Anti-choice lawmakers in Congress just voted to make abortion care even more inaccessible in the United States -- and the media should be reporting on the potential consequences of their efforts.

The day after President Donald Trump issued an executive order to reinstate prohibitions on U.S.-funded nongovernmental organizations from even mentioning abortion services to their international patients, 235 Republicans and three Democrats in the House of Representatives voted to further block domestic abortion access by making the Hyde Amendment permanent.

The Hyde Amendment is a longstanding budgetary rider that has barred the use of federal Medicaid funds to cover abortion care, except in cases of rape or incest, or to save the mother’s life. Nevertheless, right-wing media and anti-choice politicians have long called for further action to prevent taxpayers from funding abortions.

If the “No Taxpayer Funding for Abortion and Abortion Insurance Full Disclosure Act of 2017” (HR 7), now passes the Senate, it would do more than extend the current restriction; it would also make the rule stricter and more harmful than ever. Media should be taking note.

While some outlets such as Cosmopolitan, New York magazine, and Broadly have prominently highlighted HR 7’s negative impacts in their headlines -- emphasizing its disastrous consequences for low-income and already marginalized communities -- outlets like CNN, Fox News, and Buzzfeed have framed their coverage around the argument that the bill would prevent federal abortion funding. Here’s what they’re missing:

1. The Hyde Amendment Would Now Be Permanent (And More Expansive) Law

The Hyde Amendment was passed in 1977 and has since been extended as a budgetary rider to Medicaid appropriations bills. In practice, this has meant the House has had to vote to apply the rider to every funding bill. If HR 7 becomes law, anti-choice politicians would eliminate this step in the process and make the Hyde Amendment an automatic funding restriction that can be reversed only via future legislation.

Plus, as permanent law, the ban would apply to more than just federal Medicaid funds. As Mother Jones explained, HR 7 also prohibits federal funds from contributing to any “health benefit plans that include abortion coverage.” Unlike in previous iterations of the Hyde Amendment, this version creates penalties for even private insurance plans obtained through non-religious companies that cover abortion care.

As the Huffington Post reported:

The bill also provides incentives for private health insurers to drop abortion coverage, bans abortion coverage in multi-state health insurance plans except in cases of rape, incest, or life endangerment, and denies women and small businesses tax credits if they choose health plans that cover abortion.

2. Abortion Providers And Public Facilities Would No Longer Be Able To Support Abortion Services

In addition to targeting insurance coverage for abortion care, HR 7 also prohibits federally owned or operated facilities and federal employees from providing abortion services:

“No health care service furnished—

“(1) by or in a health care facility owned or operated by the Federal Government; or

“(2) by any physician or other individual employed by the Federal Government to provide health care services within the scope of the physician’s or individual’s employment, may include abortion.

The impact of the Hyde Amendment has previously been felt by anyone dependent on federally subsidized medical care, including service members or veterans. By expanding the restriction to include prohibitions on federally owned or operated facilities and providers, the bill’s authors have substantially curtailed the number of available care options for these populations. The Guardian explained:

The bill would also convert a slew of existing, provisional bans on abortion coverage into permanent law. These include bans on abortion coverage for women on federal insurance, such as many Native American women, women in the Peace Corps, in federal prisons, or those enrolled in Medicare or the Children’s Health Insurance Program, and prohibit the city of Washington DC from using its own local funds to subsidize abortion services.

3. Low-Income And Marginalized Communities Were Already Disproportionately Impacted

The Hyde Amendment has already created a significant barrier to accessing abortion care for low-income patients and those from marginalized communities. Given the number of economic and logistical barriers patients already face in trying to access abortion, the Hyde Amendment adds an additional and unnecessary complication to what is normally a safe procedure.

In a statement to Refinery29, Destiny Lopez, the president of All* Above All -- a coalition of reproductive rights activists -- explained the dire consequences of HR 7 for low-income patients. She said:

"Already, too many women are denied abortion coverage because of how much they earn: HR 7 is cruel and callous legislation that would make these discriminatory bans permanent law … This is all part of the Trump-Pence agenda to punish women.”

Beyond low-income patients, women of color -- especially black women, Latinas, and American Indians -- suffer a particularly disparate impact from the Hyde Amendment's restrictions.

4. Blocking Abortion Access Doesn’t End Abortion -- It Just Makes It Less Safe

Abortion is one of the safest and most common medical procedures. By making abortion care less accessible, anti-choice lawmakers don’t decrease the number of abortions -- they make abortion care overall less safe.

