Freebies and refreshments were effective enticement tools.
Wordy brochures and door hangers didn’t work as well.
Common themes emerged among the nonprofits, labor unions, social services centers and dozens of other groups paid to promote the new health care law in California in their first reports to the state’s health exchange.
Californians had trouble associating the state insurance exchange with President Barack Obama’s signature legislative achievement. Language-appropriate and other materials were in short supply. Organizations wanted more pictures reflecting the diverse array of people they are trying to reach.
Misinformation was rampant. At an event in Oakland, “three Chinese individuals separately claimed that ‘Obamacare was implanting everyone who signed up with a microchip,’ ” according to a report from the California School Health Centers Association. The group wanted more material in languages other than English and Spanish to combat the confusion.
The reports to Covered California, obtained by The Sacramento Bee through the California Public Records Act, lay bare the challenges facing dozens of organizations in the three months before the state exchange opened for enrollment Oct. 1.
Covered California is spending tens of millions of dollars on two-year grants ranging from $250,000 to more than $1 million. The outreach effort, meant to supplement its $80 million television, radio and internet marketing campaign, deploys trusted health, education, immigrant, faith-based and other organizations to meet with people at clinics, campuses, sanctuaries and street fairs to inform them about the health law.
Exchange officials consider the grants among the most important components to getting out the word.
In describing their work in July, August and September, organizations suggested too few people were familiar with the Covered California brand and said community members had little interest in approaching booths for organizations they didn’t know.
Some groups saw brand value in pop-up tents, while others believed they were too much trouble: too heavy to lift and too cumbersome to squeeze into most vehicles. Colorful linens were appealing and in high demand. “Still waiting for tablecloths!” one grantee wrote.
Door hangers, a staple of political campaigns, were less desirable because few groups relied on door-to-door canvassing. Bienestar, a community service and advocacy organization for Latinos, swapped out its work plan after discovering that nightclubs weren’t an effective locale for health care outreach.
IPad, the popular tablet made by Apple, was praised for easily calculating the cost of monthly premiums. The wireless devices also continued to function even when the website was acting up, or removed for maintenance or scheduled upgrades. “Definitely the best marketing strategy for me,” read a sentence in one report, preceded by “iPad!!!!!!”
Complimentary items – or the lack thereof – were near the top of the list of in-demand services. One applicant reported too many people approach their tables but are unaware of the state health exchange and can’t be pitched because “we don’t have any freebies.”
Several organizations discussed the positive effect of a freebie on customers’ subsequent willingness to hear about a program. Report authors said they could use pencils, pens, T-shirts and stickers for children. John Wesley Community Health Institute was particularly high on tote bags, an item associated with public radio pledge drives. An official with the group described hanging the totes in their booth at the Los Angeles County Fair and distributing them in exchange for a five- or 10-minute spiel.
Others suggested giveaways should target a particular customer. Young people, for example, might be drawn to a branded lanyard or a BPA-free water bottle. The California Black Health Network, in reporting people were unable to link Covered California with Obamacare, “a positive identifier” among African Americans, suggested information-laden fans for the faith-based community and dog tags and wristbands for youths.
Covered California is unlikely to respond to the requests.
“We don’t provide swag or ‘freebies,’ ” said Roy Kennedy, a spokesman for the exchange. “In fact it’s against regulation to use any grant money provided by (Covered California) to purchase anything that’s given away. We strongly discourage grantees from giving anything away.”
Groups also complained about what they considered a slow start for the effort. They cited a host of bureaucratic hurdles such as the lack of training opportunities, including sessions in multiple languages, and delays in certifying workers. Others said they were overwhelmed with the time demands of the administrative and reporting requirements.
Groups said untrained staff members were hesitant to share information about Covered California. The California Council of Churches blamed training and certification delays for missing scheduled presentations in July and August. The Los Angeles County Federation of Labor, AFL-CIO, wrote that obtaining training, certification and requisite literature were its biggest challenges. Certification and literature delays seemed to be resolved as of early October, it added.
Acquiring the right printed materials was another challenge. Price-conscious students don’t want to spend a lot of time looking at materials that don’t apply to them “and they are more likely to look at something with people like them on it instead of babies and families,” wrote grantees with the California State University system.
Asian Americans Advancing Justice pointed to inappropriately translated materials, including Vietnamese translations on cards, banners, posters and fact sheets. It also cited a lack of any materials translated into South Asian or Pacific Islander languages.
Kennedy, of Covered California, said grantees have access to a website to obtain marketing material. Since Oct. 1, the exchange has offered materials in English, Spanish, Vietnamese and Chinese languages.
“Also we work in coordination with them if it would be beneficial to their outreach and create new material with their suggestions,” he said. “It’s an ongoing process, and if we don’t have a particular piece they’re looking for we certainly try and accommodate their needs.”
Kennedy added that there are fact sheets in 13 languages – including Khmer and Lao – on its website, coveredca.com.
Some early concerns about the lack of materials may be reflected in newly released figures for the first two months of enrollment. The exchange reported 88 percent were English speakers. Just 4.6 percent communicated with the exchange in Spanish, although Spanish-speakers comprise 28.8 percent of the state population.
Nearly 110,000 Californians selected plans through the exchange in the first two months. The grantees and their subcontractors are charged with collecting leads on behalf of the exchange, some of which are mailed on cards and the majority submitted online.
Regardless of their messaging, many groups maintained that the prejudice surrounding the law would continue to challenge them in the field.
They heard that the law would eventually be abolished and would drive the country to financial ruin. One group reported hearing such “fear-based untruths” as the government telling doctors what to do and the existence of “death panels.”
“Others are saying that microchips are going to be implanted on babies in order for the government to have more control over their constituents,” wrote an official with the Healthy Community Forum for the Greater Sacramento Region.
Bewilderment with the law extended to areas where mixed-immigration families are common. The Central Valley Health Network reported widespread misinformation and rumors “including a requirement for microchipping and the potential to lose Medicare or other public coverage.”
“This requires more time to educate and allay fears, and it takes additional time and encounters to change impressions from negative to positive and convince customers to enroll,” its report said.
Some counter-messaging from the state exchange is needed to address the partial federal government shutdown that occurred and to respond to the “massive anti-Obamacare campaign,” wrote the Los Angeles County Federation of Labor, AFL-CIO.
“We should be getting daily messaging about enrollment to counter the huge investment of ACA-haters in stating that enrollment is a failure,” the federation reported. “We are on the ground talking directly to people every day, and can carry messages very effectively. We are now winging it.”