Association for Public Policy Analysis & Management

Discussion of the politics of ACA implementation usually centers around the national-level discourse, considering implementation a “success” or “failure” overall. However, the fact that the ACA’s implementation is inherently local often gets overlooked in academic and policy discourse about the ACA. Individuals in different insurance markets faced dramatically different insurance prices and plans available. They also received very different media messages about ACA implementation as it was happening. The purpose of this paper is to examine the content of local television news media reporting on the ACA during the first open enrollment period. We created a sampling frame of news covering the ACA through closed caption keyword hits of ACA-relevant words that appeared from October 1, 2013 to April 15, 2014 in the top two highest-rated evening news broadcasts in all 210 U.S. media markets. The searches yielded 150,534 hits, and then we created a sample for analysis by pulling a constructed week of coverage per month over the 6-month period, which led to a sample of 1569 news stories. We developed and applied a coding instrument to capture story tone, messages about the law, and sources cited for their expertise and/or opinion.

Overall, coverage of the law was more encouraging than discouraging, although tone varied over time and across media market. Messages about the law tended to focus on the “horserace” of enrollment (20.5%) to date or glitches in the marketplaces (25.8%), as much as all policy-relevant information combined (such as fines, subsidies, existence of navigators, how to enroll) (27.2%). Fewer than 10% of stories provided a narrative about people actually helped or harmed (with no differences in the proportion helped or harmed), and only 7% of stories mentioned Medicaid whereas for 5% it was a focus of the story.  Few differences in coverage existed between states running their own marketplaces versus the federally-facilitated marketplaces. News coverage provided more policy-relevant information in the second half of open enrollment. The most common sources cited in coverage were political officials (cited in between 22% to 65% of news stories, depending on the story type); health care professionals and health advocates were cited in less than 10% of all stories. Research findings and researchers were cited in less than 5% of news stories.

Our results show that the political journalistic style of covering campaigns persisted throughout news coverage of ACA implementation. This is consistent with general norms of journalism, but raises questions about the politics of policy implementation when implementation activities and public perceptions thereof are inconsistent.