Introduction

The purpose of this information campaign is to influence through information the public opinion in Missouri concerning Medicaid expansion in hopes of winning the fight for expansion. The primary audience is the Missouri public, who in turn should influence the policy makers in taking their desires for expansion toward legislation. The strategies to accomplish this is three-fold, combat health insurance illiteracy, express the need for health care reform, and combat the many myths about expansion by providing sound, verifiable, and well-researched information.

The campaign has four major components that are largely focused on new media technologies. They are, the creation of short, concise social media videos, a monthly blog on the topic, infographics, and a mobile application. Social media offers the opportunity to maximize exposure while limiting total costs. The campaign is designed to appeal to younger more connected audience, however, it is important to note that social media is no longer limited to younger audiences.

 

SWOT Analysis

As is known, Empower Missouri is a non-profit organization that has as its mission to be an advocate for “the well-being of all Missourians through civic leadership, education and research.” Empower Missouri envisions Missouri progressing toward greater levels of justice, equitability, and democracy. Among other areas of focus – including safety, security and human rights – your organization has also focused its attention on the health of Missourians having one political aspiration focused on the expansion of Medicaid to include incomes below 138 percent of the federal poverty level. As your website states; your organizations wishes to “Win Expansion of Medicaid” when the time is right (Empower Missouri, n.d A). With the current circulation of petitions in Missouri concerning the placement of the question of Medicaid expansion being included on the November general election ballot, it appears that that time is now (Japsen, 2018).

Before discussing more about how this campaign will work, it is important to examine the strengths, weaknesses, opportunities, and threats facing Empower Missouri having to do with this campaign.

-Strengths

Your organization has sound partnerships with organizations such as Momentum Missouri, Missouri Community Action Network, and the ACLU of Missouri – just to name a few (Empower Missouri, n.d.B). Your organization has had successful campaigns in the past including mental health legislation and helping to establish the Missouri Health Advocacy Alliance. Empower Missouri has had noteworthy membership support at its events (Empower Missouri, n.d A).

--Weaknesses

The major issue facing Empower Missouri is that it is not a large organization and has limited funding. While Empower Missouri does have several social media accounts, including Facebook and YouTube, the YouTube channel has not had a post for two years (Empower Missouri, n.d C). Messaging, mainly focused on the benefits of expansion, could be more engaging by somehow capturing a more news worthy angle – perhaps something that relates to the audience in a more personal way. As opposed to the videos of event speeches. That approach has little spark and consideration of the audience (Empower Missouri, n.d.B)(Empower Missouri, n.d C). The messages also need to be more focused and concise.

--Opportunities

Since Empower Missouri has its own website (Empower Missouri, n.d A), the site could be used to blog about topics and perhaps interact with its audience. The YouTube channel could also be better utilized with shorter, succinct videos of 60 seconds in length.

In addition, several studies support Medicaid expansions by showing improvements in overall health, reduction in the total uninsured population, reduction in health care costs, job creation, budget dollar savings, and lower insurance premiums (American Medical Association, 2017) (Courtemanche, Marton, Ukert, Yelowitz, & Zapata, 2017). One study suggests that about 10 percent of the Missouri population could benefit from expansion (McBride, Watson, & Blouin, 2016). These facts about the benefits of expansion could be used as content for the messaging campaign.

--Threats

On the topic of Medicaid expansion, Empower Missouri is facing off with some well-funded conservative groups, specifically the Missouri Century Foundation. This organization distributes negative information concerning anything associated with the Affordable Care Act (Mannies, 2015). Missourians generally accept most opposition to the ACA (National Academies of Sciences, Engineering, and Medicine, 2017).  Empower Missouri faces significant challenges as its opposition is so well-connected and well-funded.

Even though expansion could benefit a large population of Missourians, many may not understand the issue as there exists a tremendous amount of health insurance illiteracy in the state (National Academies of Sciences, Engineering, and Medicine, 2017) (Somers, S. & Mahadevan, 2011). One angle of the campaign would be to inform the public about the benefits of expansion – intending to sway public opinion in Missouri toward expansion and therefore edge legislation forward on the issue.

 

Information Environment for the Debate

--Negative attitudes about the Affordable Care Act 

Considering the fact that  the ACA proposal before the Missouri House last March was defeated 102 to 41 (Associated Press, 2017) and  evidence that many Missourians have a negative attitude about the Affordable Care Act (National Academies of Sciences, Engineering, and Medicine, 2017), it is very evident that the goal to achieve Medicaid expansion is quite industrious and will prove to be difficult.

--Support for health care reform

            However research supports the success of Medicaid expansion.  It has been shown that 10 percent of the Missouri population would benefit from Medicaid expansion (McBride, Watson, & Blouin, 2016). Recent surveys show that public opinion is in favor of government involvement in providing health care (Alfonso-Zaldivar & Kellman, 2017)( Bialik, 2017) (Kirzinger, DiJulio, Wu & Brodie, 2017).

