Q: What do porta-potties, coffee cups and airplanes have in common? A: Obamacare.

July 10, 2013

Welcome to Health Reform Watch, Sarah Kliff’s regular look at how the Affordable Care Act is changing the American health-care system — and being changed by it. You can reach Sarah with questions, comments and suggestions here. Check back every Monday, Wednesday and Friday afternoon for the latest edition, and read previous columns here.

In Connecticut, selling Obamacare involves airplanes flying banners across beaches. Oregon may reel in hipsters with branded coffee cups for their lattes. And in neighboring Washington, the effort could get quite intimate: The state is interested in sponsoring portable toilets at concerts.

The advertisements, developed with political consultants and communications firms, illustrate the ability of the health-care law’s supporters to pinpoint the precise group they want to sign up for Obamacare — young and healthy Americans who won’t weigh down the system with high medical bills.

However sophisticated, the outreach also underscores how states have become willing to try almost anything to make their pitch in the face of a poorly informed and politically divided public. With 82 days left until the insurance marketplaces open for business, public awareness remains low. Most polling data suggest that few Americans are aware of how the Affordable Care Act works — or that it even exists.

“Without question, it’s a challenge,” Anne Filipic, president of Enroll America, said of the outreach. “The folks we’re trying to reach have some skepticism from their past experience with the health-care system.”

Adding to the urgency of the state campaigns is the competition: The law’s supporters have been badly outspent by its opponents, who have poured five times as much cash into television attack ads.

By 2015, Kantor Media estimates, $1 billion will have been spent by both sides on advertising about the law. In the District and the 16 states that are building their own marketplaces — where people can shop for health coverage and, in some cases, get tax subsidies to cover part of their bill — officials are relying heavily on multimilliondollar federal grants to fund their ads.


See how the states have sided on some of the key provisions of the Affordable Care Act.

Oregon will run a $2.9 million campaign leading up to the October launch of the state’s marketplace, called Cover Oregon. Ads went live Tuesday on television and radio featuring local musicians extolling the benefits of enrolling “every logger and lawyer and stay-at-home dad” in health insurance coverage.

The state is finalizing plans for other kinds of outreach, such as putting ads in bus shelters or producing branded coffee cups, said Amy Fauver, chief communications officer at Oregon’s marketplace. By year’s end, Fauver’s team wants 90 percent of Oregonians to be familiar with the name Cover Oregon, a dramatic increase from the 10 percent who know about it now.

Nationally, a recent Kaiser Family Foundation poll found 42 percent of Americans were uncertain whether Obamacare was still a law. Gallup found last month that 56 percent of the uninsured were not aware of the law’s requirement to buy health insurance coverage by 2014.

Access Health CT, Connecticut’s marketplace, plans to head to the beach this summer to promote its new insurance marketplace. Officials will hand out sunscreen customized with a “get covered” slogan and hire an airplane to fly over beaches with a banner that advertises the new agency.


Who....wants Obamacare! (Logan Mock-Bunting/The Washington Post)

“It’s such a polarized environment,” said chief executive Kevin Counihan. “When you mention Obamacare, you’ve got people who will immediately be against it or for it, but nobody actually knows anything about it. One of the jobs of the states is to fill that gap.”

Connecticut also plans to launch retail stores across the state where consumers can get in-person assistance to sign up for health insurance coverage. By the end of June, it was the second state to launch a television advertising campaign, following Colorado’s $1.1 million ad buy in May.

Counihan previously oversaw marketing for Massachusetts when the state launched its universal coverage effort in 2006, where he set up partnerships with the Red Sox and other groups. Outreach this time is harder, he said, because of the political divisions over the federal law.

“There was a broader sense back then of shared responsibility,” he said. “It was easier to an extent when you had a Republican governor and a Democratic legislature all backing you.”

The Obama administration has faced widespread opposition from GOP-governed states, most of which have refused to set up the marketplaces or spend a dime on advertising. That task, in places such as Texas and Florida, will largely fall on political groups and nonprofits.

The states setting up exchanges are putting much of their focus into reaching young adults, many of whom are healthy. Marketers expect that a monthly premium, potentially upward of $100 a month, will be a tough sell.

“You’re talking about a high degree of skepticism,” said Michael Marchand, who runs communications for the WA HealthPlanFinder, Washington’s marketplace. “There’s a lot of ‘I don’t understand what this is and why it’s important’ or ‘I don’t understand why there’s a good return on investment when I could be getting the next Radiohead album off iTunes.’ It’s totally understandable. I get that.”

Marchand has been thinking up all sorts of ways to make sure young people hear about the new health program. Perhaps in music-heavy Washington state, it’s no surprise that his thoughts have gravitated toward outreach at concerts and music festivals.

“We’ve talked about everything we could use, even whether we could do some branding on porta-potties,” he said. “I want to sponsor charging stations, too. Talk about a captive audience. They’re standing there, charging their iPhones.”


Come for the Porta-Pottie, stay for Obamacare advertising (Mark Makela / Reuters)

Marchand has also thought about working with sports teams, although he gravitates more toward minor-league baseball teams. Ticket prices tend to be cheaper, which could make their stadiums a better place to reach the lower-income Washingtonians who will be eligible for the new programs.

“We’ve been talking to the Tacoma Rainiers here,” Marchand said. “They’re a lot more nimble, too, and willing to discuss where you might want signage, or if you want to have a family night.”

While Republicans objected to the federal government working with the National Football League, Marchand had a unique complaint about similar proposals to work with the National Basketball Association: Seattle lost its team to Oklahoma City in 2008.

“When I was talking to HHS about how they were looking at doing something with the NBA, I was thinking, please don’t do it,” Marchand said. “Affiliating anything with the NBA here is pretty much a death wish.”

KLIFF NOTES: Top health policy reads from around the Web. 

Republicans are pushing to delay the individual mandate. "Delaying the individual mandate would be far more dangerous for the White House. It would undermine the central mission of the health-care law and would likely interfere with establishing new insurance marketplaces. Insurance companies are likely to oppose a delay in the individual mandate without also delaying new provisions requiring them to cover people with pre-existing conditions — one of the law's most popular elements." Sam Baker in the Hill

What the employer mandate delay means for one business owner. "Mr. King determined that he had the equivalent of only 47 full-time employees in the year that ended June 30, according to the complex formula that the law relies on. That was down from 54 for the 2012 calendar year. Mr. King said he had cut back some busboy hours in recent months and had not replaced several employees who left." Abby Goodnough in the New York Times

The Catholic Hospital Association is on board with the law's contraceptives mandate. "A trade group for Catholic hospitals says a new Obama administration policy on birth control is just fine. That's in sharp contrast to the U.S. Conference of Catholic Bishops, which continues to battle against the policy, which exempts churches, synagogues and mosques, but requires other institutions run by religious organizations to cover birth control under employees' health insurance." Julie Rovner on NPR

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Neil Irwin · July 10, 2013