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The press failed to accurately convey the implications of a potential repeal of the Affordable Care Act (ACA) in the lead-up to the election. Now that Donald Trump is the president-elect, media must improve their health care coverage by contextualizing their stories about a potential ACA repeal and explaining the impact it would have on millions of Americans and the health care system as a whole.
A recent Media Matters study found that in the weeks leading up to the election, television journalists overwhelmingly failed to ask any substantive questions about Trump’s health care policies or the consequences of repealing the ACA. In the two weeks before Election Day, there were only four instances of broadcast or cable news hosts or reporters bringing up a substantive question about Trump’s supposed Obamacare replacement amid 77 segments ostensibly focused on health care. This was not the first time media failed to inform the public about the Republican Party’s extremist health care policy agenda. Another Media Matters study found that evening news shows virtually ignored Speaker of the House Paul Ryan’s resurrection of his Medicare privatization scheme, a proposal that could have dangerous consequences for a program relied on by more than 55 million Americans.
During the campaign, media outlets also lauded Trump for giving a so-called “policy” speech on health care, ignoring that the actual speech contained little to no policy specifics. This lack of attention to detail reflects a broader theme in election coverage, as studies found media overwhelmingly avoided substantive discussion of policy, focusing instead on “scandals” plaguing the Republican and Democratic nominees.
While cable and broadcast news tended to avoid robust discussions of the impact of health care policy, right-wing media filled the void with rampant misinformation. Since the ACA passed in 2010, conservative news outlets have consistently attacked the health law with complete fictions, claiming it will explode the budget, create death panels, bankrupt Medicare, end in a “death spiral,” and facilitate a government takeover of the health care system.
Today, media outlets regularly provide Trump surrogates with free airtime to push misinformation and avoid substantive discussion. In a series of January 3 interviews, Trump senior adviser Kellyanne Conway was given a free pass on health care policy by ABC’s Good Morning America, which neglected to even bring up the looming repeal of Obamacare. NBC’s Today and CNBC’s Squawk Box failed to push Conway with follow-up questions about how exactly the incoming administration plans to maintain popular health care reforms while repealing the law that created them. On MSNBC’s Morning Joe, Conway was allowed to push vague proposals for creating health savings accounts and allowing insurers to sell across state lines (both proposals have been highly criticized). When asked if the replacement plan is “ready to go,” Conway deflected by suggesting that planning could not start until Trump’s nominee for secretary of health and human services, Tom Price, is confirmed. The Morning Joe hosts failed to raise questions about the potential impact of the policies she promoted and allowed her to deflect from questions about the replacement plan to the irrelevant question of cabinet nominations.
Trump and congressional Republicans pledged to make repeal of the ACA one of their top priorities, which means the press must immediately rethink its strategy when covering health care policy and focus on specifics. Media outlets must contextualize the impact of repealing Obamacare in terms of the gains that have already been achieved and how those improvements will be affected or reversed by Republican policies. Health care policy is inherently complex and confusing -- it’s the media’s job to break down the complexity and explain how repealing Obamacare will impact the lives of every American.
The implementation of the ACA resulted in a record low number of uninsured Americans -- 8.6 percent in September 2016, down from 16 percent in 2010. According to estimates from the Department of Health and Human Services, more than 20 million Americans have gained health care coverage as a result of the law.
The ACA’s expansion of Medicaid extended health care coverage to more than 14 million low-income Americans. Studies of the expansion showed that it helped to combat income- and race-based coverage disparities in the insurance market, improved access to coverage for people with disabilities, and significantly improved state budgets in states that accepted federal funds for the expansion.
The implementation of the ACA significantly improved the condition of women’s health care coverage in the U.S. The ACA’s preventive services provision greatly improved access to birth control by eliminating copays -- expanding coverage to millions of women and dramatically reducing out-of-pocket costs. The ACA banned sex discrimination in health care, and put a stop to the widespread practice of “gender rating” in which health insurance companies charged women higher rates for comparable plans made available to men. The law also improved access to maternity care by classifying it as an essential service.
