Senate Majority Leader Mitch McConnell, who is overseeing GOP efforts to pass new health-care legislation. Gage Skidmore, via Flickr

IN A RECENT STORY FOR The Atlantic, Kaiser Health News reporter Julie Rovner decried the “extreme secrecy” surrounding the creation of a Republican health-care bill, which she called “a situation without precedent.” To support her case, Rovner offered some critical context—details from her own career, which spans three decades and includes coverage of major health legislation crafted by previous administrations:

Since 1986, I have chronicled the passage, and repeal, of the Medicare Catastrophic Coverage Act; the fight over former President Bill Clinton’s health proposal; passage of the Medicare prescription-drug bill; and passage of the Affordable Care Act, in addition to a dozen budget reconciliation measures that altered health care, often in fundamental ways.

Health reporters with comparable experience are hard to come by; still, Rovner isn’t the only one to take exception with the way the GOP health bill has unfolded. Sarah Kliff covered the Affordable Care Act for Newsweek and now works for Vox. In June, Kliff published a story that drew on her experience covering the ACA for context on the Republican health legislation. “I’ve covered Obamacare since day one,” reads the headline. “I’ve never seen lying and obstruction like this.”

CJR recently interviewed several veteran health-care journalists, including Kliff and Rovner, who covered health proposals under the Clinton and Obama administrations and continue to cover the Republican health bill, and asked them to compare those experiences. Their consensus: Unlike previous attempts at health reform, in which secrecy has played a more selective role, the entire process surrounding the GOP bill has been covert and rushed—from avoiding public committee hearings to bypassing the wait for the customary Congressional Budget Office score, which reveals the legislation’s effect on the federal budget. The process of moving the legislation along has been far less policy-oriented and deliberate. And a number of rhetorical challenges—from the speed of the news cycle to the ascent of Twitter to the outright lies and deception from Donald Trump and his cabinet officials down to members of Congress—have made it more difficult for journalists to puncture that secrecy and provide clear consequences of the GOP bill for their audiences.

What we’re seeing is a whole other magnitude of deception. It’s an attempt to portray the bill as the opposite of what it is.

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SECRECY AROUND HEALTH-CARE legislation isn’t exactly new—at least, not in recent memory. Most of Hillary Clinton’s Health Security Act (labeled “Hillarycare” by some critics) was crafted in secret based on recommendations of committees of outside experts. Large parts of the Affordable Care Act were also under wraps while they were being written, said Rovner during an interview. But when the bills were ready, they were sent to Congress to go through the regular legislative process.

“There was a very robust hearing and markup process that was completely absent this time, at least on the Senate side,” says Rovner, comparing the Clinton and Obama plans to the ongoing GOP health-care efforts. She adds that House Republicans’ recent proposal received “pretty perfunctory mark-ups in the House” by comparison.

Jennifer Haberkorn, who covered Obamacare for the Washington Times, now reports for Politico. She notes that Democrats have refined the same attack message that Republicans used against the Affordable Care Act in 2010: the health-care bill was written in secret, out of view of the public. Republicans seem to think the electorate will remember policy rather than how a bill is passed. Haberkorn isn’t sure that will be the case.

“I’m skeptical of that,” she tells CJR. “The GOP’s messaging against the ACA—that it was written in secret—really seemed to stick.”

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The lies and deceptions in GOP messages about its health-care plan—which have obscured potential coverage losses and financial costs—are also without precedent, reporters told me. With the Affordable Care Act, Barack Obama promised that families would save $2,500 on their health insurance, and also assured citizens that they could keep their insurance if they liked it. Likewise, Democrats promised “affordable, quality health care for all Americans.” While those statements were hollow promises, reporters said they were not as egregious as today’s lies.

“What we’re seeing is a whole other magnitude of deception,” says Jonathan Cohn, who covered the ACA for The New Republic and now writes for HuffPost. “It’s an attempt to portray the bill as the opposite of what it is. It’s being sold as a bill that will improve access to health care, protect people with preexisting conditions, will not hurt the poor, and will leave people paying less for their medical care. None of them are true in the aggregate.”

The volume of information coming in is so enormous and often contradictory that it’s hard to synthesize into a story, and to keep track of what’s being said.

THE ASCENT OF TWITTER has magnified the speed of the news cycle, and made it easier to share political messages across a wide audience, no matter their veracity. Twitter was just a few years old when Democrats unveiled the Affordable Care Act. The number of monthly active users now tops 300 million—roughly 10 times as many users as when the Affordable Care Act became law. President Trump tweeted about “Obamacare” 25 times in 2011, the year he joined Twitter. At press time, Trump’s Twitter account shows 39 “Obamacare” mentions this year.

