When Republicans’ Senate health care bill looked like it was hurtling toward a vote two weeks ago, prime-time cable news largely neglected to cover several negative consequences of the bill and instead spent a disproportionate amount of time on the political process surrounding the legislation.
Media Matters reviewed the two nights of cable news coverage -- from 5 to 11 p.m. -- between the release of the Congressional Budget Office’s (CBO) score of the Better Care Reconciliation Act of 2016 (BCRA) and Senate Majority Leader Mitch McConnell's (R-KY) announcement that the bill would be temporarily tabled until after congressional recess. We analyzed Nexis transcripts for individual statements -- defined as a single sentence -- about a wide range of reported negative impacts of the bill (including cuts to Medicaid funding, potential cuts to essential health benefits (EHBs), and a one-year freeze in federal funding for Planned Parenthood) and compared those to statements about the process surrounding the potential vote on the bill. We also reviewed coverage to see whether it included personal stories about people who would be impacted by the bill.
During those two nights of coverage -- when media outlets were under the impression the bill was imminently coming up for a vote and potentially taking a major step toward becoming law -- process overwhelmed policy:
CNN, MSNBC, and Fox News made more than four times as many statements about process as they did about the negative impacts of the bill.
There were over 33 times more statements about process than personal stories of those who would be most affected by the law.
None of the three networks featured statements about potential cuts to mental health benefits, special education programs, or the negative impact of the proposed legislation on people with HIV.
While the process surrounding the bill is a crucial part of the discussion (McConnell intentionally kept the drafting process secret and has been trying to rush the bill through the Senate), the extent to which process discussion eclipsed coverage of the impacts of the bill was staggering. On Fox News, the ratio between statements about process and statements about the negative impact of the bill was roughly 10-to-1, while on MSNBC and CNN, that ratio was nearly 5-to-1.
Cable news made over 1,800 statements about process
Over the two-day period, prime-time cable news made 1,835 statements about the process of passing the bill through the Senate. CNN made 792, Fox News made 274, and MSNBC made 769.
There were no statements on any network about cuts to special education programs in public schools
CNBC reported that out of approximately 11.2 million children in the U.S. who have special needs, “nearly 5 million rely on coverage from Medicaid and its Children’s Health Insurance Program, according to the Kaiser Family Foundation.” The BCRA’s cuts to Medicaid, made by phasing out the ACA’s Medicaid expansion program, threaten the funding for this program. The Washington Post noted trepidation among school districts that say that in order “to fill the hole they anticipate would be left by the Republican push to restructure Medicaid, they would either have to cut those services or downsize general education programs that serve all students.” There were no statements made about these cuts on CNN, Fox News, or MSNBC.
There were no statements on any network about cuts to mental health treatment
Cuts to Medicaid and a rollback on essential health benefits (EHBs) means that people with mental illness would be receiving “less coverage for more money,” according to HuffPost. As the Center for American Progress (CAP) noted, “The CBO’s prediction matches the reality of the pre-ACA insurance market,” when “a significant number of people did not have coverage for … mental health services.” There were no statements about these cuts on CNN, Fox News, or MSNBC.
MSNBC aired no statements about the one-year freeze on federal funds to Planned Parenthood
The GOP Senate bill called for freezing federal funds to Planned Parenthood for one year, blocking access to family planning and related women’s health services that the clinics offer to millions of Americans. Defunding Planned Parenthood on a state level has had detrimental effects on public health. When Indiana shuttered five Planned Parenthood facilities -- at least one of which did not offer abortion services -- in 2015, the state experienced “an unprecedented HIV epidemic caused by intravenous drug use” due to a lack of access to preventative and testing measures. In Texas, after cuts to Planned Parenthood funding, fewer women “received contraceptive services, fewer use highly effective methods, some have had unintended pregnancies, and some have had abortions they would not have had if not for these policies." There were nine statements about this freeze on CNN and two on Fox News. There were no statements about it on MSNBC.
There were no statements on any network about the detrimental impact on those with HIV
Three members of the Presidential Advisory Council on HIV/AIDS (PACHA) resigned in the wake of the proposed Senate bill. One of the former members, Scott Schoettes, told BuzzFeed News that the bill will “kill people” and force more Americans into bankruptcy due to high medical emergency costs. The National Minority AIDS Council (NMAC) condemned the bill, calling it “catastrophic for our nation’s health care system,” specifically by causing people living with or at risk of HIV and STDs to suffer and by impeding efforts to end the HIV and STD epidemics. There was no statement made about this impact on CNN, Fox News, or MSNBC.
Statements about increases in premiums for low-income people were scarce
As CBS reported, the CBO found that “for low-income people ... ‘the premium for a silver plan would typically be a relatively high percent of income,’ while the deductible for a bronze plan ‘would be a significantly higher percentage of income. As a result, despite being eligible for premium tax credits, few low-income people would purchase any plan.’” Vox noted that this would result in “making poor people pay more for less health insurance.” Additionally, The Washington Post pointed out that “by adjusting subsidy numbers and implementing policies that are projected to increase premiums, low-income people by and large end up with higher health-care costs.” There were seven statements made about these increases on CNN, one on Fox News, and five on MSNBC.
Fox News and MSNBC did not mention potential cuts to essential health benefits
The Senate bill “allows states to use a waiver to opt out of covering the essential health benefits package” that was put in place by the ACA, The Washington Post reported. The ACA provision requires insurers to cover things such as ambulatory care, hospital visits, and maternity care. Vox explained that in order for a state to opt out of a certain essential health benefit requirement under the ACA, it “has to show that its alternative plan would allow it to cover as many people, with coverage as generous, without increasing federal spending.” But the Senate bill “removes the guardrails that ensured state-based alternatives would offer strong coverage.” Without these standards, many patients “are likely to drop their coverage,” which, as one health care expert noted, would not serve to reduce costs because cost burden would shift entirely to the individuals who need the coverage. CNN made two statements about these cuts, and Fox News and MSNBC made zero.
