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Pundits, panels, but no policy: the normative role of cable news in communicating health care policy to the public

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PUNDITS, PANELS, BUT NO POLICY:

THE NORMATIVE ROLE OF CABLE NEWS IN COMMUNICATING HEALTH
CARE POLICY TO THE PUBLIC

by

Cat Duffy

A Dissertation Presented to the
FACULTY OF THE USC GRADUATE SCHOOL
UNIVERSITY OF SOUTHERN CALIFORNIA
In Partial Fulfillment of the
Requirements for the Degree
DOCTOR OF PHILOSOPHY
(COMMUNICATION)

August 2018

Copyright 2018 Cat Duffy

ii

“After a century of striving, after a year of debate, after a historic vote, health care reform
is no longer an unmet promise. It is the law of the land.”
- President Barack Obama

“This is a big f--king deal”
- Vice President Joe Biden,
iii
DEDICATION

For Hillary Clinton, who continues to inspire me to never quit.
iv
ACKNOWLEDGMENTS

The number of people I owe thanks to for helping me survive the dissertation process
is roughly equivalent to the number of cable news segments I had to code for this project
(e.g., endless). I’d first like to thank USC and the Annenberg School for Communication
and Journalism for giving me the opportunity to start this journey in the first place. I owe
a great deal of gratitude to my advisor, Tom Hollihan, for helping me through this
process and never doubting that I would finish, despite moving across the country. I will
be eternally grateful to Ann Crigler and Gordon Stables for their participation on my
dissertation and quals committees and for their critical insight on my project.
Outside of my dissertation committee, several USC faculty members were
instrumental in shaping my research and my abilities as a scholar. Thank you to Sarah
Banet-Weiser and Randy Lake for their invaluable contributions to my research as both
my teachers and members of my qualifying committee. Dennis Chong in the political
science department left an indelible mark on my research, as his class always pushed me
to be a better and more thorough scholar. I also want to thank Anne-Marie Campian and
Sarah Holterman for never failing to answer all of my emails and helping me navigate
Annenberg’s bureaucracy from afar.
I would not be at USC if not for the influence of many important mentors that helped
me on my way to the PhD. I want to thank Alessandra Beasley Von Burg, my MA
advisor at Wake Forest, who read countless drafts of my early attempts to unpack
conservative discourse on health care - the beginning of a research agenda that
culminated in this dissertation. I am so appreciative of countless other Wake Forest
faculty members helped prepare me for the rigors of a PhD program: Allan Louden,
v
Michael Hyde, Jarrod Atchison, Ron Von Burg. Paul Johnson, while never officially my
teacher, has provided invaluable advice over the years for which I owe him immensely.
I could not have finished this dissertation without the help of my amazing colleagues
at USC. Thank you all for all the laughs, the celebrations, and the camaraderie. To
Michelle Forelle and Patrick Davison for being my first real friends in LA. To Nathalie
Maréchal for keeping me sane in DC. To LeeAnn Sangalang for teaching me stats and
being my #oneHHS buddy. To Katie Elder for always assuring me I got this. To Brandon
Golob for being my quals and dissertation brother-in-arms. To Katie Walsh for
introducing me to The Bachelor franchise. To Sarah Meyers West for her unending
kindness. To the best cohort (asc-1
st
-year-phd-cohort4eva) - Xam, James, Christy,
Yomna, Melina, Shabnam, Yao, Andrea, Kristen, Yue. There is no one else I would
rather have gone through Monge’s class with than you all (shout out to Josh Clark for
being the best TA of all time).
I owe a special thanks to some of the people I met while at Media Matters, as the
work I did there provided the launching point for this dissertation. Thank you so much to
the colleagues who supported my work on health care and continue to this day: Sal
Colleluori, Sergio Munoz, Carlos Maza, Craig Harrington. In particular, I owe endless
thanks to my friend Julie Alderman. Without her help, this dissertation, quite literally,
could not have been done. Thank you for always being willing to talk through arguments
and read over a thousand segments of cable news. You are the real MVP.
Two special shout outs: To my cat Bubs for being the cutest and most snuggly writing
partner. To Barack Obama (#thanksObama) for embarking on the first successful reform
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of the health care system in my life time, improving the lives of millions and giving me
something to write about for the last seven years.
Finally, I am so lucky to have incredible friends and family, both in DC and scattered
throughout the US, that supported me through this process. To my debate ladies, Carly,
Leah, Abby. To my DC crew, Melanie, Mikaela, Sharon. Thank you all for the late night
gchats convos, the many bottles of wine, and for putting up with my inability to talk
about anything but health care. To my mom for always believing in me. To my best
friend Katie Remias for sending me the perfect motivational songs when I needed it the
most. And to Gregory Minton for being the equivalent of a Marvel superhero throughout
this whole process. Whether I needed emergency Chipotle or to rage about my inability
to put the words on the page, you were always there. Thank you so much for your support
and love.
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TABLE OF CONTENTS
Epigraph ii
Dedication iii
Acknowledgments iv
List of Figures ix
Abstract x
Chapter 1: Introduction 1
Why Health Care 3
Why Cable News 8
Journalistic Norms, Strategic Framing, and Indexing: 13
A Literature Review
Research Questions 22
Chapter Precis 23

Chapter 2: Methodology 25
Time Periods of Cable News Coverage 25
Cable News Networks and Shows 26
Segment Identification 29
Guest Coding Procedure 31
Substance Coding Procedure 34
Conclusion 35

Chapter 3: Sound Bites in Straight News Reports: 36
A Fair and Balanced Approach?
Straight News Reports, Sound Bites, and Political Balance: A Review 39
Content Analysis Results 42
Prevalence of Straight News Reports Across Networks 43
Prevalence of Sound Bites and the Partisan Break Down 44
Explanations for Sound Bite Imbalance on Fox News and CNN 48
Fox News 48
CNN 50
Distorting the Terms of the Health Care Debate 56
Conclusion 65
viii
Chapter 4: The Role of Cable News Hosts in Discussion-Based Segments 70
Discussion-Based Segments: A Review 74
The CBO: A Brief Overview 78
Problematic Trends in How Hosts Covered Health Care 86
CNN and MSNBC: Devil’s Advocate Gone Wrong 87
Fox News: Propaganda, Not Professional Journalism 98
Cable News as Inadvertent Player in Trump Gaslighting 104
Conclusion 112

Chapter 5: More Pundits, More Problems: The Lack of Experts 115
in Cable News Health Care Coverage
The Role of Experts in Journalism: A Review 117
Guest Analysis Results 121
Expert Guest Results by Network 121
Guest Results by Job Type 124
Segment Frame Results 127
Whither the Experts: Explanations for the Dominance 130
of Pundits and Political Journalists
Pundits 131
Political Journalists 134
Reinforcing Access Journalism: The Reliance on 136
Government Officials for Interviews
More Pundits, Less Policy: The Problem with Cable News’ 140
Expertise Shortage
Conclusion 148

Chapter 6: A Practical Guide for Improving Cable News 152
Coverage of Health Care
Improving Straight News Reports: Responsible 158
Practices for Partisan Sound Bites
Reimagining the Role of the Cable News Host: 162
Abandon the Devil’s Advocate, Adopt the Fact Check
Remedying Cable News’ Addiction to Pundits: Calling More Experts 171
The Role of Journalism Schools 176
The Role of the Audience 180
Key Contributions, Limitations, and Future Research 182

Bibliography 190

ix
LIST OF FIGURES

Figure 3.1: Straight Report Segment Totals 43

Figure 3.2: Wave One Straight Report Sound Bite Results 44

Figure 3.3: Wave Two Straight Report Sound Bite Results 46

Figure 3.4: CNN Partisan Sound Bite Totals 47

Figure 3.5: Fox News Partisan Sound Bite Totals 48

Figure 5.1: Total Segments Featuring Experts and Total Expert 123
Appearances by Network

Figure 5.2: Discussion-Based Segments Totals by Job Type 125

Figure 5.3: Total Guest Appearances in Discussion-Based 125
Segments by Job Type

Figure 5.4: Total Guest Appearances in Panel Segments by Job Type 127

Figure 5.5: Total Guest Appearances in Interviews by Job Type 127

Figure 5.6: Frame Analysis Results for Segments featuring an Expert 128

Figure 5.7: Frame Analysis Results for Segments without an Expert 128

Figure 5.8: Top Pundit Appearances by Network 132

x
ABSTRACT
This dissertation examines cable news coverage of the unsuccessful effort by
Republicans in 2017 to repeal and replace the Affordable Care Act, utilizing a qualitative
content analysis to uncover problematic trends and techniques in how CNN, MSNBC, and
Fox News reported on health care policy. This work adds to the current literature by
focusing on cable news coverage of public policy debates in a non-election context,
whereas most of the existing literature on the role of television news focuses on broadcast
coverage of elections. Examining the use of partisan sound bites in straight news reports,
the role of the cable news host in moderating discussion-based segments, and the types of
guests invited to participate in cable news coverage of health care, this project argues that
the confluence of the norms of political journalism, the profit motive undergirding the
television news industry, and the prevalence of conservative misinformation on health care
contributed to the manifestation of problematic biases and techniques in the cable news
coverage of the GOP health care reform effort. The final chapter provides a series of
recommendations for how cable news networks could improve coverage moving forward,
intended to serve as a practical guide for those involved in the production of cable news
moving forward, as attempts to repeal the Obama-era health law are likely to continue
throughout the Trump Administration.

1
CHAPTER 1:
INTRODUCTION

Health care reform represents one of the most important yet poorly understood
public policy issues in the United States. Health care affects every American, yet the
substance of health care policy is often treated like a footnote in cable news coverage,
subordinated to horse race reporting obsessed with the optics of reform proposals and the
potential effects on political fortunes rather than real people. The cable news coverage of
the House and Senate debates on the GOP proposals to repeal and replace the Affordable
Care Act (ACA) provides a unique opportunity to outline the major flaws in how cable
news covers health care policy and outline a path forward toward improving the
substantive quality of the news. The election of Donald Trump illustrates the need for
cable news networks to rethink how they approach covering the new administration
generally and health care policy specifically, particularly given the dramatic and
disastrous impacts his health care proposals would have on the American health care
system.
This dissertation focuses on cable news coverage because of the resurgent role of
cable networks in the new media environment. Cable news has taken on a newly
important and visible role in the media ecosystem, as viewership numbers continue to
climb and Trump’s love/hate relationship with networks like CNN makes cable news
salient in an unprecedented fashion. Previous media criticism has focused on print or
network coverage, leaving a dearth of critical work on the practices of cable news in
communicating public policy to the public.
2
This dissertation draws on the existing scholarship on the journalistic norms of
objectivity and political balance in political discourse, strategic framing in journalism,
and indexing theory to examine problematic trends in cable news coverage of the
Republican effort to repeal and replace the Affordable Care Act (ACA) from March 2017
to late July 2017. This project utilizes a qualitative content analysis of the different types
of cable news segments and the guests that appeared on those segments and the results
illustrate the different types of biases that manifested during coverage of the health care
debates. Each chapter will outline a problematic trend in a particular segment type,
provide an explanation for why this pattern or type of bias occurred, and unpack the
negative implications on the quality of cable news coverage of health care. This
dissertation argues that the confluence of the norms of political journalism, the profit
motive undergirding the trend toward infotainment in the television news industry, and
the prevalence of conservative misinformation on health care resulted in fundamentally
flawed coverage of the Republican health care effort that, inadvertently for CNN and
MSNBC or purposely for Fox News, amplified conservative narratives of misinformation
on health care. The concluding chapter will provide recommendations for improving the
substantive quality of cable news coverage of health care policy, aimed at resolving the
problematic trends isolated in each chapter. This project emphasizes how the
unprecedented nature of the Trump Administration, particularly in the context of health
care, requires cable news networks to reconsider how they share their health care
coverage, particularly since the effort to repeal the ACA is unlikely to go away anytime
soon.
3
Why Health Care
Health care policy represents a unique and timely case study for examining the
role of cable news in communicating policy to the public for a variety of reasons. First,
health care policy affects everyone. The health care industry is enormous – it comprises
one-sixth of the US economy, one in eight people are in the health care workforce, and
health care costs are predicted to be 40% of the U.S. GDP by 2040 (Jones, 2012a). The
Affordable Care Act’s individual mandate required every single person in the United
States to obtain health insurance, whether you receive coverage through your employer,
the individual marketplaces, or a government program like Medicaid or Medicare. Thus,
proposals to reform the health care system affect everyone, whether in the form of higher
(or lower) costs, changes in your financial assistance, or even whether you have access to
coverage at all.
Second, Trump’s victory in the 2016 election introduced the first opportunity for
the Republican Party to finally make good on its eight-year-old promise to repeal the
Affordable Care Act. Opposition to the ACA has evolved into an overriding priority for
Republicans, a litmus test and a coded mechanism for expressing opposition to President
Obama all in one. Given the unique role of health care in animating conservative politics
for the better part of a decade, it presents itself as a unique case study for examining how
cable news covers such an important but polarizing issue.
The potential for the GOP to finally repeal the ACA merits attention given the
massive achievements of the landmark law in expanding access to health insurance in the
United States. As a result of the passage and implementation of the ACA, the number of
uninsured Americans is at an all-time low (Mangan, 2016; Young, 2016b). The ACA’s
4
Medicaid expansion allowed more than 14 million low-income Americans to obtain
health insurance, while also reducing class and race-based coverage disparities in the
insurance market and expanding access to coverage for people with disabilities
(Courtemanche, Marton, Ukert, Yelowitz, & Zapata, 2016; Buchmueller, Levinson,
Levy, & Wolfe, 2016; Musumeci, 2014). The ACA tangibly improved access to women’s
health care by banning medical underwriting which allowed insurers to charge women
more and implementing policies like the birth control mandate that substantially reduced
out-of-pocket costs for women while dramatically increasing access to the most effective
forms of birth control (“Uninsured rate…”, 2016; Palanker & Schwab, 2016; Tavernise,
2015; Andrews, 2012). And of course while there are the popular policies that most
people know, such as the provision to allow young adults to remain on their parents’
insurance until age 26 and the ban on discriminating against those with pre-existing
conditions; the ACA has also made significant but less publicized improvements in
access to mental health care services and substance abuse treatment, which are essential
in the continued fight against the opioid epidemic (Seelye & Goodnough, 2017; Molteni,
2016; Mizrachi, 2013; Levitt, Pollitz, Claxton, & Damico, 2013). While far from perfect,
the ACA has fundamentally transformed the American health care system and made
considerable progress in expanding access to quality and (mostly) affordable health care,
thus, the Republican attempts to throw it out and replace it justify significant attention.
Third, if Republicans had succeeding in passing their proposals to repeal and
replace Obamacare, the policy implications would have been catastrophic for the vast
majority of Americans. The final version of the House bill that passed – with several
amendments but with little congressional debate – would have resulted in 23 million
5
fewer Americans possessing health care coverage as opposed to the current levels under
the Affordable Care Act by the year 2026, according to a report from the non-partisan
Congressional Budget Office (CBO).
1
The CBO report also noted that as a result of an
amendment
2
to allow states to waive the essential health benefits (EHBs) package and
protections for individuals with pre-existing conditions, “people who are less healthy
(including those with preexisting or newly acquired medical conditions) would ultimately
be unable to purchase comprehensive nongroup health insurance at premiums comparable
to those under current law, if they could purchase it at all” (CBO, 2017b). Sarah Kliff, a
health care reporter at Vox, explained that while Republicans were quick to tout the
section of the CBO report that indicated that premiums would decrease over time, the
reason premiums would drop is because the Republican plan “break[s] the promise to
protect preexisting conditions” and “sick people who need coverage more would drop out
of the marketplace,” thus taking the most expensive individuals out of the insurance
markets (Kliff, 2017c). Additionally, the AHCA and the Senate’s BCRA ended Medicaid
expansion and fundamentally changed the program’s funding structure by instituting per
capita caps, which would cut federal Medicaid funding by over $800 billion over the next
10 years and reduce the number of Americans covered under Medicaid by 14 million in
2026 (Gee, 2017; Yglesias, 2017b). The massive cuts to Medicaid represent just one of
Trump’s many broken policy promises and have been denounced by numerous experts
across the health care industry – particularly since these tremendous funding cuts are

1
It should be noted that this CBO score came out after the AHCA had already passed the House of
Representatives, because Speaker Ryan and the rest of the GOP refused to wait for a score before voting
(despite demanding multiple times for Democrats to wait for a CBO score during the debates over the
ACA).
2
This amendment is colloquially referred to as the MacArthur Amendment referring to its author,
Representative Tom MacArthur (R-NJ).
6
used to pay for the repeal of the ACA’s taxes, which translates into a $600 billion tax cut
for the wealthy (Thompson, 2017). Given the dramatic impacts the GOP proposals would
have had on the American health care system and the public, this project provides unique
insight into the problems with how cable news covered health care policy and provides
recommendations to improve the substantive quality of future reporting, since Trump and
the GOP are likely to continue their pursuit of Obamacare repeal.
Fourth, Americans are gravely uninformed about the health care system generally
and about the Affordable Care Act and the GOP proposals specifically. Recent polling by
the Kaiser Family Foundation illustrates how the American public still doesn’t
understand the connection between changes in the health insurance industry and coverage
levels and the Affordable Care Act. For example, the March Kaiser Health Tracking Poll
revealed that while 41 percent of respondents “know that the share of people who are
uninsured has decreased since the ACA was passed, nearly as many (31 percent) believe
it has increased and 26 percent think it has remained about the same” (Kirzinger, Hamel,
Sugarman, Wu, & Brodie, 2017). Americans are also uninformed about restrictions on
federal funding for abortion – a key element in the ongoing debate over whether to
defund Planned Parenthood (which the AHCA does). The March 2017 report found that
only one-third of Americans knew that “the Hyde Amendment prohibits federal Medicaid
funds from being used to pay for abortions” (Kirzinger et al., 2017). While the public
knows about high-profile provisions like the individual mandate or the provision to allow
young adults to remain on their parent’s insurance, less than half know about the medical
underwriting, and 50 percent “incorrectly believe the ACA allows undocumented
7
immigrants to receive financial help from the government to buy health insurance”
(Kirzinger et al., 2017).
This confusion over policy specifics extends to the GOP proposals, as 45 percent
reported that they expect the AHCA to provide similar protections for individuals with
pre-existing conditions, 30% thought the number of people with health insurance would
remain the same while 18% thought the number of insured would increase (Kirzinger et
al., 2017). Given the dire state of the public’s comprehension of health care policy, one
might be tempted to conclude that media coverage of the policy specifics is irrelevant,
and Americans are forever doomed to be uninformed about health care. While this
dissertation makes no causal claims about the effect of coverage on public knowledge
levels, some polling has shown opinions on specific AHCA provisions to be malleable
when exposed to new information (Kirzinger et al., 2017) and other studies demonstrate
that audiences do learn from exposure to cable news (Mutz, 2015). Moreover, this project
examines how cable news coverage adds to the ecosystem of misinformation that
pervades political discourse on health care policy. While cable news networks certainly
are not responsible for the dire nature of public comprehension of the American health
care system, this dissertation outlines a series of trends and techniques that cable news
networks used during coverage of the GOP health care reform effort that often allowed
inaccurate claims to stand unchecked and, more problematically, frequently amplified
conservative misinformation. This project maps out a series of recommendations for
improving the informational quality of coverage, outlining a normative role for cable
news in the media ecosystem that curbs the worst of its existing bad conventions and
8
techniques while still acknowledging the beneficial aspects of strategic framing and other
conventions that draw viewers to cable news.
Why Cable News?
This project focuses on cable news because the existing scholarship on the role of
the press in communicating to the public tends to focus on network broadcasts or print
journalism. Lynn Letukas explained in her book, Primetime Pundits, that while
“television news has moved beyond the traditional (or “Golden Age”) system, in which
three broadcast networks (ABC, NSBC, and CBS) earn roughly equal shares of audience
and viewership… little research has focused on the ways that cable news primetime talk
shows frame information” (Letukas, 2014, p. 8-9). When research does include cable
news, it tends to focus on the “straight news” shows like Fox News’ Special Report or
CNN’s The Situation Room, ignoring the majority of cable news programming. For
example, Harvard’s Shorenstein Center on Media, Politics and Public Policy did a series
of studies on media coverage of the election, including studies on the amount of coverage
and framing of the candidate’s policy positions, but restricted its data set to “print
editions of five daily papers (the Los Angeles Times, The New York Times, The Wall
Street Journal, The Washington Post, and USA Today) and the main newscasts of five
television networks (ABC World News Tonight, CBS Evening News, CNN’s The
Situation Room, Fox’s Special Report, and NBC Nightly News)” (Patterson, 2016, p. 6).
Given the changing nature of the fragmented media ecosystem, focusing exclusively on
the narrowly defined “straight news” shows ignores a vital media source and relies on
outdated assumptions about the role of cable news.
9
Previous research has excluded cable news from analysis because of the plethora
of pundit-based news “talk shows” that dominate Fox, CNN, and MSNBC. As Letukas
noted, “this lack of scholarly attention appears to reflect a view of talk shows on cable
news as lacking the same credibility in substantive content and reporting as traditional
mainstream print and electronic news” (Letukas, 2014, p. 9). Cable news shows are often
criticized as “aimed toward a niche audience of one political party or individuals with a
set of partisan ideological beliefs” and recent research on cable news often focuses on
investigating (real or perceived) political bias in news content and its potential impact on
public opinion (Letukas, 2014, p. 9; Baum, 2011; Morris, 2005; Morris, 2007). Cable
news hosts and pundits have been castigated as nothing more than “talking heads,” cast
off as partisan hacks who dilute rather than contribute to political debates (Hirsch, 1991).
While it is undeniable that Fox News explicitly caters to a conservative audience
(Jamieson & Cappella, 2008), MSNBC attracts a more liberal audience (Martin &
Yurukoglu, 2017), and CNN claims to be the “more balanced” “middle-of-the-road”
network (Hagey & Niedzwiadek, 2016), the extent to which each frames their news
coverage to appeal explicitly to those audiences is far from equivalent (Alterman, 2008).
Excluding cable news shows from analysis ignores the degree to which cable news has
reemerged as a leading news source in the current political climate.
Furthermore, scholars have noted how the evolution of television journalism and
cable news in particular has resulted in the increasing use of discussion-based segments,
such as interviews and panel discussions, as the primary method for covering political
news (Ben-Porath, 2007). The increasing prevalence of discussion-based segments can be
attributed to the economical nature of such segments that provides networks with a
10
relatively cheap way of filling the 24-hour news hole (Anderson, 2004; Letukas, 2014).
Panel segments in particular often include a variety of types of guests, including objective
journalists, partisan commentators, and subject-matter experts, further blurring the line
between commentary and news (Farhi, 2016b; Farhi, 2018; Anderson, 2004). While the
turn toward political talk segments as a mechanism for covering the news potentially
compromises the traditional journalistic norms of objectivity, people still turn to cable
news for information about politics, and studies show that these individuals learn from
these discussion-based segments (Mutz, 2015; Meltzer, 2010). As a result, this project
develops strategies for improving the substantive quality of coverage within these types
of segments including strategies to ensure even discussion-based segments showcase
factual discussions of health care policy, while still retaining the entertainment value of
these formats.
The 2016 election spurred a resurgence in the importance of cable networks as a
source of news for Americans. The Pew Research Center’s 2016 State of the Media
report confirmed that “even with all the available platform choices” for viewing
television like Hulu and Netflix, “viewership increased for cable news channels in 2015”
(Holcomb, 2016, p. 22). The Pew report explained that during primetime (defined as
6pm-11pm in this report), the “combined average viewership rose for the three major
news channels (CNN, Fox News and MSNBC) by 8% to 3.1 million” an increase that
“was largely due to CNN, which experienced an especially sharp uptick, growing its
evening viewership 38%” (Holcomb, 2016, p. 22). Daytime viewership also increased, as
Pew Research Center analysis of Nielsen Media Research data found that “between the
hours of 6 a.m. and 6 p.m., average viewership for the three channels combined increased
11
9% to 2 million” (Holcomb, 2016, p. 23). Another Pew Research study of the media
consumption patterns of Americans found that cable news topped the list of news source
that they find helpful for finding news about the election (Gottfried, Barthel, Shearer, &
Mitchell, 2016). Cable news rating historically jump during elections, only to recede after
November passes (Young, 2016a). Despite this, cable news ratings continue to climb,
with all three networks seeing increases in daytime viewership in the first month of 2017
in comparison to their 2016 audience numbers (Koblin, 2017).
The current political environment presents a unique opportunity to study the
trends in cable news coverage of policy and map out normative standards for future
reporting because of President Trump’s affinity for cable news and the challenges his
administration poses to journalism. President Trump continues to fuel record-breaking
cable news coverage and viewership in part because of the controversies that continue to
surround his presidency but also because of his own public consumption of and attitudes
toward cable news. Unlike any president before him, Trump consumes an unusually large
amount of cable news, estimated to be over five hours per day, including MSNBC’s
“Morning Joe,” Fox News’ “Fox & Friends,” and various CNN shows (Bump, 2017a;
Allen & VandeHei, 2017). Trump’s “obsession” with cable news – and media coverage
of his presidency generally – is evident from the President’s Twitter feed, as he tweeted
about “Fox & Friends” seven times in March alone, and often tweets criticism of “Fake
News CNN” (Godfrey, 2017). Reporting on the early days of his presidency has
illustrated the degree to which Trump deeply cares about how cable news covers his
presidency and how it influences his decisions as President, as Ashley Parker and Robert
Costa (2017), two reporters for The Washington Post, explain:
12
For Trump — a reality TV star who parlayed his blustery-yet-knowing on-air
persona into a winning political brand — television is often the guiding force of
his day, both weapon and scalpel, megaphone and news feed. And the president’s
obsession with the tube — as a governing tool, a metric for staff evaluation, and a
two-way conduit with lawmakers and aides — has upended the traditional
rhythms of the White House, influencing many spheres, including policy, his
burgeoning relationship with Congress, and whether he taps out a late-night or
early-morning tweet.
Trump’s consumption of cable news supercharges the need for cable networks to ensure
their coverage strives to produce truthful, informative reporting on policy issues and hold
his administration accountable – particularly given the unprecedented degree to which
President Trump and his administration spreads misinformation and outright lies. As of
June 2017, the PolitiFact scorecard of fact-checks of Trump’s statements found 20
percent to be “Mostly False,” 33 percent to be “False,” and 16 percent to be “Pants on
Fire” lies – meaning almost 70 percent of Trump’s statements that they evaluated were
mostly false or worse. The Washington Post Fact Checker team (2017) analyzed all the
false or misleading claims made by Trump during his first 100 days and found 492 false
or misleading claims “as of Trump’s 100
th
day.” This predilection for spreading
misinformation and lies extends beyond Trump himself, as this project will analyze how
the media’s historical reliance on official sources and interviews with administration
officials must contend with the reality that the most unreliable sources are now often
Trump administration officials. The complexity of health care policy and the generally
uninformed state of the American public reinforces the need for cable news to reevaluate
13
how it reports on policy issues and establish new normative standards for how to deal
with the challenges posed by the Trump administration
Journalistic Norms, Strategic Framing, and Indexing: A Literature Review
This project draws on the existing scholarship on how the principles and norms
engrained in the profession of journalism and examines how these norms manifest in
particular practices and techniques in cable news. While much of the literature examined
in this section pertains to traditional forms of journalism (primarily print but also some
broadcast television), this dissertation argues that cable news utilizes key tropes and
stylistic features of traditional journalism and that, as a result of that appropriation, cable
networks should be held to similar journalistic standards, regardless of how innovations
have transformed how the news is delivered.
A crucial aspect of this project revolves around analyzing how journalism’s
obsession with objectivity as a guiding professional norm manifests in cable news
coverage of health care policy. Objectivity rose to prominence as a dominant principle in
the production of the news in the mid 1800s, as technological advances made quick mass
production of the news possible and the development of economic pressures to cater to
the widest possible audience caused the press to turn away from its partisan roots toward
an ‘objective’ style (Cunningham, 2003; Schudson, 2001). While the objectivity norm
has come under periods of scrutiny and backlash, it continues to play a fundamental role
in shaping the production of the news to this day (Cunningham, 2003; Patterson, 2013).
The objectivity norm in journalism represents the attempt to present the news in a way
that “correspond[s]” to the way things really are” (Iggers, 1998, p. 92), although the
baseline for determining how things ‘really are’ is inherently subjective and the choices
14
inherent in which aspects of a news story to emphasize and which to downplay reflect
intentional choices that impact how an audience views the issue or event in the story
(Delli Carpini, 2005; Jamieson & Waldman, 2003). The drive toward objective reporting
has created “a set of procedures that the reporter uses in order to produce those
objectively true accounts” (Iggers, 1998, p. 92), which has resulted in practices like
relying on official sources (Bennett, 2016), instituting balance into stories by routinely
showcasing ‘both sides’ of an issue, sometimes irrespective of the validity of each side
(Jamieson & Waldman, 2003; Edelson, 2012), and an engrained reluctance to engage in
fact checking (Patterson, 2013; Rosen, 2009). The adherence to the objectivity norm as a
guiding principle in journalism results from economic pressures, as the he said/she said
template facilitates quick formulaic reporting, and from self-preservation instincts, as
objectivity functions as a shield for journalists against criticism (Cunningham 2003;
Rosen 2009).
Political balance, bias, and neutrality represent key concepts intertwined with the
objectivity norm in the production of political news in particular. Political balance as a
construct has been “a notoriously difficult concept to operationalize,” but the definition
of political balance that is standard in US studies (and most political systems with two
parties) views political balance as “equal treatment” of the two parties and examines the
balance in visibility, or “access to media content,” in particular
3
(Hopman, Aelst, &
Legnante, 2011, p. 244; D’Alessia & Allen, 2000). Hopman, Aelst, & Legnante (2011)

