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
Using the Right Messages to Talk about Health Insurance Options (Enroll America)
Connecting Millions of Americanswith Health Coverage: Enrollment andMessaging WorkMartine Apodaca, Director, Public Education Campaign, EnrollAmerica
2Maximize the number of uninsuredAmericans who enroll in healthcoverage made available by theAffordable Care ActEnroll America will help deliver on the promise ofaffordable health care for millions of AmericansEnroll America will execute a national enrollment campaign using cutting-edgeengagement strategies and will continue to build coalitions + share best practicesOur Mission
The 2014 Enrollment Challenge051015Source: July 2012 CBO estimatesMillionsEnroll more than16 million people in new coverage options} 9 million in Exchange coverage7 million in Medicaid or CHIP}3
The uninsured are a diverse group4AgeGenderEthnicityIncome (as % of Poverty LevelMale55%Female45%<13851%139-40038%19-2517%<1816%26-3421%35-5434%55-6412%400+10%White45%Latino32%AfAm15%Other8%Source: Kaiser Commission on Medicaid & The Uninsured, October 2012
Two thirds of the uninsured live in 13 states5Uninsured by State<230K 230K -600K600K -1.1M1.1M+Number of UninsuredCATXFLNYILGANCOHPANJMIAZVARest ofthe U.S.67% of uninsured live in 13 statesSource: Census Bureau, Current Population Survey, March 2011 and 2012
As a result, enrollment will be a challenge to overcome6Enrollment in optional public benefitprograms is well below 100%Limited public awareness of benefitsof recent health reformsProgram% of EligibleEnrolledAdult 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’tknow about the newhealth insuranceexchangesof people who couldbe eligible for the newMedicaid expansiondon’t know about it78%83%Lack of awareness provides opportunity for education with effective messagingSource: Enroll America, November 2012Source: ASPE, March 2012
Grounded in ResearchResearch and BrandingWe want to learn:(1)The most effective messages toreach different demographic andgeographic groups?(2)Who are the best messengers forthese communications?(3)What are the best ways todeliver these messages (e.g.television, radio, socialmedia, etc.)?
8Collaborating with GMMB, Lake Research Partners conducted a nationalsurvey for Enroll America in September and October of 2012.The sample consisted of n=1,814 adults ages 18-64 with incomes at or below400% 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 audiencesFirst, some details about the research…
More details910FocusGroups• November 13-18 in Philadelphia, Columbus, SanAntonio, and Miami• Groups include Latinos (English- and Spanish-speaking), African Americans, young adults, parents(low and moderate income), childless adults (lowand moderate income)• Test branding and messages
Some Common Key Findings1. Universal value of insurance2. Cost and affordability are biggest barriers3. Universal messages surrounding exchanges4. Deep skepticism among consumers Previous bad experience Too good to be true5. Insurance is confusing6. Latinos vastly overrepresented among uninsured7. Everyone wants help enrolling in coverage
For many, looking for health coverage is anegative experience.11How they want to feel isconfident, informed, secure, satisfied, andin control.If you had to look for health insurancenow, what feelings do you think you wouldhave?
However, many have had negativeexperiences shopping for coverage inthe past1244% have shopped for health insurance outside their job andmajority of these individuals have had one or more difficulties17%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
13Initial reactions to new coverage options in2014 are positive…69% express interest in learning more about these options when they arepresented with basic information about the new coverage (12 % are neutraland 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 youneed insurance. Most people now have health insurance through their jobs, andthat will not change. But if you do not have insurance or if you lose insurance, youwill be able to find a quality health insurance plan that fits your budget.
Sample premium amounts may not seemaffordable…After being presented with a sample premium amount for an individual or familyof 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 consideryearly savings.When they read “with this help [you/your family] would save [$xxxx] a yearcompared to what you would pay on your own right now,”51% say it sounds affordable.14
In Broad Messaging, Introduce Options with Top Facts
In sum, here are our initial takeaways from theresearch so far…• There will likely be a lot of initial interest in learning about coverage optionsin 2014 but also a good deal of skepticism (will coverage really beaffordable?).• We need to acknowledge that looking for health coverage is a negativeexperience for many. It will be key to present the exchanges as a differentkind of experience.• We need to lead by telling consumers what services are covered, that theywill not be turned down because of pre-existing conditions, and that theycould get financial help.• Our messages need to tap into the theme of financial security when trying todrive consumers to exchanges – i.e., enrolling in coverage means nothaving to worry about big medical bills anymore; they will be able to find aplan that will fit their budget.• Overcoming concerns about affordability will be a challenge. Alwayscontextualize the costs presented on exchanges – i.e., present yearlysavings from the tax credits as a way to show the value of the coverage.17
5 Clusters of Targets1. 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%)
Demographic Profile18 to 64 at or below 400% FPL
Uninsured, Unnecessary & Uninterested (11%)Skeptical, Young (Mostly) Men
Reluctant but Reachable (10%)Young, Diverse, Uninsured
Desperate & Believing (8%): Poorest, Sickest, Least Educated
Connected Low-Income Women (9%):The Medicaid/CHIP Connection
Insured but At-Risk (13%): Young, under 250% FPL
Fine Tuned Messages from the States• The leading perceived benefit amongseveral populations in several statesPeace of Mind• A key message for womenPrevention• Resonated most with men and youngadults in some statesProtection fromFinancial Ruin or Injury• Resonated with AfricanAmericans, Latinos, and Medicaid eligibleAccess To Care• Key message for low income, MedicaideligibleLow cost or free healthinsurance coverage• The biggest motivator in MassachusettsLaw and AssociatedPenalties
Building an Effective CampaignGrassrootsfield effortsCreative use ofsocial mediaNational andlocal surrogatesEducation & engagementthrough partner entities withdirect reach to targetpopulationsEarned media eventsand Activities incommunities tomagnify messagingEnrollmentassistance bytrustedcommunitysources26Paid advertisingon TV, radioonline, and inprint mediaPaid advertising onTV, radio, online, and in print mediaData, Analytics, MicrotargetingConstituencyengagementStrategicPartnerships
Campaign Timeline271. Initial Planning andDay of Action2. Capacity Buildingand Education3. Marketplace Opensand Coverage Begins4. Learning andCapacity Building5. Marketplace Opens• Hire additional leadership, write plans, continue tobuild partnerships. March 23 Day of Action.• Build organization and launch education andawareness campaign in collaboration withpartners.• 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 andcontinue to build organization in prep for October• Marketplace open again from Oct 15 to Dec 15• Launch full effort w/ media, events, grassrootsJan - Mar ‘13Apr - Sep ‘13Oct ‘13 - Mar ‘14Apr - Sep ‘14Oct - Dec ‘14Phase Dates Priorities
Working Together• Sharing research& materials• Coordinateefforts with HHS& statesGoals:• Non-duplicative• Value-added
Questions?Martine ApodacaDirector of Public EducationEnroll Americamartinea@enrollamerica.org202-737-6340