--Opposition to health care reform

 

The Missouri Century Foundation is a well-funded lobbying group opposed to expansion. Gregg Keller, the Missouri Century Foundation Chairmen has been very outspoken about his organization’s plans to try to disrupt any movement toward Medicaid expansion (Mannies, 2015).

            The Missouri Century Foundation, is primarily made up of former lobbyist who have a niche in working directly with government lawmakers in the Missouri capital of Jefferson City with the majority of their efforts going to lobbying legislator’s, providing talking points, funding campaigns, and bending the legislator’s ears with anti-Obama Care rhetoric (Dunn, 2015). While the Missouri Century Foundation’s efforts to oppose expansion cannot be ignored, research and ethical interpretation of information is on the side of Medicaid expansion.

 

 

 

Goals and Objectives

The primary goal of this campaign is to motivate Missouri legislators to take action and implement Medicaid expansion in Missouri. I believe that this goal can be achieved by influencing public opinion in favor of expansion, which will ultimately pressure legislators to implement expansion in Missouri. These goals are supported with three strategies as has been outlined in the introduction; 1) combat health insurance illiteracy by emphasizing the benefits of expansion., 2) inform the public about the need for health care reform, and 3) Share messages that rebut many of the negative viewpoints about Medicaid expansion. For strategy #1 the following messages will be communicated;

[….]

The primary audience of the first strategy is those within the ten percent of the Missouri population that would benefit from expansion – that is those making below the 138 percent marker on the Federal Poverty level as outlined in the Affordable Care Act

For strategy # 2, the following messages will be communicated;

[….]

The audience for this strategy is those individuals in the insurance gap who make too much for Medicaid but not enough to afford health insurance.

And for strategy #3…we have the following messages;

            […]

The mechanisms for communicating all of these messages will take the form of infographics, blogs, short social media videos, and a mobile application. Appendices A and B are examples of infographics that support strategic targeting of these audiences. Sample video scripts are included in Appendices C and D. Blogs written by staff and guest writers could support this strategic messaging as well. Guest blog writers could include physicians, lawmakers, and other professionals in related fields that have a point of view that advocates for expansion. Empower Missouri is already engaged in a wide variety of events on the topic. The events could provide an opportunity to promote the use of the mobile application. The app could include not only information and talking points regarding the benefits of expansion, but also external links to health care and health insurance resources. The app could also include a budget calculator that is geared toward finding extra funds that could be applied to purchasing health insurance, as well as a glossary of health insurance terms and phrases. Social media testimonial and informational videos that are geared toward influencing the audience to petition their local legislator to take action – implemented on the organization’s YouTube channel and Facebook page – will also be used to communicate these messages.

 

COSTS AND TIMELINE

Most of the devices that are to be employed in this campaign are inexpensive and require only some adjustments to the social media video content and some of the material found on the website. Internships could be offered to university students majoring in journalism or public affairs to help create the videos and infographics. Volunteers from professional walks of life, in addition to organization staff, could create the blog content for the organization website. The most significant cost associated with this campaign would be the contracting of a consultant to design a mobile application.

There is currently a movement for the topic of Medicaid expansion to be included on the general election ballot in November 2018 (Japsen, 2018). For these reasons it is important that Empower Missouri begin action on this campaign as soon as possible.  Immediately, the organization should begin movement focusing initially on creating the infographics and seeking volunteers to assume roles such as those who would provide a blog of the month or help with the creation of the videos. The contracting of an agent to create the mobile application must be done early on as well. By early to mid May, the creation phase of the videos should be in full swing. By the end of May the application should be being promoted to potential users at organizational events. By June a third blog should have been published, and the social media videos should be completed and uploaded to YouTube and Facebook. By July, feedback should be arriving concerning the success of the campaign so far – these could include number of “likes” on social media or total views on YouTube. The number of mobile application downloads could also be evaluated. This process should continue and repeat itself up until the proposition is on the Missouri ballot in November. Perhaps additional videos could be created, and each month leading into November a new blog should be published.

 

Metrics

Again, we must turn our attention toward the three strategies brought forth in the early stages of this presentation – as they are illustrated again here.

[…]

Let us first consider the metrics associated with strategy number one.

The primary purpose of this particular strategy is to improve health insurance literacy with the side effect of influencing opinions about the benefits of Medicaid expansion. In a perfect word it would be possible to gauge how much people were learning about health insurance through the campaign efforts. This is a difficult thing to measure. However, their enthusiasm for the topic may be an indicator of this – gauged by the data points indicated in the table, that is “likes” and shares, number of downloads, and number of event goers. In turn, this enthusiasm could translate into social media mentions as well as traditional media if a “buzz” is created surrounding the app, the blog, or the events themselves.

Now lets again consider strategy number two;

[…]

Again, in a perfect world we would be able to measure this strategy by being able to quantify the degree in which individuals are informed about the need for health care reform. And again, this is impossible. However we again can gauge this by how receptive the audience is to the messages on social media – indicated  by “likes” and shares as well as mentions in various online mediums.

