Why Anti-Obamacare Ads Actually Increased Obamacare Enrollment

Opponents of the Affordable Care Act outspent Obamacare's proponents 15-to-one, but they might have been funding their rivals' cause. 

Mike Segar/Reuters

Sacha Baron Cohen’s movie Borat was, to say the least, not very flattering to the nation of Kazakhstan: the title character, presented as a cultural emissary from the Central Asian country, is misogynistic, anti-semitic, and generally pretty racist. And yet, after the film was released in 2006, Hotels.com said that requests for information about the country’s accommodations increased by 300 percent.

It turns out there’s a branch of marketing research that draws a line from this Borat effect to the slew of advertising earlier this year that was intended to dissuade people from signing up for insurance coverage under the Affordable Care Act. Niam Yaraghi, a researcher at the Brookings Institution recently tried to determine the impacts these ads had on enrollment. His analysis, which he detailed in a blog post, compared states' per-capita ad spending with their enrollment rates, and found that it was often the case that the more money spent on anti-ACA ads, the more Americans signed up for coverage—a trend made more impressive by the fact that, in the run-up to this fall’s midterm elections, the advertising budget of the ACA’s opponents was about 15 times the size of that of the law's supporters.

Why might this be the case? “There are basically two theories,” Yaraghi told On The Media last week. “The first one is that with the negative ads, citizens’ awareness about this subsidized service increases, and the more ads they see, the more they know that such a service exists. … The other theory is that citizens who were exposed to an overwhelming number of ads about Obamacare are more likely to believe that this service is going to be repealed by the Congress in the near future … [so] he or she will have a higher willingness to go and take advantage of this one-time opportunity before it goes away.”

Until recently, most research on negative publicity suggested that it was dependably damaging. One 1984 study found that a reviewer’s verdict influences a reader’s opinion of a film; another study, from 2003, suggested that a negative movie review diminishes ticket sales. In 2010, though, researchers from Wharton and Stanford put out a study that sought to qualify this view of bad publicity. Noting the Borat example, among others, the paper’s authors argued that there were, in fact, scenarios in which bad publicity led to good things. But what conditions needed to exist for that to be the case?

To answer this question, the researchers examined the sales data for books reviewed in the New York Times, monitoring a book’s numbers before and after a review was published. They found that a favorable review in the Times bumped up a book’s sales almost without exception, while a negative review of a well-known author’s book tended to cause a decrease in sales. But here’s the unexpected part: A negative review of a book by a more obscure author caused sales to increase by an average of 45 percent, even taking into account the most vitriolic reviews.

“Our analysis showed that by making consumers aware of a book they would otherwise not know about,” one of the study’s authors later wrote in the Harvard Business Review, “even the harshest review can be a boon.” The takeaway, then, is that it isn’t worthwhile for fledgling causes to combat bad publicity, even if it is the case that a well-known brand would be wise to do so—just ask Kazakhstan.