3
Visibility studies empirically have looked at imbalance in the amount of attention the news media devotes
to incumbents versus challengers in elections. It has previously been measured by “cod[ing] the party
affiliations of actors appearing in news stories,” a method used in this chapter for evaluating the imbalance
in the use of partisan sound bites in straight news reports (Hopman et al., 2011, p. 248).
15
define balance and bias as “antonyms” because “the absence of balance implies a bias”
(p. 243-4). Bias in the news can refer to a variety of ways in which the presentation of the
news strays from the ideal of objectivity, including partisan slant in the perspective
provided in reporting, as seen in the news programs on MSNBC and Fox News (Martin
& Yurukoglu, 2017; Bard, 2017), a dependence on elite sources resulting in a limited
perspective into the range of voices on a given debate (Bennett, 2016; Bennett, Lawrence,
& Livingston, 2007), or distortions in how policy debates are presented as a result of
false equivalences (Edelson, 2012). Neutrality in journalism “is an assessment of the
starting point of journalism” most often referring to the “predisposition a reporter or news
operation brings to the job” as opposed to “the ending point” of “what is reported” (Bard,
2017, p. 103). Iggers (1998) criticized the “myth of neutrality” in journalism, arguing that
it functions to demarcate the appropriate boundaries of action for journalists, preventing
them from stepping “outside the role of neutral observer and messenger” because to do so
would “undermin[e] both their own objectivity (that is, their ability to see things
impartially) and their credibility” (p. 99). This project argues that various problematic
practices displayed during cable news coverage of the GOP health care debates result
from flawed manifestations of these guiding principles and illustrates how the driving
forces of journalism that venerate objectivity and balance often result in a news product
that is inherently biased. Given the stakes of efforts to reform the American health care
system, this dissertation argues that cable news networks must reevaluate how they
approach the production of the news on important public policy issues and advocates for
a more active interpretive role for cable news reporters and hosts.
16
Within the discussion of how journalistic norms shape cable news coverage of
health care policy debates, this project draws on the scholarship that examines the role of
framing in journalism, particularly the analysis on what this dissertation refers to as
‘strategic framing,’ which encompasses a variety of related journalistic practices such as
he said/she said reporting, horse-race focused stories, and the dominance of conflict as a
framing device in political stories. Communication scholars have long studied the role of
framing in the media and how it may or may not impact the public’s perceptions of
candidates and public policies. Entman (1993) described framing as the process of
selecting “some aspects of a perceived reality and make them more salient in a
communicating text, in such a way as to promote a particular problem definition, causal
interpretation, moral evaluation, and/or treatment recommendation for the issue at hand”
(p. 52). Others have emphasized the multiplicity inherent in the process of framing, as
Chong (1996) noted that “an issue can be interpreted using any number of frames” and
underscored that different frames can induce individuals to draw “different conclusions”
than if another frame had been used (p. 200). As the scholarship on framing developed,
scholars noted that framing does not happen in a vacuum, particularly in the political
sphere comprised of a competitive environment with multiple actors attempting to frame
and counterframe a given issue (Chong & Druckman, 2007; Chong & Druckman, 2013).
Strategic framing in journalism, as defined by this project, focuses on the political
strategic or political ramifications instead of the substantive content or the real-world
implications of events, issues, and policies (Callaghan & Schnell, 2005; Delli Carpini,
2005; Jamieson & Waldman, 2003). Strategic framing dominates much of political
journalism, its prevalence resulting from the fact that it “is portable, reusable from cycle
17
to cycle, and easily learned by newcomers” and “journalists believe it brings readers to
the page and eyeballs to the screen” (Rosen, 2008). The trend toward punditry in cable
news coverage and the over-reliance on generalists, who can speak about many topics in
a surface level way, rather than experts, who possess substantial knowledge on their
particular field, reinforces the use of the strategic frame, a trend this dissertation will
explore (Letukas, 2014; Jamieson & Waldman, 2003). In their book The Press Effect,
Jamieson and Waldman (2003) criticized the use of the strategic frame, focusing
specifically on horse race framing, and argued that the emphasis on “seeing the story
through the lens of strategy and tactics” caused reporters to neglect “their role as
custodian of fact” (p. 2). Other criticisms of strategic framing focus on the degree to
which it can induce passivity in the audience, because “by emphasizing strategy over
substance, and winning and losing over issues, politics ‘becomes something to watch,
like a sporting event, instead of something [citizens] can join” (Delli Carpini, 2005).
Defenders of the strategic frame argue that it results in more engaging coverage rather
than straight reporting on policy facts that cause viewers to change the channel. In
contrast to those who believe the strategic frame eliminates substantive coverage, some
journalism veterans believe “the horse race story does not get in the way of policy
discussion but is the one feature … that makes policy discussions possible and appealing”
(Schudson, 2008, p. 92).
Strategic framing includes a variety of different practices (largely resulting from
the quest to adhere to the traditional tenets of objectivity and balance) used by journalists
to focus a news segment on discussions of the strategic dimensions of an issue, including
but not limited to the ‘he said, she said’ style of reporting, emphasizing the game aspect
18
of politics in analyzing the legislative process as a ‘horse-race’ between two sides, and a
fixation on amplifying conflict. ‘He said, she said’ reporting, also referred to as ‘both
sides’ analysis, involves presenting competing sides of an issue or event in a relatively
equivalent manner, regardless of their relative validity, with little to no attempt “to assess
clashing truth claims,” leaving it up to the audience to parse the accuracy of the
arguments presented (Rosen, 2009; Gans, 2014). This approach to ensuring political
balance in reporting fails to acknowledge that “there are not always two sides to every
story” and “when reporters follow the balance trap model, they create a false equivalency
that incorrectly suggests to readers that each side of the ‘debate’ has a fair point to make
and choosing between the two positions is simply a subjective decision” (Edelson, 2012,
p. 557). Scholars have noted that journalists utilize this technique and are generally
“reluctant to call a lie a lie” because “they fear this will make them look biased,” but this
‘both sides’ approach can degrade public comprehension of the issues, particularly
complex ones like health care policy, if “people [are] not able to separate fact from
fiction on matters of public interest” (Edelson, 2012, p. 530-531). This project examines
how the impulse to present both sides of the health care debate resulted in the
amplification of false claims and misinformed narratives, as later chapters will show how
the Trump Administration and congressional Republicans relied on factually inaccurate
talking points that were often repeated during cable news coverage of the congressional
health care debates with little to no context or attempts at fact checking.
Analyzing the ‘horse-race’ aspects of the legislative process “plays well on
television” because it caters to the strengths of political journalists and pundits who “tend
to be much more comfortable making evaluative strategic statements than evaluative
19
statements about policy” (Jamieson & Waldman, 2003, p. 167). By filtering discussions
of complex health care proposals through the strategic frame, it reinforces the political
neutrality of cable news hosts and journalists because “‘who’s gonna win?’ is not an
ideological question” (Rosen, 2011). However, this “relentless focus on tactics” often
occurs without a corresponding discussion of the substantive content of policy proposals,
which “leaves voters unable to assess whether politicians’ claims should be believed”
(Jamieson & Waldman, 2003, p. 166-167). This dissertation examines the degree to
which this type of coverage dominates the reporting on the congressional debates on the
GOP health care proposals and examine how cable networks can bolster the substantive
quality of their health care coverage without abandoning the ‘inside baseball’ analysis
that draws the political partisans to watch cable news.
Reporting on and analysis of the political sphere often highlights the element of
conflict intrinsic to the legislative process, as “reporters are biased toward conflict
because it is more interesting than stories without conflict” (Cunningham, 2003). While
political journalists have long highlighted controversy and conflict in their reporting,
cable news in particular “feasts on controversy,” as the format of cable news coverage
has increasingly turned toward discussion-based segments that delivers the news via
dialogue and debate (Patterson, 2013, p. 39; Ben-Porath, 2007). The evolution toward
infotainment, “a theatrical style of news” that emphasizes drama and the entertainment
value of the news in an attempt to increase audience numbers, reinforces this emphasis on
conflict (Patterson, 2013, p. 20; Jones, 2012b). This project analyzes how the obsession
with conflict can result in problematic distortions in the coverage of public policy
20
debates, particularly when intra-party conflict becomes a dominant storyline, resulting in
a skewed perception of the key questions in the debate.
This project does not seek to answer whether or not the strategic frame is good or
bad but rather to examine how cable news uses this frame in the context of discussing
health care and the degree to which this frame is compatible with substantive discussions
of the implications of proposed health care policy reforms. In particular, this project
draws on the work done by Michael Delli Carpini (2005) to emphasize that a variety of
norms and constraints on journalists result in journalistic frames that “necessarily
produce alterations in the presentation of choice problems” (p. 24). His work focused on
print journalism, but he notes in a footnote that “the central argument of this chapter –
that the norms and constraints of journalism combine to produce frames that inevitably
lead to “biased” presentations of the world – is as or more applicable to the new media
environment emerging as a result of cable and satellite television” (Delli Carpini, 2005, p.
197). Of particular note, he emphasized that the new media environment “coupled with
economic changes in the media that have increased the pressure for profitability in the
news, have exacerbated the influence of the practical constraints … and implicitly
challenged the normative underpinnings of the social responsibility theory of the press”
(Delli Carpini, 2005, p. 197). The social responsibility theory of the press believed that
the press should provide the day’s news in a truthful and comprehensive fashion,
providing competing viewpoints while “weighing the reliability of various sources and
putting facts into some kind of context” (Delli Carpini, 2005, p. 26). This project argues
for the incorporation of elements of the social responsibility theory into how cable news
networks approach covering health care policy and the Trump Administration in
21
particular, advocating for cable news journalists and hosts to adopt a more active role in
interpretation and assessing the validity of truth claims pushed by competing sides in
policy debates, particularly given the prevalence of misinformation in the arena of health
care policy.
One final area of scholarship that informs this project is the work done on
indexing, a theory first introduced by W. Lance Bennett. Indexing “refers to the tendency
of mainstream news organizations to index or adjust the range of viewpoints in a story to
the dominant positions of those whom journalists perceive to have enough power to
affect the outcome of a situation” (Bennett, 2016, p. 15-16). Bennett argues that indexing
emerged out of the engrained commitment to “cling to a norm of balance, fairness, or
objectivity” and the entrenched notion that “journalists must channel images of reality
through external sources, and the safest sources are those who are elected by the public
and who have the power to shape political outcomes” (Bennett, 2016, p. 16). Indexing
theory helps to explain why government officials constitute a large majority of the
sources or quotes for news stories – a trend that extends to cable news. The conundrum
for journalists who rely on indexing as a mechanism for determining what sources to use
and which viewpoints to portray in their stories arises when you have a politician like
Trump, who repeatedly and unremittingly lies (Fallows, 2016; Farhi, 2016a). When one
side in a political debate (or election) promotes misinformation or “untruthful spin,” a
journalist or news outlet that portrays the ensuing debate or comparison of the two sides
can inadvertently present that misinformation “as equally valid alongside more plausible
versions” (Bennett, 2016, p. 16). One notorious example in recent history is the Iraq War,
as the news media repeated the Bush Administration’s claims about the presence of
22
weapons of mass destruction in Iraq, spreading the misinformation even after the claims
had been challenged (Bennett, 2016). This project analyzes how the reliance on elite
sources, such as elected representatives and Trump Administration officials, as sources of
information in public policy debates like health care represents a flawed method for
informing the public about health care, particularly given the factual inaccuracy of many
of the conservative talking points utilized during the 2017 congressional debates on
health care.
Research Questions
Drawing on this survey of literature, these are the central research questions that
this study tackles, culminating in the creation of a series of recommendations for
improving the substantive quality of cable news coverage of health care policy and
mapping out a normative role for cable news in the media ecosystem:
• How do traditional journalistic norms of objectivity and political balance
influence cable news coverage of health care policy?
• What patterns emerge in the use of partisan sound bites during straight news
reports and how does it influence the image of the congressional health care
debates presented to the cable news audience?
• How do cable news hosts moderate discussion-based segments during coverage of
the GOP health care debates and how do the techniques utilized by hosts improve
or degrade the informational quality of cable news coverage of health care?
23
• What types of guests do cable news networks invite to participate in coverage of
health care policy and what effect does that have on the substantive content of the
health care discussions and debates?
• What should the role of cable news be in communicating health care policy to the
public in light of the challenges presented to political journalism by the new
Trump Administration?
Chapter Precis
Chapter Two outlines the methodology used to conduct the qualitative content
analysis. It explains the procedures used for identifying shows and segments for analysis
and the process used for coding the guests and substantive content of segments.
Chapter Three investigates the use of partisan sound bites in straight news reports
during CNN, MSNBC, and Fox News’ coverage of the health care debates. The results of
the content analysis revealed a significant political imbalance in the use of sound bites, as
straight news reports featured significantly more sound bites of Trump and congressional
Republicans, resulting in a problematically distorted image of the congressional health
care debates.
Chapter Four examines the role of cable news hosts in discussion-based segments,
outlining problematic trends in how hosts moderated discussions of the GOP health care
reform effort across the three networks. This chapter argues that the problematic question
formats hosts used and the inconsistency with which they fact checked false claims made
during discussion-based segments result either from the flawed manifestation of the
journalistic norms emphasizing political balance and neutrality, in the case of CNN and
24
MSNBC, or as the result of political ideology in the case of Fox News. This chapter also
places the critiques of cable news coverage of health care in the context of the broader
challenge to television journalism posed by the Trump Administration and urges
networks to reconsider their approach to covering a presidency that does not respect facts.
Chapter Five presents the results of the analysis of the types of guests that appeared
on CNN, MSNBC, and Fox News during the House and Senate debates on the GOP
health care proposals, which show that networks predominantly relied on pundits,
political journalists, and elected legislators as guests during discussion-based segments,
while rarely including health care subject matter experts in their coverage. This chapter
explains how the trend toward an infotainment-style of covering the news explains why
cable news networks primarily rely on these types of guests and argues that the over
reliance on pundits and dearth of health care experts degrades the informational quality of
cable news coverage of health care policy.
Chapter Six provides a series of recommendations for reforms cable news networks
could enact to improve the substantive quality of their coverage of health care policy.
These recommendations provide a variety of actions that would ameliorate the flaws in
the cable news coverage of the 2017 health care debates and can serve as a practical
guide for cable news producers and executives. This chapter concludes with a discussion
of the competing influences that face cable news networks in covering public policy and
makes the normative case for a more productive role for cable news in the media
ecosystem under the Trump Administration.
25
CHAPTER 2:
METHODOLOGY

This project utilized a qualitative content analysis of cable news coverage of the
congressional debates over the Republican health care proposals, examining many facets
of how CNN, MSNBC, and Fox News covered health care policy including the different
forms of segments, types of guests, and the substantive quality of coverage. This chapter
lays out the methodological process used during this project, including the reasoning
behind the time periods of cable news coverage chosen for the study, the process of
identifying qualifying cable news shows and segments for analysis, and the parameters
for evaluating the quantity and quality of coverage that guided the coding process.
Time Periods of Cable News Coverage for Analysis
This project examined cable news coverage of the Republican efforts to repeal
and replace the Affordable Care Act, defining that as the debates over the American
Health Care Act (AHCA) in the House and the Better Care Reconciliation Act (BCRA) in
the Senate. The coverage of the House debates ranges from March 7-24, 2017 and April
20 – May 4 2017, omitting the time between the first aborted vote (March 24) and the
reintroduction of the AHCA (April 20). The brief time in between the two periods of
coverage included for analysis was omitted for the sake of creating a data set that was
manageable while not excluding any major periods of coverage or important legislative
events. The debates over BCRA occurred between June 22 – July 28, 2017 and the entire
time period was coded for analysis. While health care continues to dominate as a key
topic of conversation and legislative debate on Capitol Hill, this project does not include
26
any of the coverage of other health care proposals (such as the Cassidy-Graham bill) or
alterations to the Affordable Care Act (e.g., the repeal of the individual mandate in the
Republican tax law). The debates over the AHCA and BCRA constitute the main
legislative attempts by Republicans to repeal the Affordable Care Act, making them an
ideal case study for examining how cable news covers health care policy.
Cable News Networks and Shows
This project included all three networks to allow for a comparative look across
cable news networks to examine potential differences in their health care coverage.
Examining all three networks enables a more comprehensive survey of the cable news
ecosystem while using each segment as the unit of analysis will allow for uniform
comparison across the different types of shows on the three networks. While this project
studied all three networks, some of the chapters focus more directly on CNN, because
CNN posits itself as the “middle of the road” option for cable news viewers. The current
CNN president Jeff Zucker has argued explicitly that CNN’s election viewership gains
were a result of his repositioning the network “to appeal to Republicans and Democrats
alike” resulting in a “much more-balanced network” (Hagey & Niedzwiadek, 2016).
Bryan Curtis (2016) argued that the serious journalists on CNN like Jake Tapper and
Brian Stelter view “CNN’s middle ground as a moral high ground from which to cover
both candidates.” CNN presents an interesting case study because while its “middle
ground” approach nods toward journalism’s historical preference for objectivity, it also
embodies (and pioneers) much of the trend toward infotainment, as Zucker has
intentionally introduced entertainment-based original programming and emphasized
spectacle events like town halls and public debates to draw in more viewers (Sherman,
27
2014; Hagey & Niedzwiadek, 2016). This dissertation unpacks how both of these trends
in cable news coverage impact public debate over health care and focusing on CNN in
some of these discussions allows for a more in-depth discussion. Additionally, given that
MSNBC and Fox News have well-established partisan slants (or at least the perception of
such bias), focusing on CNN in some instances (while still making comparative
arguments) makes sense given their position in the ideological cable news spectrum.
4
As
the pioneer in 24-hour cable news programming, CNN has a historical legacy and clout
that make it ripe for analysis and critique, particularly given its current high-profile in the
media ecosystem thanks to the network’s ongoing feud with President Trump. While
CNN will be used as a case study for some of the trends in cable news this project will
analyze, data on all three networks will be used to make comparative arguments across
the three networks to ensure a comprehensive view of the cable news ecosystem.
While Fox News was included in the content analysis design, the network’s
coverage of health care is largely excluded from the analysis in this project. As the
project evolved with the results of the study, the focus turned to an examination of how
the techniques used by cable news networks resulted in coverage that highlighted
conservative narratives about health care, in particular investigating how different types
of coverage resulted in the repetition of right-wing misinformation about health care.
Numerous studies have firmly established Fox News as a conservative-leaning
ideologically driven outlet, that shapes its coverage of the news to both cater to a

4
This is particularly true for Fox News, which has been prominently criticized for its overly friendly
coverage of the Trump Administration. MSNBC, however, has made hiring decisions and programming
shake-ups in an attempt to move the network away from its perceived liberal slant, which will be addressed
at length in Chapter 4.
28
conservative audience and facilitate the Republican agenda (Levendusky 2013; Jamieson
& Cappella, 2008; Alterman, 2003). The conservative nature of Fox News has taken on a
new life under the Trump Administration, as the network has transformed into something
akin to state TV according to some critics, a trend that will be further discussed in
Chapter 3 (the sound bite chapter). Thus, it made little sense to include Fox News into
chapters analyzing how conservative narratives and talking points about the ACA
infiltrated cable news coverage of the Republican health care effort, as those narratives
constitute the basis of their coverage.
This project focused on primetime weekday coverage on the three networks,
defining primetime as the hours between 6 and 11pm. This range was chosen because
primetime coverage generally produces the highest ratings and it models the
methodology of other cable news studies (Letukas, 2014; Holcomb, 2016). For CNN, the
four primetime shows remained the same throughout the period of study
5
and included
The Situation Room with Wolf Blitzer, Erin Burnett OutFront, Anderson Cooper 360
(which is two hours long), and CNN Tonight. MSNBC’s primetime lineup changed
slightly during the coverage of the Senate debates. The content analysis included
Hardball with Chris Matthews, All In with Chris Hayes, The Rachel Maddow Show, and
The Last Word with Lawrence O’Donnell throughout the entire period of study. For the
Record with Greta was included until it was cancelled on June 30. That hour of coverage
on MSNBC was excluded from July 1-23 until it was replaced by The Beat with Ari
Melber on July 24.
6
The Fox News primetime line up also changed during the period of

5
The only exception was that The Lead with Jake Tapper replaced the 9pm hour of Anderson Cooper 360
from April 25 - April 28. Those shows were included for analysis.
6
This gap in coverage is not ideal but reflects the real time changes in primetime coverage. The Lexis
29
study. The content analysis included Special Report with Bret Baier, The First Hundred
Days, The O’Reilly Factor, Tucker Carlson Tonight and Hannity until the departure of
Bill O’Reilly resulted in the network adding The Five to the primetime line up. The
conclusion of the Trump Administration’s first 100 days resulted in the network choosing
to replace The First 100 Days with The Story with Martha MacCallum.
Segment Identification
Transcripts of the primetime shows from each network were retrieved from the
Lexis-Nexis database. Segments for inclusion were identified by using keyword searches
for the terms “health care” or “Obamacare” or “Affordable Care Act” or “ACA” or
“American Health Care Act” or “AHCA” or “Better Care Reconciliation Act” or
“BCRA” or “Trumpcare” or “Ryancare.” Cable news coverage included for analysis
involved a substantive discussion of health care reform – defined as either an interaction
between a host and a guest, a lengthy discussion of health care policy introduced by a
guest, or a host monologue that features a substantive discussion of health care. The
discussion of health care must focus on major reforms of the American health care
system. Discussions of coal miner health benefit reforms, state-based reform efforts,
Planned Parenthood or abortion not in the context of the AHCA or BCRA defunding
provisions,
7
and other tangentially related health care issues, while rare, were not
included in analysis because they did not speak to the effort to repeal or reform the ACA.

Nexis transcripts that were used to obtain the data for analysis only included Hardball with Chris
Matthews, All In with Chris Hayes, The Rachel Maddow Show, and The Last Word with Lawrence
O’Donnell during that time period.
7
These types of segments only occurred on Fox News, typically during Tucker Carlson Tonight as he
hosted Planned Parenthood representatives in an attempt to smear the organization as an abortion factory.
These segments had no relation to the broader ACA repeal efforts and reflect the partisan agenda of Fox
30
The unit of analysis was the segment and four types of segments were identified -
the straight report, the host monologue, the panel discussion, and the interview. A straight
report involves a news update from a network’s reporter focused on delivering an
objective news report on a given issue, including pre-recorded “packages” where the
reporter provides voice-over commentary on top of short video clips and also live reports
from correspondents on location that include no pre-recorded footage.
8
When straight
reports were repeated on a network (not an uncommon occurrence as it saves the network
money and helps fill the news hour), the repeated segment was coded as if it were new, as
the segments would typically feature a different introduction from the host or different
follow up questions which impacts the substance of the segment. A host monologue is a
lengthy segment featuring the cable news program host providing either a news update,
or more often, commentary on the news of the day. Host monologues were identified as
distinct from lengthy introductions to panel discussions or interviews - those extended
host comments were included as part of the panel or interview they preceded, unless they
occurred at the beginning of the show, in which case they were considered to be a host
monologue. Host monologues that occur in the middle or end of a program must be
wholly separate discussions of health care to be considered on their own.
9
A panel
discussion involves two or more participants in addition to the host. Panels that were
broken up by a commercial break were considered to be separate segments, as each panel
usually involved multiple topics of conversation and may add or subtract members as the

News.
8
Chapter 3 will further investigate and define the major characteristics of the straight news report.
9
The host monologue was identified as a segment type in the original content analysis design, however,
this segment type is not featured in the analysis in this project. This type of segment occurs predominantly
on Fox News and MSNBC, which feature more commentary from the hosts, given their partisan nature.
Future research that focuses more exclusively on partisan news networks could examine the content in host
monologues and their role in communicating policy to the public.
31
show continued. An interview involves a discussion between the cable news host and one
other individual, frequently a politician but not always. Interviews that were interrupted
by commercial were considered to be one segment for coding purposes.
Guest Coding Procedure
The second unit of analysis for this project was each participant in a segment about
health care. Every participant in a segment was coded for a series of demographic
variables, professional categories, and partisan affiliation. One individual could be
identified as belonging to several of the professional categories. For instance, Rick
Santorum was coded as an elected official due to his history as a Senator from
Pennsylvania from 2001-2007, but also fell into the pundit category, as he currently
works for CNN as a political commentator. This approach was chosen to fully encompass
an individual’s background, as those backgrounds often constitute the reason why
individuals are chosen to participate on panels or in interviews.
Every effort was made in order to make objective decisions about how to categorize
individual guest’s professional backgrounds. The coding process relied on the
information provided within a segment (i.e. how an individual was introduced by the
program host) and auxiliary research to verify an individual’s professional history. I
performed the initial wave of coding, my second coder completed a secondary wave of
coding, and we resolved the differences in conference, an approach used by previous
media studies (Kerbel, Apee, & Ross, 2000; Ross, 1992).
10
While qualitative coding is

10
The inter-rater reliability for the coding process was over 90%.
32
inherently interpretive, the coding process used the following category definitions to
guide the coding process.
Host: Individuals who anchor each show. These individuals were only identified as the
host during these shows, but were identified by other categories (journalist, pundit, etc.)
when they served as guests on other cable news shows.
11
The host was coded in every
segment, as they play a role in all types of cable news segments, ranging from
introducing the straight news report to moderating panel debates.
Journalist: An individual who is employed either by the cable news network on which
they are appearing or another news media outlet, including newspapers, other cable news
networks, or online news outlets like blogs. Journalists are distinct from columnists,
because columnists write opinion-based articles and often have partisan affiliation, while
the vast majority (but not all) of journalists were identified as non-partisan
12
. Journalists
who also worked for cable news networks as analysts were coded as journalists, as that is
their primary profession and their role in discussion-based segments primarily revolves
around giving their insight as political journalists, rather than commentators.
Pundit: An individual including “editorialists, commentators, columnists, and analysts
when they offer opinions about complex issues in the public arena” (Letukas, 2014, p. 6).
Individuals were coded into this category when their role in discussion-based segments
revolves around giving their opinions and thoughts about the news, as punditry is “the

11
This occurred most frequently on Fox News, as The Five has five individuals who function as hosts on
the panel-based show, but the hosts frequently change and appear on other shows as guests.
12
The only journalists identified with a partisan affiliation were individuals who worked at explicitly
conservative outlets (Brit Hume, Matthew Continetti, John McCormack, Francesca Chambers, Phil Klein)
or reporters who openly admitted their political party identification (Josh Barro).
33
process or activity of making speculative or opinion claims in a public arena” (Letukas,
2014, p. 4). While many pundits held partisan affiliations, not all do, as CNN employs a
slate of partisan and non-partisan pundits.
Advocate/Activist: An individual who works at a non-profit or advocacy group,
progressive or conservative. This category included individuals who work at conservative
organizations like FreedomWorks and the Tea Party Patriots as well as progressive
organizations like Planned Parenthood, MoveOn, and Indivisible.
Individual Impact: An individual hosted by a network who would be impacted by the
implementation of the GOP proposal.
Elected Official/Administration Official: An individual who either currently or
previously served as an elected official (at any level of government) or served in a
president’s administration. Administration officials included any member of the
President’s Cabinet, an executive agency, or the transition team (most notably Anthony
Scaramucci). Individuals currently serving were only identified as elected officials
(unless they possessed an M.D., and thus were also coded as doctors) but former officials
were coded for their current professional identification when it fit one of the project’s
categories.
Doctor: An individual who possesses a medical degree, and either currently practices or
previously practiced medicine.
Non-Doctor Health Care Expert: An individual with substantial background in health
care policy, either through graduate-level education or professional experience in public
policy. This category was included to identify a range of health care experts who do not
34
hold an M.D. but still possess substantial knowledge about health care. This included
individuals who represent health care organizations like the American Medical
Association or Planned Parenthood, reporters who focus on health care beats, and public
policy experts with extensive health care experience (such as Neera Tanden). This
category was also included to acknowledge the fact that possessing a medical degree does
not automatically mean that individuals are well versed in the health care system. The act
of practicing medicine is fundamentally distinct from the practice of designing health
care systems and the public policies that foster those systems, and this code speaks to that
difference (Beam, 2009; Rovner, 2016).
13

Substance Coding Procedure
Each segment was coded for one of three frames - a strategic frame, a policy frame,
or a mixed frame. Segments coded as the strategic frame meant that the majority of the
discussion focused on typical horse-race style commentating, speculation about the
likelihood of passage, discussions about Trump’s role in facilitating passage of the bill, or
other similar themes. Segments coded as the policy frame meant that the focus of the
segment revolved around discussions of the substance of the GOP bill or the Affordable
Care Act and discussions about the impact of the legislation on the American public and
the existing health care system. Segments coded as the mixed frame meant that a

13
The methodology for the study purposely separated out doctors from non-doctor health care experts for
two reasons. One, some media studies too narrowly defined what constitutes a health care expert as only
those with post-graduate degrees, and primarily medical degrees at that. This categorization ignores the
expertise of journalists who exclusively cover health care beats (e.g., Sarah Kliff) or public policy
professionals who may not possess a medical degree (e.g., former Health and Human Services Secretary
Sylvia Burwell). Given that one of the core assumptions of this study revolved around the expectation that
cable news would feature a very small number of experts to begin with, we crafted our definition to
encompass an expansive but still accurate measure of expertise.
35
segment included a relatively even level of discussion of strategic-focused elements and
policy-based discussion. Due to the fact that the assumption underpinning this project
held that the majority of the coverage would focus on horse-race style punditry, any
discrepancies in coding were resolved in favor of either coding a segment as the policy
frame or mixed frame, to err against our assumptions.
Each segment was coded for the type of segment and for a variety of codes pertaining
to the substance of the discussion. These codes included examinations of discussions of
Medicaid, the Congressional Budget Office, the impact of the GOP legislation on people
with pre-existing conditions, the elderly, health care costs, and the overall number of
uninsured. The design of the content analysis purposely included a wide range of topics
to examine in order to get a sense for the broader contours of the health care debate and
the patterns in discussions over time, even though many of the categories of substantive
coding were not included for analysis in the final results. The relevant substantive codes
are discussed in depth in each chapter.
Conclusion
This project utilized a qualitative content analysis to allow for comprehensive study
of multiple parameters of cable news coverage of health care policy during the GOP
reform efforts. This chapter provides a description of how and why networks and shows
were chosen for analysis and an overview of the procedures used for the segment coding.
The next chapter introduces the results of the analysis of straight news reports and the use
of partisan sound bites within those segments, including more detailed information on the
subsequent waves of coding that were utilized to further parse the data.
36
CHAPTER 3:
SOUND BITES IN STRAIGHT NEWS REPORTS: A FAIR AND UNBALANCED
APPROACH?

The structure of cable news complicates the clear divide between straight news
reporting and commentary, as cable news networks have increasingly moved toward
shows that include both traditional news updates and political talk segments (or shows
comprised exclusively of discussion-based segments) (Letukas, 2014; Nadler, 2016).
Despite the innovations in cable news that stray from the traditional forms of television
journalism, the three cable news networks still “rely on professional journalists for much
of their news gathering, and they share some common textual and aesthetic features” with
traditional broadcast news, including “frequent shots of anchors behind desks and the use
of many of the same kinds of sound bites and live shots” (Nadler, 2016, p. 83-4). Perhaps
the most prominent example of cable news programs appropriating the format of
broadcast television news is the straight news report, a segment involving an introduction
from the network host and a news report from an on-site correspondent. This type of
segment occurs throughout the day on cable news networks, a common feature of the
shows that explicitly market themselves as straight news broadcasts, like Fox News’
Special Report with Bret Baier (Folkenflik, 2011), but also frequently occur during the
discussion-based political talk shows on CNN like Erin Burnett OutFront and Anderson
Cooper 360.
The straight news reports also make frequent use of video clips of politicians
interspersed throughout the correspondent’s news update. Cable networks use these video
clips, or sound bites as this chapter will refer to them, to present arguments from
37
Republican or Democratic politicians, highlight breaking news developments, or to
illustrate examples of political gaffes or hypocritical position flip flops. While the use of
partisan sound bites is not a new phenomenon in cable news, it presents a problematic
method for covering health care, a policy arena dominated by misinformed narratives
(Nyhan, 2010), talking points based on false assumptions (Graves, 2017b), and by a
general lack of knowledge (both in the public and government) (Kirzinger et al., 2017).
This is particularly true given the penchant for spreading false information displayed by
the Trump Administration (generally and especially health care specifically) (Fallows,
2016; Farhi, 2016a; Levey, 2017).
This chapter investigates the use of partisan sound bites in straight news reports to
evaluate the image of the congressional debates over the Republican health care bills
presented to the television audience. Using a content analysis of straight news reports, the
results show a severe imbalance in the number of sound bites used by all three networks
that resulted in disproportionately more sound bites from congressional Republicans or
Trump than from Democrats. The visibility bias in the use of partisan sound bites in
straight news reports across the three networks likely results from different motivations
but results in similar negative distortions of the image of the congressional health care
debates. When networks overwhelmingly present more sound bites of conservative
policymakers and activists, it shifts the terms of the health care debate presented to the
public by centering the core controversy on questions of how best to repeal the
Affordable Care Act, functioning to obscure questions about whether or not it should be
repealed at all. This conservative tilt is particularly problematic in the instance of the
straight news report – a segment that in style and format mirrors traditional objective
38
broadcast journalism but in these instances is -- intentionally in the case of Fox News or
(likely) unintentionally in the case of CNN -- presenting a distorted view of the
legislative debate. The frequent use of sound bites of Trump making outlandish claims or
other Republicans parroting what this study will demonstrate are factually inaccurate
claims about the Affordable Care Act further degrades the substantive quality of what
theoretically should be the most factual of all cable news segments.
This chapter begins with a discussion of what constitutes a straight news report
and a review of the existing research on the use of sound bites and the concept of political
balance in journalism. It then outlines the content analysis results on the use of partisan
sound bites during straight news reports on all three cable news networks and presents
potential explanations for why this type of visibility bias manifested in the cable news
coverage, focusing in particular on CNN and Fox News. After this exploration of
potential causes, the chapter turns to a discussion of why this stark imbalance in partisan
sound bites problematically distorts the image of the health care debates presented to the
television audience and the potential negative consequences of such distortions on public
comprehension of both the current American health care system and the GOP reform
proposals. The concluding section highlights examples of successful straight news reports
that occurred during the coverage of the GOP health care reform effort, segments that
pushed back on misinformation and provided factual updates to the audience, in contrast
to the trends critiqued in this chapter. These segments can provide a template for future
coverage of health care policy and preview the recommendations for improving future
coverage that will be discussed in depth in the final chapter.
39
Straight News Reports, Sound Bites, and Political Balance: A Review
The straight news report ostensibly represents the most objective and unbiased of the
four different types of segments found in cable news. The straight news report segment
can take one of three different formats. The first is the standard straight news report that
features an introduction from the host and then a news report delivered from a
correspondent, usually a slickly produced pre-taped “package” that presents a series of
video clips with voice-over narration from the reporter. This form often involves a few
follow-up questions from the host, depending on time. The second format is a live report
from a correspondent on location. This usually includes no video clips and often can
function as more of a dialogue between the reporter and the host, particularly in breaking
news situations. The third and least common type uses a human-interest story as a hook
for reporting on an aspect of a developing news story. It includes a pre-taped package
featuring a correspondent interviewing an individual, family, or group of individuals with
a shared characteristic (e.g., Trump voter profiles), and typically attempts to highlight the
‘real-world’ impact of policy change. These segments typify the canons of objective
journalism - they provide a factual update on a news story, providing both viewpoints in a
controversy, and typically refrain from commentary or criticism, leaving such judgments
up to the audience.
One of the gaps in the current literature on cable news revolves around the dearth of
research differentiating the types of segments within a cable news show, with a particular
lack of work focused on the straight news report. While studies have examined the
impact of cable news coverage on attitudes and public opinion toward public policy and
political candidates or parties, many of these studies either do not differentiate between
40
types of segments (Aday, Livingston, & Hebert, 2005), focus on panel or interview
segments (Frost & Phillips, 2011), or use the show as a whole as the unit of analysis
(Feldman, Maibach, Roser-Renouf, & Leiserowitz, 2012; Weaver & Scacco, 2013).
While Lynn Letukas’ excellent book does examine what she calls the “structured
segments” of a cable news show, she does not address straight news reports or statements
from news correspondents due to her exclusive focus on punditry (Letukas, 2014, p. 141-
142). One of the unique contributions of this project is the focus on different types of
segments, as this chapter and chapter 4 investigate the role of particular types of
segments and how cable news networks use them when covering health care. This focus
on the straight news report aims to add to the typology of cable news segments and make
a normative case for holding cable news networks to the standards of objective
journalism, particularly when the networks make the conscious choice to appropriate the
style and format of traditional broadcast news.
This chapter focuses on the straight news report but in particular investigates the use
of sound bites within this type of segment. A sound bite is “an audiovisual segment in
which one can see and hear a speaker” (Bas & Grabe, 2015). Numerous scholars have
studied the role of sound bites in television news coverage, however, most of this
research focuses on the length of the sound bite in campaign coverage and whether or not
the decrease in the length of a sound bite over time has degraded the quality of television
news. Adatto (1990) and Hallin (1992) first discovered the downward trend in the length
of sound bites in television news. Ensuing research argued that the decreasing length of
sound bites negatively impacted politician’s abilities to express their full policy positions
and arguments, as reporters chopped up sound bites to take control of the narrative and
41
assert their own authority (Patterson, 1993; Farnsworth & Lichter, 2003; Rinke 2016).
However, not all scholars agreed with the concern over the incredible shrinking sound
bite, as Russomanno and Everett (1995) found that sound bite length and sound bite
impact on voter behavior are independent. Similarly, Mitchell (1996) argued that “longer
sound bites would not necessarily elevate television news or political discourse in
general,” because lengthier quotes of a stump speech full of truncated talking points
rarely provides a fuller understanding of a candidate’s policy positions (p. 22). This
project adds depth to the current literature by examining the use of sound bites in a non-
election setting and shifts the focus from the length of a sound bite to analyzing the
number of sound bites used, with particular attention paid to who is doing the speaking.
Furthermore, this chapter will raise important questions about how cable news uses sound
bites and about the appropriateness of utilizing sound bites wherein the speaker promotes
misinformation or factually inaccurate claims.
In addition to the literature on sound bites, this chapter draws on some key concepts
from the existing scholarship on bias and political balance in news coverage. Claims of
partisan bias in the media are not novel or new, and numerous scholars have investigated
whether or not news coverage is biased, looking at a variety of types of news media and
coming to different conclusions (D’Alessio & Allen, 2000; Kuypers, 2002; Alterman,
2003; Gentzkow & Shapiro, 2010; Lott & Hassett, 2014). While partisan bias plays a
fundamental role in shaping cable news, as MSNBC and Fox News have each cultivated
and maintained their liberal and conservative images respectively, Nadler (2016) notes
that all three networks “make some claim to offer non-biased news coverage outside of
commentary-based programs” (p. 84). The purpose of this chapter is not to determine
42
whether or not cable news has a partisan bias, but rather to examine the bias that exists as
a result of the imbalance in the use of partisan sound bites. Political balance as a
construct has been “a notoriously difficult concept to operationalize,” but this chapter
uses the definition of political balance that is standard in US studies (and most political
systems with two parties) which views political balance as “equal treatment” of the two
parties and examines the balance in visibility, or “access to media content,” in particular
14

(Hopman, Aelst, & Legnante, 2011, p. 244; D’Alessia & Allen, 2000). Hopman, Aelst, &
Legnante (2011) define balance and bias as “antonyms” because “the absence of balance
implies a bias” but note that “this definition does not imply that the bias should
necessarily be seen as a ‘partisan bias’” (p. 243-4). While discrepancies in how political
journalists treat ‘both sides’ of an issue or political controversy are often treated as
evidence of a news organization’s partisan bias (Hopman, Aelst, & Legnante, 2011), this
chapter provides potential explanations for why the visibility bias that exists in straight
news reports results from entrenched journalistic norms and competitive economic
pressures rather than some secret partisan bias in CNN’s health care coverage.
Content Analysis Results
The content analysis of straight news reports looked at three main aspects of this type
of coverage: its rate of use across all three networks, the number of sound bites used in all
straight reports cumulatively, and the partisan affiliation of each straight report.

14
Visibility studies empirically have looked at imbalance in the amount of attention the news media
devotes to incumbents versus challengers in elections. It has previously been measured by “cod[ing] the
party affiliations of actors appearing in news stories,” a method used in this chapter for evaluating the
imbalance in the use of partisan sound bites in straight news reports (Hopman, Aelst, & Legnante, 2011, p.
248).
43
Prevalence of Straight News Reports Across Networks
The association between the straight news report and objective journalism helps
explain the variance in the degree to which each network utilizes this format of segment.
CNN, the mainstream non-partisan outlet, features this segment in every hour of their
primetime coverage, often several times per hour depending on the show and news cycle.
In the period of health care coverage reviewed in this study, CNN used the straight news
report format to report on health care 161 times, almost double the number of segments
as Fox News and eight times as many as MSNBC. These results are shown in the table
below.

Figure 3.1 – Straight Report Segment Totals
That Fox News and MSNBC use the straight news report format substantially less than
CNN is not surprising, given their partisan slant. Fox News used the straight news report
82 times during the post-election coverage period and MSNBC used the format 20 times.
The disparity between Fox News and MSNBC can likely be attributed to the fact that Fox
News’ 6pm show, Special Report with Bret Baier, explicitly markets itself as the hard-
44
hitting news update hour of Fox’s primetime coverage and opens with several straight
news reports, while MSNBC has no show that adopts a similar format during its
primetime coverage (Folkenflik, 2011).
Prevalence of Sound Bites and the Partisan Break Down
In addition to coding for the prevalence in the use of the straight news report, this
study sought to determine whether or not a given straight news report featured a sound
bite of Trump, a sound bite from a Republican
15
(including any GOP legislator, Trump
surrogate, or administration official) and/or a sound bite from a Democrat (including any
Democratic legislator, current or former). These three categories were isolated in the first
round of coding as a blunt mechanism to evaluate the degree to which cable news
networks used sound bites of official sources in their straight news reports and whether or
not they quoted Republicans and Democrats roughly the same amount. These results are
displayed in the table below.

