BROOKE GLADSTONE: Earlier this year, we covered the flood of anti-Affordable Care Act ads that aired right before the end of the first phase of enrollment. The administration needed to get millions of young people to sign up for coverage before a March 31st deadline, or else the law just wouldn't work. It was going to be tight. The ads got intense, even cartoonish.
[CLIP FROM AD]:
WOMAN: All right, can you swing on over, scoot on down and try to make yourself comfortable.
BROOKE GLADSTONE: One notorious anti-Obamacare ad featured a creepy “Uncle Sam” giving patients terrifying internal exams.
Spending on negative Obamacare ads eclipsed spending on positive ads by a remarkable 15 to 1. Did they have any impact? Niam Yaraghi, a Governance Studies Fellow at the Brookings Institution, says that, in fact, they did.
NIAM YARAGHI: Anti-Obamacare ads increased the Obamacare enrollment number.
BROOKE GLADSTONE: How is that possible?
NIAM YARAGHI: There are basically two theories. The first one is that the, the negative ads, citizens’ awareness about this subsidized service increases and the more ads they see, the more they know that such a service exists. So they will go and look for more information about the service.
The other theory is that citizens who are exposed to overwhelming number of negative ads about Obamacare are more likely to believe that this service is going to be repealed by the Congress in the near future, so if a citizen thinks that this service, which is subsidized heavily by the government, is going to soon discontinue, he or she will have a higher willingness to go and take advantage of this one-time opportunity before it goes away.
BROOKE GLADSTONE: [LAUGHS] However, there are a tremendous number of variables in why people sign up for the coverage: the cooperation of the state, the nature of the law in that state, the cost of the premiums. All this, combined with the disastrous rollout at the website, would seem to create a lot of confusion and uncertainty as to how you arrived at your conclusion. So tell me how the study worked and why you think the results got past all that noise.
NIAM YARAGHI: What we did was that we took the per capita spending on the negative ads and studied its effect on the enrollment ratio in Obamacare. And to calculate the per capita ad spending, I simply divide the total amount of dollars spent on negative ads to the total residents of that state.
BROOKE GLADSTONE: Then you went ahead and determined how many people out of those eligible for this kind of insurance, either the uninsured or those who have private insurance, actually went and got Obamacare.
NIAM YARAGHI: Exactly. Let’s say that there are 200,000 people out of a total of 1 million residents in that state who were eligible for Obamacare and at the end of the first open enrollment period 50,000 people out of those 200,000 people actually went and got Obamacare, the enrollment ratio in this state would be 50,000 divided by 200,000.
BROOKE GLADSTONE: So how do you answer critics who say, how do you control for income, how do you control for the relative costs of all the premiums that they’re paying?
NIAM YARAGHI: The short answer is that we also measured as many variables as we could. So, for example, we accounted for the proportion of the residents living under the federal poverty line. We considered the effects of the private insurance premiums, in our analysis. We are going to publish the reports fairly soon and your audience would be able to access much more details about the effects of all of these variables that we mention.
BROOKE GLADSTONE: Kentucky and Arkansas and North Carolina have tightly contested Senate elections coming up. There were far, far more ads in those states than, say, in New York where there were hardly any. In those states, do your results hold up?
NIAM YARAGHI: They do, and those states are among the states that actually represent a high number of Obamacare enrollees.
BROOKE GLADSTONE: A-ha!
NIAM YARAGHI: The point is that I think the opponents of the Obamacare did a strategic mistake by overwhelmingly airing negative ads, which led to the popularity of this service and higher enrollment. This is not a unique phenomenon. We have seen similar effects in other contexts. For example, there is a study in the Journal of Marketing Science, published in 2010 by researchers from Wharton School and Stanford, and they show that the negative reviews at New York Times would increase the sales of the books of the unknown authors.
BROOKE GLADSTONE: A bad review is better than no review at all.
NIAM YARAGHI: Correct. The 50 Shades of Grey –
- you know, many of the reviews were negative. However, those negative reviews may have led to its popularity and increased sale.
BROOKE GLADSTONE: Mm-hmm. [AFFIRMATIVE] I guess the heart has its reasons.
NIAM YARAGHI: Yeah. [LAUGHS]
Now I’m thinking about it and somehow comparing Obamacare with Fifty Shades of Grey, so I just – just remove that part. [LAUGHING]
BROOKE GLADSTONE: [LAUGHS] We are so not doing that - unless you insist.
NIAM YARAGHI: [LAUGHING]
BROOKE GLADSTONE: Niam, thank you very much.
NIAM YARAGHI: You’re welcome, glad to be on your show.
BROOKE GLADSTONE: Niam Yaraghi is a Governance Studies Fellow at the Brookings Institution.