According to the American College of Obstetricians and Gynecologists, “Where abortion is legal, it is extremely safe. … In contrast, historical and contemporary data show that where abortion is illegal or highly restricted, women resort to unsafe means to end an unwanted pregnancy.”

* Image courtesy of Sarah Wasko

News outlets rushed to report on President Donald Trump’s executive order on the Affordable Care Act (ACA) without knowing what exactly it entailed, resulting in botched headlines that uncritically repeated the false claims made by the Trump Administration.

Late on Friday night, Press Secretary Sean Spicer announced that Trump had signed his first executive order on the ACA claiming that it would “ease the burden of Obamacare as we transition from repeal and replace.” Even before the official text of the executive order was released, reporters rushed to file stories with wildly inaccurate headlines such as Politico’s “Trump signs sweeping order that could gut Obamacare” and The Washington Post’s “Trump signs executive order that could effectively gut Affordable Care Act’s individual mandate.” Others just uncritically repeated Spicer’s framing, like NPR’s headline “Trump Signs Executive Order To 'Ease The Burdens Of Obamacare'.”

In contrast to headlines suggesting an immediate, dramatic change to the ACA, the text of the executive order reveals that it amounts to a symbolic gesture indicating the dedication of the Trump Administration to dismantling the health care law -- a commitment already known, and one that Trump’s appointees could act on even without the order. These inaccurate headlines are the newest episode in a repeated pattern of news organizations failing to report the truth when covering Trump’s false and self-serving talking points.In the health care context, this pattern is particularly problematic given the massive impact of repealing the law and the degree to which Americans are uninformed about health care.

These headlines falsely inflated the actual impact of the executive order even as the substance of many of these articles emphasized that the vague wording of the action cast doubt on its actual effects. For example, that same NPR article noted “it's not clear what kind of relief the executive order envisions.” The flawed Politico article emphasized “the order changes nothing immediately and doesn't spell out exactly what Trump would like his government to do,” an important piece of information that was left out of the article's headline.

Numerous health care policy experts called out the news outlets for their flawed analyses, and underscored that this executive order caused no immediate policy changes and instead reflected “recycled campaign talking points” that amounted to a symbolic gesture until further action is taken. For example, Larry Levitt, vice president at the Kaiser Family Foundation, said “this order doesn’t in and of itself do anything tangible” but it sends “a signal that the Trump Administration is not waiting for Congress” on dismantling the ACA. Tim Jost, health law expert and law professor at Washington and Lee College, emphasized that law “doesn’t allow [Trump] to repeal the Affordable Care Act unilaterally” and noted that no action was likely “until the heads of HHS, Treasury, and probably Labor, as well as the CMS Administration and IRS Commissioner are in place.” Five Thirty Eight’s Anna Maria Barry-Jester explained that the executive action “does very little because it doesn’t grant the administration any powers that it didn’t already have” but that it did telegraph “that change is coming.”

The flawed coverage of Trump’s first executive order is the latest in a trend of inadequate headlines in the coverage of the Republican Party’s moves on the ACA. During an interview with The Washington Post, Trump promised his ACA replacement will guarantee “insurance for everyone,” prompting a spate of headlines that uncritically repeated his vow, despite the fact that he has released no policy details, and all existing GOP replacement ideas would result in millions losing coverage. Similarly, when Trump’s nominee for the Secretary of Health and Human Services, Tom Price, declared that “nobody is interested in pulling the rug out from under anybody,” news outlets made the headline his “vow” to not take away health care coverage, when in reality, Price’s own health care policy proposals would gut coverage and seriously degrade the health care system.

News organizations repeatedly publishing flawed headlines are doing a disservice to their audiences, even if underlying reporting in their articles may accurately contextualize the headlining statements. As The Washington Post reported, “roughly six in 10 people acknowledge that they have done nothing more than read news headlines in the past week,” and “that number is almost certainly higher than that, since plenty of people won't want to admit to just being headline-gazers but, in fact, are.”

The gravity of repealing the ACA and the relative lack of public comprehension of health care policy highlights the need for news outlets to do a better job in crafting their ACA headlines. The repeal of the ACA will result in millions losing health care, allow the return of medical underwriting which discriminates against women for being women and against individuals with pre-existing conditions, and will disproportionately impact the marginalized and vulnerable. ACA repeal affects all Americans, regardless of whether or not they get their insurance through the exchanges.