15
Several segments featured a clip from a political advertisement sponsored by a conservative advocacy
organization (most notably Club for Growth and a Trump-associated Super PAC) which were also coded as
Republican clips.
45
Figure 3.2 – Wave One Straight Report Sound Bite Results
The initial wave revealed that out of 161 straight news segments on CNN, 55 contained at
least one sound bite of Trump (or 34% of all segments), 87 included at least one sound
bite of a Republican (or 54% of all segments), and 31 featured at least one sound bite of a
Democrat (or 19% of all segments). 54 segments total did not show a sound bite (or 34%
of all segments). The disparity between video clips of Republicans versus Democrats on
the ostensibly non-partisan cable news network is stunning. Interestingly, in the first
wave this disparity appears to be much smaller on the conservative Fox News, which had
27 segments that featured at least one sound bite of Trump (or 33% of all segments), 61
that included at least one Republican sound bite (or 74% of all segments), and 41 that
presented at least one Democratic sound bite (or 50% of all segments). Only 18 straight
news reports on Fox News did not show a sound bite (or 22% of all segments). Of
MSNBC’s 20 straight news reports, only 8 used sound bites at all — 2 included Trump
sound bites and 7 featured at least one Republican sound bite with no Democratic sound
bites. Given MSNBC’s infrequent use of the straight news report format and the small
number of sound bites used overall, the rest of this chapter will focus on CNN and Fox
News, due to the lack of data for MSNBC.
16

The disparity between sound bites that showcase liberal arguments on health care
versus conservative ones illustrated in the initial round of coding are striking but only tell

16
The lack of data for MSNBC is not particularly interesting or surprising given their prime-time line up.
In comparison to CNN or Fox News, MSNBC’s primetime coverage emphasizes shows with hosts that
utilize extensive host monologues and interviews. MSNBC’s style and approach to covering the news (in
primetime) has evolved away from the traditional form of broadcast journalism, embracing the political talk
show format. Even though Fox News’ shows like Hannity and Tucker Carlson Tonight are similar in their
style to MSNBC’s anchor-heavy approach, it is counterbalanced by the straight news emphasis of Special
Report with Bret Baier and to a lesser degree The First 100 Days and The Story with Martha MacCallum,
which feature straight reports in addition to several panel discussion and interview segments.
46
part of the story. Not only do straight news reports on CNN and Fox News feature sound
bites in the majority of their straight news reports, but a significant number of them
feature numerous sound bites from either the same individual or several individuals,
broken up by commentary from the news correspondent. To further parse the distinctions
in how CNN and Fox News used sound bites from politicians in their straight news
reports, the study re-coded all the straight news reports to quantify how many times a
segment featured a quote from a Republican, a Democrat, and/or Trump. Using the Lexis
Nexis transcripts, the study identified each individual quote, its speaker, and the
speaker’s political party affiliation. The vast majority of the time this information was
provided in the transcript itself. On a few occasions the speaker’s name would be omitted
but either the identity of the individual or at the very least their political party affiliation
could be ascertained from the substance of the quote. Multiple quotes from one individual
were counted separately if they were broken up in the transcript by either another quote
or by commentary from the cable news correspondent. The results of this second wave
coding are displayed in the table below.

47
Figure 3.3 – Wave Two Straight Report Sound Bite Results
The results of this second round of coding reaffirmed the stark imbalance in the use
of partisan sound bites on CNN. CNN featured 109 clips of Trump, 297 clips from a
Republican source, and only 45 from a Democratic source. In total, 66% of CNN’s
partisan sound bites used a Republican source, 24% featured Trump, and only 10% of all
clips used a Democratic source. The relative parity between liberal and conservative
sources in the first round for Fox News straight reports disappeared in the second round
of coding. The closer analysis of the total volume of sound bites found that straight news
reports on Fox News contained 46 clips of Trump, 212 clips from a Republican source,
and 73 clips from a Democratic source. In total, 84% of Fox News’ partisan sound bites
featured a Republican, 14% used a Trump clip, and 22% used a Democratic source. The
charts below underscore the stark disparity in the total use of different partisan sources
for sound bites on each network:

Figure 3.4 – CNN Partisan Sound Bite Totals
48

Figure 3.5 – Fox News Partisan Sound Bite Totals
Explanations for Sound Bite Imbalance on Fox News and CNN
Fox News
The significant imbalance between sound bites featuring a Republican legislator
or Trump versus those citing a Democratic politician on Fox News likely results from the
partisan slant that filters through the network as a whole. Fox News, the “pioneer of the
partisan strategy” in cable news, “built its brand around an appeal to conservatives
convinced that mainstream media outlets have a liberal bias” (Nadler, 2016, p. 105-6).
This approach to packaging the news from a partisan viewpoint emphasizes that “the
news is a vehicle to advancing a particular point of view” rather than seeing the news as
“an end in and of itself” (Levendusky, 2013, p. 8). While Fox News’ slogan for years
claimed their approach to the news was “fair and balanced,” the inclusion of liberal
viewpoints is largely tokenized, as those commentators are often greatly outnumbered by
conservatives and generally given less time to speak (Fitts, 2014). The ‘balanced’ in their
49
slogan is “achieved by simply inviting liberal guests - not ensuring that their ideas will
receive comparable time” (Jamieson & Cappella, 2008, p. 49). The pattern in the use of
partisan sound bites reflects this partisan approach to “balance” - while straight news
reports do use liberal sound bites, they use more than double the number of sound bites
from conservative view points.
This pattern of amplifying conservative messages on Fox News is not new, however,
the feedback loop between Fox News and official Republican messaging has only grown
stronger under the Trump Administration. Gabriel Sherman (2018), the noted biographer
of Roger Ailes, the former Chairman and CEO of Fox News, explained that while early
in the primary, “Fox News was one of Trump’s chief antagonists,” after he won the
Republican nomination, “the network quickly fell into line” noting that “prominent
voices at Fox openly seem to be aiding the Trump agenda,” citing Sean Hannity, Jesse
Watters, and Jeanne Pirro. David Drezner (2018), a professor of international politics at
Tufts, wrote about the feedback loop that exists between Trump and Fox News, noting
that “just as Trump has paid more attention to Fox News, the channel has lavished more
favorable attention on the president,” a trend also noted by other media critics and
reporters, (Maza, 2018; Nguyen, 2018). Thus, the transformation of Fox News into
something akin to state media provides a solid explanation for why their straight news
reports predominantly feature sound bites from Republican officials and Trump himself,
while still featuring liberal sound bites but to a much lesser extent.
While it is not particularly surprising that Fox News presents a conservative-leaning
perspective on the health care debates to its audience through its use of sound bites in
straight news reports, it still results in a flawed representation of the key questions
50
underpinning the congressional debates and can undermine the overall substantive quality
of the health care information provided to the public by repeatedly airing factually
inaccurate sound bites. The potentially deleterious consequences of these types of
distortions will be discussed after an exploration of the possible explanations for why this
sound bite imbalance also manifested on the supposedly non-partisan CNN.
CNN
The vastly disproportionate use of partisan sound bites during straight news reports
on CNN presents a more complicated result to parse, given the network’s lack of a clear
partisan identity. This section will introduce two possible explanations for this visibility
bias: first, it could be an overcorrection in response to claims of liberal bias or, second
and more convincingly, it results from cable news’ love of conflict which resulted in a
focus on the GOP civil war over their health care proposals.
One possible interpretation of these results could argue that it occurred as function of
the desires of Jeff Zucker, the CEO of CNN, to reorient CNN as the middle of the road
cable news option, “just liberal enough for a Democratic viewer” and “just Trump-
friendly enough for a Republican” (Curtis, 2016). When Ted Turner founded CNN in the
1980s, the network built “its reputation by sticking quite close to traditional conceptions
of objective journalism,” evident in Turner’s claim that on CNN “the news is the star”
(Nadler, 2016, p. 91). In spite of CNN’s early attempts to adhere to the tenets of objective
journalism, conservatives claimed that CNN had a significant liberal bias - a reputation
largely created by Roger Ailes as he successfully branded CNN the “Clinton News
Network” in the 1990s, presenting Fox News as the non-biased alternative (Battaglio,
2017; McNear, 2017). These attacks on CNN alleging a liberal bias have grown stronger
51
as Trump made “fake news CNN” a key sparring partner during the campaign and
throughout his administration thus far (Lee & Quealy, 2018; Schwartz, 2018).
While one might expect CNN to ignore such attacks from partisan motivated sources,
Zucker has made comments and enacted personnel changes at the network that reflect his
belief that to some degree CNN coverage did display a liberal tilt before he took over at
the helm. During interviews discussing CNN’s resurgence in audience ratings, Zucker
claimed that CNN saw such success during the 2016 election because “he repositioned
[the network] to appeal to Republicans and Democrats alike” (Hagey & Niedzwiadek,
2016). He went so far as to say that he thought “it was a legitimate criticism of CNN that
it was a little too liberal” and by adding “more middle-of-the-road conservative voices”
to CNN’s roster it produced “a much more-balanced network and, as a result, a much
more inviting network to a segment of the audience that might not have otherwise been
willing” to watch (Hagey & Niedzwiadek, 2016). Zucker’s attempts to rectify CNN’s
alleged liberal bias resulted in the network hiring numerous Trump surrogates during the
campaign such as Jeffrey Lord, Corey Lewandowski, Kayleigh McEnany, and Katrina
Pierson. This trend continued after Trump won the 2016 election as CNN hired
individuals to represent the Trump Administration’s point of view like Jack Kingston and
Jason Miller. The network also continued to employ Jeffrey Lord and Kayleigh McEnany
(until they left CNN due to controversy in Lord’s case and other job opportunities in
McEnany’s case).
Given Zucker’s public statements and his personnel changes in the Trump era, the
significantly higher rate of conservative sound bites might represent another
manifestation (intentional or not) of the network’s attempts to respond to claims of liberal
52
bias. Perhaps in attempting to fairly cover the President who frequently refers to the
network as fake news, CNN producers and correspondents over corrected by featuring
Republican and Trump sound bites disproportionately more than Democratic sound bites.
Ultimately, this explanation feels fairly unconvincing. Zucker’s personnel changes only
affected individuals used in panels and interviews during the discussion-focused
segments of CNN’s primetime coverage, separate from the hard-hitting reporters who
deliver the majority of the straight news reports. The disparity between the use of liberal
and conservative sound bites seems too vast to be the result of some internalized
overreaction to claims of liberal bias.
The second and more convincing explanation revolves around cable news’ love of
framing political news stories as tales of conflict, which explains the focus in CNN’s
coverage on the fight with in the Republican caucus over whether or not the conservative
health care proposals truly repealed ‘Obamacare.’ The focus on conflict as a driving force
in framing news stories actually pre-dates cable news, as it results from the “journalistic
convention that there are two sides to any story” (Schudson, 1995, p. 9). As Cunningham
(2003) explains, “reporters are biased toward conflict because it is more interesting than
stories without conflict,” particularly in the instance of an intra-party fight that plays to
the ‘inside baseball’ nature of political coverage and punditry. This impulse toward
emphasizing conflict as a mechanism for sensationalizing the news to increase audience
interest reflects the infotainment trend in cable news, that emphasizes the primacy of
profit as the main objective (Nadler, 2016; Jones, 2012b). While this tendency toward
emphasizing conflict is not unique to cable news, Nadler (2016) explains how the format
and style of cable news often entrenches the worst of objective journalism’s tendencies
53
including “exacerbat[ing] modern journalism’s tendency toward horse-race coverage and
a focus on political strategy and maneuvering rather than exploring perspectives and
issues” (p. 117-8).
The internal struggle in the Republican caucus over the shape and size of the
conservative health care proposals provided CNN (and other networks) with a ready-
made conflict for framing their health care coverage. In both the House and the Senate,
Republicans fought, fairly publicly, over the health care proposals, as moderates believed
the conservative reform efforts reduced coverage numbers too drastically while hardline
conservatives claimed the reform bill failed to fully repeal Obamacare. Senator Rand
Paul (R-KY) took a particularly prominent role in criticizing the Republican reform
effort, giving numerous interviews and public statements calling the AHCA “Obamacare-
lite” because it failed to fully repeal the ACA (Luhby, 2017). Paul was joined by the
House Freedom Caucus, the notoriously conservative group in the lower chamber, led by
Rep. Mark Meadows (R-NC) in denouncing the AHCA until several concessions were
made by Republican leadership to make the bill more conservative (Galewitz, 2017;
Hamblin, 2017; Enten, 2017). On the other side, moderate conservatives like Rep.
Charlie Dent (R-PA) and Rep. Leonard Lance (R-NJ) in the House and Sen. Susan
Collins (R-ME) and Sen. Lisa Murkowski (R-AL) in the Senate publicly criticized the
bills for dramatically reducing the number of Americans who could maintain health care
coverage, specifically denouncing the drastic cuts in Medicaid funding and the rollback
of the ACA’s expansion of the Medicaid program (Fox & Lee, 2017; Shabad, 2017).
The competing priorities within the Republican caucus meant that internal tensions
and infighting were present at the outset of the Republican effort to repeal the ACA, as
54
evidence by the first straight news report on CNN that claimed that “House and Senate
conservatives are already threatening [the AHCA’s] very existence” due to an “early
revolt” from hardline conservatives.
17
CNN continued to frame the debate around “the
revolt among conservative Republicans,”
18
often referring to the debate as the “battle” to
win over wavering Republicans and get the bill “across the finish line.”
19
Presenting the
debate over the health care bills as a high-stakes drama resembling a scene out of the TV
show House of Cards makes for more interesting news reporting than a detailed
breakdown of the provisions in the draft legislation and their potential impact on the
American health care system (Maza, 2017b).
This focus on the spectacle of GOP infighting also helps to explain why CNN used
disproportionately more Republican sound bites than Democratic ones.
20
A key (but
often-criticized) facet of objective journalism revolves around the use of official sources
(Cunningham, 2003; Patterson, 2013; Bennett, 2016) and particularly during
congressional debates between opposing sides, “reporters are likely to simply set their
claims against each other” to show the competing view points in their own words
(Jamieson & Waldman, 2003, p. 9). The straight news report replicates the style and

17
Burnett, E., & Mattingly, P. (2017, Mar. 7). Erin Burnett OutFront. CNN. Retrieved from Lexis-Nexis.
18
Blitzer, W., & Jones, A. (2017, Mar. 9). The Situation Room with Wolf Blitzer. CNN. Retrieved from
Lexis-Nexis.
19
Blitzer, W., & Mattingly, P. (2017, Mar. 21). The Situation Room with Wolf Blitzer. CNN. Retrieved
from Lexis-Nexis.
Blitzer, W., & Serfaty, S. (2017, May 4). The Situation Room with Wolf Blitzer. CNN. Retrieved from
Lexis-Nexis.
20
This explanation could also apply to Fox News, as the network also covered the GOP civil war and often
uses conflict-focused frames in their news coverage. However, it is also very likely Fox’s GOP-heavy focus
would have existed in a world where the Republican health care reform effort was not defined by
conservative infighting, due to Fox News’ partisan agenda, as explained previously.
55
format of objective journalism, and these results suggest that CNN’s straight news reports
on health care also replicate the tendency toward using official sources. Problematically,
this reliance on official source sound bites in the context of the focus on conflict framing
resulted in the use of more conservative sound bites. If a main focus of the straight news
reports on CNN revolved around dramatizing the Republican caucus’ internal strife, it
logically follows that these segments would feature more conservative sound bites as a
mechanism for illustrating the GOP’s competing claims in their own words. While this
approach to covering the health care debate arguably replicates the methods of objective
journalism, those methods represent some of the most criticized aspects of traditional
journalism. The combination of the dependence on official sources and the prioritization
of conflict frames in presenting the news resulted in the overwhelming use of Republican
sound bites which skewed CNN’s health care coverage, articulating the image of the
congressional debates in largely conservative terms that emphasized the impending
collapse of the ACA. This misrepresentation of the health care negotiations altered the
key questions of the debate and may have inadvertently contributed to the spread of
misinformation due to the repetition of dubious claims made in many of the sound bites
used in the network’s straight reports. The next section will explain these distortions,
using exemplars to show how the kinds of sound bites used in straight reports often
featured false or misleading claims predicting an Obamacare ‘death spiral,’ which
functions to shift the terms of the health care debate to a rescue mission, creating a false
sense of urgency for the reform effort.
This emphasis on dramatizing conflict provides an interesting explanation for the
imbalance in CNN’s use of partisan sound bites because the Republican caucus found
56
itself split over the health care proposals, as moderates fought with hardline conservatives
over how stringent the Republican replacement package should be on a variety of
metrics, most notably whether or not the GOP replacement should provide the same level
of health care coverage as the ACA.
Distorting the Terms of the Health Care Debate
The severe imbalance in partisan sound bites in cable news networks’ straight news
reports distorts perceptions of the congressional debate and the purpose of health care
reform. First, by disproportionately reporting conservative viewpoints, even competing
ones, it shifts the central question underpinning the congressional reform effort from how
best to improve the health care system to the conservative question of how best to kill the
Affordable Care Act. While the results should not be taken as evidence of a conservative
bias on CNN, focusing predominantly on debates within the conservative caucus and
showcasing significantly more Republican sound bites necessarily means that Republican
narratives and talking points received significantly more air time than those of the
minority party. While Republicans differed on the substantive policies within their
replacement plan, Republicans were united in their dedication to repealing the Affordable
Care Act (or, at the very least, dedicated to the talking point that supports repealing the
ACA). Hardline conservatives actively campaigned against the Republican health care
bills by either claiming it did not fully repeal the ACA or arguing that it would replicate
the biggest flaws in the Obama-era law (Berman, 2017). Even the moderate Republicans
who opposed the health care proposals based on their negative impact on health care
access and coverage, like Rep. Dent, Rep. Lance, Senator Murkowski and Senator
57
Collins, voted for repeal of the ACA multiple times during the Obama Administration.
21

Thus, the debate presented to CNN’s audience defined the parameters of the health care
negotiations as a question of how best to repeal the ACA, obscuring questions of whether
or not repeal represented good policy in the first place.
Focusing the debate on the fight within the GOP over how to repeal the ACA
implicitly accepts a core conservative claim - that the ACA is failing - as true and the use
of competing Republican sound bites to illustrate the conservative “battle” often resulted
in the frequent repetition of inaccurate claims that Obamacare was in a “death spiral.”
Republican leadership rarely made a positive case in advocating for the Republican
reform bills, instead often arguing that the collapse of the ACA was imminent and swift
action must be taken to save the American public from the ‘disaster’ that is Obamacare,
and CNN sound bites reflected this rhetoric. Sound bites of Speaker Paul Ryan showed
him claiming the ACA has “failed,” or “collapsed,” pointing to “skyrocketing” premiums
and “disappearing” choices as evidence that Republicans must keep the “promise to lift
the burden of Obamacare from the American people.”
22
Rand Paul, one of the most
prominent conservative opponents of the Republican proposals, echoed similar themes in
sound bites where he claimed “the death spiral of Obamacare continues,” and criticized
the House bill as “Obamacare light” declaring “it won’t work, premiums and prices will
continue to spiral out of control” meaning “the problems of Obamacare will remain and

21
HealthReformVotes.org, a public database of all federal votes on health care related legislation,
maintains an extensive database for each Representative and Senator.
22
Acosta, J., & Cooper, A. (2017, Mar. 9). Anderson Cooper 360. CNN. Retrieved from Lexis-Nexis.
Blitzer, W., & Serfaty, S. (2017, May 4). The Situation Room with Wolf Blitzer. CNN. Retrieved from
Lexis-Nexis.
Acosta, J., & Cooper, A. (2017, May 5). Anderson Cooper 360. CNN. Retrieved from Lexis-Nexis.
58
may get worse.”
23
Two straight reports used a sound bite of House Majority Leader Rep.
Kevin McCarthy claiming that “we have to make sure this passes to save those people
from Obamacare that continues to collapse,” while another showcased him sidestepping a
question about whether or not the GOP bill covered pre-existing conditions by criticizing
the ACA asking “how do you care for pre-existing conditions when there’s no care at all”
in the status quo.
24
CNN straight reports showcased then-Press Secretary Sean Spicer
claiming the ACA was “failing on its own,” “dying on the vine,” “not working,” and
other varieties of the death spiral talking point numerous times, often repeating the same
sound bite in multiple segments.
25
Additionally, straight reports on CNN used a sound
bite of Trump calling the ACA a “disaster” no less than 9 times,
26
featured his threat to

23
Cooper, A., & Foreman, T. (2017, Mar. 9). Anderson Cooper 360. CNN. Retrieved from Lexis-Nexis.
Blitzer, W., & Mattingly, P. (2017, Jun. 22). The Situation Room with Wolf Blitzer. CNN. Retrieved from
Lexis-Nexis.
Burnett, E., & Nobles, R. (2017, Jul. 13). Erin Burnett OutFront. CNN. Retrieved from Lexis-Nexis.
Foreman, T., & Lemon, D. (2017, Jul. 18). CNN Tonight. CNN. Retrieved from Lexis-Nexis.
24
Cooper, A., & Mattingly, P. (2017, May 3). Anderson Cooper 360. CNN. Retrieved from Lexis-Nexis.
Cooper, A., & Mattingly, P. (2017, May 3). Anderson Cooper 360. CNN. Retrieved from Lexis-Nexis.
Acosta, J., & Cooper, A. (2017, May 5). Anderson Cooper 360. CNN. Retrieved from Lexis-Nexis.
25
Burnett, E., & Serfaty, S. (2017, Mar. 13). Erin Burnett OutFront. CNN. Retrieved from Lexis-Nexis.
Acosta, J., & Blitzer, W. (2017, Mar. 14). The Situation Room with Wolf Blitzer. CNN. Retrieved from
Lexis-Nexis.
Acosta, J., & Cooper, A. (2017, Mar. 14). Anderson Cooper 360. CNN. Retrieved from Lexis-Nexis.
Acosta, J., & Blitzer, W. (2017, May 3). The Situation Room with Wolf Blitzer. CNN. Retrieved from
Lexis-Nexis.
Carroll, J., & Cooper, A. (2017, May 3). Anderson Cooper 360. CNN. Retrieved from Lexis-Nexis.
26
Cooper, A., & Zeleny, J. (2017, Jun. 27). Anderson Cooper 360. CNN. Retrieved from Lexis-Nexis.
Blitzer, W., & Murray, S. (2017, Jul. 18). The Situation Room with Wolf Blitzer. CNN. Retrieved from
Lexis-Nexis.
Cooper, A., & Murray, S. (2017, Jul. 18). Anderson Cooper 360. CNN. Retrieved from Lexis-Nexis.
59
let Obamacare “explode” or “fail” ten times,
27
and general claims of a death spiral ten
times.
28
To illustrate that these examples constitute a trend in coverage rather than a

Foreman, T., & Lemon, D. (2017, Jul. 18). CNN Tonight. CNN. Retrieved from Lexis-Nexis.
Mattingly, P., & Cooper, A. (2017, Jul. 24). Anderson Cooper 360. CNN. Retrieved from Lexis-Nexis.
Mattingly, P., & Blitzer, W. (2017, Mar. 13). The Situation Room with Wolf Blitzer. CNN. Retrieved from
Lexis-Nexis.
Cohen, E., & Burnett, E. (2017, Mar. 21). Erin Burnett OutFront. CNN. Retrieved from Lexis-Nexis.
Murray, S., & Bolduan, K. (2017, Mar. 24). Erin Burnett OutFront. CNN. Retrieved from Lexis-Nexis.
Mattingly, P., & Cooper, A. (2017, Mar. 24). Anderson Cooper 360. CNN. Retrieved from Lexis-Nexis.
27
Blitzer, W., & Mattingly, P. (2017, Mar. 24). The Situation Room with Wolf Blitzer. CNN. Retrieved
from Lexis-Nexis.
Burnett, E., & Serfaty, S. (2017, Mar. 24). Erin Burnett OutFront. CNN. Retrieved from Lexis-Nexis.
Cooper, A., & Mattingly, P. (2017, Mar. 24). Anderson Cooper 360. CNN. Retrieved from Lexis-Nexis.
Cooper, A., & Murray, S. (2017, Mar. 24). Anderson Cooper 360. CNN. Retrieved from Lexis-Nexis.
Blitzer, W., & Zeleny, J. (2017, Jun. 27). The Situation Room with Wolf Blitzer. CNN. Retrieved from
Lexis-Nexis.
Blitzer, W., & Zeleny, J. (2017, Jul. 17). The Situation Room with Wolf Blitzer. CNN. Retrieved from
Lexis-Nexis.
Cooper, A., & Nobles, R. (2017, Jul. 17). Anderson Cooper 360. CNN. Retrieved from Lexis-Nexis.
Foreman, T., & Lemon, D. (2017, Jul. 18). CNN Tonight. CNN. Retrieved from Lexis-Nexis.
Cooper, A., & Murray, S. (2017, Jul. 18). Anderson Cooper 360. CNN. Retrieved from Lexis-Nexis.
Burnett, E., & Carroll, J. (2017, Jul. 18). Erin Burnett OutFront. CNN. Retrieved from Lexis-Nexis.
Foreman, T., & Lemon, D. (2017, Jul. 18). CNN Tonight. CNN. Retrieved from Lexis-Nexis.
28
Blitzer, W., & Mattingly, P. (2017, Mar. 24). The Situation Room with Wolf Blitzer. CNN. Retrieved
from Lexis-Nexis.
Burnett, E., & Serfaty, S. (2017, Mar. 24). Erin Burnett OutFront. CNN. Retrieved from Lexis-Nexis.
Cooper, A., & Mattingly, P. (2017, Mar. 24). Anderson Cooper 360. CNN. Retrieved from Lexis-Nexis.
Cooper, A., & Murray, S. (2017, Mar. 24). Anderson Cooper 360. CNN. Retrieved from Lexis-Nexis.
Blitzer, W., & Jones, A. (2017, May 4). The Situation Room with Wolf Blitzer. CNN. Retrieved from Lexis-
Nexis.
Burnett, E., & Zeleny, J. (2017, May 4). Erin Burnett OutFront. CNN. Retrieved from Lexis-Nexis.
60
series of coincidences, two codes were included in the substantive coding of segments –
one that coded for any general mention of negative news about the Affordable Care Act
and a second code for any mention of specific claims that the ACA was collapsing or in a
death spiral. In CNN’s straight news reports, 42 reports or 26% of all segments included
some mention of general negative news about the Obama health law (e.g., mentions of
premium hikes, insurer drop outs, or other discussions of trouble in the ACA’s individual
markets), and 27 straight news reports or 17% of all segments included specific death
spiral claims (27 segments in total). These codes did not count individual mentions or
delineate between whether the source was a partisan sound bite or the reporter featured in
the segment. These sound bites represent a key narrative running throughout CNN’s
coverage of the health care debates, not the infrequent claims of fringe conservatives, but
core claims forwarded by key Republicans and the President himself.
The focus on claims of the urgent threat posed by the ACA to the American
people works to create a (false) sense of urgency behind the Republican reform effort.
Depicting the ACA as a crisis allows conservatives to paper over criticisms of their bill
by diverting attention to the catastrophic harm that awaits the American public if the
ACA continues down the path to collapse. Robert Hackey, the director of the Health

Acosta, J., & Cooper, A. (2017, May 4). Anderson Cooper 360. CNN. Retrieved from Lexis-Nexis.
Blitzer, W., & Zeleny, J. (2017, Jun. 27). The Situation Room with Wolf Blitzer. CNN. Retrieved from
Lexis-Nexis.
Blitzer, W., & Mattingly, P. (2017, Jun. 27). The Situation Room with Wolf Blitzer. CNN. Retrieved from
Lexis-Nexis.
Cooper, A., & Zeleny, J. (2017, Jun. 27). Anderson Cooper 360. CNN. Retrieved from Lexis-Nexis.
Cooper, A., & Murray, S. (2017, Jul. 18). Anderson Cooper 360. CNN. Retrieved from Lexis-Nexis.
61
Policy and Management Program at Providence College, wrote about the negative role
crisis framing plays in health care discussions in the public sphere, wherein he argues that
“language is significant in debates over health reform because the labels used to describe
policy problems are not neutral” and that “the language of crisis shapes how policy
makers, providers, and the public think about the health care system” (Hackey, 2012, p.
2). The use of crisis as a framing device in health care reform efforts dates back to the
1960s and the invocation of crisis functions to “preempt more accurate and constructive
definitions” of the problems in the health care system and “circumscribe[s] public debate
about reform” (Hackey, 2012, p. 4). More often than not, this crisis framing succeeds at
“captur[ing] popular discontent and anxiety” about the health care system, but “sheds
little light on what to do to fix the system” (Hackey, 2012, p. 2). In this instance,
conservatives use the image of the ACA in crisis as the justification for pushing ahead
with their deeply flawed bill because “if it’s really true that the ACA is doomed to
collapse, then even a bad replacement looks pretty good” (Yglesias, 2017a). The
substance of the GOP bill fades into the background when discussions about health care
reform focus on whether or not the ACA is collapsing - the conversation becomes a
deliberation about the status quo instead of a debate about whether or not the AHCA
improves the health care system. The cable news audience thus sees an image of the
congressional health care debates filtered through this crisis framing, as the repetition of
sound bites featuring death spiral claims reinforces the conservative narrative of urgency
underpinning their reform efforts.
Despite the constant repetition of the death spiral claims from Republicans, all
credible data shows that the ACA is not collapsing. The GOP has a long history of
62
incorrectly predicting the death of Obamacare (Alderman, 2017). Conservatives have
repeatedly overhyped predictions of skyrocketing premiums (Berrier, 2014; Harrington,
2015) and predicted that too few young adults would sign up in order to make the
individual marketplaces sustainable (Sandmeyer, 2014). In 2016 alone conservatives
claimed that the 2017 benchmark premium hikes and Aetna’s withdrawal from the
insurance exchanges would cause a death spiral - neither did (Kodjak, 2016; Singer,
2017; Duffy, 2016). Despite the best efforts of Republicans to fear monger and predict its
imminent death, the Affordable Care Act remains relatively health - despite issues in the
individual exchanges (“Fact check,” 2017). Most notably, the Congressional Budget
Office (2017) analysis of the first version of the American Health Care Act noted that
“the nongroup market would probably be stable in most areas under either current law,”
or in other words, the individual marketplaces for consumers who don’t receive health
care from an employer or university would remain stable and, contrary to Republican
assertions, not collapse.
While the ACA does have significant issues, many of those issues are the result of
intentional Republican attempts to sabotage the Obama health law. From the beginning
Republicans worked to undermine the health law, as conservative governors refused to
set up their own exchanges and congressional Republicans “refused repeatedly to
appropriate dedicated funds” to build out HealthCare.Gov to compensate for the
unexpectedly large number of states that would rely on it (Purdum, 2013). The significant
number of conservative states that decline to accept the Medicaid expansion left millions
uninsured who could have gained access under the federal program (Tavernise &
Gebeloff, 2013). In late 2015, Senator Marco Rubio successfully led the charge to gut the
63
ACA’s risk corridors, a mechanism created “to protect insurers against the uncertainties
they faced in setting the level of insurance premiums when they did not know who would
sign up for coverage” given the new requirement to cover all individuals regardless of
pre-existing conditions (Pear, 2015). Rubio succeeded in reducing the risk corridor
payments from the expected $2.9 billion to a mere $400 million, which threw insurance
companies “into a crisis,” causing them to withdraw from marketplaces in “states with
low incomes and thus poorer health,” or dramatically increased premiums to recoup their
losses (Hartmann, 2017). Health care executives explicitly cited the uncertainty created
by Trump’s refusal to commit to the ACA’s cost-sharing subsidies as the reason for large
price increases in the 2018 benchmark premiums for the individual exchanges (Kliff,
2017d). Thus, many of the issues facing the ACA actually result from the intentional
campaign by Republicans to sabotage the Obama health law - context that is largely left
out of the reporting on the health of the ACA.
The dramatic imbalance in partisan sound bites in straight news reports ensured that
the conservative death spiral narrative dominated the conversation and shaped the image
of the debate presented to the audience. While some straight news reports debunked the
death spiral claims,
29
the vast majority did not, leaving the factually inaccurate claims to
stand uncorrected. Even fewer discussed the history of Republican interference or the
active attempts by the Trump Administration to undermine the Obama health law,
leaving out key context in reporting on the ACA’s problems. The fundamental imbalance
in the use of partisan sound bites and the inadvertent promotion of dubious conservative
health care narratives represents a particularly problematic trend because it occurred

29
Foreman, T., & Lemon, D. (2017, Jul. 18). CNN Tonight. CNN. Retrieved from Lexis-Nexis.
64
during the straight news report format. The straight news report maintains the style, look,
and formatting of traditional broadcast journalism, even when it occurs in the context of a
primetime political talk news show that devotes much of its time to discussion, like Erin
Burnett OutFront or Anderson Cooper 360. The formality of the news anchor behind the
desk, the traditional shot of the reporter on-site at Capitol Hill, the slickly produced sound
bite montages with reporter voice over - all of these features invite the audience to
believe they are watching an objective news update. The reporters who most commonly
deliver straight news reports rarely participate in the panel segments that comprise the
political talk component of CNN’s primetime coverage, further entrenching a line
between what should be perceived as objective journalism versus punditry or
commentary. Additionally, the public struggles to differentiate between partisan news
hosts and objective reporters, as polling data showed that “the public believes that it gets
news from the partisan media” like Fox News or MSNBC, as fully 40% believed Bill
O’Reilly was a journalist (Jamieson, Hardy, & Romer, 2007). If audiences struggle to
differentiate between a partisan pundit like O’Reilly from a credentialed journalist, it
increases the likelihood that they might view the straight news report as a credible
objective source of news.
This is particularly likely on CNN, given its explicit attempts to position itself as the
middle-of-the-road, centrist cable news option (Curtis, 2016; Nadler, 2016). Polling about
whether or not audiences view news sources as objective tells a mixed story, as a
Gallup/Knight Foundation poll found that Fox News was chosen as the most objective
news source by more individuals than any other news source, but this finding likely
results from “the network’s dominant position among Republicans (60 percent of whom
65
say it is objective) and their near complete distrust of other sources” (Lanktree, 2018).
The same poll and others show that Democrats, Independents, and the majority of
millennials view CNN as objective reporting or as a trusted news source (Adriens, 2018;
Engel, 2014). But the argument here is not whether or not audiences view CNN as an
objective news source, but rather a criticism of cable news outlets using the format and
style of traditional broadcast journalism, which implies objectivity, to deliver a
fundamentally flawed news product. Putting aside Trump’s claims of fake news, the
people who choose to watch CNN likely view the straight news report as a reliable source
of political news, amplifying the dangers of CNN’s stark visibility bias in its use of
partisan sound bites. The average viewer may believe she is consuming objective
journalism, but as a result of the considerable imbalance in partisan sound bites actually
receives a distinctly conservative perspective that focuses the debate on the question of
how best to repeal the ACA, rather than how to expand health care coverage and improve
the existing system.
Conclusion
While this chapter has outlined serious flaws in how networks used straight news
reports to cover the GOP effort to repeal and replace the Affordable Care Act, this
concluding section will highlight an example of a quality straight news report as evidence
that not all hope is lost when it comes to objective reporting on cable news. In a March
9
th
segment, CNN Sunlen Serfaty delivered an update on the Republican attacks on the
Congressional Budget Office (CBO) as an unfolding controversy in the GOP health care
efforts. While this segment did problematically include several sound bites of
Republicans maligning the non-partisan agency, Serfaty took care to emphasize that the
66
CBO is “the highly respected non-partisan agency that has been leaned on for years as the
go-to independent arbiter on Capitol Hill to analyze the financial impacts of legislation,”
followed by a sound bite from Douglas Holtz-Eakin, the former director of the CBO
under President George W. Bush, where he explained that “the job by law is to be non-
partisan and not take into account party considerations.”
30
Furthermore the segment
highlighted the hypocrisy of Republican critiques of the CBO’s accuracy, as Serfaty
noted how Republicans previously used CBO numbers to criticize the ACA and generally
lauded the agency’s credentials in the past. In closing the segment Serfaty underscored
the CBO’s “very strong track record,” and contextualized the claims that the CBO missed
the mark on the ACA, noting that “yes, there were indeed some parts that they were off
the mark and got it wrong, but there were also some other areas where they are more
accurate, specifically the estimate for the insured rate for non-elderly adults.”
In this segment, Serfaty pushes back on distorted claims about the CBO herself and
utilized an expert sound bite to debunk the inaccurate claims of CBO bias, which
inherently bolsters the credibility of the debunk. She engages the claims on both sides of
the argument but situates the distorted claims of CBO inaccuracy in the broader context
of the CBO’s lengthy history and the relative accuracy of the agency’s predictions about
the ACA overall. This effort to include the broader context in reporting on stories
pertaining to health care policy is crucial to help ground the conversation and also to
highlight when criticisms or arguments rely on selective or cherry-picked evidence, as is
frequently the case in the health policy arena. For example, while it is true that the ACA’s

30
Cooper, A., & Serfaty, S. (2017, Mar. 9). Anderson Cooper 360. CNN. Retrieved from Lexis-Nexis.
67
individual marketplaces face challenges, responsible reporting on these stories requires
acknowledging the history of conservative attempts to undermine the implementation of
the law as a main factor in contributing to those issues. The Serfaty segment illustrates
the importance of fact checking inaccurate claims within a segment and the need for
grounding reporting in the broader policy context, journalistic characteristics that will be
further examined in the recommendations forwarded in the concluding chapter.
This chapter has established the existence of a severe visibility bias in CNN and Fox
News’ use of partisan sound bites in straight news reports. While the imbalance on Fox
News likely results from the network’s overarching ideological agenda, the CNN
imbalance could be attributed to Zucker’s attempt to correct what he perceived to be an
existing “liberal bias” at the network when he took over. Or, more convincingly, it
occurred as a result of the tendency for cable news to focus on spectacle in the political
arena, as the infighting within the Republican caucus provided the dramatic conflict for
CNN to emphasize, resulting in a disproportionate usage of Republican sound bites. This
visibility bias in the political balance of partisan sound bites distorts the audience’s
perception of the congressional debates over health care by defining the terms of the
debate in distinctly conservative terms, implicitly accepting and promoting inaccurate
conservative talking points like the claim that the ACA is on the verge of collapse. The
focus on the conservative battle over the shape and substance of the Republican
replacement legislation shifts the core question underpinning the debate from a question
of how best to reform the health care system to how best to repeal the Affordable Care
Act. Such a rhetorical move rests on the assumption that the ACA has failed - a
demonstrably false claim - while simultaneously skirting conversations about how
68
Republican actions undermined the stability of the Obama health law, contributing to
many of the troubles conservatives point to as evidence of the ACA’s imminent demise.
This analysis focused primarily on CNN for several reasons. First, MSNBC utilizes a
political talk show format for its primetime line up that emphasizes the role of the host as
a commentator and, as a result, rarely used the straight news format. Given the significant
disparity between the use of this format on MSNBC versus CNN and Fox News,
MSNBC was excluded from further discussion. Second, while this chapter does discuss
Fox News in some detail, the partisan imbalance in their use of sound bites likely results
from the network’s overarching ideological agenda that caters exclusively to a
conservative audience. It would have been more surprising if Fox News had maintained a
balance in the number of conservative and liberal sound bites they used in their straight
news report - the manifestation of political bias is the norm, not an anomaly, for Fox
News. Finally, this chapter focuses on CNN in particular, given the network’s history of
striving toward objective journalism and the continued emphasis by executives to
position the network as a middle-of-the-road, centrist option for audiences who find Fox
News and MSNBC too polarizing. Whether or not audiences view CNN as objective is
largely irrelevant to the argument made in this chapter, as it highlights problematic
manifestations of political bias in segments that appropriate the style of objective
television journalism and argues that networks that purposefully choose the format of
traditional broadcast journalism must adhere to similar journalistic standards for their
news product. Presumably the majority of individuals who watch CNN do so because
they believe it represents a trustworthy news source, and this study illustrates that the
69
coverage they consumed presented a fundamentally flawed depiction of the GOP health
care proposals.
The significant partisan imbalance in sound bites in straight news reports resulted in a
representation of the debates over the GOP health care proposals that disproportionately
emphasized the conservative viewpoint and aired misinformed or demonstrably false
claims in sound bites, undermining the informational quality of those segments
substantially. While cable news represents only one source of news in a now vast and
varied media ecosystem, these networks play an important role in delivering the news to
a significant portion of the public (Holcomb, 2016). This chapter focuses on the straight
news report in particular because it most closely resembles traditional broadcast
journalism, and the strategic use of this style and format implies that the news delivered
in this segment is objective. The next chapter will illustrate how the manifestation of
conservative bias in the discussion of health care reform extends beyond the straight
news report, as news hosts utilize problematic question formats that inadvertently repeat
conservative narratives and flawed talking points.

