Exploring Health Care-Related Media and the Implications for Reform

• In Event: Public Opinion and the COVID-19 Pandemic

Abstract

Background
The media play a complex role in public understanding of health politics and policy. Research has established that media serves as a communication mode that can provide cues and influence policy and attitudes about policy (Petersen et al. 2010, Rose and Baumgartner 2013). Additional work has suggested that the media can initiate or reinforce beliefs of who deserves policy benefits (Brady and Sniderman, 1985; Gilens, 2009). The current debate around health and health care policy in the U.S. offers motivation to further understand how the media depicts those deserving of a health care policy benefit (access to health insurance) and offer insights of how this might impact attitudes about new or existing policies (Medicare for All or Medicaid expansions) and behaviors targeted by these policies (health insurance enrollment). Health care reform efforts have stalled at questions of financing - who pays and how much will it cost- and also around beneficiaries - who gets insurance and why? An understanding of how groups commonly viewed as deserving of social policy benefits - such as children, disabled adults, or the elderly (Ingram and Schneider, 2005) - are depicted in health care-related media (in this study, health insurance advertisements) is necessary to research and advocacy that seeks to promote policies that address health and health care needs alongside related, embroiled politics.

Research Motivation
Evidence that health care policy-related media can be highly politicized; that television advertisements are important to behaviors targeted by health care policy; that gaps in research around the content of advertisements persist; and that health reform remains on the policy agenda, provide the motivation for this work. This study builds on recent scholarship exploring the content and implications of health care policy-related media (see Gollust, Franklin Fowler, and Niederdeppe, 2020 for a review of this work). Of note, studies have documented the extent that local television news content related to the Affordable Care Act featured political debate rather than policy-relevant information (Gollust, et al 2017) as well as the relationship between health care-related media and behaviors targeted by the ACA. Related to the latter, one study illuminated the effects of health insurance television advertisements on health insurance enrollment and information-seeking, and found that more individuals enrolled in health plans in areas where more health insurance television ads aired (Karaca-Mandic, et. al 2017). One related study explored the individuals featured in health insurance advertisements and the behaviors they were engaging in (e.g. behaving in a way so as to convey they were young and invincible), though the authors leveraged a small sample of ads and did not code every individual featured in the ad (Barry, et al 2018).

Methods
This study will focus on two related research questions:
1.What individuals and family structures are featured in health insurance advertisements?
H0: Individuals and family structures depicted largely reflect populations perceived as deserving (the elderly, children, and two-parent families).
2.How representative are these depictions of the populations targeted in new and existing health care policy, including those targeting COVID-19-related disparities?
H0: Individuals of color, single pregnant women, and individuals with disabilities will not be featured in a large proportion of advertisements.

Using data from Kantar Media’s Campaign Media Analysis Group of ads that aired on local television or national cable in each of the 210 US media markets between January 1 and December 15, 2018, I will summarize overall trends in the populations depicted and analyze how populations differ by the type of insurance product advertised. Specifically, I will focus the analysis on advertisements for Medicaid plans as compared to non-Medicaid plans. Additionally, I will run logistic regressions to assess the effects of different modifiers, such as the length of an ad (assuming longer ads have more opportunity to depict individuals).

Implications
The implications of this research are particularly salient in light of the generation defining public health crisis at hand - COVID-19. The COVID-19 global pandemic and resulting inequities in incidence, burden, and death, underscore the need for the baseline resulting from this work: an understanding of how populations in need of health insurance, and by extension, health care services, were depicted in media content airing pre-pandemic and the stereotypes these depictions may initiate or reinforce. Findings will be critical to efforts to inform policymaking and outreach among numerous stakeholders; to ensure that what is introduced as a temporary policy in a time of crisis (e.g. the CARES Act) is targeted effectively so as to withstand political debate and address misconceptions.

Author

• Margaret Tait, University of Minnesota-Twin Cities