HEALTH COVERAGE RESEARCH

Appalachian Kentucky newspapers emphasize political voices on Obamacare

By Justin Richter and Al Cross
University of Kentucky College of Communication and Information
Appalachian Kentucky newspapers gave their readers limited information about the Patient Protection and Affordable Care Act in the two months before the Oct. 1 rollout of the law, and their coverage of it was dominated by opinions of public officials, largely those opposed to the law. Coverage improved in October, but still left much to be desired.
The research on coverage of what is widely called Obamacare was conducted by the Institute for RuralJournalism and Community Issues, part of the School of Journalism and Telecommunications at the University of Kentucky.
An estimated 640,000 Kentuckians have no health insurance, so “Any news about obtaining it seems like a worthy topic for publication,” said Al Cross, director of the Institute, who supervised the research as part of work funded by the Foundation for a Healthy Kentucky.
The research examined most of the newspapers in one of the unhealthiest and poorest regions of the country to see how well they were helping their communities deal with huge changes in the health-insurance system.  Despite the law’s importance and effect on individuals, six of the 39 newspapers published nothing about Obamacare, and nine of them published just one article about the law.
Appalachian Kentucky has 54 counties with 61 newspapers; many are small weeklies, and only six are dailies. Weekly newspapers generally limit their coverage to local news and are not members of The Associated Press, which provides state and national news. However, about half the weeklies in Kentucky participate in a story-sharing service operated by the Kentucky Press Association, and all of them receive weekly updates from Kentucky Health News, a publication of the Institute for Rural Journalism and Community Issues.
While only about half of Kentucky weeklies have regular editorial pages, and only a third have regular editorials (even when broadly defined as a column from the editor or publisher), about 40 percent of the Obamacare coverage in Kentucky Appalachian newspapers consisted of opinion columns, usually from politicians or commentators opposed to the law.
From Aug. 1 to Oct. 31, the law was the topic of 40 opinion articles, 49 news stories and 12 press releases. Many of the news stories reported mainly on opinions delivered by politicians opposed to the law, such as Republican U.S. Sen. Mitch McConnell.
McConnell figured large in coverage throughout the three-month period.  About one-fourth of all Obamacare coverage in Appalachian Kentucky newspapers was about McConnell’s opinions, either by publication of a column from him or coverage of his expression of opinion.
During the period, McConnell continued a tour that he said had taken him to more than 50 Kentucky hospitals in the last three years.  At each stop, he attacked Obamacare, and that was the subject of six news stories in the papers examined. He made the same attack and mentioned the tour in opinion pieces headlined “Kentuckians still don’t like Obamacare,” which appeared in five of the 38 papers examined. A later column, “Kentuckians Still Not Buying Obamacare,” appeared twice in the papers surveyed.  Overall, the senator was either a dominant voice in, or the writer of, 24.5 percent of all stories.
Five other public officials gave their opinions on the law through opinion articles, including Democratic Gov. Steve Beshear, who has embraced the law by expanding Medicaid and creating the state's own health-insurance exchange.  Commentators included political analysts and two anonymous writers, generally opposed to the law.
Before the Oct. 1 rollout, 69 percent of news stories were dominated by public officials’ opinions of Obamacare.  In October, that declined to about 40 percent.  Sources like the Associated Press, Kentucky Health News, and other sources were used in more than half the articles published in October.   
The research period included the August congressional recess, which included two major political events: the speaking at the Fancy Farm Picnic in far Western Kentucky and the Kentucky Farm Bureau’s Country Ham Breakfast at the state fair, at which Beshear and Republicans traded jabs about Obamacare. Nine stories on those events appeared in the newspapers surveyed.
Overall, a lack of journalistic enterprise was seen in the newspapers.  Four papers showed enterprise by doing their own stories in advance of the exchange and noting the number or percentage of people in their counties that were estimated to have no health coverage.
The uninsured angle was emphasized by Tom Mills of the Greensburg Record-Herald and Janie Slavin of the McCreary County Record, both in Southern Kentucky, an area where the percentage of uninsured is greatest. These stories gave information on the opportunity to become insured, and gave others in the county an opportunity to realize the significant number of their neighbors who lack health insurance.
Such statistics were also mentioned by Tony Fyffe of the Louisa-based Big Sandy News and Amelia Holliday of the Hazard Herald in front-page stories the week before the exchange opened.
The Greensburg story was based partly on, and gave credit to, Kentucky Health News. Two other papers ran a KHN story about the fact that smokers would pay as much as a 40 percent surcharge for premiums on the exchange.
The Mountain Eagle in Letcher County published “New Health Care Law Appears Popular Here,” a story that related the positive experiences of staffers at a Whitesburg medical clinic since the rollout.  The story quoted Teresa Fleming after helping individuals receive coverage: “I keep saying hope. That’s what this is.”
During the research period, the Appalachian Kentucky newspapers in the survey published 12 press releases that gave readers factual information that could be helpful. “The Affordable Care Act is Upon Us - What We Need to Know” appeared in the Licking Valley Courier of West Liberty.  This release from Kentucky Voices for Health was free of political representations, gave statistics and conclusions from Kaiser Family Foundation studies, and informed Morgan County readers of the law’s individual mandate and options for obtaining health insurance. 
Kentucky Voices for Health does not lobby, but is an umbrella organization for lobbies that say everyone should have affordable, high-quality health insurance. Its executive director, Regan Hunt, said perhaps one in 20 newspapers of in the state publish her releases, even less so in Appalachian Kentucky. She said she has provided information to advocates in Appalachia so they could write their own articles for local newspapers, but they were published “very rarely.”