Additionally, Americans remain confused about what the ACA actually does, as polls show high approval ratings for many individual parts of the ACA while largely disapproving of the law as a whole. A recent NPR poll showed that while most people knew the ACA covered individuals with pre-existing conditions, more than half of the respondents “didn't know that the ACA reduced the number of people who are uninsured to a record low” -- one of the biggest accomplishments of the law. The combination of the enormous impact of repeal combined with the confusion that pervades the health law means that news outlets must be more diligent in crafting headlines for ACA stories, since often that headline will be the only thing the general public reads.

Unlike other media outlets that uncritically parroted the conservative American Action Network’s false claims about Latino coverage under the Affordable Care Act (ACA), NBC News Latino showed evidence disproving the political group’s false statement that “the number of uninsured Hispanics has grown” under the ACA. This statement was based on the group’s misinterpretation of a report that actually found that more Hispanics have gained health insurance under the ACA.

In an effort to boost the Republican effort to repeal the ACA, the American Action Network -- a conservative political group affiliated with the Congressional Leadership Fund super PAC -- announced that in addition to English-language television ads, it would also be launching Spanish-language television ads to garner opposition to the ACA among Hispanics. In the press release, AAN executive director Corry Bliss falsely asserted that “Obamacare supporters claimed this law helps Hispanics, yet the number of uninsured Hispanics has grown.” In reality, the ACA has expanded minority access to free preventive care, improved the overall quality of care in minority communities, and reduced the number of uninsured persons of color.

The Washington Post repeated Bliss’ claim uncritically, noting that “AAN cited a study last year by the nonpartisan Commonwealth Fund … that found that the share of Latinos without health-care coverage grew from 29 percent in 2013 to 40 percent in 2016, higher than other racial or ethnic groups.” The Hill also echoed AAN’s misinterpretation of the Commonwealth Fund report.

On the other hand, NBC Latino accurately interpreted the report and corrected AAN’s misleading statement by explaining that “American Action Network's press release points to an NBC Latino story that cites a Commonwealth Fund report that found that the share, though not the number, of uninsured Hispanics grew.” That means that even though Hispanics make up a larger share of the uninsured, the number of Hispanics who gained health insurance under the ACA grew, albeit slower than other groups. The article pointed out that Republican states that “opted to not expand Medicaid under Obamacare” have large Latino populations, which, among other reasons, explained why Latinos’ uninsured rate decreased more slowly than other groups’ rates. From the January 18 NBC News Latino report:

In a news release, Bliss asserted that "the number of uninsured Hispanics has grown."

In fact, the number of Hispanics without health care has dropped, meaning the percentage of Hispanics without insurance has gone down.

[...]

American Action Network's press release points to a an NBC Latino story that cites a Commonwealth Fund report that found that the share, though not the number, of uninsured Hispanics grew. Latinos are 40 percent of all uninsured, including whites and blacks, a share that grew from 29 percent in part because Hispanics gained coverage at a slower rate than whites.

The report cites several reasons why Latinos are a growing share of the uninsured, among them:

- Many uninsured Latinos live in states such as Texas and Florida that opted to not expand Medicaid under Obamacare.

-- There is a disproportionate share of Latinos who are poorer or lower income but not eligible for Medicaid either because their state didn't expand the program or they are not aware of eligibility.

-- There are Latinos who are legal residents and their state restricts access of legal immigrants who have not had legal residency for at least five years, as the Affordable Care Act allows. (The uninsured rate among U.S. born Latinos is about 12 percent but for foreign born Latinos, it is 39 percent.)

-- Many Latinos are immigrants who don't have legal status and therefore are not eligible for Obamacare. Immigrants who benefit from the Deferred Action for Childhood Arrivals, DACA, program also are not eligible for Obamacare. (Attempts to extend Obamacare to immigrants without legal status drew heavy Republican opposition while the law was being debated.)

-- There are Latinos who qualify for coverage under Obamacare but won't sign up out of fear that their family members who lack legal status may be found out by the government and detained and deported. The fear of turning over information to the government has increased with the election of Donald Trump.

These are factors that would have to be addressed in order to make a dent in the number of Hispanics who are uninsured.

As conservatives on Capitol Hill threaten to defund Planned Parenthood under dubious pretenses, Iowa’s Des Moines Register is modeling how state papers should handle efforts by local anti-choice lawmakers to do the same.

