There are more than 337,000 people without health insurance in Connecticut, and a new marketplace for buying coverage called Access Health CT is intended to make a dent in that number.
In just over three months, it will be open for business, ready to enroll people in private health plans that take effect next year.
But first, the uninsured need to know it’s there, and how to use it. So will people who have coverage but want another option.
And so, Access Health — the state’s health insurance exchange, created as part of the federal health reform law — is undertaking a major marketing campaign. It will include broadcast advertising in English and Spanish, major and ethnic newspapers, billboards, and posters in convenience stores, clinics, beauty salons and barber shops, trying to get a few points across: Federal health reform is happening. There’s a new way to buy health insurance. Many people will qualify for federal subsidies that will make their coverage less costly. You might be one of them.
It will be supplemented with a “ground game,” an in-person strategy that will include knocking on 120,000 doors, twice.
“This plan, for us, is the biggest campaign I think you’ve ever seen,” Lt. Gov. Nancy Wyman said during a press conference Monday to announce the launch of the marketing campaign. Wyman leads the exchange’s board. “We will be touching into all neighborhoods, from the Greenwiches to the Hartfords.”
Health insurance is complicated, but those marketing the exchange have another challenge, too: Misinformation and skepticism about the law known commonly as Obamacare are widespread.
A poll commissioned by the nonpartisan Kaiser Family Foundation in April found that 42 percent of those surveyed didn’t know that Obamacare was still the law and being implemented.
And people know even less about the exchanges, one of the key pieces of the law. In its June poll, Kaiser found that 45 percent of people said they had not heard anything at all about the new insurance marketplaces. And among the exchanges’ target audience, people without insurance, 55 percent were unaware they exist.
“Traditionally, when you roll out a product, you talk about the benefits that it has for individuals. But in this case, some people don’t even know that the product we’re rolling out is for them,” said Jason Madrak, Access Health’s chief marketing officer.
The lack of information about the exchange could be an advantage, he said Monday, giving marketers a blank slate to work with. But he and his colleagues know traditional advertising strategies won’t be enough to get people through the sometimes cumbersome process of selecting and signing up for coverage.
“I talk about this stuff with my own family and they’re still confused,” Madrak said. “We’re talking for hours over the course of a barbecue, and they still don’t get it. If I have that challenge there, clearly I’m not going to be able to solve it with a postcard or a TV ad.”
Targeting the uninsured
So how is the exchange going to reach its target audience, and persuade them to sign up for insurance?
There’s the media campaign, which Madrak said is aimed at making people aware of Access Health and defining it as something approachable, a source for expert guidance.
People from Access Health will have a presence at community events, like the jazz and salsa festival in Hartford next weekend. School packets sent to parents in September will include fliers about the exchange.
There will be storefronts with computer terminals and experts, intended to resemble Apple stores. People looking to sign up for insurance will be able to reach a call center, apply through a website or get help in person.
But there will also be a more targeted, in-person approach, involving people who are trusted in communities. Community organizations will be eligible for grants to do outreach. The exchange is working to make contacts with clergy.
The local focus is shaped in part by research that indicates that Connecticut’s uninsured and underinsured residents tend to be concentrated in a few areas. Nearly 10 percent of those without insurance in the state live in five zip codes in Hartford. Another 8 percent live in three New Haven zip codes. Nearly 38 percent of the uninsured in Connecticut — nearly 128,000 people — live in 20 zip codes.
In the first year, between 80,000 and 100,000 people are expected to buy insurance through Access Health. Another 20,000 to 30,000 people who are eligible for Medicaid are expected to get connected to that coverage through the exchange.
Meeting those targets won’t mean everyone in the state will have insurance. It would move the state’s rate of people without insurance from 9.6 percent to between 6 percent and 7 percent, leaving between 214,000 and 244,000 people without coverage.
Overall, about 120,000 of the uninsured are expected to become eligible for Medicaid as of Jan. 1, 2014, when eligibility expands as part of the federal health reform law. Another 176,000 are expected to be eligible for subsidies — in essence, a discount — to buy their coverage through the exchange, according to Access Health’s figures. And 49,000 of the uninsured won’t be eligible for any help paying for coverage.
Red Sox, newspapers and churches
Massachusetts, which passed an insurance mandate in 2006, offers a blueprint for how to get people signed up for coverage.
Like Connecticut, the state took two approaches — a mass media campaign and a grass-roots effort involving employers and community groups, many of which received grants from the state.
The media campaign included broadcast advertising, mailings and ads on mass transit. It got a big boost from the Red Sox, which ran ads during games, had a booth for prospective insurance customers at Fenway Park and had a formerly uninsured person throw out the first pitch at a game.
Brian Rosman, research director at Health Care for All, a Massachusetts organization that participated in the effort, said market research helped shape the ad campaign. Initially the ads featured players talking about the importance of health care, but it turned out the target audience didn’t identify with multimillionaire athletes. The campaign had more success when they featured Fenway groundskeepers and ticket-takers, people with the aura of the Red Sox but easier to relate to.
The wide-scale campaign raised awareness, but Rosman said the more direct contact made through the grass-roots efforts were what got people to take action. Community groups set up tables in malls and went to church health fairs. Some went door to door or participated in radio call-in shows, including on Spanish or Portuguese-language programs. Churches brought in doctors to do blood pressure testing, which led to conversations about whether members had insurance. For those who didn’t, people were on site to help them sign up. CVS agreed to put fliers in the bags people got when picking up prescriptions.
There was regional variation. In Western Massachusetts, where newspaper readership is high, the campaign included newspaper ads, fliers and inserts. In the southeastern part of the state, people went door-to-door in places like New Bedford, where there were many people without insurance.
“You have to get over the hump of people’s discomfort with the whole idea and the whole issue,” Rosman said. “They don’t know what it’s going to cost. This is brand new for everybody. People don’t realize that they’re eligible for premium assistance and with affordable copays.”
“They’re scared of getting a bill every month for something that they can’t afford,” he said.
There were also differences in what worked for men and women, Rosman said.
The importance of having insurance to get regular check-ups and stay healthy appealed to women, he said. It wasn’t as successful for men. For them, the more effective messages had to do with the possibility of getting into an accident, and what it would cost to get treatment without health insurance.
“What they found is people had no clue how much health care costs if they were uninsured,” Rosman said. “So in their ads they had the actual prices you would have to pay for just a short three-day stay in the hospital.”
Access Health CEO Kevin Counihan, who worked at Massachusetts’ exchange, said interfaith councils were very effective in spreading the message. So was training community health center workers, people who work in emergency rooms, health care advocates and insurance brokers.
When people who bought insurance through the Connector were surveyed, he said, many said they had heard about it through relatives. And although television advertising was a big part of the campaign, Counihan said one of the most potent ways of spreading the word was through newspaper stories.