VIDEO • Tracing the origins of Obamacare confusion: Study highlights role of ‘politicized’ local TV news coverage

Michael Joyce is a multimedia producer for He tweets as @mlmjoyce

During the first open enrollment for the Affordable Care Act (ACA; also called “Obamacare”) back in 2013-2014 most people were getting information regarding the law’s health insurance options from local television news, but that news coverage was highly politicized and rarely included information consumers needed to make an informed choice. A study published today in the  American Journal of Public Health shows many of the sources interviewed had clearly defined political affiliation which may have contributed to news stories with ” a ‘horse race’–focused journalistic style … with an emphasis on who is winning or losing.”

During those critical early days of rolling out the ACA, roughly 10 million Americans signed up for health insurance through state and federal marketplaces, or through expansion of Medicaid offerings in 24 states. Researchers at the University of Minnesota School of Public Health, led by Dr. Sarah Gollust, analyzed over 1500 newscasts from about 200 major U.S. media markets, specifically looking for health-related content that might be of use to consumers or potential enrollees. She discusses the motivation, findings and implications of the study in this video:

Major Findings

  • About 1 in 4 stories focused exclusively on the politics of the ACA and did not provide information regarding health insurance options.
  • Roughly 45 percent focused entirely on the health insurance options available through the ACA.
  • Nearly 30 percent presented a mixture, looking at both politics and health insurance options.
  • Among stories that did mention health insurance products (in whole or partly):  about one-third provided factual information regarding enrollment, about one-third focused on glitches at sign up websites, and about 25 percent mentioned the number of enrollees to date.
  • less than 10 percent of news stories mentioned Medicaid expansion or subsidies.
  • Over 40 percent of sources had a clearly identified political affiliation.

The media angle


Dr. Sarah Gollust • University of Minnesota – School of Public Health

“It boiled down to the substance of the law versus strategy,” says lead researcher Gollust. “How much of the coverage was about the policy or public health substance that would actually help consumers … versus … the amount of coverage that was political or strategic in a ‘horse-race’ sense of winners and losers?”

In other words, for proponents of the Affordable Care Act ‘winning’ would be suggested by stories highlighting growing enrollment numbers, while ‘losing’ would be reflected in stories focused on glitches at sign up websites (ie, the federal site or state marketplaces). The research finding that over 40 percent of sources used in the broadcasts had clear political affiliation suggests that a key editorial decision – who should we interview for this story? – may have had a polarizing influence in framing people’s perceptions of the merits of the ACA. Since most Americans did not participate in ACA coverage, their first impressions regarding whether it was a good or bad law most likely came from media coverage, not personal experience.

The issue of public perception takes me back to a national survey conducted by Stanford University researchers in the early days of the ACA  (2010 & 2012). Some notable findings were:

  • “Most people have favored most of the elements of the ACA that we examined, but not everyone recognized that these elements were all in the plan.”
  • “Most people opposed policies that were sometimes falsely thought to be parts of the ACA.”
  • “If the public had perfect understanding of the elements that we examined, the proportion of Americans who favor the bill might increase from the current level of 32% to 70%.”

At that time, the Stanford authors concluded: “Taken together, all this suggests that if education efforts were to correct public misunderstanding of the bill, public evaluations might increase considerably in favorability.” Taking this in the context of the findings of Gollust and her colleagues raises an important question: can we count on the media – in particular, TV news – to play a role in enhancing understanding – or correcting misunderstanding – of the ACA?

The University of Minnesota study would suggest not.

“We were surprised that two of the more important aspects of the law were the least covered,” said Gollust. “The availability of subsidies (financial assistance for premiums and cost-sharing) and the Medicaid expansion were both key in extending coverage but were both covered in only about 7 percent of the stories. Contrast that with just over half of the stories covering at least some or all of the political disagreement over the law. Questions of repeal and replace that we’re talking about today were already being mentioned in news stories as early as 2013.”

Here is an example from KGW News 8 in Portland, Oregon in which the sole source is the Democratic Governor clearly downplaying website glitches in favor of highlighting the party talking points of increasing enrollment and expanded coverage. In line with the study results, the basic gist is clearly political rather than consumer-oriented.


Gollust and colleagues point out there are some limitations of their study. First, and perhaps most notable, is focusing solely on local TV news to the exclusion of other popular media. Secondly, the inherent subjectivity and variability of using over 30 coders to screen media content for keywords. Finally, one can not conclude from a descriptive study such as this that mere exposure to news stories directly equates to effects on viewer’s opinions.

This study gave me pause to consider: If it is true that most people do NOT understand the Affordable Care Act … and if it’s true that most people relied upon the abbreviated sound bites of nightly news to get their information … and that information was usually incomplete and presented with political spin … then it is highly likely that from the very beginning, the public perception and ultimate fate of what we now know as Obamacare, was predicated on political strategy rather than evidence.

Something that should make us all ask in the coming months: do you know what you are replacing and with what exactly?

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Comments (1)

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Rob Oliver

February 16, 2017 at 11:32 pm

The biggest thing that the media failed to cover at the time was that there was NO plausible funding mechanism established for the ACA. The administration and Congressional Democrats flat out lied on this to get a bilateral (any bill) through by party line vote, hoping that the details would get sorted out down the road. It was a very cynical political moment, that is now being realized with an actuarial crippled program collapsing under its own weight.