Trump’s order on healthcare: How word choice contributes to bias
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Trump’s order on healthcare: How word choice contributes to bias

October 13, 2017

The Raw Data

Unspun and unbiased. These are the facts.

Trump signs executive order on ACA insurance rules, terminates subsidies

On Thursday, President Donald Trump signed an executive order that calls for changes to three areas of the Affordable Healthcare Act (ACA), also known as Obamacare. The order aims to expand access to association health plans (AHPs), increase the maximum time limit of short-term insurance plans (STLDI), and widen the use of health reimbursement arrangements (HRAs).

The executive order, titled “Promoting Healthcare Choice and Competition Across the United States,” says Trump’s administration will “prioritize” the three areas “for improvement in the near term.” The order does not implement immediate changes; rather it calls on federal agencies, like the Departments of Labor and Treasury, to propose regulations or revise guidance “consistent with law” within 60 days.

The order states that expanding access to AHPs will make it easier for small businesses to join together in groups, allowing them to negotiate cheaper health plans for their employees. The document calls for increasing the maximum time limit for STLDIs from three months to one year. Short-term plans are not required to comply with the ACA rules about protections for people with pre-existing conditions. HRAs allow employers to give employees money to buy their own coverage.

Later on Thursday, the White House released a statement saying health care subsidies for insurers, which help reduce the out-of-pocket costs for low-income people, will be terminated. The termination will take effect immediately, according to Department of Health and Human Services Secretary Eric Hargan.

The subsidies were introduced by the Obama administration, and the Trump administration has been continuing them on a month-by-month basis. A district court ruling from 2014 said the Obama administration was paying these subsidies illegally as the Senate had never appropriated money for that purpose. The Obama administration appealed the ruling and that case has yet to be decided. The previous administration was allowed to continue the subsidies while the court considered the appeal.

Arguments for and against

Trump has argued the order will give consumers more options when choosing healthcare plans, lower premiums and increase competition among insurers. On the other hand, The Huffington Post reports that healthy customers, who do not expect to need extensive and more expensive coverage, could leave ACA plans and opt for new cheaper alternatives, like STLDIs. This could make plans with comprehensive, ACA-compliant coverage more expensive and harder to find for those with pre-existing conditions, The Huffington Post says, if such products become less profitable for insurers because their costs would not be offset by healthy customers.

For more information on the U.S. healthcare system and the executive order, see our coverage here.

Additional source: The New York Times

Distortion Highlights

  • What does the word “undermine” evoke? What about something described as a “relief”?
  • These words have quite different meanings, yet both were used to describe the same thing: Trump’s executive order on healthcare.  
  • The word choice the media used in its coverage creates biased views of the order, discouraging a well-rounded understanding of the issue.  

Show Me Everything

The Numbers

See how the articles rate in spin, slant and logic when held against objective standards.

View Technical Sheet >

The Distortion

The Knife’s analysis of how news outlets distort information. (This section may contain opinion)

Top Spin Words

  • Positively toxic

    The mandate is unpopular with the public generally and positively toxic among some conservatives, but experts and insurers say it’s an essential piece of the Affordable Care Act’s architecture because it encourages relatively healthy people to enroll. (The Huffington Post)

  • Arcane

    The public’s reaction could make a huge difference, as well, though it remains to be seen whether the arcane, drawn-out process of writing regulations will generate the same kind of backlash that GOP legislative efforts to pass a repeal bill have had. (The Huffington Post)

  • Trouble

    But the other side of the insurance market, with the plans that continue to meet the Affordable Care Act’s standards, could be in trouble. (The Huffington Post)

  • Feared

    About half of U.S. counties will have only one ObamaCare insurer next year, although it appears that no counties will be left without a carrier as was initially feared.  (Fox News)

  • Damaging

    Critics, who include state insurance commissioners, most of the health-insurance industry and mainstream policy specialists, predict that a proliferation of other types of coverage would have damaging ripple effects: driving up costs for consumers with serious medical conditions and prompting more insurers to flee the law’s marketplaces. (The Washington Post)    

  • Grip

    Trump Signs Executive Order to Loosen Obamacare Grip (Breitbart)

  • Unscrupulous

    Such arrangements have existed for decades, and scandals have on occasion exposed “multi-employer welfare arrangements” started by unscrupulous operators who took members’ money and either did not have enough reserves to cover hospital bills or absconded with premiums. (The Washington Post)

  • Concerns

    But responding to concerns, the White House said participating employers could not exclude any workers from the plan, or charge more to those in poor health. (Fox News)

  • Hobbling

    Even so, with a shortened sign-up period and large cuts in federal funds for advertising and enrollment help already hobbling the marketplaces, “if there’s a lot of hoopla around new options that may be available soon, it could be one more thing that discourages enrollment,” said Larry Levitt, Kaiser Family Foundation’s senior vice president. (The Washington Post)

