One of the saddest outcomes of the Republican moves against the Affordable Care act was that revelation that many ACA enrollees didn’t know Obamacare was the same thing. Patients tweeted things like “Down with Obamacare! I’m on an Affordable Care Act plan!” The same patients may well have voted for the current president and for anti-ACA Republicans, not realizing that they themselves would lose their health insurance.
How did this branding mishap happen, in a world where everyone knows that Luxottica makes every single pair of machine-made sunglasses in the country and Lancome mascara comes from the L’Oreal people?
The Affordable Care Act missed key opportunities to market itself effectively. Because President Obama was so tightly linked with Obamacare, the Republicans had extra motivation to kill it, while anti-Obama patients have decided to hate the concept of a mandate for insurance with penalties. Let’s take a look at the core principles of marketing, contrasting the Affordable Care Act/Obamacare with another big brand, Louis Vuitton (maker of handbags and clothes), and see what ACA planners could have done better.
- Product
Health insurance is a service, while Louis Vuitton might sell a carryon bag, but the principles are the same. A product has to satisfy a perceived need and offer features and accessories that fit the terms the customer group demands. Name and packaging are major considerations.
Who needs a LV bag? Exactly no one—they can cost thousands of dollars. The key is that the need is perceived—because celebrities carry the bag in real life and in magazines. The actual need is not a bag. It’s the wealth, beauty and status of the celebrity.
Millions of people did sign up for health insurance under the ACA, but millions of eligibles didn’t, as well. The ACA created a perceived need of avoiding a penalty and getting health insurance. However, these have negative connotations in most people’s minds. Few people adore their health insurer, and who wants to be reminded of a financial penalty imposed by the government? Instead, the product could have been sold as a perceived need to save money. The website certainly made it easy to see whether insurance premiums would be cheaper using healthcare.gov, but case studies showing how real or imaginary people would have saved money on the overall cost of care had they had insurance drive the point home harder.
People love free things, and the free aspects of care under the ACA could have been sold more, especially to young, healthy patients. I would envision a marketing plan less “get your health insurance today” and more “Your friends have free birth control pills…do you?”2
Allowing the ACA to be referred to as Obamacare in the press and popularly also created negative consequences, as seen by the confusion on Twitter. A concerted effort should have been made to shut down the use of the name, in order to focus attention on affordable care, not President Obama.
- Price
Louis Vuitton prices seem astronomical—but not to women with a little money in the bank and a copy of Vogue magazine. The price is set by demand and perceived value. For many bags in the luxury market, there is also low supply—they are limited-edition, driving up their prices and especially their secondary market prices (see: women who make an entire living reselling purses in China).
Because insurance isn’t a tangible good apart from a little white card, pricing needs to not be a barrier. While formulas calculated premiums for families that were affordable on paper, the formulas didn’t account for recent depletions of savings due to a car accident, spouses with credit card problems, needing to pay for Grandmother’s surgery in another country, child care expenses, or outstanding loans. Because of this, the ACA would have benefited from an even more inexpensive option (with correspondingly limited coverage) so that financially strapped patients could feel like they chose to pay instead of being forced to pay, and still see the benefits of free mammograms and physicals. Also missing were tools to remind patients to set up a savings account to pay off potential deductible costs. Yes, health savings accounts exist; and virtually no one knows how to use them properly. Making it easy and integrated to set up a health savings account along with a high-deductible health plan would have alleviated much of the backlash about out-of-pocket costs associated with the ACA.
- c) Place
Where will you sell your product? What’s the distribution channel? Louis Vuitton often pays for the most expensive real estate to make itself easy to shop for—the first boutique as you walk into an upscale mall, or a prominent location on a fancy shopping boulevard. N
Countless clinics received funding due to Medicaid expansions. This should have been obvious to anyone walking into those clinics. Quick, what’s the logo of the ACA? I don’t know either. Just like Yelp.com sends a sticker to each business doing well on its website, clinics should have a prominently displayed indicator of their funding. Patients—who are also voters—aren’t mind readers. Clinics running in part due to the ACA are operating more like unmarked bars—without the cool-kid buzz. Similarly, doctors and nurse practitioners who accept the insurance should have something to display as well, especially to counteract the negative association of the ACA with poor pay. There’s an opportunity to turn taking ACA insurance into a point of pride.
- d) Promotion
Promotion requires an understanding of the media and of the priorities of potential buyers. Why does LV spend so much money on Vogue ads, runway shows, fancy events, and Jaden Smith? http://people.com/style/jaden-smith-is-the-new-face-of-louis-vuitton-womenswear-wearing-a-skirt-comes-naturally-to-him/ Because it leads to purchases and profit!
The Affordable Care Act, via the healthcare.gov website, did a good job of sending out emails with signup deadline reminders, putting up billboards, ad engaging community centers to sign people up for health insurance. An even more comprehensive strategy could have been to provide signup and marketing materials free of charge to doctors and to create ways to sign up in post offices, grocery stores, and banks. Louis Vuitton is a completely unavoidable brand. The ACA should have had a goal to be unavoidable as well.
You can bet that LV executives were smiling when Sarah Jessica Parker gifted Jennifer Hudson a LV bag in the “Sex and the City” film. Product placement is key. Where were the Victoria’s Secret models advocating for mammograms while selling bras? Good promotion leads to great branding. A good brand is desirable, aspirational, and feels worth it. Some celebrities were indeed enlisted to sell patients on the ACA, but their message was intangible. Their hashtag of choice was #getcovered. “Coverage” sounds a lot less exciting than a purse. Instead, the messaging could have been directed toward getting a physical exam free of cost, getting your refills, getting free flu shots, or protecting your savings. Even #gethealthy is more interesting than #getcovered.
Policymakers and promoters of health care coverage should think long and hard about how to sell their product.
Monya De, MD MPH 