The Register’s editorial board called on Gov. Terry Branstad (R-IA) to “sit down and write the names of the entities that can provide comprehensive family planning services in Iowa” before following through on his budget plan to eliminate state funding for Planned Parenthood. The paper quoted Branstad saying that his plan “redirects family planning money to organizations that focus on providing health care for women and eliminates taxpayer funding for organizations that perform abortions.”

Branstad’s plan comes from a familiar anti-choice playbook. To justify defunding Planned Parenthood, right-wing media and anti-choice politicians in a number of states have wrongly claimed that the organization uses taxpayer money to subsidize abortion services. Although in reality, the government reimburses Planned Parenthood only for non-abortion services, and that money is provided via Medicaid, lawmakers use this incorrect allegation to demand that funds be shifted to so-called “community health clinics” (CHC). Lawmakers believe these CHCs could absorb patient demand should access to Planned Parenthood be eliminated -- a claim experts call “a gross misrepresentation of what even the best community health centers in the country would be able to do.”

By demanding specifics from conservatives who claim that there are numerous “alternatives” to Planned Parenthood, the Register modeled the kind of reporting local outlets should be doing about threats to defund essential health care in their communities.

1. Demand To Know What So-Called “Alternatives” To Planned Parenthood Are Available

Planned Parenthood is an essential care provider for millions of Americans nationally, 60 percent of them low-income patients covered through Medicaid. In Iowa, this process is facilitated through the Iowa Family Planning Network (IFPN) waiver program, which gives patients the option to receive “a form of limited insurance coverage” through Medicaid that covers “basic family planning services.”

As the Register noted, Branstad “must know that many of the more than 30,000 Iowans obtaining services made possible by the waiver receive them from Planned Parenthood,” which means that if he “rejects this particular organization, he should specify exactly who has the statewide ability to take its place.”

There’s ample reason to believe that this task will prove impossible for the long-serving anti-choice governor. As the Register reported, providers have already warned state officials that there “are not enough providers in Iowa to absorb the patients Planned Parenthood of the Heartland currently serves.”

Rather than taking Branstad or other anti-choice lawmakers at their word about the viability of so-called alternatives, the Register performed a critical journalistic function and demanded to know what these facilities were, and whether they have the capacity to meet the medical needs of low-income patients across the state.

2. Ask About The Types Of Services “Alternatives” Can Actually Provide

Beyond asking Branstad to name specific alternatives to Planned Parenthood, the Register also asked that the list exclude clinics that are “no longer in business” and include only facilities that “actually provide family planning services.”

This may seem like an odd stipulation, but the Register’s specific question about alternative providers’ actual services is exactly the kind of scrutiny local outlets should apply when lawmakers threaten to radically alter the infrastructure of essential health care systems.

Across the country, anti-choice lawmakers have conflated the total number of CHCs with the much smaller number of those facilities that are actually equipped to provide primary care and family planning services. As the Register explained:

Florida lawmakers learned that lesson the hard way. After passing an anti-Planned Parenthood bill last year, they sought to demonstrate there were numerous, alternative providers. Their list became a national joke because it included the names of elementary and middle schools, dental practices and at least one eye clinic.

While Planned Parenthood clinics all offer preventive and basic care services, CHCs can qualify for that classification while providing more limited care -- making direct comparisons between the overall numbers a misleading measure of actual health care provision capacity.

By demanding specific answers about threats to defund Planned Parenthood, The Des Moines Register’s editorial board provided a model for local outlets to critically interrogate claims by lawmakers about so-called alternatives -- questions that are essential when access to health care is on the line.

Forty-four years ago, Roe v. Wade determined that the constitutionally protected right to privacy ensures an individual’s ability to make personal, medical decisions without interference from politicians -- including the decision to have an abortion.

But now, President-elect Donald Trump and anti-choice politicians who have made careers from promoting scientifically dubious and medically harmful anti-abortion laws want to eliminate Roe’s protections.

During the 2016 presidential campaign, Trump promised to appoint “pro-life justices” who would “automatically” overturn Roe. After the election, Trump told CBS’ Lesley Stahl that he would prefer control over abortion “go back to the states” even it it meant that women would “perhaps have to go … to another state” to obtain necessary reproductive health care.

This may sound like hyperbolic campaign rhetoric, but the threat is very real -- and it’s impossible to overstate how dangerous losing federally protected abortion rights would be.

Right-wing media have consistently argued that greater state control over abortion clinics and providers is necessary to “protect women’s health.” The Supreme Court rejected this allegation in Whole Woman’s Health v. Hellerstedt, which rebuked states for attempting to baselessly regulate abortion clinics under the guise of improving public health and safety.

