Using the Right Messages to Talk about Health Insurance Options (Enroll America)
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Using the Right Messages to Talk about Health Insurance Options (Enroll America)
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Using the Right Messages to Talk about Health Insurance Options (Enroll America)
- 1. Connecting Millions of Americans with Health Coverage: Enrollment and Messaging Work Martine Apodaca, Director, Public Education Campaign, Enroll America
- 2. 2 Maximize the number of uninsured Americans who enroll in health coverage made available by the Affordable Care Act Enroll America will help deliver on the promise of affordable health care for millions of Americans Enroll America will execute a national enrollment campaign using cutting-edge engagement strategies and will continue to build coalitions + share best practices Our Mission
- 3. The 2014 Enrollment Challenge 0 5 10 15 Source: July 2012 CBO estimates Millions Enroll more than16 million people in new coverage options } 9 million in Exchange coverage 7 million in Medicaid or CHIP } 3
- 4. The uninsured are a diverse group 4 AgeGender EthnicityIncome (as % of Poverty Level Male 55% Female 45% <138 51% 139-400 38% 19-25 17% <18 16% 26-34 21% 35-54 34% 55-64 12% 400+ 10% White 45%Latino 32% AfAm 15% Other 8% Source: Kaiser Commission on Medicaid & The Uninsured, October 2012
- 5. Two thirds of the uninsured live in 13 states 5 Uninsured by State <230K 230K - 600K 600K - 1.1M 1.1M+ Number of Uninsured CA TX FL NY ILGA NCOHPA NJMI AZ VA Rest of the U.S. 67% of uninsured live in 13 states Source: Census Bureau, Current Population Survey, March 2011 and 2012
- 6. As a result, enrollment will be a challenge to overcome 6 Enrollment in optional public benefit programs is well below 100% Limited public awareness of benefits of recent health reforms Program % of Eligible Enrolled Adult Medicaid 62% Subsidized Medicare 33% Medicare Rx benefit (low-income subsidy) 40% Unemployment benefits 72-83% Earned income tax credit 80-86% SNAP (food stamps) 54-71% of the uninsured don’t know about the new health insurance exchanges of people who could be eligible for the new Medicaid expansion don’t know about it 78% 83% Lack of awareness provides opportunity for education with effective messaging Source: Enroll America, November 2012Source: ASPE, March 2012
- 7. Grounded in Research Research and Branding We want to learn: (1)The most effective messages to reach different demographic and geographic groups? (2)Who are the best messengers for these communications? (3)What are the best ways to deliver these messages (e.g. television, radio, social media, etc.)?
- 8. 8 Collaborating with GMMB, Lake Research Partners conducted a national survey for Enroll America in September and October of 2012. The sample consisted of n=1,814 adults ages 18-64 with incomes at or below 400% of the Federal Poverty Level (FPL). The survey addressed the following topics: • Who the healthcare “connector” is in households • People’s experience searching for health insurance in the past • Reactions to new health coverage options in 2014 • Testing key facts about coverage in 2014 and motivations to check out new options • Reactions to the exchange portal • Perceptions of affordability, including sample costs • Testing ways to contextualize costs • Kind of help they want when they enroll • Best messengers and mediums for reaching audiences First, some details about the research…
- 9. More details 9 10FocusGroups • November 13-18 in Philadelphia, Columbus, San Antonio, and Miami • Groups include Latinos (English- and Spanish- speaking), African Americans, young adults, parents (low and moderate income), childless adults (low and moderate income) • Test branding and messages
- 10. Some Common Key Findings 1. Universal value of insurance 2. Cost and affordability are biggest barriers 3. Universal messages surrounding exchanges 4. Deep skepticism among consumers Previous bad experience Too good to be true 5. Insurance is confusing 6. Latinos vastly overrepresented among uninsured 7. Everyone wants help enrolling in coverage
- 11. For many, looking for health coverage is a negative experience. 11 How they want to feel is confident, informed, secure, satisfied, and in control. If you had to look for health insurance now, what feelings do you think you would have?
- 12. However, many have had negative experiences shopping for coverage in the past 12 44% have shopped for health insurance outside their job and majority of these individuals have had one or more difficulties 17% 55% 66% 70% 77% "I was denied for a pre-existing condition" "Hard to know where to look to find a plan" "Hard to find a plan that covered care I need" "Hard to understand the fine print and… "Hard to find a plan I could afford" Source: Enroll America, November 2012
- 13. 13 Initial reactions to new coverage options in 2014 are positive… 69% express interest in learning more about these options when they are presented with basic information about the new coverage (12 % are neutral and 16% are not interested). …but there is skepticism. 38% do not think they would find a plan they could afford. 33% do not think they would find a plan that covers all the care they need. As you may know, in 2014 there will be new health insurance options for you if you need insurance. Most people now have health insurance through their jobs, and that will not change. But if you do not have insurance or if you lose insurance, you will be able to find a quality health insurance plan that fits your budget.
