Media barrage

Healthcare reform supporters are using every available advertising and communications vehicle to urge Americans to sign up for health coverage on the new state insurance exchanges, while Obamacare opponents are using ominous ads to persuade them to “opt out.”

Many experts are concerned that the public, which remains largely uninformed or misinformed about the provisions and benefits of the Patient Protection and Affordable Care Act, may be whipsawed and perplexed by the conflicting information. Results from the Kaiser Family Foundation's latest health tracking poll, released in August, show that 51% of Americans still are confused about what the law means for them and their family. That could affect exchange plan enrollment.

Enroll America kicked off its national Get Covered America campaign in June. Some states running their own exchanges, such as Oregon, started their educational campaigns about the same time. Other states, such as California, which is running an $80 million ad campaign, will be ramping up ad efforts beginning Oct. 1.

But opposition ads have been airing in waves since before the bill even became law in 2010 and have taken a sharp new negative turn. Kantar Media's Campaign Media Analysis Group estimates that more than $500 million has been spent on ACA-related advertising since 2010, with four times as much spent on anti-Obamacare ads as on supportive ads. Experts say that may well have had an impact on public attitudes toward the law and enrolling in exchange plan coverage.

The Obama administration hopes to counteract that with the launch of a six-month public education campaign to persuade millions of uninsured Americans to enroll in insurance through the new marketplaces and take advantage of the federal premium and cost-sharing subsidies. The public relations effort began with recent speeches from President Barack Obama and other prominent administration allies. But now the administration's focus will shift to social media and online channels to attract the young, healthy people whose participation is crucial to keep exchange plan costs down but who may prove the hardest to enroll.

Surveys suggest the public may be receptive because most Americans want health coverage. Of the uninsured adult population under age 65, only two out of 10 say they are “healthy enough” to forgo insurance, according to a study by the Center for Studying Health System Change.

Targeting that group, the Obama administration on Sept. 30 will debut its first online video created in partnership with the comedy website Funny or Die, which was started by the production company owned by comedians Will Ferrell and Adam McKay.

Meanwhile, conservative groups that oppose the law have launched a variety of mostly online videos that range from sarcastic to spooky. One ad is from the not-for-profit Crossroads Grassroots Policy Strategies, affiliated with Republican strategists Karl Rove and Ed Gillespie. The ad mocks Obamacare with terms designed to appeal to young millenials, warning that young, healthy people will end up paying premiums three times as high as before and have their job hours reduced to part time.

Jonathan Collegio, communications director for Crossroads GPS, said his group spent about $100,000 on ads during the summer. It was able to get lots of free media coverage by driving viral attention to its videos.

Generation Opportunity, which bills itself as a non-partisan youth advocacy organization but has financial ties to the billionaire conservative activist Koch brothers, released its own set of online ads this month as part of its $750,000 #OptOut campaign of ads and grass-roots activities. Dubbed the Creepy Uncle Sam ads, the two online spots depict a sinister-looking Uncle Sam slipping on surgical gloves and adjusting stirrups in a gynecological exam. “Don't let government play doctor,” the ads warn. “Opt out of Obamacare.”

Ron Pollack, executive director and vice president of Families USA, which supports the healthcare reform law, dismissed these ads. “The notion that Uncle Sam is looking at women's private parts during a gynecological exam is so absurd and ridiculous that I don't think these ads are going to be effective,” he said.

Still, the Uncle Sam ads have gone viral, garnering more than 3.5 million YouTube and Facebook views. And they could influence young, uninsured people already inclined to be skeptical about buying insurance on the exchanges. “The videos are clearly having an impact,” said David Pasch, Generation Opportunity's communications director.

Follow Rachel Landen on Twitter: @MHrlanden