Legal abortion is one of the safest and most common medical procedures. According to the American College of Obstetricians and Gynecologists, “Where abortion is legal, it is extremely safe. … In contrast, historical and contemporary data show that where abortion is illegal or highly restricted, women resort to unsafe means to end an unwanted pregnancy.”

In contrast, life before Roe v. Wade -- without federally protected abortion rights -- was dangerous and difficult. Women traveled to neighboring states or even other countries to receive an abortion, often alone, in secrecy, with just enough money pooled together from friends or roommates. Some even saw their friends die from what can and should be a safe and simple procedure.

Trump and anti-choice lawmakers seem to think a return to this grim reality would constitute “protecting women.”

Even without attacks on Roe, accessing reproductive health care is already difficult -- especially for marginalized communities. Between rules like the Hyde Amendment, which prohibits federal funding for abortion, and the targeted restriction of clinics meant to increase logistical barriers to abortion access, essential reproductive care is already tenuously out of reach for many.

Conservatives are already putting people’s lives at risk with medically unnecessary laws that restrict abortion access. If they succeed in eliminating the federal and constitutional protections guaranteed by Roe v. Wade, people will get hurt.

Anyone trying to spin that as “protecting women’s health” is lying to you.

During CNN’s town hall with Speaker of the House Paul Ryan (R-WI), Jake Tapper showed the value of fact-checking conservative misinformation on health care policy -- even in a conversational setting -- by providing strong pushback about funding for Planned Parenthood. But there were several other moments during the event when Ryan pushed false information about the Affordable Care Act (ACA) that Tapper could have fact-checked. Going forward, more media outlets should adopt an aggressive approach to addressing conservative misinformation on health care policy, given the severe consequences of ACA repeal.

During the town hall discussion of the fight over the ACA, the final question on health care came from an audience member asking where the millions of women who use Planned Parenthood to access women’s health care services will go if the Republican Congress defunds the network. When Ryan falsely tried to claim that providing federal funds to Planned Parenthood “commit[s] people’s taxpayer dollars to fund” abortion, Tapper correctly noted that the Hyde Amendment bans taxpayer money from funding abortions.

Tapper also noted the hypocrisy in Ryan’s earlier statements emphasizing the necessity of choice in health care policies, asking, “You believe in providing more choice for people when it comes to health insurance, except for Planned Parenthood?”

But there were also many other opportunities for Tapper to fact-check Ryan as he used the town hall to reiterate stock talking points and push false narratives about the ACA. When asked whether “the government should guarantee health care” for Americans, Ryan falsely claimed that the ACA is failing and that premium spikes were proof that “the law is collapsing.” In reality, during the most recent open enrollment period, more people signed up on the ACA insurance marketplaces than during the previous year, contradicting the conservative claim that people are fleeing the market. Ryan’s claims about premium hikes omit the crucial context that subsidies rise in proportion to premium hikes, mitigating the impact for the majority of enrollees. While the ACA clearly has problems, claims that the law is “collapsing” or in a “death spiral” are clearly false and should be rebutted as such.

When an audience member who survived cancer asked Ryan how the GOP’s plans would impact individuals with pre-existing conditions, Ryan claimed that “state high-risk pools are a smarter way of guaranteeing coverage for people with pre-existing conditions.” While high-risk pools sound like a good idea in theory, they have a long history of problems, as they are typically chronically underfunded, are prohibitively expensive for customers, and provide inadequate coverage. Similarly, Ryan’s claims about the benefits of refundable tax credits and health savings accounts should prompt substantive follow-up questions, as legitimate critiques raise questions about their effectiveness in reducing costs and maintaining coverage.

While Tapper illustrated the value of fact-checking conservative misinformation during the discussion on Planned Parenthood, he ought to have also provided substantive follow-up questions and pushback on some of Ryan’s policy claims. Going forward, media outlets should use any interview, in any format, to hold conservative politicians’ feet to the fire on the issue of the ACA -- to prevent the further spread of false narratives and to investigate the efficacy of proposed GOP policies. The lack of consensus on what a replacement plan might look like, combined with the massive impact repeal will have on the millions who have obtained insurance through the Affordable Care Act, makes it especially vital for the media to ask substantive questions about conservative claims on health care policy.

