Print Advertising in the Health Care Reform Debate
by Eric M. Appleman/Democracy in Action revised April 4, 2010

view a sampling of ads
Given the significance of health care spending in the American economy it is not surprising that interest groups of all stripes ranging from various segments of the health care sector, to business, labor, and religious organizations, to ideological and partisan groups weighed in on the debate during 2009-10.

Major stakeholders include patients, employers, providers, and payers as well as government at all levels. Within these groupings there are many subcategories. For example, patients include seniors, children, people with chronic conditions, the disabled, and more broadly victims of malpractice and by extension trial lawyers. Employers include small businesses and large corporations; governments are also employers. Providers is a very broad category encompassing hospitals (including university hospitals, public hospitals, religious hospitals, children’s hospitals, etc.), HMOs, nursing homes and hospices, doctors ranging from general practitioners to specialists, nurse practitioners, nurses, home care personnel; pharmaceutical companies (including brand and generic manufacturers as well as biotech companies); and medical device and equipment manufacturers. Payers include insurance companies and the government. 

There are many different ways in which groups can seek to influence legislation, for example by organizing supporters to make calls, holding a rallies, lobbying, and advertising. For example an Americans for Prosperity “Hands off My Health Care” bus tour made appearances in the summer. Organizing for America responded with a “Health Insurance Reform Now” bus tour. Groups were very busy on the lobbying front. According to a Center for Responsive Politics’ analysis of lobbying reports, by the fourth quarter of 2009 over 1,500 clients were lobbying on health reform at least to a minor degree compared to just shy of 400 clients in the first quarter.

Dozens of groups ran broadcast, print and internet campaigns for and against health care reform legislation. Much of the money went into television. For example, Health Care for America Now (HCAN), a progressive coalition which launched in July 2008, spent $12 million on TV, print and online advertising in 2009-10 (through late March), of which about half a million dollars was for print ads. Some organizations ran coordinated print, broadcast and internet campaigns, while others focused on just broadcast or just print.

Different media work better for different approaches. Television and radio ads can be more emotional and punchy. Print ads allow for more detail and are more affordable than television. Special web sites allow for even greater detail.

This very limited survey examines a narrow sliver of the overall advertising pie, looking at print advertising primarily in three Capitol Hill publications: Roll Call, Politico and The Hill. As described in their media kits, these publications target an elite audience. Roll Call notes that its “award-wining reporting and insightful analysis have a dedicated place in the hearts and minds of anyone who works on Capitol Hill.” The open rate for a full-page four-color ad is $12,900. Politico claims it “reaches more influentials than any other Capitol Hill news source.” The open rate for a full-page, four-color ad is $12,200 and a black and white ad runs $10,740. The Hill is “known among those who influence policy as a ‘must read’ in print and online;” the newspaper also claims it is “read more regularly than any other congressional publication.” The open rate for a full-page four-color ad is $11,900.

This survey thus does not consider organizations and ad campaigns that focused exclusively on broadcast media. It largely misses national focus ads that ran in the Washington Post, New York Times, Wall Street Journal and USA Today, although I have included a few of those to give a sense of what was run. Ads by groups such as the American Medical Association and the American Hospital Association appeared in one or several of these national publications, but not in the Capitol Hill papers. The survey also misses the targeted district ads, and there were many of those. Finally, this is not even an exhaustive survey of every health care ad in every issue of the three Capitol Hill publications—the sample is thin in the early months and in the summer. Despite these many limitations the survey does give a good sense of what different groups were doing and may hopefully serve as a starting point for further research.

In addition to the choice of media, advertising strategy and tactics varied in other aspects. Groups targeted ads towards a national audience, more narrowly inside the Beltway, or towards key members of Congress in their districts. Their ads addressed the broad ideological thrust of the reforms or specific provisions. In terms of timing, some organizations had ongoing campaigns while others made the most of limited resources by pegging ads to specific events. Some ran simple text-only ads produced in house while other ads were more designed, including imagery of doctors and patients, seniors, and hospital scenes.

Sometimes groups joined together or coordinated to run ads. The American Association of Homes and Services for the Aging spearheaded a coalition that grew from about 15 sponsoring organizations in March 2009 to dozens a year later. One of the more unusual groupings was the pairing of PhRMA and Families USA, which on April 21, 2009 announced at three-point advertising campaign “to help achieve high-quality, affordable health coverage for all Americans.” On the progressive side HCAN pooled the resources of dozens of coalition members; its ads strongly condemned the insurance industry. Health insurers ran few prints ads. America's Health Insurance Plans (AHIP), the national trade association, did have an effective web campaign “The Campaign for an American Solution” and according to news reports put resources into third party ads, for example by the Chamber of Commerce.

As noted above, many groups ran ads on specific provisions of the bills being considered. AARP focused its ads on the doughnut hole and coverage for people aged 50-64. Labor unions came out strongly against the excise tax on “Cadillac” plans contained in the Senate Finance Committee bill. Abortion language prompted a spate of ads. A more general ad from the National Coalition on Health Care emphasized cost containment as a necessary component of health reform. There were some very political ads; American Future Fund ran an aggressive campaign warning Members that voting for big government health care would jeopardize their chances for re-election.

Finally, there was a lot of “background” advertising. Various sectors of the health industry ran general campaigns arguing in effect that they were already leading the way on reform.

A good example of such background advertising was PhRMA’s ads promoting its Partnership for Prescription Assistance. (Another PhRMA ad campaign highlighted the industry's importance to the economy). In a similar vein Pfizer ran ads throughout the period of the debate promoting Pfizer Helpful Answers^TM. Early ads showed the Statue of Liberty and later ones a light house; according to the copy the company was providing over 100 medicines for free or at savings.

Premier, an alliance of 2,100 non-profit hospitals (whose trademark is “Transforming Healthcare Together”) also ran ads throughout much of the period of the debate noting that they are “innovating and integrating best practices.” The ads featured smiling people, had the headline “Guess who wins when hospitals pull together? Everyone.”

Another example of background advertising came from the Foundation for Chiropractic Progress. The Foundation’s mission is “to promote positive press for the profession in national, regional and local media.” In an Aug. 20, 2009 press release the Foundation announced a $1 million media blitz to “reinforce the role of chiropractic care as it impacts the delivery of quality, cost-effective health care nationwide.”

In sum, this survey documents the print advertising messages of many players in the health care reform debate. In these ads one can see arguments made for and against the reform proposals by groups ranging from health providers and consumers to business and labor to ideological groups. Some ads address broad reform objectives or specific provisions of particular bills, others are more political, and still others are more generic background advertising.