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National Coverage: media messaging trends from the ACA rollout

Charlie Plain | July 23, 2014

History was made this year when more than 8 million Americans became the first to sign up for health insurance via the Affordable Care Act (ACA).

MNsure, Minnesota's ACA program, advertised its insurance products with commercials featuring Paul Bunyon.
MNsure, Minnesota’s ACA program, advertised its insurance products with commercials featuring Paul Bunyon.

Many of those people learned about the legislation through an onslaught of local television commercials and news programs during the first weeks of its rollout in early October, 2013.

The media barrage spurred School of Public Health professor Sarah Gollust to wonder what kinds of ACA-related ads and news stories local media markets showed and how they might have influenced decision-making.

The first phase of her research is now complete. Her study, “First Impressions: Geographic Variation in Media Messages During the First Phase of ACA Implementation” in the Journal of Health Politics, Policy and Law, reveals that, across the nation, advertising and media coverage varied dramatically in volume, content and tone. In fact, coverage itself ranged from seemingly constant to oddly—almost blatantly—non-existent.

“Depending on where you live and watch TV, your exposure to news and information regarding the ACA may have been very different,” says Gollust.

What’s on TV
Gollust partnered with the Wesleyan Media Project, known for tracking advertising and news coverage for political campaigns, to conduct the study. The group took part in this research to branch out into public health policy issues.

Data for the study were collected during the first two weeks of the ACA rollout. During that period, the Wesleyan Media Project–with participation from Gollust and collaborators at Cornell University and Johns Hopkins University–counted and analyzed the content and tone of ACA-related advertisements, political spots and news stories from each of the nation’s 210 major media markets. News stories were sampled from two stations in each market during the most watched half-hour of local news.

“We looked at markets as small as Duluth and as large as New York City,” says Gollust.

Mostly negative ads, mostly positive stories
The analysis of the local broadcasts showed that collectively 309 distinct ads promoting ACA insurance programs were aired more than 44,000 times. The ads typically came from state marketplaces, federal agencies, insurance companies and brokers.

Viewers also saw 17 individual political ads a total of 1,978 times.

“The political ads were nearly all negatively toned ads,” says Gollust. “And some parts of the country were exposed to a very high volume of negative information about the health exchange and the ACA in general.”

News, however, presented a more upbeat story.

Local television stations aired 1,286 ACA-related stories during the initiative’s infamously rocky rollout. At that time, the unveiling of enrollment was marred by website glitches and failures that made it difficult to impossible for people to sign up for coverage.

“Given that healthcare.gov wasn’t really working and a lot of the states had big problems, you’d expect that the predominant story tone would be discouraging, but that’s actually not what we found,” says Gollust.

On the contrary, they found that 79 percent of local news stories conveyed partly or completely encouraging information about the new health insurance marketplace.

Even so, Gollust discovered some big differences in the tone of ACA news coverage, even in the same state.

An example is the case of Lubbock and Tyler, TX, which are about 450 miles apart. Both cities received similar amounts of coverage, yet the tone of Tyler’s news was strongly discouraging, while Lubbock’s stories were mainly encouraging.

Next round
Gollust and her team plan further research to discern the ways in which things like varying news story tone may have influenced people’s attitudes and decision to sign up for insurance.

“Ultimately, I’m very interested in seeing is how the local media coverage for the ACA matches with enrollment patterns,” says Gollust. “Examining the media’s impact on enrollment could offer important insight and the people assessing how well the ACA is meeting its benchmarks should be interested in this, too.”

~ Post by Charlie Plain

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