Obamacare exchanges get advice from ad, PR pros

The advertising and marketing campaigns to persuade Americans to sign up for Obamacare coverage during the first open enrollment a year ago came under heavy criticism from marketing professionals, many of whom have ideas about how it could have been done better.

The Obama administration, the state-run exchanges, insurers, hospital systems and enrollment groups have taken note of the criticisms and are trying to do a more effective job this year. They hope that the federal and state exchanges will work much more smoothly this time around.

For the first enrollment period, “everything about that campaign was sort of cursed,” said Clarke Caywood, who teaches crisis management, public relations and marketing at Northwestern University. He cited the first open enrollment's repeated deadline changes associated with website glitches as a major complicating factor in marketing the enrollment campaign.

Even so, marketing and outreach campaigns for 2014 enrollment—combined with the huge amount of free publicity stemming from the botched rollout of the HealthCare.gov website and some of the state exchange websites—helped achieve enrollment under the Patient Protection and Affordable Care Act that exceeded expectations. More than 7 million Americans signed up and paid their premiums. The original estimate by the Congressional Budget Office had been 6 million enrollees.

On the other hand, polls consistently have shown that the healthcare reform law overall is unpopular with the public, and political observers say its unpopularity contributed to the Democrats' drubbing in the Nov. 4 elections. Some marketing professionals say the law's political unpopularity is related to ineffective promotion of its benefits.

The Associated Press estimated that nearly $700 million was spent on marketing Obamacare during the first open enrollment period. The marketing campaigns, along with all the free media coverage of the botched launch of the exchanges, paid off in public awareness. The Commonwealth Fund said that in late summer 2013, before the marketing began, only 39% of those surveyed were aware of the new marketplaces. Between April and June of 2014, 73% knew about them.

Still, Glenn Karwoski, managing director of Minneapolis-based PR firm Karwoski & Courage, whose clients have included Target Corp., General Mills, 3M and Pfizer, said the Obama administration “really made some marketing blunders. I don't think they had a very good segmentation strategy in terms of understanding the diversity of audiences and how Obamacare specifically appeals to each one of these groups,” he said.

Jose Munoz, chief marketing officer for GetCoveredIllinois, the state's insurance exchange, argues that Illinois did a pretty good job. He said marketing, public relations, advertising and community events helped the state enroll nearly 700,000 uninsured people out of a total uninsured population of 1.2 million, placing Illinois ninth among the states in meeting federal enrollment targets.

Munoz, who previously ran campaigns for Aetna targeting African-Americans and Latinos, said healthy young adults, especially from the Latino and African-American communities were key targets during the first open enrollment and will be again in the second, shorter enrollment running from Nov. 15 through Feb. 15. He said the other states and the Obama administration are using the same playbook for the most part.

To reach young people, GetCoveredIllinois used a variety of approaches, including a snarky ad campaign in the Onion, the parody newspaper and website. Exchange officials also deployed a recreational vehicle to sign people up during special events associated with Day of the Dead festivities in the Latino community and Black History Month. In addition, the exchange posted tongue-in-cheek YouTube videos as part of its #HardChoices campaign aimed at young adults.

In one 30-second video that was part of the YouTube campaign, a voice-over announcer says: “Without health insurance, you could face fines and big medical bills and then you'll have to get a creepy roommate.” The YouTube videos also presented scenarios cautioning that without health insurance, millennials could run up big medical bills and be forced to take second jobs, give up expensive coffee drinks and cancel Internet service.

Munoz said new videos will be posted during the second year of the integrated marketing campaign, which has a $26 million budget, including $12.5 million for paid ads and the rest for public relations, social media and community events. About the same amount was spent in the first year.

Cynthia McCafferty, senior vice president at FleishmanHillard, which is handling public relations for GetCoveredIllinois, said that based on research, the Illinois campaign will emphasize the availability of in-person assistance for enrollment, as well as the availability of premium subsidies, to assure consumers that they can afford coverage.

What follows are suggested strategies and tactics from four experienced marketing professionals about how the state and federal exchanges could do better.

