Messaging Insights Surrounding the Affordable Care Act As a result of the Robert Wood Johnson Foundation’s (RWJF) recent message projects surrounding the Affordable Care Act (ACA), we have identified several key trends in how consumers are talking about and researching ACA as well as what messages work best in communicating the law’s key benefits and provisions. Overall, we’ve learned that states’ communications around ACA should be straightforward and demonstrate, in the simplest way possible, how the law benefits residents. The insights in this memo are supported by a number of message projects and polls including: • Focus group message testing conducted by Lake Research Partners, on behalf of RWJF, with opinion elites, in Maryland and Washington, Jan. 19 and Jan. 27, 2011 • Online listening project conducted by MotiveQuest, on behalf of RWJF, examining national online ACA conversations among consumers, April – Sept. 2010 • Harris Interactive/HealthDay poll, national survey, Feb. 16‐18, 2011 COMMUNICATING ABOUT THE AFFORDABLE CARE ACT Talk to Consumers as Patients Leading up to passage of ACA, messaging was geared toward the voter. Immediately following passage, there was a shift to the consumer. Now, nearly a year out from the signing of the law, we see a need to message to the “patient.” The vast majority of individuals searching for ACA information online are sufferers of chronic conditions – most of them not immediately life threatening. People who are most frequently seeking care and trying to navigate our health care system want to know what’s in it for them. If we can communicate the benefits of the law to this audience – which according to a recent study is upwards of 129 million – then we stand to educate and hopefully create messengers out of an informed and passionate audience. Moving forward, states should think about ways to segment their consumer audiences and partner with health care organizations and facilities that reach and treat people with chronic conditions and disease to help communicate about ACA and its benefits for this audience. Focus on Key Benefits States should continue to message around the benefits of the law, specifically the top testing concepts and benefits which include: • Putting you in charge of your health care • Protecting your choice of doctors • Small business tax credits • No more denials for pre‐existing conditions • Medical loss ratio • Coverage for 21‐26 year olds • Closing the Medicare donut hole for seniors Keep it Simple Communications surrounding ACA should be simple and straightforward. Consumers want the facts and real world examples—including specific dollar amounts when talking about premium increases or savings goes a long way. Consumers want practical information delivered with straight talk. States should avoid information overload – keeping in mind that every last detail isn’t relevant to most. The more state‐specific language and information included, the better. Simple phrases like “Created in Oregon for Oregonians” resonate with consumers and including state‐specific data can help reinforce what residents stand to gain. MESSAGE INSIGHTS Individual Mandate In testing what is probably the most unpopular provision of the law (a recent Harris Interactive/HealthDay poll shows 50 percent of Americans oppose the "individual mandate" provision in the law), we learned several important takeaways to use when messaging around the individual mandate. First, when discussing costs, don’t overpromise or your message will lose credibility. Explain how the costs of caring for the uninsured are shifted to people who currently pay for insurance. And use facts whenever possible to prove that costs and federal spending will not increase as a result of the mandate. Last month’s Harris Interactive/HealthDay poll confirmed these message findings, showing that 71 percent of Americans polled think that for “health insurance to work, it is necessary to include people who are healthy in order to help pay for those who are sick.” And 56 percent agree that if everyone is required to have health insurance, including healthy people, the cost of health insurance will be less expensive. Second, it helps to make an explicit connection between the mandate and eliminating denials for pre‐
existing conditions. It’s important to explain that everyone benefits when no one is denied coverage and how the requirement to purchase health insurance broadens the risk pool to ensure that happens. The Harris Interactive/HealthDay poll shows that 51 percent agreed that requiring insurance companies to provide coverage to people with pre‐existing conditions will only work if everyone is required to have insurance. The best testing messages include: Cost and Affordability Making sure everyone has health insurance reduces health care costs for the rest of us. Currently, when someone who is uninsured gets sick and can’t pay, those of us who have insurance pick up the tab. And that costs more than if we simply helped people afford insurance. Requiring the uninsured to get insurance—and even helping to pay for those who cannot afford coverage—is cheaper for us than paying the cost of care for the uninsured. Pre‐Existing Conditions For decades, insurance companies have decided who gets covered and who does not. As a result, millions of Americans have been denied the coverage they need simply because they have a preexisting health condition, like asthma, diabetes, or cancer. Beginning in 2014, this discrimination will end. Insurance companies will be required to cover everyone, even those who have a preexisting condition. But it only works if everyone is required to get insurance. If we allow people to wait until they get sick or have an accident to buy insurance, the cost of health care will continue to skyrocket for everyone else. And we will all once again be left to the mercy of insurance companies to decide who gets covered. Preventive Care #2 Affordability and coverage go hand‐in‐hand. Forcing insurance companies to make quality health care affordable will mean more than 30 million previously‐uninsured Americans will have access to coverage. And that means we all get the high quality, comprehensive coverage we need, including no denials for preexisting conditions and coverage for preventive care like cancer screenings and wellness checkups. Moving Ahead with Reform Despite Challenges To help make the point that states need to move ahead with implementation despite what’s happening on the federal level, it helps to underscore that the state has a responsibility to make health care more affordable and accessible for its residents. Focusing on how ACA will help make health care more affordable while reducing waste and inefficiencies in the system, helps to address concerns over implementing the law during tough financial times. The best testing messages include: Despite Repeal Efforts While insurance premiums having doubled on average over the last 10 years, and hundreds of thousands of our residents are unable to afford any health insurance at all, the only responsible thing to do is continue our work to make health care more affordable and accessible. That’s why state officials and health providers are working not only to meet the requirements of the current federal law, but they are also using newly available federal funds to create programs and policies that are designed specifically to meet the needs of our [STATE’s] health system and its residents. Regardless of what happens to the federal reform law in coming years, [STATE] is moving forward with an open and transparent process to lower costs, increase access and improve the quality of care for all residents. Despite Current State Budget Cuts We understand that [STATE’s] immediate task is to balance the budget and keep the state moving. But, we should not be short‐sighted and ignore the opportunity created by health reform to improve our health care system and make it more efficient. For the long term health of [STATE’s] finances and its residents, we need to transform our health care system so that it provides quality, affordable care to more people while reducing waste and inefficiencies. Health Insurance Exchanges The best way to explain the Health Insurance Exchange is to say what it is to the consumer: a website. Since so much surrounding exchanges are up in the air, it’s best to provide basic, minimal information until late 2013. Highlighting that Members of Congress will get their insurance through exchanges is a popular point with consumers. The best testing message is below: The [STATE] Health Insurance Exchange will serve as a one‐stop shopping, website where residents can compare both public and private health coverage options and make decision on the plans that work best for them and their families. Private insurers will compete for their business in a fair and completely transparent marketplace where consumers will have the opportunity to compare rates, benefits and quality among plans to help find the one that best suits their needs. All Members of Congress will get their health insurance through the exchange as well. MESSENGERS The best messengers continue to be health care professionals and people who stand to gain the most from the bill. Having messages come from nurses, doctors, small business owners as well as fellow residents – those who have personal experience with or witness firsthand the benefits of the bill – will go a long way in communicating trusted information on ACA.