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How to create change one behavior at a time.

Obamacare Survived, Now What? 5 Things Insurers Should Know.

With the latest upheaval of the American health insurance system now on hold, how should insurance companies and others who care about coverage face the immediate future? After years of interviewing Americans about health insurance, the research team at Marketing for Change has come up with five things we think everyone – from politicians to health insurers to providers – should know for the times ahead.

1. Obamacare faces many challenges; lack of demand is not one of them.

You’ve heard the talking point: “The government shouldn’t force people to buy anything.” But what we have heard more often in hundreds of focus groups and dozens of surveys is that Americans want to have health insurance – and most who don’t have it have tried to buy it within the previous 90 days. They just don’t want to pay a lot for it, with most describing an “affordable’ premium as $75 a month or less.

Many choose the penalty as the cheaper option  not because they are reckless, but because their horizon is paycheck-to-paycheck. They know how to cut back and not get everything they want. Health insurance is just one more of the cuts they need to make.

The opportunity: As politics and policy play out in the wake of the failure of repeal and replace, insurers and others will want to closely track how future changes address the pent-up demand for affordable insurance, while leveraging the insights below to show consumers how insurance products can meet their needs.

2. Everyday moments sell insurance better than scare tactics.

Consumer views of healthcare are complex and often contradictory. Over and over in our research we find that yes, people are very concerned about not being able to pay for their healthcare; but no, their financial plans do not include paying for healthcare. One obvious issue – and usually the first reason given – is cost. But there is another, more hidden, logic at play: it’s tough for a young and healthy person to justify allocating money for bad stuff that might happen; it’s easier to pay for good stuff they can ensure will happen.


pacific blue cross health insurance ad about biking accident


The opportunity: Insurers can focus on the immediate benefits that health insurance provides. Peace of mind is the most obvious; testing shows that ads portraying modest near-miss accidents (like a broken leg) test better than scare tactics. But people also long for the sense of pride and belonging during day-to-day moments like being able to check “insured” on a child’s permission slip or ER intake form, or getting help for a nagging sports injury.

3. The social norm is more powerful than ever – if you can make it visible.

Perceived social norms (what we think other people like us are doing, thinking, etc.) have an enormous influence over behavior. But the key word in this case is “perceived.”

Here’s the issue: The actual norm has changed. The number of uninsured adults is at an all-time low. If you’re not insured, you are increasingly an outlier – a situation that would normally pressure the uninsured to become covered. But most people don’t see it this way.

Here’s a stunning statistic from the National Health Survey: Six in 10 Americans do not know that the uninsured rate has declined under the ACA. In fact, 3 in 10 think it has increased.  (In our own research, most uninsured people say they don’t know anyone who has been covered by the ACA; they are in their own bubble, too).


uninsured rate is at an all-time low, but public doesn't know it


The opportunity: If more people recognize a norm, more people are influenced by it. If Americans believe the great bulk of Americans like them are covered, they will feel a greater urgency to get covered themselves. The tricky part is that personal experiences will always carry more weight than an abstract national headline. But this is a problem communication and advertising can actually solve. We’d suggest a careful focus on the people-like-me part – so communicating a norm that is local and of the same demographic, including race, ethnicity and income.

4. Insurance hasn’t cracked the “plain language” barrier (or even come close).

For something so widely used and debated, health insurance is surprisingly misunderstood. Anywhere from one-third to one-half of consumers typically report having difficulty understanding the health insurance information they read. What’s more, they find it hard to find good answers to their questions.

difficulty understanding health insurance information

No wonder. Lingo that experts take for granted – premiums, copays, coinsurance, deductibles, provider networks – very quickly piles up on top of more complicated notions, like health savings accounts and tax credits, leaving consumers overwhelmed by choice. One way to avoid the confusion is to remain uninsured.

The opportunity: Communicate clearly and abandon industry shorthand. The obvious place to start is using more simple graphics and turning on the Flesch-Kincaid test for grade level in Word, aiming for 6th grade or lower. But just because someone can read something does not guarantee comprehension. Use the Cloze test to ensure people understand individual words as well as the context those words are being used in and the overall meaning of the materials.

5. The uninsured don’t live without healthcare. They live without health insurance.

Uninsured Americans don’t totally go without. Most have developed a system of compromises, workarounds and self-care – a system they may not want to ditch entirely. To them, a lot of it is working quite well, thank you.

The uninsured go to local clinics, seek advice from pharmacists, look up home remedies, create payment plans with providers, prioritize and rotate their bills, and, when worse comes to worst, know they can get treatment at most emergency rooms. They look at insurance with skepticism, with many seeing it as a racket or a scam. After all, they’ve gotten this far in life without needing it.


healthcare clinic


The opportunity: Many uninsured consumers want a product or service that fits the logic they’ve operated under and the life they’ve created. In the future, policy-makers and insurers might consider support for products that offer discounts at pharmacies or a limited number of providers. Another option might be a lower-level concierge service that offers the simplicity of this increasingly popular approach but with an extremely limited scope.

What’s next?

Despite the American Health Care Act’s dramatic legislative halt, the debate over how best to insure American consumers is far from over. As insurers, health foundations and others struggle to navigate uncertainty and provide products, programs and policies, they can leverage these insights to develop the empathy needed to understand behaviors and help people get covered.

Behavior change audience research guide

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