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Hope and optimism are more motivating

than cynicism.

When we suggest that this will be an

uphill battle or unlikely to happen in

Idaho, we give lawmakers tacit permission

to ignore this issue.

Tip: Be Aspirational


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We feel first and think second.

Tip: Values First


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Values are our moral

compass

Freedom/justice for all

Honesty/integrity

Equal opportunity

Hard work

Personal responsibility

Everyone does fair share

Golden ruleDiversity makes us strong

Our kids deserve a better world


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Our health values

Control

ChoicePeace of mindsecurity

Fairness

Personal responsibility


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Lets also think about values that resonate in Idaho.

For example:Freedom

Family Security

Personal Responsibility

CommunityFiscal Responsibility

Pragmatism

Tip: Values First


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We cant give the government or Medicaid or a black-

eye, while calling on Idaho to invest more in theprogram.

Thats not consistent and this doesnt support our long-

term goals of strong public systems to protect our

health.

Tip: Elevate our PublicSystems


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43% of pregnant mothers in Idaho depend on Medicaid

for their prenatal care and delivery (2009). How wouldwe make sure these babies are born healthy in the

absence of this care?

Medicaid is incredibly efficient and good at getting

dollars directly to care delivery--3% of Idahos Medicaid

budget goes to administrative fees, compared to around

20% for private health insurance companies.

Tip: Elevate our PublicSystems


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Focus on the our, the we, and to foster a sense of

interdependence.

This is about all of us as Idahoans and our communities,

not just a small group of us. These messages are more

relatable and guide us toward a community solution.

Tip: Focus on We


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Do NOT say:

Many people think Medicaid beneficiaries are

lazy and unemployed, but actually

Traps to Avoid: Dont repeatunhelpful stereotypes


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What is a frame?

For gun control, two frames might be:

Freedom vs. Public Safety

Traps to Avoid: Dont stepinto the other sides frame


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Stay away from frames around the federal deficit, the

size of government.

If caught in a federal deficit frame, pivot to:

What we really want to do is use our public dollars in a

smart way: on prevention that keeps families healthy,

not on costly ER care.

Traps to Avoid: Dont stepinto the other sides frame


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Choose stories to emphasize community, not

individuals.

If you have a story about an individual, make sure you

also make it about the community.

We need a community solution, not an individual

solution.

Traps to Avoid: Choosestories wisely


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Choose stories to emphasize community, not

individuals.

Talking about hard-working Idaho families (a term we

call relate to), rather than the poor or low-income

families.

Traps to Avoid: Dont uselanguage that otherizes


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If you find yourself talking about dual eligibles or

138% of the federal poverty line, you run the risk of

boring people and you risk losing emotional connection.

One simple statistic or number per paragraph is

probably a maximum. No decimal points are necessary.

Ever.

Traps to Avoid: Dont usejargon and use statistics

sparingly


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In 2013, our careless politicians refused to expand Medicaid, leaving poor

people out in the cold. They like to use excuses about occasional fraud and

abuse, but that is very rare. Its as though they care more about the federal

deficit than the lives oflow-income people!

Now when the health reforms are implemented, Idahoans with incomes

between 100 400% of the federal poverty line will be eligible for tax

subsidies, but the people with incomes below 100% of the federal poverty

line wont get anything. And we know that low-income people have higher

rates of tobacco use and obesity, so they are especially in need of health care.The divide between the haves and the have-nots will continue to grow. Typical

government at work!

High Jargon, Cynical, Anti-Government Message:


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We want all of Idahos families to have the security of knowing they can get

the health care they need without going bankrupt. We also want our state to

have laws that are fair to everyone and dont play favorites.

In 2014, uninsured Americans in every state within a certain income bracketwill receive tax subsidies to help them purchase coverage. This will keep these

middle-income families healthier and more economically secure.

Idaho faces a very important choice: If we accept the new Medicaid dollars

set aside for Idaho, there will also be an affordable coverage option forfamilies that fall below this income bracket. If we reject the Medicaid dollars

and only implement half the policy, thousands ofhardworking Idaho families

will not have access to coverage and will have no protection when faced with a

health emergency.