70
CHAPTER 4:
THE ROLE OF CABLE HOSTS IN DISCUSSION-BASED SEGMENTS

One of the major features of the rise of cable news revolves around the
mainstreaming of discussion-based segments as a mechanism for delivering the news.
With the introduction of the 24-hour news cycle, cable news channels increasingly began
to rely on political talk segments like extended interviews and panel discussions as a
cheap and easy way to provide entertaining content that filled the news hole (Letukas,
2014; Nadler, 2016). All three of the major cable networks, MSNBC, CNN, and Fox
News, use discussion-based segments in every single one of their prime-time programs,
illustrating the ubiquity of the use of the political talk format in delivering and discussing
the news. Some have criticized the prevalence of discussion-based segments, arguing that
they exemplify the slippery slope toward infotainment, as cable news networks transform
into entertainment channels that no longer serve as journalistic outlets (Jones, 2012b).
Others have argued that these discussion-based segments can turn into “a continual op-ed
page,” which can confuse the audience by blurring “the lines between news and talk and
infotainment” (Anderson, 2004, p. 46). Panel discussions in particular can complicate the
division between the news and commentary, as these segments often include objective
journalists next to partisan pundits with little to no attempt to differentiate between their
professional background and role in the discussion. While political interviews represent a
time-tested journalistic tool for gathering information, the entrenched reliance on official
sources can result in an incomplete view into public policy debates, as officials are
incentivized to stick to basic talking points and interviewers, hamstrung by competing
71
journalistic principles of neutrality and adversarialism, often fail to challenge their
sources (Bennett, 2016; Clayman & Heritage, 2002; Finlayson, 2001).
Despite these issues, it would be a mistake to cast off discussion-based segments
as a format for delivering the news, because to do so would require writing off cable
news entirely. Discussion-based segments are not intrinsically flawed as a method for
delivering the news - it’s a question of how they are implemented. The role of the cable
news host and the type of guest involved in a segment represent two of the most
important aspects influencing the quality of discussion-based segments. As previous
research has illustrated, the approach a host takes to moderating a segment can influence
the tone and informational quality of that segment (Clayman & Heritage, 2002; Vraga,
Edgerly, Bode, Carr, Bard, Johnson, Kim, & Shah, 2012). This chapter examines how
cable news hosts adjudicated discussion-based segments during the coverage of the GOP
effort to repeal and replace the Affordable Care Act (ACA) as a case study for
articulating the need for cable news networks to reimagine how they report on public
policy issues like health care in the Trump era.
This chapter builds on the work done in the previous chapter on straight news
reports by illustrating how cable news hosts on CNN and MSNNC inadvertently repeated
and likely reinforced the dominant conservative narratives during the health care debates,
examining the discussions about the Congressional Budget Office and the health of the
ACA in particular. It also examines how Fox News hosts used similar techniques to CNN
and MSNBC hosts, but also explicitly promoted conservative talking points based on
false or distorted evidence, illustrating how the network functioned more like propaganda
for the Trump Administration than as a journalistic outlet. While this project explicitly
72
does not argue that cable news networks (outside of Fox News) have a conservative bias,
it does illustrate the prevalence of conservative misinformation in discussions about
health care and helps to illustrate how the norms of political journalism that emphasize
objectivity and displaying both sides of an issue can inadvertently promote misinformed
or distorted claims.
CNN and MSNBC inadvertently repeated and amplified misinformed or
demonstrably false talking points pushed by the Trump Administration on health care in
three primary ways. First, hosts phrased questions on key controversies, like the
credibility of the Congressional Budget Office (CBO) or the likelihood that the ACA was
on the verge of collapsing into a death spiral, that were predicated on the assumption that
the conservative talking point on that issue was true, reinforcing the validity of the
misinformed claim. Second, hosts used references to inaccurate conservative talking
points as an introduction to substantive questions about the impact of the GOP bills,
which often problematically involved the repetition of GOP sound bites with no
contextual information. This form of question foregrounds the conservative talking point,
which often would either go unanswered or would be reaffirmed by a conservative guest.
Third, hosts failed to consistently debunk or push back on guest’s false claims, often
allowing inaccurate assertions to remain uncontested as hosts turned the conversation to
other - often non-substantive - issues or questions. While this chapter argues that the
flawed techniques used by hosts on CNN and MSNBC represent problematic
manifestations of the journalistic norms promoting neutrality and political balance, Fox
News’ active propagation of conservative misinformation on health care results from the
network’s broader ideological agenda.
73
This investigation into the role of cable news hosts in promoting conservative
misinformation on health care, either accidentally or intentionally, raises important
questions about how cable networks should approach covering the Trump
Administration, particularly given the Trump Administration’s all-out attack on facts
(Fallows, 2016; Farhi, 2016a). The discussion of the attacks on the CBO and the
continued repetition of death spiral claims illustrates how the Trump Administration
attempted to gaslight
31
the American public into supporting a bill that would have harmed
millions of Americans. Trump, administration officials and congressional Republicans
attempted to supplant reality with their own ‘alternative facts,’ categorically denying any
negative impacts would result from the law and making claims about what the bill would
include that were largely detached from the actual substance of the legislation (Kliff,
2017e; Politi, 2017; Ehrenfreund, 2017). While Trump’s predilection for ignoring
inconvenient facts is hardly restricted to health care, the degree to which these talking
points have trickled down and were used by many members of the Republican Party and
the seriously negative consequences the GOP proposals would have had on the American
health care system make this particular attempt at gaslighting more insidious than say
Trump’s attempts to convince the public that his inauguration crowds were large. This in
turn calls for cable news networks to reevaluate how they cover the Trump
Administration, and this chapter makes specific recommendations for how to improve the
quality of coverage by better arming program hosts with the facts and empower them to
play a more active role in the adjudication of discussion-based segments and to also

31
The term gaslighting comes from the 1930s play “Gas Light,” defined as the attempt to “psychologically
manipulate a person to the point where they question their own sanity” (Duca, 2016).
74
reconsider employing individuals who purport to represent the views of the Trump
Administration, but in reality, just function to spread misinformation and false claims
about health care.
These trends speak to the need for networks to properly arm their hosts with the
information they need to debunk false claims, but also so they can phrase their questions
and moderate discussions in a manner that does not accidentally reinforce misinformation
about health care. This chapter maps out a vision of the normative role of cable news
hosts in interviews and panel discussions that requires a more active role in combating
the proliferation of misinformed claims on policy issues that requires moving beyond the
traditional tropes of ‘he said, she said’ journalism that characterize the majority of the
discussion-based segments currently. While problematic trends in host questioning and
moderating ran throughout the coverage, this chapter will also highlight the examples of
strong interviews and successful attempts to push back on misinformation that should
serve as a model for future coverage of health care, as it is clear that the Trump
Administration’s assault on the Affordable Care Act is far from over.
Discussion-Based Segments: A Review
Discussion-based political talk shows pre-date cable news. The first political talk
shows such as “The Alan Burke Show” and “Firing Line” adopted a debate format
“where ideologically and politically diverse pundits argued and debated one another”
(Letukas, 2014, p. 26). These shows focused on entertainment rather than delivering the
news, however, they established a format and style that would influence the development
of cable news programs. The creation of the 24-hour news cycle created a “news
75
vacuum” that “significantly changed the character and content of news programming in
the United States” because suddenly producers had significantly more time to fill than in
traditional news broadcasts (Letukas, 2014, p. 30-31). While CNN used strategies like
recycling new stories to fill time, the demands of the 24-hour news vacuum also led to
longer on-air interviews and the creation of discussion-based segments and even entire
discussion-focused programs in the early 1980s, as those segments and programs filled
the news hole “with little preparation and were inexpensive to produce compared to
investigative journalism” (Letukas, 2014, p. 31). This chapter focuses on the role of the
news anchor in two types of discussion-based segments, the interview and the panel
discussion.
Interviews represent one of the oldest facets of political journalism. They provide the
opportunity for “journalists [to] perform certain core democratic functions: soliciting
statements of official policy, holding officials accountable for their actions, and
managing the parameters of public debate, all of this under the immediate scrutiny of the
citizenry" (Clayman & Heritage, 2002, p. 2). A key element of the interview revolves
around the power dynamic between the interviewer and interviewee, as questioning in an
interview is both a “device for seeking the truth” and a “vehicle for demonstrating
authority” (Schudson, 1995, p. 75). A fundamental tension exists between political
journalism’s dedication to objectivity and maintaining neutrality and the veneration of
adversarialism, as seen through the lionization of reporters like Carl Bernstein and Bob
Woodward, whose dogged pursuit of the truth revealed core corruptions in Washington
(Clayman, 2002; Bennett, 2016). As such, interviewers often refrain from active fact-
checking, “restrict[ing] themselves to asking questions and hence avoid[ing] actions
76
whose primary purpose is to express a point of view” (Clayman & Heritage, 2002, p.
151). The Trump Administration’s penchant for promoting misinformation raises
important questions for the continued reliance on political interviews as a mechanism for
holding officials accountable. As Jay Rosen (2016b) argues, the “existing methods for
‘holding power to account’ rest on assumptions about how it will behave” and “a man in
power untroubled by contradictions,” as Trump is,” cannot be held accountable by
normal means.”
While panel segments also provide an inexpensive mechanism to fill the news hole,
they often cater to the worst aspects of political journalism. First, they create an incentive
for guests to act dramatically and to make inflammatory comments, because often “the
ability to frame information within a sound bite, engage in heated arguments, appear
personable on camera, and construct an aurora of authority, matter more than expertise
and training” when cable networks search for guests (Letukas, 2014, p. 43). Panel
discussions featuring “polarized points of view yelling back and forth” create “an
artificial sense of excitement,” that taps into cable networks’ love of drama and conflict
as a mechanism for framing the news, as discussed in the previous chapter (Anderson,
2004, p. 46). Program hosts play a vital role in controlling the tone of a panel, as a host’s
framing of a question “can invite the panelists to respond to one another rather than to the
issue at hand” or “can invite expressions of disagreement in particular,” which “can thus
nudge the panelists toward an argumentative confrontation” (Clayman & Heritage, 2002,
p. 319). While fiery debates may make for entertaining television, the devolution of
panels into shouting matches where “participants become unable to develop their points”
77
means “the entertainment value has overwhelmed informational substance” of the news
segment (Clayman & Heritage, 2002, p. 334).
Second, the tension between a news anchor’s adherence to norms of political balance
and objectivity and adversarialism also exists in the panel discussion format, often
resulting in segments that pit a conservative against a liberal to debate a given news issue.
This assumes all debates have two equal sides based on facts and evidence and allows the
anchor to rely on the panelists to answer each other’s claims, rather than actively
adjudicating the conversation herself. As scholars of media coverage of climate change
have shown, depicting policy issues in a balanced way when one side of the “debate” is
based on false claims or misinformation fundamentally harms public comprehension and
facilitates the spread of dubious information (Boykoff, 2008; Boykoff, 2013; Fahy, 2017;
Freudenburg & Muselli, 2010). The quality of discussion-based formats depends heavily
on the type of guests that networks choose to feature in these segments, which becomes
particularly problematic when a network (CNN) chooses to employ a series of individuals
(such as Stephen Moore and Jeffrey Lord) who consistently and emphatically promote
misinformation and factually inaccurate claims (Weissmann, 2017; Rubin, 2017).
Third, panel segments in particular can diminish the role of the news anchor, allowing
them to function as a glorified referee of turn-taking, rather than an active adjudicator
who fact-checks and moderates the substance of the discussion. In his discussion of what
he terms the “dialogical newscast,” Ben-Porath (2007) argues that “studio hosts have the
authority to ask the questions and decide when the discussion commences or concludes,
but often refrain from contributing their own answer” (p. 420). Panel discussions allow
the program host to maintain the veneer of objectivity by allowing participants to debate
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and (theoretically) fact-check each other, thus removing the host “from the heat of
battle,” allowing them “to act as a disinterested catalyst” (Clayman & Heritage, 2002, p.
322). This tendency to adopt the role as the middle ground moderator is a “risk-
reduction” strategy (Rosen, 2009), which shields the anchor’s (and thus the network’s)
authority from risk, as active fact-checking or adjudication of the substance of the debate
may be perceived as a “deviation from neutrality” that could anger a segment of the
audience, thus undermining profits (Gans, 2014, p. 2489).
Despite these flaws, none of these criticisms represent intrinsic elements of the panel
format, as Clayman and Heritage (2002) note, the “argument culture” that can permeate
many discussions “is not a necessary or inevitable consequence of the panel interview
format,” because “it all depends on how that format is implemented” (p. 336). This
chapter seeks to reveal problematic trends in how program hosts moderated discussions
of health care during the debates over the AHCA and BCRA, but also highlight
successful examples of how to foster substantive discussions of public policy and push
back on attempts to spread (intentionally or not) misinformation.
The CBO: A Brief Overview
This section introduces background information about the Congressional Budget
Office and outlines the criticisms forwarded by the Trump Administration and
congressional Republicans in an attempt to undermine the agency’s credibility and thus
negate the impact of the negative estimates of the GOP health proposals. This overview
of the conservative narratives about the CBO and the facts (or lack thereof) underpinning
those narratives provides the necessary context for investigating how cable news hosts
79
approached discussions of the CBO. While this chapter also examines how hosts
discussed conservative claims of an ACA death spiral, the previous chapter already
provided an overview of Republican predictions of the ACA’s allegedly impending
collapse and the preponderance of evidence debunking those claims.
In the 1970s, Congress created the Congressional Budget Office “as a non-partisan
agency to help lawmakers deal with the federal budget and add financial rigor to pending
appropriations and other legislation” (Lee, 2017). The CBO was born out of a desire to
reassert congressional authority in the budget process and creating a non-partisan
organization that could provide “economic and budgetary figures” necessary for budget
making freed Congress from its dependence on the White House controlled Office of
Management and Budget (Joyce, 2017). Philip Joyce, a professor of public policy and
author of The Congressional Budget Office: Honest Numbers, Power, and Policymaking,
found through his research that “the CBO has put Congress on a more equal footing with
the president, changed how policymaking works through cost estimates, and helped
federal budget making become more open and transparent” (Joyce, 2017). That the CBO
was created as a mechanism for increasing transparency of the legislative process and for
countering the authority of the executive branch provides interesting context to the
Trump Administration’s concerted assault on the CBO’s credibility during the
Republican health care debates.
The attacks on the CBO began before the non-partisan agency released its first
assessment of the American Health Care Act on March 13, 2017. During a White House
press briefing on March 8
th
, then-Press Secretary Sean Spicer declared “if you’re looking
at the CBO for accuracy, you’re looking in the wrong place” because “they were way,
80
way off the last time in every aspect of how they scored and projected Obamacare” (Qiu,
2017). He added that “if you look at the number of people that they projected that would
be on Obamacare, they are off by millions,” and claimed that “the idea that that is any
kind of authority based on the track record that occurred last time is a little far-fetched”
(Qiu, 2017). The White House and congressional Republicans continued to repeat these
types of critiques of the CBO all through the health care debates. In a statement on June
26
th
, the White House claimed:
The CBO has consistently proven it cannot accurately predict how healthcare
legislation will impact insurance coverage. This history of inaccuracy, as
demonstrated by its flawed report on coverage, premiums, and predicted deficit
arising out of Obamacare, reminds us that its analysis must not be trusted blindly.
Mick Mulvaney, the director of OMB, said in an interview “at some point, you’ve got to
ask yourself, has the day of the CBO come and gone?” and expressed doubts about the
CBO’s non-partisan bona fides, saying “we always talk about it as the nonpartisan
Congressional Budget Office. Given the authority that that has, is it really feasible to
think of that as a nonpartisan organization” (Klein, 2017). In an interview with Fox
News’ Tucker Carlson, then-HHS Secretary Tom Price declared “there’s no way to
predict” how many people would be covered by the GOP bill and claimed that the “CBO
has a terrible record on predicting how much coverage,” insisting on his belief that “there
would be more people, more individuals being able to be covered with the system that is
currently being contemplated in the Senate.”
32

32
Carlson, T., & Price, T. (2017, Jul. 17). Tucker Carlson Tonight. Fox News Channel. Retrieved from
Lexis-Nexis.
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Attacks on the CBO’s accuracy and credibility trickled down to congressional
Republicans, as Rep. Tom MacArthur (NJ-3) claimed the CBO has “a terrible record on
health care” and that he “found a lot of examples of bias in their work”.
33
Speaker Paul
Ryan (WI-1) claimed “they sort of overestimate the uninsured number just like they
overestimated who would be insured by Obamacare” when asked about the CBO’s first
estimate of the House legislation.
34
When asked about the CBO’s estimate that millions
would lose coverage under AHCA, Rep. Ted Yoho (FL-3) said “I don’t support those
numbers” because “if you look at the numbers that the CBO estimated would be there by
2016, there would be over 20 million people signed up on the Affordable Care Act. But if
you look at reality, it was less than half of that.”
35
Rep. Chris Collins (NY-27) argued that
the CBO doesn’t “really know how to estimate things like numbers of folks covered.
They missed it by a wide margin on Obamacare,” and called their AHCA estimates
“ludicrous.”
36
These comments reflect just a few of the statements made by Republicans
that castigated the CBO’s scores and cast doubt on the credibility of the institution as a
whole.
The Republican critiques of the CBO rely on the assertion that the agency’s estimates
of how many people would receive health insurance under the Affordable Care Act were
inaccurate. Their criticisms of the CBO’s scores are partially accurate. When Republicans
claim the agency overestimated how many people would obtain coverage as a result of

33
Cooper, A., & MacArthur, T. (2017, Jun. 22). Anderson Cooper 360. CNN. Retrieved from Lexis-Nexis.
34
Baier, B., & Ryan, P. (2017, Mar. 13). Special Report with Bret Baier. Fox News Channel. Retrieved
from Lexis-Nexis.
35
Blitzer, W., & Yoho, T. (2017, Mar. 13). The Situation Room with Wolf Blitzer. CNN. Retrieved from
Lexis-Nexis.
36
Blitzer, W., & Collins, C. (2017, May 4). The Situation Room with Wolf Blitzer. CNN. Retrieved from
Lexis-Nexis.
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the ACA, they’re referring to the overly optimistic forecasts for how many individuals
would gain coverage through the individual marketplaces. The initial CBO projections
“overestimated marketplace enrollment by 30 percent,” as the original estimate predicted
that 8 million individuals would obtain coverage through the exchanges in 2014, when in
reality only 6 million individuals maintained their marketplace coverage throughout the
year (Glied, Arora, & Solís-Román, 2015). Furthermore, the CBO overestimated the
decline in the overall number of uninsured individuals, as it predicted only 21 million
Americans would lack coverage in 2016, when the actual number is closer to 27 million
(Ehrenfreund, 2017).
However, viewing these predictions in isolation ignores two key contextual factors.
First, the CBO was more accurate than any other forecaster. An analysis by the
Commonwealth Fund found that the CBO estimates were more accurate than those from
the RAND Corporation, the Urban Institute, or the Department of Health and Human
Services’ Centers for Medicare and Medicaid Services (Glied, Arora, & Solís-Román,
2015; Matthews, 2017a). The CBO’s overall prediction for the decrease in the number of
uninsured was fairly accurate, particularly for the nonelderly, as it predicted that the
“nonelderly rate [of uninsured] would fall to 11 percent, and the latest figure put the
actual rate at 10.3 percent” (Jackson, 2017). Maya MacGuineas, the president of the
nonpartisan Committee for a Responsible Federal Budget, extolled the accuracy of the
CBO, noting that “the CBO has a long history of providing credible and impartial
estimates based on the center of a range of likely outcomes” (Lee, 2017). Michael Strain,
a conservative economist at the American Enterprise Institute, defended the CBO,
commending the agency for performing its job with “the utmost integrity” and called its
83
analyses “sound and reasonable” (Ehrenfreund, 2017). A study of accuracy and bias in
forecasting comparing estimates from presidential administrations, the CBO, and the
Federal Reserve Board found that “the most accurate forecasting is done by the CBO”
(Frendreis & Tatalovich, 2000). Thus, even if the CBO’s predictions were slightly off,
their estimates were generally accurate on overall numbers and performed better than
other forecasting models. Furthermore, the CBO’s rigorous approach to forecasting
makes it more likely that the inaccuracies in the original ACA estimates would not be
repeated, as the agency routinely “adjusts their projects to incorporate new data, research,
and experience” (Graves, 2017a). The GOP’s argument assumes a static CBO that failed
to update its models and forecasting methodology in the fact of new evidence, when in
reality the experience of scoring the ACA likely bolstered the ability of the agency to
make more accurate estimates (Graves, 2017a).
Second, experts emphasize that the CBO’s predictions for the ACA were reasonable
at the time, particularly since the agency could not have foreseen a variety of external
forces (namely Republican attempts at sabotage) that impacted the implementation of the
Obama health law. Matthew Fiedler, a fellow at the Brookings Institution’s Center for
Health Policy, said that “with respect to precise quantitative point estimates, the
differences between CBO's estimates and actual experience are well within the range that
I would expect given the scope of the change CBO was being asked to analyze” (Graves,
2017a). The CBO could not have predicted the Supreme Court case challenging the
constitutionality of the ACA, the outcome of which upheld the ACA’s legality but made
the Medicaid expansion optional for states, rather than compulsory.
37
This resulted in

37
The decision in the case, National Federation of Independent Business v. Sebelius, held that while the
84
nineteen states (typically those with conservative-dominated legislatures and/or
Republican governorships) opting not to accept the expansion, which “result[ed] in fewer
people receiving coverage than initially envisioned” (Ehrenfreund, 2017). Additionally,
28 states refused to set up a state-based insurance marketplace instead defaulting to the
federal exchange - a decision that is at least partially attributable to conservative
opposition to the Obama law (Jones & Greer, 2013). The original vision of the ACA
assumed the majority of states would set up their own localized marketplaces, and the
law actively incentivized states to set up their own exchange by including “an open
appropriation for exchange planning and establishment grants to states” (“Health
Insurance Exchanges,” 2013). While the unexpectedly large federal marketplace resulted
in high-profile issues like the disastrous launch of HealthCare.Gov, studies of
marketplace performance have found that “insurance markets remain healthier in the 17
states that run their own insurance marketplaces than in those that rely on the federal
marketplace” (Hall & McCue, 2018). Furthermore, the Trump Administration has
engaged in a series of actions that have undermined the foundations of the ACA’s
individual insurance market, such as reducing the open enrollment period, cutting
advertising and outreach, revoking cost-sharing subsidies, and expanding “short-term”
health plans with reduced coverage requirements, all of which negatively impact the
health of the exchanges and increase the number of uninsured Americans (Soffen, 2017;
Levitz, 2018). In short, while the CBO projections weren’t perfect crystal ball
predictions, one must evaluate the entire context - including the sustained attempt to

individual mandate was legal, the Medicaid expansion represented an attempt to coerce states to accept the
expansion because it held federal Medicaid dollars hostage (Kopel, 2012).
85
undermine the law over the last eight years - when evaluating the efficacy of the agency’s
predictions.
Partisan critiques of unfavorable CBO estimates and even attacks on the agency as a
whole are not new, nor are they solely a Republican phenomenon. Reagan called CBO
deficit estimates “phony,” former House Budget Chair Jim Nussle said, “The CBO sucks,
and you can quote me on that” in response to a farm bill score, and Democrats
aggressively lobbied the CBO to “make scoring decisions that they hoped could help
Clinton’s health bill” in the 1990s (Prokop, 2018). While politically motivated criticisms
of the CBO represent a common facet in U.S. policymaking, the unprecedented nature of
the concerted assault waged by the Trump Administration (and to a lesser degree
congressional Republicans) on the credibility of the CBO as a whole and the way in
which the GOP used attacks on the CBO to undercut criticisms of a bill that would
deprive millions of their health care deserves unique criticism. This point will be further
expanded upon later in this chapter in a broader discussion of the role of cable news hosts
in adjudicating panel debates and the need for cable news to reevaluate how it approaches
coverage of health care policy under the Trump Administration. The next section
examines some of the key examples of how cable news hosts mishandled discussions of
the CBO and claims of an ACA death spiral, first investigating the problematic trends in
host behavior on CNN and MSNBC that inadvertently reinforced conservative talking
points on health care and then interrogating how Fox News hosts used those tactics in
addition to explicitly promoting conservative misinformation about the CBO and ACA.
Problematic Trends in How Hosts Covered Health Care
86
This section first presents an in-depth analysis of the themes that arose during
discussions of the CBO and the ACA during discussion-based segments on CNN and
MSNBC before describing the nature of health care coverage on Fox News. These
segments were identified in the coding process through the use of several substantive
codes. All segments were first coded for the presence or absence of the mention of the
CBO and then for the presence or absence of any mention of a criticism of the CBO. As
discussed in the previous chapter, segments were also coded for mentions of general
negative news about the state of the ACA and then for specific mentions of the death
spiral argument. Within the identified segments, several themes in how cable news hosts
dealt with these topics emerged, leading to the thematic analysis presented within this
section. While not every segment included the flawed techniques criticized in this
chapter, the segments highlighted in the ensuing analysis present representative
exemplars of these trends and this chapter argues that even limited manifestation of these
practices represents a trend worth criticizing, given the broader political environment.
The chapter focuses on the discussion of the problematic patterns that arose in how
CNN and MSNBC hosts moderated discussions about the GOP health care proposal and
argues that problematic manifestations of journalistic norms emphasizing objectivity and
political balance resulted in these non-partisan and liberal news show hosts inadvertently
repeating and reinforcing conservative narratives. The emergence of similar themes on
CNN and MSNBC speaks to the prevalence of conservative talking points in discussions
about health care and reaffirms the necessity of cable news hosts in rethinking how they
approach moderating these types of discussions given the broader attempt by the Trump
Administration to destabilize what people believe is and is not true about the American
87
health care system. The discussion of Fox News will illustrate how the conservative
network went beyond the patterns exhibited on CNN and MSNBC that inadvertently
repeat and emphasize Republican talking points to instead actively propagate
conservative narratives in effort to support the Republican effort to repeal and replace the
ACA. This chapter purposefully isolates the discussion of Fox News, as it will argue that
the conservative network functioned more as a propaganda mouthpiece for the Trump
Administration than as a news outlet following any conventional journalistic norms while
covering the health care reform effort.
CNN and MSNBC: Devil’s Advocate Gone Wrong
One of the trends that arose during the thematic analysis of discussion-based
segments revolved around hosts posing questions to segment participants that were based
on misinformed right-wing talking points. Health care represents a complex and largely
misunderstood area of public policy, but the examples isolated in this chapter go beyond
a simple mistake or accidentally poor phrasing, as examples can be found on each
network and reflect similar patterns. This section will highlight a few segments that
provide representative examples of the problematic framing of questions, focusing on the
discussions of the Congressional Budget Office and debates over whether or not the
Affordable Care Act was on the verge of collapse. These two subjects were chosen as
they represent two of the main conservative narratives in the Republican effort to repeal
and replace the ACA, both of which were based on misinformation and cherry-picked
evidence.
When cable news hosts presided over conversations and debates about the CBO, they
would, at times, pose questions to panel participants predicated on the conservative
88
argument that the CBO is bad at predictions and has a history of errors. These questions
would go beyond what some might call a defensible use of ‘devil’s advocate’ style
questioning, and either explicitly repeat conservative critiques of the CBO or place the
onus on the panel participant to debunk the claims of CBO inaccuracy - an irresponsible
approach given the dearth of health policy experts hosted by cable news networks, a trend
that will be discussed in the next chapter. For example, during a panel discussion with
Gene Sperling and Rick Santorum, CNN’s Erin Burnett asked Sperling about the CBO’s
accuracy by commenting that then-Secretary Price “came out and said the CBO analysis
is just totally bogus in his view,” and then aired a sound bite of Price claiming the CBO
score is “just not believable” before Burnett said the following:
I mean, Gene, the CBO has been wrong before, right? It estimated the number of
uninsured would drop by 30 million under Obamacare, it since cut that to 22 million.
That's a 30 percent miss in an estimate. Could this analysis be totally wrong that
we're getting today?
38

Her question de-contextualizes the reasons why the CBO readjusted its prediction on the
ACA’s effect on the uninsured - i.e., the agency recognized the original prediction did not
assume a concerted campaign by Republicans to undermine implementation or other
exogenous factors like the NFIB v. Sebelius court decision. This approach to framing
CBO questions heightens the salience of the right-wing attacks on the non-partisan
agency by repeating the criticism in her own words and then showing a sound bite of the
original critique. Her framing gives credence to the conservative arguments about CBO

38
Burnett, E., Sperling, G., & Santorum, R. (2017, Mar. 13). Erin Burnett OutFront. CNN. Retrieved from
Lexis-Nexis.
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inaccuracy and shifts the burden of proof to the panel participant, Sperling, to debunk the
Republican claims and defend the budgetary agency. Perhaps one could argue that this
type of questioning is less problematic when posed to a credible (and liberal) expert like
Sperling who is likely to efficiently push back on the flawed assumptions in Burnett’s
question. While this type of questioning satisfies the conventional norm of political
balance - allowing Burnett to highlight the conservative dominant talking point setting up
her guest to presumably debunk it - it still reinforces the flawed perception that the CBO
is historically inaccurate. Furthermore, hosts did not exclusively use this type of question
to play ‘devil’s advocate’ to liberal guests, as MSNBC’s Greta Van Susteren said “we
have a CBO score, whether you like it or not, whether you think it’s fair or wrong” when
asking John McCain about whether or not the Senate should wait for a new CBO score of
the BCRA after several amendments were added to the bill. This framing opened the door
for the Republican senator to respond by criticizing the agency, claiming “the CBO
scoring of Obamacare at its inception was way off” and that “the CBO over time has lost
some of the credibility that it used to have,” a claim she allowed to stand uncorrected.
39

This example and others discussed in this chapter illustrate that questions that foreground
misinformed conservative talking points are not exclusively posed to liberal
commentators, let alone experts, making this question format particularly fraught.
Hosts also used this question format - one that assumes the right-wing talking point to
be true - in conversations about the health of the ACA. During a CNN panel discussion,
Burnett posed the following question to Jonathan Tasini:

39
McCain, J., & Van Susteren, G. (2017, Mar. 22). For the Record with Greta. MSNBC. Retrieved from
Lexis-Nexis.
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The reality of this, Obamacare was broken, Jonathan. Premiums were surging, 22
percent for the average plan. Aetna is getting out of Virginia this week, that would
leave one option for people in 27 counties. Iowa, you could end up with no options.
Right? Obamacare was not working. Would you acknowledge that?
40

Burnett’s insistence that “Obamacare was broken” mirrors the language used by Trump
and Republican congressional leaders to describe the state of the health law (Speaker
Ryan Press Office, 2017).
41
No one would deny that the ACA individual marketplaces
face significant issues, including high premiums and dwindling insurance options in some
markets. However, Burnett’s insistence that Obamacare is “broken” goes beyond
acknowledging problems inherent in the health law and instead echoes the long-standing
conservative claims that the ACA is collapsing and is beyond repair. Her question
foregrounds the Republican talking point while failing to acknowledge that many of the
issues facing the ACA resulted from concerted attempts by conservatives to undermine
the Obama health law. Similarly, MSNBC’s Greta Van Susteren conducted a series of
interviews with Democratic legislators where she questioned the guest about the health of
the ACA that forced the guest to negate the claim that Obamacare would collapse, as if it
were a question of opinion rather than fact. She asked Sen. Chris Coons (D-DE) “would
Obamacare, if left alone, would it collapse? Because that’s what the GOP says, that
Obamacare is such a mess. Left alone, collapse?”
42
Van Susteren questioned Rep. John
Yarmuth (KY-3) if “Obamacare would have been fine to just sort of go on the next few