- 14. Sample premium amounts may not seem affordable… After being presented with a sample premium amount for an individual or family of four at around 250% of the FPL, only 29% thought it was affordable (16% neutral and 53% “not affordable”). …but it seems more affordable when they consider yearly savings. When they read “with this help [you/your family] would save [$xxxx] a year compared to what you would pay on your own right now,” 51% say it sounds affordable. 14
- 15. Use Messages that Tap Into Security
- 16. In Broad Messaging, Introduce Options with Top Facts
- 17. In sum, here are our initial takeaways from the research so far… • There will likely be a lot of initial interest in learning about coverage options in 2014 but also a good deal of skepticism (will coverage really be affordable?). • We need to acknowledge that looking for health coverage is a negative experience for many. It will be key to present the exchanges as a different kind of experience. • We need to lead by telling consumers what services are covered, that they will not be turned down because of pre-existing conditions, and that they could get financial help. • Our messages need to tap into the theme of financial security when trying to drive consumers to exchanges – i.e., enrolling in coverage means not having to worry about big medical bills anymore; they will be able to find a plan that will fit their budget. • Overcoming concerns about affordability will be a challenge. Always contextualize the costs presented on exchanges – i.e., present yearly savings from the tax credits as a way to show the value of the coverage. 17
- 18. 5 Clusters of Targets 1. Uninsured, Unnecessary & Uninterested (11%) 2. Reluctant but Reachable (10%) 3. Desperate and Believing (8%) 4. Connected, Low-income Women (9%) 5. Insured but At-Risk (13%)
- 19. Demographic Profile 18 to 64 at or below 400% FPL
- 20. Uninsured, Unnecessary & Uninterested (11%) Skeptical, Young (Mostly) Men
- 21. Reluctant but Reachable (10%)Young, Diverse, Uninsured
- 22. Desperate & Believing (8%): Poorest, Sickest, Least Educated
- 23. Connected Low-Income Women (9%):The Medicaid/CHIP Connection
- 24. Insured but At-Risk (13%): Young, under 250% FPL
- 25. Fine Tuned Messages from the States • The leading perceived benefit among several populations in several states Peace of Mind • A key message for womenPrevention • Resonated most with men and young adults in some states Protection from Financial Ruin or Injury • Resonated with African Americans, Latinos, and Medicaid eligible Access To Care • Key message for low income, Medicaid eligible Low cost or free health insurance coverage • The biggest motivator in Massachusetts Law and Associated Penalties
- 26. Building an Effective Campaign Grassroots field efforts Creative use of social media National and local surrogates Education & engagement through partner entities with direct reach to target populations Earned media events and Activities in communities to magnify messaging Enrollment assistance by trusted community sources 26 Paid advertising on TV, radio online, and in print media Paid advertising on TV, radio, online, an d in print media Data, Analytics , Microtargetin g Constituency engagement Strategic Partnerships
- 27. Campaign Timeline 27 1. Initial Planning and Day of Action 2. Capacity Building and Education 3. Marketplace Opens and Coverage Begins 4. Learning and Capacity Building 5. Marketplace Opens • Hire additional leadership, write plans, continue to build partnerships. March 23 Day of Action. • Build organization and launch education and awareness campaign in collaboration with partners. • MP open Oct 1 to Mar 31, coverage begins Jan 1 • Launch full effort w/ media, events, grassroots • Debrief and learn lessons from past year and continue to build organization in prep for October • Marketplace open again from Oct 15 to Dec 15 • Launch full effort w/ media, events, grassroots Jan - Mar ‘13 Apr - Sep ‘13 Oct ‘13 - Mar ‘14 Apr - Sep ‘14 Oct - Dec ‘14 Phase Dates Priorities
- 28. Working Together • Sharing research & materials • Coordinate efforts with HHS & states Goals: • Non-duplicative • Value-added
- 29. Questions? Martine Apodaca Director of Public Education Enroll America martinea@enrollamerica.org 202-737-6340
Notas do Editor
- Our goal is ensure that all Americans get enrolled and stay enrolled. We do this through a two fold strategy – One is through the best practices Insitute that Anita will talk about later today, Promoting enrollment best practices by focused on identifying, developing, and disseminating information about enrollment and eligibility policies that support optimal health coverage enrollment and make it easy for people to enroll. The Institute serves as a resource for stakeholders at both the national and state-level who are working to get these consumer-friendly enrollment practices implemented across the countryWe will also have a national public education campaign to raise public awareness that coverage will be available. Working with states and entities within states to build broad coalitions to bring people together under one common goal of getting folks enrolled
