This article is an excerpt prepared for Apolitical from ‘Persuasive: 40 Lessons in Communicating for the Common Good’, written by Marrianne McMullen.
_In Persuasive: 40 Lessons in Communicating for the Common Good, Marrianne McMullen draws useful lessons from her career in government, nonprofits and journalism, closing each of the 40 chapters with a lesson. In this excerpt prepared for Apolitical, she describes The Persuasion Matrix, a unique tool introduced in the book and used to increase enrollment in healthcare. _
The Affordable Care Act (ACA) didn’t transform the US health-care system. But the 2010 passage of what was later dubbed Obamacare did provide a path to health insurance for millions of people—a path that was dependent on a massive communication campaign to persuade people to enroll.
I was a presidential appointee at the Administration for Children and Families (ACF), the human-services arm of the U.S. Dept. of Health and Human Services. ACF’s communication campaign about the ACA began with extensive census data about who was uninsured in the United States. We knew what geographic areas the uninsured were concentrated in and what type of work they were more likely to do. And we knew that a large portion of the uninsured were already enrolled in at least one federal benefit program. ACF served millions of Americans through dozens of programs: childcare, child support, foster care, Temporary Assistance for Needy Families, Head Start—more than 70 distinct programs in all. I worked with each major program office to develop a strategy to reach the people they served with news about available health insurance and how to enroll. We knew that signing up for health care was difficult; the complexity of coverage options was overwhelming if not incomprehensible. The uninsured needed to work with health-care navigators who could help them through the application process. Connecting our beneficiaries to navigators was a primary goal of our outreach.
Time spent on the nuances of building a strategy can yield unlikely tactics and partners, which in turn can yield real results.
With the leadership of each program office, we filled out the Persuasion Matrix. The “desired action” for each office was to get program participants to enroll in health care. Some were straightforward. The Office of Child Care managed federal childcare subsidies nationwide for low-income families. When we identified that it was the state childcare offices that administered this program, we developed materials and resources for them to use to connect those receiving childcare benefits with health-care navigators to help them get health insurance. We did the same with the Office of Head Start, supplying the program’s social workers with appropriate outreach materials.
This strategy work got even more complex with the Office of Community Services (OCS). One of the programs OCS administered was the Low-Income Heating and Energy Assistance Program (LIHEAP). When we did the matrix for this group of benefit recipients, we had a major breakthrough at the “messengers and channels” step. We realized that the one messenger, the one channel that reaches all the people who were uninsured—indeed that reached into every home in America—was utility companies. This insight was a strategic breakthrough that would drive our outreach strategy into the second term of the Obama administration.
When we decided to focus on utility companies, we went back to the Persuasion Matrix, inserting a new desired action in the top square: getting utilities to help their customers enroll in health care. The message: The number one cause of personal bankruptcy is unexpected medical expenses. Bankrupt people can’t pay their utility bills, so help us help them avoid unpayable health costs by getting health insurance.
Then we did a matrix for each company, figuring out how to reach them, those in the company we should approach, which messages would be most persuasive. Because of the high level of uninsured in Texas, Florida, and the Mississippi Delta, we started in the South. We reached out to Atmos Energy in Texas, Entergy in Louisiana, and Florida Power & Light. Entergy already had a robust outreach program to its low-income customers and was all in. For years they had helped their customers sign up for food stamps and other benefits, all with the goal of putting them in a better position to pay their utility bills. They happily incorporated our materials into their mailings and allowed ACA navigators to set up tables at their energy fairs.
Atmos in Texas and Florida Power & Light, though, gave “Obamacare” the cold shoulder and gave us a brusque “no thank you.” We turned our attention north, where there were large pockets of uninsured in more politically friendly environments. We thought we might do even better with a publicly owned utility, so we reached out to Philadelphia Gas Works. They were instantly responsive. I was soon on an Amtrak train from DC heading to a meeting with their senior management. They not only set up places for navigators to work in all of their offices in low-income areas but also publicized the effort, which led to news coverage of this utility-focused initiative for the first time.
As we continued to reach out to utility companies, we got better at refining messages that would land with their senior officials. Maps were particularly helpful. With regional census offices as our partners, we were able to produce maps of where the uninsured were, by census tract. Utility companies, we learned, were particularly cagey about talking about turning off power to those who hadn’t paid their bills. No law required them to disclose how frequently they did this and to whom. But they knew in great detail where the bills weren’t paid. And they knew how bad they would look if the public saw exactly whose plugs they were pulling.
That’s why the maps resonated. In February 2016 we met with six executives from Detroit Power and Light (DP&L) at their headquarters. Two women from the Detroit Health Department and a representative of Enroll America in Michigan joined me and Angela Green, the ACF regional administrator based in Chicago. We handed out a map showing where the uninsured people were in Detroit specifically, and the health department officials emphasized that these were the same areas that had the highest incidence of asthma, heart disease, and infant mortality.
As they took in the map, we saw the DP&L officials look at each other. “This looks familiar,” DP&L vice president Nancy Moody said. We knew they were also looking at a map of where their most frequent shutoffs were.
DP&L agreed to work with us on targeted outreach to the mapped areas in Detroit. They did not want our partnership broadcast, particularly to the rest of Michigan, which was considerably more conservative than Detroit. Most important, new relationships were established between state health department officials and a utility company with more than 2 million customers.
“If you build it, they will come,” was a compelling line from the movie A Field of Dreams. If only it were so. Here’s the real-world math: if you build it, figure out who is most likely to come, determine the best messages to get them to come, find out who the most persuasive messengers will be to deliver that message, and deliver the message multiple times— then about 25 percent of them will come.
Not so pithy, and not so easy. But time spent on the nuances of building a strategy can yield unlikely tactics and partners, which in turn can yield real results. After all, by the end of the Obama administration, 20 million additional people got health insurance. We built it, and with an incredible amount of effort to get them there, they came.
Lesson learned
Using the Persuasion Matrix can help you think about each audience in a thorough and strategic way, opening the way for innovative strategies.
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