Now with Values, Less Jargon, Less Negativity about

Government:


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Communication Insights

Accept ing Federal Money to Cover More Uninsur ed People

through M edicaid

February 2013

National Womens Law Center

Center for Children and Families,

Georgetown University Health Policy Institute


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The National Womens Law Centerand Georgetown University Center for

Children and Familiesjoined together to sponsor this research project .

The goal was to gain insight into how to communicate with voters about complex decisions

their state leaders are making about accepting federal dollars to extend health coverage

to more uninsured people through Medicaid and about improving access to

health coverage for children. This presentation shares insights into messages on

covering more uninsured people through Medicaid.

The project started with four focus groupswith moderate and conservative leaning voters inPhiladelphia (November 2 9 , 2012 ) and Atlanta (December 3 , 2012). It concluded with a

national surveyof n=1 ,0 21 registered voters conducted January 18 -26 , 2 013 . The marginof error on the total results for the survey is + 3 .7 %.

Background

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By a margin of 2-to-1, voters want their state to accept the federal money to

extend coverage to more uninsured people through Medicaid.

Helping hard-working families have the security of health coverage and avoiding big

medical bills is by far the top reason for states to accept the money.

Other important reasons include the following: covering uninsured parents so the

whole family has coverage, reducing spending on ER care,and keeping localhospitals open.

Once explained, most voters (63%) are also concerned about the coverage gap

that will occur if states do not accept the money. Nearly one-quarter of voters

(24%) believe they could fall into this coverage gap themselves.

The argument that states can cover more people and save taxpayer dollars byreducing ER care is much more powerful than an argument that Medicaid is

already too expensive and that expanding Medicaid will only lead to higher taxes and

more debt (61% vs. 37%).

Summary

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Insightsinto Audiences

When it comes to accepting federal funds to cover more people throughMedicaid, Democrats, people in the Northwest and West, lower income

individuals, African Americans, and more educated individuals have the

highest rates in favor of accepting the money.

Individuals in the South and Midwest, Republicans, individuals 65+ and

middle income individuals tend to have more concerns about acceptingthe federal money than others.

The Coverage Gap message cuts across these divisions somewhat many

of those who are initially neutral or against accepting the money express

concern about the coverage gap and see it as a good reason to accept the

federal money.

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Right off the bat, voters

support their state accepting

the federal money to cover

more people through

Medicaid by a ratio of 2-to-1.

Voters feel this way after

reading a simple descriptionof the issue.

Keeping the focus on

accepting the money and

covering more peoplethrough M edicaid works well

-- other polls show this

language is much more

effective than focusing on

expanding Medicaid or not.

Under the new health care law, XXX,XXX people

in STATE who are currently uninsured could haveaffordable health insurance st ar t ing next year.

This is because the health care law includes

money for each state to cover more people

thr ough M edicaid. The federal government will

pay 100% of these costs in the first few years,

and at least 90% of the costs after that. STATE

will have to pay the remaining costs. STATE will

decide in the next few months whether to acceptthis money or turn it down.

W hat do you think STATEshould do?

Context

Accept the Money

Turn the Money Down

51%

25%

23%Neutral

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Top Message

By far, the top reason for voters to suppor t their states

accepting the federal money is:

Hard-working families need the security

ofquality health coverage to get thecare they need when they need it

without facing huge medical bills.

35%This is the percent ofvoters for whom this is

the top reason to

accept the federal

money.

The bolded words reflect the phrases that resonate most with voters in

focus groups. This message hits both health security and financial securitythemes, which is a powerful combination for voters currently.

This reason is strongest across the board and with all different

demographic groups. It should be used routinely when communicating on

this issue and can work in combination with other messages.23


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Messages

Percent for

whom this is

the top

message

Message Insights

STATE has successfully brought the uninsured

rate for children down to record lows thanks to

MEDICAID/ CHIP. Now it is t ime t o help their

uninsured parents get health coverage too so

that the whole family can get the health care

they need to stay healthy like getting moms

blood pressure checked and getting her

daughter the asthma medication she needs.