Repeal of the ACA would permit the return of discriminatory practices like gender rating, reducing overall access to health care and significantly increasing out-of-pocket health care costs for women.
The ACA helped the fight in achieving LGBTQ equality by dramatically improving access to health care for LGBTQ patients often targeted by discriminatory practices (like dropping individuals with pre-existing conditions), prohibiting sex discrimination, and guaranteeing protections to married same-sex couples regardless of the state in which they reside. Studies have shown that the ACA has reduced the number of uninsured LGBTQ people and decreased health disparities in the LGBTQ community. The law provided marketplace insurance subsidies to nearly 732,000 individuals, and its expansion of Medicaid was particularly beneficial to LGBTQ youth, who are disproportionately likely to experience poverty and homelessness.
Repeal of the ACA would allow insurance companies to discriminate on the basis of gender, strip coverage for transgender people and transition-related care, and increase the number of uninsured people by repealing the marketplace subsidies and Medicaid expansion.
The ACA has extended the solvency of Medicare by over 10 years, despite false claims to the contrary from right-wing opponents of the program. Discussions of Medicare’s budget outlook typically refer to Medicare’s Hospital Insurance program -- which covers hospital visits, nursing care, and other medical costs. Studies have shown that the ACA has extended the full budgetary solvency of the Hospital Insurance program through 2028, after which “payroll taxes and other revenue will still cover 87 percent of Medicare hospital insurance costs.” In addition to enhancing Medicare’s budget outlook, the ACA improved senior care by reducing prescription costs and extending coverage to key services.
Medicare spending will increase by $350 billion over the next decade if Congress repeals the ACA, accelerating the program’s insolvency. Potential plans to privatize Medicare will gut access to care and cause skyrocketing health care costs for the elderly.
Implementation of the ACA has reduced the budget deficit even more than was originally predicted by the Congressional Budget Office. Studies have shown that since the implementation of the ACA, while premiums have increased steadily, the number of individuals struggling to pay medical bills has steadily declined. While costs overall increase, they have increased by a much smaller margin than they would have if the ACA had not been enacted. Additionally, the ACA helps to combat economic inequality in the U.S., as it increases incomes in low-income households by reducing health care costs through mechanisms like the Medicaid expansion.
The ACA helps to fight the significant health disparities among Americans, expanding minority access to free preventive care, improving the overall quality of care in minority communities, and reducing the number of uninsured persons of color. The ACA invested in community health centers, whose patients are primarily minorities. The ACA provided the foundation for other efforts to combat inequities in the health care system for communities of color, including the HHS Action Plan to Reduce Racial and Ethnic Health Disparities.
The ACA banned health insurance companies from engaging in medical underwriting, most commonly known as discriminating against individuals for pre-existing conditions. If the ACA were repealed, an estimated 50 to 129 million individuals -- or between 19 and 50 percent of non-elderly Americans -- could be denied access to affordable health care coverage for a pre-existing condition. This fundamental reform protects millions of Americans from being needlessly priced out of the insurance market or denied coverage for common conditions like acne or cataracts.
Despite some claims that a Republican-sponsored replacement package could maintain the pre-existing conditions ban, existing potential plans significantly weaken consumer protections and fail to maintain the same level of coverage provided by the ACA.
The ACA substantially increased the number of insured young adults -- by 5.5 million individuals -- by allowing them to remain on their parent’s health insurance plan until the age of 26. Given the high unemployment rate for people ages 18-29, this provision provides a crucial lifeline to that demographic.
While this rule is one of the most popular parts of the ACA, proponents of repeal have yet to explain how they could keep this provision while getting rid of the other parts (like the insurance mandate) that help pay for it.
The ACA greatly expanded coverage of mental health care services by requiring that most plans -- including all plans sold in the HealthCare.gov insurance marketplaces -- cover mental health services, classifying them as essential services. By eliminating medical underwriting and requiring parity between mental and physical health services, the ACA extended coverage to those who were previously refused on the basis of their mental health issues.