President-elect Donald Trump dodged a question during his January 11 press conference about how he plans to repeal and replace the Affordable Care Act (ACA) and whether or not the replacement plan would insure as many people, but he did indicate the attack on health care reform will be led by his nominee to run the Department of Health and Human Services (HHS), Rep. Tom Price (R-GA). In light of Trump’s delegation to Price, the media must do a better job of scrutinizing the devastating consequences of Price’s proposals than they have in the past

A Media Matters study of pre-election coverage found that prime-time cable and broadcast news failed to ask substantive questions about what Trump’s replacement for the ACA would look like. This cannot be the standard going forward.

On January 11, Trump held his first press conference in nearly six months and took questions on a variety of issues. A reporter asked Trump a two-part question about the future of Obamacare, first, asking for specifics on the timeline for the repeal and replacement of the ACA, and second, questioning whether or not Trump’s replacement would “guarantee coverage” for those who gained insurance under health care reform. During his three-minute answer, Trump provided no specifics on what policies the replacement package might include and dodged the question of whether or not it would maintain current levels of insurance coverage, instead insisting:

DONALD TRUMP: We're going to be submitting as soon as our secretary is approved, almost simultaneously, shortly thereafter, a plan. It‘ll be repeal and replace. It will be essentially simultaneously.

Trump’s answer, while not containing any policy specifics, did reveal two key things about the upcoming ACA fight.

First, Trump’s reluctance to answer whether or not his replacement will cover as many individuals as the ACA does is a trend, not an anomaly. As Vox senior editor Sarah Kliff and other reporters have noted, Republicans continue to dodge and obfuscate when pressed for details on how their ACA replacement will maintain the coverage expansions achieved since 2010. According to a December 15 article in The New York Times, a Republican congressional aide promised that the GOP plans would guarantee “universal access” of health care and coverage but provided no details about how this would improve on existing law.

Second, Trump’s claim that his administration would submit a plan “as soon as [his] secretary is approved,” seems to indicate that his replacement package would closely resemble the legislation authored by his HHS nominee, Tom Price. Price’s bill, the “Empowering Patients First Act,” is the most developed health care replacement of all the Republican plans. (After dozens of symbolic votes to repeal the ACA and six years of campaigning against the law, Price is the only congressional Republican to actually put a replacement plan together in legislative language.)

Price’s plan would gut access to health insurance in the U.S. and eliminate the essential health benefits package -- allowing insurers to determine whether or not things like maternity care should be covered. This dismantling of health care reform would benefit younger, healthier individuals while sending costs skyrocketing for older or sicker individuals. The plan would reinstate high-risk pools, endangering health care access for individuals with pre-existing conditions an ACA provision conservatives claim to want to preserve. Price’s bill would also rescind the ACA’s Medicaid expansion entirely and convert the program to a block grant, blocking access to care for many low-income communities. Additionally, as the HHS secretary, Price could unilaterally reverse the contraception mandate, a benefit he has dismissed because he claims he has yet to meet “one woman” who had trouble accessing birth control before the ACA. If enacted, Price’s “Empowering Patients First Act” would roll back the gains the Affordable Care Act has achieved, leaving millions more Americans uninsured -- as would most of the variants of “Trumpcare.”

Given that the incoming president suggested during his press conference that he will leave stewardship of repealing and replacing the ACA to his HHS secretary, journalists need to actively scrutinize Price’s record and his proposals for the future of American health care.

During the January 11 press conference, reporters asked just one question about the ACA, with zero attempts at a follow up, despite the fact that Trump functionally avoided the original question. The initial reporting on Price’s nomination whitewashed his history of opposition to reproductive health care, and largely failed to contextualize the potential impact of his proposed policies on the American health care system. Since Trump hinted at the major role Price might play in the upcoming ACA fight, it is incumbent on reporters to step up beyond their pre-election coverage and take the current job of vetting Price seriously, making clear the disastrous effects his proposals could have on the American health care system.

During the January 8 edition of MSNBC’s AM Joy, host Joy Reid put on a master class in how to cover anti-choice lawmakers’ latest attempts to defund Planned Parenthood.

The Sunday after House Speaker Paul Ryan announced that Republicans would prioritize defunding the essential health care provider, Reid demonstrated four best practices for reporting on reproductive rights topics: hosting diverse guests, discussing the material consequences of policy decisions, including personal testimony in reports, and emphasizing the disparate impact of anti-choice laws on marginalized communities.

Planned Parenthood is an essential health care provider for millions of Americans -- many of them low-income patients reliant on Medicaid to access primary care. To justify defunding Planned Parenthood, right-wing media and anti-choice politicians have falsely claimed that the organization’s primary goal is to coerce women into having abortions using taxpayer money.

