April 2010 Research Summary: An Early Post-Passage Messaging Guide

29 June 2010

Context

This document is based on the findings of a Herndon Alliance national poll conducted by Anzalone Liszt Research immediately after passage of the health law. The poll captures how Americans feel about the new law (majority do not as yet support it) and how critical it is that we begin an education campaign to build public support for health reform prior to Labor Day. The education campaign has three goals:

To engage and energize supporters of health reform (the base) so they speak out on behalf of the reforms;
To connect with the 'persuadable' public (independents who say they still need more information about reform before they can take a firm position on it) to ensure that we expand and activate support for reform in the state and national debates;
To develop and deepen overall public support so reforms are successfully
implemented.

The findings have provided us with:

key persuadable audiences—those most likely to move in support of the law;
persuasive arguments—ones that test well with key persuadable audiences but, at this point in time, do not move them enough to support the law;
values that continue to connect with the public;
a clearer understanding of the opposition's attack frames.

Keep in mind that the public is weary of and skeptical about health reform. Many elements of the bill are seen as beneficial, but Americans are not convinced that the bill's benefits are enough to counter its costs and fear that it could yield many negative, unknown consequences. Americans are in no mood to hear rhetoric; they want clear, specific information.

An education campaign needs to both hold the base of engaged supporters and win over a portion of the 40% of voters who say they still need more information about reform before they taking a firm position. Without this campaign, we will leave a vacuum—and opponents of reform will fill this void with their negative messaging. The best defense is a good offense.

Increasing support for reform is an uphill climb, especially when confronted with sustained opposition messaging, but this document seeks to provide supporters with guidance for how to most effectively talk about healthcare reform.

Targeted Populations

These are the key persuasion audiences—those particularly receptive to pro‐reform messaging and should be targets for persuasion:

White women (especially White women over 65);
Hispanics;
Small business employers/employees;
White voters with household incomes between 75K and 100K.
The base

Always remember to know your audience and customize the messaging to your specific audience (see below for examples).

Strong Messages

Top Message

Reform requires that Members of Congress get their healthcare coverage from the same plans as millions of Americans. It will also make healthcare coverage more secure by ensuring that working families cannot be denied coverage due to a pre‐existing condition, or lose their coverage or be forced into bankruptcy when someone gets sick.

This is our most persuasive message for Independents and swing voters—indeed for most audiences. Any effort to win the public over on healthcare reform should feature this message.

The reasons for its effectiveness are that it establishes trust (the congressional requirement) and highlights the most popular – and also one of the most believable – benefits of reform (ensuring that insurance companies can no longer deny or drop coverage).

The congressional requirement is the component that makes skeptical voters willing to consider healthcare reform. They are fearful that the bill's length and complexity will lead to unknown, negative consequences, no matter what politicians might claim. The reason this component is so powerful is that it backs up the politicians words with actions. Therefore, the most effective way to convince skeptical voters that reform won't hurt them is to inform them that it applies to Members of Congress as well. As a number of participants noted in the focus groups, "If it's good enough for them, it's good enough for us."

Adjusting this Message the Base

Reform will make healthcare coverage more secure by requiring insurance companies to cover people with pre-existing conditions and banning them from dropping coverage when someone gets sick. It will also increase competition on insurance companies to help lower costs, and will prohibit insurance companies from charging women more than men for the same coverage.

Because core supporters already trust that healthcare reform will not hurt them, the congressional requirement component is not necessary to use in messaging to energize them. It is better to focus on some of the other key benefits that are popular with the base – particularly ensuring that insurance companies can no longer drop or deny coverage – while also demonstrating how reform holds insurance companies accountable.

Adjusting the Message for Seniors

Reform requires that Members of Congress get their healthcare coverage from the same plans as millions of Americans. If it is good enough for Members of Congress and their families, it will be good enough for
average Americans. The plan will also reduce prescription drug costs for seniors by closing the current coverage gap in Medicare and will give seniors free yearly check‐ups.

While security is much more important than the congressional requirement among our base, the opposite is true for seniors. They are particularly distrusting of healthcare reform so the congressional requirement component is very important to them. But since healthcare security is less of an isssue for them it is better to highlight reform's impact on prescription drug costs and that annual check‐ups will be covered than delving into messaging on greater security.

Note that preventive care resonates strongly with seniors and just half of seniors are aware that the plan will close the current prescription drug coverage gap.

Persuasive Arguments

Reform will improve healthcare for women and children by prohibiting insurers from charging women more than men for the same coverage and requiring coverage for maternity care. It will also require insurance
companies to cover any child with a pre‐existing condition and allow children to stay on their parents insurance until they are 26.

Reform will lower healthcare costs for individuals and improve healthcare for women and children by prohibiting insurers from charging women more than men for the same coverage and requiring coverage for maternity care. It will also require insurance companies to cover any child with a pre‐existing condition and allow children to stay on their parents insurance until they are 26.

Reform lowers the costs of prescription drugs for seniors by closing the coverage gap in Medicare, cuts waste from the system to ensure that Medicare funds go to improving care, and provides for annual check‐ups so seniors can have better preventive care.