40
Burnett, E., Moore, S., & Tasini, J. (2017, May 4). Erin Burnett OutFront. CNN. Retrieved from Lexis-
Nexis.
41
Blitzer, W., & Mattingly, P. (2017, Jul. 24). The Situation Room with Wolf Blitzer. CNN. Retrieved from
Lexis-Nexis.
42
Coons, C., & Van Susteren, G. (2017, Mar. 15). For the Record with Greta. MSNBC. Retrieved from
Lexis-Nexis.
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years [or] was it going to collapse?”
43
Van Susteren’s questions either explicitly or
implicit repeat the conservative claim that the ACA is collapsing, and while the
Democratic legislators she interviews all predictably refute that point, her question format
still reinforces the credibility of the conservative death spiral claims by treating it as an
argument that Democratic legislators must refute, rather than as baseless partisan spin.
Furthermore, all of these segments occurred after the release of the CBO score of the
AHCA that revealed that the ACA marketplaces would, in fact, not collapse
(Congressional Budget Office, 2017). Given this and the laundry list of actions the
Trump Administration has taken to fundamentally weaken the ACA (Soffen 2017), it
represents irresponsible journalism to mainstream conservative talking points -
particularly those based on false claims - while failing to contextualize the factors
underpinning problems in the ACA.
Other times hosts used references to CBO critiques as a framing device for questions
about other aspects of the health care debate not related to the CBO’s predictive power.
For example, in the introduction to a panel segment on June 26
th
, Anderson Cooper said
“The White House tonight put out a statement sharply critical of the CBO. It reads, in
part, the CBO has consistently proven it cannot accurately predict how health care
legislation will impact insurance coverage.” He then turned the conversation not to a
debate about the veracity of the White House’s claims but instead toward a discussion of
whether or not the substance of the report will influence Republican votes, asking CNN
analyst Gloria Borger if the “big headline” of “22 million more people being left

43
Van Susteren, G., & Yarmuth, J. (2017, Mar. 16). For the Record with Greta. MSNBC. Retrieved from
Lexis-Nexis.
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uninsured by 2026” is “too much for some Republicans to swallow?”
44
During that same
segment, Cooper referenced Senator Lindsey Graham’s (R- SC) comments about the
CBO estimate in a question, asking “Senator Lindsey Graham said, if you’re on the
fence, this score is not going to push you towards the bill. Others are saying the CBO is
not reliable. Is he right, though? I mean, does this score keep a ‘no’ or ‘on the fence’
from voting for this bill?” Cooper later said “the president said that the House bill was,
quote, mean, and that bill left, according to the CBO, 23 million more people uninsured,
just one million more than the Senate's version. Again, you can say the CBO is not
accurate. But if the president believed that version was mean, how is this not?” Three
times in one panel discussion Cooper used references to the criticisms of the CBO as a
framing mechanism for questions about reactions to the bill, granting legitimacy to the
original claims of inaccuracy and implicitly reinforcing the conservative narrative.
Similarly, MSNBC’s Greta Van Susteren said “I know that the CBO is sort of like
predicting snowstorms in D.C. and also the polls last summer who is going to win,”
followed by a question of how the GOP bill will impact the rate of uninsured individuals
using the emergency room to obtain care and the costs attendant with increased ER
usage.
45
Van Susteren’s snowstorm analogy echoed OMB Director Mick Mulvaney’s
criticism of the CBO, when in an interview on CNN he said “Good morning from
Washington, where, according to the CBO, it's sunny and 75 degrees this morning” even
though DC was experiencing a snowstorm at the time (Koss & Cahlink, 2017). Not only

44
Borger, G., Cooper, A., Haberman, M., Jennings, S., & Jones, V. (2017, Jun. 26). Anderson Cooper 360.
CNN. Retrieved from Lexis-Nexis.
45
Hewitt, H., Press, B., & Van Susteren, G. (2017, Mar. 14). For the Record with Greta. MSNBC.
Retrieved from Lexis-Nexis.
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did she use CBO criticisms to frame a question about the impact of the AHCA on
emergency room costs, but she mirrored the language used by one of the most vociferous
critics of the CBO in the Trump Administration.
By choosing to foreground discussions of the impact of the Republican proposal in
the context of criticisms of the CBO, this type of question either forces panel participants
to rebut the claims about the CBO, diverting from substantive discussion of the health
law or it goes unanswered, thus leaving the audience to either parse out the truth for
themselves or to uncritically accept criticisms of the CBO as fact. Given that these hosts
base these questions on evidence taken from the CBO estimates, framing these questions
in the context of allegations of CBO inaccuracy represents the worst kind of ‘he said-she
said’ political journalism that seeks to present ‘both sides’ of an issue. Framing a
question based on CBO conclusions in the context of allegations of CBO inaccuracy not
only implicitly undermines the strength of any argument based on the non-partisan
agency’s analysis, but also gives panelists who support the GOP bill a convenient
rhetorical scapegoat, allowing them to choose to attack the CBO’s accuracy as a
mechanism for deflecting criticism of the bill.
Anchors also used conservative death spiral claims to frame questions about the
substance of the GOP proposal or the likelihood of congressional passage. In framing a
panel discussion about the impending House vote on the AHCA, Anderson Cooper used a
sound bite clip of House Majority Leader Kevin McCarthy, who claimed:
We are going to pass it. We are going to pass it. Let's be optimistic about life. In fact,
today, did you all read the story of the health care pulling out of Iowa? Where you
94
have 94 counties out of 99 that do not have health care? That's why we have to make
sure this passes to save those people from Obamacare that continues to collapse,
where they don't even have health care.
46

He then asked “what about the White House’s push back, that, you know, you heard
Kevin McCarthy? I think Aetna now is pulling out of exchanges in Virginia as well.”
Cooper framed his broader question about the likelihood of House passage in the context
of the Republican claims that the ACA is collapsing, thus creating the urgent need for
reform. Don Lemon quoted a Trump tweet that claimed “Obamacare is dead” as the
introduction to a question about Republican senators who opposed the Senate bill and
were “seeking changes.”
47
This use of a death spiral reference is particularly problematic
because Lemon was addressing Jason Miller, a CNN contributor and functional Trump
surrogate, who readily seized on the opening, by initially addressing the question about
GOP opposition before claiming that “fundamentally as we saw yesterday with the news
of Anthem, BlueCross, BlueShield pulling out of Indiana, in Ohio, and Wisconsin,
Obamacare is absolutely imploding.” This exchange exemplifies the problems with using
references to conservative talking points in questions not related to probing the veracity
of those claims, as it gives ideologically inclined panelists the opportunity to shift the
conversation to attacking the ACA and reinforcing the idea that the impending collapse
of the health care system necessitates support for the GOP repeal effort. While these
references to GOP death spiral claims likely represent an attempt by hosts to maintain
neutrality by sometimes forwarding conservative arguments in their questions, it

46
McCarthy, K. (2017, May 3). Anderson Cooper 360. CNN. Retrieved from Lexis-Nexis.
47
Kander, J., Lemon, D., & Miller, J. (2017, Jun. 22). CNN Tonight. CNN. Retrieved from Lexis-Nexis.
95
functions to reinforce both the salience and validity of those viewpoints, particularly
when it provides an opening for conservative panelists to double down on the argument.
Beyond dubious question framing, hosts inadvertently reinforced anti-CBO talking
points by inconsistently fact-checking their guests. On MSNBC there were several
instances of program hosts failing to push back on inaccurate or distorted claims about
the CBO, particularly during interviews with members of Congress. Greta Van Susteren
let Sen. John McCain (R-AZ) claim “the CBO scoring of Obamacare at its inception was
way off” and argue that “the CBO over time has lost some of the credibility it used to
have” without any push back.
48
During an interview with MSNBC’s Chris Hayes, Rep.
Steve King claimed “we know that the CBO scoring was way off on Obamacare,” and
instead of providing context for why the CBO estimates were inaccurate, Hayes agreed
that the CBO scores of the ACA were not “good.”
49
During a debate over the Senate bill,
CNN contributor Rick Santorum claimed “if we pass laws that comported with the CBO,
our economy would look like the Soviet Union… So, I throw the CBO out” before going
on to discuss the mood at the GOP conference on the health care bill. Instead of pushing
back, or even asking Santorum to further explain his preposterous claim, Anderson
Cooper gave a preview of the agenda for the rest of the show before breaking for a
commercial.
50
During a panel discussion on Anderson Cooper 360, CNN’s Senior
Economics Analyst, Stephen Moore answered a question about the CBO’s first AHCA
estimate by declaring, “I don’t believe this report. I think it’s hocus-pocus” and argued

48
McCain, J., & Van Susteren, G. (2017, Mar. 22). For the Record with Greta. MSNBC. Retrieved from
Lexis-Nexis.
49
Hayes, C., & King, S. (2017, Mar. 9). All In with Chris Hayes. MSNBC. Retrieved from Lexis-Nexis.
50
Cooper, A., & Santorum, R (teal). (2017, Mar. 23). Anderson Cooper 360. CNN. Retrieved from Lexis-
Nexis.
96
that “the Republican plan on health care throughout the campaign and what they’re
saying today was two features. Repeal Obamacare. That’s what the CBO has scored.
What they haven’t scored is replace Obamacare.”
51
Cooper uses the panel format to
evade responsibility for engaging with Moore’s demonstrably false claims, instead
turning to Robert Reich, former Labor Secretary during the Clinton Administration, to
give his opinion.
Hosts also failed to consistently fact check guests when they falsely claimed that the
ACA was collapsing. MSNBC’s Chris Matthews neglected to fact-check Rep. Joe
Barton’s claim that “Obamacare has failed” and that “nobody thinks - even the
Democrats, at least off camera, admit that it has failed. So, we have to protect the people
that chose to participate in it,” allowing the panel discussion to end on that note. During
an interview on CNN’s Erin Burnett OutFront, Sen. Rand Paul argued that “there’s a
death spiral in the insurance market” and the House bill “doesn’t fix the crucial problem
that insurance rates are going through the roof, premiums are soaring.” Burnett’s follow
up question focused on how Paul would change the bill, allowing his death spiral
assertion to stand uncontested.
52
In a panel discussion on Anderson Cooper 360, Jason
Miller asserted that “Obamacare itself is heading off of a cliff,” to which Cooper replied
“The White House has been hammering that message.”
53
Similarly, Don Lemon allowed
Miller to claim that “Obamacare is absolutely imploding” in a broader discussion of the
substance of the Senate bill, prompting Lemon to follow up with a question about the

51
Cooper, A., Reich, R., & Moore, S. (2017, Mar. 13). Anderson Cooper 360. CNN. Retrieved from Lexis-
Nexis.
52
Burnett, E., & Paul, R. (2017, Mar. 21). Erin Burnett OutFront. CNN. Retrieved from Lexis-Nexis.
53
Cooper, A., & Miller, J. (2017, Mar. 14). Anderson Cooper 360. CNN. Retrieved from Lexis-Nexis.
97
tension between conservative and moderate Republican senators’ demands for altering
the legislation. During a panel segment, Cooper let Stephen Moore assert that “our health
insurance system in America today under Obamacare, it was happening before
Obamacare, is truly imploding. We have to change it. I mean, people are going to start
seeing massive additional increases in their health premiums if we don't do something to
fix this.”
54
Instead of correcting Moore’s false claims of a death spiral, Cooper chose to
respond to Moore’s comments about Trump’s “masterful” technique in persuading House
members to vote for the AHCA, commenting that “even if you don’t like [Trump’s]
policies, he can be an incredibly charming guy.” During the premiere of his new show
The Beat, MSNBC’s Ari Melber let Sebastian Gorka, Trump’s former deputy assistant,
claim “in the last eight years, we’ve seen Obamacare implode. It’s a disaster.” Instead of
pushing back on the Trump surrogate’s bogus claims, Melber pivoted the conversation to
the political horse-race, asking “what is the White House’s legislative strategy? Is it that
the President will sign anything, but not get involved in the details?”
55
While hosts
cannot and should not attempt to fact check every potentially dubious claim made by
guests during panel discussions and interviews, the falsehoods explored here represented
fundamental themes in the Republican effort to sell their disastrous health care reform
bill. The next section will examine these problematic trends in CNN and MSNBC’s
health care coverage in the context of the broader challenge to journalism posed by the
Trump Administration and how Trump’s assault on the truth as a governing philosophy
and explain how the manifestations of conservative talking points outlined in this chapter

54
Cooper, A., & Moore, S. (2017, Mar. 22). Anderson Cooper 360. CNN. Retrieved from Lexis-Nexis.
55
Melber, A., & Gorka, S. (2017, Jul. 24). The Beat with Ari Melber. MSNBC. Retrieved from Lexis-
Nexis.
98
may have inadvertently aided in the conservative attempt to deceive the public about the
GOP health care proposals.
Fox News: Propaganda, Not Professional Journalism
Fox News engaged in similar forms of questioning in discussions about the CBO or
the health of the ACA. The hosts that represent the allegedly objective news side of Fox
News, such as Bret Baier, Sandra Smith, and Shannon Bream, frequently used references
to White House criticisms of the CBO to frame questions or asked questions that
implicitly argued that the ACA was collapsing.
56
For example, in an interview with Sen.
Chuck Schumer (D-NY), Baier asked “do you disagree that [the ACA] would implode if
it is just left to go,” and countered Schumer’s claim that it would not collapse by
emphasizing that “the markets for Obamacare show demand has leveled off. Prices for
premiums and deductibles are skyrocketing.”
57
Instead of fact checking or correcting
false claims, hosts consistently allowed guests to assert that CBO estimates are “very
notoriously bad,”
58
or claim that “Obamacare is failing everywhere”
59
because “insurers
are in a death spiral [and] the Obamacare exchanges are collapsing”
60
with little to no

56
Death Spiral Segments:
Baier, B., & Schumer, C. (2017, Mar. 15). Special Report with Bret Baier. Fox News Channel. Retrieved
from Lexis-Nexis.
Hemmer, B., Goldberg, J., Hemingway, M., & Stoddard, A. (2017, Jun. 26). Special Report with Bret
Baier. Fox News Channel. Retrieved from Lexis-Nexis.
CBO Segments:
Bream, S., Holtz-Eakin, D., & Slavitt, A. (2017, Jun. 26). The Story with Martha MacCallum. Fox News
Channel. Retrieved from Lexis-Nexis.
Smith, S., Duffy, S., & Tarlov, J. (2017, Mar. 9). The First 100 Days. Fox News Channel. Retrieved from
Lexis-Nexis.
57
Baier, B., & Schumer, C. (2017, Mar. 15). Special Report with Bret Baier. Fox News Channel. Retrieved
from Lexis-Nexis.
58
Baier, B., Hemingway, M., Gold, H., & York, B. (2017, Mar. 13). Special Report with Bret Baier. Fox
News Channel. Retrieved from Lexis-Nexis.
59
Baier, B., & Priebus, R. (2017, Apr. 26). Special Report with Bret Baier. Fox News Channel. Retrieved
from Lexis-Nexis.
60
Wallace, C., Krauthammer, C., Schlapp, M., & Lane, C. (2017, May 4). Special Report with Bret Baier.
Fox News Channel. Retrieved from Lexis-Nexis.
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pushback.
61
While these examples are perhaps more extreme cases of similar trends of
uncorrected false claims and flawed question formats that occurred on CNN and
MSNBC, Fox News coverage was unique in that it also actively participated in the
propagation of false narratives, as hosts independently pushed conservative talking points
about the CBO and the ACA.
Fox News hosts explicitly critiqued the accuracy of the CBO, expressing their own
doubts about the validity of the non-partisan organization’s estimates, as opposed to hosts
on MSNBC and CNN who repeated criticisms leveled by other individuals. In an
interview about the American Health Care Act, Bill O’Reilly argued with Austan
Goolsbee about the validity of the CBO estimates, claiming the agency “wildly missed
the Obamacare predictions” and criticized the score for not taking into account Trump’s
proposal to eliminate the barriers to selling insurance across state lines (a provision that
was not included in the House bill).
62
In an interview with Speaker Ryan, Sean Hannity
questioned “why so much emphasis put on the CBO” since “they said Obamacare would
have 24 million enrolled people. They have 11,” declaring it an “effort in futility to keep
going back to [the CBO] when they are so wrong so often.”
63
Greg Gutfeld, one of the
hosts of “The Five,” argued that the CBO estimate that predicted that 22 million

61
See also:
Barrasso, J., & Hemmer, B. (2017, Jun. 27). Special Report with Bret Baier. Fox News Channel. Retrieved
from Lexis-Nexis.
MacCallum, M., & Scott, R. (2017, Jun. 27). The Story with Martha MacCallum. Fox News Channel.
Retrieved from Lexis-Nexis.
Hemmer, B., & Thune, J. (2018, Jun. 29). Special Report with Bret Baier. Fox News Channel. Retrieved
from Lexis-Nexis.
Benson, G., Hemingway, M., Hemmer, B., Krauthammer, C., & Lane, C. (207, Jun. 28). Special Report
with Bret Baier. Fox News Channel. Retrieved from Lexis-Nexis.
62
Goolsbee, A., & O’Reilly, B. (2017, Mar. 13). The O’Reilly Factor. Fox News Channel. Retrieved from
Lexis-Nexis.
63
Hannity, S., & Ryan, P. (2017, Mar. 20). Hannity. Fox News Channel. Retrieved from Lexis-Nexis.
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individuals would lose their insurance under the Senate bill was “totally exaggerated,”
claiming “we know the CBO exaggerates. It’ll probably be closer to 5 than 22” million
uninsured.
64

Hosts similarly endorsed the Republican death spiral refrain, aggressively insisting in
their own voice that the ACA was collapsing under its own weight. While guest hosting
an episode of The O’Reilly Factor on March 24
th
, Eric Bolling argued with Democratic
strategist Jessica Tarlov about the health of the ACA, insisting that it is “a failing health
care plan.” He claimed that the House failure to pass the AHCA is “a win for Donald
Trump” because when “Obamacare starts to falter” Trump can step in and say “we’re
going to take care of the people who would be left on the sidelines because of this terrible
bill that is failing” and quickly pass “the replacement bill we should have had all
along.”
65
Similarly in an interview with Rep. Brad Sherman (CA-30), Bolling claimed
that “Obamacare literacy is collapsing from within itself.”
66
Tucker Carlson agreed with
Rep. Buddy Carter’s (GA-1) assertion that “Obamacare is imploding,” claiming “I think
most people agree with you, and that’s why Republicans control” Congress and the White
House because Republicans have “told their voters, this is a disaster, this Obamacare…
we’re going to give you something better.”
67
Even Bret Baier, the ostensibly non-partisan
objective journalist in Fox News’ primetime line up, aided in amplifying death spiral
claims, responding to Steve Hayes’ criticism of Republicans for failing to “tell the story

64
Guilfoyle, K., Gutfeld, F., Perino, D., Watters, J., & Williams, J. (2017, Jun. 26). The Five. Fox News
Channel. Retrieved from Lexis-Nexis.
65
Bolling, E., Cohen, A., & Tarlov, J. (2017, Mar. 24). The O’Reilly Factor. Fox News Channel. Retrieved
from Lexis-Nexis.
66
Bolling, E., & Sherman, B. (2017, Mar. 10). The O’Reilly Factor. Fox News Channel. Retrieved from
Lexis-Nexis.
67
Carlson, T., & Carter, B. (2017, Mar. 7). Tucker Carlson Tonight. Fox News Channel. Retrieved from
Lexis-Nexis.
101
of Obamacare” beyond arguing “Obamacare is collapsing,” prompting Baier to insist that
“part of the story is that these insurance companies are leaving this year,” turning the
conversation to Matt Schlapp who reinforced his claim, saying “yes, that’s right. It is
imploding, that’s just a fact.”
68

Fox News hosts promoted the false talking points advanced by the Trump
Administration and congressional Republicans about Medicaid, which emerged as a key
flashpoint in the GOP reform effort as moderate conservatives and the public backlashed
to the debilitating cuts to the social safety net program included in the GOP bill. When
Austan Goolsbee claimed that Trump was betraying his campaign pledge to “never cut
Medicare or Medicaid” by endorsing the House bill’s “$800 billion cut to Medicaid,”
O’Reilly pushed back by insisting “it’s a cap, not a cut” in the program’s budget,
69

similar to the administration’s false claims that the House bill did not cut Medicaid
(Greenberg, 2017; Politi, 2017; Kliff, 2017e). During a panel discussion on “The Five,”
Jesse Watters claimed congressional Republicans were “actually saving and
strengthening Medicaid” with their health care proposals,
70
mirroring the false claims
from the Trump Administration that Medicaid would have “more resources” to help “the
disabled and aged” (Benen, 2017; LeTourneau, 2017). Other segments criticized the
Medicaid program as a defensive argument to undercut critiques of the massive cuts,
arguing that the program provides “second-rate insurance”
71
that results in worse health

68
Baier, B., Hayes, S., Liaison, M., & Schlapp, M. (2017, Mar. 7). Special Report with Bret Baier. Fox
News Channel. Retrieved from Lexis-Nexis.
69
Goolsbee, A., & O’Reilly, B. (2017, Mar. 13). The O’Reilly Factor. Fox News Channel. Retrieved from
Lexis-Nexis.
70
Guilfoyle, K., Gutfeld, G., Perino, D., Watters, J., & Williams, J. (2017, Jun. 22). The Five. Fox News
Channel. Retrieved from Lexis-Nexis.
71
DeMint, J., & O’Reilly, B. (2017, Mar. 16). The O’Reilly Factor. Fox News Channel. Retrieved from
Lexis-Nexis.
102
outcomes than if an individual had no insurance at all,
72
or framed it as an example of
wasteful government welfare, rife with fraud as “able-bodied” individuals took resources
from the vulnerable populations Medicaid was intended to help.
73
These examples
illustrate how the conservative cable network attempted to amplify political spin at the
expense of the truth, promoting the “alternative facts” put forth by the Trump
Administration and congressional Republicans to try to sell their disastrous bill.
The disregard for the truth displayed by Fox News hosts and the consistency between
their arguments and the dominant Republican talking points marks a significant deviation
from how CNN and MSNBC hosts discussed health care. Their actions go beyond deeply
flawed forms of ‘devil’s advocate’ style questioning and serve to actively propagate the
major Republican narratives, explicitly endorsing conservative misinformation. Whereas
Anderson Cooper inadvertently may reinforce concerns of an ACA death spiral by
repeating conservative arguments predicting Obamacare’s collapse, Fox News hosts like
O’Reilly, Gutfeld, and Carlson explicitly make those arguments themselves, actively
promoting the White House talking points. These results reinforce findings in previous
studies of Fox News’ coverage of health care that found that “prime-time programs often
did not abide by the traditional journalist value of accuracy and an allegiance to the facts”
because the major themes in their coverage emphasized conservative talking points based
on misinformation and distorted narratives, in addition to focusing almost exclusively on
conservative arguments against the Obama health law (Bard, 2017, p. 112). Bard (2017)

72
Baier, B., Hemingway, M., & York, B. (2017, Mar. 13). Special Report with Bret Baier. Fox News
Channel. Retrieved from Lexis-Nexis.
Guilfoyle, K., Gutfeld, G., Perino, D., Watters, J., & Williams, J. (2017, Jul. 11). The Five. Fox News
Channel. Retrieved from Lexis-Nexis.
73
Carlson, T., & Carter, B. (2017, Mar. 7). Tucker Carlson Tonight. Fox News Channel. Retrieved from
Lexis-Nexis.
103
argued that the distortions in Fox News coverage of the ACA in 2009 and 2014 more
closely resembled “the traditional elements of propaganda” (p. 113), which he defined as
“a method by which the user elicits an intended action on the part of recipients through
the manipulation of the recipient’s individual and societal beliefs by using a combination
of facts and lies, along with an attempt to shield the recipient from opposing facts and
points of view” (p. 104). The patterns in how Fox News covered the 2017 health care
debates repeat these propagandistic methods. The anti-CBO arguments forwarded
explicitly by Fox News hosts actively negating the validity of the CBO critiques of the
GOP bills, functioning to shield the audience from that negative information by depicting
it as biased and inaccurate. The consistent promotion of the false death spiral narrative
created a false sense of urgency for the conservative audience, encouraging them to
continue support the GOP effort to repeal the ACA. The partisan breakdown of the hosts
and guests that appeared in Fox News’ health care coverage showed that only 55 total
individuals were identified as Democrats in comparison to 414 individuals identified as
Republicans, reflecting the general bias built into the Fox News structure that minimizes
Democratic representation on the network. While CNN and MSNBC’s problematic
question format that inadvertently foregrounded or repeated conservative talking points
and failure to consistently fact check inaccurate claims can be traced to flawed attempts
to adhere to journalistic norms of political balance and objectivity, the patterns on Fox
News reflect the characteristics of propaganda, as the network hosts explicitly parroted
false talking points and distorted narratives promoted by the Trump Administration and
congressional Republicans.
104
The next section will examine the trends in cable news health care coverage in the
context of the broader challenge to journalism posed by the Trump Administration,
especially Trump’s assault on the truth, and emphasizes the need for responsible cable
news outlets to reconsider how they approach covering public policy debates in the
modern era. As a result, the concluding sections necessarily exclude any further
discussion of Fox News, because while MSNBC and CNN may act as unwitting
accomplices in the Republican effort to gaslight America about their health care bill, Fox
News often functioned as a mouthpiece for the propagation of the fundamental arguments
underpinning the alternative vision of the Republican health care effort as articulated by
the Trump Administration and congressional Republicans. As the network’s health care
coverage discussed thus far illustrates, the overriding ideological imperatives of Fox
News preclude any chance for improving the substantive quality of their reporting (sans a
complete ownership turnover and the removal of many program anchors).
Cable News as Inadvertent Player in Trump Gaslighting
The discussion of how cable news hosts inadvertently reinforced conservative
misinformation or failed to consistently fact-check false claims illustrates the need to
reform the role of the host during discussion-based segments in order to bolster the
informational quality of cable news coverage of health care policy. The improvement of
the substantive content of cable news represents an important goal in and of itself, but it
is particularly imperative in light of the attempts by the Trump Administration and
congressional Republicans to fundamentally deceive the public about the actual impact of
their policy reform proposals. The rampant lying by the chief executive and the degree to
which congressional Republicans adopted those false talking points espoused by the
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Trump Administration presents a grave threat to the American public, given the
disastrous impact the GOP health care bills would have had on the American health care
system. This chapter argues that responsible cable news programs and their hosts must
reevaluate their approach to covering health care policy and the Trump Administration as
a whole, as the problematic manifestation of journalistic norms that resulted in the flawed
trends outlined in the previous section may function to inadvertently promote Trump’s
‘alternative facts’ about his health care proposals.
Glenn Kessler, the Washington Post’s fact checker, remarked during the 2016
presidential campaign that while “professional politicians mostly want to get it right,”
Trump is unique in that, “he seems to have no interest in getting important things
factually correct” (Farhi, 2016a). James Fallow (2016) wrote about the difficulties for
political journalists in covering Trump’s predilection for constantly making and repeating
false claims, remarking that “Trump either cannot tell the difference between truth and
lies, or he knows the difference but does not care.” However, the problem is not just that
Trump and his administration as a whole continue to promote inaccurate claims and
outright lies, but specifically the way in which the Trump Administration has weaponized
misinformation in an attempt to substitute reality for their own “alternative facts.” Jay
Rosen (2016a) noted that in his presidential campaign, Trump went beyond the normal
distortions of fact that all politicians engage in and “tried to substitute his world for the
one we actually live in.” Lauren Duca (2016) wrote about this phenomenon in her Teen
Vogue article, “Donald Trump is gaslighting America” where she argued that “to gas
light is to psychologically manipulate a person to the point where they question their own
sanity, and that’s precisely what Trump is doing to this country.” She noted that “at the
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hands of Trump, facts have become interchangeable with opinions, blinding us into
arguing amongst ourselves, as our very reality is called into question.” She further argued
that “as a candidate, Trump's gas lighting was manipulative, as President-elect it is a
deliberate attempt to destabilize journalism as a check on the power of government”
(Duca, 2016). While Rosen and Duca were referring to Trump’s unswerving attacks on
the ‘fake news’ media, the concept of gaslighting, in particular the transformation of fact
into opinion and relentless attacks on any person or institution (such as the Fourth Estate)
that attempts to push back, helps explain the Trump Administration (and to a lesser
degree congressional Republicans) approach to promoting and defending their health care
bill.
The passage of the Republican’s health care proposal would have tangibly worsened
the American health care system and resulted in millions of Americans losing their health
care coverage. The legislation changed the financial subsidies that low-income
individuals currently receive under the ACA, making them substantially less generous,
while simultaneously allowing insurance companies to charge the elderly substantially
more and creating opportunities for insurance companies to hike up the rates for people
with pre-existing conditions (Morris, 2017; Gould, 2017). Furthermore, both the House
and the Senate versions included severe cuts to Medicaid, elimination of the ACA’s
expansion and changes to Medicaid’s funding structure which would have shifted
substantial costs to the states, resulting in millions being dropped from the Medicaid rolls
and restricted benefits for those who remained (Broaddus & Park, 2017; Schubel, 2017;
Matthews, 2017b). Numerous major advocacy groups representing the health care system
and patients, including but not limited to the American Academy of Family Physicians,
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American Academy of Pediatrics, American College of Physicians, American Congress
of Obstetricians and Gynecologists, and the American Psychiatric Association American
categorically opposed the Republican bills (Marcus, 2017). Premiums and deductibles
would have risen dramatically in the short-term, decreasing over time only as the sick and
elderly were priced out of the insurance markets, leaving only healthy individuals in the
pool (Kliff & Nelson, 2017).
However, if you listened to Trump, his administration officials, or congressional
Republicans describe the bill, a very different picture emerged. In an interview with
CNN’s Jake Tapper, then-Secretary Price claimed that “there are no cuts to the Medicaid
program” in the AHCA; and he insisted that the changes to the funding structure would
occur “in a way that allows states greater flexibility” (Politi, 2017). Trump took to
Twitter to refute claims that the GOP bill cut Medicaid by tweeting a picture of projected
Medicaid spending over time and claiming, “Democrats purposely misstated Medicaid
under [the] new Senate bill - actually goes up” (Bump, 2017b). In talking to NBC’s
Chuck Todd, Price insisted that “nobody will be worse off financially in the process that
we’re going through,” claiming that people will “have choices that they can select the
kind of coverage they want for themselves” (Koenig, 2017).
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In an interview with CBS’s
John Dickerson, Trump addressed criticisms that the GOP bills would harm individuals
with pre-existing conditions, claiming, “pre-existing conditions are in the bill. And I just
watched another network than yours, and they were saying, "Pre-existing is not covered."

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Price continued to defend this comment in subsequent interviews, including during a CNN Town Hall
event where he responded to an individual’s question about the impact of changing the age band to allow
companies to charge the elderly up to five times higher premiums by saying “I don’t believe you’ll be
worse off financially from a health care standpoint” under the AHCA (Price Town Hall, 2017).
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Pre-existing conditions are in the bill. And I mandate it. I said, "Has to be." Similarly,
Speaker Ryan insisted that “people will be better off with pre-existing conditions under
our plan” because the House bill had “multiple layers of protections for people with pre-
existing conditions” (Shuham, 2017). A quick scan of Trump’s Twitter feed during the
debates over the Republican bill reveals numerous tweets insisting the Republican
proposal will result in lower health care costs, including one tweet which claimed that the
GOP bill will “have much lower premiums & deductibles while at the same time taking
care of pre-existing conditions!” (Bump, 2017b).
The proliferation of false claims about the impact of the GOP proposals transcends
the normal bounds of lying or distortions of the truth intrinsic to the political sphere,
particularly when viewed in conjunction with the attempts to undermine the credibility of
the CBO and the campaign to depict the existing health care system as collapsing. The
Republican messaging during their health care reform effort functioned as an attempt to
gaslight the American people about what their bill actually did by repeating demonstrably
false claims about the substance and potential impact of the GOP health bills while
simultaneously waging a war to undercut the credibility of the CBO and its estimates.
The CBO was created as a mechanism to empower Congress in the policy making
process by providing it with non-partisan facts and analysis, so the legislative branch was
no longer beholden to the White House controlled OMB. The CBO’s long-history of
accurate estimates and rigorous analysis transformed the CBO into a “political power
center in its own right,” particularly given the emphasis the media has historically placed
on the role of CBO scores in affecting the fate of legislation (Prokop, 2017). The White
House attacks on the CBO’s accuracy and credibility began before the release of the first
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AHCA estimate, indicating that the Trump administration understood the historical
importance of those estimates in derailing legislative action. Attacking the CBO
functioned as a mechanism for defending a bad bill, because “if the numbers were wrong,
then the entire critique - that the bill would strips millions of their health insurance and
make those who still had coverage pay more in premiums and deductibles - was invalid”
(Matthews, 2017a). While politically motivated criticisms of CBO scores are not new,
there exists a qualitative difference between previous critiques, which argued that
particular estimates were flawed for a variety of reasons, and the Trump messaging,
which attacked the CBO’s “whole role in the legislative process” as seen when Mulvaney
questioned whether the agency’s day had “come and gone” (Matthews, 2017a).
Furthermore, the construction of the image of the American health care system as
collapsing helps Republicans to paper over criticisms of their proposals, because even if
their bill is not perfect, the impending death spiral would be worse for the American
people. A frequent refrain in conservative messaging on health care revolved around
pivoting to a discussion of the problems of the Affordable Care Act, citing the troubles in
the individual insurance markets as the motivating factor for urgent action.
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Republicans
justified voting on legislation that was subject to little-to-no congressional debate or

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Segments featuring Republican sound bites citing ACA “troubles” as warrant for quick action:
Serfaty, S., & Burnett, E. (2017, Mar. 13). Erin Burnett OutFront. CNN. Retrieved from Lexis-Nexis.
Acosta, J., & Blitzer, W. (2017, Mar. 14). The Situation Room with Wolf Blitzer. CNN. Retrieved from
Lexis-Nexis.
Acosta, J., & Cooper, A. (2017, Mar. 14). Anderson Cooper 360. CNN. Retrieved from Lexis-Nexis.
Acosta, J., & Blitzer, W. (2017, May 3). The Situation Room with Wolf Blitzer. CNN. Retrieved from
Lexis-Nexis.
Carroll, J., & Cooper, A. (2017, May 3). Anderson Cooper 360. CNN. Retrieved from Lexis-Nexis.
Mattingly, P., & Cooper, A. (2017, May 3). Anderson Cooper 360. CNN. Retrieved from Lexis-Nexis.
Mattingly, P., & Cooper, A. (2017, May 3). Anderson Cooper 360. CNN. Retrieved from Lexis-Nexis.
Acosta, J., & Cooper, A. (2017, May 5). Anderson Cooper 360. CNN. Retrieved from Lexis-Nexis.