While the mental health coverage in the ACA is far from perfect, repeal will undercut the law’s achievements, gut coverage for tens of millions of people with mental illnesses, and roll back other positive gains in related mental health legislation.
In the lead-up to the election, prime-time news shows functionally abdicated any role in questioning what President-elect Donald Trump will offer in place of the Affordable Care Act (ACA) and how it might affect the millions of Americans who gained insurance coverage as a result of the landmark law. Instead of asking pointed questions about Trump’s piecemeal policy proposals, TV personalities focused on negative stories like the 2017 premium hikes and conservative fearmongering about the potential of a so-called “death spiral.” Going forward, media figures must make “What is Trump’s replacement plan?” their first question in any discussion of health care policy and ask necessary follow-ups to pin guests to substantive proposals.
According to a Media Matters analysis of broadcast and cable evening news coverage from October 24 to November 7, TV personalities asked questions about Trump’s potential ACA replacement plans only four times amid 77 total discussions of health care. In total, TV personalities, panelists, and reporters mentioned Trump’s health care plans 13 times, and these mentions occurred exclusively on cable shows, revealing a serious deficit in broadcast coverage of health care in the last weeks of the election. Compounding the problem, nine of the 13 mentions came from either Fox News or a Trump surrogate (like Corey Lewandowski or Kellyanne Conway) on CNN, meaning right-wing media spin dominated the limited substantive discussions of Trump’s plans.
Media figures’ failure to probe politicians and surrogates on Trump’s plans kept important context out of the health care discussion. For example, during a panel segment on CNN Tonight, correspondent Corey Lewandowski insisted that “Trump has laid out a plan” to let individuals “buy health insurance across state lines,” calling it a “simple solution.” CNN host Don Lemon asked no follow-up questions -- problematic given the numerous critiques of the “state lines” proposal -- and instead changed the subject. Hosts must be prepared with the facts on proposed policies and hold guests accountable for explaining the impact of those policies. Permitting conservative talking points to stand unchallenged allows conservative misinformation to fill the void in a confusing policy arena that is poorly understood by the American public.
Coverage of health care in the last two weeks of the election largely focused on the news of double-digit premium increases next year on average for insurance plans sold on Obamacare’s online marketplace at Healthcare.gov. As Trump used this news to make his pledge to “repeal and replace” a focus of his closing campaign, news coverage failed to ask important questions about his idea to keep the popular parts of the ACA -- like prohibiting insurers from discriminating against individuals with pre-existing conditions -- while getting rid of other provisions. Instead, TV personalities focused on the premium hikes and fearmongering about the potential for a “death spiral.” The focus on negative news like premium hikes makes sense -- it was an important story that deserved coverage. But that coverage completely eclipsed almost any substantial discussion of what Trump’s replacement plan might include -- a trend reflected in the broader failure to engage in much of any policy discussion throughout the election.
The overall lack of coverage about the specifics of Trump’s replacement plan represents a fundamental problem in media’s treatment of health care policy and must quickly change now that Trump is the president-elect. A recent study from the Urban Institute showed that 24 million people will lose health care coverage by 2021 if Congress repeals the ACA. Trump’s nominee for secretary of health and human services, Tom Price, is a known foe of the law’s birth control mandate, a regulation that has dramatically reduced out-of-pocket health care costs for women and massively expanded contraceptive coverage. Repeal could also roll back the gains made in reducing the budget deficit, extending the life of Medicare, and lowering health care costs that resulted from the implementation of the ACA.
While no concrete plan for a replacement currently exists -- due to Republican infighting -- repealing Obamacare remains a top priority for the incoming Trump administration. Journalists must start asking questions about what a replacement plan will look like, how it will affect millions of Americans who gained coverage under the ACA, and what its true goals are. Every interview or panel segment about health care must begin with the question, “What is Trump’s replacement plan?” and include aggressive follow-ups about how it would function in order to hold the Trump administration accountable and educate the American public on the future of health care in the United States.