CNN and Fox News each aired only one statement about the Senate bill’s impact on patients with pre-existing conditions
As The Atlantic pointed out, decreasing the requirements that a state must meet to waive coverage for essential health benefits would create a “backdoor way” to discriminate against people with pre-existing conditions. Los Angeles Times columnist Jon Healey wrote that, while the bill does not “directly” remove coverage for pre-existing conditions, it “would leave” those with pre-existing conditions “open to indirect attack by state officials eager to cut insurance premiums the easy way: by allowing insurers to cater to the customers they really want to serve, which are the ones who don’t need healthcare.” As CAP’s Topher Spiro summed up, under the Senate bill, “coverage would be eviscerated for millions of people with preexisting conditions.” There was one statement about these impacts on CNN and one on Fox News, and there were seven on MSNBC.
Fox News didn’t mention cuts in funding for substance abuse treatment
Time reported that if the Senate bill’s proposed changes to state essential health benefits waivers were implemented, “insurers may not continue to cover … out or inpatient substance use disorder services.” And while the BCRA “offer[s] $2 billion in funding to help combat the ongoing opioid epidemic,” lawmakers and activists for addressing substance use disorders have said that “much more money is needed”; one health economics professor told Mother Jones that the opioid epidemic funding allocation is merely “a joke.” Mother Jones also pointed out that slashes to Medicaid, which is “the largest payer for addiction services across the country,” would be “crippling,” particularly “for many of the communities that voted Trump into office.” CNN made 13 statements about these cuts, and MSNBC made nine. Fox made none.
Fox News made just two statements about the bill's major tax cut for the most wealthy
PBS reported that under the Senate bill, the wealthiest Americans will receive an average annual tax cut of nearly $52,000, according to analysis by the Tax Policy Center. The bill would repeal the Obama-era tax on wealthy investors, as well as repeal a Medicare payroll tax on high-income families. There were 20 statements about these tax cuts on CNN, two on Fox News, and 22 on MSNBC.
Cable news aired only a handful of statements about the bill's potential to reinstate lifetime caps on coverage
NPR reported that the Senate bill “could even bring back lifetime caps on how much an insurer would pay for such services for a particular patient.” According to an estimate by CAP, “About 20 million people with employer-based coverage would face lifetime limits on coverage.” There was one statement about these caps made on CNN and there were five on MSNBC. There were no statements made on Fox News.
Fox News made only four statements about cuts to Medicaid
The CBO report projected that the Senate health care bill would cut $772 billion in federal money from Medicaid over a 10-year period. Between 14 and 15 million people would reportedly lose their health insurance under this drastic cut. According to CAP, under the Senate bill, “many states would face serious funding shortages for their Medicaid programs.” There were 58 statements about these cuts on CNN, four on Fox News, and 54 on MSNBC.
Fox News made only 15 statements reporting that millions more would be uninsured under the Senate bill
According to the CBO report, under the Senate bill, the number of people without health insurance would increase by 22 million over the next 10 years. There were 66 statements made about the increase in uninsured people on CNN, 15 on Fox News, and 67 on MSNBC.
Media Matters searched news transcripts in the Nexis database on CNN, Fox News Channel, and MSNBC for the following programs: CNN’s The Situation Room, Erin Burnett Outfront, Anderson Cooper 360, and the 10 p.m. hour of CNN Tonight; Fox News’ The Fox News Specialists, Special Report with Bret Baier, The Story with Martha MacCallum, Tucker Carlson Tonight, The Five, and Hannity; and MSNBC’s Meet the Press Daily, For the Record with Greta Van Susteren, All In with Chris Hayes, The Rachel Maddow Show, and Last Word with Lawrence O’Donnell. We searched for any of the following terms in the body of the text: health care, Better Care Reconciliation Act, BCRA, Senate health, GOP health, Republican health, Affordable Care Act, ACA, Obama care, or Obamacare.
Segments were included in the study if the Better Care Reconciliation Act was the stated topic of discussion or if two or more speakers in a multitopic segment discussed the BCRA with one another. If a speaker mentioned the BCRA in a multitopic segment and no other speaker in that segment engaged with the comment, then it was excluded from the analysis as a passing mention. All teasers of upcoming segments about the BCRA were also excluded from the analysis.
For each segment we included in the study, two researchers independently coded the number of statements -- defined as a single sentence -- that included:
Mentions of a personal narrative that contextualized how the BCRA would impact the subject of the narrative.
Mentions of the process, e.g., how the bill would pass, how members of the Senate would or would not vote, how Senators would negotiate for votes, the optics of the bill, and anything that could influence a Senator’s vote for or against the BCRA.
Mentions of the following negative impacts of the BCRA:
Mentions of cuts to Medicaid.
Mentions of the increase in premiums or out-of-pocket costs for low-income Americans.
Mentions of the potential elimination of essential health benefits.
Mentions of the impact of persons with pre-existing conditions.
Mentions of potential cuts to mental health care.
Mentions of cuts to substance abuse treatment.
Mentions of how cuts to Medicaid would impact special education programs in schools.
Mentions of cuts to Planned Parenthood.
Mentions of the impact of the BCRA on persons with HIV.
Mentions that the BCRA would provide significate tax cuts to wealthy or high-income Americans.
Mentions that the BCRA would allow insurers to reinstate lifetime caps.
Mentions of the reduction of the total number of insured Americans.