Grace Leong is managing partner at New York-based Hunter Public Relations, whose clients include Kraft Foods, McNeil Consumer Healthcare and Church and Dwight.

Strategy: Leong's strategy would focus on market segments. “I feel like (marketing of the ACA) has been too universal. It's universal healthcare, but that doesn't mean marketing should also be universal. The marketing team needs to spend time defining and understanding the multiple targets and developing specific, insight-driven strategies to reach these audiences.”

Tactics: Her tactics would include creating individualized marketing plans for each segment based on insights from consumer research. “If females aged 45-55 emerge as a key target, a Facebook campaign of content and ads could be the best medium to reach this target,” she said.

Leong said she would consider a content and distribution service such as BuzzFeed to push a campaign to consumers through Facebook feeds. “It's not like, 'Go and sign up for Obamacare.' Rather, it's '10 reasons why you need Obamacare.' Facebook users love to click on list-type content.”

To reach male millennials who value dry wit but likely don't worry about getting sick and needing coverage, the Obama administration, the state-run exchanges and enrollment groups might want to consider paid product placement on late-night TV that's woven seamlessly into one of the late night shows.

“If Jimmy Fallon creates a skit about signing people up, 1 million millennials will know about it. Boom. Done. And even if it's somewhat tongue-in-cheek and a little bit disparaging, it still makes people aware of what's going on, makes it part of the cultural conversation. This would be money better spent than $3 million to print a bunch of brochures that sit in a social service office that nobody walks into,” she said.

Leong noted that GetCovered Illinois.gov, the Illinois version of HealthCare.gov, went after so-called young invincibles with an ad campaign during the first open enrollment that ran in the Onion, the parody newspaper and website. One ad was headlined, “Man without health insurance forced to sell action figures to pay for medical bills.” The ad directed readers to keep their action figures and buy insurance. Similarly, the CMS and HealthCare.gov launched a video public service announcement a year ago on the comedy website Funny or Die with a spoof called “Scandalous,” featuring actress Jennifer Hudson encouraging visits to the federal health insurance enrollment website.

To create buzz, Leong suggested creating a reality show based in a government office where workers are signing up ACA enrollees. The show would cover the difficulties of enrolling, how they can be overcome and how the newly insured are helped.

To reach older consumers who may be less tech-savvy or leery of entering personal data on Internet sites, Leong's campaign would create partnerships with community programs in churches and schools, as well as beauty salons and barber shops. “When people are sitting around with their friends and getting their hair cut or nails done, they actually talk about healthcare,” she said. “Some older consumers don't trust the Internet or don't have access, but they do trust their reverend, hairdresser or community leader. And that's where conversations about healthcare can start.”

Leong said it's hard to estimate how much her marketing campaign would cost because it would first be necessary to define the targets. “Reaching females ages 45 to 54 might be more of an efficient task than reaching millennials, who are not consumers of the traditional media,” she said.

Ron Culp, director of the graduate public relations and advertising program at DePaul University in Chicago, held senior public relations positions at four Fortune 500 companies, including senior vice president of public relations and government affairs at Sears.

Strategy: Culp would market the ACA as a new and improved product, like a detergent or cola, that is trying to overcome lingering memories of the problems in launching the program last year. “It has to be almost framed as new and improved in order to get people to take a second look,” he said.

Tactics: Culp said offbeat, humorous tactics incorporating facts about the ACA's benefits would attract millennials, a major target for marketing. “What this program needs is an Ice Bucket Challenge,” he said, referring to this past summer's highly successful social media campaign by the ALS Association to raise money for research on Lou Gehrig's disease. “You need influencers to get behind it.”

He cited President Barack Obama's tongue-in-cheek appearance on website Funny or Die's “Between Two Ferns with Zach Galifianakis” to plug HealthCare.gov and the ACA.

During the appearance, Obama and Galifianakis exchanged jibes about domestic spying, drones and box-office flops. Obama noted in the comedy bit that it costs as much to be covered under the ACA as to pay a monthly cellphone bill.