Media Matters conducted a Nexis search of transcripts of weekday network broadcast evening news programs on ABC, CBS, NBC, and PBS and weekday prime-time news programming (defined as 6 p.m. through 11 p.m.) on CNN, Fox News, and MSNBC from October 24, 2016 (the day the Obama administration announced the premium hikes), through November 7, 2016. We identified and reviewed three types of segments -- news reports, panel segments, and interviews. We searched for “Obamacare” or “Affordable Care Act” or “health care” and identified and reviewed all segments in which health care/ACA/Obamacare was the stated topic of discussion, or health care/ACA/Obamacare was discussed by at least two speakers in the segment (e.g., a host asking a single question about the ACA to a guest and the guest responding during a multitopic interview would count).
Initial reporting on the president-elect’s selection of fast-food CEO Andy Puzder to replace Tom Perez as the next secretary of labor depicted Puzder as a “vocal” critic of Obama administration policies while failing to note the conservative media-fueled inaccuracies that inform the incoming secretary’s anti-worker views.
On December 8, The Wall Street Journal was first to report that President-elect Donald Trump planned to name Puzder -- the CEO of CKE Restaurants, which owns the Carl’s Jr. and Hardee’s burger chains -- as the incoming labor secretary in his administration. The Journal’s report, and subsequent reporting from The New York Times, Los Angeles Times, and USA Today, focused mostly on Puzder’s opposition to specific economic initiatives from the Obama administration -- raising the minimum wage, expanding overtime protections, and extending the scope of the Affordable Care Act (ACA) -- while failing to mention that Puzder’s arguments against each have been widely discredited:
Despite amplifying Puzder’s criticism of progressive economic policies, none of the outlets saw fit to mention that his arguments are wrong.
First, Obama-era regulations have not “stifled growth in the restaurant industry” or created a “restaurant recession.” According to data from the Bureau of Labor Statistics (BLS), employment in the restaurant industry is up more than 20 percent since Obama took office in January 2009:
Second, while it is true that Puzder is an ardent opponent of increased minimum wages -- he once argued that modest wage increases actually encourage low-wage workers to game the system so they can stay in poverty -- it is important to note that his arguments are unfounded. Puzder and other right-wing media personalities have waged a campaign of misinformation against raising the minimum wage, claiming that it hurts businesses and kills jobs. In reality, reliable professional studies of the minimum wage consistently find a negligible relationship between the minimum wage and employment activity.
As is the case with Puzder’s opposition to living wages, the incoming labor secretary’s antagonism toward the ACA is also not based in facts. Right-wing media outlets and allied politicians have spent years claiming that President Obama’s signature health care reform law is hurting the economy and stymieing the job market despite all evidence to the contrary. In reality, Obamacare has reduced the uninsured rate to historic lows, has reduced medical debt and benefited public health outcomes while strengthening the economic security of low-income families.
Finally, Puzder’s opposition to expanded overtime protections amounts to little more than retooled talking points generated by right-wing media. Conservative media outlets opposed President Obama’s proposed overtime expansion before they even knew the details, claiming it threatened to undermine American work ethic and turn the country into Greece. Puzder’s claim that a “regulatory maze,” which includes overtime expansion, has “reduced opportunities, bonuses, benefits, perks and promotions” ignores the obvious economic benefits of paying millions of American workers for the hours they actually work and that the overtime threshold “has the advantage of simplicity” that makes it efficient for employers to implement.
Media Matters outlined the many ways media should approach his troubled relationship with the truth. If coverage today is any indication, major outlets still have a lot to learn.
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Media figures praised Republican presidential nominee Donald Trump for his speech in Valley Forge, Pennsylvania that briefly touched on health care, calling it a “very, very good speech” focused on the substance of his proposals for repealing and replacing the Affordable Care Act. In reality, Trump’s speech was full of recycled, unworkable Republican proposals that would increase the deficit and leave an estimated 24 million people without health insurance coverage.
Right-wing media are pre-emptively attacking a “public option" health care proposal supported by Democratic presidential nominee Hillary Clinton and President Barack Obama by linking it to supposedly “socialist” single-payer systems that have been routinely demonized through the history of health care reform. Conservative media used this tactic to disparage the public option in 2009 during the legislative debates that created the Affordable Care Act (ACA) and to tap into powerful historical tropes that promote misinformation and misperceptions of the American health care system, stymieing much-needed reform and perverting the public opinion.
