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How to ‘course-correct’ Obamacare: Experts weigh in

U.S. President Barack Obama makes remarks as First Lady Michelle Obama listens along with mothers after a meeting to discuss how the Affordable Care Act, known as Obamacare, can help families plan their health care, in the Oval Office of the White House Dec. 18, 2013.

Mike Theiler/Reuters

The troubled rollout of the Affordable Care Act – popularly known as Obamacare – still haunts U.S. President Barack Obama. Earlier this month, he began an campaign to change perceptions about his signature health-care law, although it's not clear he has succeeded. Mr. Obama's approval ratings remain at the lowest point of his presidency.

Dec. 23 was the official deadline for many Americans to sign up for health care in order for their coverage to start on Jan. 1, but it was extended by a day because of high volume on the website. Menawhile, in what a White House official described as a "symbolic" act, Mr. Obama enrolled on the weekend, selecting a bronze-tiered insurance plan on the D.C. marketplace.

The Globe and Mail reached out to advertising, political communication, crisis management and grassroots mobilization specialists to find out what they would advise the President if he were their client.

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Each was asked to approach Obamacare as a case study and say how they would storyboard an image change for the health-care law.

World of advertising: Monica Ruffo, chief executive officer of Lowe Roche Toronto

In a nutshell: The Obama administration faced two uphill battles, according to Ms. Ruffo. First, it had to get people interested in government policy, a difficult task in any society. "And the other thing is you're asking them to do something – the behaviour. You're asking them to actually go out and do something, which is very difficult as well," she added.

Healthy young people – a key group being targeted to sign up and help keep overall health insurance premiums down – were turned off by website problems, Ms. Ruffo said. "The medium became the message because they're so accustomed to stuff online just working."

The solution: Studies show that when people become more knowledgeable on an issue, they become "radically more favourable," she said, adding that the solution is to get back to basics – and facts.

Her strategy would take advantage of how people now consume content on multiple screens, she said. A television ad conveying a single important fact about Obamacare could provide more depth of content by pointing viewers to a website, she said.

This kind of content-driven, mainly Web-based marketing strategy – because people spend more time online exploring content – could convey "digestible facts" about Obamacare. "This is a huge change in society in the way of looking at health. I think that they should stick with the facts, and just explain it in a very simple, straightforward way. So that people understand what it's about and what's in it for them," she said.

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Once the Obamacare rollout is back on course – Mr. Obama's tarnished image will rebound, she said.

World of political communication: Leonard Steinhorn, American University in Washington, D.C.

In a nutshell: More than the botched website rollout of Obamacare, there is a bigger problem for Mr. Obama, according to Mr. Steinhorn, an expert in political communications.

"What happened with the poor [Obamacare] rollout is that it confirmed a meme among some people that government can't function. That is far more troubling, particularly for the Democratic Party, because if government can't handle something like this, then it undercuts the liberal, or Democratic, philosophy that governments can help solve problems," Mr. Steinhorn said.

The solution: The Obama administration does not need ad consultants, according to Mr. Steinhorn – it needs people to make sure the Obamacare sign-up system is working as promised and enrolment is increasing.

"And then when you have the nation's attention with the State of the Union address [in late January], that's when you try and reframe the conversation," he added.

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In Mr. Steinhorn's view, the message would be part apology, part salesmanship.

"If I were him, what I would do would be to show humility and to accept that it wasn't the way that he had planned – to say, 'Yes, even AT&T has blackouts and Wal-Mart has [website] shutdowns and these things happen, but we expect more of our government,' " he said.

"And then to reaffirm that 'yes we got it right, yes it's working, yes it's helped this many people and the larger question is not whether a website works but what is government's role in improving peoples' lives.' So he has to show humility and conviction at the same time," Mr. Steinhorn added.

Mr. Steinhorn said he recognizes that the President has already apologized on numerous occasions. But this time, he explained, Mr. Obama's apology would have a more positive context – and people will be more likely to forgive.

World of crisis communications: Brad Lavigne, vice-president, Hill+Knowlton Strategies, Ottawa

In a nutshell: "At this stage, I would put this under the category of crisis communications. This is not an oil spill, this is not a product recall. But it is a fundamental problem for the Obama administration that they need to quickly correct and aggressively correct," said Mr. Lavigne, who served as national campaign director and principal secretary to the late Jack Layton of the New Democratic Party.

The challenge, according to Mr. Lavigne, is to "change the channel from the problems with the website, and the lack of pickup because of that, on to what the real intention of the program is to do," he said.

The solution: A public media campaign that presents members of key demographic groups that have benefited since the rollout of Obamacare would go a long way in changing its image, Mr. Lavigne said.

"So, if a demographic were to have seniors with pre-existing conditions who are enrolled and cannot be refused health insurance, I would be putting them up on the storyboard," he said. "Young people who are now permitted to enroll with their parents' plan – put them up," he added.

Keeping the campaign on a human level, focusing on the net effect of Obamacare, and highlighting the improving sign-up metrics will help change peoples' perception and drive more sign-ups, according to Mr. Lavigne.

The public ad campaign would take place on TV and radio and in newspapers. "But an emphasis that I would place is online and that would be to mobilize individuals to take action [and sign up] right there and then on that very platform," he said.

The target audience is not the strongest critics of Obamacare, but the lost "middle ground" that can be recaptured – the insured, the underinsured, and those who have health-care coverage but support expanding coverage for other Americans, Mr. Lavigne said.

"That's the needle that needs to be moved – and not worry at this stage about what Republican voters or Tea Party voters are thinking," he said.

World of grassroots activism: Adam Fox, director of strategic engagement, Colorado Consumer Health Initiative

In a nutshell: The 28-year-old has been on the front line of selling the merits of Obamacare – and, at times, has looked at the government's publicity strategy with dismay.

"The communication strategy should have started before the law was even signed by the President," Mr. Fox said, "and … advocacy groups have often felt that we've been trying to make up lost ground."

He added that "there could have been a lot more done from the outset to talk about this law, what it was going to do and when."

The solution: Social media is key because it allows campaigners to target specific groups – the uninsured and under-insured among young adults and women, Mr. Fox said. "It's certainly one that has been underutilized as far as outreach around Obamacare. I think paid advertising is great, but I think that what often happens is paid advertising is not always placed as precisely as it could or should be," he said.

With a $25,000 (U.S.) budget, Mr. Fox and his colleagues created a lively website earlier this year and a social media-only campaign that drew nearly 22 million visitors by early December through 30 highly shareable posters.

The "Brosurance" poster depicts a college student doing a handstand on a beer keg. "Keg stands are crazy," reads the poster. "Not having health insurance is even crazier."

The "Let's Get Physical" poster was the most widely shared and depicts a young woman showing birth control pills and a thumbs-up while standing next to a young man.

"When reproductive health is such a fundamental component of health care and Obamacare is doing so much to increase access to reproductive health care, we felt it was really important to address that," Mr. Fox said.

The one thing Mr. Fox would recommend in light of the Obamacare reboot earlier this month: "Really, it's coming up with the basic messaging points that you need to get across to get people enrolled – and sticking with it, and really pushing those out there in any way possible."

For Mr. Fox, the formula was social media and humour.

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About the Author
Multimedia Reporter

Affan Chowdhry is the Globe's multimedia reporter specializing in foreign news. Prior to joining the Globe, he worked at the BBC World Service in London creating international news and current affairs programs and online content for a global audience. More


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