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public vetting by arguing that quick action was necessary to save the American people
from the devastating of Obamacare. Claims of the ACA’s impending collapse also
reinforced questions about the CBO’s credibility, as Republicans argued that the CBO
gravely overestimated how many people would be covered and at what cost. These three
elements in conservative messaging on health care combine to create a reality where the
only logical conclusion is passage of the Republican health care bill. These arguments are
fundamentally untrue and attempt to dupe the public into supporting a reform bill that
would take health care away from millions of Americans.
At best, cable news hosts failed to consistently expose the inaccuracies and, at times,
outright duplicity in the Republican health care messaging campaign. At worst, cable
news hosts inadvertently facilitated the conservative attempts to deceive the American
public by adopting the language and messaging narratives in questions about the CBO
and the health of the ACA. While CNN and MSNBC used flawed tactics to question
guests about the CBO and the ACA that implicitly reinforced conservative
misinformation about those two subjects, numerous Fox News’ hosts explicitly promoted
those arguments on their shows, in addition to utilizing the problematic but more passive
question formats. This chapter illustrates how cable news hosts used conservative talking
points about the CBO and allegations of an ACA death spiral as the basis for questions or
introductions to other substantive questions about the GOP health bills. The repetition of
these conservative narratives, particularly by program anchors whose role as anchor gives
them inherent credibility and authority, may have helped to mainstream these narratives
and increase their salience in the public’s perceptions of the GOP health bills. This is
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particularly true in the context of a complex public policy such as health care, where
existing knowledge gaps leave the public open to misinformation.
Even if cable news programs have limited impact in public comprehension of health
care policy, these examples illustrate how cable news needs to reevaluate how it covers
the Trump Administration. In a world where the president, congressional legislators, and
one entire cable news channel are consistently promoting dubious facts and distorted
narratives, the inconsistent fact checking of false claims made by guests about health care
can reinforce those narratives of misinformation, because “when a guest makes a
statement and the host agrees or allows the statement to pass unchallenged, the host is
essentially endorsing the message being sent to the audience” (Bard, 2017, p. 107). While
hosts cannot push back on every single dubious claim in all instances, this chapter
illustrates how program anchors failed to actively fact check claims on the dominant
narratives surrounding the GOP health care effort. Hosts can and should be strategic in
how they push back on guests but getting the facts right on the major controversies –
particularly when those talking points are used to undercut justified criticisms of
legislation or policy proposals – represents a necessary standard for cable news shows to
meet. Furthermore, while some anchors may justify the language used in the examples in
this chapter by claiming they were acting as a ‘devil’s advocate,’ cable news hosts should
recognize the folly in presenting the ‘other side’ of an issue when it requires promoting
distorted facts or outright lies. While Fox News will likely continue to propagate
narratives of misinformation in an effort to bolster the Trump Administration, program
hosts on CNN and MSNBC must reconsider how they approach covering health care
policy. The concluding chapter will discuss how cable news networks can improve
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moving forward and make the case for empowering news anchors to adopt a more active
and informed role in discussion-based segments.
Conclusion
This chapter examined the role of cable news hosts in adjudicating conversations
about health care in discussion-based segments in the context of the Trump
Administration’s attempts to mislead the American public about the impact of the GOP
health care proposals. The active attempts by Fox News hosts to promote conservative
talking points about the CBO and the health of the ACA that were based on demonstrable
false claims or serious distortions of fact reinforces the previous research that argued that
the conservative network more closely resembles propaganda than a serious journalistic
outlet (Bard, 2017). While hosts like Bret Baier used the flawed techniques to
questioning guests that occurred on CNN and MSNBC, other hosts like Greg Gutfeld and
Bill O’Reilly explicitly argued that the ACA was collapsing and impugned the credibility
of the CBO. The combined effect of these tactics in conjunction with the structural
approach of Fox News in minimizing any representation of opposing viewpoints
functions to amplify the attempts by the Trump Administration to redefine the GOP
health reform bill, fundamentally deceiving the conservative audience (some of whom
would have been the most impacted by the GOP legislation) (Cohn, 2017).
In contrast to the partisan propagandizing of Fox News, the emergence of these trends
on CNN and MSNBC stemmed from the professional norms engrained in political
journalism that discussion-based segments tend to exacerbate in the cable news
atmosphere. The majority of the examples discussed occurred on CNN, which makes
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sense given the network’s alleged commitment to neutrality which can result in shoddy
‘both sides’ coverage of policy issues, as will be discussed. However, the inclusion of
several MSNBC examples is notable, given the network’s liberal reputation. Part of this
might be attributable to the network’s right-ward lurch away from its “Lean Forward”
motto, as show through the hiring of Greta Van Susteren (however briefly) and Nicole
Wallace as hosts, George Will as a commentator, the cancellation of programs hosted by
Joy-Ann Reid and Melissa Harris-Perry, and the rumors surrounding Lawrence
O’Donnell’s near cancellation (Oremus, 2017; Sheffield, 2017). Either way, the
emergence of similar themes on CNN and MSNBC speaks to the prevalence of
conservative talking points in discussions about health care and reaffirms the necessity of
cable news hosts in rethinking how they approach moderating these types of discussions
given the broader attempt by the Trump Administration to destabilize what people
believe is and is not true about the American health care system.
This chapter examined how cable news hosts dealt with these topics in discussion-
based segments, isolated flaws in how anchors approached these subjects and argued that
cable news shows must reimagine how hosts adjudicate these types of segments in light
of the Trump Administration’s apparent war on truth. Hosts used flawed question formats
that inadvertently reinforced misinformation and conservative distortions of fact, which
on CNN and MSNBC likely a result of the manifestation of the norms promoting political
balance and neutrality that undergirds political journalism, particularly in discussion-
based formats. Given the broader attempt by the Trump Administration to fundamentally
confuse the American public and lie to them about health care, it is incumbent upon cable
news networks to rethink the way they cover public policy debates during this
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administration. Traditional uses of question formats like the ‘devil’s advocate’ represent
fundamentally flawed methods for covering a presidency that explicitly promotes
misinformation in advocating for public policies that would impact millions of
Americans. The concluding chapter will provide a series of recommendations aimed at
bolstering the informational quality of discussion-based segments by empowering news
hosts to adopt a more active role in these segments and equipping them with the
information necessary to successfully moderate health care debates in a fact-based
manner.
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CHAPTER 5:
MORE PUNDITS, MORE PROBLEMS: THE LACK OF EXPERTS IN CABLE
NEWS HEALTH CARE COVERAGE

One of the most common criticisms of cable news revolves around the allegation
that these networks rely on political pundits instead of qualified experts to provide
commentary on public policy issues, such as health care, to the detriment of the audience.
In an interview with Bill Moyers (2007), Walter Isaacson, the former CEO and Chairman
of CNN, remarked that “one of the great pressures we're facing in journalism now is it's a
lot cheaper to hire thumb suckers and pundits and have talk shows on the air than actually
have bureaus and reporters.” In an article analyzing the trends in commentary in the 2016
presidential campaign cycle, Washington Post media reporter Paul Farhi (2016b)
declared “we have reached peak punditry.” Noted elections analyst Nate Silver (2016)
wrote an article titled “How I acted like a pundit and screwed up on Donald Trump,”
claiming that his failure to predict Trump’s eventual win in the Republican primary
resulted from a pundit-like failure to not change his mind about assumptions
underpinning his model in the face of new evidence. In 2001, noted political historian
Rick Perlstein declared “pundits who predict the future are always wrong.”
While the political pundit makes for a good scapegoat in channeling frustrations
about all that ails the cable news industry, the overabundance of commentators and
opinion slingers on CNN, Fox News, and MSNBC only tells half the story of the problem
of cable news coverage of health care policy. This project examined all the guests on
cable news during the spring and summer of 2017 that participated in segments about the
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GOP health care reform effort and argues that the problem with cable news coverage of
health care policy is not just the overwhelming presence of pundits and political
journalists but also the dearth of guests with expertise in health care policy, which
compromises the substantive quality of coverage.
This chapter investigates the types of guests and how frequently they appeared
during discussion-based segments about health care during the congressional debates
over the Republican health care bills. The results of the guest analysis show a significant
bias toward using political pundits and journalists to comprise panel segments,
reinforcing the trends within cable news toward an infotainment style of coverage that
emphasizes conflict and drama while minimizing the financial costs to the network. A
closer look at the guest breakdown for interviews revealed that the majority of these
segments involve current elected representatives or Trump administration officials, which
this chapter argues provides a flawed source of information for the audience on health
care as legislators are incentivized to adhere to surface-level talking points and
interviewers inconsistently hold officials accountable for their often dubious and highly
partisan claims. Furthermore, the results of the frame analysis for discussion-based
segments illustrate that when a health care subject matter expert appears in a segment, the
conversation more likely focuses on substantive policy questions for the majority of
segments, while segments without an expert focused on horse-race style strategic
coverage of the political dimensions of the GOP health care reform efforts.
These trends in the type of guests that the three cable news networks
predominantly relied on during coverage of the AHCA and BCRA debates reinforce the
problematic manifestations of political imbalance and bias highlighted in the previous
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chapters. The overwhelming lack of experts and reliance on pundits and journalists to
provide commentary meant the majority of guests lack the policy knowledge and
expertise to provide the audience with the right facts and to potentially push back on
factually inaccurate sound bites or misleading host questions. The plethora of pundits
invited onto cable news networks to represent the Trump Administration point of view
who consistently pushed dubious claims and false talking points exacerbated the dearth of
experts in discussion-based segments, flooding the zone with misinformation that either
derailed conversations about health care or, more problematically, went unchecked.
While pundits and fiery discussion-based segments represent essential tools in the cable
news arsenal for attracting and maintaining the interest of viewers, this chapter argues
that the benefits of infotainment backfire when the participants in these segments
propagate demonstrably false claims.
The Role of Experts in Journalism: A Review
There exists a significant amount of research on the role of experts in the news
making process, but much of this literature focuses on how journalists working in
traditional formats (primarily print but some broadcast television) use expert sources in
their reporting. This project expands on this literature by examining the use of experts by
cable news networks to give information and commentary on health care, examining the
number of expert guests in comparison to other types of professions often represented on
cable news.
While some evidence has shown that the use of expert sources in journalism has
increased over time (Steele, 1995; Albæk, Christiansen & Tobey, 2003, Barnhurst, 2003),
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the use of experts in comparison to other types of sources or guests illustrates that they
still, by and large, represent the smallest source category overall. Frost and Phillip’s
(2011) study of guests in crime reporting found that “politicians/practitioners remain
among the most frequent guests” and that “criminologists remain underrepresented as
guests on cable news programs” (p. 106). The results of Boyce’s (2006) analysis of
expert and non-expert sources in media coverage of the MMR vaccine debate revealed
that “scientific expert-sources did not dominate,” constituting only a third of the overall
sources, as “the majority of sources were non-experts” (p. 895-896). A study of
newspaper coverage of governors’ races in 2002 that examined the use of horse-race
‘experts’ and issue experts found that horse-race experts were cited in 27% of stories
while issue experts were cited in only 14% of stories (Freedman & Fico, 2004). An
analysis of media coverage of the day of Trump’s decision to withdraw from the Paris
Climate Accord found that no cable network hosted a climate scientist to discuss the
implications (Calderone, 2017). Additionally, another study of media coverage of climate
change found that when coverage does cite scientists as expert sources on global
warming, it often ‘balances’ that perspective by citing a climate denier, despite the
frequent disparity in qualifications between the sources, resulting in distorted coverage
(Boykoff & Boykoff, 2004). While some studies found an increase in the number of
expert sources over time, these studies either included no baseline of non-expert sources
for comparison to assess the overall proportion of types of sources (Albæk, Christiansen
& Tobey, 2003) or the results showed that, despite an increase over time, expert sources
represented the smallest category of sources in coverage (Barnhurst, 2003).
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The relative dearth of experts represents a fundamental flaw in the way news
outlets approach covering public policy debates, as experts play a crucial role in
journalism. Experts can most obviously provide the facts, lending their expertise to media
coverage of public policy issues, and help to explain complex issues or controversies in
ways that the public can comprehend (Boyce, 2006). Schudson argued that experts can
“clarify the grounds of public debate and so improve the capacity of both legislators and
the general public to engage effectively in democratic decision-making” (Schudson,
2008, p. 118-119). While Schudson is speaking of the normative role experts play in
democracies, experts can fulfill this same normative function while participating in cable
news segments, providing unique expertise and information that makes clear the
parameters of a given policy debate. Beyond normative considerations, evidence
indicates that the presence of experts impacts audience perceptions of issues covered in
the news. A study of the impact of different types of sources in news coverage on public
opinion found that experts “have quite a substantial impact on public opinion,”
highlighting the influence of expert opinion on support for the SALT II arms treaty, a
1981 arms deal with Saudi Arabia, and campaign finance reform, among other issues
(Page, Shapiro, & Dempsey, 1987). However, the study fails to clarify the definition of
what an expert is, which is particularly troublesome given that they examine a variety of
different policy issues, thus limiting its utility. In the arena of health, “the source of
health information can have an impact on the manner and frequency of its use” as
“sources may have different credibility with various segments of the population” which
“can have a marked impact on the acceptance of information” (Freed, Clark, Butchart,
Singer, & Davis, 2011, p. 107-108). The assumption that expert sources can bolster the
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persuasiveness or credibility of reporting makes sense given the research on the
importance of source credibility and its persuasive impact that has shown that people "are
more persuaded by high-credibility sources" because individuals inherently associate
highly credible sources with truthful information (Fragae & Heath, 2004, p. 226; also,
Guillory & Geraci, 2013).
This project also draws on previous research that has examined how journalists
and news outlets define what it means to be an expert and what types of experts news
outlets gravitate towards over others. The criteria that reporters (or in the instance of this
project, news producers) utilize to make their decisions reflects the journalistic norms
that shape and constrain the production of the news overall, as has been discussed
throughout this project thus far. In a case study of the role of experts in television news
reporting on the Gulf War, Steele (1995) found that "journalists define expertise
explicitly in terms of 'real world' experience, access to and knowledge of the 'players,'
and willingness to make predictions" (p. 805). She found that this definition of expertise
that emphasizes experience over formal academic training or other barometers of
knowledge resulted in a reliance on former government officials as ‘experts,’ and argued
that this definition “coincides exactly with what can be termed television’s ‘operational
bias,’ or the emphasis television news organizations place on players, policies, and
predictions” (Steele, 1995, p. 805). This reliance on former officials also reflects the
overarching dependence on official sources within journalism - a pattern reflected in the
results in this chapter that will be discussed at length in the following sections.

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Guest Analysis Results
The analysis of individuals who participated in segments about health care on CNN,
MSNBC, and Fox News revealed that networks invited a very small number of experts
on to discuss the health care proposals, instead relying on pundits, political journalists,
and congressional and administration office holders to participate in interviews and panel
discussions. This section will detail the results of the analysis of guest participation in
discussion-based segments, first reporting the expert guest totals by network, then
comparing the guest results by job type, and finally undertaking a comparison of the
results of the frame analysis for segments featuring an expert versus those without an
expert.
Expert Guest Results by Network
While the original coding process included two separate codes for experts - one
for doctors and one for non-doctor health care experts - this section presents the results
for both codes combined into one experts category for two reasons. First, the majority of
doctors (20 out of 36 total) featured on segments about health care were actually current
elected representatives or Trump Administration officials.
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The initial purpose of
including a doctor code focused on investigating whether cable news networks used the
doctor signifier as a proxy for credibility on health care issues. Polls show that
empirically the majority of Americans trust recommendations for improving the health
care system when they come from doctors (Saad, 2009), despite the fact that medical
schools rarely require students to take courses on health care policy, with most offering

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Another four of the appearances by doctors were by former elected officials, one appearance by Nan
Hayworth and three by Howard Dean.
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one or two elective courses that are often discounted as unnecessary (Rovner, 2016).
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While doctors endure years of training and their profession makes them most proximate
to the problems of the health care system, their background in medicine does not make
them public policy scholars. However, the fact that the majority of doctors featured in
cable news coverage of health care were actually legislators and cabinet officials largely
nullifies the relevance of their medical degree. While it is possible that cable news
networks chose those particular legislators and officials because they are doctors, it
seems much more likely that they were chosen because of their stature (e.g., Tom Price is
a doctor, but he was also the Secretary of Health and Human Services at the time) or due
to their prominent role during the GOP efforts (e.g., Senator Rand Paul appeared on cable
news seven separate times to lobby against the GOP bill). Furthermore, while cable news
hosts would introduce officials as doctors some of the time, there were no examples of
cable news hosts referencing a legislator’s background as a doctor as a mechanism for
bolstering the guest’s credibility. Three legislators referenced their background as doctors
during their commentary on the GOP health bill (Sen. Paul did so once, Rep. Ami Bera
twice, and Rep. Roger Marshall once), but these were fleeting references rather than fully
developed arguments that leveraged their background to increase the persuasiveness of
their points.
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Thus, any concerns about the use of the image of the doctor as a credibility

77
Some medical schools have recognized this deficiency in how their programs prepare medical students
for dealing with the health care system and are instituting programs and fellowships to develop a more
holistic approach to educating future doctors. For example, George Washington University has created “a
three-week fellowship in health policy for medical residents” run jointly by its schools of medicine and
public health (Rovner, 2016). Harvard Medical School “start requiring every student to take a semester-
long class in health care policy,” in order to better train medical students to “think at the societal level”
about the health care system according to Harvard medical professor Haiden Huskamp (Beam, 2009).
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Bera, A., Matthews, C., & Rattner, S. (2017, May 4). Hardball with Chris Matthews. MSNBC. Retrieved
from Lexis-Nexis.
Bera, A., Kornacki, S., Avella, D., Hunt, K., & Robinson, E. (2017, Jun. 22). Hardball with Chris
Matthews. MSNBC. Retrieved from Lexis-Nexis.
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signifier were largely unfounded. Segments featuring doctor legislators were still
included in the total results for expert appearances on cable news.
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Second, the remaining doctors were either health care journalists, representatives of
health care advocacy groups or insurance companies, or former HHS employees. All of
these individuals would have qualified as non-health care experts in the world in which
they were not doctors. As a result, the two expert categories were combined and the
results for both are referred to as one singular experts category from here on.

Figure 5.1 – Total Segments Featuring Experts and Total Expert Appearances by
Network

Paul, R., & Henry, E. (2017, Mar. 9). Tucker Carlson Tonight. Fox News Channel. Retrieved from Lexis-
Nexis.
Marshall, R., & Melber, A. (2017, Jul. 17). All In with Chris Hayes. MSNBC. Retrieved from Lexis-Nexis.
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There was a discussion about omitting these results from the overall expert appearance totals, given that
these individuals likely go on cable news because of their role as legislator rather than their role as doctor
and their inclusion could give the appearance of higher rates of expert participation on cable news coverage
of health care. However, the overall low rates of expert appearances even including the doctor legislators
and the fact that the original coding scheme defined a doctor as an expert category resulted in the decision
to include these segments as expert appearances.
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The total results for expert appearances on each network are displayed in the table above.
Out of 731 total possible segments across the three networks, only 83 featured at least
one expert.
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In other words, only 10% of cable news coverage of the GOP effort to
repeal and replace the Affordable Care Act included an expert. MSNBC had the most
coverage featuring an expert, with 42 segments featuring at least one expert, while CNN
had 26 segments, and Fox News had 18. While MSNBC had more segments with at least
one expert, the network also had the highest number of overall segments. In terms of the
overall number of experts throughout the coverage period, MSNBC hosted an expert 48
times, CNN hosted an expert 27 times, and Fox News hosted an expert 20 times. This
language is important because these are not necessarily 48 different experts, as some
experts appeared on a network (or multiple networks) several times.
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Overall, there were
only 39 different experts total across all three networks. Given that the overall number of
segments featuring an expert is so small, the next section will compare the total numbers
for different job types to see which types of professionals that the cable news networks
chose to feature during their coverage of the health care debates.
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Guest Results by Job Type
In terms of total numbers, cable news networks overwhelmingly featured pundits more
than any other type of professional. In discussion-based segments, networks featured 850

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While there were actually 1,124 segments in total, these results excluded any host monologue segments
or straight news report segments, as they, by definition, could not include any expert. While an argument
could be made that these host monologues or straight news reports might cite expert sources in their
monologues (which many did), this chapter focused on the network guests, not any source of expert
evidence which would have dramatically expanded the scope of the study.
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For instance, Austan Goolsbee, the former Chairman of the Council of Economic Advisers during the
Obama Administration, appeared on CNN and Fox News twice each and on MSNBC once.
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A chi-square test of independence was performed to determine if there were significant differences
between the three networks and the different job categories. The results were not significant (p > 0.05),
which is why the following analysis presents the guest totals overall, as opposed to divided by network.
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pundits, 330 journalists, 269 current elected or administration officials and 93 experts
overall. Within those segments, 367 featured at least one pundit (50% of all segments),
207 featured at least one journalist (28% of all segments), 265 featured at least one
current elected or administration official (36% of all segments), and 83 featured at least
one expert (11% of all segments). These results are displayed in the tables below.

Figure 5.2 – Discussion-Based Segments Totals by Job Type

Figure 5.3 – Total Guest Appearances in Discussion-Based Segments by Job Type
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The dominant job type for segment participants in panel discussions was the pundit
by far. Out of 357 total panels and 1206 total panel guests, 289 segments featured at least
one pundit, 116 featured only pundits as guests, and panels featured 772 pundits overall
or roughly 64% of all panel guests. Panel segments featured at least one journalist in 187
segments and included 330 journalists overall (27% of all panel guests). Panel segments
included at least one expert as a guest in 39 total segments and included 48 experts
overall (4% of all panel guests). Panel segments included current elected officials or
administration officials in 15 segments and featured 25 officials overall (2% of all panel
guests). These results are displayed below.

Figure 5.4 – Total Guest Appearances in Panel Segments by Job Type
Current elected officials and administration members constituted the large majority
(68%) of interviews, with 253 out of a total 375 interviews. Pundits were interviewed 78
times (21% of all interviews), experts were featured in an interview 44 times (12% of all
interviews), while journalists were only interviewed 20 times (5% of all interviews).
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Figure 5.5 – Total Guest Appearances in Interviews by Job Type
Thus, the types of individuals cable news networks chose to participate in their health
care coverage varied depending on what type of segment was occurring. What remained
consistent, however, was the low level of participation by experts regardless of the
format.
Segment Frame Results
The results of the content analysis for the segment frame indicate that segments that
included an expert focused on substantive policy issues the majority of the time, while
segments without an expert largely revolved around horse-race style strategic coverage of
the political dimensions of the health care debate. Out of 83 segments that featured at
least one expert, 55 were coded as the policy frame (66% of segments), 9 were identified
as the strategic frame (11% of segments), and 19 were classified as a mixed frame (23%
of segments). Out of the 645 discussion-based segments that occurred without an expert
present, 356 were coded as the strategic frame (55% of segments), 147 were identified as
the policy frame (23% of segments), and 142 were coded as the mixed frame (22%).
Thus, the segments were policy focused more than half the time when an expert was
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present, and segments were focused on the politics of the health care debate more than
half the time when an expert was absent from the discussion. Given the disparity in the
number of segments that occurred without an expert versus those with an expert, the
charts below help to underscore the substantive disparity between the segments with and
without an expert:

Figure 5.6 – Frame Analysis Results for Segments featuring an Expert

Figure 5.7 – Frame Analysis Results for Segments without an Expert

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The next section offers possible explanations for why these patterns emerged in what
types of guests occurred most frequently, a deeper dive into the types of experts that
cable news networks chose to invite onto their shows, and an explanation as to why these
trends might negatively impact the substantive quality of cable news coverage of health
care policy.
Whither the Experts: Explanations for the Dominance of Pundits and Political
Journalists
The broader trend in cable news coverage toward an infotainment-style of
covering political news provides a plausible explanation for why coverage featured
pundits and journalists substantially more than experts during the congressional debates
on the Republican health care bill. Patterson (2013) defined infotainment as “a theatrical
style of news… designed to compete with cable entertainment,” associated with the rise
of ‘soft’ news and an overall decline in substantive reporting (p. 20). Jones (2012b)
described it as an “unholy marriage of information and entertainment,” attributing the
trend to “commercial pressures” that made the focus on “sensational narratives, attention-
grabbing visuals, a focus on celebrity, a privileging of conflict, drama, and spectacle”
dominant on cable news (p. 47). Generally, infotainment represents an approach to
covering the news that emphasizes the entertainment value of news coverage, focused on
maximizing profits often (but not always) at the expense of the substantive quality of
cable news coverage.
Scholars have attributed the rise in infotainment to broader changes in the media
market structure resulting from massive FCC deregulation, technological innovations,
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and the increased competition in the ‘all-news’ market – all factors that served to
reinforce the importance of profit-making in the cable news industry (Letukas, 2014;
Patterson, 2013; Anderson, 2004). While Ted Turner’s original vision for CNN held that
“the news is the star” (Nadler 2016), the deregulation of the media industry caused the
media marketplace to shift toward a “corporate focus on growth and ownership
concentration” (Letukas, 2014, p. 30), which “relegated news to the same bottom-line
demands as entertainment content” (Bennett, Lawrence, & Livingston, 2007, p. 4).
Schudson (1995) noted that many (but not all) of the “serious defects in American
journalism… can be traced to the profit motive,” explaining that even if “the corporate
structure of the media does not in itself determine news content, it still tends to
marginalize some news and some ways of telling the news” by “subordinat[ing] news
values to commercial values” (p. 4-6). Technological advancements facilitated the
creation of the 24-hour news cycle, which massively increased the scope of the news hole
networks had to fill, leading to the expanded use of discussion-based segment formats as
a cheap way to fill time (Letukas, 2014). The introduction of MSNBC and Fox News as
alternatives to CNN resulted in a competitive market for the all-news cable channels,
reinforcing the pressure from network executives to maximize audience share (and thus
profits) through “dramatic and entertaining programs that replicated the breaking news
format and structure that was popular with the American public” (Letukas, 2014, p. 33).
The increasing focus on making the news profitable underpinning the embrace of
infotainment helps to explain why cable news networks chose to disproportionately
feature pundits and journalists more than any other type of guest in their coverage of
health care. These guests provide cost-effective commentary likely to maximize the
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entertainment value of discussion-based segments, despite the fact that these individuals
lack specific topic knowledge which makes them ill-suited to the task of explaining
complicated health care policy to the public.
Pundits
First, relying on pundits to occupy the majority of the seats on a panel represents one
of the cheapest ways for networks to cover the health care debate. As discussed before,
panels and political talk segments in general cost very little to produce, as they “require
very little resources or preparation, especially compared to general news seen on the
traditional nightly programs that require detailed investigative research and preparation,
staffers to fact-check information, [and] a host of writers” to create a clear and
comprehensive news report (Letukas, 2014, p. 39). Pundits are generalists in terms of
what types of knowledge they bring to the panel table, they typically lack any
“specialized training as journalists or expertise in one particular area” because networks
utilize them specifically for “their ability to speculate and argue about a variety of
subjects” (Letukas, 2014, p. 39). This means that while each network employs a slate of
pundits, the ability to use these pundits for commentary on any type of political event or
policy makes for a very cost-effective means of covering the news. The table below
shows the top five pundits in terms of their frequency of appearance on each network:
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Figure 5.8 – Top Pundit Appearances by Network
The fact that the pundits who appeared on each of these networks most frequently
during the segments analyzed in this project also represent paid network analysts
reinforces the notion that these individuals are chosen to participate in these segments
because they’re on the payroll rather than due to their unique issue expertise. The
repeated use of paid network pundits maximizes the networks’ existing resources to cover
the congressional health care debates, saving the network’s resources and money while
maximizing profit. Finding experts to staff each panel would require news producers to
spend the time and resources looking up suitable candidates, performing background
checks to ensure their credibility, and potentially paying them transportation or
appearance fees. One might expect cable networks to rely on pundits during breaking
news events, as producers simply would not have the time to locate credible experts to
participate in immediate discussions. However, the dominant use of pundits goes far
beyond the unexpected breaking news events like the release of a CBO score or the
announcement of another Republican defection, suggesting that pundits provide the
preferred approach to covering health care rather than an option of last resort.
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Second, the nature of punditry and its evolution into a fixture in political journalism
means that this type of guest tends to provide commentary and arguments that reflect the
news values prized by cable news networks, reinforcing the trend toward an infotainment
approach to covering the news. Despite the negative connotations associated with
punditry, the move by cable news networks toward an emphasis on political talk shows
and segments as a tool for covering the news has transformed the pundit into “a critical
part of the cable news-industrial complex,” as the increasing use of discussion-based
segments and entire shows dedicated to political talk has necessitated the
professionalization of punditry (Farhi, 2016b). The increasing ubiquity of political
pundits puts a premium on the entertainment value of a commentator. While network
officials might claim that their preferred political pundit should be “‘passionate,’
‘authentic,’ and ’articulate’” (Farhi, 2016b), networks also require such guests to provide
“colorful and provocative commentary, whether or not the facts support it” (Tugend,
2003, p. 49). The industry’s emphasis on conflict in discussion-based segments has
incentivized pundits to hold strong opinions and to defend them energetically in panel
discussions, because “the way to get attention, to climb the ladder of talk success, is to
shout, to polarize, to ridicule” (Kurtz, 1997, p. 13). CNN’s Jeff Zucker was referring to
breaking news events when he claimed that “chaos is good for CNN,” but the degree to
which heated mega-panels have become a central part of the CNN brand suggests that the
network thinks chaos in panel format represents a formula for economic success
(Sherman, 2014; Barr, 2018). However, this penchant for pundits who can deliver
incendiary sound bites and engage other panelists in argument can tip the scales from
entertaining debate into “cheap-shot yelling matches that are just showbiz” (Farhi, 2018).
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While this type of coverage might be appropriate for discussing the strategic dimensions
of political events, it can negatively impact the substantive quality of conversations about
important public policy issues, such as health care, particularly when guests promote
misinformation.
Political Journalists
The prioritization of drama and conflict in infotainment inspired news coverage also
explains the substantial number of political journalists who participated in discussion-
based segments about health care. Jamieson and Waldman (2003) noted that one of the
major characteristics of political journalists’ approach to covering the news revolves
around the “relentless focus on tactics,” which causes them to channel discussions of
politics - even those focused on policy - “through the strategic filter” (p. 166). Schudson
(1995) reaffirms the political journalist’s predilection for framing news coverage with
“an emphasis on strategy and tactics, political technique rather than policy outcomes,”
attributing this trend to the fact that “political reporters tend to be politics-wonks rather
than policy-wonks,” thus “inside baseball” style discussions cater to the reporter’s
strengths (p. 10). Furthermore, political journalists tend to focus their reporting to
emphasize conflict, which they believe makes for more dramatic and thus more
interesting coverage (Cunningham, 2003). This focus on dramatic conflict caters to the
infotainment approach to covering the news, and the way the congressional debates over
the Republican health care proposals unfolded provided excellent fodder for this style of
coverage. As explored in Chapter 3, one of the major storylines covered by cable news
centered on the conflict between the moderates versus the more conservative
Republicans, as political journalists turned the effort to repeal and replace the ACA into a
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story about the Republican ‘civil war.’ For instance, a panel on MSNBC’s Hardball with
Chris Hayes featuring three journalists – Shannon Pettypiece, Ayesha Rascoe, and
Jonathan Swan – focused on the hypothetical ramifications of a failure in the Senate to
pass the health care bill and Trump’s comments suggesting that the best course of action
would be to simply “let [Obamacare] be a disaster, because we can blame that on the
Dems.”
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The discussion of the potential impacts of a failure to pass a bill through the
Senate focused exclusively on questions of “who gets blamed” and debating the degree to
which Republicans would face political fallout for failing to make good on their seven
year promise to repeal the ACA. Swan argued that “if [Republicans] don’t get this done,
they’re going into 2018 with” a failure on “the single issue they campaigned on for the
last seven years.” Pettypiece called the Republican dilemma a “quagmire” and claimed
the health care effort was “sort of like becoming their Vietnam. They just can’t get
themselves out of it.”
Trump’s suggestion that Republicans should simply let the ACA collapse so that they
can blame the ensuing fallout on the Democrats is troubling for several reasons. First, it
assumes that the ACA will collapse if left alone - a demonstrably false claim. Second, it
is incredibly craven for the President of the United States to suggest that the party in
control of Congress and the presidency should allow the health care system to collapse,
which would negatively impact millions of Americans, for political gain. Instead of
discussing the veracity of Trump’s predictions of the ACA’s collapse or a debate about
the appropriateness of the chief executive threatening to allow millions to suffer in order

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Matthews, C., Pettypiece, S., Rascoe, A., & Swan, J. (2017, Jun. 27). Hardball with Chris Hayes.
MSNBC. Retrieved from Lexis-Nexis.
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to score political points against the Democrats, the panel focused on whether or not
Republicans would suffer at the ballot box in 2018 if they failed on the years-long
promise to repeal the ACA. The exclusive focus on the horse-race elements of the GOP
bill - whether or not it would pass, the conflict within the Republican Party, how the bill’s
passage or failure would affect the party in power - exemplifies the type of coverage that
political journalists naturally gravitate toward in discussing politics. This approach to
covering the legislative debates turns the fight over the substance of the proposal into a
high-stakes political game that often obscures any discussion of the substantive impact
that the different proposals would have on the American health care system (Maza,
2017a). While not all segments featuring pundits or journalists focused exclusively on
analyzing the strategic calculations of legislators and decoding of the political stakes of
the congressional debates, well over half of the segments that did not feature a health care
expert did fall into the strategic frame. As the MSNBC example indicates, the
professional norms that shape political reporters’ news coverage also affects their
approach to participating in cable news coverage of political events, which may satisfy
news producers looking for inside scoops about congressional infighting but limits the
opportunity for substantive dialogue about policy specifics.
Reinforcing Access Journalism: The Reliance on Government Officials for
Interviews
Despite cable news’ embrace of infotainment - a largely non-objective journalistic
form - the networks’ approach to covering the news still retains structures of traditional
political journalism, most notably the dependence on official sources. Cable news
networks dedicated over two-thirds of their collective interviews to segments featuring
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current elected officials or Trump Administration members, reflecting the degree to
which cable news continues to rely on the use of elite sources for information on public
policy. The journalistic norm of objectivity shapes cable news interviews, as they
represent a segment format that largely resembles the traditional broadcast interview and
the cable news hosts and journalists who conduct the interviews generally adopt the
image of the objective newsperson even if they represent a partisan network like Fox
News or MSNBC. The televised interview represents a symbiotic relationship between
the network and the official, as “journalists need access to public figures for their
livelihood, while public figures need journalists to gain access to what Margaret Thatcher
once called ‘the oxygen of publicity’” (Clayman & Heritage, 2002, p. 28-29). Networks
give elected legislators interviews, which provides them the platform to push their
legislative priorities and address concerns or misperceptions in the political sphere. Cable
news channels seek out these opportunities because interviews with high-ranking
officials, particularly during primetime, bolster the prestige and credibility of the
network, burnishing a cable news network’s claim to represent a legitimate source of
news. Also, these interviews can turn into news stories themselves, if an official
inadvertently commits a political gaffe or if the interviewer oversteps the boundaries of
what the audience and/or journalistic community deems to be acceptable behavior, either
by acting overly aggressive or too conciliatory toward the interviewee.
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Numerous examples of the interviewer inadvertently becoming the story exist throughout the history of
journalism. Dan Rather was widely criticized for his interview with George Bush, as critics argued he
“stepped over the line” by stepping “outside the role of reporter and… into the role of the judge” (Clayman
& Heritage, 2002, p. 150). On the other side of the spectrum, Matt Lauer’s town hall interview with Trump
turned into a Twitter hashtag (#LaueringTheBar), as he failed to hold the presidential candidate accountable
for any of his policy positions, instead repeatedly offering up softball questions (Tunney, 2016).
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Some scholars have criticized the dependence on official sources, arguing that
journalists often turn to them out of convenience rather than because they represent a
useful and reliable source of information (Cunningham, 2003). Others hold that the
reliance on government sources reflects a dedication to the mode of journalism that
emphasizes access, which means that reporters will refrain from aggressively fact-
checking or challenging a legislator during an interview, for fear of losing that insider
access (Patterson, 2013; Cunningham, 2003). Margaret Sullivan (2017), media columnist
for the Washington Post, claimed that access journalism is “dead” under the Trump
Administration, arguing that “official words do matter, but they shouldn’t be what news
organizations pay most attention to, as they try to present the truth about a new
administration.” She was reflecting on the increasing irrelevance of the White House
press briefing as a reliable source of information, but her overall argument that the Trump
Administration’s penchant for spreading false or misinformed claims should prompt a
reconsideration of how news outlets cover politics applies to the use of political
interviews on cable news, particularly given the problematic trends in how cable news
hosts moderate discussions about health care, outlined in the previous chapter.
While it is not surprising that official government sources represent the largest
category of guests in interviews on cable news networks, these sources represented nearly
a quarter of the total coverage of the health care debates across all networks (253
segments out of 1125 total). Given that cable news networks dedicate such a substantial
portion of their overall coverage to one type of segment with one type of guest, the
question becomes what is the purpose of the interview? Is it to inform the public about
the details of the health care debate? Or perhaps to hold officials accountable for their
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positions? If the answer is to hold public officials accountable for their actions, then that
represents a valid and commendable goal in the world where news anchors and reporters
actively fact-check and push back on any misinformed claims or attempts to push false
talking points. However, as the previous chapter illustrated, news anchors frequently
failed to debunk politicians’ inaccurate arguments, often letting political spin and dubious
claims stand uncorrected during discussions of health care policy. Furthermore, if the
purpose of a cable news interview is to inform the viewer about health care policy, then it
is wrong to allow for such ineffective and misleading journalism to dominate coverage.
Government officials are not health care experts for the most part and the televised
interview format, given the public nature and time constraints, incentivizes legislators to
provide “answers or comments that are banal and uncommitted rather than risk saying
anything that may be taken amiss” (Finlayson, 2001, p. 340). In the best-case scenario,
politicians are likely to repeat their generic but truthful talking points (as seen by the
numerous interviews with Sen. Bernie Sanders where he repeats a laundry list of negative
impacts of the GOP bill almost verbatim in each segment) or takes the opportunity to
push their own legislative ideas, sidestepping the core of the debate (as Sen. Rand Paul
did frequently in interviews). In the worst-case scenario, these interviews become
platforms for politicians to push their alternative facts about health care policy, turning
the segment into a fight about the truth between the interviewer and legislator or, more
problematically, the misinformation stands unchecked. None of these scenarios provides
the audience with a better understanding of what the GOP health care bills do or how it
would affect the American health care system, outside of superficial claims that the bill
lowers premiums or increases the number of uninsured. While some interviewers did
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hold legislators responsible for their specious allegations, the inconsistency in interviewer
behavior and the repeated use of fundamentally flawed questions illustrates the degree to
which cable news networks must reevaluate their reliance on interviews with government
officials.
More Pundits, Less Policy: The Problem with Cable News’ Expertise Shortage
While the previous section provided potential explanations for why cable news
networks chose to predominantly rely on pundits, journalists, and official sources to
participate in discussion-based segments about health care, this section will articulate the
problems inherent in this approach to covering the news. In particular, this section will
explain why the inclusion of more experts could improve coverage, why the reliance on
pundits in particular can degrade the informational quality of discussion-based segments,
and how the dearth of experts compounds the other problems inherent in cable news
coverage of health care, as illustrated by the previous chapter.
The bias toward hosting pundits, journalists, and official sources - all largely non-
expert sources of information - necessarily trades off with the capacity for networks to
devote time to health care experts. The content analysis revealed that the absence of
health care experts in discussion-based panels often resulted in discussions that lacked
substantive policy information, instead focusing on speculations of whether or not the
GOP legislation would pass and identifying the key players in the Republican struggle.
News coverage of any issue in any format is limited, whether by physical space on a
newspaper front page or by time in a news program. While cable news expanded the
universe of television journalism to the 24-hour news cycle, each primetime cable news
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program still faces time constraints posed by commercial breaks, the necessity of
covering a multitude of issues, and resource constraints that limit the network’s ability to
find and host a limited number of guests per segment.
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These restrictions mean that there
exists a loosely zero-sum relationship between the different types of guests that
participate in discussion-based segments. The prevalence of pundits and other non-expert
guests on cable news coverage of health care necessarily trades off with the capacity for
cable news networks to dedicate more airtime to health care experts. While the reliance
on non-expert sources of commentary and information might represent the most cost-
effective way to cover the health care debates for a network concerned only with the
economic bottom-line, such coverage has negative implications for the substantive
quality of their coverage and leaves viewers largely uninformed.
The framing results reported reveal that there is a difference in the substantive
focus of the health care discussions when the segment guest list includes an expert and
when it does not. The majority of the segments that included a health care expert
addressed substantive questions about what provisions were included in the Republican
health care bills, how they compared to the Affordable Care Act, and how their
implementation would affect the American health care system. While the presence of an
expert did not guarantee a policy-focused dialogue, over 65 percent of the segments with
at least one health care expert did primarily focus on substantive discussions of the
congressional health care debates, whereas segments without an expert devoted the
majority of the discussion to parsing the strategic dimensions of the health care debates.

