18 August 2010
Research Results - August 12, 2010
Messaging on healthcare reform continues to pose a challenge to supporters of the health law. Not only did opponents successfully define the law as increasing costs and a government takeover of the private sector, but it is clear that voters still do not have a clear idea of the law's status, content, or how it will be implemented.
It has been very difficult to get traction on improving views towards healthcare reform. This research was undertaken to identify a positive case for reform; one that would help make gains in support and build resistance to repeal of the law.
Obviously every public debate has its own context, but the research suggests some common threads that will help supporters successfully communicate about the healthcare legislation and efforts around repeal.
Most significantly, we found the public can be substantially moved from initial skepticism of the law to favorable feelings toward healthcare reform. A specific communications approach—the use of a personal story wrapped around two or three simple reforms— is required to facilitate this shift in attitude.
TOP BENEFITS: The most compelling benefits of the reform law: (in order of popularity)
1. Bans denials due to pre-existing conditions;
2. No more dropping patients when they get sick;
3. Ends lifetime Caps;
4. Provides tax credits for small businesses;
5. Offers free preventive care.
KEEP IT SIMPLE: Communication about the law must be educative and not assume that people know the content of the legislation or how it will impact them—or even that a law has passed. The language must be kept simple—telling people how the law works and focusing on the core provisions that the public values.
TELL SIMPLE PERSONAL STORIES: coupled with non-rhetorical statements of how the law would benefit people at the individual level are the most compelling way to talk about the law. These stories need to be credible; despite the fact that people have suffered from horrific experiences at the hands of insurance companies, it is more believable when the story is simple (e.g., a child denied coverage because of a pre-existing condition). Narratives that make broad, rhetorical claims about what the legislation will do are less powerful and are prone to "overstating" the short-term impact, thus undermining overall credibility.
WOMEN: Women are important targets of communication about healthcare reform and are also ideal messengers; rectifying inequities in women's health stand out as key benefits of reform. Research for Herndon and others also demonstrates the strength of covering preventive care without co-pays or other out-of-pocket costs.
IT AIN'T PERFECT: It is helpful to use "bridge" statements about the law, to give permission to people to relax their defensive reactions to the law. The strongest testing statement allows that "the law isn't perfect, but we need to improve it, not repeal it."
TELL THEIR OWN STORY: Candidates themselves are not the most effective messengers about the law—they should allow their constituents to tell their story of how the law rectifies a wrong committed against them or will lead to better health outcomes.
IN THE SAME BOAT: At the same time, it is critical to communicate that Members of Congress will be required to participate in the same plans as the rest of the country. Language around this issue is challenging, however, as delving into the details of healthcare exchanges threatens to overcomplicate the narrative.
SENIORS: In addition to questions of cost and scarcity, there is real vulnerability around charges that the healthcare reform law cuts Medicare by a half trillion dollars and endangers the coverage seniors enjoy. As other research has shown, seniors respond favorably to personal stories, reassurance that basic Medicare benefits are protected and that preventative care is now free.
We saw marginal gains against repeal and we saw substantial movement in favorable feelings towards healthcare reform – resulting in overall support for reform particularly when a personal story is paired against generic conservative attacks on healthcare.
We view these results as considerable progress in moving the debate about healthcare reform forward.
Appendix A: Personal Stories
"My name is Lindsay, I'm 23 years old and I have a 6-year-old son named Jacob who has asthma. We got our health insurance from my husband's employer, but he lost his job recently. He found a new job that pays ok, but his new health insurance company will not give Jacob coverage because he has a pre-existing condition. I wait tables too, but we just can't afford to pay medical expenses out of pocket. I know the new health insurance law isn't perfect, but starting in September, it will be illegal for insurance companies to deny children with pre-existing conditions healthcare coverage. I can't tell you what a relief it is to me that Jacob will get the care that he needs. I really hope this law does not get repealed." Note: 29% of respondents said that the phrase "pre-existing condition" stood out to them; 47% said that the phrase "children with pre-existing conditions" stood out.
"I'm getting up there in years - I'm almost 60 - and I recently found out that I have cancer. After a few surgeries and some complications along with radiation and chemotherapy, my insurance company told me that I've reached my lifetime limit for coveage. My employer and I have been paying my premiums, copays, and deductibles religiously for 20 years, and now I might have to declare bankruptcy or lose my home to pay my medical bills. I know the new healthcare law isn't perfect, but it will stop insurance companies from imposing lifetime or annual caps on coverage or even dropping people when their health care gets too expensive. I sure hope this law doesn't get repealed." Note: 38% of respondents said that the phrase "stop lifetime caps" stood out to them; 27% said that the phrase "reached my lifetime limit" stood out.
Appendix B: Things to Do, Things to Avoid
- Let Voters know the health care reform law passed
- Use personal stories to convey critical benefits of reform
- Explain in simple terms how the law works
- Focus on the handful of core provisions that are most important
- Keep it simple, using terms they can understand
- Use "bridge" or "transition" language to relax defenses
- Address scarcity and cost concerns
These don't connect with the public:
- Assuming everyone already know health care reform passed
- Listing off benefits outside of any personal context
- Assuming they understand teh law and how it will affect them
- Barraging voters with a long list of benefits they won't remember
- Using complex language or insider jargon
- Using heated political rhetoric or congratulatory language
- Saying that the law will reduce deficits
Appendix C: Research and Methodology
Lake Research Partners conducted eight focus groups in four cities (Las Vegas, NV; Charlotte, NC; Philadelphia, PA; and St. Louis, MO) between July 8-19, 2010. The groups were composed of seniors, blue collar women, voters under 40, Latinos, and rural and suburban St. Louis women.
Greenberg Quinlan Rosner conducted an online survey among 2000 likely voters in the 2010 elections conducted from July 29-August 1, 2010. The sample was draw from a panel – and is not a representative, probability based sample. The results were weighted to mirror the 2010 likely electorate. All the exercises were balanced with anti- and pro-repeal messages of equal length.
 The Herndon Alliance has commissioned extensive research on healthcare reform over the last year and half, including focus groups, national surveys, and online testing. The follow recommendations stem from this collective research. Please see appendix for details.
 Anzalone Liszt Research also conducted a survey of 1,000 likely 2010 voters between April 19-25, 2010.