Selling Obamacare
The weird, misleading propaganda behind the federal health care law
It might seem odd that Joanna Coles, editor in chief of Cosmopolitan, was invited to the White House for lunch. After all, why would the most powerful person in the world bother meeting with the editor of a publication that specializes in hot summer sex tricks and the year's most dangerous diet? Particularly on May 2, 2014, when just about every important political journalist was in town for the White House Correspondents Dinner, the annual gala where pols and press rub shoulders and bond over bottomless booze.
But Coles had a big favor coming to her. In 2013, she publicly pledged her magazine's ad space and editorial content to help promote the Patient Protection and Affordable Care Act, better known as Obamacare. There are now more than 100 references to Obamacare on Cosmo's website, almost all of them glowing.
It would have been one thing if the magazine had exercised any degree of creativity or editorial tie-in while touting the law, e.g. "7 Tricks to Get Your Boyfriend to Sign Up For Overpriced Health Insurance-in Bed!" But alas, Cosmo's Obamacare headlines have all the joie de vivre one expects of diktats from the Ministry of Information: "5 Important Questions About the Affordable Care Act"; "Valerie Jarrett: 'All Insurance Plans Are Required to Cover Contraception"; "What the Affordable Care Act Means for Women With Pre-Existing Conditions"; and the hilariously defensive "Fox News Wrongly Believes Obamacare is 'Advertising' in Cosmopolitan."
So instead of earning money for disseminating White House press releases, Cosmo settled for a cheap date in the West Wing. Other witting promoters of the law, like comedian Zach Galifianakis and his surrealist Between Two Ferns web broadcast, simply traded editorial space for a chance to interview the president of the United States.
But the main task of selling Obamacare has come with a massive price tag: nearly $700 million, which has created a veritable ecosystem of turnspits working to convince Americans that a government takeover of one sixth of the economy is a good idea.
The amount of taxpayer money involved is unprecedented. "Obamacare seems due to join Social Security and Medicare in one respect: as a public policy advertising phenom, a program that is reviled and perhaps eventually revered in political advertising for billions of dollars in ad spending to come," Elizabeth Wilner, vice president for strategic initiatives at Campaign Media Analysis Group (CMAG), wrote in a press release last year.
Such government P.R. campaigns have become a regrettable staple of American politics, since the default attitude among those in power is that propaganda is only bad when the other guy does it. When the Bush administration got caught violating a statutory ban on "covert propaganda" by passing off fake news reports to local TV stations and paying a columnist hundreds of thousands of dollars to promote the "No Child Left Behind" law, Democrats were justly outraged. And yet, these days Democrats are untroubled that their own campaign to sell Obamacare is taking government propaganda to new heights-and depths.
It says a lot about the law's appeal that this many resources are being deployed to sell Americans a product that the Internal Revenue Service (IRS) will soon compel them to buy. Polling shows the public has consistently disliked Obamacare since long before it was passed, yet the Obama administration has consistently blamed the Republican opposition rather than the myriad of problems with the law.
The Young Invincibles
On many occasions it has seemed that selling the law, rather than getting it to work, is the main political priority. On November 19, after the Healthcare.gov launch turned into a flaming dirigible of website crashes, President Obama's response to the crisis was that the White House would have to "remarket and rebrand" the law. Just days after his remarks, Organizing for Action, the 501(c)4 that advocates Obama's agenda, sent out an email urging supporters to use canned Obamacare talking points on their relatives that Thanksgiving. Seven months and several similarly terrible marketing campaigns later, insurance executives told Congress in May that the exchange website still had major technical problems.
But Obamacare is unprecedented not just in the size of the propaganda campaign but also because the very success of the law hinges on that propaganda campaign being successful. As an actuarial matter, Obamacare's ambitious and costly plan to expand health coverage to millions of Americans requires the participation of precisely those who have the least incentive to sign-up for health insurance-the so-called "young invincibles."
