Senate Republicans on July 25 voted to start debate on a health-care bill as Sen. John McCain (R-Ariz.) urged senators from both parties to work together. (Bastien Inzaurralde/The Washington Post)

Senate Republicans voted Tuesday night to open debate on repealing and possibly replacing the Affordable Care Act — the first iteration of which promptly stumbled on procedural grounds.

But does any proposal have enough support to pass?

The ACA repeal was always going to be a tough, uphill battle in the Senate, as we explained here in May. The stakes are high — both for the millions of Americans who now have insurance through Obamacare, and for the Republican Party that promised to repeal it.

Senate efforts have failed so far for a variety of reasons. But here’s one that hasn’t yet been explored: local television news. That drumbeat of coverage in their home districts during Senate debates may have made some GOP senators think twice about angering constituents — including those of their own party.

Here’s how we did our research

Most Americans get the largest part of their information about health policy from the news media. Despite the broad political attention to national and cable broadcast outlets, local television has larger audiences and has been cited as an influential source.

We have been tracking local television news coverage of health-care reform in all 210 media markets across the United States since the American Health Care Act was unveiled in early March. We’ve done this by searching a database of the closed captioning for all evening local television news broadcasts (from 4 p.m. to midnight) on local stations affiliated with the four major networks (ABC, CBS, NBC and Fox).

We search for key words used in the closed captioning of local broadcast news, including various spellings of and references to Obamacare, ACA, AHCA, Trumpcare, health reform or health insurance. We have removed multiple hits within programs, and plotted the cumulative total of newscasts with keyword hits for all weekdays in the figure below.

Here’s how local media attention to health-care reform may have made a difference 


Evening local television newscasts mentioning 2017 ACA repeal efforts

Local television news discussed health-care reform extensively between the day that House Republicans first revealed details about the American Health Care Act and March 24, the day that Speaker Paul D. Ryan (R-Wis.) told the president that they didn’t have the votes to pass the bill. When the AHCA was revived with newly proposed amendments in late April, coverage picked up again, jumping on May 4, when the House passed the bill.

Our hunch is that local TV covered the ACA and the AHCA quite differently. When we did an in-depth analysis of 2013-2014 ACA news coverage, we found that local TV was more likely to focus on political conflict and its winners and losers than on the policy details of the law.

While we have not yet conducted that careful analysis on AHCA coverage, we expect that it has been different. For one, the AHCA sought to change some of the most popular (and not previously well-covered in the news) ACA provisions, like a ban on denying health insurance because of preexisting conditions and minimum coverage requirements for all health insurance plans.

If our hunch is right, and local media drew attention to what might be lost — which they could do even without changing the focus on winners and losers — then that would help explain why the ACA has grown more popular, and the AHCA less so, the more citizens learned what one did, and the other would not contain. Something similar may well have happened with Medicaid, which was featured rarely in the first round of stories about the ACA in 2013-2014, but which likely got much more attention once both the House and Senate proposed to cut it significantly.

Once the Senate picked up the repeal legislation, a small group of senators drafted the bill behind closed doors — in what may have been an effort to quiet the news coverage that was prompting the public to pressure legislators. If the move was strategic, it largely worked.

As you can see in the figure above, local television news rarely referred to Senate deliberations during this period — much as it rarely covered the bill while it was quiescent in the House, after Ryan pulled the first vote and Congress was in recess. When the Senate bill’s details were finally unveiled June 22, local TV newscasts started reporting on legislative developments, only taking a break from coverage on July 4.

To put the difference in coverage into context, we have graphed the average number of weekday, evening newscasts with mentions in the month before and after the Senate bill was unveiled, as you can see below.


Average count of evening local TV newscasts mentioning ACA repeal before and after Senate bill unveiled

As you can see, the number of local television newscasts mentioning health reform jumped dramatically after the Senate bill’s details were unveiled. That was even more true — with upward of five newscasts an evening containing mentions — in states represented by key Republican senators like Susan Collins of Maine, Shelley Moore Capito of West Virginia or Dean Heller of Nevada usually considered to be swing votes. That’s a lot of coverage for local newscasts that usually don’t focus much on national affairs.

Of course, we do not know yet precisely how local TV covered the Republican repeal and replace effort. But a look at the drop in public approval of efforts to repeal the ACA suggests that local TV coverage cannot have made things easier for wary GOP senators. On the one hand, they face a public that largely disapproves of the proposed repeal; on the other, they made campaign promises that may come back to haunt their reelection chances.

Whatever happens in the coming days or weeks, the ACA repeal debate will surely keep showing up prominently in news coverage. Journalists will be digesting the results. And then discussion of the ACA will return in yet another medium that matters: the political advertising campaigns leading up to the 2018 elections.

Erika Franklin Fowler is associate professor in the department of government at Wesleyan University and co-director of the Wesleyan Media Project. She specializes in political communication, examining the content and effect of local media messaging in electoral and health policy environments.

Sarah E. Gollust is associate professor in the division of health policy and management at the University of Minnesota School of Public Health. Her research interests are in the politics of health policy, particularly the role of the media and public opinion in shaping the health policy process.