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Tufts Health Communication » Affordable Care Act » 9M and Counting: The Affordable Care Act

9M and Counting: The Affordable Care Act

ACA_affordable_care_act_buttonsOn January 10, 2013, the total ACA enrollment totaled 9 million, following a cascade of education campaigns from health insurers, employers and federal and state governments. Getting the word out beforehand was a gargantuan effort.


At the federal level, the US Department of Health and Human Services (HHS)website includes steps to coverage via the marketplace, specifics of coverage changes for different groups (e.g. women, those with pre-existing conditions) and key elements of the law. HHS has promoted social media spread of information using the hashtag #getcovered and a blog with narratives and stories highlighting personal benefits brought by the new law.

Since the ACA health insurance exchanges vary by state, state governments have been responsible to communicate the new law to citizens. Community Catalyst, a consumer health advocacy organization, created a guide for states,Strategies for Successful State Implementation of the Affordable Care Act. The New York Times published a Q&A: A Guide to the New Exchanges for Health Insurance.

Employers and health insurance companies have been preparing for some while to explain these new changes to current and prospective enrollees. Aflac, the largest provider of supplemental insurance in the United States, developed a health care communication toolkit.

To support enrollment efforts, Enroll America, a nonprofit whose mission is to maximize the number of uninsured who enroll in health insurance, has developed a wide range of tools. The most recent,Get Covered Guide: Understanding the New Health Insurance was co-authored by Lucy Berrington, who received her MS in Health Communication at Tufts. Her guide provides basic information, definitions and simple explanations of policies in plain language.


Health insurance enrollment has grown since exchanges opened in October, yet numbers are still short of their targets, according to both National Public Radio and The New York Times. In December poll the Kaiser Family Foundation found that 54% of non-elderly uninsured say they don’t have enough information to know how the law will affect them, and 69% say they’ve heard only a little or nothing about the new health insurance marketplace.

Were the communications developed in preparation for the ACA sufficient? Has the federal government successfully explained the new law? What about the state governments, and insurance companies? As a health communicator, what do you think?

Emily Oppenheimer ‘13, holds her MS in Health Communication from Tufts University School of Medicine. She’s lived in New Hampshire, Massachusetts, Spain, New Mexico, and currently resides in NYC. She’s fascinated by how cultural competence and creative communication can improve health.

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3 Responses to "9M and Counting: The Affordable Care Act"

  1. Bradley Moore says:

    There has certainly been a lot of communication around the Affordable Care Act. I have found good literature that summarizes thousands of pages of federal regulation in easy to understand formats. Yet, there is also some misinformation and confusing material. For every concise and useful health communication guides, there are talking points and information sheets that give conflicting information, sometimes with a negative tone. When politics, technological difficulties, and significant social needs combine, it might take time for the good, relevant material to float to the top and have an impact.

    As a Tufts MPH graduate and a current state health navigator, I do wish there were more ACA material in other languages. Some of the most vulnerable populations are difficult to reach because of communication barriers. This is also the population that might benefit the most from the new reform. The best information is only good if it is understandable and usable. I hope enrollment numbers go up even more as public health professionals find more effective ways of penetrating the harder to reach populations.

  2. Kate Perch says:

    Thanks, Emily, for a great post about an extremely hot button issue all health communication professionals should be familiar with. I was involved in creating consumer-facing ACA messaging (Get Covered included) and social media content at the federal level, here in DC. While I think we created some approachable, plain language, clear content that conveyed complex policies and procedures, the dissemination of such information was lacking. Especially as Bradley suggests, reaching the audiences we really needed to reach (young & healthy; Spanish-preferred) could have been better executed. It was especially hard to reach a young audience that didn’t necessarily make healthcare a priority, let alone seeking health information online. I wish the more emphasis had been put on celebrity relationships and on grassroots outreach through partnerships with community-based organizations. The top-down approach was not ideal for an initiative this large and complex. That being said, I do think government agencies and advocacy organizations like Enroll America and Young Invincibles did try some innovative strategies and were able to reach millions, as evidenced by the massive demand for website access on October 1st. And, many State Exchanges, such as in California and Oregon, were able to draw a reasonable crowd as well through innovative, multilingual campaigns. That’s my $.02 for now. Thanks, again.

    1. sue gallagher says:

      Thanks for your thoughtful posts Emily, Bradley and Kate. Dissemination is always a critical aspect that doesn’t get enough attention regardless of the topic. Although I have not been involved in any ACA work, I believe that many of the hard to reach are not aware that financial assistance is available for them to purchase health insurance, so they don’t even bother following up. And media reporting seemed to tout the implementation problems and drown out the messaging created by the federal government.
      So how do we reach the young who feel invincible? Just think how many could have been reached in Colorado by having outreach workers and a computer set up on opening day at the marijuana shops as young consumers waited in line!

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