This October, Americans finally will start confronting the 2010
Affordable Care Act (ACA), or vice versa. They've heard a lot about
it, both good and bad, but due to a nearly 5:1 ad spend advantage
by critics of the law, they've heard mostly bad. The rallying cry
among critics: that it's big government at its worst, hijacked by a
liberal, spendthrift President. The so far muted response from
supporters: that it's the US government at its best in the
safety-net tradition of Social Security and Medicare.
The law both parties now call "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 spend to come. Yet while Social Security and Medicare have
been litigated on the airwaves for more than 40 years, Kantar Media
CMAG expects the ACA to break the $1 billion mark at an
astonishingly young age, by its fifth birthday in 2015.
That being said, it's one thing for a law to be the focus of
historic levels of ad spending and another thing to drive it. The
ultimate size of the incremental TV advertising gains driven by the
ACA, both political and consumer, is difficult to project.
CMAG's $1 billion estimate is based on the following
We're already halfway there. CMAG tracked more
than $500 million in advocacy and campaign advertising referencing
the health care reforms from the very first spots to air about the
prospect of a law in 2009 up through Q2 2013. Some of these ad
sponsors were unique to the ACA, particularly the early advocacy
advertisers, but much of this spend would have happened in the
course of regular campaigning.
During this phase, critics outspent supporters on the air by
more than 5:1. The issue achieved remarkable depth on the ballot.
Swipes at "Obamacare" pervaded Republican election ads in 2010 and
2012 races from president and Congress, to governor and state
attorney general, on down to local offices with no real role in its
The impact of the onslaught to date has been uncertain. Kaiser
Family Foundation polling shows that public opinion about the ACA,
while consistently more unfavorable than favorable, has remained
relatively static. The Kaiser June 2013 tracking poll found a
fav/unfav rating of 35%/43%; in May 2012, the rating was 37%/44%.
Republican pollster Jan van Lohuizen, who worked for President
George W. Bush, recently wrote to clients, "Our tracking of voter
attitudes towards the ACA suggests that the public has not focused
on it since it was adopted in 2010."
Implementation and the midterms. That's about
to change. Large segments of the US population are about to be
affected by ACA implementation while at the same time, they'll be
making up their minds about how to vote in 2014. The Cook Political
Report considers public sentiment about the ACA as one of its
five key election factors to watch. Again, some of these ad
sponsors will be unique to the ACA, but much of this spend will
occur in the course of regular campaigning.
- $1 billion projected political TV ad spend on Obamacare by 2015
- $500 million tracked political TV ad spend on Obamacare by mid-2013
More races: As a midterm election, 2014 will bring more races,
including races for most US governorships and other statewide
offices that can claim some role in either implementing or
blocking-and-tackling the ACA.
More Democratic ad spend: CMAG expects Democrats on the ballot
in 2014 to embrace the individual mandate in TV advertising after
basically forfeiting the airwaves to Republicans and other critics
for the past three years. Even President Obama largely avoided
mentioning his signature legislative accomplishment in his own
campaign advertising in 2012.
Continuing Republican ad spend: The one-year delay of the
employer mandate means we may not see TV ads featuring people who
lost jobs or critical income because their employers tried to
squeak below 50 full-timers, but the absence of direct impact for
voters hasn't exactly stopped the ACA's critics from advertising
before (see #1). The delay might just embolden critics. "'The ads
in swing races are being written as we speak,'" one GOP strategist
said in the July 4 Washington Post.
Fresh angles for advertising: Even with the postponement of the
employer mandate, some premium increases for employers already have
kicked in. Some tax increases also will start to kick in, including
the half-point increase in Medicare withholding and the 3.8% tax on
"unearned" income for higher income taxpayers.
One Democratic health care lobbyist points out that the overlap
between the individual mandate and the 2014 midterm elections will
make for some interesting decisions on timing. The ACA's political
critics may hold off during the expected promotional push and wait
for early 2014 to pounce. "That would increase the odds that when
Democrats embrace ACA as pollster Stan Greenberg (D) suggests, they
are also embracing the tax increases."
The coming PR push. We're about to see a swell
of advocacy advertising by government, nonprofits and the state
exchanges seeking to educate people about the process and the
benefits of the law in advance of open enrollment starting on
January 1. This advertising will be original to the ACA, i.e.,
driven by the law.
The promotional effort will account for the bulk of the
incremental gain in ACA-related political TV advertising. The US
Department of Health and Human Services already has pumped an
estimated $50 million into TV since the law was enacted in 2010.
Nearly all that spend has gone to national network and cable.
The US government also has given states about $3.7 billion in
grants to start up and promote their respective exchanges. Any of
these funds that wind up on TV will get there via local spot and/or
local cable. According to Spots n Dots, Covered California, that
state's exchange, will spend $86 million on an ad campaign to
enroll eligible residents.
Any state-specific nonprofit TV advertising around the ACA and
the exchanges-for example, the California Endowment private health
foundation was a big early promoter, spending more than $6.5
million according to CMAG-also will wind up on local TV.
One X factor is how much money will be raised and spent by the
new national nonprofits with roots in the Obama 2012 campaign, such
as Enroll America and Organizing for Action. OFA's new TV ad
campaign so far has spent a little over $100,000 on national
The Hispanic opportunity. Per the June 29 New
York Times, the ACA provides 10 million uninsured Hispanics with
the chance to get affordable coverage-40% of the total uninsured
who are expected to gain coverage under the law. The 2012 Obama
campaign repeatedly promoted the law in Spanish TV ads. One of the
first awareness campaigns about a state exchange captured by CMAG
recently hit in Denver, in Spanish.
The ACA gives politicians a means to curry favor with a critical
growing demographic and gives Spanish-language broadcasters the
chance to make up some ground. CMAG found in a 2012 study that political ad spend on
Spanish-language TV has lagged far behind where it should be
whether compared with consumer Spanish-language ad spend, or
compared with the growing Hispanic percentage of the
Consumer. Absent the ACA, health insurers
typically would be spending $250 million in Q4 2013 and Q1 2014 to
target people who aren't covered by Medicare. Kantar Media
Intelligence Chief Research Officer Jon Swallen expects a
short-term spike in consumer and corporate promotion TV advertising
by insurers competing for the millions of new customers the ACA is
expected to bring into the market. This advertising, mainly local
spot, will focus on markets that are home to uninsured Americans
who are especially healthy, with a possible secondary focus on
markets that are home to uninsured who are unhealthy.
After the spike, Swallen expects the ad spending to shift to
direct mail and other forms of follow-up media to complete the
process of signing people up-similar to how advertising unfolded
earlier this century during the implementation of Medicare Part
Other product makers and service providers that stand to profit
either directly or indirectly from the ACA also will advertise. Tax
prep chain H&R Block already promoted its familiarity with the
tax implications of the ACA in ads this past spring.
As with political, many of these ad dollars would be spent,
anyway, though some major advertisers may shift considerable
portions of their national TV budgets to local.
Radio and digital. Finally, incremental gains
in ad sales for highly targetable media such as terrestrial radio
and digital may be even larger than for TV given their potential
role in enrollment. Terrestrial radio's ability to target
geographically and demographically defined populations-e.g., rural
and urban areas, Hispanics and African-Americans, etc.-will make it
a valued component of pro-ACA promotional ad campaigns. The same
holds for digital advertising (including online radio),
particularly with younger uninsured.