Healing America’s Healthcare
Communications Tips for Talking with Voters
About Health Insurance Exchanges*
(Additional Tips for Red States – see page 3)
Herndon Alliance conducted a public opinion poll of likely voters in February for the purpose of
identifying the best messaging for health care advocates to use in building public support for
health care exchanges. Specifically, this messaging is intended to make the best case to the
public and decision makers for passing strong exchange legislation and implementing effective
exchanges for consumers and patients.
An informed public is favorable to an exchange and interested in using it, especially if they don’t
currently have insurance or are fearful of losing their coverage. What we call the ‘exchange’ is
less important to the public than its features.
Leverage support for state control—A majority of voters want their state to move ahead
to create an exchange rather than wait for the federal government to create one for
Be proactive in discussing the exchange—A plurality of voters support the exchange
after hearing a brief description, but 40% still remain uncertain;
Talk about function over structure—The public responds to what an exchange does, not
how it’s structured (other than not wanting insurance companies controlling it);
Exchanges need to be sold by using values based messaging—Hearing about the
functions of an exchange engages the public but doesn’t inoculate against attacks that
raise fears of a new bureaucracy ‘coming between me and my doctor’; values based
messaging keep the attacks from gaining momentum;
Connect the exchange with these values—The public values security/peace of mind and
fairness, while older men in particular value personal responsibility and competition.
Success with exchanges can help bolster the public’s support of the ACA overall.
People of color—Hispanics and African Americans in particular
Men—independent men; older non-college men (note: the exchange is the first ACA
related issue polled that identified men as a moveable group)
Younger non-college women
30-39 year olds; 50-64 year olds
The public wants these functions in an exchange which compares benefits between competing
plans (note: between 65 – 72% of voters approved/liked each of these functions):
The exchange offers plans that allow you to keep your doctors.
Quality and affordable plans on the exchange can’t deny coverage due to pre-existing or
chronic conditions like cancer.
Plans on the exchange must have basic benefits (coverage for doctor visits, preventive
care, hospitalizations, and prescriptions).
The exchange is voluntary; if you like what you have you can keep it.
Plans on the exchange won’t be able to charge women higher rates than men.
If you lose your job, coverage, or want to start a business, the exchange is there for you.
Strong oversight will protect you from misleading information and hidden costs.
The exchange gives individuals/small businesses equal purchasing power as big
Members of Congress will be purchasing their health insurance from the exchange.
The public has concerns about the insurance industry serving on a board overseeing
their state exchange— 54% favor prohibiting it.
The public leans toward believing that exchanges will help to decrease cost (32% believe
it will lower costs; 22% say it will increase costs) and improve quality (30% believe it will
improve quality; 19% say it will lower quality). A third of the public believes an exchange
will have no impact; however, they may be persuadable.
Attacks on Exchanges that Resonate with the Public:
Big bureaucracy (The exchange will increase our taxes to pay for this new bureaucracy)
Loss of coverage (Employers will stop offering insurance to employees, who will then be
dumped in an exchange where they’ll end up with worse coverage than what they had)
Government take-over (The exchange is part of ObamaCare that mandates everyone
buy insurance whether or not they can afford it. Exchanges are a further step toward
the government take-over of our health care, placing limits on insurers that will reduce
choice and quality while driving up costs)
Best Tested Messages - after hearing pro and con arguments, people moved from 43% to 57%
in support of the exchange (mostly target populations who originally identified as ‘not sure’):
[PRE-EXISTING CONDITIONS] The exchange will provide quality affordable choices for those who
currently have none. By law, insurance plans will not be able to deny coverage to people
because of pre-existing or chronic conditions like cancer or diabetes. The exchange will also
automatically tell consumers if they qualify for discounts or qualify to participate in state
programs based on their income.
[SECURITY] Right now too many middle class families have nowhere to turn if they lose the
coverage offered by their employer. The exchange will guarantee individuals a secure place to
go to get quality, competitively priced health plans if they lose their job or want to start their
own business. This will give millions of Americans peace of mind.
[PEACE OF MIND] Members of Congress will be required to get their health insurance coverage
from the same exchanges as everyone else. Their coverage will be the same as consumers and
small businesses, which will help ensure that the exchange works as a good place to find quality
affordable coverage with good benefits and protections for everyone.
[FAIRNESS/NO DISCRIMINATION] The exchange will provide quality affordable choices for those
who currently have none. By law, insurance plans will be prevented from discriminating against
women by charging them higher rates than men. The exchange will automatically tell consumers
if they qualify for discounts or qualify to participate in state programs based on their income.
The following two messages are particularly effective with men.
[PERSONAL RESPONSIBILITY] The exchange encourages personal responsibility and control over
your own health care. If you need health insurance you can visit the website and make your own
decisions about the kind of plan that is best for you including being able to keep your current
doctor. The exchange gives you affordable options and puts you in control.
[COMPETITION] The exchange will increase competition among insurance companies because
consumers and small businesses will have access to clear, fair, apples-to-apples comparisons.
This will bring down insurance costs for consumers and small businesses who shop on the
exchange and lower costs in the rest of the insurance market as well.
Red States and the Exchange
The above findings from our national poll were also reflected in our Missouri poll conducted two
weeks later. The following Missouri findings are particularly relevant in red states.
Good news—even in red states:
A majority want the state to move ahead and not wait for a national exchange;
Informing the public is critical because about 1/3 of the population doesn’t know/aren’t
sure about an exchange;
The public wants to know what an exchange delivers to them (services) not what its
governance or structure is;
When informed about an exchange, people move in support of it.
To move people in support of the exchange, informing them of the services is critical but so is
reassuring them. Reassure by framing the exchange as being:
Voluntary—you can keep your current insurance;
Flexible—you can keep your doctor;
Always there for you – peace of mind;
Many easy to understand choices;
An opportunity for everyone to take personal responsibility for their health care.
Strongest oppositional argument/attack is an anti-government one. Don’t allow opponents to
connect the exchange to the government—redirect the focus to holding insurance companies
accountable and not allowing them to continue to come between us and our doctors and
determine our health care treatments. When necessary, refer to oversight of the exchange by an
Continued on page 4
Red States and the Exchange
Outreach to these populations:
Too many people in the ‘base’ remain uninformed and need to hear about the benefits and
services of the exchange (especially people of color)
Those who expressed most interest in signing on to the exchange—younger women (age
pattern stronger in Missouri than nationally) especially under 30.
Convinceables—initially younger women are most supportive of the exchange, but after
hearing about the services of the exchange the biggest movers in support of the exchange
were women (even some republicans) over 55 (youngest and oldest men are the toughest
*Communications tips are based on the findings from a national poll and a
Missouri based poll of likely voters, the majority of whom self-identify as
moderate or conservative, conducted by Lake Research Partners, February 2012.
For further information please contact firstname.lastname@example.org