  • “Great, great”

    “This will cost the United States government virtually nothing and will provide people great, great health care,” Trump said. (Breitbart)

  • Unleash

    GOP repeal bills would unleash [transformation] if one of them were to become law. (The Huffington Post)

  • Characteristic

    … the president spoke in his characteristic superlatives about the effects of his action and what he called “the Obamacare nightmare.” (The Washington Post)

Healthcare legislation in the U.S. is complex: the ACA has provided benefits for some people and presented drawbacks for others, and Trump’s executive order will likely also have positive and negative effects. But some of the news coverage of the order suggests it’s universally good or bad, without making distinctions or accounting for multiple viewpoints. The outlets suggest that either:

  • Trump’s order is good: The ACA is harmful to consumers, and the order will help alleviate the problems. Or…
  • Trump’s order is bad: It will undo beneficial aspects of the ACA that help people.  

How does the news promote these judgments? Multiple ways. For instance, there’s selection of sources: one outlet may only include quotes that support the order, while another focuses on criticism. There’s also the use of subjective, charged language (spin) that imports judgment, and that’s what we’ll focus on here. Consider these examples (italics added):

Trump’s order is good

Breitbart: Trump said the order intended to create “options for Americans to experience Obamacare relief.”

  • Assumes: Obamacare is harming Americans, as “relief” refers to the removal of some painful or unpleasant thing.

Trump’s order is bad

HuffPost: The order “could rattle” the ACA’s private markets “by allowing a proliferation of cheaper, less comprehensive plans that would undermine rules about who and what insurers must cover.”

  • To “undermine” can mean “to subvert or weaken insidiously or secretly,” and to “rattle” in this context can mean “to upset especially to the point of loss of poise and composure.” These descriptions portray the order as negative.

Polarized news coverage doesn’t encourage the public to evaluate healthcare legislation in a comprehensive way that looks for both the pros and cons. Looking at both allows for critical discourse, which may do more to help address current limitations in the system, while preserving positive aspects.

Is it fact or fiction? Which outlet presents the most spin?

  • 52% Spun

  • 63% Spun

  • 63% Spun

  • 66% Spun

Fiction
or
Fact

HuffPost

“Markets even in struggling states seemed to be stabilizing… Now, markets in some of those states are suddenly looking shaky again.”

None.

HuffPost

“In states like Iowa and Tennessee, the newly reformed private insurance markets have teetered on the edge of collapse.”

As of October 2017, Iowa has one provider in its healthcare insurance exchange.

Fact Comparison

  • Facts in only 1 source
  • Facts in 2 sources
  • Facts in 3 sources
  • Facts in all sources

About half of U.S. counties will have only one ACA insurer next year. (Fox News)


This information may misrepresent people’s overall insurance options by focusing on the number of options per county rather than the number of options per enrollee. For example, the Center for Medicare and Medicaid Services projected on Sept. 20, 2017, that 48.52 percent of U.S. counties would have only one insurer in their health exchange programs. However, that number amounts to 29.33 percent of all enrollees, as they are typically more rural counties. An updated statistic by Bloomberg published on Oct. 4 puts the number of enrollees with only one insurer option at 24 percent, with another 24 percent of enrollees having two insurer choices, 17 having three choices and 34 percent having four or more. So even though nearly half of all counties will have one insurer, the majority of enrollees will have two or more choices.

Headlines

An article’s headline can direct how the news is understood. Compare and contrast how different outlets present the story through their headlines.

Implies Obamacare has been strangling the U.S.

This suggests Trump did a good deed on Thursday by loosening Obamacare’s grip on the nation. That is opinion, not fact, and only presents one possible interpretation of the facts.

Doesn’t say how it would “undermine” rules.

This headline is dramatic and not very informative. It implies that the order will have a negative effect, without any data to back it up.

Implies the “dismantling” has now begun.

Trump’s executive order does not provide for any immediate changes, rather it tasks a number of departments with re-writing existing rules. CNN’s wording could be misleading.

This gives the news without including opinion for or against the order, unlike some of those above.

Balance

Get the full picture! Don’t buy into cherry-picked information.

The media’s slant:
  • Depending on who you listen to, Trump’s executive order is either going to fix issues associated with ACA, such as the high cost of insurance (Breitbart, Fox News), or it’s going to “collapse” and “split” the market (The Huffington Post, The Washington Post).
  • The order is a “repeal” of what currently exists. (The Huffington Post)
What the media doesn’t explore:
  • Insurance markets are complex in nature. The executive order prioritizes changes to three areas of the ACA, and those can have both positive and negative effects that are yet unknown. Also, positive aspects of the ACA are not discussed by the outlets, which gives a biased view of the legislation.
  • This order does not repeal any laws. Instead it orders federal agencies to review particular guidances and create regulations “consistent with law.” It may affect the application of the ACA, rather than repeal it.