Governing magazine: State and local government news for America's leaders

How to Market a Health Insurance Exchange

Many Americans still don’t know about the online health insurance marketplaces that are being created under the Affordable Care Act. The District of Columbia is trying to figure out how to change that.
by | February 13, 2013

Scribbled in purple marker on a poster board at the front of the room were these words: “Message: Affordable Health Care.” That’s the message that officials at the Washington, D.C., Health Benefits Exchange want to deliver to the public. Now they just have to figure out how to send it.

Government officials, health-care providers, advocacy groups and all sorts of stakeholders convened at Mt. Vernon United Methodist Church Tuesday for a communication summit, hoping to create a strategy for getting the word out. It’s a tall task: many Americans still don’t know what a health insurance exchange -- or marketplace, if you like -- is. But more than 20 million are expected to be purchasing health coverage through them in the next decade, choosing an insurance plan in an online experience much like Expedia’s, the online travel booking service.

Even in Washington, where the Affordable Care Act (ACA) that created the exchanges was born, officials face a significant challenge.

“They say: ‘If you build it, they will come.’ I don't believe that,” Mohammad Akhter, chairman of the D.C. health exchange’s board of directors, told the attendees at Tuesday’s meeting. “It's only when everyone gets involved, that is the only way to turn the tide and get everyone insured. That’s why we need your help.”

D.C. is one of 19 state-level exchanges to be approved by the U.S. Department of Health and Human Services (HHS) to open on Oct. 1, 2013. Creating the marketplace, which amounts to launching a huge interactive website, is an immense undertaking. (To get a sense of the scope, check out Governing’s series on Rhode Island’s health exchange implementation.)

But once the website is up and running, you have to get people signed up for it, and nobody is quite sure how to do that. People aren’t used to buying health insurance on their own, and ‘exchange’ is probably one of the wonkiest terms in health policy. So states are getting creative, floating ideas like working exchanges into primetime TV storylines or advertising on Pandora radio. But that just underlines how daunting the problem is.

“Beyond the Beltway, nobody knows anything about the [ACA],” Kim Holland, executive director of state affairs for the BlueCross/BlueShield Association, told Governing last month. “We cannot underestimate the amount of effort it will take to get people to the system.”

In the District of Columbia, everyone from church clergy to city accountants to doctors, got together to sketch a strategy for doing that. The emphasis was on collaboration: if people can get information about the exchange from almost any source, whether it’s their doctor’s office or their church or the health department, they’re more likely to get the message. With as many as 63,000 District residents going without insurance at some point during the year, you need to cast as wide of a net as possible.

It's also about keeping thing simple. Like simple message on the board at the front of the room said, remember the mantra: affordable health care. Who can get it? Any eligible U.S. citizen. Where do they get it? The website or a toll-free phone number. See? That’s not so complicated. Of course, then you need to explain how costs will be shared, what services will be covered and how consumers can redeem the federal tax subsidies that are supposed to make insurance cheaper. That's why customers will need a knowledgeable presence to help them out.

The bland conference room where the meeting was held felt like a gospel revival tent at times as the exchange officials and attendees tried to galvanize excitement about their task. Whoops, applause and hearty laughter abounded.

To cultivate that communal feel, each of the 150-plus participants was asked at the beginning of the meeting to introduce themselves and describe their personality with an adjective that shared the first letter of their first name. One speaker began his presentation by asking the audience if they knew someone who was uninsured, and every hand went up. With a healthy showing from the faith community, and a sense of urgency clearly present, there was no hesitation in invoking the Almighty.

“This is a very important endeavor we're embarking on. We need your help,” said Linda Wharton-Boyd, who runs the exchange’s communications office. “We need your support. We need your prayers.”

But they also had some very specific ideas about how to accomplish their mission. The exchange has already convened workgroups, which almost anyone can join, and they are already providing official policy recommendations to the exchange board. Officials are currently in the midst of developing a ‘brand’ for the marketplace, thus doing away with the wonky ‘exchange’ moniker. Market research is underway to identify who will use the exchange. An advertising campaign will launch sometime in September for the Oct. 1 opening.

One floated idea was setting up official service centers across the District, complete with kiosks where users can access the exchange. Those could also be placed in other public places, too, like libraries. The city will secure federal grants to pay for training of ‘navigators’ and ‘assisters’, many of whom will be volunteers at community organizations, who will learn all the details of the ACA and develop their own strategies to get that information to their distinct constituents.

Danielle Davis, the communications director at neighboring Maryland’s health exchange, came to share how her state is handling some of the same issues. They include: drafting template materials for navigators in English and Spanish, crafting a social media outreach plan and coordinating launch events across the state closer to the exchange’s opening. One attendee also offered the idea of ‘peer educators’, normal people who live alongside Washington’s uninsured and volunteer to distribute information to their friends and neighbors.

That was the most prevalent theme as the summit wore on. Fair or not, the uninsured are more likely to be low-income and less educated. They might not be web savvy or might have concerns about online privacy. So they're going to need a helping hand in finding the exchange and understanding it once they’re get there. Those people are probably going to trust their neighbor or their doctor or their church brethren more than a government official or an impersonal advertisement on the television or radio. Just one example: Hispanic Washingtonians are more likely to digest information about the exchange if it comes from one of the many cultural groups or associations that they already know.

Doctors should be asking their patients if they need insurance. Clergy should be asking their parishioners the same thing. Help thy neighbor. That’s the principle that will be driving the District’s communications strategy going forward.

“We can't depend on them to come to us. We've got to go to them,” said Richard Sorian, a former HHS official who assisting the exchange with its outreach. “We need trusted voices, people who work in their community and live alongside them.”

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