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Although CNN certainly tries to push the boundaries on this with their mega-panels. The largest panel
during the period of coverage studied in this project was 11 people, not including the host.
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The notion that the presence of a health care expert in a segment positively
influences the informational quality of the discussion makes sense for two reasons. First,
health care experts, from health care journalists to the former director of the Centers for
Medicare and Medicaid Services, possess specialized knowledge about the health care
system, acquired through their professional and, in some cases, educational experience
that makes them uniquely equipped to provide commentary on the effects of competing
policy options and translate complex concepts for the general audience. Actively
including a robust number of experts in cable news coverage of health care policy is
important for improving the substantive quality of the cable news product because
expertise “is a form of authority that… can be passed on and shared” (Schudson, 2008, p.
119). Experts on cable news programs can function as teachers, distributing their
knowledge which “does not turn everyone into an expert but it does empower people”
(Schudson, 2008, p. 119).
Second, anecdotal evidence from the panel segments featuring health care experts
and pundits indicates that cable news anchors might tailor their questions to different
guests based on their professional background, and the presence of a health care expert
could prompt anchors to dedicate at least some portion of the segment to policy
considerations. For instance, during a panel discussion with pundits John Heilemann,
Charlie Sykes, and Dr. Nitin Damle, the former President of the American College of
Physicians, MSNBC host Lawrence O’Donnell asked Dr. Damle about the substantive
impact of the AHCA in light of the bill’s passage through the House earlier that day.
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Damle, N., Heilemann, J., O’Donnell, L., & Sykes, C. (2017, May 4). The Last Word with Lawrence
O’Donnell. MSNBC. Retrieved from Lexis-Nexis.
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Damle gave an in-depth account of the negative impacts the GOP legislation would have
on Medicaid, the elderly, individuals with pre-existing conditions, and talked about
specific provisions, like the high-risk pools provision, and detailed how it would result in
expensive, insufficient coverage for the most vulnerable. However, when O’Donnell then
turned to Heilemann and Sykes, he shifted the conversation to a discussion of speculating
that the reason why moderate Republicans who initially opposed the AHCA eventually
got on board was in order to move on to passing tax cuts and the degree to which the
House Republicans viewed passing a bill in any form as a political necessity. O’Donnell
closed the segment by asking Damle what he would tell a senator about the House bill if
they were in a Senate elevator together, giving the doctor the opportunity to emphasize
that “these are patients’ lives that are at stake” and that “coverage can be improved but
not through the AHCA.” Similarly, in a large panel during the debates over the AHCA,
Anderson Cooper opened a segment by asking CNN medical correspondent and doctor
Sanjay Gupta “from the medical community’s perspective, what was the most
controversial change being mulled over by Republicans?” allowing Gupta to respond at
length about the importance of the essential health benefits package in protecting the
most vulnerable and the dangers of repealing that provision.
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Cooper immediately
flipped the conversation from policy analysis to political punditry, as he then turned to
CNN senior political analyst David Gergen, and asked “I heard you said earlier that this
was shaping up in your opinion to be the worst first 10 days of any presidency. Do you
stand by that?” which remained the focus for the rest of the segment. While news anchors
also sometimes asked pundits policy questions and experts for their political predictions

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Gupta, S., Cooper, A., & Gergen, D. (2017, Mar. 24). Anderson Cooper 360. CNN. Retrieved from
Lexis-Nexis.
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about the future of the legislation, these examples suggest the presence of an expert
during a panel discussion may prompt cable news hosts to devote some time to
substantive health care issues.
Beyond the positive benefits to including more experts, the propensity of cable
news networks to rely on pundits in discussion-based segments can degrade the
informational quality of coverage of health care in a few ways. First, the generalist nature
of punditry means that the vast majority of these individuals typically lack any
specialized knowledge in health care policy. Given the inherent complexity of the health
care system and the degree to which misinformation pervades this public policy arena, it
is intrinsically problematic that cable news predominantly relied on these generalists to
comment on the GOP health care reform effort. Not only do pundits typically lack in-
depth knowledge about the intricacies of health care policy, some pundits view
background information or preparation for segments as counterproductive, claiming that
“all those facts can weigh like an anvil on your mind when you’re asked for a snappy
comment” (Farhi, 2016b). That comment is particularly revealing for how pundits view
their role in television news discussions and reflects what cable networks prize most
highly in their commentators: “the ability to frame information within a sound bite,
engage in heated arguments, appear personable on camera, and construct an aurora of
authority” (Letukas, 2014, p. 43). Margaret Carlson, a Bloomberg columnist and former
weekly panelist on CNN’s now-defunct Capital Gang program, underscored the division
between knowledge and punditry:
What's good TV and what's thoughtful analysis are different. That's been conceded by
most producers and bookers. They're not looking for the most learned person; they're
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looking for the person who can sound learned without confusing the matter with too
much knowledge (Kurtz, 1997, p. 6).
Policy background and expertise explicitly take a back seat to the ability to engage in
entertaining debate and construct catchy sound bites in order to generate higher ratings
and increase viewership (Letukas, 2014, Nimmo & Combs, 1992). The emphasis here
revolves around the ability of pundits to project an image of credibility and authority
when discussing policy issues, regardless of whether or not he actually knows about the
issue being discussed. This projection of authority without any basis in actual knowledge
is particularly problematic given the predilection of pundits for holding strong opinions
and defending them vigorously, regardless of their validity. Without an active effort by
either the program host or other qualified panelists to fact check pundit claims, this
approach to covering health care requires the audience to be capable of parsing what is
true and what is not.
Furthermore, the professionalization of punditry has engrained the preference for
television savvy generalists who can deliver on the entertainment values that cable news
requires, incentivizing outrageous opinions and argumentative personas that often turn
panel discussions into shouting matches (Tugend, 2003; Letukas, 2014). A pundit’s lack
of specific health care knowledge is exacerbated by the facets of punditry that require
those individuals to project the image of credibility even when they lack the facts to back
up their argument. The Trump surrogates on CNN provide good examples of the worst
type of pundit that embodies the extreme of infotainment-style commentating, with an
emphasis on an inflammatory style and fearless argumentation born out of a strong
viewpoint rather than the facts. The critique here is not that fiery debates are necessarily
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bad, but rather that punditry becomes dangerous when individuals push misinformation
and outrageous false claims and defend opinion as if it were fact. When Santorum claims
that CBO-approved laws would make the US look like the Soviet Union, or when Moore
calls CBO estimates “hocus-pocus,” they are not engaging in important political
dialogue. These Trump surrogates actively pushed the false claims advocated by the
Trump Administration and demagogued about the CBO, degrading the informational
quality of these discussion-based segments by flooding them with misinformation. The
raucous fights spurred by the outrageous claims made by Lord, Moore, and others may
embody the chaos that Zucker believes to be good for CNN, but this ‘more exciting’ form
of television not only fails to educate the public about the substance of congressional
health care debates, but often misinforms the audience as these pundits repeatedly spout
demonstrably false claims. More often than not these segments turn into debates over
accuracy of the conservative pundit’s false claims, diverting the conversation from any
substantive discussion of the content of the GOP health care proposals. Thus, not only is
the audience deprived of a discussion about the policy proposals that would have
dramatically changed the American health care system for the worse, but these types of
debates are rarely resolved, leaving the audience to parse through what claims about the
CBO or the ACA are true or false. While viewpoint diversity represents an important
element of political journalism, the drive to ensure the representation of the Trump
viewpoint should not necessitate the employment of individuals who repeatedly push
misinformation and degrade the overall quality of the health care discussions.
Dramatic discussion-based segments have an important role in how television news
programs cover politics. Studies have shown that ‘in-your-face’ style confrontations
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during discussion-based segments can cause the audience to remember more about the
content of the argument, including justifications for arguments on both sides of the issue
(Mutz, 2015). Discussion-based segments that feature dramatic fights and grandiose
personalities make for more interesting television and can cause more people to tune in as
well as “encourage attention and retention while viewing” (Mutz, 2015, p. 69). However,
there exists an important difference between entertaining political discussion, which is
fundamental for getting the public to tune in, and a debate featuring individuals who
propagate inaccurate, and at times, outrageous claims, which is what this chapter targets.
This project advocates for the inclusion of more experts and the exclusion of pundits like
Jeffrey Lord and Stephen Moore who repeatedly parrot the Trump Administration line on
health care, regardless of the facts. Debating the best approach to reforming the health
care system does not require turning cable news into the PBS NewsHour but it does
require cable news networks to reconsider hosting individuals who prioritize promoting
their political party’s narratives on health care when those talking points are
demonstrably false.
Finally, the lack of experts and substantive focus in discussions of health care
compounds the negative implications of the manifestations of political bias and
inadvertent repetition of conservative misinformation discussed in the previous chapters.
The magnitude of the detrimental influence of cable news anchors frequently repeating
misinformed conservative claims about the CBO or the health of the ACA in setting up
questions about other unrelated health care issues largely depends on who they are
addressing. While this format of questioning is intrinsically problematic, one can excuse
this poor form of the ‘devil’s advocate’ if anchors exclusively posited these questions to
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health care experts with the policy background and knowledge to credibly and thoroughly
debunk them. However, the general lack of experts in the majority of segments about
health care and the examples outlined in the previous chapter illustrate that this is not the
case. Often, these questions go to partisan pundits who use the opportunity to further
reinforce the conservative narratives criticizing the CBO or predicting Obamacare’s death
or to political journalists who may let the false claim stand because they lack the policy
expertise or do not want to engage in active fact-checking, for fear of appearing
partisan.
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While some pundits and journalists might engage in active fact-checking or
push back on misinformed questions (by the host or other guests), the professional norms
that make pundits and political journalists most attractive to cable news producers trying
to maximize the entertainment value of the news program also make them unlikely to
engage in such behavior.
Conclusion
This chapter examined the patterns in the type of guests that most frequently appeared
in cable news coverage of the congressional health care debates, highlighting how the
dominance of pundits, journalists, and elected legislators and the dearth of health care
experts negatively impacted the quality of cable news coverage overall. The results of the
guest analysis showed a significant bias toward using political pundits and journalists to
comprise panel segments, reinforcing the trends within cable news that emphasize an
infotainment style of covering the news, reflective of how the network’s prioritization of

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Research indicates that concerns about objectivity result in reporters often refraining from active fact-
checking in their reporting, as they are “much more comfortable making evaluative strategic statements
than evaluative statements about policy” (Jamieson & Waldman, 2003, p. 167).
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profits can influence the shape of the news product. As discussed in the previous section,
cable news networks’ embrace of infotainment did not necessarily guarantee bad
coverage of health care policy, as individuals often learn important information from
fiery panel debates and interviews and retain that information better (Mutz, 2015).
However, the positive effects of infotainment-induced drama in discussion-based
segments backfired when the participants in those segments propagate deceitful and
inaccurate arguments. The fact that the audience retains more information during in-your-
face style segments is normatively troubling if what they retain is false predictions of the
ACA’s collapse.
While pundits and journalists might provide commentary and frame their reporting in
ways that ostensibly bolster the entertainment value of discussion-based segments by
emphasizing stories of conflict and political intrigue or turning panel discussions into
fiery debates, the reliance on these types of sources necessarily trades off with the time
and resources devoted to providing expert sources of information on health care. The
results of the framing analysis indicated that the presence of a health care expert in
discussion-based segments often led to coverage that focused on substantive debates
about the Republican health care proposals, while segments without an expert tended to
discuss whether or not the legislation would pass or Trump’s role in securing votes
without deliberating the impact of the plan to repeal and replace the ACA on the
American health care system. Discussions of political intrigue and horse-race style
analysis represent a fixture in television coverage of politics for good reason - many
individuals find this type of coverage interesting and engaging (Mutz, 2015). The
argument here is not that there is no place in cable news coverage for strategic-focused
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discussions of political intrigue but that it is normatively troubling to see the degree to
which this type of discussion dominated the coverage of the GOP effort to repeal the
Affordable Care Act. Furthermore, the panel discussion on MSNBC introduced in the
previous section illustrates the degree to which expert testimony can occur alongside
horse-race analysis, proving that discussion-based segments can be informative while still
catering to the demands of infotainment. The next chapter will discuss recommendations
for improving the substantive content of cable news coverage of health care policy,
including suggestions for how to remedy the flaws outlined in this chapter, balancing the
need for entertainment against the necessity of improving the informational quality of
cable news segments on health care.
The paucity of health care experts in coverage of the Republican reform efforts
further exacerbates the potential impact of the problematic trends isolated in the previous
chapters. The distorted view of the health care debate presented in straight news reports
and the flaws in how news anchors moderated discussion-based panels represent
fundamental flaws in how cable news covered the Republican health care bills. However,
these problematic trends could be blunted in the world where discussion-based segments
hosted a substantial number of health care experts who could push back on the
misinformation spread in Trump sound bites or fact-check flawed premises in panel
segment questions. Health care experts possess unique institutional and professional
knowledge that makes them uniquely equipped to debunk false claims and attempts to
push misinformation but also to attempt to educate the public by sharing their expertise.
Cable networks must actively reconsider their approach to staffing discussion-based
segments during times when health care reform is salient in the news. While shifting
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resources to dedicate more time and money to recruiting qualified experts to participate
in segments necessarily requires economic tradeoffs, networks may find that the change
in substantive quality of their coverage may help their bottom line after all.
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CHAPTER 6:
A PRACTICAL GUIDE FOR IMPROVING CABLE NEWS COVERAGE OF
HEALTH CARE POLICY

On April 27, during a special primetime episode of The Lead with Jake Tapper, CNN
host Jake Tapper hosted a panel discussion that centered on the new amendment to the
House’s American Health Care Act (AHCA) introduced by Representative Tom
MacArthur (NJ-3).
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The ‘MacArthur Amendment’ would have allowed states to waive
regulations instituted by the Affordable Care Act. Most notably, states could waive the
“community rating” requirements and the essential health benefits package, if they
participated in the ‘Patient and State Stability Fund,’ a fund for states “to set up high risk
pools or shore up insurers” (Kliff, 2017a; Jost, 2017; Fiedler, 2017).
90
This amendment
required states “to ‘attest’ that their requested waiver was intended to “reduce premium
costs, increase the number of persons with health care, or advance another benefit to the
public interest in the state” but did not require states to provide evidence of the veracity
of their claims (Jost, 2017). Numerous health care experts denounced the provision,
noting that the waiver system would likely gut key protections for people with pre-
existing conditions, resulting in higher premiums and the loss of coverage for many. In
particular, the history of high-risk pools illustrates how they empirically fail as a safety

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Tapper, J., Kuchinich, J., Kander, J., Ham, M., & Bauer, A. (2017, Apr. 27). The Lead with Jake Tapper.
CNN. Retrieved from Lexis-Nexis.
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Community rating is “a method of setting premiums so that risk is spread evenly across the community,
with all individuals paying the same rate regardless of their health status and other factors such as age,
gender, and lifestyle characteristic” (“Health Insurance Market Reforms,” 2012).
153
net for vulnerable populations due to chronic underfunding and poor administration,
resulting in long wait times and restricted benefits (Mitts, 2017; Aron-Dine, Park, &
Leibenluft, 2017; Jost, 2017; Hall, 2015).
While Rep. MacArthur had introduced the amendment several days prior to this panel
discussion, CNN chose to host only pundits and political journalists during this segment,
as Tapper moderated a discussion between Jackie Kucinich (reporter at The Daily Beast),
Andre Bauer, (the former Lieutenant Governor of South Carolina, Trump supporter, and
CNN contributor), Jason Kander (former Missouri Secretary of State, 2016 Democratic
candidate for Senate, and CNN contributor), and Mary Katharine Ham (editor-at-large of
Hot Air, senior writer at The Federalist, and CNN contributor). Tapper introduced the
segment by saying “Republicans are in their two-minute offense trying to run a revived
health care bill across the goal in time for President Trump to spike the ball on the 100
th

day of his presidency,” and aired a sound bite of a previous interview with Representative
Diane Black (TN-6) where she denied that the MacArthur Amendment would hurt
individuals with pre-existing conditions, insisting that “this latest provision says that if a
state decides that they’re going to do certain measures on pre-existing conditions, they
must have an alternative, and that is, they must have an alternative within their state for a
high-risk pool.” Tapper turned to Jackie Kucinich who explained the political optics of
the MacArthur Amendment, emphasizing how it angered moderate Republicans because
the amendment “shift[ed] the blame from the Freedom Caucus” for blocking the GOP bill
to the moderate “Tuesday Group,” and described the moderate Republicans’ political
dilemma, arguing that “if they vote for this thing,… it’s going to probably die in the
Senate and then they cast a vote that’s political detrimental and what do they have for it?”
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Tapper then asked conservative pundit Mary Katharine Ham “what do you think of this
attempt,” noting that the rush to pass the legislation appeared to be “based on” the desire
to “give the president some sort of win” by his 100
th
day. Ham claimed she “[didn’t]
think it should be done for that reason,” but argued that “it’s actually easier not to act for
both sides of the caucus.” She quickly shifted the conversation to a criticism of the ACA,
contending that “the only way that Obama got Obamacare through [was] by saying ‘You
won’t lose anything, everything will be better for everyone’” but that “none of that was
true,” and she criticized the essential health benefits package as “a giant package of
benefits” that “every state has to carry” which makes premiums “so much more
expensive.” Tapper reinforced the credibility of Ham’s claims by highlighting that she
was “on an Obamacare exchange in the Commonwealth of Virginia.” Tapper allowed
Jason Kander, the lone liberal on the panel, to respond to Ham’s claims, as he said “I
think that was all an outstanding argument for what President Obama has said, which is
there are things that could be made better here and let's focus on doing those things”
because “no one is going to be happy with … the idea of saying to somebody who has a
pre-existing condition right now that we’re going to throw you back into limbo.” Ham
argued that “no one is happy” with the House bill because “it’s not a full repeal,” and
responded to Kander’s claim that “people are not happy because [the bill] does really bad
things” by saying this:
Wait, hold on. When you give the state -- let me explain this for my left of center
friends who only understand federalism when it applies to sanctuary cities. This is
allowing states and cities -- states to do different things when it comes to health care
choice. Allow some insurance companies to build different products that might be
155
cheaper that younger people would buy, get them into pools so that you can subsidize.
It doesn't mean that this bill is perfect, but the idea that letting some of these federal
mandates become negotiable on a state level would hurt everyone is silly. You could
– you bring down some of the prices. You could build products that more people
want.
Instead of responding to any of Ham’s claims, Tapper concluded the segment by turning
the conversation to Andre Bauer to comment on the “promise” that “Trump made about
repealing and replacing Obamacare” because “that’s an important one for him to keep.”
This segment embodies the core flaws in how cable news covered the GOP effort to
repeal and replace the Affordable Care Act, exemplifying many of the trends criticized in
this dissertation. The segment opens with a sound bite of a Republican politician making
a series of dubious claims about the effects of the GOP proposal, but included no
conversation about the veracity of those claims. It also reflects the troubling trend of
using conservative sound bites without proper context or fact checking. Instead of hosting
experts to discuss the substantive merit of the MacArthur Amendment or moderating any
type of discussion over whether or not the provision would gut access to care for people
with pre-existing conditions or the viability of high-risk pools as a safety net, CNN
permitted pundits and political journalists to debate the strategic motivations behind the
amendment and the political ramifications of trying to pass the bill by Trump’s 100
th
day
in office. Tapper’s refusal to push back on any of Mary Katharine Ham’s claims about
the effects of the amendment’s waiver system reflects the trends outlined in Chapter 4, as
anchors often chose to remain ‘neutral’ and thus passive facilitators of discussion-based
segments, functioning only to coordinate turn-taking rather than serving as an active
156
participant in the conversation or as a referee shaping and improving the quality of
discussion. While Ham’s claims about the GOP bill appear to be more reasonable
versions of the GOP messaging pushed by other conservative pundits on cable news
networks, her arguments still fundamentally misrepresent the potential impacts of the
GOP bill and ignore substantial contradictory evidence. While her arguments reflect
traditional conservative rhetorical strategies emphasizing federalism and state flexibility,
her dismissal of criticisms of the bill as “silly” conveniently ignores how the waivers
could have “undermine[d] the Affordable Care Act’s ban on annual and lifetime limits”
and the cap on “out-of-pocket spending for people in employer coverage” - regulations
that affect the entire insurance market, not just those individuals on the ACA exchanges
(Fiedler, 2017). Tapper simply allows Ham to assert that the proposal’s high-risk pools
would work, despite the long history of high-risk pools failing over and over and the
evidence that the meager funding included in the GOP’s bills would fall far short (Hall,
2015; Rovner & Ying, 2017; Kliff, 2017b). While some might not expect cable news
hosts to understand the insurance regulatory regime, if the panel had included a health
care expert, she could have easily rebutted the variety of distorted claims forwarded by
the conservative pundit.
This project examined how the journalistic norms promoting objectivity, political
balance, and neutrality manifested in unproductive and dangerous ways during cable
news analysis of health care policy, highlighting key trends that appeared during
coverage of the GOP health care reform effort in 2017. In particular this dissertation
argues that cable news networks must reconsider how they approach reporting on health
care policy, given the challenges presented by the Trump Administration. Cable
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newsrooms must contend with the degree to which traditional conceptions of neutrality
and balance in political journalism depend on both sides of the political aisle respecting
the idea that beyond normal partisan spin, the truth matters. Molly Ball, a TIME political
correspondent, succinctly summarized the issue, explaining that “the problem is that this
idea that Trump is fundamentally uninterested in facts and arguments and substance is
gaining credence among Republican members,” as evidenced by the proliferation of
demonstrably false claims forwarded by Trump and congressional Republicans in the
effort to sell the GOP proposals.
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In a world where one political party advocates for a
bill that tangibly harms millions of Americans by insisting none of the negative impacts
are true, cable news networks must confront how the journalistic desire for the truth
comes into tension with the journalistic impulse for neutrality (Kliff, 2017e; LeTourneau,
2017). A journalist cannot be committed to reporting on the truth and also to remaining
neutral when one side of a political debate is consistently and repeatedly forwarding lies
(Levey, 2017, Feb. 28; Politi, 2017; Shuham, 2017).
This dissertation thus far has mapped out the problematic trends that arose in cable
news coverage of the GOP health care reform effort. This chapter serves as a practical
guide for people involved in the production of cable news, from anchors to journalists to
researchers to producers, and provides recommendations for how to improve the
substantive quality of cable news coverage of health care. While these recommendations
respond to the specific criticisms outlined in this project and focus on health care policy
coverage in particular, they also function to bolster the informational quality of cable

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Ball, M., Matthews, C., Herndon, A., & Karni, A. (2017, May 4). Hardball with Chris Matthews.
MSNBC. Retrieved from Lexis-Nexis.
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news coverage of public policy in general. The recommendations are organized
sequentially by chapter, first presenting the recommendations for reforming straight news
reports, second, addressing how best to create a more productive role for cable news
anchors in discussion-based segments, and finally discussing what types of guests should
be invited onto cable news programs to improve the quality of the debates on health care
policy. The chapter then turns to a discussion of the potential for journalism schools to
facilitate this shift in how cable news journalists approach reporting on public policy
debates and the responsibilities of the audience in consuming cable news and the need to
develop more sophisticated media literacy skills in the current political climate. This
chapter concludes with a discussion of the key contributions of this project, the
limitations of this study, and suggestions for future avenues of research.
Improving Straight News Reports: Responsible Practices for Partisan Sound Bites
Chapter 3 firmly established the existence of a severe imbalance in the use of partisan
sound bites on cable news networks, as all three networks used disproportionately more
sound bites of a Republican (either Trump or a congressional Republican) than those
featuring Democrats. This manifestation of bias in the use of partisan sound bites in the
straight news report - the type of segment that ostensibly represents objective journalism
- presents a particularly troubling phenomenon. The visibility bias presents a
fundamentally skewed image of the congressional health care debates, shifting the terms
of the debate presented to the cable news audience by centering the key questions in the
debate on how best to repeal the ACA, rather than how best to reform the American
health care system. The question now becomes what should be done to rectify such an
imbalance and how can cable news improve their coverage of complex public policy like
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health care, in the context of the straight news report. This section outlines three
recommendations for improving the substantive quality of straight news reports on cable
news networks: establishing some degree of parity in the use of partisan sound bites,
ending the practice of using sound bites that repeat dubious or false information, and
incorporating more elements of fact-checking into straight news reports.
First, reporters and producers creating straight news reports that use sound bites
should intentionally be mindful of the number of sound bites included in a particular
segment and the partisan affiliation of each speaker. Cable news has never been subject
to the FCC’s Fairness Doctrine, requiring a network to air all sides of an issue, or the
requirements that broadcast news programming serve the public interest (Rendall, 2005;
Brotman, 2017). Nadler (2016) claims that because cable news lacks the “legacy” of
public interest obligations, “the commercial and corporate nature of cable news networks
means they cannot put a mission to invigorate public life ahead of financial gain” (p.
117). However, just because cable news lacks the public interest legacy of broadcast
journalism, does not mean that those networks cannot tangibly improve their coverage at
the margins, without totally sacrificing financial objectives. Moreover, because cable
news networks strategically use the trappings and themes of objective news reporting in
their straight news reports, it creates a normative responsibility to adhere to higher
journalistic standards for those segments than say the standards for a panel discussions.
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This should not be construed as advocating for a requirement for formal parity in partisan

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That being said, this project still argues for the reformation of the role of news anchors in discussion-
based segments, transforming the anchor from passive moderator to active fact-checker and participant in
order to improve the substantive quality of these discussions of health care. While the normative
journalistic standards for straight news reports should be higher than those of discussion-based segments, it
does not excuse the repetition of misinformation about health care policy in panels or interviews.
160
sound bites, as such a rule would reinforce the worst aspects of he said/she said reporting
that already dominates journalism generally (Rosen, 2009). Some bias toward the party in
power makes sense, given that they typically have their hands on the levers of power and
represent the driving force behind legislative efforts. However, reporters and their
producers should maintain a rough idea of the number of utilized sound bites in each
partisan category as an oversight mechanism to prevent such a severe imbalance.
Second, more consideration should be given to what kind of sound bites are used
in straight news reports. While a sound bite of Trump hyperbolically declaring that the
ACA is a “total disaster” and that he and Republicans should “just let Obamacare fail”
makes for a more engaging news report, including sound bites that are predicated on
misinformation or false claims is fundamentally irresponsible.
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Using sound bites that
reinforce existing false narratives on complex public policy like health care, where
significant knowledge gaps exist, can make audiences vulnerable to misinformation. Just
because Republicans have repeated the death spiral claim over and over since the passage
of the ACA doesn’t make it true, and cable news networks shouldn’t treat demonstrably
false claims as if it simply represents a different point of view. Health care policy is
supported by data and facts and while disagreement can exist over the best approach to
providing health care coverage or what the role of the government should be in the health
care arena, networks shouldn’t treat dubious political spin as fact. This is particularly true
in the context of the Trump era, as the President, administration officials like former
Health and Human Services Secretary Tom Price, and even some congressional

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Blitzer, W., & Murray, S. (2017, Jul. 18). The Situation Room with Wolf Blitzer. CNN. Retrieved from
Lexis-Nexis.
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Republicans continued to falsely claim their bill covered individuals with pre-existing
conditions (it didn’t) or would not leave numerous Americans financially worse off (it
would) (Morris, 2017; Koenig, 2017). As conservatives sold a bill to the American public
that was fundamentally different from the one actually debated in Congress, CNN used
sound bites that featured various conservatives making these factually inaccurate
claims.
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The Trump Administration’s affinity for making false claims upends the
traditional mode of access journalism, as noted media critic Margaret Sullivan (2016)
argued that the mode of journalism where “official statements … are taken at face value
and breathlessly reported as news … is over. Dead.” Where previously cable news could
use sound bites of administration officials as a mechanism for summarizing an argument
or official position, the constantly changing nature of Trump’s policy preferences and his
affinity for “alternative facts” must cause cable news networks to reconsider their use of
sound bites, at the very least those promoting demonstrably false information.
Finally, correspondents writing and delivering straight news reports must take a more
active role in fact checking dubious claims during policy debates. George Lakoff
provided useful instruction for the best method of fact-checking Trump during an
interview with Reliable Sources host Brian Stelter. Lakoff argued that simply introducing
a sound bite with Trump or a politician introducing a false claim and then negating it fails
to debunk the false claim and instead strengthens the misinformation because the story is
framed around the false claim. Instead, he suggested that journalist should “frame with

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Acosta, J., & Blitzer, W. (2017, May 3). The Situation Room with Wolf Blitzer. CNN. Retrieved from
Lexis-Nexis.
Blitzer, W., & Mattingly, P. (2017, Mar. 13). The Situation Room with Wolf Blitzer. CNN. Retrieved from
Lexis-Nexis.
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the truth first. Your job is to present the truth for the public good. And you do it first
because if [Trump] gets to frame it first, that’s how people understand the situation”
(King, 2017). Journalists should go beyond merely setting competing claims against each
other in a policy debate like health care, because “when one side in a policy debate makes
a prediction about the effects of legislation, reporters have a responsibility to make
judgments about the likelihood those consequences will actually occur” (Jamieson &
Waldman, 2003, p. 12). This requires a more active interpretive role for cable news
journalists and reinforces the need to abandon the traditional model of access journalism
that functions so poorly under the Trump Administration. This call for fact-checking
could also involve the incorporation of more sound bites of experts as a credible source
of policy information, as will be discussed in greater depth in chapter 5. While some
aspects of cable news step beyond the boundaries of traditional objective journalism, the
straight news report clearly maintains the image and format of broadcast journalism, thus
prompting the call for those cable news reporters to adhere to higher journalistic
standards than those informing the punditry-focused segments.
Reimagining the Role of the Cable News Host: Abandon the Devil’s Advocate,
Adopt the Fact Check
Chapter Four investigated problematic trends in how cable news hosts moderated
discussion-based segments during the GOP effort to repeal and replace the Affordable
Care Act. Analysis of these segments revealed how cable news hosts often used
problematic question formats that at best repeated dubious conservative talking points
and at worst reinforced conservative misinformation and amplified false talking points.
These fundamentally flawed techniques for presiding over conversations about health
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care can be attributed to the program host attempting to remain neutral and maintain
political balance by relying on segment guests to debate and debunk each other, reflecting
journalism’s continued obsession with objectivity, even in the context of a policy debate
where one side actively propagates false information.
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However, the criticisms outlined in this project pertaining to how news hosts
conducted interviews and panel discussions do not represent intrinsic features of the
format. Rather, the quality of these segments depends on how the host comports herself
during the segment and on who the cable news networks might choose to invite on as
guests for interviews and panel debates. This section outlines recommendations for how
networks can empower their hosts to take a more active role in panel debates by
equipping them with the information necessary for active fact-checking and institutional
support for hosts taking a more aggressive line in pushing back on misinformation,
particularly in the context of conversations about important public policies such as health
care. While this project makes arguments about how to improve the substantive quality of
conversations about health care in particular, these recommendations could easily be
extrapolated to how hosts conduct themselves in discussion-based segments about policy
issues writ large.
First, the most important aspect of improving how hosts mediate conversations about
health care requires properly preparing hosts with the information they need to push back

