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You need to keep in mind that the press freedom ratings is not a measure of freedom of speech, but freedom of the press, and the US is still ranked as "fairly good".

Specifically, the index describes itself:

What does it measure?

The Index ranks 180 countries and regions according to the level of freedom available to journalists. It is a snapshot of the media freedom situation based on an evaluation of pluralism, independence of the media, quality of legislative framework and safety of journalists in each country and region. It does not rank public policies even if governments obviously have a major impact on their country’s ranking.

They also provide more detail about their methodology and the questionnaire used to create the index is available online.

I was unable to find a full report, but in a short analysis, the index specifically mentions Trumps hostility to the media.

They go into a bit more depth about this in a press release for the 2017 data:

In 2017, the 45th President of the United States helped sink the country to 45th place by labeling the press an “enemy of the American people” in a series of verbal attacks toward journalists, attempts to block White House access to multiple media outlets, routine use of the term “fake news” in retaliation for critical reporting, and calling for media outlets’ broadcasting licenses to be revoked. President Trump has routinely singled out news outlets and individual journalists for their coverage of him, and retweeted several violent memes targeting CNN.

The violent anti-press rhetoric from the White House has been coupled with an increase in the number of press freedom violations at the local level as journalists run the risk of arrest for covering protests or simply attempting to ask public officials questions. Reporters have even been subject to physical assault while on the job.

However, the Trump effect has only served to amplify the disappointing press freedom climate that predated his presidency. Whistleblowers face prosecution under the Espionage Act if they leak information of public interest to the press, while there is still no federal “shield law” guaranteeing reporters’ right to protect their sources. Journalists and their devices continue to be searched at the US border, while some foreign journalists are still denied entry into the US after covering sensitive topics like Colombia’s FARC or Kurdistan.

The wikipedia page of self censorship just tell part of the story, there are other "invisible hand" such as corporate censorship.

Media may reject story or even advertisement that "offend" their main advertisement buyers. A good example is consumer goods price hikes using creative marketing or packaging : financially self-sustainable consumer group and media in Europe are usually more freely to criticized the corporate practice than USA counterpart.

While I agree the issues listed by RSF are serious, I would not put too much stock in relative ranking large swaths of such indexes because they can be sensitive from year to year changes on fairly obscure issues.

Compare the ranking on RSF's Freedom Index vs FH's Freedom of the Press

United States  #45 #33

France         #33 #44

South Korea    #43 #66

Japan          #67 #48

How the various issues are weighted in such indexes can have a big impact on relative ranking of countries. Now if some index ranks China (#176 #186) ahead of the US, I'd start to get really worried.

There are multiple issues going on.

The big one is, that you can have rights, but how they are implemented and enforced in practice - the unspoken aspects of it - really are crucial in determining what your real situation is, and your safety or potential risks in exercising those rights.

For example - in some countries you have free speech and freedom - except that you may lose your job, or be taken by secret police if you actually try to use those rights. In others, there are strong incentives that steer companies controlling the media or publication, so that rights are again, hard to really exercise.

It's not a free press if exercising that freedom in good faith risks you getting pejorative treatment, any more than it is encouraging whistleblowing, to have a whistleblowers charter in a company but realistically your career dead-ends anyway and the matter gets hushed up and you described as a problematic troublemaker. In many cases you can fight back legally if treated wrongly, but in others you can't (or its difficult to: money, standing, whatever), and for real press freedom you shouldn't have to.

So when you look at how a country is rated for freedom of the press, you have to nearly ignore the rights people * should * have according to their country's laws and constitutions, because those will almost always say it's fine and great. You have to go by what actually happens on the ground, not what's claimed to be the case or should be the case.

So you look at things more in this kind of way: When journalists come across a story that's negative or harmful to some powerful interest (person, police, govt body, politician), or could be seen as threatening them by suggesting they aren't okay in some way (they treat workers badly, they committed genocide, they're institutionally racist, they broke their own laws or committed illegal acts). Or they've reported on a foreign matter in which their govt has some involvement, or talked down their own or another country/states. How does the country actually treat them?

Will it block them at the borders? Arrest them (many places)? Charge them with defaming the nation? Revoke their right to attend press conferences? Harass them? Pressure the employer to fire or discipline them, or dissociate itself from their reports (subtly or not so subtly), or begin an "investigation" into "irregularities" at the employer such as tax related? Consider them legitimate targets for surveillance/tapping? Or what? What about foreign journalists?

Unfortunately in that light, many countries that you'd think do well, actually don't. Because its in those kinds of cases, that press freedom is really tested and able to be seen (or not) for what it really is.

• 
  Update: The saying that "It's the exception that proves the rule" is very relevant here. The word "proves" in this saying has its olden-day meaning of "tests" (as in the expression "put to the proof") - it is the exceptions and edge cases that really test and demonstrate how "real" a rule or belief is, not the regular ordinary cases which anyone can point to and say "see? it's fine".

Disclaimer: I'm not a lawyer and not an U.S. citizen.

The formal "Freedom of Speech" in the U.S. means that the government (lawmaking, executive etc.) must not restrict the speech of its citizens in any form or fashion. I.e., it is a restriction of the government. It does not necessarily mean that everybody can say or write anything at all without any kind of repercussions.