In reality, this could not be further from the truth. Due to the Hyde Amendment, the federal government is already barred from funding abortion services. Instead, the government reimburses Planned Parenthood for non-abortion services provided to low-income patients via Medicaid -- just like any other health care provider. Although right-wing media argue that so-called “community health clinics” (CHCs) could absorb this patient demand should Planned Parenthood clinics close, experts agree that CHCs lack the capacity, experience, and resources to replace Planned Parenthood.

In its coverage of the defunding effort, AM Joy set the standard for reporting the consequences of congressional Republicans’ politically motivated attack on health care access -- and other outlets should take note.

1. Host Diverse Guests

During the January 8 segment, Reid hosted two women to discuss the impacts of defunding Planned Parenthood: the organization's president, Cecile Richards, and the executive director of the National Latina Institute for Reproductive Health (NLIRH), Jessica González-Rojas.

In a previous study of prime-time cable news coverage of reproductive rights topics, Media Matters found that networks relied heavily on male panelists to discuss the consequences of policy decisions about abortion and reproductive rights issues. This problem of representation is also more generally borne out across the Sunday political talk shows, which have overwhelmingly relied on guests who are white, conservative, and male.

Hosting diverse guests is essential to providing in-depth, quality coverage of many topics. Non-white and non-male perspectives in newsrooms are often rare, a trend that should incite concern not only about equality but also about coverage accuracy.

2. Discuss The Material Consequences Of Policy Decisions

AM Joy also focused on the material impacts of defunding Planned Parenthood -- not just the political spectacle of the legislative fight.

At the start of the segment, Reid immediately debunked the pervasive conservative arguments about the consequences of defunding Planned Parenthood:

JOY REID: Let’s be clear about this so-called defunding legislation -- what it would really do. It would prohibit Medicaid recipients from obtaining any kind of services from Planned Parenthood. We're not talking about abortion services because federal law already prohibits those being paid for with federal dollars. We're talking no cancer screenings, no contraception, no STD testing, no medical services as all. The defunding will be packaged with the repeal of the Affordable Care Act, aka Obamacare, which is currently providing health insurance to 22 million people and counting.

Richards and González-Rojas each provided examples of the consequences that defunding Planned Parenthood would have for a number of patients across the country. As Richards explained, “Any senator who votes [to defund] is hurting women in their own home state” because they are “essentially saying to low-income women, 'You can't go to Planned Parenthood for your cancer screenings and birth control.’”

González-Rojas agreed, adding that when Indiana denied Planned Parenthood state Medicaid reimbursements, “we saw an STI outbreak,” and when Texas blocked the reimbursements, “we saw the rates of unintended pregnancy and birth increasing. We heard stories of women splitting birth control pills to make it last longer.”

3. Include Personal Testimony About Reproductive Health

Throughout the January 8 segment, Reid emphasized personal testimony from herself, Richards, and González-Rojas about relying on Planned Parenthood for essential health care.

Reid noted that Planned Parenthood was “the place where, when I graduated from college and had no money and was broke and had a low-paying job, [I] got all my health care.” Richards echoed the sentiment, explaining that “one in five women in this country go to Planned Parenthood for health care in their lifetime, including me, including you.”

The practice of including personal testimony should be a staple when reporting on the consequences of anti-choice laws, including -- while not directly relevant here -- abortion access.

4. Highlight The Disparate Impact Of Anti-Choice Laws On Marginalized Communities

AM Joy also provided a platform to discuss the disparate impact of anti-choice laws, which have a greater impact on marginalized communities than on other groups.

As González-Rojas explained:

JESSICA GONZÁLEZ-ROJAS: I think a good example comes from Texas when we saw the defunding of a lot of the family planning services in Texas. We saw a health crisis happen. We saw health disparities happen. Things like cervical cancer, which is largely preventable, Latinas had huge rates of cervical cancer and that's something that they shouldn't have happen in their life. If they have access to regular screenings, paps, mammograms -- all the services that Planned Parenthood provides -- those types of things would be prevented. So this is a disproportionate impact on communities of color, on immigrant communities, on low-income women and families, young people, so a fight against Planned Parenthood is a fight against our communities.

Because the economics of accessing necessary health care are already so precarious for many communities, networks and outlets should emphasize the disproportionate impact anti-choice laws have on these groups whenever possible.

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 Matters study 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.

