Russian Twitter trolls attempted to cull opposition to the ACA during repeal attempts

Russian trolls operated more than 600 accounts that tweeted—often negatively—about the ACA. (Getty Images/FARBAI)

Russian trolls posted about the Affordable Care Act (ACA) on Twitter nearly 10,000 times in attempts to sway American politics and policy, The Wall Street Journal reported Wednesday.

The trolls were affiliated with the Internet Research Agency (IRA), a St. Petersburg-based company that uses social media to influence business and politics in prime minister Vladimir Putin’s favor.

More than 600 IRA-linked accounts posted about the ACA between 2014 and 2018. One account alone had more than 138,000 followers, suggesting the tweets reached several hundred thousand followers collectively, if not millions.

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WSJ’s analysis of the ACA-related tweets, which it received from Clemson University, found 80% had conservative-leaning messages, most of which were disparaging toward the healthcare law. The IRA probably focused on the ACA because it’s a deeply partisan issue, experts from Clemson and the University of Michigan told WSJ.

Those messages can have an enduring impact, according to Jennifer Hopper, Ph.D., assistant professor of political science at Southern Connecticut University and author of “Presidential Framing in the 21st Century News Media: The Politics of the Affordable Care Act."

“Once rumors and misinformation take hold in a person’s mind, they can be very difficult to dislodge. This is especially true for a complex public policy issue like health care reform,” Hopper said. “This is highly problematic for a law like the ACA that rests in part on the public understanding how it works, how to enroll, [and] viewing its programs as legitimate."

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Much of the discussion about Russian interference in U.S. politics has centered on the events that unfolded before the 2016 election. However, tweets about the ACA peaked in frequency during July and August of 2017—after the election but in the midst of Republican repeal attempts.

Experts say the remedies for the problem will be complicated and require more cooperation from the social media companies themselves.

"There’s technically no crime against…creating false accounts and spreading, arguably, opinion or information,” though it may breach Twitter’s terms of service, said Grant Elliott, CEO of health IT security company Ostendio.

However, Twitter could do “much more” to authenticate accounts and educate users, Elliott told FierceHealthcare.

For example, the government and Twitter could form a type of partnership called an Information Sharing and Analysis Organization (ISAO), said Chris Cummiskey, a senior strategic advisor at Guidehouse and former undersecretary for management at the Department of Homeland Security (DHS). 

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“Bringing to the table to share what they’re seeing, what strategies would be effective, what their roles are…in a comprehensive fashion would be a good way to approach this, to have one strategic approach as opposed to the kind of fragmentation that often happens in these situations," he said.

However, Hopper cautioned against reacting too strongly to this news.

The ACA is more popular than ever, despite the trolls’ intense efforts last summer, which seems to speak to “the limits of their influence,” she noted.

“Although we don’t want to discount these attempts to interfere with our democracy,” Hopper said, the public’s personal experiences with the ACA “might go further in shaping their views in this sphere.”