President Obama’s political group Organizing for America has just launched a seven-figure ad campaign to sell Americans on the Affordable Care Act. Spending on health care advertising is nothing new, of course. The famous “Harry and Louise” ads of 1993 and 1994 cost about $14 million, and helped stop the Clintons’ health care reform effort. Furthermore, about $25 million was spent on advertising in the period leading up to the passage of the ACA.
It is a little unusual to spend significant amounts of money on already-passed legislation, but unusual has become the new norm when it comes to the ACA. A recent study by Kantar Media CMAG shows that $475 million has been spent in political advertising on the ACA since it became law in March 2010, an unprecedented amount. This figure does not count the new OFA ad campaign, which is sure to spur additional spending in the months ahead.
Of the $475 million measured by Kantar, ACA critics have spent the bulk of it, $400 million, more than five times what supporters have spent. While the overall spending levels are surprisingly high, the 5-to-1 disparity makes some sense, as supporters got what they wanted (the law’s passage) and opponents are trying to overturn and reform the existing law, which is always a more difficult task. From the opponents’ perspective, advertising against the health care law has been beneficial in this respect: Opposition to the law remains greater than support for it, with a plurality of respondents consistently remaining opposed. This stands in contrast to the vast majority of other social welfare laws, in which passage has typically softened opposition. Opponents can look to the ad campaign as proof that their efforts to expose what is in the law belie Nancy Pelosi’s promises that passage would lead to wonderful discoveries.
Despite these successes, however, Republicans have not moved opposition to the ACA high enough for their purposes. Opposition, though greater than support, remains below 50 percent. This fact raises questions about the ability of more advertising to increase that number further. To gain additional traction, opponents would need to provide new evidence of the ACA’s flaws. This should not be too difficult. The forthcoming implementation of the law will likely provide ample horror stories at every level, from individual to statistical, including victims of cold bureaucratic decision-making and evidence of higher premiums. Expect those advertising against the ACA to highlight these issues in the months ahead.
For their part, Democrats could not be more on the hook for the legislation, which helps explain the new OFA spending. Democratic leaders in Congress rammed the bill through despite bipartisan opposition, and the consistent and vocal warnings from Republicans. Despite some Democratic attempts to blame the GOP for the law’s implementation woes, Democrats will be tarred with any and all of its flaws. At the same time, Democrats have long been skillful at highlighting individual beneficiaries of government programs, and the law’s expensive subsidy levels will give Democrats many opportunities to crow about new recipients of federal largess. This will likely be the focus of the new OFA effort. In addition, the expectations for the ACA are so low at this point that even a weak implementation may surpass expectations, giving Democrats an opportunity to advertise that things aren’t as bad as projected.
ACA critics are unlikely to fold in response to the new ad campaigns, so anti-ACA spending will continue at high levels as well, with three goals in mind: to counter the new Democratic spending, to highlight flaws in the implementation and rollout of the ACA, and to make sure that the American people don’t just shrug and move on, as has typically happened with new social welfare programs.
Since the ACA’s opponents will not be able to continue out-spending supporters at a 5-to-1 rate, they will need to improve the quality of their messaging to maintain a competitive edge. The upcoming implementation period will provide a relatively narrow window of voter focus and attention before the American people decide if they want to keep or discard the law. As with any other high-cost, high-profile effort, the advertisers need to think seriously about what they want to accomplish before plunging into these waters. But the task, while difficult, is far from impossible. After all, Harry and Louise managed to shape our perceptions at under $14 million — which is how much our $2.5 trillion health system spends every five minutes.