Comms key to success of Affordable Care Act

The Affordable Care Act is at a critical juncture. Solidified by President Barack Obama's re-election and the earlier Supreme Court decision, the legislation is moving toward full implementation by January 2014.

The Affordable Care Act is at a critical juncture. Solidified by President Barack Obama's re-election and the earlier Supreme Court decision, the legislation is moving toward full implementation by January 2014. In October, state exchanges will be open for enrollment.

Like nervous backers of a Broadway production, people are saying, “Is the Affordable Care Act ready for prime time?” Even supporters of the healthcare law have a case of the jitters, and for good reasons.The state exchanges vary in their readiness to meet the enrollment deadline. Many states, such as Texas, Pennsylvania, and North Carolina have not accepted the Medicaid expansion, a central piece of the law that was made optional by the Supreme Court.

And, there is still active opposition to the law on legal and political fronts. Republican leaders have voted to repeal what they call “Obamacare” 37 times now.

As if these challenges were not enough, the act faces huge hurdles with the public. According to a Kaiser Family Foundation poll, a massive 42% of Americans don't even know it is a law. An NBC/Wall Street Journal poll found for the first time that more people oppose the law, 49%, than support it, 37%. This is no doubt due to heightened
rhetoric from opponents who predict dire consequences when the law is implemented.

Its complexity, long timetable for implementation, and opposition messaging have created a perfect storm of public confusion.

As President Obama has noted, the act is a “big undertaking” and there is no doubt that communications is crucial to its ultimate success. That is one of the few areas of bipartisan agreement.

The administration has launched a major public education campaign, coordinated by Enroll America. The effort entails broadcast advertising, as well as PR and social media outreach. Similarly, each state is conducting a campaign to inform the public about its exchange and drive enrollment. Insurers, hospitals, and nonprofit groups are expected to supplement the effort.

The communications initiatives will be aimed at the 10% to 15% of Americans who do not have insurance coverage. It is this segment that will be eligible for coverage through Medicaid or the state exchanges.

There is a knowledge gap among the uninsured that will impede the act's success if not addressed. According to the Kaiser poll, 58% of the uninsured say they do not have enough information to know how the law will impact their families. The good news is that the uninsured view the law favorably by a 40% to 32% margin. Yet three in 10 people still have no knowledge or opinion of it.

It will take a multifaceted and concerted effort to break through the confusion. The uninsured comprise a diverse population – ranging from the young and healthy to people with chronic health conditions – who have been living without access to care.

It's not enough to raise awareness. The end goal is to create a value in healthcare coverage and a pathway to achieving that. The devil is not just in the details; it is in the messages. A key feature of the law is the government subsidies that will help people buy insurance. Of Florida's 4 million uninsured people, an estimated 1.7 million
could benefit from subsidized coverage. Yet few people there, or elsewhere, are aware of the subsidies and eligibility guidelines.

The individual mandate, a cornerstone of the act, says everyone must have health insurance or they will be fined by the IRS. The mandate is controversial and will require sophisticated messaging that includes details about subsidies to buy insurance.

The drive to enrollment is not a one-size-fits-all effort. Each group must be targeted with messages that resonate. To get a 20-something who thinks they don't need health insurance to enroll is a different challenge than reaching a 50-year-old Latino with chronic diabetes. Regardless of the audience, the messaging must be compelling enough to withstand the noise of the act's foes and motivate individuals to act.

The role of communications has rarely been more crucial to a public health effort in the US. It has long been a goal of the country to achieve universal healthcare coverage. Key steps in passage and implementation of the law have been achieved. Now, communications can push the act over the finish line. 

Nancy Hicks is associate director, North America healthcare practice, Ketchum. She joined the agency in 2001.

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