- As a good analyst, CBO estimates that of the more than 40 million who will be eligible for coverage in 2014, just 16 million will enroll.Now, there is no guarantee we will enroll 16 million in 2014. So our first goal has got to be to AT LEAST reach those 16 million to ensure that the ACA is not judged politically as a failure. And 16 million is fully HALF of the entire enrollment that CBO anticipates between 2014 and 2019. Very few programs achieve a 50% enrollment rate in the first year. It is quite normal (as I’ll discuss more in a minute) to have a slow ramp up of enrollment as people learn about a new program and decide whether to participate. But we don’t think that CBO took Enroll America and its partners into account. Our goal is not just to meet the 16 million threshold, but to surpass it. There are another 25 million people who will be eligible in 2014 who CBO thinks will remain uninsured that whole year. 7 million additional people in Medicaid/CHIP8 million people in exchanges with premium tax credits1 million people in exchanges without premium tax credits
- WHAT DO WE KNOW ALREADY – UNINSURED ARE A DIVERSE GROUPMOST OF THEM – 55% ARE BETWEEN 26 AND 54. AS A GROUP THEY ARE LOWER INCOME – 89% ARE BELOW 400% OF POVERTYAND THEY ARE SPREAD UNEVENLY ACROSS DEMOGRAPHIC GROUPS – SEE THE CIRCLE GRAPH ON THE RIGHT. WHILE LATINOS ARE ABOUT 13% OF THE US POPULATION, THEY ARE ABOUT 32% OF THE UNINSURED.
- THIS IS A GRAPHIC REPRESENTATION OF THE UNINSURED. 2/3 OF THEM ARE CONCENTRATED IN A BOUT 13 STATES. DOWN HERE IS OUR FAVORITE, PENNSYLVANIA, AT #9.50% of the uninsured live in the 7 most populous states: CA, TX, FL, NY, GA, IL, and NC. 66% live in the top 12 most populous states. Add: OH, PA, NJ, MI, & AZ. As orwell liked to say – some are more equal than others.
- We found this in two surveys CVS and Our ownTHE FOCUS GROUPS WERE EYE OPENING – ONE GENTLEMAN THOUGHT THAT THE MANDATE MEANT THAT YOU HAD TO DO WHAT YOUR DOCTOR TOLD YOUANOTHER THOUGHT THAT THE WHOLE THING WOULD BE THROWN OUT WHEN THE NEW CONGRESS COMES INThe population of uninsured is disproportionately minority, and in some of our potential target states – overwhelmingly hispanic. Even in places where Hispanics are a teeny tiny portion of the populace, they are vastly overrepresented among the uninsured.
- So – How Will We Do this Campaign??GMMB and Lake Active all over the Country11 BIDS, 23 FIRMS.
- WHO IS THE PERSON WHO MAKES HEALTH CARE DECISIONS? WHO CONVINCES OTHERS TO MAKE GOOD HEALTH DECISIONS?WHAT IS THEIR EXPERIENCE WITH THE HEALTH CARE SYSTEM WHAT DO THEY KNOW OR THINK ABOUT THE HEALTH COVERAGE OPTIONS COMING IN 2014?WHAT WILL MOTIVATE THEM TO CHECK OUT THE NEW INSURANCE OPTIONSHOW DO WE CONTEXTUALIZE COSTS? HOW DO WE TEST PERCEPTIONS OF AFFORDABILITY
- 26 Minute National Survey Core message conceptsMotivations to enroll in coverageBiggest barriers by target audienceMost trusted and valued messengers by audienceBest communicators by target audienceAwareness and attitudes toward ACA 2014 activitiesOversamples:Uninsured adults (n=579)Adults at or below 138% of the FPL (n=582)Adults between 138% and 400% of the FPLAfrican Americans Latinos (n=631)Young adults (n=464)Additional analysis by geographical grouping, gender, age cohorts, education levels, marital status, employment status, parental status, etc. 10 focus groups to test branding and messaging Latinos (in English and Spanish)African-AmericansYoung AdultsParents under 250%Childless adults under 250%Parents 250-400% Childless adults 250-400%
- THIS WAS TRUE ACROSS ALL DEMOGRAPHICS AND ALL GEOGRAPHIES. WE THOUGHT MAYBE THERE WOULD BE SLIGHT DIFFERENCES BUT THAT WASN’T THE CASE AT ALL. PERCEPTIONS OF AFFORDABILITY WILL BE ONE OF OUR BIGGEST CHALLENGES TO OVERCOMEEXCHANGES ARE USING SOME PRETTY UNIVERSAL MESSAGES – PEACE OF MIND, FINANCIAL SECURITY, ACCESS TO CARE, ETC. DEEP SKEPTICISM AMONG CONSUMERSIN MANY CASES WE’RE TALKING FOLKS WHO’VE NEVER HAD INSURANCE AND THUS DON’T KNOW WHAT A PREMIUM IS, HOW A DEDUCTIBLE WORKS. ]AND BECAUSE THIS POPULATIONS TENDS TO SKEW LOWER INCOME AND LOWER EDUCATION, WE HAVE A LOT OF BASIC LITERACY ISSUES TO CONSIDER. 6. EVERYONE EVERYONE EVERYONE WANTS HELP
- 44% have shopped for insurance outside their job67% have been uninsured for 2 years or moreThey want to feel in control, relaxed, and confident about the decisions they make.