Forcing insurers to provide comprehensive coverage for millions of older and sicker Americans is really expensive. So insurers need lots of young and healthy Americans to offset the cost by signing up for overpriced insurance policies. The law dictates that insurers can't charge older Americans more than three times what younger Americans pay for health insurance, despite the fact that older Americans are a much wealthier demographic. (Remember this next time you hear Democrats drone on about income inequality.)
Last year, the Congressional Budget Office estimated that in order for the exchanges to be financially sustainable, 39 percent of those signing up for the Obamacare exchanges needed to be adults between the ages of 18 and 34. But of the 8 million people the White House initially reported signing up for the federal health insurance exchange, only 28 percent are in this demographic target group. And despite being one of Obama's most reliable electoral demographics, a Harvard poll last December found that 57 percent of millennials disapproved of the law.
Obamacare's financial structure was already a bad deal for young Americans, but the problem became compounded because, as one headline in the Daily Beast put it, "Obamacare's Marketing to Millennials Has Been a Disaster." Instead of telling young Americans the truth about how the law works (which, in fairness, would probably turn them off), the state and national ad campaigns have consistently presupposed that most young people are vapid social media addicts and slutty drunkards.
The efforts to woo millennials have been heavily focused on online campaigns, which have gone viral mostly in the sense that they've produced an epidemic of eye rolling. At one point the White House tweeted a photo of a college-aged young man wearing a plaid onesie and holding a mug, with the caption "Wear pajamas. Drink hot chocolate. Talk about getting health insurance." The picture was worth a thousand words about effete hipsterdom, and almost instantaneously "pajama boy" was subject to merciless criticism and a slew of mocking photoshops.
The administration even tried to capitalize on the internet "doge meme," which, if you haven't seen it, is about as awkward to explain as it is dumb. Superimposed on a picture of a Shiba Inu dog in colorful Comic Sans font it says, "So health insurance. Very benefits. Wow. Many coverage. Much affordable."
Another White House attempt to reach millennials by partnering up with Internet start-up PolicyMic turned into a debacle when the organization considered staging a contest in which "free health care" was the prize. Given the law's astronomical price tag, the White House decided that this was not a helpful message, and shut it down. Indeed, with each new administration press release touting a new Obamacare promotional effort for the "YouTube generation," the White House looks increasingly out of touch.
Brosurance and Birth Control
But at least the White House's efforts have been merely stupid, rather than categorically offensive. The Colorado Consumer Health Initiative and ProgressNow Colorado Education-the same organizations behind the website ThanksObamacare.org-were pilloried nationally for a cluster of ads targeted at millennials. One was a print ad showing a couple of guys doing a keg stand and urging them to get "brosurance." Another showed a young chick standing next to a cocky Lothario and brandishing her birth control pills. The ad copy was more than a little revolting: "OMG, he's hot! Let's hope he's as easy to get as this birth control. My health insurance covers the pill, which means all I have to worry about is getting him under the covers. Thanks Obamacare!"
These ads weren't produced by some marginal left-wing outfit. The Colorado Consumer Health Initiative's "ACA Implementation Fund Project" is, according to the organization's website, underwritten by "the Atlantic Philanthropies, the California Endowment, the Nathan Cummings Foundation, Ford Foundation, the Jacob and Valeria Langeloth Foundation, and the Rockefeller Foundation to ensure effective and consumer focused implementation of the Affordable Care Act." Liberal foundations, many with close ties to the White House, have played a large and, at times, questionable role in selling the law.
According to a Government Accountability Office (GAO) report released in April, Department of Health and Human Services (HHS) Secretary Kathleen Sebelius made a phone call last year soliciting funds for Obamacare's flagging Enroll America initiative from the Robert Wood Johnson Foundation, which promptly coughed up $13 million for the effort (implausibly, the foundation denied that its gift had anything to do with the phone call). HHS also solicited Kaiser Foundation Health Plans and Hospitals, Ascension Health, and Johnson & Johnson for nonfinancial help with Obamacare's enrollment plan, which is problematic when you consider that HHS also regulates these same organizations.
