The sales pitch for the health law is getting an overhaul for the fall.
Supporters and advocates of the Affordable Care Act say they learned lessons from last year’s sign-up effort, when they persuaded a few million uninsured people to buy coverage. They plan to incorporate those lessons into the marketing campaign for the next enrollment period, which begins in mid-November.
In for this fall: testimonials from real people, more emphasis on deadlines, and an increased focus on in-person help.
Out: No longer will ACA advocates steer clear of talking about the law’s requirement that people either get health coverage or pay a penalty when they file their taxes. It turns out the so-called individual mandate actually does motivate some people to sign up, research suggests.
A Tougher Audience
More than eight million people got private insurance for 2014 through the law’s insurance exchanges, which were plagued with technical problems when they opened in October 2013 but stabilized toward the end of the six-month sign-up period. It isn’t yet clear how many of those people were uninsured previously as opposed to switching plans, but several recent polls have suggested a noticeable dent in the number of U.S. uninsured, which totaled about 50 million people before the law’s passage.
For example, a survey from polling organization Gallup found that the percentage of American adults without health insurance dropped to 13.4% in April after peaking at an average of 18% in the months immediately before the Oct. 1 rollout of the law.
Still, many of those who bought insurance during the ACA’s first year were the “low-hanging fruit,” says Barbara Webber, director of the Health Action New Mexico advocacy group. This time, “we’re going to have to really get to the hard-to-reach people in the remote communities,” she says. Among the groups that weren’t as easy to get were those outside of big metropolitan areas and uninsured Hispanics.
The nonpartisan Congressional Budget Office has projected that 13 million people will use the exchanges this time around, five million more than did in 2014. But advocates won’t have as much time to reach them because the enrollment period is shorter, starting in mid-November 2014 and ending mid-February 2015.
The Centers for Medicare and Medicaid Services, the federal agency in charge of implementing the law and operating exchanges for the states that declined to set up their own, says it plans to make tweaks to its marketing message.
In a presentation to insurers in May, CMS officials said that they believed the aggressive marketing campaign around the launch of the insurance marketplaces last year was effective and that people who saw the ads were more likely to know about HealthCare.gov and shop for coverage.
This year, they’re going to refine the message by, among other things, placing a greater emphasis on the deadlines for buying coverage and using testimonials from those who have already enrolled to show that coverage is affordable, such as: “I only pay about 70 bucks a month for it.”
Meanwhile, Enroll America, a coalition of the law’s supporters and sign-up activists, plans to step up in-person assistance after realizing how important that was last year. The group says it will launch an online tool to tell people where in their area they can find this kind of help.
Using the Stick
Enroll America may make other changes to its strategy after a study it commissioned from PerryUndem Research/Communication, a polling firm frequently used by health-law supporters, found that as many as four in 10 of the newly enrolled said they wouldn’t have signed up for coverage if the law hadn’t required them to.
Supporters of the law previously had played down the health law’s mandate in favor of emphasizing the quality and affordability of available health plans, saying they preferred using carrots instead of sticks to persuade people to sign up. Now they’ve concluded the mandate has to be part of the conversation.
The law and fine motivated many people to get covered during the first enrollment period, Enroll America said in summarizing the research. As such, talking more explicitly about the mandate and the fine may encourage more people to sign up for 2015, it said.
The fine for not having coverage is $95, or 1% of family income, this year, but it is set to grow to $695 per adult, or 2.5% of family income, by 2016. The survey found that among people who didn’t get coverage, 42% said they would definitely or probably get coverage next year. People who were given details about the penalty were more likely to say they would “definitely” sign up, rather than “probably.”
Even with the retooled marketing campaign and its emphasis on deadlines and testimonials, some groups remain worried about the timing of the 2015 enrollment period.
Tax-preparation firms such as Jackson Hewitt Inc., which played a big role in helping people enroll last year, say the shorter sign-up period overlaps significantly with the holiday season, when people are distracted and financially stretched.
Last year, part of the Obama administration’s digital marketing campaign encouraged people to start conversations about health insurance around the Thanksgiving dinner table. Yet the bulk of enrollments still came in February and March.
The tax firms also say that some uninsured people may not realize they have to pay a penalty for 2014 until they come in to file their returns in April. At that point it will be too late to enroll for 2015.