14%

This is the second strongest

message. It works best with people

who already sympathize with this

issue and who believe Medicaid is a

good program. This is a good

message to use with the base

Democrats, people who suppor t

Medicaid, etc.

Many hospitals care for uninsured patients and

end up with a lot of unpaid bills. If STATE

accepts the federal money, it will help keep

more local hospitals open and will mean that

hospitals will spend less money on the

uninsured and more money on improving care

for everyone.

12%

This message and the one below

work well with everyone else

Republicans, those voters more

conflicted about accepting the

money, and those with negative

views of Medicaid.

STATE is already spending money to treat

uninsured people in emergency rooms. Making

sure more state residents have health

insurance and can get t he care t hey need from

their doctors before they get sicker will reduce

spending on emergency room care. This is a

smar ter use of healthcare dollars.

9 %

The theme of reducing spending on

ER care to treat the uninsured is a

powerful reason to accept the

federal funds especially among

those who do not initially sympathize

with this issue. Smar ter use of

healthcare dollars is good

terminology.

Other Strong Messages

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Messages

Percentfor whom this is

the top

message

Message Insights

We are moving forward with new

approaches that will fix our health care

system . Accepting the federal money givesus the best chance to help uninsured people

get covered so they can afford the health

care they need.

7%

This is not a top message, but it

still resonates with people. It works

best with Democrats and AfricanAmer icans. It is a message for

those who support health care

reform.

If all states accept the federal money, an

additional 7 million women will be able to get

preventive health screenings, birth control,

check-ups and the care they need to

manage chronic health conditions.

3%

Like the message above, this

message is not a top message,

but it is a compelling reason to

accept the money for many people.

It works best with youngeraudiences (


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Messages Reasons why they might be less effective

The federal government has already allocated

the money for STATE to cover XXX,XXX people

who are uninsured right now. If we tur n down the

money, we will just be lett ing other st ates use

our tax dollars.

This may work with policymakers but it is not very

effective with voter s. They do not think of

themselves as winning or losing things in relation

to other states, so this does not resonate with

them.

Removing barriers to affordable health care will

help people take better care of their health.Their health needs wont go away if the state

turns down the money.

Some people like this message but it does not

have the oomph of other messages. Use

stronger messages not this one.

In many states, researchers and economists say

that accepting the federal money to help cover

more uninsured people will likely bring in new

revenue and create new jobs.

This message works well with a lot of people

mainly because researchers and economists ar e

top messengers on this topic. We suggest using

researchers and economists as messengers for

other messages perhaps around cost savings by

reducing ER care.

Accept ing the federal m oney will help STATEs

businesses by expanding the number of workers

who have access to healthcare. Workers with

health insurance will be healthier and more

productive.

Again, this is a type of message that is more

effective with policymakers and business leaders

than it is with voters.

Less Effective Messages

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Concerns

Percent Who

Strongly or Somewhat

Agree

Expanding Medicaid could mean higher taxes and more

government debt. We need to cut government spending, not

increase it.

71%

There is a lot of fraud and abuse in Medicaid. We shouldnt be

putting more money into a program that already wastes so

much of it.

66%

Expanding Medicaid could mean less money in the state budget

for education and other priorities.64%

This is par t of Obamas government t akeover of health care. W e

should not be working to expand a government health program.52%

Voter Concerns

Voters have concerns about accepting the federal money to extend coverage to more

uninsured people in their states. The top concern is about higher taxes and moregovernment debt . This is the opposition message you must address. A full 94% ofvoters who say their state should turn down the money agree with this concern.

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Responses to Taxes/Debt Attack

One side says that we cannot

afford to expand Medicaid rightnow and should tur n down the

federal money. Medicaid is

already one of the most costly

budget items. Expanding the

program will only mean higher

taxes and more government

debt. We need to cut

government spending, notexpand government pr ograms.

By tur ning down the money, we

can avoid increases in

government spending.

