As an observer of advertising and vendor of ad data, I have to give thanks for the Affordable Care Act. Unprecedented in the annals of television advertising, the law is triggering hundreds of millions, soon to be billions of dollars in both political and product TV advertising. In some areas of the country, these ads already are colliding as Republican candidates and issue groups excoriate “Obamacare,” state exchanges urge the uninsured to sign up, and insurers chase new customers, all in the same markets.
The darker green areas on this map by CMAG’s Harley Ellenberger show the heaviest concentrations of anti-ACA political ad spending by media market to date in 2013. Use the filter to see which of those markets are home to high percentages of uninsured Americans and you get an idea of where the message mix could get interesting for ACA stakeholders.
On that note, the ACA also has inspired some thoughtful graphic and poll design work lately, some of which I’ll tie in here. Thanks to the newly minted partnership of GMMB and Civis Analytics for the data on uninsured by media market, which CMAG scraped from their map showing the political tilt, voter demographics, upcoming 2014 races and estimated cost of ads in every media market. You can access the GMMB/Civis map through CMAG’s by clicking “Source” in the bottom righthand corner of the page.
Let’s tick through the reasons for the ACA’s unique place in advertising history:
In four years, it has been the focus of more political ad spending than any other government program in history except for Social Security and Medicare, which have been the subject of such advertising for 10 times as many years. Eradicating or weakening “Obamacare” has basically replaced the old rallying cry of cutting (or “strengthening”) Social Security and Medicare in Republican ad messaging. The depth this anti-ACA advertising has reached on the ballot—in races for President and US Senate on down to races for state and local offices—is what has driven spending on ACA-related political advertising to such heights so quickly. CMAG counted nearly $500 million as of July, at a ratio of more than 4:1 negative to positive. That was before healthcare.gov crashed upon takeoff, inspiring a new wave of negative ads, though it also was before positive ad campaigns by the ACA-created state exchanges began in earnest.
The unprecedented negative advertising disparaging the law known as “Obamacare” may help explain why the nickname draws the least favorable reaction of possible descriptions of the ACA recently tested by Gallup (38% approve, 54% disapprove). It may also explain why the Administration now rejects the name, even though Organizing for Action used it briefly in TV ads earlier this year. Many national news outlets also use it. Unfortunately for the Administration and any forthcoming rebranding effort, it may be too late to re-cork this genie.
The Kaiser Family Foundation has created a nifty interactive graphic of the results of their national ACA tracking poll—which provides even more context for the new low reached by the ACA in favorability: 33%. Kaiser also released a lesser-noticed “data note” cautioning poll consumers about the “possible pitfalls of using standard national public opinion polls to make judgments about Americans’ early experiences with health plan enrollment under the ACA.”
It has broken the mold of traditional issue advertising by inspiring far more—and still mounting—advertising after its enactment than before. Pundits like to compare this situation to the enactment of Medicare Part D, which remained somewhat unpopular after its enactment and had an afterlife in advertising, but only for one cycle. The ACA is heading into its third election cycle, post-enactment, when it will be the focus of tens or even hundreds of millions of dollars more in ad spending. To liken the ACA’s launch to that of Part D, in terms of the arc of public opinion, is to overlook the possible impact of hundreds of millions of dollars in ongoing negative TV ads.
The creation of state exchanges in the post-enactment advocacy effort will boost spending even higher and narrow the negative-to-positive ad spending gap somewhat. CMAG recently released an interactive graphic showing most state exchanges increasing their ad buys through the fall.
Even so, since open enrollment began on October 1, CMAG shows that 19 anti-ACA political advertisers have been on the air. A number of them have been candidates, from gubernatorial nominee Ken Cuccinelli on down to a state legislative candidate in Alabama. But many have been issue advertisers playing early in 2014 races, including the Senate races in Alaska, Arkansas, Kentucky, Louisiana and North Carolina.
In Louisiana, a new poll by Southern Media and Opinion Research (Nov. 6-12, 600 likely voters, +/-4%) suggests Sen. Mary Landrieu (D) is more vulnerable due to the ACA’s unpopularity in the state. “While pollster Bernie Pinsonat does not draw a direct link between her declined popularity and the Affordable Care Act,” writes LaPolitics Weekly, “the poll shows 59% against the federal health insurance program and only 34% in favor… 70% of those who are undecided in the poll or wouldn't pick a candidate are opposed to Obamacare. If the health care law remains a key issue in the race next year, Pinsonat concluded, ‘[Landrieu] is not in control of her destiny.’”
Since October 31, Americans for Prosperity has aired two ads in state markets using footage of Landrieu saying, “If I had to vote for the bill again, I would vote for it tomorrow.” Gov. Bobby Jindal (R) also starred in a TV ad criticizing the law that aired in Louisiana markets for most of October.
It has directly unleashed tens to hundreds of millions of dollars in product advertising. The ACA is sending millions of Americans—voluntarily or not—looking for healthcare coverage. When has the market for any product or service instantly expanded by millions for any reason? But the US government’s role in blowing open this market, and the politics around the ACA, have insurers responding in different ways.
Only one national brand, Blue Cross Blue Shield, and many regional and local insurers are aggressively targeting potential customers by using the ACA in their ads. Using messages that are funny (or almost funny), jarring, reassuring or unnerving, the ads position these insurers as the solution to viewers’ ACA-caused confusion and uncertainty. These small insurers and Blue’s state-centric network see the ACA as a growth opportunity, especially where (working) online marketplaces promise the chance to compete on a level playing field with the big dogs. They are also less wedded to the “B2B”—i.e., business-to-business—sales approach that the other major insurers have engaged in for so long that they’re only just starting to market more directly to consumers.
The other national brands, while they’re all on the air with generic ads, are playing it safe and not touching the ACA in its politically controversial, publicly unpopular state.
Another result is that some insurers, depending on their decisions to take part in state exchanges or not, see the government as competition. Wellmark Blue Cross Blue Shield, which operates in Iowa and South Dakota, went so far as to make fun of the problems plaguing healthcare.gov in three recently launched TV ads.
Other product advertisers also will try to capitalize on the law. H&R Block, which aired commercials around tax time 2013 promoting their knowledge of the ACA, is doing so again for 2014 as part of a more elaborate ACA-focused initiative.
Probably a smart business move by a tax-prep service likely to have customers wondering why their accountants can’t keep them from getting hit with the ACA’s penalty for nonparticipation.