Justin Richter is a student in the College of Communication and Information at the University of Kentucky. Al Cross is an associate extension professor in the college’s School of Journalism and Telecommunications and director of the school’s Institute for Rural Journalism and Community Issues. This article was researched and written as part of an independent-study course.


PRELIMINARY STORY ON FIRST TWO MONTHS OF RESEARCH:

By Justin Richter
University of Kentucky College of Communication and Information
Newspaper readers in Appalachian Kentucky rarely had the opportunity to read factual, impartial information about health-care reform in the two months before the new health-insurance system opened for enrollment. 
That is among the preliminary findings of an ongoing study by the Institute for Rural Journalism and Community Issues, part of the School of Journalism and Telecommunications at the University of Kentucky.  The research found that coverage was dominated by opinions of public officials, largely those opposed to the law.
The research examined most newspapers in one of the unhealthiest and poorest regions of the country to see how well they were preparing their communities for a huge change in the health-insurance system.  An estimated 640,000 Kentuckians have no health insurance, so “Any news about obtaining it seems like a worthy topic for publication,” said Al Cross, director of the Institute.
Appalachian Kentucky has 54 counties with 61 newspapers. The study examined the 39 available at the University of Kentucky, or 64 percent of the total. Many of the papers are small weeklies; only six are dailies.
Eight of the 39 papers published nothing in August and September about the Kentucky Health Benefits Exchange, an insurance marketplace created under the reform law – the Patient Protection and Affordable Care Act, widely known as Obamacare.
Of the 61 articles the other newspapers published on Obamacare in the two-month period, 21 were opinion articles, mainly from public officials; six were press releases from organizations supporting the law, all of them factual; two were fact-based columns; and 32 were news stories.
While most of the articles were news stories, 22 of the 32 stories were dominated by the opinions of public officials, largely those opposing the law. Only 10 of the news stories were based largely on fact rather than opinion. In addition to the six fact-based press releases, other fact-based articles were a short item about a community forum in an extension agent’s column, and a column by a journalist criticizing politicians for misinforming the public about issues, including Obamacare.
               The research period included the August congressional recess, which included two major political events: the speaking at the Fancy Farm Picnic in far Western Kentucky and the Kentucky Farm Bureau’s Country Ham Breakfast at the state fair, at which Democratic Gov. Steve Beshear and Republicans traded jabs about Obamacare. Nine stories on those events appeared in the Appalachian newspapers surveyed.
During August, Republican U.S. Sen. Mitch McConnell continued a tour that he said had taken him to 51 hospitals in the last three years.  At each stop, he attacked Obamacare, and that was the subject of six news stories in the papers examined. He made the same attack and mentioned the tour in opinion pieces headlined “Kentuckians still don’t like Obamacare,” which appeared in five of the 39 papers examined.
All told, McConnell’s opinion was reflected in more than a quarter of all articles found about Obamacare, and some newspapers gave the senator two bites of the apple.  For example, his hospital tour was covered in the Appalachian News-Express of Pikeville as a news story on Aug. 17; on Sept. 18, his opinion article appeared in the thrice-weekly paper. 
Thus, political voices overwhelmed those of independent, authoritative sources and journalists.  Public officials were able to use their positions and influence to dominate the conversation on Obamacare.
There were exceptions.  The News-Express ran a comprehensive story about Obamacare and the opening of the insurance exchange on Sept. 25. The story was written by Robyn L. Minor of the Daily News in Bowling Green, which circulates in the western Appalachian counties of Edmonson and Hart; it was distributed statewide by the Kentucky Press News Service, a story-sharing service of the Kentucky Press Association. A similar story in the Lexington Herald-Leader, which circulates in Appalachian Kentucky, was distributed by the service, but the study did not examine the Herald-Leader’s coverage.
Four Appalachian newspapers showed enterprise in doing their own stories in advance of the exchange and noted the number or percentage of people in their counties that were estimated to have no health coverage.
The uninsured angle was emphasized by Tom Mills of the Greensburg Record-Herald and Janie Slavin of the McCreary County Record. These stories gave information on the opportunity to become insured, and gave others in the county an opportunity to realize the significant number of their neighbors who lack health insurance.
The statistics were also mentioned by Tony Fyffe of the Big Sandy News and Amelia Holliday of the Hazard Herald in front-page stories the week before the exchange opened.
The Greensburg story was based partly on, and gave credit to, Kentucky Health News – the service of the Institute for Rural Journalism and Community Issues that provides health coverage to Kentucky newspapers. Two other papers ran a KHN story about the fact that smokers would pay as much as a 40 percent surcharge for premiums on the exchange.
               Among the press releases, the most comprehensive was from Kentucky Voices for Health. “The Affordable Care Act is Upon Us - What We Need to Know” appeared in only one of the 39 papers examined, the Licking Valley Courier of West Liberty.  This release was free of political representations, gave statistics and conclusions from Kaiser Family Foundation studies, and informed Morgan County readers of the law’s individual mandate and options for obtaining health insurance. 
Kentucky Voices for Health does not lobby, but is an umbrella organization for lobbies that say everyone should have affordable, high-quality health insurance. Its executive director, Regan Hunt, said perhaps one in 20 newspapers publish her releases, even less so in Appalachian Kentucky. She said she has provided information to advocates in Appalachia so they could write their own articles for local newspapers, but they are published “very rarely.”

So, as the opening of the exchange approached, there was a general lack of journalism about Obamacare in Appalachian Kentucky, as politicians’ appearances and opinions were the main source of information. The study is continuing, and the Institute will report on October coverage sometime in November.

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