- WE NEED TO ACKNOWLEDGE THIS – AND THIS IS PARTICULARLY TRUE FOR THIS WITH PRE EXISTING CONDITIONS
- INITIAL REACTION ARE POSITIVE BUT AGAIN THERE IS A LOT OF SKEPTICISM.
- CONTEXT CONTEXT CONTEXT. Counts – health insurance seems totally out of reach when we’re just talking about premiums or subsidies.You have to give consumers the whole picture – not just about what it costs, but what it means to them. STARTING OUT, LATINOS ARE THE ONES WHO MOST BELIEVE THE PREMIUMS WILL BE AFFORDABLE – BUT ONCE YOU GIVE THEM A PRICE, ALMOST NO ONE BELIEVES THAT’S TRUE. IN MOST CASES, IT’S NOT HELPFUL TO GIVE AN EXACT PRICE OR AN EXACT SUBSIDY. WHAT IS IMPORTANT IS GIVING THEM THE BIG PICTURE. IN MANY CASES, WE’RE TALKING ABOUT POPULATIONS WHERE A TAX RETURN MAY BE THE BIGGEST FINANCIAL MOMENT OF THE YEAR. IT WOULD BE LIKE GOING TO A FINANCIAL PLANNER WHO SAYS - TO REACH YOUR FINANCIAL GOALS, ALL YOU HAVE TO DO IS SAVE AN ADDITIONAL TWO MILLION DOLLARS A YEAR!
- SO HOW DO WE REACH THEM
- Lots of Initial InterestAcknowledge Where People AreLead By Telling Consumers What’s CoveredWe MUST Talk about Financial Security – it’s the top message across all groupsAffordability is our biggest challenge. MEET THEM AT GOOGLE.
- THESE ARE CLUSTERS OF THE UNINSURED – THE DEMOGRAPHICS WE’RE MOST INTERESTED IN. THIS IS NOT TRUE FOR THE EXCHANGES, MANY OF WHOM WILL BE DELIVERING MESSAGES TO EVERYONE, NOT JUST THE UNINSURED.
- AS YOU CAN SEE – 67% OF THE UNINSURED HAVE BEEN UNINSURED FOR MORE THAN 2 YEARS. 84% DO NOT HAVE A COLLEGE DEGREE – LOWER ON THE EDUCATION SPECTRUM
- THESE GUYS ARE MOVABLE. THESE ARE THE FOLKS HHS IS GOING TO BE THE MOST FOCUSED ON.THESE ARE ONE OF THE YOUNGEST CLUSTERS – AND LEAN LESS EDUCATED THAN SOMEOF THE OTHER GROUPS – THESE ARE THE LEAST CONNECTED TO MEDICAID, AND 45% ARE SOUTHERNERS. STRONGLY SKEPTICAL – ONLY 3-4% ARE INTERESTED IN THE NEW OPTIONS. LAKE IDENTIFIED THESE GUYS FOR US AS UNINSURED, UNECESARY, AND UNINTERESTED – BUT I CALL THEM MAMA’S BOYS ON ACCOUNT OF THE PERSON THEY GO TO FOR INFO AND THE PERSON WHO IS GOING TO HELP THEM OR CONVINCE THEM TO ENROLL.