FOR THE BASE ONLY – at this time, independent voters are not as persuaded by hits on insurers as the base is:

Insurance companies spent over five hundred million dollars opposing healthcare reform because they knew it would hold them accountable. Reform will require insurance companies to cover people with pre‐existing conditions, ban them from dropping coverage for people who get sick, crack down on their unjustified premium hikes, and increase competition among them to help lower costs.

Messages to Avoid

Do not pro‐actively argue that reform will reduce the deficit, create jobs, or strengthen Medicare. No matter the evidence provided, those claims do not pass the believability threshold with voters. Including these arguments therefore undermines any broader message that they are part of.

Values to Reinforce

As past Herndon Alliance research has shown, the following values still have strong sway with both the base and persuadable voters:

Accountability for insurance companies
Control for consumers
Individual responsibility first, then shared responsibility
Effective oversight and fairness
Peace of mind

Other Benefits to Highlight

While the Congressional requirement and the assurance that coverage can no longer be dropped or denied are the most popular benefits of reform, there are a number of other benefits that are potentially worth noting as well. Below are five of the most popular:

Brings light to unjustified premium hikes by insurance companies
Medicare—closes the coverage gap, provides preventive care such as annual visits, cuts waste
Increases competition among insurance companies to help lower costs
Reduces healthcare costs for small businesses by providing them with tax credits and allowing
them to band together in new insurance markets
Bans insurers from charging women more than men for the same coverage and requires
coverage for maternity care

Going on the Attack

The best defense is a good proactive offense (messaging designed to win over skeptical voters and increase support for reform). However, we also need to respond to the attacks from the opponents of reform.

Because of the opposition to healthcare reform law, it is unwise to attack opponents of reform for opposing the law itself. It is better to attack them for opposing popular components of the law by linking their opposition to their ties to the insurance industry and focusing on specific benefits of reform. Our response to attacks can be strengthened by citing contributions the candidate received from insurance companies.

Attacking Opponents of Reform

_______ has received xx in campaign contributions from insurance companies and consistently sides with their interests over the interests of working families. He/she voted to allow insurance companies to continue to deny coverage based on pre‐existing conditions, voted against providing tax credits for small business to provide healthcare to their employees and opposed requiring members of Congress to have the same healthcare coverage as millions of Americans.

Responding to Specific Attacks

Because of the opposition to healthcare reform, opponents have a built in advantage in almost any debate over the issue. This advantage is compounded when they choose to focus on aspects of the debate that are particularly in their favor, such as the perceived impact on the deficit, the individual mandate and job creation. While the responses below may not allow supporters to win a debate over a specific aspect of reform – and in many cases will not even manage a tie – they can help mitigate the damage done. For now we recommend using them. Within a few weeks, additional focus groups should provide messaging that allows us to win the debate.

Debates Where Supporters Can Break Even With Opponents

Best response(s) to claim that reform will increase premiums:

Reform will help lower the costs of premiums by creating new competitive markets that will increase competition among insurance companies.
Insurance companies have been increasing premiums for the past thirty years in pursuit of bigger profits. Reform will finally bring light to unjustified premium hikes and help drive them down.

Best response(s) to claim that reform represents a government takeover:

For years, insurance company bureaucrats decided if treatments recommended by doctors would be covered. Reform will ensure that insurance company bureaucrats can no longer come between you and your doctor.
Reform holds insurance companies accountable by providing fair rules and setting high standards. That's not a government takeover, that's government doing what it is supposed to do—working on behalf of citizens.

Debates Where Opponents Have Advantage, But Impact can be Mitigated:

Best response to claim that reform will cost jobs:

Reform will help to create jobs by allowing small businesses to band together in new competitive insurance markets which will allow them to spend less money on healthcare and invest more in growing their businesses.

Best response to claim that reform should be repealed and replaced:

The public believes we should give reform a chance and make changes that improve it. Those who support repeal are siding with insurance companies who want to continue their practices of premium hikes and denied coverage.

Best response to attack on individual mandate:

Just as requiring all Americans to have car insurance protects other drivers, requiring everyone to have health insurance protects taxpayers by ensuring that everyone pays their fair share.

Best response to claim that reform will increase the deficit:

The independent organization in charge of predicting the cost of federal legislation estimates that by slowing the growth in healthcare costs and cutting waste from the current system, reform will reduce the deficit by over one hundred billion dollars in the first ten years, and by over a trillion dollars in the next twenty years.

Messengers

The public learns about health reform from the media—61% of those polled cited the media as their most trusted source on the new law. They also trust messengers such as doctors/nurses (16%) and neutral organizations like AARP (10%) and the American Cancer Society. Get your stories into the media and utilize the most effective messengers.

Next Steps

Additional focus groups and polling:

to develop a strong overarching narrative that connects with our key audiences and effectively bridges with the post‐Labor Day political campaigns;
to develop strong responses to attacks that move the key 'persuadables' to support the law;
to identify language and materials that work in a post Labor Day political environment.