The Affordable Care Act has become a major topic of conversation leading up to the election. Right-wing media have manufactured scandals by taking former President Bill Clinton’s comments at an October rally out of context and falsely claiming the newly announced health care marketplace premium increases are evidence of the so-called “death spiral” conservative media have been predicting for years -- despite no evidence the law is in danger of collapsing in on itself. The newest target of right-wing media ire is the public option, a proposal supported by Hillary Clinton and President Obama, which would introduce a low-cost, government-administered health insurance option into the federally run health insurance marketplaces.
The strategy right-wing media are using to scandalize the public option revolves around linking it to the single-payer systems used in countries with socialized medical options, either implicitly or explicitly invoking the specter of “Big Government.” Some media argue that the public option is a “Trojan Horse” to destroy the current private insurer-based market or claim that the public option is just “single-payer on the installment plan.” Others argue that Clinton “ultimately wanted a single-payer ultimate government control system for health care” and thus will eventually “go towards the single payer option” when she “replace[s] Obamacare with Hillarycare.”
If these attacks sound familiar, it’s because they are. The original draft versions of the ACA included a robust public option that Democrats ultimately dropped, partially because it became politically toxic as a result of concerted right-wing media assaults. Prominent right-wing media figures called the proposed public option a “stalking horse” or a “buy in,” arguing that “such a plan will lead to a single-payer system.” Others argued that the key to defeating the public option is “expos[ing] the positive-sounding ‘public option’ for what it truly is: a government grab.” They used the same fearmongering “Trojan Horse” rhetoric that right-wing media use now to play upon distrust of the government. They also actively demonized the public option as a socialist takeover of the health care system -- framing that has significantly impacted public opinion on the ACA and health care policy generally.
But none of this is true. Numerous fact-checkers have debunked the claim that the public option is just single-payer in sheep's clothing or that Clinton secretly wants a single-payer system. The public option is a government-administered health insurance plan that would compete in the insurance markets against private insurance plans, while in a single-payer system, “everyone in the country would have health coverage provided by the government,” according to FactCheck.org. Jonathan Oberlander, a professor of social medicine and health policy at UNC Chapel Hill, noted that “‘single payer’ is often used loosely to refer to everything” and argued that “depicting the Affordable Care Act (ACA) as a ‘slippery slope’ to single payer is bizarre.” Thus, efforts to conflate the two actively spread misinformation and make health care policy even more confusing than it already is for the American public.
This practice of scandalizing the public option in an effort to torpedo reform efforts is particularly problematic since the ACA does need reforms. Clinton and Obama both acknowledge the necessity of reforming the ACA to address fundamental issues about affordability and competition in the marketplaces. Recognizing that there are issues with the ACA does not mean the law is failing. However, purposefully stigmatizing a substantive proposal for reforming the current health care system is particularly troubling since Republicans have yet to produce a viable alternative to replace Obamacare. Americans remain seriously uninformed about health care policy, and the media shouldn’t allow conservative media myths to demonize a potentially productive reform before the public even has the chance to properly learn about it.
Reports that benchmark health insurance premiums will increase by an average of 25 percent from 2016 to 2017 for plans purchased on Healthcare.gov marketplace exchanges have prompted right-wing media outlets to claim the price hike is proof of “the collapse” of the Affordable Care Act (ACA) and evidence of a so-called Obamacare “death spiral.” In reality, the majority of individual insurance customers will be insulated from cost increases due to proportional increases in the health care subsidies, and these premium increases are still in line with anticipated health care costs initially predicted by the Congressional Budget Office (CBO).