Culp said this segment went “really crazy” in social media. “I thought that was a brilliant move,” he said. His campaign, he said, would emphasize social media and public relations over traditional media, which millennials distrust and tune out.

He said campaigns using Twitter, Facebook and Instagram would have a bigger impact at a lower cost than advertising. He said he would spend less than the nearly $700 million the Associated Press estimated had been allocated by the federal government and the states to previously market ACA enrollment.

To reach Latinos, a major target, tactics ought to include partnerships with family-focused events and retailers. “I would recommend an enrollment program at high-traffic Sears stores and other retailers where Latinos shop,” he said. “People trust these locations more than many of the public and government facilities.”

Laura Ries is president of Ries&Ries, a branding and marketing consultant firm in Atlanta whose recent clients include Ford, Samsung and Doritos.

Strategy: Ries would focus on a simple message: The ACA is working and is affordable now and will be in the future. She said affordable healthcare is nearly impossible to dismiss. She doesn't believe in developing different messages for different market segments. “McDonald's talked about a different method for every market, (but) we think that's the exact wrong way to go. Find different ways to reach people using the same message.”

Tactics: Ries said the program needs a “youngish, attractive czar” who would simplify messages about a complex program and spread them in tweets and other social media as well as in speeches and at events. She said someone like CNN health correspondent Dr. Sanjay Gupta would fill the bill.

Ries said she would use $350 Apple Watches, due out in early 2015, as a giveaway to persuade people to enroll in coverage. The device has sensors to read the user's pulse and heart rate, plus an accelerometer and GPS to track physical movement. She calls the campaign “Watch Your Health.” “Bribery works,” she said.

Patients and their doctors could use the Apple Watch technology to track vital statistics, and doctors could use the devices to remind patients to take their medications.

Her marketing campaign would cost about $100 million. Ries said advertising's credibility is low, especially among young people. Hence, she said only about half of her budget would be spent on paid media to reinforce the major ideas of the campaign and motivate consumers to enroll, with the remainder going to social media, public relations and field work.

Jonathan Wilson is president of Washington, D.C.-based Spectrum Science, a public relations agency specializing in communicating health and science. Clients include St. Jude's Children's Research Hospital in Memphis, Tenn., the American College of Cardiology, the Medicare Diabetes Screening Project and Zeltia Group, a Spanish biopharmaceutical organization.

Strategy: Wilson said he would focus on eliminating lingering myths about the ACA, showing how the program has helped many previously uninsured patients. “The strategy here has to shift from dispelling the myth to telling a success story,” he said. “The healthcare law is a highly political issue, but President Obama has always had the moral high ground. He still does. It's difficult to argue against a law that has extended health coverage for so many, particularly young people and those with pre-existing health conditions.”

Tactics: Wilson sees personal testimonials as a key tactic. He would focus heavily on in-person assisters and navigators who have helped patients enroll as well as on individuals who have benefited from the ACA.

“I would focus on making as many people as possible champions for Obamacare. The story must be told from the inside out. The staff plays a critical role in making access to healthcare a reality for their fellow Americans. Be honest about what a momentous task it really is and focus on getting it right. If they do that, they can begin to regain the trust of the American public.”

Wilson said there must be hundreds of individual success stories, especially from younger people. Telling those stories through social media would help persuade other young people to sign up.

Indeed, the federal and state marketing programs have used this tactic. The HHS blog “#GetCovered: My Story” offers text and video testimonials from around the country.

For example, a Latina college student from Texas describes how easy it was to enroll. A blues singer from Huntsville, Ala., said the ACA saved her life. “I don't understand how people could be so heartless to say a person like me should not have affordable health insurance,” she said.

Wilson said HHS' collection of testimonials is compelling. But he added that “it feels hidden and it doesn't seem like the site is being promoted the way it should be. The people featured in the personal stories could be a tremendous resource for Obamacare promotion. They could become official ambassadors and be featured speakers at community events in key congressional districts, and spokespeople for a national and regional media-relations strategy.”