Reprinted with permission from Media Matters for America.
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 Mattersstudy 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.
1. Passage Of The ACA Has Resulted In The Lowest Uninsured Rate In Recent History
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.
These gains would be reversed and the uninsured rate would surpass 2010 levels if the ACA is repealed.
2. The ACA Medicaid Expansion Provided Health Care Access For Millions Of The Most Vulnerable Americans
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.
Conversely, proposals to repeal the expansion or reform Medicaid into block grants would gut coverage for at-risk populations and strip insurance coverage from millions of Americans.
3. The ACA Tangibly Improved Women’s Health Care Coverage
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.
4. The ACA Helped America Take Huge Steps Toward LGBTQ Equality
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.
5. Contrary To Popular Belief, The ACA Extended The Solvency Of Medicare By Over 10 Years
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.
6. The ACA Reduced The Budget Deficit, Reined In Medical Costs, And Reduced Economic Inequality
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.
Repeal of the ACA will remove vital checks on health care costs and explode the budget, adding billions of dollars to the national debt over the next 10 years.
7. The ACA Improved Health Care Access For Minority Communities.
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.
Repeal of the ACA would significantly increase the number of uninsured people in minority communities and undo the gains made in reducing health disparities thus far.
8. The ACA Banned Discrimination Against Those With Pre-Existing Conditions
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.
9. The ACA Provided Crucial Insurance To Young Adults
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.
10. The ACA Resulted In The Biggest Expansion Of Mental Health Care Services In Decades
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.