- THIS IS AMONG THE YOUNGEST CLUSTERS AND LOWEST INCOME. IT’S A HIGH LATINO AND AFRICAN AMERICAN CLUSTERSAMONG TH ELEAST EDUCATED. MOST LIKELY TO EXPRESS SOFT INTEREST IN NEW OPTIONS – MOST ARE INTERESTED, BUT ONLY 1/3 are SUPER. THE MOVE TO A BETTER POSITION AFTER SOME BASIC INFORMATION. ALMOST UNIVERSALLY FOLKS SAY THEY WOULD GO TO GOOGE TO GET INFORMATION.
- THIS IS THE HEAVIEST LATINO SECTOR. IT’S ALSO ONE OF THE SECTORS THAT’S THE POOREST, AND ARE THE LEAST EDUCATED. THESE ARE OUR LOW HANGING FRUIT IN TERMS OF CONVINCINGTHEY EXPRESS THE MOST INTEREST AND LEAST SKEPTICISM. THEY ARE HOPEFUL ABOUT THE CHANGES COMING AND STRONGLY BELIEVE THERE WILL BE A PLAN THEY CAN AFFORD. THEY WOULD SEEK OUT A MEDICAID OFFICE OR SOMEONE FROM STATE GOVERNMENT. THEY ARE THE SECOND MOST CONNECTED TO A MEDICAID OFFICE – THIS IS INTERESTING BECASUSE WHILE MANY FOLKS HATE THE CONCEPT OF A MEDICAID OFFICE, THEY APPRECIATE THE ADVICE AND HELP THEY GET ONCE THEY ARRIVE AT THE CASE WORKER. THEY ALSO CITED HEALTH INSURANCE COMPANIES – THE MOST IMPORTANT THING IS KNOWLEDGE. WHILE THERE IS SKEPTICISM OF INSURANCE COMPANIES GENERALLY, IF THEY ARE BUYING A PLAN FROM A PARTICULAR COMPANY THEY WANT TO TALK TO THAT COMPANY. THE IMPORTANT THING HERE IS KNOWLEDGE. INSURANCE BROKERS ALSO EMERGED AS A TRUSTED RESOURCE OF INFORMATION. I THINK THE WAY PEOPLE FEEL ABOUT AN OVERWHELMING MAJORITY SEE HEALTH INSURANCE AS A NECESSITY.I THINK MANY PEOPLE FEEL ABOUT INSURANCE COMPANIES THE WAY THEY FEEL ABOUT CONGRESS
- 60 PERCENT OF THIS CLUSTER IS CONNECTED TO MEDICAID EITHER FOR THEMSELVES OR SOMEONE IN THEIR HOUSEHOLD – MOST LIKELY A CHILD. THIS IS THE LOWEST INCOME SECTOR-77% ARE GOING TO BE MEDICAID ELIGIBLE BECAUSE THEY’RE UNDER 138%THIS GROUPS SEES HEALTH INSURANCE AS NECESSARY OVERWHELMINGLY. THE TOP TWO MESSENGERS ARE SOMEONE LIKE YOU WHO ENROLLED, BUT ALSO SOMEONE FROM A MEDICAID OFFICE.
- THESE ARE OUR AT RISK FOLKS – most of them have insurance, but they are teetering on the edge and self identified as being at risk of losing it. THIS IS ONE OF THE YOUNGEST CLUSTERS. LIKE THE FIRST CLUSTER, THIS CLUSTER EXPRESSES WEAK INTEREST AND IS VERY SKEPTICAL.
- From Massachusetts but applicable everywhere: In general, the research found that participants responded best to messages that focused on the personal benefits of having health insurance. However, differences emerged among different demographic groups that helped to frame both the messages and messengers used to reach those groups. For example, women were particularly influenced by messages emphasizing the importance of access to preventive health care. In contrast, messages related to the importance of insurance as protection from financial risk if an injury or illness should occur resonated most significantly with men, especially the young men who comprised the largest proportion of people who were uninsured. These findings were critical to developing a comprehensive marketing and advertising strategy, ensuring that specific messages, the medium used to deliver them, and the settings used to disseminate them could be targeted for specific demographics.
- WE ARE COORDINATING WITH CLOSELY WITH HHS AND THE STATE BASED EXCHANGESLAST WEEK WE BROUGHT 7 EXCHANGES – IT WAS GOING TO BE 8 BUT WE LOST ONE PARTICIPANT TO THE FLU, CT, CO, CA, IL, MD, MN, VT TO TALK COORDINATION, PARTNERSHIP MODELS, HOW WE SHARE RESOURCES, HOW WE CAN COORDINATE OUR ASKS FROM CORPORATE AND CONSUMER PARTNERS.
- We expect the media effort to being in earnest several months before the first Open Enrollment period in October 2013. That means June/July