Trump States “I Don’t Use Much Obamacare” Minutes After Claiming, “All Of My Employees Are Having A Tremendous Problem With Obamacare”
During a phone interview with Fox News, Republican presidential nominee Donald Trump claimed that his companies “don’t use much Obamacare” just minutes after publicly stating that “all of [his] employees are having a tremendous problem with Obamacare.” The contradiction went unnoticed at Fox, which allowed the GOP nominee to peddle misinformation about the law’s supposed impending demise.
The Affordable Care Act, also known as Obamacare, was thrust into national headlines on Monday after the Obama administration confirmed double-digit premium increases on average for insurance plans sold on Obamacare’s online marketplace at Healthcare.gov for 2017. This will raise the average cost for a “Silver” plan, which is the benchmark that Obamacare subsidies are calculated for, to $3,552 annually, before subsidies are applied (the vast majority of enrollees receive substantial subsidies). As MSNBC’s Ali Velshi explained today, this premium level is consistent with the Congressional Budget Office’s 2009 analysis of future rates.
Trump made a series of false claims about the ACA during the interview that went unchecked by Fox anchor Bill Hemmer, including touting the benefits of repealing and replacing Obamacare (there is no replacement plan), calling the average figure for premium increases of 25 percent a “phony number,” praising the benefits of health savings accounts (they’re widely criticized by health experts as an insufficient replacement for insurance), and denouncing Obamacare for killing jobs (it doesn’t).
Perhaps most perplexing was Trump’s claim that he doesn’t “use much Obamacare” when numerous reporters confirmed that Trump claimed “all of my employees are having a tremendous problem with Obamacare” during a rally in Doral, Florida, just before the Fox interview.
Trump: "All of my employees are having a tremendous problem with Obamacare."
— Reid J. Epstein (@reidepstein) October 25, 2016
Trump at his Doral property: "All of my employees are having a tremendous problem with obamacare" pic.twitter.com/5hA9raeguR
— Ashley Killough (@KilloughCNN) October 25, 2016
Trump in Doral: "Obamacare is blowing up." "All of my employees are having a tremendous problem with Obamacare."
— Patricia Mazzei (@PatriciaMazzei) October 25, 2016
While right-wing media and Trump tend to focus on exaggerating the troubles of the health insurance exchanges, those marketplaces represent one part of the ACA, which includes vital consumer protections and mechanisms to improve care quality while lowering costs. Trump’s flip-flop on whether or not he “uses” Obamacare is particularly baffling, since the Employer Shared Responsibility Provision of the ACA (also known as the employer mandate) “penalizes employers who either do not offer coverage or do not offer coverage which meets minimum value and affordability standards.” So either his employees do have “a tremendous problem with Obamacare,” which means he doesn’t provide health benefits for his employees since his businesses would qualify as “large employers,” or he doesn’t “use much Obamacare,” which still means his businesses do provide insurance and thus are complying with the law. Either way, Trump’s inconsistent claims about Obamacare and Fox’s decision to not push back on his plethora of misinformed claims about the ACA reveals their fundamental misunderstanding of the Affordable Care Act as a whole.
Watch the full interview from the October 25 edition of Fox News’ America’s Newsroom:
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Republican presidential running mates Donald Trump and Mike Pence took former President Bill Clinton’s comments about Obamacare out of context to claim he “absolutely trashed” Obamacare in recent remarks. Numerous media outlets noted that Clinton’s statements on improvements necessary to the Affordable Care Act (ACA) are actually “referring to the same central challenge” that President Barack Obama and Democratic presidential nominee Hillary Clinton want to address.
Republican vice presidential nominee Gov. Mike Pence and Democratic vice presidential nominee Sen. Tim Kaine (D-VA) will face off on October 4 in a debate at Longwood University in Farmville, VA. As media outlets prepare for the only vice presidential debate of the 2016 election, they should have all facts about how Indiana really fared during Pence’s governorship.
Republican presidential nominee Donald Trump’s penchant for promoting right-wing media myths and other misleading claims presents a unique challenge heading into the first presidential debate of the general election. If the September 26 debate is anything like the opening debates of 2008 and 2012, it will focus heavily on issues relating to the American economy, and both moderator and audience should be prepared for a torrent of misinformation from the GOP standard-bearer.