March 29, 2016 — Sarah Kliff, deputy managing editor for visuals at Vox, discussed media coverage of the Affordable Care Act, what’s next for health care policy, and Vox’s approach to covering policy.

Kliff, whose work has included coverage for Vox, The Washington Post, Politico, and Newsweek, began reporting on health care policy in April 2010, the month after the Affordable Care Act passed. Her friends were baffled at the time, she said, wondering what she would write about with the large legislative battle seemingly over. Yet the past six years proved to be anything but boring, with multiple Supreme Court cases and a government shutdown challenging the law, as well as differences in implementation at the state level.

“Implementation and regulation are not usually the most exciting beats to have, but with health care they really were,” said Kliff. The Affordable Care Act is also a “big sprawling law,” and encompasses more than health insurance and Medicaid expansion. Other parts of the law include a tax on tanning salons and requirements for calorie labels at fast food restaurants, to name a few examples, explained Kliff.

Media coverage of the Affordable Care Act has been especially important in how people view the effects of the legislation, said Kliff, as 6 percent of the U.S. population gained coverage after its passage—the majority of Americans who already received health care through their employer experienced little change. “Most of us aren’t experiencing Obamacare directly, we’re learning about it secondhand from news sources and the people that we talk to,” she said.

“If you’re someone who’s in favor of Obamacare…you’re probably watching the TV networks that are saying good things about Obamacare. You’re hearing this reinforced story about the good things that Obamacare is doing like expanding insurance or that health care costs are growing at slower rates,” said Kliff. “If you’re someone who already opposes Obamacare, you’re probably hearing stories about all the people who are harmed by Obamacare and the people who lost insurance and the people who have had their premiums go up. And both of these are true stories…but the set of stories becomes very polarized, very separate,” she said. “It’s very easy to live in two different worlds where Obamacare is a completely different law.”

As a result, public opinion has changed little since the passage of the law. “In April 2010, 46 percent approved and 40 percent disapproved. This year, 41 percent approved, 46 percent disapproved,” said Kliff. When asked about whether the Obama administration could have done more to influence public opinion, she was doubtful, given the current climate of polarization, with many people viewing “Obamacare as a proxy for Obama.”

Turning toward the 2016 presidential election, Kliff observed that the focus for Republicans is different than in 2012, when the party pushed to stop the implementation of the Affordable Care Act. “In this election cycle, there’s definitely a lot less Obamacare repeal talk” in the debates and at campaign events, she said. Previously, “the gains of Obamacare were mostly theoretical…now those people have insurance, and now when you talk about repealing Obamacare, you’re talking about taking away their insurance, and that really changes the debate.”

The 2016 campaigns have instead been characterized by “grandiose” plans that “fall a bit short of their promises,” said Kliff. Bernie Sanders’ single-payer plan as it was initially released, “likely falls short of paying for all of the health care that it offers,” she said, as it made assumptions about prescription drugs savings “that weren’t quite right.” Donald Trump set himself apart from other Republicans by saying that everyone would have access to better options than those provided by the Affordable Care Act, but the details of his plan don’t deliver on that promise, said Kliff. “It looks very similar to a typical Republican repeal plan. The [Committee] for a Responsible [Federal] Budget in Washington estimated that 21 million people would lose insurance.”

With 27 million people still uninsured and “incredibly high” health care prices, “there’s a lot of work left to do, and 2016 seems to be the election where the conversation is just starting about that next level of work,” said Kliff.

Kliff also discussed Vox’s approach to covering policy. “Vox is an argument about what was missing in journalism,” she said. She and Ezra Klein learned at Wonkblog that there was “a real appetite for policy news,” but that readers didn’t have a “great resource” for learning about policy. “We took the questions that people had and we tried to answer them to the best of our ability, and I think that’s what Vox grew out of,” she said.

“One of the founding ideas of Vox is that if readers aren’t interested in our stories, that’s not a policy issue. We can’t just say ‘that’s a boring issue, that’s not going to get attention.’ That’s on us as journalists. We have to work harder to make our stories more accessible and more interesting,” Kliff continued. At Vox, this has meant, among other tactics, the production of their popular explainers, as well as interactive features with “payoff” for the reader, such as a tax calculator that shows the reader’s tax rate under each presidential candidate’s tax plan.

During the question and answer session, Kliff also discussed access to women’s health care and contraception at the state level, the challenges of implementing a single-payer system, improving the efficiency and outcomes of health care spending, and her tips for aspiring policy reporters, among other topics. Listen to the full audio recording above.

Article and photo by Nilagia McCoy of the Shorenstein Center.