Trump took to Twitter recently and suggested that Congress should “immediately repeal” the ACA, and “replace at a later date” if the two steps couldn’t happen in proximity. That tweet, which contradicted previous comments in which Trump suggested the two steps would happen “essentially simultaneously,” shaped news coverage of the health-care bill for days afterward.

Rovner says the speed of the news cycle makes it “insanely difficult” to cover the debate over the GOP bill. “Wait two minutes and the news changes. The volume of information coming in is so enormous and often contradictory that it’s hard to synthesize into a story, and to keep track of what’s being said to every other journalist.”

Faced with a swell of information, some of it distressingly misleading, reporters seemed more willing this year to call out lies and misinformation, and to engage on Twitter with comments that might have been construed as less-than-impartial and inappropriate just a few years ago. In 2013, speaking about the Affordable Care Act on “Morning Joe,” NBC’s Chuck Todd said the media was not responsible for educating the public about partisan misinformation and spin. Indeed, during the debate surrounding the Affordable Care Act, journalists rarely went there.

This year is different.

“We’re seeing Trump say he would cover everyone, but support a bill that leads to loss of coverage for millions,” says Kliff. She made the same point in March, when she accused Secretary of Health and Human Services Tom Price of lying about the Republican plan. (During an interview on “Meet the Press,” Price said, “Nobody will be worse off financially” under the GOP’s health-care plan.)

Price has sent the same message since. In June, he told CNN’s Dana Bash, “We would not have individuals lose coverage that they want for themselves of for their family.” Reporters have pushed back directly:

This is a 100% lie. Secretary Tom Price is straight lying https://t.co/C3q0dYe6HU — rolandsmartin (@rolandsmartin) June 25, 2017

When Trump and Price lie about what their bill would do, it can be tough for resource-strapped reporters to divine the truth. Mike Dennison, who previously covered politics for Lee Newspapers in Montana and is currently chief political reporter for the Montana Television Network, says most local and regional reporters are not able to explain the context of what comes out of Washington.

When you talk to Republicans and ask what’s the point of their bill, they say, ‘We need a bill that can get 51 votes.’

“They just don’t have the knowledge to do so, or the ability to call out the bull of the political rhetoric,” says Dennison, whose reporting on the Affordable Care Act distinguished itself for its clear explanations of policy impacts. “You have to help people out, and you can’t do that if your own knowledge is thin.”

Beltway reporters themselves don’t necessarily have time to flesh out all the nuances of a complicated story. Kliff describes the pace of covering the ACA as “more measured and slower,” which gave her more time to reflect and dig into the policy particulars. This year, the policy goals themselves are different.

“In 2009 the goals were very clear—cover more people and reduce costs,” she says. “When you talk to Republicans and ask what’s the point of their bill, they say, ‘We need a bill that can get 51 votes.’”

Cohn agrees. “The debate about the ACA was about giving people health insurance and nudging the system to become more efficient. It was promoted like that and covered as such.” The time of the Affordable Care Act, says Cohn, was also “the golden age of blogs, which enabled a lot of detailed policy discussions.”

Still, Cohn admits, coverage of Obamacare wasn’t perfect. He believes the media didn’t appreciate the extent to which people who already had insurance would see their coverage change and increase in cost. The backlash from members of the public who liked their policies and were asked to change them, plus the media’s reluctance to fully address affordability questions and explain what the individual mandate would do, have come back to haunt the ACA and its backers.

A similar backlash could await Republican officials, if the electorate feels dissatisfied with their new coverage and mislead by policymakers. However, that adverse reaction could be directed by lawmakers at the news media, if the public decides the press didn’t make the consequences of new health care policy clear.

Coverage of the Clinton and Obama health plans gave short shrift to the impacts of policy changes on coal miners, schoolteachers, and clerks at rural Walmarts, to name just a few. That’s been true this time, as well. And while abbreviated policy discussions on blogs and Twitter are fine in some ways, it’s rare that they reveal the effects of sweeping health-care changes.

“This is the first time in American history a major social benefit would be repealed,” says Haberkorn, referring to the Affordable Care Act and its Medicaid expansion. “For as much as the public understands this more, there’s still a lot that’s missing in what people know and don’t know. If people are tweeting at me saying they don’t understand it, we have to pay attention.”

CJR’s health care reporting is sponsored in part by a grant from the Commonwealth Fund.

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Trudy Lieberman is a longtime contributing editor to the Columbia Journalism Review. She is the lead writer for CJR's Covering the Health Care Fight. She also blogs for Health News Review and the Center for Health Journalism. Follow her on Twitter @Trudy_Lieberman.