37%of voters agree with

this side

The other side says that by accepting the federal

money, STATE will be helping thousands more hard--working families get preventive care and the medical

services they need. W hen people get preventive

care, they lead healthier, more productive lives

benefiting everyone in our state. Preventive care also

keeps people out of hospital emergency rooms and

saves us money. By accepting the money, more

people can get the preventive care they need and

lead healthier, more productive lives.


this side

The other side says we can cover more people in

STATE and save taxpayer dollars that are cur rently

spent on treating uninsured people in emergency

rooms. M ore hard-working families can getpreventive care and see a doctor when they need to

instead of ending up in the emergency room. By

accept ing the money, we could cover more people

and spend healthcare dollars more wisely.


this side

W hen tested in head-to-heads against

the attack about higher taxes and moregovernment debt, messages that

focus on prevention and reducing

ER care both come out on top.

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Coverage Gap

The purpose of the new health care law is to

provide a path to health insurance for all

Amer icans. Star t ing soon, many people will be

able to get tax credits to help them afford

health insurance. These tax credits will be

available in every state. In states that accept

the federal money to cover more people

through Medicaid, many people with lower

incomes will also be able to get affordable

coverage. However, if STATE turns down themoney, those with lower incomes will fall into a

coverage gap. In other words, they will not get

any help towards affording health insurance,

while many people with higher incomes will still

get help.

How concerned are you about this coverage

gap if your state turns down the money?

63%

35%

Concerned

Not Concerned

The Coverage Gap

Most voters (63 %) are concernedabout people falling into the

coverage gap if their state turns downthe money.

Nearly one-quarter of voters(24%)

believe they would possibly fall into thecoverage gap themselves.

Two-thirds of voters (68%) say that

avoiding people falling into the

coverage gap is a good reasonfortheir state to accept the federal money

(29 % say not a good reason).

A message on the coverage gap could be

powerful with those who are neutral on

whether to accept the money or not.

Nearly three-quarters (74%) of these

conflicted voters say it is a good reason to

accept the money.

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Best Messengers

MessengerPercent selecting as a

top two messenger

Your doctor 31%

Nationally recognized researchers and economists 29%

Families, fr iends, and neighbors 25%

Researchers and economists from (STATE) universities 22%

Local hospitals and health clinics 21%

Groups representing patients, such as the Amer ican Cancer

Society

19%

Organizations representing women and children 14%

Groups representing doctors, such as the American Academy of

Pediatricians

13%

Nurses 9%

Elected officials in your state (e.g., your governor or state

legislators)

8%

Your local newspaper 5%

Doctors, researchers/ economists, family/ fr iends, and local hospitals are themost tr usted messengers on this topic.

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Frame t he discussion around accepting the federal money to cover more people

through Medicaidor not as opposed to expanding Medicaid or not.

Your core message should be about hard-working families having the security of knowingthey can get the care they need without big medical bills.

W hen messaging to your base, use the message about whole family coverageby covering

uninsured parents. W hen messaging to those more conflicted about M edicaid, talk about cost

savings through reducing ER care(for hospitals and the system) andspendinghealthcare dollars more wisely.

Consider explaining the coverage gapas a message because it moves people who areneutral onto your side.

Respond to opposition att acks about higher taxes and more government debt. You have two

messages that ar e str onger. One theme is you can cover m ore people and save money by

reducing ER care. Another theme is around hard-working families getting preventive

care.

Use doctors, economists, researchers, and local hospitalsas messengers.

Message Strategy

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Persuadables women, seniors, Latinos, young


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For more information see:

www.publicworks.org

www.herndonalliance.org

www.nwlc.org

www.ccf.georgetown.edu
http://www.herndonalliance.org/http://www.herndonalliance.org/http://www.nwlc.org/http://www.ccf.georgetown.edu/http://www.ccf.georgetown.edu/http://www.nwlc.org/http://www.herndonalliance.org/http://www.herndonalliance.org/http://www.herndonalliance.org/

medicaid comm network kick-off presentation (abridged)

Documents