E.g., APPLYING THE CONSTITUTION TO PRIVATE ACTORS (NEW YORK LAW JOURNAL):

With the notable exception of the Thirteenth Amendment’s ban on slavery, the individual liberties guaranteed by the United States Constitution protect against actions by government officials but not against actions by private persons or entities.

You can find plenty of further reading in the collection of sources linked from here.

This means that any other involved party (except the government) are not covered under the "Freedom of Speech" moniker. Or, in concrete terms; everybody is free to go to the courts to try to shut down their neighbour (which according to the comments may be hard in practice); and of course resort to non-constructive or even shady/illegal activites as laid down in other answers.

It is absolutely not the case that anybody can just say anything at any point in time without consequences.

Examples where Freedom of Speech will not help you:

• If your boss does not like how you talk to him (or what you write), he can fire you in concordance with whatever regulation your state has, i.e. "Right to Work", or remove you from your current position and "park" you somewhere else in his company.


• If you spread harmful lies about people, they are free to go to court to make you stop. And of course they can try to do the same even if what you wrote is true. Or try to cow you with a large lawyer budget.


• While you seemingly are allowed to openly insult police officers - they are associated with the government after all and thus under the Freedom of Speech limitations regarding retalation against you - you certainly cannot do that to just anybody without repercussions.


• Going to a meeting of (non-government) people of the other side of the political spectrum and starting a ruckus may absolutely get you into trouble (depending on how beligerent everybody is - not with the "government" but with the guys actually there); and Freedom of Speech does not protect you (other laws may of course, i.e. if they beat you up while throwing you out of the building).

There may be other laws making the work of the press easier, but Freedom of Speech is not necessarily one of them. The index linked in the question mentions a few other (non-governmental) forms of suppression.

In the end, there are many ways to repress or discourage a member of the press without conflicting with Freedom of Speech.

Because the United States is a superpower.

Like other freedoms, press freedom is a matter of negative and positive liberties. Constitutions and laws establish negative liberties, which serve as the foundation of the freedom of the press. Positive liberties, driven by the priorities of successive administrations over decades, determine whether the freedom can be actualized. This is where the United States loses.

The stakes are always high in the politics of a superpower, and the priorities are often driven by the needs of the powerful. Many actions are justified by matters of national security. Yet every time the national security justification is used, something else is valued higher than freedom. Small countries with lesser ambitions can often afford more freedom, if they choose so. Their political issues tend to be less serious, and their administrations can concentrate more on domestic matters.

Most countries that rank consistently higher than the US in the Press Freedom Index and the Freedom of the Press report are ones with modest international ambitions. Instead of trying to change the world, their administrations have prioritized making the country a good place to live in. The United States also used to be like that, but its administrations have had other priorities since WW2.

Edited to clarify: The comparisons are not about theoretical freedoms protected by constitutions and laws. They tell how often the freedom of the press is violated in practice, regardless of the reason. Every time a court forces a journalist to reveal their sources or a whistleblower is jailed for revealing classified information, press freedom is violated. It does not matter that the reasons for the violation may be morally and constitutionally justified, because it's still a violation. Major powers cannot afford as much freedom as certain lesser countries, because they have other priorities. Their national security issues are simply more serious, and they face such issues more frequently.

The United States ranked 45th worldwide in press freedom this year, slipping two spots from last year's ranking, according to Reporters Without Borders' World Press Freedom Index.

The backdrop: Since President Trump was elected in 2016, the U.S. has dropped from 41st to 45th in Reporters Without Borders' rankings. However, it ranked as low as 47th in 2011 during the Obama administration — despite ranking as high as 20th in 2009.

One aspect of the rating is, frankly, silly. It demonstrates the perils of applying numbers without context.

I refer, of course, to "chilling" statements by Trump.

It has been well-established for 30 years now that the "mainstream media" (minus Fox News, of course) is personally overwhelmingly (liberal/progressive/left of center). As a result, chilling statements by Trump only serve as a goad to further criticism of him. Which, frankly, is as it should be.

In a country with greater government control of the press, chilling comments are a serious issue. Unless I seriously misunderstand my own country (and if I did, I wouldn't realize it, of course), at least in the current political climate this illustrates that not all criteria have the same applicability between all countries.

Because the chief censor does not often interfere with news reporting, the recent banning of the hate manifesto and the mass murder video were unusual (as was the event itself)

The chief censor does not report directly to the government and is not beholden to the goverment's whims.
Their responsibility is to suppress publications that are harmful to society.

I'm pretty sure is an a reporter in USA tried to publish a report on child sex that included still or motion pictures of childeren engaged in sexual acts this work would also be subject to censorship.

The press freedom index does not measure rights, it measures the experience of journalists.

If you look at the two nations of your example USA and NZ the difference are clear. The censor in New Zealand does not assess content on whether it hurts the government, the military or any other special interest group, only on whether releasing it will harm society. instructions on bomb-making and cooking methamphetamine are suppressed, reports into possible war-crimes in Afghanistan or financial malfeasance are not.

I'm sure USA has censors too, is the murder video or the hate manifesto available there?

USA is chasing whistle-blowers, NZ is strengthening protection for them.

etc.