At the Minnesota State Fair last month, state employees handed out thousands of paperboard fans bearing pictures of Paul Bunyan and Babe the Blue Ox to promote Minnesota’s health insurance marketplace.
Over Connecticut beaches this summer, airplanes flew banners emblazoned with “Get Covered!” as teams below distributed free sunscreen packets as part of the state’s campaign to get more of its residents insured under the Affordable Care Act.
In Colorado, Oregon and a handful of other states, radio and TV spots have been running for weeks encouraging the uninsured to seek health coverage starting Oct. 1.
In Illinois so far? Mostly silence.
Less than three weeks before the online market where consumers can compare and buy private health insurance plans is set to open, the major portion of a $35 million marketing and advertising plan has yet to launch, leaving many consumers in the dark about the benefits they may be eligible to start receiving in January.
That raises the specter that they may remain on the sidelines for the largest expansion of health insurance since the introduction of Medicare in 1965. At stake is the viability of the state exchanges, the primary venue where consumers can buy insurance plans, many subsidized by the federal government.
A pillar of President Barack Obama’s massive health care overhaul, the exchanges must attract the healthy as well as the sick to help spread risk and keep premium prices down.
The fear is that those who have a pressing need for insurance, particularly the sick, already know about the new coverage and plan to enroll. That makes attracting the young and healthy, who historically have not been as concerned about having health insurance, crucial.
If the campaign fails to reach these “young invincibles,” costs could rise dramatically.
The result could be higher insurance premiums in future years, which could dissuade some from buying or retaining coverage through the exchanges; an exodus of insurers from the system, reducing competition; and higher costs to the government and taxpayers in the form of subsidies.
“The fact is, the basic education hasn’t happened,” said Eric Anderson, chair of the marketing department at Northwestern University’s Kellogg School of Management. “It’s a little bit of a shame that (they weren’t) out there telling people about this far in advance so they (could) plan for it.”
While the state won’t begin its marketing and advertising blitz for another week, Illinois has one of the highest numbers of uninsured residents nationwide. Reaching them in a compressed time frame is a colossal task.
The lack of buzz surrounding the launch of the insurance exchanges is reflected in recent surveys that show Americans remain deeply confused about the law, with half unaware of how their family may benefit.
According to the latest tracking poll from the nonpartisan Kaiser Family Foundation, 51 percent of Americans say they don’t understand how it will affect them or their family, and 62 percent of the uninsured say they don’t have enough information about the health law.
Another survey released last week by Bankrate.com, an online publisher of personal finance content, shows that 20 percent of respondents were unclear about whether the law, signed in 2010, will be implemented, while 15 percent wanted to know “what Obamacare is.”
“What this shows me, at least from our survey, is that a lot of people are just completely clueless,” said Doug Whiteman, an insurance analyst with Bankrate.com. “People really seem to be in the dark, and it’s pretty startling considering the train is getting close to the station.”
The federal government has yet to kick off the brunt of its marketing and educational campaign. It won’t begin running the majority of its advertisements until open enrollment in health insurance plans begins next month, officials said.
In Illinois, state officials say small-scale education and outreach campaigns launched weeks ago throughout the state, conducted mostly by dozens of community organizations that received state and federal grants in July and August.
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Most efforts have focused on deploying small teams at community events like congressional town halls and presentations to local chambers of commerce, and on enrolling and training the 1,200 or so paid experts who will help explain health insurance and assist consumers in signing up for plans.
“We’re laying the foundation with the public and making sure they’re educated before we layer on marketing and advertising,” said Jennifer Koehler, director of the Illinois Health Insurance Marketplace, the state agency running the health insurance expansion. “This is really about boots on the ground and one-on-one interaction.”
Marketing experts said the federal and state governments should have been promoting the law with simple, repetitive messaging several months ago.
“That’s what we call the basic blocking and tackling,” said John Reinan, a senior director at the Minneapolis marketing firm Fast Horse Inc. “You almost have to make people sick of hearing about it. This program is too complicated, has too many moving parts to just do a crash launch in two months.”
By holding back, the government missed its “chance to influence how people feel about the law, and the consequences are they may not have as many people sign up as they hoped.”
Koehler maintains there’s ample time to reach the estimated 1.9 million Illinoisans without health insurance. Consumers have until Dec. 15 to sign up for coverage that starts Jan. 1, and until March 31 to obtain coverage if they want to avoid paying a penalty.
“It’s not all about Oct. 1. That’s not the finish line, it’s the starting line,” she said. “Another important thing to remember is that ads don’t enroll. They’re going to be helpful, but that’s not what’s really going to motivate people to get in front of the computer and sign up.”
Instead, she said, trusted sources like sisters, mothers, members of their health clinic or churches will play the leading role in persuading people to enroll.
Illinois originally planned to have a marketing firm selected to develop a comprehensive marketing and outreach strategy by the end of 2011, according to a project plan drafted in late 2010. It aimed to launch the campaign Jan. 1.
But because state lawmakers failed to pass legislation that would allow the state to run its own insurance exchange, Illinois was forced into a partnership with the federal government to operate the system, at least for 2014.
As a result, the state lost some flexibility in conducting the public campaign.
“States that made decisions earlier on to control their own destiny with a state-based exchange were able to pull down federal money sooner, and they had to make decisions earlier on in the process on elements like public education and marketing campaigns,” said Matt Eyles, an executive vice president at Avalere Health, a Washington, D.C.-based consulting firm tracking efforts around the country.
Illinois ranks in the middle of the pack nationally in terms of the timing of its marketing and outreach strategy, Eyles said.
Illinois didn’t receive the federal go-ahead to conduct its campaign until January and had to wait until April 8 to get federal funds for the program.
As soon as word came from federal officials, “we moved as quickly as we could” to start planning the effort, Koehler said.
A month later, it began evaluating bids from 13 companies vying for the contract. It selected FleishmanHillard on July 11.
Maxine Winer, general manager of Fleishman’s Chicago office, said at the time that her firm “delivered a fully integrated plan that was ready to go” and hoped to launch the campaign “immediately.”
But Illinois officials and health care consultants said the major portion of the ad blitz was withheld so it wouldn’t drum up too much interest before people could compare and buy insurance.
Because so much remains unfinished — the launch of the state’s exchange website, a call center and the release of pricing on plans to be offered in the exchange — “there’s only so much value in starting to advertise early,” Eyles said.
Even so, with limited time remaining, pressure is mounting to build enough momentum to reach and educate the diverse and segmented group of Illinois’ uninsured.
“Nobody’s disputing that,” Koehler said. “This requires a major cultural shift, and changing the culture is always hard and it takes some time.”
Tribune reporter Peter Frost and a panel of experts will appear at a Trib Nation event Sept. 19 to discuss the upcoming rollout of the Affordable Care Act. For more information, go to trib.in/1eDwFCQ.
Twitter @peterfrost