If there were fairness in this world, Rita Rizzo would be a media star.
Rizzo, 60, owns a management consulting firm for nonprofit groups and government offices in Akron, Ohio, with her husband, Lou Vincent, 64. Vincent, who suffers from Type 2 diabetes and high blood pressure, has gone without health insurance for 10 years. "We got 30 denial letters," Rizzo told me last week.
Three years ago, Rizzo got a hip replacement. Her own insurance premiums were going to rise by $500 a month, to about $800, so she chose instead to triple her deductible to $6,000 to keep the increase to a mere $150 a month.
The couple used a $5,000 tax-deductible health savings account to cover her out-of-pocket expenses; Vincent's medication, which ran to $178 a month; and his blood work-ups, at $2,400 a year.
In December, Rizzo signed up for Obamacare. She now has a policy that covers her and Vincent together, including all his meds and lab work, for $379 a month, with a $2,000 family deductible.
"I feel like I died and went to insurance heaven," she says.
But you haven't heard Rizzo's story unless you tuned in to NBC Nightly News on New Year's Day or scanned a piece by Politico about a week later. In the meantime, the airwaves and news columns have been filled to overflowing with horrific tales from consumers blaming Obamacare for huge premium increases, lost access to doctors and technical frustrations — many of these concerns false or the product of misunderstanding or unfamiliarity with the law.
While Rizzo was working her way to thousands of dollars in annual savings, for example, Southern California Realtor Deborah Cavallaro was making the rounds of NBC, MSNBC, CNBC, CBS, Fox and public radio's Marketplace program, talking about how her premium was about to rise some 65% because of the "Unaffordable" Care Act. What her viewers and listeners didn't learn was that she hadn't checked the rates on California's insurance exchange, where (as we determined for her) she would have found a replacement policy for less than she'd been paying.
With the March 31 deadline for 2014 enrollment in individual health insurance just days away, more questions are being asked about the mismatch in publicity about the Affordable Care Act by its opponents and supporters.
The millions of beneficiaries of the measure — families excluded from insurance because of high premiums or preexisting medical conditions, low-income individuals made newly eligible for Medicaid, seniors receiving a new subsidy for prescriptions, women granted the legal right to affordable maternity coverage for the first time — seem to be absent from the news media or political ad campaigns. But you can't turn on your TV without seeing a well-produced 30- or 60-second spot featuring a purported tale of woe.
"Why aren't Democrats taking this simple approach to defending Obamacare?" asked Slate.com in a recent headline.
It's a good question, but the answer is that the approach isn't all that simple.
"This is a difficult environment to sell this product," says Robert J. Blendon, an expert on policy marketing at the Harvard School of Public Health. "There's lots of anti-government feeling; the IRS is at the lowest point in its public standing, and people are asking if it's going to be checking up on them. People are very cynical."
Indeed, Rizzo says that when she tries to tell her story online, including through items on the Huffington Post, "I hear in response, 'You're a media plant' or 'You're an Obama plant' or 'You're not a real person.' I've heard some really crazy stuff."
The botched rollout of HealthCare.gov last fall made the marketing task even harder in two ways. First, it played into the opponents' "master narrative that government can't do anything right, that it's too intrusive in our lives," in the words of Andy Goodman, co-founder of the Goodman Center, a Los Angeles organization that advises nonprofits on how to get their messages out.
Second, it prompted the Affordable Care Act's supporters, including insurance companies, to defer their own pro-Obamacare advertising campaigns until the website could be fixed. The rationale, reasonable enough, was that there was no point in encouraging people to sign up for insurance as long as the enrollment portal was sealed shut.
But the delay in getting the website operating was a gift to opponents, whose anti-ACA ads ran unchallenged for weeks. "The opponents were able to get out the doubt early," Blendon says, "and once people form opinions, they're very hard to change."
Other factors make telling a positive story harder than a negative one. Of course, there's the news media's constitutional preference for stories of pain, suffering and conflict over sweetness, light and good cheer.
Also, when a program is aimed at changing the status quo, it's always easier to undermine the effort by identifying its problems rather than to promote it by playing up its goals.
"If you want to show something is flawed," Goodman says, "you just have to point out one flaw." Against that argument, supporters of the Affordable Care Act would have to make the case that it's perfect — and nothing ever is perfect.
The expert at batting down efforts to undermine big programs by picking at individual flaws was President Franklin D. Roosevelt, a master at putting things in perspective.
Addressing attacks on his work relief programs in April 1935, he told radio listeners: "When an enterprise of this character is extended over more than 3,000 counties throughout the nation, there may be occasional instances of inefficiency, bad management or misuse of funds. When cases of this kind occur, there will be those, of course, who will try to tell you that the exceptional failure is characteristic of the entire endeavor. It should be remembered that in every big job there are some imperfections."
Congressional Democrats, the White House and consumer advocates haven't been as adept at making that case for the ACA as Roosevelt was for the WPA.
That doesn't mean that Obamacare success stories aren't being published. In January, for instance, the Miami Herald reported the experience of Steven Greenwald, 60, who said the act's provisions cut his family's annual health insurance cost to $8,000 from the $32,000 he was being quoted by Florida insurers.
"The numbers are totally in my favor," he said. Greenwald had emailed his particulars to his Democratic state legislator, Lori Berman, who presented him to the local press in a conference call that included a White House advisor.
"We get stories placed all the time," says Ron Pollack, executive director of FamiliesUSA, a consumer advocacy group that has maintained a story bank of cases of shortcomings of the American health insurance system for two decades, and cases of ACA successes since the law's implementation began. As a nonprofit, however, FamiliesUSA doesn't provide leads to political campaigns, only news agencies.
Communications experts suggest that the proper marketing approach for ACA supporters would be to pick a few representative cases and promote them constantly to the public. Four or six individuals or families representing the full range of Obamacare's target market — a twentysomething without job-based insurance, a middle-aged couple and an older applicant with preexisting conditions.
"They need some 'poster child' cases with people who suffered major obstacles getting coverage and now are signed up," Goodman says. "So people say, 'There but for the grace of coverage, go I.'"
The current pro-ACA pitch from Washington, which involves playing up the surge in enrollment as the March 31 deadline approaches, won't take. Goodman notes: "Saying that millions have signed up here or there — those are big numbers, but people are never moved by big numbers."
The question is whether it's too late to change the prevailing narrative on the ACA. Only time can answer that question. One thing is clear, however: The pitiless political calendar remains a formidable obstacle.
"If there were no election over three or four years, 25 million sign-ups would change the mood," Blendon says. "But we have a consumer referendum in 2014, and it's not clear how it will play out."
One major shortcoming of the ACA's marketing that casts a long shadow is that many Americans still don't know what's in the program and how it will affect them.
Says Timothy Reyburn, 51, a business owner in Laurel, Md., who is saving $7,000 a year with his new platinum-level ACA plan, including coverage for his wife, who suffers from muscular dystrophy: "A lot of the folks who are vitriolic against the Affordable Care Act just don't understand it. But for us, the coverage is better, and we don't have to worry about being dropped — I had no hesitation about signing up."