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The first nationwide analysis of state advertising campaigns for children’s health insurance programs (CHIPs) finds that the ads are attractive and appealing and convey basic information, but lack details that participants in parent focus groups have said they want before they consider enrolling.
The study was sponsored by the Kaiser Commission on Medicaid and the Uninsured to create a baseline of information about states’ marketing efforts for children’s health coverage programs and to identify common approaches and messages states are using as well as innovative approaches and ideas. Kaiser Commission policy analyst Christina Chang tells State Health Watch that the effort is unique in combining interviews with state officials with an analysis of ads from many states by public opinion research firm professionals under contract to the commission.
Interviews with state agency officials revealed that most states are giving their CHIP program an appealing name so that it doesn’t sound like a government program. "There’s definitely a movement for states to shape a new identity for CHIP and even for Medicaid," Ms. Chang commented. States use a combination of television, radio, and print ads to promote the program, and generally promote CHIP and Medicaid jointly. The survey found that nearly two-thirds of states make efforts to target specific geographic areas or populations and all states work with diverse community-based organizations in their outreach efforts.
Ms. Chang says states are trying to make clear to the public, and even to state agency personnel, that these are not welfare insurance programs. "They’re choosing new names that appeal to parents, and they’re working hard with community-based organizations to supplement the advertising and develop support in the community to link families to the system."
More than two-thirds of the states say they have conducted some form of evaluation of their ads’ success. "Most states did this by tracking the volume of calls or applications coming in and asking callers to an 800 number where or how they learned of the program," the study says. "Others have a question on their application asking people how they heard about the program. A handful of states surveyed program enrollees for their feedback. Some states are now also asking callers what they think could be changed about the ads or applications that would make the ads more effective and the application process easier."
Analysis of many ads from various states found four common themes: "It is affordable;" "This is working for parents like you;" "Children need health coverage;" and "You will have peace of mind." Kaiser researchers say that secondary messages emphasize concepts such as the importance of health coverage to children’s development; the high cost of health coverage today; the availability of a new alternative; differences from the Medicaid program; the ease of enrollment; and the many benefits of coverage for children.
While there are subtle differences among state advertising efforts, states generally use many of the same approaches to encourage enrollment. First, ads for children’s health coverage have the look and feel of ads for commercial products, with a child-friendly, optimistic feel, showing visuals of diverse happy and healthy-looking children. It is not readily apparent that the ads are for a government health program. Most of the ads provide only limited information about the program itself, rarely talking about how the program works, who qualifies, how to enroll, how much it costs, and what services are covered.
The ads target working families. There are no scenes of poverty and urban settings are less prevalent than rural locations. Affordability of the program is stressed as often as the assertion that enrollment is simple and easy. Most states emphasize that the coverage is just for children and some ads feature the services that CHIP and Medicaid cover, especially checkups, medication, hospitalization, and dental care.
"Age limits, telephone numbers, catchy slogans, and the program’s name and logo are staples of most children’s health coverage ads," the survey authors say. "The main message that most states use is that CHIP/Medicaid is affordable health coverage for uninsured children in working families. Previous focus group research with parents suggests this message has much appeal."
The professionals who reviewed the ads were struck with how "polished" they were, Ms.Chang says, looking more like ads for commercial products than the traditional state-produced public service announcement.
The researchers say, however, that the ad campaigns face two important challenges — a lack of detail and a need to target broader audiences, especially those at the lower end of income eligibility. "Focus group research shows that some parents feel that the current wave of ads is missing key information. They want to know specific facts about the program, such as what services are covered, whether they qualify, and how much they would have to pay, before they call a toll-free number. [And] although most studies are targeting working families at the highest end of the income eligibility scale, some families, particularly those without experience with government health programs, may not believe that they now qualify for assistance. At the same time, few states seem to be reaching out to former welfare beneficiaries with their ads, despite the fact that many children in these families still qualify for coverage."
Kaiser says the next phase of CHIP advertising will have to reach parents who have not responded to the current ads and perhaps will need to incorporate new messages while reinforcing some of the original messages. They suggest states should continue to:
• use appealing images of diverse children and teens, while adding images of children with disabilities to show that the programs are also for those with special needs;
• address "peace-of-mind" themes, while avoiding frightening images such as children getting injured or a very ill child, because studies show such images may turn parents off to the message;
• emphasize that CHIP and Medicaid provide free or low-cost health coverage;
• identify health services covered by CHIP or Medicaid;
• make phone numbers and Web site addresses even more prominent;
• stay focused on workers, perhaps mixing in images of less-affluent families and neighborhoods so that families in the lower eligibility levels can see that the programs are for them as well;
• emphasize that health coverage is important for children to flourish and that providing coverage is part of being a good parent, avoiding any language that implies blame for parents who have uninsured children;
• give an example of how much a family can earn and have children who qualify;
• keep saying that enrolling in CHIP and Medicaid is easy, but make sure that the enrollment process is, in reality, easy for parents to access and complete.
Ms. Chang says the two most important factors seem to be including some type of income guideline and listing covered services. She says that calling attention to covered dental and vision services can be a hook to get people to look into the program further since they often have the hardest time obtaining those services.
The researchers say that parents also want to hear that CHIP covers all family members who are uninsured. If that is not the case, they want to hear suggestions on how to obtain coverage for uninsured family members not covered under CHIP or Medicaid. "A recurring theme in a number of studies with low-income parents is the desire for whole-family health coverage," the study says. "Many parents dislike the notion of insuring some family members while other family members remain uninsured. In recent focus groups, some parents objected to CHIP only covering children, and they recommended that the program cover other uninsured family members as well. They assert that parents need health coverage, too, and that sick parents cannot care for their children nor can they hold down a regular job. The whole family suffers when even one member is uninsured. While some states have expanded coverage to families, most have lower eligibility levels for parents, making the parent unlikely to qualify for assistance." Expanding coverage to parents may actually help reach more uninsured children, Kaiser says, as research shows that eligible children are more likely to be enrolled if their parents also qualify for coverage.
Cindy Stamper, manager of eligibility and outreach for Indiana’s Medicaid and Hoosier Health programs, tells State Health Watch that her agency’s most effective broadcast ad ran last spring and "produced calls by the thousands." Ms. Stamper says it was a general ad without income or coverage specifics that tried to reach those who had just become eligible due to a state expansion of income guidelines to 200% of the poverty level.
Ms. Stamper says she has mixed feelings about the commission’s recommendation to include income information because "you can screen people in but also screen them out." She says it is true that people who call in to get more information often say they were responding to a "catchy, cute commercial," but didn’t think they would qualify and are surprised to learn that they do.
In New York State, according to Health Department spokesman John Signor, Gov. George Pataki has made enrolling every eligible child in the state’s Child Health Plus program a priority, even to appearing in commercials himself. Ms. Chang praised the governor’s involvement, saying it sends a clear message to the community and to agency staff about the importance he attaches to the program.
Mr. Signor says the result is that enrollment has gone from 90,000 when Mr. Pataki took office to more than 550,000 previously uninsured children in the program now. "No other state can match that enrollment," he says. "Much of it was due to an aggressive media campaign that includes benefits information." The state also has allocated $10 million to use community-based organizations as "facilitated enrollers," working evenings and weekends to be available to parents who work and can’t enroll their children during normal business hours. The community groups are also going out into neighborhoods to find unenrolled families and bring them in. And the state has started a Family Health Plus program so entire families can obtain coverage.
[Contact Ms. Chang at (202) 347-5270, Ms. Stamper at (317) 232-4906, and Mr. Signor at (518) 474-7354.]