ConsultantCare
Aside from inappropriately wielding the implicit threat of its regulatory powers, HHS also spent heavily to shape the debate about Obamacare, with arguably effective yet still problematic results.
For instance, the Urban Institute, a liberal think tank, has been churning out a series of uniformly positive studies on the beneficial effects of Obamacare. According to the organization's findings, Obamacare has reduced the ranks of the uninsured by 5.4 million, will not have a negative effect on employment, and will encourage 1.5 million Americans to either leave their jobs, become self-employed, or take early retirement. These studies have generated a blizzard of positive headlines for Obamacare, but what's almost never mentioned in the press coverage is how they were funded. Since 2010, the Urban Institute has received $58,942,510 in grants directly from HHS, according to USASpending.gov.
And when it comes to manipulating media coverage of the law, there's at least one instance in which the HHS cut out the middleman altogether. MIT economist Jonathan Gruber has been one of the most prominent defenders of the law, cranking out op-eds and making frequent TV appearances. In 2010, it emerged that he had obtained nearly $400,000 in consulting contracts with the Department of Health and Human Services for "technical assistance." Gruber insisted these contracts had nothing to do with his public opinions, but shortly after his ties to the administration became known, The New York Times ran a correction on a recent op-ed it had published by Gruber: "Had editors been aware of Professor Gruber's government ties, the Op-Ed page would have insisted on disclosure or not published his article."
Product Placement
Ultimately, the problem with using tax dollars for Obamacare propaganda is that we don't know what we don't know. Outlets such as Cosmo that actually own up to promoting unpopular White House initiatives are rare, and even then private meetings at the White House aren't suggestive of transparency. Despite some press coverage of a few high-profile asks-the NFL mercifully declined the White House's Obamacare overtures-we really don't know the extent or legality of the White House's solicitations. There's more than enough evidence of malfeasance to warrant concern, yet as we've seen with the Urban Institute and Jonathan Gruber, the media are pretty incurious about where all this pro-Obamacare information is coming from.
Even more disturbing is that the ambitious Obamacare marketing campaign went well beyond the typical awareness initiatives sponsored by government, making forays into the much more opaque world of popular culture. In 2012, California's Obamacare exchange spent at least $900,000 hiring the marketing firm Ogilvy to do P.R. as part of an effort that would enlist "Hollywood, an industry whose major players have been supportive of President Obama and his agenda," according to The New York Times. The effort was said to be working on a reality TV show about families without health insurance, as well as weaving Obamacare story lines into prime time shows and Spanish language TV. "I'd like to see 10 of the major TV shows, or telenovelas, have people talking about 'that health insurance thing,'" Peter V. Lee, the executive director of California's exchange, told the Times.
Two years later, the White House was still working on getting Hollywood to promote "that health insurance thing." In March, White House aide Valerie Jarrett told Popsugar.com, "I'm meeting with writers of various TV shows and movies to try to get [Obamacare] into the scripts." The 2012 California-based effort at getting Obamacare cameos on your favorite shows was scotched in favor of more traditional outreach, but the next time you hear the word Obamacare on the small or big screen, you're probably right to wonder whether it's the ideological equivalent of product placement.
Aside from her ethically dubious plans to politicize popular entertainment, Jarrett provided an unintentionally revealing window on the administration's propaganda efforts. "What we want to do here is, like, nag," she said. "We're really good at nagging. I'm a mom so I know. I'm a really good nag. And I can come at the same issue like 20 different ways until my daughter goes, 'OK, I'm cool, I'll just do it."
It's a point lost on people like Valerie Jarrett, but state propaganda has long been justified in the name of assuming government knows what's best for the little people. It's one thing if your actual mother tells you to take better care of yourself. It's quite another when the White House picks your pocket and lies to you about all the good they're doing with your money.
Mark Hemingway is a senior writer at The Weekly Standard.
