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Political Advertising|By Elizabeth Wilner, February 11, 2014

In politics, the $27 million Americans for Prosperity says it has spent on anti-"Obamacare" advertising in six months is serious money, especially when focused like a laser beam on select media markets hosting a key US Senate contest here, a hot House race there. AFP's campaign, and the response it's forcing from its Democratic targets and their allies, is a big reason why we're seeing more intense ad activity at this early stage of a midterm election cycle than ever before.

But the advertising inspired by the Affordable Care Act is also unlike anything we've ever seen before. As a controversial law that's compelling an entire industry to change how it does business, reorienting insurers' approach from "B2B" (B = business) to "B2C" (C = consumer), the ACA has touched off an unprecedented confluence of political and product advertising.

Six Months = Three Weeks
For every political ad dollar spent these days on criticizing the ACA, considerably more insurer ad dollars are being spent trying to get people covered. Covered by the insurers directly, yes, as opposed to via healthcare.gov or a state exchange, but covered all the same. As this table by CMAG's Mitchell West shows, AFP's $27 million in six months is about equal to what health insurers are spending on TV advertising (see "all health insurer ads") in three weeks, at least since the Administration got healthcare.gov working.

Week of…All Insurer SpotAll Insurer Est. SpendACA-Related Spot% of Total SpotACA-Related Spend% of Total Spend

Now (major caveat alert), this isn't an apples-to-apples comparison. The anti-ACA political ad dollars and the ACA-driven product ad dollars aren't necessarily being spent in the same ways. For starters, a fair amount of insurer dollars go to network advertising, whereas AFP and other political critics have concentrated their firepower on local broadcast. The messaging in all the political ads is sharply negative ("lie of the year," "disaster," "just isn't working"), whereas the messaging in a typical insurer ad falls somewhere between less negative and neutral ("confusing," "concerned").

But the broader point remains that unlike most political advertising, the latest anti-Obamacare campaign isn't happening in a total vacuum. What will be interesting to see is whether insurers change their ad messaging or strategies for the next open enrollment period starting October 1, when their ads seeking sign-ups will be competing with, most likely, some of the most intense and vitriolic political advertising against the ACA in its short but eventful life.

A Short History of Open Enrollment
Mitch's table and this graphic tell a story. For one thing, note the spike in insurer ad spending between the last week of November, when everyone who wasn't crashing to fix healthcare.gov was celebrating Thanksgiving, and the first week of December when the government delivered on a working website as promised. Insurer ad spending during that first week of December peaked at $34.1 million, about three times as much as insurers have spent during any week since, suggesting that insurers were indeed reserving some ad firepower during the first rocky two months of enrollment.

Note, too, how reluctant health insurers have been to mention the ACA in their advertising. Only well into December did ads containing ACA-related messages (the orange line) start accounting for a sizable share of all health insurer advertising (the blue line). Per CMAG's coding, ACA-related messages can be as specific as citing the healthcare law by name, or mentioning "healthcare reform," or as veiled as an out-of-context nudge to "enroll by March 31."

With two months to go before enrollment ends, we're seeing what looks like the start of a bigger push by insurers overall, as well as the possible start of more insurer advertising devoted to messages mentioning or referencing the ACA. For the past two weeks, the percentage of all insurer spot occurrences that included some reference to the ACA hit 50% or higher for the first time this year, while 42% of all insurer ad spending in the last week included some reference to the ACA, also the highest levels this year.

Just anecdotally, some insurers seem more willing to be direct. Three of the biggest brands, Cigna, Humana and Kaiser Permanente, which had previously had been shy about acknowledging the healthcare law in their advertising, all have launched much more explicit ads recently. "With all the new healthcare rules, it can be hard to figure out what's best for you," the new Cigna ad says. "You could read all the new rules [visual of massive stack of paper], but it might take you awhile."

Winning and Losing Ugly
When it comes to enrollment, the Administration ultimately may not care how people sign up. They probably didn't expect health insurers to play off people's angst and uncertainty about the healthcare law to win customers, but enrolling ugly is better than not enrolling at all.

That said, the few hundred million dollars in insurer ads that ultimately will have aired during this first six-month enrollment window won't help the Administration in the public opinion department. The advertising may help the Administration close in on their enrollment targets--it just won't help them keep the Senate or net seats in the House.