” to skirt the requirements.

None of the segments reviewed for this analysis mentioned that Graham-Cassidy proposes to roll back essential health benefits (EHBs) enshrined by the ACA, by letting states opt out of requiring insurers to cover some particularly costly health care products. As FamiliesUSA explained in a June 27 blog, hollowing out these insurance requirements would be detrimental to millions of Americans who currently need or may one day seek treatment for mental health and substance abuse disorders or require prenatal and maternity care. By rescinding EHB guarantees, Graham-Cassidy “would be a return to the days before the ACA” when “millions of people purchasing coverage on their own couldn’t get coverage for critical care,”including maternity care, ambulatory care, and hospitalization.

Low-income families, the elderly, people with disabilities and mental health concerns

Local TV coverage often neglected the disastrous effects of Graham-Cassidy’s Medicaid cuts on low-income communities that are served by the program. Just three segments (7 percent) mentioned that the law would harm low-income Americans by rolling back the ACA’s expansion of Medicaid benefits to “poor, working-age adults, a population traditionally not eligible for coverage.” As CBPP noted in its breakdown of the legislation, individual states would face “no requirement to offer low- and moderate-income people coverage or financial assistance.” Indeed, the toll Graham-Cassidy would have on working- and middle-class Americans is particularly harsh given that the legislation is also expected to result in a spike in insurance premiums -- a fact mentioned just twice in 43 segments.

Graham-Cassidy’s disturbing impact on older Americans merited only four mentions -- in just over 9 percent of segments -- despite concerns voiced by the AARP that the bill “would result in an age tax for older Americans who would see their health care costs increase” as a result of the loss of consumer protections surrounding EHBs and pre-existing conditions.

At the same time, the impact of the legislation on the tens of millions of Americans living with a disability was virtually absent from local coverage of Graham-Cassidy, and the legislation’s harmful effects on people dealing with mental illness was entirely neglected. Just one segment out of 43 mentioned that Graham-Cassidy would harm people with disabilities by restricting programs they rely on, such as Medicaid, and removing protections they have under current law. The harmful effects the law would have on health care providers and patients dealing with mental illness were never mentioned.

Graham-Cassidy’s impact on women’s health overlooked

Just three of 43 segments mentioned that the Graham-Cassidy legislation would freeze federal funding for Planned Parenthood. According to Stats, the law “effectively defunds Planned Parenthood by prohibiting Medicaid reimbursements to organizations that meet a narrow description” clearly intended to target Planned Parenthood. Planned Parenthood is a comprehensive national health care provider that disproportionately serves low-income women, but which is misleadingly portrayed as, at best, nothing more than an abortion clinic and, at worst, a criminal enterprise.

In addition to the financial hit to Planned Parenthood, which right-wing opponents erroneously claim can be replaced by other community health centers, a Washington Post review of the legislation revealed that Graham-Cassidy is actually designed to impose a backdoor ban on constitutionally protected rights to an abortion. The legislation as currently proposed would begin funneling tax credits for individual market insurance plans through the Children’s Health Insurance Program (CHIP) in 2021, making the money subject to the Hyde amendment, “which prohibits taxpayer funds from paying for abortions except in cases of rape, incest or if the woman’s life is at stake.”

In addition to the restrictions Graham-Cassidy would impose on reproductive health care, the bill also limits ACA-enshrined protections for maternity care and contraceptive coverage, thereby increasing the cost burden for women who wish to prevent, maintain, or terminate a pregnancy. Despite the fact that Graham-Cassidy seems uniquely designed to harm women’s health, local TV news mentioned the disproportionate impact it would have on American women only once during the survey period.

Impact on minority communities

Local coverage of the Graham-Cassidy proposal failed entirely when discussing how the law would negatively affect minority communities if enacted. According to data compiled by the Centers for Disease Control and Prevention (CDC), while roughly 21 percent of all Americans rely on Medicaid as their primary form of health insurance, the number spikes to over 34 percent for Native Americans and Native Hawaiians or Pacific Islanders, over 33 percent for African-Americans, and over 30 percent for Hispanic Americans. Given their increased reliance on Medicaid, minority communities are among several disadvantaged groups that are particularly ill-equipped to handle additional cuts to the program.

Furthermore, by eliminating protections for people with pre-existing conditions, the legislation would leave many minority communities at the mercy of massive premium increases in an unregulated insurance marketplace. Due to a confluence of environmental factors, some of the “health disparities affecting people of color” include increased susceptibility to cancer, heart disease, HIV/AIDS, diabetes, osteoporosis, and other ailments.

A tax giveaway to the wealthy

Another aspect of the Graham-Cassidy bill that went unmentioned during the survey period was that Graham-Cassidy’s proposed expansion of the existing health savings account (HSA) model is effectively a tax giveaway to wealthier Americans. The legislation would increase the amount of pretax income families and individuals can contribute to HSAs, but it would do nothing for low- and middle-income Americans who already cannot afford to save money. As CBPP vice president Edwin Park noted in a November 2016 takedown of GOP proposals to expand HSAs, such a plan “would mostly help wealthy, not uninsured” people. Economist Kathryn Phillips further elaborated in a December blog for Health Affairs that HSAs “primarily benefit the wealthy, the healthy, and the educated” by providing a savings vehicle to tackle modest expenses. Additionally, KFF found in 2006, when the GOP was vetting a major health care overhaul during the Bush administration, that HSAs can increase out-of-pocket costs for “people with chronic conditions, disabilities, and others with high-cost medical needs” and would do nothing to increase coverage among the uninsured.

Methodology

Media Matters used iQ media to search evening newscasts (airing at 9 p.m., 10 p.m., or 11 p.m.) from local affiliates of ABC, CBS, Fox Broadcasting, and NBC in Anchorage, AK; Cincinnati, OH; Charleston, WV; Phoenix, AZ; and Portland, ME for segments that aired between September 18 and 22 about Graham-Cassidy. The markets included were either the largest television market in the selected states or, in the case of Cincinnati, a large market where Sen. Portman lives. We identified and reviewed all segments that included one or more the following words or phrases: Graham, Cassidy, Senate health, GOP health, Republican health, Affordable Care Act, ACA, Obama care, Obamacare. Segments were then coded for mentions of the following issues regarding Graham-Cassidy:

• cuts to Medicaid;
• increase in uninsured people;
• impact on the elderly;
• impact on minority communities;
• impact on low-income people;
• impact on disabled people;
• impact on women;
• increase in reliance on health savings accounts (HSAs);
• increase in premiums;
• potential rollback of essential health benefits (EHBs);
• impact on people with pre-existing conditions;
• freeze in Medicaid funding for Planned Parenthood;
• impact on mental health care;
• impact on addiction care; and
• impact on rural hospitals.

We also coded for mentions that:

• HSAs primarily help the wealthiest and/or do nothing to help low-income or uninsured people; and
• a bipartisan group of governors criticized the bill in a September 18 letter.