How to Make Your Friends Buy Insurance

People don't like or understand Obamacare. So as the law's deadline approaches, its advocates are trying to boost enrollment with a little help from social psychology.
Shutterstock/Olga Khazan

The president has recently appeared on Quora, on Ellen, and between two ferns to plug Obamacare. It's working, kind of. Younger people are signing up at a slightly faster pace, though the Obama administration is still desperate to recruit Millennials and other healthy people in large numbers.

But perhaps funny videos aren’t the best bait for something as unsexy, yet totally necessary, as health insurance. In fact, insurance is one of those dreary, procrastination-inducing things, like 401ks and organ donation, that’s just begging for some kind of nudgy solution. The kind that would maybe later appear on a Freakonomics episode, beginning with some guy seeing a scary flier about “deadlines” and ending with him getting his appendix removed for just a small co-pay.

The trouble is, scare tactics don't always work, either.

“It’s challenging to reach these people who have been outside of the health insurance system for so long,” Jennifer Tolbert, director of state health reform at the Kaiser Family Foundation, told me. “Many people don't have experience signing up for health insurance coverage. It's hard to get the message to them in a way that will motivate them to take action.”

With the deadline to sign up for coverage just a few days away, health insurance experts think they’ve figured out some of the best strategies for prodding people to buy something they know little about and somehow don’t really like anyway. Here’s a look at some of them.

Make it about the fine

There’s been a tendency for people to think that the penalty for not enrolling in Obamacare will be too small to make a difference. It will only be $95, after all, or 1 percent of income—whichever is greater.

But that “1 percent” will get you. Someone who earns $40,000 would be on the hook for $400. And that’s just for the first year. In 2015, the fee rises to $325 per adult or 2 percent of household income, and in 2016 it’s $695 per adult or 2.5 percent of income. And again, that’s money for nothing—you’re not insured if you pay the fine.

As tax-filing season heats up, the size of the penalty has been taking many Obamacare refuse-nicks by surprise.

“They are not pleased,” tax preparer Susana Veamatahau Pau told KQED in California. “Some are just barely getting refunds. One got a refund that’s like $300. Their penalty is going to pretty much eat that up.”

Some health reform analysts think the state and federal exchanges haven’t done enough to emphasize these fees. Spots like “Between Two Ferns” are great for social media, but they might dwell too much on the cuddly, helpful side of insurance and overlook the razor-sharp teeth of the tax penalty.

Last year, Nevada’s state health exchange held focus groups with Nevadans who qualify for the federal subsidies to buy health insurance.

“All of the focus groups stated that they needed to know that there was a penalty for not having health insurance,” CJ Bawden, communications officer for the Nevada exchange, told me in an email. “None of the focus groups liked the penalty, but felt that it was of utmost importance to inform the public.”

So from August to October, the exchange pushed ads highlighting the penalty, with a voice-over saying things like, "Nevada Health Link is here to protect you from a fine on your taxes by helping you purchase state-approved health plans."

Nevada Health Link

Did you get that? "Fine" and "taxes" = bad guy. Nevada Health Link = hero of the day. In reality, of course, they're part of the same law.

The state later transitioned to commercials like this one, which showcase the benefits of insurance and are backed by uplifting muzak:

Enroll America, a nonprofit that aims to increase Obamacare enrollment, told me they’ve also done some “message testing” to figure out how to frame the penalty. Their research suggested that the word “fine” has a better ring than “fee” or “penalty,” Enroll America spokesman Justin Nisly told me.

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Olga Khazan is a staff writer at The Atlantic, where she covers health.

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