Communications Tips - Exchange - Talking with Voters


Communications Tips for Talking with Voters

About Health Insurance Exchanges*
(Additional Tips for Red States - see bottom of page)


Herndon Alliance conducted a public opinion poll of likely voters in February for the purpose of identifying the best messaging for health care advocates to use in building public support for health care exchanges. Specifically, this messaging is intended to make the best case to the public and decision makers for passing strong exchange legislation and implementing effective exchanges for consumers and patients.

An informed public is favorable to an exchange and interested in using it, especially if they don’t currently have insurance or are fearful of losing their coverage. What we call the ‘exchange’ is less important to the public than its features.

  •  Leverage support for state control—A majority of voters want their state to move ahead to create an exchange rather than wait for the federal government to create one for them;
  • Be proactive in discussing the exchange—A plurality of voters support the exchange after hearing a brief description, but  40% still remain uncertain;
  • Talk about function over structure—The public responds to what an exchange does, not how it’s structured (other than not wanting insurance companies controlling it);
  • Exchanges need to be sold by using values based messaging—Hearing about the functions of an  exchange engages the public but doesn’t inoculate against attacks that raise fears of a new bureaucracy ‘coming between me and my doctor’; values based messaging keep the attacks from gaining momentum;
  • Connect the exchange with these values—The public values security/peace of mind and fairness, while older men in particular value personal responsibility and competition.

Success with exchanges can help bolster the public’s support of the ACA overall.

Target Populations:

  • People of color—Hispanics and African Americans in particular
  • Men—independent men; older non-college men (note: the exchange is the first ACA related issue polled that identified men as a moveable group)
  • Younger non-college women
  • 30-39 year olds; 50-64 year olds
  • Progressives/liberals/democrats

The public wants these functions in an exchange which compares benefits between competing plans (note: between 65 – 72% of voters approved/liked each of these functions):

  • The exchange offers plans that allow you to keep your doctors.
  • Quality and affordable plans on the exchange can’t deny coverage due to pre-existing or chronic conditions like cancer.
  • Plans on the exchange must have basic benefits (coverage for doctor visits, preventive care, hospitalizations, and prescriptions).
  • The exchange is voluntary; if you like what you have you can keep it.
  • Plans on the exchange won’t be able to charge women higher rates than men.
  • If you lose your job, coverage, or want to start a business, the exchange is there for you.
  • Strong oversight will protect you from misleading information and hidden costs.
  • The exchange gives individuals/small businesses equal purchasing power as big employers.
  • Members of Congress will be purchasing their health insurance from the exchange.


  • The public has concerns about the insurance industry serving on a board overseeing their state exchange— 54% favor prohibiting it.
  • The public leans toward believing that exchanges will help to decrease cost (32% believe it will lower costs; 22% say it will increase costs) and improve quality (30% believe it will improve quality; 19% say it will lower quality). A third of the public believes an exchange will have no impact; however, they may be persuadable.

 Attacks on Exchanges that Resonate with the Public:

  • Big bureaucracy (The exchange will increase our taxes to pay for this new bureaucracy)
  • Loss of coverage (Employers will stop offering insurance to employees, who will then be dumped in an exchange where they’ll end up with worse coverage than what they had)
  • Government take-over (The exchange is part of ObamaCare that mandates everyone buy insurance whether or not they can afford it. Exchanges are a further step toward the government take-over of our health care, placing limits on insurers that will reduce choice and quality while driving up costs)

Best Tested Messages - after hearing pro and con arguments, people moved from 43% to 57% in support of the exchange (mostly target populations who originally identified as ‘not sure’):
[PRE-EXISTING CONDITIONS]  The exchange will provide quality affordable choices for those who currently have none.  By law, insurance plans will not be able to deny coverage to people because of pre-existing or chronic conditions like cancer or diabetes.  The exchange will also automatically tell consumers if they qualify for discounts or qualify to participate in state programs based on their income.

[SECURITY]  Right now too many middle class families have nowhere to turn if they lose the coverage offered by their employer.  The exchange will guarantee individuals a secure place to go to get quality, competitively priced health plans if they lose their job or want to start their own business.  This will give millions of Americans peace of mind.

[PEACE OF MIND]  Members of Congress will be required to get their health insurance coverage from the same exchanges as everyone else. Their coverage will be the same as consumers and small businesses, which will help ensure that the exchange works as a good place to find quality affordable coverage with good benefits and protections for everyone.

[FAIRNESS/NO DISCRIMINATION]  The exchange will provide quality affordable choices for those who currently have none. By law, insurance plans will be prevented from discriminating against women by charging them higher rates than men. The exchange will automatically tell consumers if they qualify for discounts or qualify to participate in state programs based on their income.

The following two messages are particularly effective with men.

[PERSONAL RESPONSIBILITY]  The exchange encourages personal responsibility and control over your own health care. If you need health insurance you can visit the website and make your own decisions about the kind of plan that is best for you including being able to keep your current doctor. The exchange gives you affordable options and puts you in control.

[COMPETITION]  The exchange will increase competition among insurance companies because consumers and small businesses will have access to clear, fair, apples-to-apples comparisons. This will bring down insurance costs for consumers and small businesses who shop on the exchange and lower costs in the rest of the insurance market as well.

Red States and the Exchange

The above findings from our national poll were also reflected in our Missouri poll conducted two weeks later. The following Missouri findings are particularly relevant in red states.

Good news—even in red states:

  • A majority want the state to move ahead and not wait for a national exchange;
  • Informing the public is critical because about 1/3 of the population doesn’t know/aren’t sure about an exchange;
  • The public wants to know what an exchange delivers to them (services) not what its governance or structure is;
  • When informed about an exchange, people move in support of it.

To move people in support of the exchange, informing them of the services is critical but so is reassuring them. Reassure by framing the exchange as being:

  • Voluntary—you can keep your current insurance;
  • Flexible—you can keep your doctor;
  • Always there for you – peace of mind;
  • Many easy to understand choices;
  • An opportunity for everyone to take personal responsibility for their health care.

Strongest oppositional argument/attack is an anti-government one. Don’t allow opponents to connect the exchange to the government—redirect the focus to holding insurance companies accountable and not allowing them to continue to come between us and our doctors and determine our health care treatments. When necessary, refer to oversight of the exchange by an independent agency.

Outreach to these populations:

  • Too many people in the ‘base’ remain uninformed and need to hear about the benefits and services of the exchange (especially people of color)
  • Those who expressed most interest in signing on to the exchange—younger women (age pattern stronger in Missouri than nationally) especially under 30.
  • Convinceables—initially younger women are most supportive of the exchange, but after hearing about the services of the exchange the biggest movers in support of the exchange were women (even some republicans) over 55 (youngest and oldest men are the toughest to move).