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This is only true for CNN and MSNBC of course. Chapter Four explains how Fox News hosts utilized
these techniques but also engaged in explicit propaganda by actively pushing conservative talking points
and misinformed narratives, regardless of their veracity. These recommendations focus only on CNN and
MSNBC, as there exists some hope for those networks to reform how they approach the news, as the
destructive techniques result from flawed manifestations of journalistic norms rather than an intentional
strategy resulting from an ideological agenda.
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on false claims. Thomas Patterson (2013) wrote about the need for knowledge-based
journalism, arguing that “journalists’ knowledge deficiency is a reason they are
vulnerable to manipulation by their sources” (p. 75). While Patterson wrote about
traditional forms of journalism, the notion of equipping journalists with the facts and
evidence they need to understand the substance and scope of public policy issues,
particularly in the context of parsing the accuracy of information from sources, can be
applied to the world of cable news. In this instance, hosts must have primers on the key
narratives surrounding health care, the top line information on the current state of the
American health care system, and knowledge of how potential proposals might impact
the public when facing the task of moderating a panel discussion. Some have argued that
discussion-based segments are incompatible with fact-checking, because the live nature
of these segments means hosts lack the opportunity to obtain the information to push
back on misinformed claims made by segment participants (Ben-Porath, 2007). Ben-
Porath argued that “interviews are incompatible with fact-checking” because “unless
some impartial arbiter appears at the end of the interview and proclaims the truthfulness
of arguments made, fact and fiction are afforded the same credence by this form of
journalism” (p. 422). While this might accurately describe a majority of the discussion-
based segments that currently occur on cable news networks, there were examples of
active attempts to fact-check misinformed claims and to provide context to distortions of
evidence that indicate that a more robust role for program hosts could exist.
During a segment about Trump’s claim that the best plan of action in light of the
House’s (initial) failure to pass the AHCA was simply to let Obamacare collapse,
Anderson Cooper began by playing a series of clips of various Republicans (including
165
Speaker Ryan and Trump among others) claiming the ACA is in a death spiral and then
actively debunked those claims by saying:
Well, the idea that Obamacare is teetering on the brink of collapse has been debunked
a number of times, most recently, the Congressional Budget Office’s scoring of their
replacement bill. It concluded that neither the replacement, nor the existing law,
Obamacare will send insurance markets into a death spiral.
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Cooper clearly denounces the Republican claims as demonstrably false and cites expert
evidence - ironically the CBO - to back up his fact-checking. While the sound bite
package of a series of clips reinforcing the death spiral claim presents its own set of
issues (as explored in the previous chapter), the active refutation of these claims by
Cooper illustrates that he does have the capacity to contextualize these false claims as
fundamentally inaccurate. During a panel discussion with Stephen Moore and Austan
Goolsbee, Don Lemon fact-checked Moore’s claim that “the entire insurance market is
falling apart under Obamacare” by saying “if you look at the fact check, that is rhetoric.
The insurance market will fall apart only if Republicans allow Obamacare, that they don't
fund it, then the insurance markets will fall apart” then turning the conversation to
Goolsbee for his response.
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Crucially here Lemon actively pushes back on Moore’s false
claims, noting that the markets are not failing and providing important contextual
information for the audience about Republican attempts to sabotage the markets as a key
factor underpinning their troubles before turning to the other panelist for his response.
Lemon exemplifies the model of a host equipped with the facts who actively moderates

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Cooper, A., & Gupta, S. (2017, Mar. 24). Anderson Cooper 360. CNN. Retrieved Lexis-Nexis.
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Lemon, D., Goolsbee, A., & Moore, S. (2017, May 2). CNN Tonight. CNN. Retrieved from Lexis-Nexis.
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the substance of the conversation about health care policy, rather than merely relying on
other panelists to (hopefully) do that work for him. MSNBC’s Chris Hayes debunked
claims of an impending death spiral, highlighting the preponderance of evidence that
showed the relative stability of the ACA insurance markets.
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Blitzer aggressively
questioned Rep. Ted Yoho in an interview, debunking Yoho’s claims of CBO inaccuracy
by noting that Republicans appointed the agency’s director and highlighting the
inconsistency in Republican claims as they rejected the estimate projections on the
number of uninsured but happily touted the projected deficit savings.
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These examples illustrate that the idea of the cable news host as an effective
moderator and arbiter of facts represents not an idealistic pipe dream but an achievable
goal. At times, these hosts cited credible evidence and experts, they intervened to dispute
inaccurate claims, and, at times, provided more context to panelists’ claims to help the
audience understand the broader scope surrounding the health care reform effort.
Jamieson and Waldman (2003) noted that “when reporters tie the facts at hand to the
larger policy debate in ways that help the public see the connections between specific
policies and larger concerns, their successful arbitration of competing claims can
enlighten the citizenry" (p. 186). Cable news producers should arm their hosts with the
research necessary to make fact-checking and contextualization easier. While health care
policy is admittedly incredibly complex, cable news programs maintain research
departments for just this reason and numerous health care organizations create fact-sheets
and primers explicitly aimed at breaking down complex policy information for the

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Banks, J., & Hayes, C. (2017, Mar. 17). All In with Chris Hayes. MSNBC. Retrieved from Lexis-Nexis.
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Blitzer, W., & Yoho, T. (2017, Mar. 13). The Situation Room with Wolf Blitzer. CNN. Retrieved from
Lexis-Nexis.
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general public. Families USA, a non-partisan nonprofit, dedicated to representing health
care consumers has a variety of resources that could be used in this context. Their
research department produces fact-sheets, infographics, explainer-style blogs, and more
that is written for the general audience, making it particularly useful for cable news hosts.
The Kaiser Family Foundation creates in-depth fact-sheets and conducts numerous
studies on the state of the health care system, on the effect of proposed reforms, and on
American attitudes toward health care. Think tanks like the Urban Institute, the
Commonwealth Fund, and the Century Foundation provide expert commentary in
addition to research reports and policy briefs on health care. While these reports might be
slightly denser than the materials anchors typically consult, they could be very useful in
creating broader policy primers in a non-breaking news context. Thus, the resources to
infuse cable news discussions with more facts and knowledge about health care already
exist, it’s just a question of implementation.
Furthermore, this should not be construed as a call for cable news hosts to get into the
weeds, for example, about the granular details of per capita caps versus block grants for
Medicaid’s funding structure. The expectation is not for cable news hosts to suddenly
become health care experts overnight, but rather to furnish them with the information
necessary to ensure fact-based discussions about the major contours of health care policy.
The reason the examples outlined in this chapter present such a troubling phenomenon is
because they center on two of the main conservative narratives during the health care
debates. Attacks on the CBO and predictions of a death spiral are not nitty gritty policy
details - these represented core elements of the conservative messaging during the
Republican effort to repeal and replace the ACA. The baseline standard for cable news
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hosts should require them to consistently get the facts right on the major points of
controversy during public policy debates.
A second crucial aspect of empowering cable news hosts to adopt a more concerted
role in fact-checking in discussion-based segments requires a rethinking of the norms of
political balance in panel settings and a re-evaluation of who the various cable news
networks will select as guests for these segments. As stated earlier, program hosts face
competing requirements during discussion-based segments, as the norms of political
journalism prioritize interviewer neutrality while also venerating adversarial approaches,
idolizing the rugged reporters crusading for the truth. This tension is inherent in cable
news coverage, particularly on the ostensibly non-partisan CNN, as news anchors attempt
to remain neutral during panel debates which can, at times, allow misinformation to
flourish while aggressive interviews can sometimes go viral but also open the network to
accusations of liberal bias.
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Neutrality should not require that false claims are permitted
to go unchecked. A more problematic incarnation of this paradox between these
competing norms occurs when cable news hosts ask flawed questions under the guise of
acting as a ‘devil’s advocate,’ particularly when the panelists are pundits rather than
health care experts. The repetition of distorted claims or false information as a
mechanism for showcasing the viewpoint of the other side represents an intellectually
bankrupt approach to public discourse on policy issues. Adopting the opposing viewpoint
when interviewing a panelist with an established political viewpoint is fine in the world

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A good example of this is Jake Tapper’s interview with KellyAnne Conway in February 2017 after her
mistaken comments about the false “Bowling Green massacre.” Tapper’s aggressive questioning and
demeanor resulted in the CNN clip of the interview going viral but invited claims of bias and opened
Tapper to attacks from conservative politicians and right-wing media (Ruiz, 2017).
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in which that opposing view doesn’t rely on constructed narratives of misinformation,
like the conservative ‘death spiral’ talking point. Hosts should actively avoid this
question template when the inquiry requires repetition of distorted claims. This is
particularly true when this type of question is posed to non-experts, who might lack the
policy expertise to fully refute the misinformation. While cable news hosts should be
prepared to adjudicate factual disputes on the key controversies during health care
debates, the majority of cable news guests are pundits or political reporters – generalists
with little-to-no background in health care policy, making it an unrealistic expectation for
network commentators to be able to fill the fact-checking role. A key part of improving
the substantive quality of cable news discussions of health care - and a potential
mechanism for lessening the informational demands on cable new hosts - would involve
increasing the number of health care experts hosted by networks, a recommendation that
will be further explored in the following chapter.
In conjunction with avoiding ‘devil’s advocate’ style questions when it pertains to
health care, hosts must stop the practice of using conservative talking points as
introductions for questions on unrelated substantive health care issues. While reading a
Trump tweet about the health care reform effort that claims that Obamacare is dead might
make for a snappy hook to introduce a panel, unless the host explicitly debunks that claim
within the question introduction, it results in one of three scenarios, none of which help
the substantive quality of health care coverage on cable news. First, the guest could
choose to focus only on the substantive question posed by the host, allowing the
misinformed claim in the question intro to stand uncorrected. Second, the guest might
attempt to debunk the GOP talking point latent in the question, trading off with a more
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robust discussion of the particulars of the health care reform effort.
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Or third, the guest
might use the opening provided by the inclusion of the conservative talking point as a
mechanism for either only talking about that, skirting substantive discussions entirely, or
both answering the question and reaffirming the validity of the predictions of a death
spiral or the CBO’s history of inaccuracy. None of these scenarios result in a more
informational approach to discussing health care and at best, result in the repetition of
conservative misinformation without any corrective.
This call to empower hosts to adopt a more active role in adjudicating the factual
content of discussion-based segments about health care should not, however, be
construed as an endorsement of hostility or incivility as a method for moderating
discussions. Some scholars have argued that hosts who “embrace conflict as a way to
moderate debates” can divide audiences, as some see this approach as “barbaric and
combative” while others see “aggressive interviewing as a check against the powerful”
(Vraga et al., 2012, p. 9). Studies comparing the “host as combatant” approach to other
more dispassionate approaches to moderating segments found that viewers rated both the
anchor and the show featuring an aggressive host as less credible and significantly
lowered the audience’s trust in the media (Vraga et al., 2012; see also Ben-Porath, 2010).
While these results might seem to contradict this call for a more active role for cable
news hosts in monitoring the factual accuracy of the segments in their shows, there exists
an important delineation between an aggressive pursuit of the truth, which is what this

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Admittedly this does assume the host asked a policy-based question as opposed to a strategy focused
question about the likelihood of the bill’s passage or some other politically framed inquiry, which only two
of the examples in the results section were. This scenario is the weakest argument for why this type of
question is flawed but could still occur which is why it is included.
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project advocates, and unwarranted aggression for the sake of its entertainment value.
The recommendation that hosts adopt a more active role in monitoring the veracity of
claims forwarded by guests does envision a world of more aggressive cross-examination
and argumentative engagement by hosts, but this active host participation occurs in
response to attempts by guests to misinform the cable news audience, as opposed to
baseless grandstanding. Furthermore, studies have found that while some viewers react
negatively to uncivil host behavior, viewers who support the watchdog function of the
press tolerate “aggressive communication… when it is journalistically justified” (Ben-
Porath, 2010, p. 340). Evidence also shows that aggressive and argumentative segments
can have positive externalities, as the audience learns important information about
arguments and their justifications and retains that information better than those exposed
to more civil interactions (Mutz, 2015). While other recommendations in this chapter aim
to rein in the excesses of infotainment in cable news, this call to promote a more active
role, and at times aggressive style, for cable news hosts represents a rare instance where
appealing to the love of conflict inherent in infotainment can also bolster the
informational quality of the coverage of health care policy. By encouraging cable news
hosts to adopt a more interpretive role in adjudicating discussion-based segments, cable
news networks can empower hosts to step beyond the boundaries of the norms of
objectivity and political balance, reflective of the tenets of the social responsibility theory
of the press discussed in Chapter One (Delli Carpini, 2005).
Remedying Cable News’ Addiction to Pundits: Calling More Experts
Chapter Five reported the results of the guest analysis which examined the types of
guests that dominated cable news coverage of the GOP health care debates, revealing a
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substantial bias toward the use of pundits and political journalists as guests on discussion-
based segments. This reliance on these types of guests reflects the trend toward an
infotainment-style of covering the news that accentuates conflict and drama, maximizing
the entertainment value of segments but often resulting in informationally deficient
coverage of the health care debates. The lack of experts in the majority of cable news
coverage of the GOP health care reform effort reinforces the negative trends highlighted
in previous chapters, as partisan pundits push dubious claims, flooding discussions with
misinformation that hosts often let stand uncorrected (either due to lack of information or
desire to appear as a neutral arbiter).
The solution is simple: invite more health care experts to participate in cable news
coverage of health care policy. While pundits, journalists, and elected legislators
represent important and fundamental participants in the production of cable news
programs, their presence in discussions of public policy issues should not
overwhelmingly outnumber individuals with actual expertise in that policy arena. While
finding qualified experts to participate in cable news segments requires more resources
than simply calling up a network pundit on retainer, numerous think tanks and academic
institutions provide extensive information on how to reach their experts. The RAND
Corporation, one of the largest non-profits in the US, features a “RAND Policy Experts:
Find an Expert” page on its website to facilitate access to their experts, including
specialists in health care access, health care costs, and a variety of other health care
related fields.
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Most academic institutions have media contact pages for their subject
matter experts - for instance, UCLA’s Center for Health Policy Research provides

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https://www.rand.org/news/experts.html?topic=health-care-costs
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extensive biographies and contact information for their health policy experts.
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The lack
of expertise on cable news programs does not reflect a shortage of qualified health care
policy experts in the world, but rather the degree to which cable news networks prioritize
the profit-maximizing news values associated with the infotainment approach to covering
the news over providing a quality informational news product. Given that evidence exists
to negate the idea that this type of coverage will result in economic profits, cable news
networks should be more willing to invest at least some resources in bolstering the
number of experts who appear on their airwaves.
Aside from simply introducing more experts into the mix, another improvement cable
news networks could implement to help audiences is to introduce what the Columbia
Journalism Review calls ‘on screen nutrition labels’ during panel discussions and, to a
lesser degree, interviews. Barbara Cochran, the former president of the Radio-Television
News Directors Association, claimed that “the most dangerous thing about talk is to see it
as a substitute for news, and that people might confuse what they hear on a talk show
with news reporting” (Anderson, 2004, p. 46). Given the format of panel segments and
the limited information that news anchors provide the audience when introducing
panelists, it can be “hard to tell the reporters from the opinion slingers, especially when
the panels bleed into the delivery of the news itself” (Farhi, 2018). While networks
sometimes display on-screen graphics labeling someone as “New York Times reporter,”
“CNN commentator,” or “former Senator,” these taglines rarely reveal more than one
piece of information about a panelist’s likely extensive background, which can and
should influence how audiences view their commentary. Stencel and MacDicken (2018)

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http://newsroom.ucla.edu/ucla-faculty-experts-health-care-policy
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argue that while segment time and graphic space may be limited, sports events on TV
show that coverage can still provide a significant amount of information, without
negatively impacting the quality of the viewing experience.
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They advocate for these
“on screen nutrition labels” which would provide not just one but several facts about a
panelist’s background and resume, arguing that these represent “an investment in trust”
because:
Consistently accurately identifying commentators tells viewers why the news
networks have decided to rely on those people, and even showcases the range of
views they represent… It also clearly draws a line between the networks’
commentators and their reporters and correspondents—much more clearly than the
current labels and subtle set differences the networks use now to try make those
distinctions (Stencel & MacDicken, 2018).
In situations where a panel features one expert but a variety of pundits, journalists, and
other non-expert sources, a more robust approach to informing the audience about who
each panelist is and what they bring to the discussion table can help the viewer parse
what information can be trusted and what information just represents one pundit’s
opinion. While some might argue that improved on-screen graphics are a ‘leading a horse
to water’ sort of situation because there’s no guarantee viewers will read them, cable
news networks should still strive to improve the overall quality of their health care

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They specifically reference the example of coverage of a college football game where “a quarterback’s
bio box during any college football game can offer more than a dozen lines of background, such as
hometown, high school, past accomplishments, current averages – up to two full screens of information that
might appear back-to-back for as long as 10 seconds. That’s an eternity in TV time, and yet hardly
disruptive or distracting” (Stencel & MacDicken, 2018).
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coverage and more clearly delineating between objective sources of information and
partisan pundits represents one small step toward that goal.
In addition to inviting significantly more individuals with health care expertise,
networks, primarily CNN but increasingly also MSNBC, should reconsider their
approach to implementing political balance in their discussion-based segments by
employing a variety of conservative commentators, especially those pundits are hired to
explicitly represent the Trump perspective. These individuals embody the worst aspects
of argument culture in discussion-based segments, as they are notorious for making
incendiary comments that might make for a viral news clip but collapse the informational
quality of the segments in which they participate. This practice has already resulted in
numerous scandals for CNN. Jeffrey Lord called Trump the “Martin Luther King of
health care,” which resulted in what Washington Post reporter Derek Hawkins called “a
full day’s worth of high-decibel CNN entertainment” but eviscerated the substantive
quality of health care discussions for the whole day, which now focused on Lord’s gaffe
rather than the substance of the GOP health care bill (Hawkins, 2017). CNN continued to
employ Lord until his use of a Nazi slogan in a tweet finally prompted the network to cut
ties (Grynbaum, 2017). CNN employs Stephen Moore as an economics expert, despite
his well-chronicled history of “shoddy predictions, intentional misinformation, and
misleading claims” (Harrington, 2017). The fact that the network positions Moore as an
expert makes his consistent efforts at pushing misinformed and distorted claims about
health care even worse, as the expert signifier tells the audience his claims should be
taken seriously. These Trump surrogates consistently repeated false claims, reinforced
conservative talking points, and diverted conversations from discussions of the impact of
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the GOP proposal to debates over the relative merits of the ACA. Establishing viewpoint
diversity should not require the employment of individuals who serially misinform the
cable news audience. Just because the President repeatedly pushes a variety of lies does
not mean cable news needs to employ people to do the same.
The Role of Journalism Schools
The recommendations included in this chapter range from small reforms at the
margins that still substantially bolster the informational quality of cable news coverage of
health care to suggestions that require cable news networks, program hosts, and
correspondents to fundamentally reconsider how to report on public policy debates.
These recommendations were written in order to maximize the feasibility of their
implementation, with an eye to the competing influences facing cable news networks,
between the necessity of maintaining a profitable bottom line and the normative ideal of
providing an informational news product. While this project attributes many of the
problematic trends in the cable news coverage of the GOP health care debates to the logic
of infotainment carried out to excess, it still recognizes the fundamental - and inevitable -
need to make cable news programs appealing to the audience. As John Avlon, the editor-
in-chief of The Daily Beast and a CNN political analyst, succinctly noted, “there’s no
shame in recognizing that we need to entertain while we educate” (Avlon, 2016). The
problem, as identified by this project, occurs when the news value of cable news
coverage of public policy debates becomes entirely subordinate to the entertainment
value.
Changing the way cable news networks approach covering public policy debates
and political news in general requires changing the mindset of journalists in how they
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approach their job. Delli Carpini (2005) argued that “changing the way public affairs are
covered requires changing the world-view - the schema - of journalists” (p. 38). This
requires journalists to acknowledge that the production of the news “is far more
subjective and far less detached than the aura of objectivity implies” (Cunningham,
2003). Part of the solution here might lay in reforming journalism schools, implementing
policies similar to the reforms instituted at University of Colorado, Boulder’s Journalism
and Mass Communication Program that require journalism students to obtain minors
outside of the journalism school to develop a separate area of expertise (Krueger, 2014).
Debates over reforming how journalism schools prepare the next generation of journalists
have raged for years, and many have criticized j-schools for failing to evolve in response
to the technological changes confronting the practice of journalism (Finburg, 2013;
Marcus, 2014). Now more than ever it is pressing for these schools to reconsider how
they train students in terms of what skills and values are prioritized and how programs
approach the traditional norms of objectivity and balance in the current political
environment.
Beyond curriculum changes, journalism schools should take an active role in
fostering public debate and dialogue about journalism and the coverage of public policy
issues. In particular, journalism schools could create media criticism centers or programs
– a sort of in-house version of the Columbia Journalism Review – aimed at promoting the
best practices for reporting on complex public policy issues. These centers can recognize
good coverage and highlight efforts by particular journalists or outlets that represent
exemplary reporting on public policy debates. Similarly, they should also engage in
constructive media criticism, critiquing flawed reporting techniques, noting when outlets
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propagate misinformation or flawed narratives, and providing recommendations for how
to improve reporting and highlight best practices. These centers could be generalists or
be dedicated to specific issues. The Center for Health Journalism at the University of
Southern California provides an example of a program aimed at fostering better media
coverage of health policy, as it provides fellowships and training programs to young
journalists in addition to highlighting superior reporting across the country on health
issues. Furthermore, the Center for Health Journalism hosts interactive webinars and
events with experts discussing the nitty gritty details of health care policy controversies
as they emerge, giving reporters the opportunity to unpack complex policy issues and
understand events in order to foster quality reporting. These types of events could be
integrated into journalism schools, either as a part of or independent of any media
watchdog center, as a mechanism to help develop reporters’ policy knowledge.
Integrating watchdog-style organizations into journalism schools can help foster public
deliberation, both within the school and in the broader public, about what are the
informational needs of the audience and what are the best practices to meet those needs.
Some might argue that the problems identified in this project with cable news
reflect long standing, entrenched norms that make any productive change in how cable
news approaches covering the political sphere incredibly unlikely. However, the
developments of the past year in cable news generally indicate that this pessimistic view
of cable news’ capacity for reform is unwarranted. Many of the most problematic
segments identified on MSNBC during this study involved Greta Van Susteren - who
lasted barely six months at the network (Fox, 2017). While most attribute her departure
from the network to the lagging viewership of her show, MSNBC’s choice of Ari Melber
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to replace her represents a positive step toward improving cable news coverage of policy
issues. While Melber checks the traditional cable news requirements of the attractive,
charismatic anchor, as a former First Amendment lawyer and political strategist, Melber
“approaches journalism as though he were working the courtroom, probing witnesses,
circumventing circumventers, and pushing for resolution” (Krueger, 2014). Melber brings
a level of expertise to his hosting that reflects the need for “people with actual knowledge
of the subjects they are reporting” because “people who have an expertise reflect that
expertise on the air. They have an additional dimension besides just a nice personality,”
according to Frank Sesno, the director of George Washington University’s School of
Media and Public Affairs (Krueger, 2014). The success of Melber’s show thus far
indicates that there exists an appetite for this “journalism of expertise” (Krueger, 2014;
Barr, 2017). Additionally, the practice of journalism has gone through radical changes
over the course of history, as technological innovations and market transformations have
forced journalist to reform and retool, even though “these actions are painful and go
against the community’s dogmatic, petulant, and stubborn nature” (Meltzer, 2010, p.
171). Even with the increasing reliance on social media and online news sources,
“television news will not fade away” because “the same basic psychological, social, and
intellectual needs that have always caused audience members to seek out and connect
with particular types of journalists and journalism will continue” (Meltzer, 2010, p. 179).
Thus, the rate of change might be slow - after all it did take Jeffrey Lord tweeting a Nazi
salute for CNN to finally cut ties - but progress is possible.
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The Role of the Audience
While cable news networks can and should reform how they approach covering
important public policy issues such as health care, the challenges of the new media
environment and the current landscape of the political sphere require citizens to take the
search for valid information into their own hands. While the odds of all Americans
suddenly becoming fascinated with the intricacies of health care policy are about as likely
as CNN turning into the PBS NewsHour, “even small changes… can make important
differences” (Bennett, 2016, p. 222). In the concluding chapter of his book News: The
Politics of Illusion, Bennett (2016) argues that “if people learn to read between the lines
and see beyond the images” in the news, “they can reduce their frustration and
confusion” because becoming informed is not just “reading more papers or watching
more television” but rather “it means decoding the information from these and other
sources with a critical eye” (p. 223). In the context of cable news, this requires
individuals to perhaps watch more than just the cable network that offers up information
that reinforces one’s pre-existing convictions and beliefs, to seek programs that
“challenge those beliefs with information that is at odds with them” (Bennett, 2016, p.
224). Paying closer attention to what type of guest is making claims during discussion-
based segments and evaluating how their professional affiliation or background might
influence the arguments being made. Seeing past the buzzwords about “state flexibility”
or “access to care” or “universal coverage” to process the quality of the arguments put
forth on cable news, rather than passively accepting terms that trigger ideological
processing of information. While these tasks require more cognitive effort and time spent
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by the audience in seeking information about health care policy, even small steps in this
direction may help Americans unpack this complex public policy arena.
This should not, however, be read as a call for increased skepticism across the
board. As Bennett argued, “the goal of news criticism is not to reject everything – it is to
think confidently and independently about world events… Nor is the point to distrust all
authorities – it is to trust your own judgment” (Bennett, 2016, p. 225). This connects to
the existing scholarship on media literacy, which aims “to help individuals [to]
understand the constraints of the news process, the role the press plays in American
democracy, and [to] develop critical thinking skills to analyze news content” (Vraga &
Tully, 2015, p. 423). A promising new program tested in the Ukraine called ‘Learn to
Discern,’ indicates that media literacy programs might help individuals understand
“where their news was coming from” and how to “detect disinformation” (Guernsey,
2018). This program, run by IREX, a global education nonprofit, provided media training
and exercises to a group of individuals and a follow-up study showed that “the program
actually was able to change participants’ behavior – even 18 months after they’d
completed the course” (Owen, 2018). Learn to Discern builds on the growing momentum
of media literacy “as educators look to help their students take a more critical eye to the
news,” indicating the potential for programs outside the education system in addition to
universities and formal training programs to arm individuals with the skills they need to
become more refined media consumers (Guernsey, 2018). Particularly in the current
climate where misinformation permeates so many of the discussions about health care
policy, citizens must become more discerning consumers of media content and a renewed
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emphasis on media literacy training may be a key component in arming the American
citizenry with the skills they need.
Key Contributions, Limitations, and Future Research
This dissertation provides important contributions to the understanding of the
varied approaches in how cable news covers health care policy. First, this project adds to
the limited scholarship that currently exists on cable news by examining the different
types of segments within cable news programs to illustrate how different features of
distinct segment types influence the substantive content of policy coverage. Whereas
previous research examined cable news programs as a whole or looked at segments
unique to a particular show, this project establishes a typology of cable news segments
that exist on CNN, MSNBC and Fox News alike, and compares the use and substantive
content of these segments across all three networks. Furthermore, the structural nature of
the analysis in this project means that this approach can potentially be applied to other
public policy domains. While this project focused on health care, the structural critiques
could be used to analyze other public policy controversies, particularly those that are
prone to narratives of misinformation (the recent tax bill debate or the continued fight
over immigration reform comes to mind).
This project deepens the current understanding of cable news networks by
explicitly grounding this study in the literature on the traditional journalistic norms of
objectivity, balance, and neutrality. While many scholars have examined how cable news
strays from traditional conceptions of objective journalism, this project examines how the
norms of traditional journalism shape cable news coverage and interact with the
competing influence of infotainment. The structural approach used in this dissertation
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facilitated an in-depth examination of how traditional norms manifested in different ways
in different segments types. For instance, Chapter 3 illustrated the problem with a severe
lack of political balance in straight news reports while Chapter 4 demonstrated the
complications that arose when cable news hosts prioritized balance as the guiding
principle in discussion-based segments. These results are not contradictory but instead
illustrate how the excessive adherence or abandonment of journalistic norms can
compromise the quality of cable news coverage in similar ways, as both instances
resulted in the amplification of conservative narratives and misinformation. This project
illustrates the need for a more sophisticated approach in how scholars approach the
critique or veneration of journalistic norms in the study of cable news that is
contextualized to the specific features of different types of segments.
This project reinforces the previous scholarship that casts doubt on the integrity of
Fox News as a journalistic outlet and, in particular, this study illustrates the pervasiveness
of conservative narratives and misinformation in cable news discourse on health care
policy across the board. The discussion of Fox News hosts featured in Chapter 4
reaffirms the findings by Bard (2017) that held that the lack of allegiance to the truth
displayed in the conservative network’s coverage of health care policy problematizes
attempts to study the network as a journalistic outlet, as it resembles the traditional
elements of propaganda rather than journalism. While the negative outlook for Fox News
hardly constitutes a revolutionary result, the degree to which conservative talking points
and misinformed narratives pervaded the coverage of health care policy on CNN and
MSNBC should give pause. Whether through the uncritical airing of sound bites of
conservative legislators pushing distorted talking points or problematic repetition of
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conservative narratives in ‘devil’s advocate’ style questioning by hosts or the
employment of Trump surrogates as pundits, the ostensibly non-partisan CNN and to a
lesser degree the liberal MSNBC inadvertently amplified Republican perspectives and
arguments in their coverage of the GOP health care debates. Admittedly, some of this
focus can be attributed to the fact that the Republican Party controls the White House and
both chambers of Congress, and the findings of this study are limited to this particular
iteration of health care reform. However, the history of health care reform debates in the
United States illustrates the propensity for misinformation to take root (Nyhan, 2010;
Quadagno, 2005), and the degree to which these networks gave airtime to demonstrably
false narratives about the Congressional Budget Office or the health of the Affordable
Care Act reveals fundamental flaws in how CNN and MSNBC approached reporting on
health care policy. In a world where health care policy has become fundamentally
polarized, cable news networks must develop a new vocabulary for discussing health care
reform proposals that avoids the pitfalls outlined in this project.
While this dissertation adds unique insights into how cable news covers public
policy, filling a hole in the scholarship that largely looks at broadcast coverage of
elections when examining the role of television news, there are limitations to this study.
First and foremost, this study makes no definitive causal claims about how cable news
coverage affected public knowledge levels about the Republican health care proposals or
the American health care system overall. While an experimental component was outside
the bounds of this study, the trends in how cable news programs discussed health care
policy in the different types of segments analyzed in this project could provide the basis
for future research that could examine the impact of the different phenomenon identified
185
in this project. For instance, future scholarship could (and should) examine the impact of
partisan sound bites on public comprehension of health care policy, in particular
investigating whether or not the uncritical repetition of falsehoods and misinformation
distorts public knowledge of reform proposals or the American health care system
overall. Subsequent research could also expand the current literature on the role of the
experts in cable news coverage and examine whether the presence of an expert in a
discussion-based segment impacts overall knowledge levels and/or whether the existence
of an expert on a panel causes the audience to more critically analyze claims made by
other participants in the segment.
Similarly, this project largely avoids questions about the role of emotion in
influencing how the audience consumes information in cable news programs. The
recommendations for reimagining the role of the cable news host that advocates for an
empowered anchor that engages in a more aggressive pursuit of the truth could be
investigated in an experimental setting, expanding on the work done by previous scholars
on incivility in discussion-based segments (Mutz, 2015; Meltzer, 2010, Ben-Porath,
2010). However, this research should go beyond the civil/uncivil dichotomy examined by
previous research and investigate whether or not “context-specific expectations” held by
the audience cause them to respond differently to hosts forcefully fact checking
demonstrably false claims versus hosts engaged in baselessly aggressive interview tactics
(Ben-Porath, 2010, p. 341).
This project only examined primetime coverage of health care policy on cable
news networks, in line with much of the previous work done on cable news (and
television news generally) given that viewership is typically the highest at that point in
186
time. Daytime cable news presents a more challenging data set to study, as transcripts for
non-primetime shows are only available for CNN. However, the unique dimensions of
daytime cable news, including an increased emphasis on interviews and straight news
reports, could provide an interesting avenue of comparison to primetime coverage,
particularly to investigate whether differences in substantive quality of policy coverage
exist between the two time periods. While this dissertation excluded weekend coverage to
create a more manageable data set, other scholarship has shown the vital role the ‘Sunday
shows’ play in influencing the political sphere (Baitinger, 2015), indicating an avenue for
future research to examine how the Sunday shows discuss public policy issues,
particularly given the emphasis on interviews with elected representatives during those
programs.
Finally, and perhaps most importantly, the nature of cable news, the current state
of American politics, and the audience who consumes this type of media might make any
improvement simply impossible. The majority of the cable news audience represents
political partisans – individuals with a partisan affiliation who are interested in politics –
as non-partisans increasingly choose entertainment options over political news shows
(Hollander, 2008). In commenting on the increasing viewership numbers of cable news
since the 2016 election, Adam Klein, an adjunct professor at Columbia Journalism
School, noted that “both sides of the political spectrum are looking for reassurance and
guidance about their own narrative at the moment… a place of like-minded thinking”
(Berg, 2017). While cable news viewership might be increasing, this could simply be an
increase in political partisans choosing cable news as their preferred news source, rather
than a general broadening of the cable news audience. These individuals are more likely
187
to hold pre-existing opinions on issues like health care policy that are determined by
political party affiliation – particularly given the polarized nature of Obamacare and the
repeal attempts – making them less susceptible to new knowledge that might change their
opinions (Blendon, Benson, & Casey, 2016). In essence, these individuals watch cable
news shows as a form of political sport – for entertainment and confirmation of their
existing partisan beliefs rather than for information. This might vindicate the trend within
cable news coverage of health care policy toward strategic framing and the dominance of
pundits and political journalists in discussion-based segments and casts doubt on the
viability of the reforms outlined earlier in this chapter. The most cynical view of this
project holds that the recommendations forwarded in this project simply don’t matter
because politics in the United States has become so tribalized that political party
identification predetermines how individuals respond to cable news coverage of health
care policy. While parts of this dissertation might be shouting into the void, the work
done in this project is normative – even if the audience impact might be minimal, even
marginal improvements in public comprehension of health care policy matter. This
project examines the flaws in cable news coverage of the health care and maps out a
series of recommendations in service of what the normative of cable news networks
should be in covering health care policy, even if the chances of practical implementation
of the reforms is low.
Despite these limitations, this dissertation provides an overview of the most
pressing issues in how cable news networks report on health care debates and provides a
practical guide for moving forward to improve the substantive quality of cable news
coverage of health care. This project focused on cable news coverage of health care
188
policy for a variety of reasons, including personal passion for health care policy, the
importance of health care to all Americans, and the immense impact the GOP proposals
would have had on the American health care system. However, perhaps the most
important reason for analyzing cable news coverage of health care policy revolves around
the fact that the Republican attempt to undermine and repeal the Affordable Care Act will
likely continue throughout the Trump presidency, elevating the need for cable news
networks to improve their reporting in this policy arena in particular. Since the failure of
the Senate bill in July 2017, Congress has considered multiple other repeal bills, several
proposals to shore up the ACA’s individual markets, and passed a tax bill that repealed
the ACA’s individual mandate (Haberkorn, Everett, & Kim, 2017; Matthews, 2017b).
Trump has independently taken several actions to sabotage the Obama-era health law
including ending the cost-sharing payments to insurers, signed an executive order to
allow short-term and association health plans to be sold on the individual marketplaces,
and actively encouraged and approved state proposals to institute work requirements for
Medicaid (Dickinson, 2017; Cancryn & Demko, 2017; Englehard, 2018). Given that
Republicans have pledged for the last eight years to repeal Obamacare and will likely
continue to seek opportunities to make good on that promise, it is vital for cable news
networks to recognize the flaws in how they have approached covering health care policy
debates thus far and ameliorate those issues moving forward.

189

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Asset Metadata

Creator Duffy, Cat (Caitlin) (author)

Core Title Pundits, panels, but no policy: the normative role of cable news in communicating health care policy to the public

School Annenberg School for Communication

Degree Doctor of Philosophy

Degree Program Communication

Publication Date 08/07/2018

Defense Date 05/31/2018

Publisher University of Southern California (original), University of Southern California. Libraries (digital)

Tag cable news,health care,media criticism,OAI-PMH Harvest,political communication

Format application/pdf (imt)

Language English

Contributor Electronically uploaded by the author (provenance)

Advisor Hollihan, Thomas (committee chair), Crigler, Ann (committee member), Stables, Gordon (committee member)

Creator Email catduffy@gmail.com,duffycai@usc.edu

Permanent Link (DOI) https://doi.org/10.25549/usctheses-c89-59094

Unique identifier UC11671680

Identifier etd-DuffyCatCa-6678.pdf (filename),usctheses-c89-59094 (legacy record id)

Legacy Identifier etd-DuffyCatCa-6678.pdf

Dmrecord 59094

Document Type Dissertation

Format application/pdf (imt)

Rights Duffy, Cat (Caitlin)

Type texts

Source University of Southern California (contributing entity), University of Southern California Dissertations and Theses (collection)

Access Conditions The author retains rights to his/her dissertation, thesis or other graduate work according to U.S. copyright law. Electronic access is being provided by the USC Libraries in agreement with the a...

Repository Name University of Southern California Digital Library

Repository Location USC Digital Library, University of Southern California, University Park Campus MC 2810, 3434 South Grand Avenue, 2nd Floor, Los Angeles, California 90089-2810, USA