In the lead-up to the election, prime-time news shows functionally abdicated any role in questioning what President-elect Donald Trump will offer in place of the Affordable Care Act (ACA) and how it might affect the millions of Americans who gained insurance coverage as a result of the landmark law. Instead of asking pointed questions about Trump’s piecemeal policy proposals, TV personalities focused on negative stories like the 2017 premium hikes and conservative fearmongering about the potential of a so-called “death spiral.” Going forward, media figures must make “What is Trump’s replacement plan?” their first question in any discussion of health care policy and ask necessary follow-ups to pin guests to substantive proposals.

According to a Media Matters analysis of broadcast and cable evening news coverage from October 24 to November 7, TV personalities asked questions about Trump’s potential ACA replacement plans only four times amid 77 total discussions of health care. In total, TV personalities, panelists, and reporters mentioned Trump’s health care plans 13 times, and these mentions occurred exclusively on cable shows, revealing a serious deficit in broadcast coverage of health care in the last weeks of the election. Compounding the problem, nine of the 13 mentions came from either Fox News or a Trump surrogate (like Corey Lewandowski or Kellyanne Conway) on CNN, meaning right-wing media spin dominated the limited substantive discussions of Trump’s plans.

Media figures’ failure to probe politicians and surrogates on Trump’s plans kept important context out of the health care discussion. For example, during a panel segment on CNN Tonight, correspondent Corey Lewandowski insisted that “Trump has laid out a plan” to let individuals “buy health insurance across state lines,” calling it a “simple solution.” CNN host Don Lemon asked no follow-up questions -- problematic given the numerous critiques of the “state lines” proposal -- and instead changed the subject. Hosts must be prepared with the facts on proposed policies and hold guests accountable for explaining the impact of those policies. Permitting conservative talking points to stand unchallenged allows conservative misinformation to fill the void in a confusing policy arena that is poorly understood by the American public.

Coverage of health care in the last two weeks of the election largely focused on the news of double-digit premium increases next year on average for insurance plans sold on Obamacare’s online marketplace at Healthcare.gov. As Trump used this news to make his pledge to “repeal and replace” a focus of his closing campaign, news coverage failed to ask important questions about his idea to keep the popular parts of the ACA -- like prohibiting insurers from discriminating against individuals with pre-existing conditions -- while getting rid of other provisions. Instead, TV personalities focused on the premium hikes and fearmongering about the potential for a “death spiral.” The focus on negative news like premium hikes makes sense -- it was an important story that deserved coverage. But that coverage completely eclipsed almost any substantial discussion of what Trump’s replacement plan might include -- a trend reflected in the broader failure to engage in much of any policy discussion throughout the election.

The overall lack of coverage about the specifics of Trump’s replacement plan represents a fundamental problem in media’s treatment of health care policy and must quickly change now that Trump is the president-elect. A recent study from the Urban Institute showed that 24 million people will lose health care coverage by 2021 if Congress repeals the ACA. Trump’s nominee for secretary of health and human services, Tom Price, is a known foe of the law’s birth control mandate, a regulation that has dramatically reduced out-of-pocket health care costs for women and massively expanded contraceptive coverage. Repeal could also roll back the gains made in reducing the budget deficit, extending the life of Medicare, and lowering health care costs that resulted from the implementation of the ACA.

While no concrete plan for a replacement currently exists -- due to Republican infighting -- repealing Obamacare remains a top priority for the incoming Trump administration. Journalists must start asking questions about what a replacement plan will look like, how it will affect millions of Americans who gained coverage under the ACA, and what its true goals are. Every interview or panel segment about health care must begin with the question, “What is Trump’s replacement plan?” and include aggressive follow-ups about how it would function in order to hold the Trump administration accountable and educate the American public on the future of health care in the United States.

Methodology

Media Matters conducted a Nexis search of transcripts of weekday network broadcast evening news programs on ABC, CBS, NBC, and PBS and weekday prime-time news programming (defined as 6 p.m. through 11 p.m.) on CNN, Fox News, and MSNBC from October 24, 2016 (the day the Obama administration announced the premium hikes), through November 7, 2016. We identified and reviewed three types of segments -- news reports, panel segments, and interviews. We searched for “Obamacare” or “Affordable Care Act” or “health care” and identified and reviewed all segments in which health care/ACA/Obamacare was the stated topic of discussion, or health care/ACA/Obamacare was discussed by at least two speakers in the segment (e.g., a host asking a single question about the ACA to a guest and the guest responding during a multitopic interview would count).