And finally, let us consider strategy number three;

[…]

As with the previous strategies, this third one is also difficult to measure. But we can measure the enthusiasm surrounding the communication products that we offer.

 

Conclusions

The campaign has four major components that are largely focused on new media technologies. They are, the creation of short, concise social media videos, a monthly blog on the topic, infographics, and a mobile application. Social media offers the opportunity to maximize exposure while limiting total costs. The campaign is designed to appeal to younger more connected audience, however, it is important to note that social media is no longer limited to younger audiences and can now be well applied to a wide variety of demographics.

If Empower Missouri intends to be a driving force in the debate on Medicaid expansion, it is highly recommended that the proposals submitted here be considered  as they are not only cost effective, but they will also prove to be effective to the cause.

 

References

Alfonso-Zaldivar, R. & , Kellman, L.. (2017) . 62 percent of U.S. want federal government to ensure health care for all, poll says . Public Broadcasting Service . Jul 20, 2017.  retrieved from https://www.pbs.org/newshour/health/62-percent-u-s-want-federal-government-ensure-health-care-poll-says

 

American Medical Association (2017) . Research summary: benefits of Medicaid expansion. www.ama-assn.org .retrieved February 6, 2018 from https://www.ama-assn.org/sites/default/files/media-browser/research-summary-benefits-of-medicaid-expansion.pdf

Associated Press (2017) . Missouri House Votes Down Medicaid Expansion . US News . March 29, 2017 . retrieved from https://www.usnews.com/news/best-states/missouri/articles/2017-03-29/missouri-house-votes-down-medicaid-expansion

 

Courtemanche, C.; Marton, J.; Ukert, B., Yelowitz, A.; & Zapata, D. K. (2017) . Early effects of the Affordable Care Act on health care access, risky health behaviors, and self-assessed health . Working Paper 23269 . National Bureau of Economic Research . Cambridge, Massachusetts . March 2017 . available at  Americans say government should ensure health care coverage. Available at http://www.nber.org/papers/w23269

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Dies, T. (n.d.) Up and Go. Shutter Stock Music . retrieved March 29, 2018

Dunn, R. (2015) . Keller chairing new anti-“Obamacare” group . The Missouri Times . January 22, 2015 . retrieved from https://themissouritimes.com/16053/keller-chairing-new-anti-obamacare-group/

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Empower Missouri. (n.dA) . Organization website . retrieved February 5, 2018 from http://empowermissouri.org/

Empower Missouri (n.d.B) . Facebook . retrieved February 6, 2018 from https://www.facebook.com/pg/empowermissouri/posts/?ref=page_internal

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Empower Missouri (n.d C) . YouTube . retrieved from https://www.youtube.com/channel/UCS_b-sR5ejL30ylG47g9fTA

Japsen, B. (2018) . Study Illustrates How Medicaid Expansion Can Pay For Itself. Forbes . March 18, 2018 . retrieved from https://www.forbes.com/sites/brucejapsen/2018/03/18/how-medicaid-expansion-pays-for-itself/#5313f3045fdd

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Kirzinger, A.; DiJulio, B., R.; Wu, B..; & Brodie, M. (2017) . Kaiser Health Tracking Poll – July 2017: What’s next for Republican ACA repeal and replacement plan efforts? . Jul 14, 2017 .KFF.org. retrieved from https://www.kff.org/health-reform/poll-finding/kaiser-health-tracking-poll-july-2017-whats-next-for-republican-aca-repeal-and-replacement-plan-efforts/

 

Mannies, J. (2015) . Missouri Groups With Secret Donors Have Public Impact . St. Louis Public Radio . February 4, 2015 . retrieved from http://news.stlpublicradio.org/post/missouri-groups-secret-donors-have-public-impact#stream/0

 

McBride, T.; Watson, J..; & Blouin, A. (2016) . The Missouri Medicaid Expansion: Good for All Missourians Most Critical Impact in Rural Missouri, Reducing Uninsured by Up to 31 Percent . The Missouri Budget Project . January 2013 . retrieved from http://www.mobudget.org/files/medicaid_expansion_rural_1-2013.pdf

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National Academies of Sciences, Engineering, and Medicine (2017) . Health insurance and insights from health literacy: helping consumers understand: proceedings of a workshop” . Chapter 4: Solutions . Washington D.C. National Academy Press . March 13, 2017.  doi: 10.17226/24664

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McDonald, E. (n.d) . Panoramic Landscapes . Shutterstock music . retrieved March 25, 2018

Sommers, B.; Blendon, R.; Orav,J.; & Epstein, A. (2016) .“Changes in Utilization and Health Among Low-Income Adults After Medicaid Expansion or Expanded Private Insurance.” JAMA Intern Med. August 8, 2016. doi:10.1001/jamainternmed.2016.4419.