Understanding The Narratives Behind The U.S. Health Care Battle

Thursday, May 4 2017 Reinhard Cate Content Marketing Manager Categories:

The Affordable Care Act has been one of the most contentious topics in recent American politics. President Trump and the Republican party have begun a renewed push to repeal the ACA following a victory today in the House, despite an initial defeat earlier this year. Before the Senate vote takes place, however, Republicans, Democrats, and their stakeholders will seek to win an ongoing narrative battle across news and social media to shape the public’s perceptions about the new legislation.


Understanding the narratives about the ACA, their volume, and how they impact and resonate are critical to gauging the future of “Obamacare” or what could soon be called “Trumpcare”. Utilizing the Protagonist engine, we pulled a data set from over 80,000 pieces of content on the narrative landscape around the ACA and its potential replacement, the American Health Care Act. Deconstructing the data with Narrative AnalyticsTM, we found an ideological battle waged through narratives within this landscape by Republican and Democratic leaders, their influencers in media, and every day Americans. We use data to see precisely who is set to win the narrative battle and why.


For context, if we look deeper within the text of a narrative, we can break it down through the lens of a traditional four-part story with heroes, villains, and a call to action. This helps us understand the deep-rooted beliefs and values that make up an argument or action. While a narrative may not always catch every distinct nuance, we’ve seen narratives successfully capture the core beliefs and values about issues, topics, people, and even companies. Let’s go through a break-down of the components of the narratives we’ve surfaced in the data that are being pushed by Republican and Democratic leaders and unpack them in this four-part structure. We’ll start with the primary Republican narrative Skyrocketing Costs:


Cost is the central theme with an emphasis on the fundamentals of the Affordable Care Act being broken and financially untenable, together with real-world costs of implementation impacting a broad array of heroes: individuals, companies, and even the government itself. The idea of excessive cost and the ACA itself seem to be the critical villain rather than a person or group. Here’s an example of President Trump pushing this narrative in the Washington Post:


While the President was quoted after the Republican replacement for the ACA first failed to pass in the House, the President attaches the Democratic party to the Skyrocketing Costs narrative as an additional villain. Now let’s examine the main Democratic narrative Playing Politics over Patients:


People who need healthcare are the primary character or hero in this narrative. While patient outcomes are central within its call to action, the Democratic narrative also frames President Trump and the Republican party as the villains attaching them to outcomes related to the ACA’s repeal. Here’s an example of Democrat House Minority Leader Nancy Pelosi amplifying this narrative to CNN:


It’s clear within the quote from House Minority Leader Pelosi there is an emphasis on patient outcomes within the narrative alongside the attachment of the Republican party as a villain. As we’ll discuss later, the ultimate buy in and amplification of this narrative by non-Democratic stakeholders are key to its impact and resonance.


Leveraging a machine learning model, we classified every story within our data set to capture and calculate narrative impact, a measure of the overall impact of a narrative in a landscape based on its share of volume and engagement. With this measure alone, it’s evident that the Democratic narrative, Playing Politics with Patients, is winning the narrative battle, capturing most of the conversation at 56% compared to Skyrocketing Costs, which only holds 2% of impact. Additionally, the narrative Take ACA Even Furtherwhich focuses on replacing the ACA with a single payer system, has a 3% share of impact, also larger than the sole Republican narrative.



While politics is central within this landscape, conversation about the adverse impacts of the ongoing battle over the ACA repeal also has a large share of impact. These neutral narratives, which aren’t pushed by either political party, examine the other effects the battle over the Affordable Care Act has on American society, from direct impacts on the Health Care industry itself to broader knowledge disconnects about the ACA from American voters.


Despite the differences in focus, the narratives are driven by both events and messaging. The starkest indicator is the spikes in both the Republican and Democratic share of narrative impact just before the anticipated House vote to repeal the Affordable Care Act and replace it with the Republican designed American Health Care Act. In both Republican and Democratic narratives, consistent volume of the message over time is key. While we can see this over the course of the last three months, it’s evident that Democratic messaging is consistently higher in volume and impact.


A final critical key distinction between Democratic and Republican messaging is who amplified the narrative. The primary speakers pushing the Republican narrative were President Trump and House Speaker Paul Ryan. While Democratic leadership like House Minority leader Nancy Pelosi and Senator Chuck Schumer amplified the Democratic message, their overall narrative footprint was low compared to Republican leadership.



President Trump has the highest individual narrative footprint, which is expected. What is critical to note, however, is that alongside Speaker Ryan, Republican leaders have a greater overall footprint within their own narratives than Democratic leaders. Nancy Pelosi and Chuck Schumer have a significantly smaller narrative footprint across all narratives. Rather than Democratic leadership, American protestors have been amplifying the Playing Politics with Patients narrative in interviews across the country, representing some of the highest impact stories in the data set. This quote from the New York Daily News captures a perfect example of this:

Demonstrators protest the Republican push to repeal the ACA. Photo via Mobilus in Mobili via Flickr Creative Commons.


This key distinction between who delivered the message is perhaps what dictated the success of the Democratic narratives over the Republican narrative. Yet while volume and impact are absolutely critical for winning a narrative battle, message resonance, particularly how real people react to a narrative, is the true indicator of narrative success. While it’s clear the volume of people amplifying the democratic narrative is higher, it’s crucial to examine message resonance.

Often, despite the sheer volume of a narrative, it still doesn’t hit the mark with its audience. In this case, however, we didn’t see that. We broke down total social sharing of content within each narrative category — Democratic, Neutral, and Republican — to assess just how well these narratives connect to their audience. If we use this measure as a barometer for who is winning this narrative battle, it’s largely apparent that Democratic narratives are easily dominant, with more than a million total shares across social media. Republican narratives performed significantly weaker, with roughly forty-five thousand total shares.


While the repeal of the ACA was halted at the onset, it’s clear with today’s passage in the House that for President Trump and the Republican Party removing and replacing the Affordable Care Act is top priority. This political battle will continue as the bill moves forward to the Senate, but the ability of the President to garner legislative success and public buy in hinges on whether the Republican party can amplify their narrative about the ACA and ultimately if that will resonate with every day Americans.