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Marketing Campaigns Proposed for States with Federal Exchanges or Partnerships

By Jane Norman, CQ HealthBeat Associate Editor

April 19, 2013 -- The Obama administration is telling states that will have federal marketplaces or state–federal partnerships that they can apply for federal exchange establishment grants to pay for statewide marketing campaigns.

According to a Centers for Medicare and Medicaid Services (CMS) newsletter, a "new funding opportunity" will allow those states to apply to tap the open-ended pot of money available through the exchange establishment grant fund. However, the statewide marketing campaigns must agree to use "federal messages" and language for their efforts, the newsletter said.

A spokeswoman for CMS confirmed that a set of fact sheets "will be posted soon" with details about how states will be able to apply for the marketing money. She said that "technically" the funding opportunity is not new because it builds on guidelines for exchange establishment grants laid out in June 2012.

This new offer from the administration might increase spending in federal and partnership states when it comes to promoting exchange enrollment, which is set to begin Oct. 1.

But it would also require some state Republican leaders who have been less than enthusiastic about the overhaul to ask the federal government for money to boost the law (PL 111-148, PL 111-152) to their state's consumers.

The CMS spokeswoman said she couldn't anticipate how many states might ask for marketing money. And in terms of how much each state might receive, the spokeswoman said that HHS will consider whether a state's proposed budget is "sufficient, reasonable and cost effective."

Anxiety has been rising among lawmakers and others about educating Americans on how to enroll in the new exchanges, with Senate Finance Chairman Max Baucus, D-Mont., this week predicting a "train wreck".

One problem is that the Department of Health and Human Services (HHS) has just $54 million in grant money for the navigator program to spread among 34 states that will have federal exchanges or state-federal partnerships. HHS is including Utah in that group, although Utah has continued to negotiate with the federal government over whether it can continue to run its small business exchange while the feds operate the marketplace for individual customers.

Health policy experts have said there could be significant differences in enrollment outreach between the federally run exchanges and state-run marketplaces. That's because the $54 million in navigator grants for the federal states had to be eked out of congressional appropriations. State-based exchanges, in contrast, can receive much larger grants out of the much larger exchange establishment fund for a new category of government-paid helpers HHS created called "in-person assisters."

Now, HHS apparently is willing to let that exchange establishment money flow to rest of the states for their marketing efforts. So far, $3.6 billion in establishment grants has been awarded to states, according to the Kaiser Family Foundation. States can continue asking for establishment grants through 2014.

The state marketing campaigns will have to be in line with the federal marketing message. One document on a website set up by CMS about marketing explains how states should talk to the public about this new program that isn't going to be available until this fall.
Among the "top messages" are that people may be eligible for a "new kind of tax credit that lowers your monthly premiums right away" and that consumers may "pay less for health insurance right away."

And on language "dos and don'ts," apparently based on research, CMS urges that communications refer to "the health insurance marketplace" rather than "exchange" because "people think 'exchange' is a place to trade or swap merchandise and don't immediately associate it with health care."

Another phrase to "use cautiously," says CMS, is one that says that families earning up to $92,000 a year can get help, which refers to the upper limit for a family to receive a tax credit. "The $92K figure is too high for low-income consumers to relate to as a motivational message," says the document.

Meanwhile, the publication PR Week reported that both CMS and the state of Maryland hired the public relations firm Weber Shandwick to run campaigns promoting the exchanges and "combined, the contracts are worth nearly $14 million."

A spokeswoman for the Maryland exchange, which is state-run, said the Maryland contract with the company is for $5.975 million, and it covers the period from Jan. 13, 2013, until Dec. 31, 2014.

She also said that the Maryland Health Connection—the name of the state's exchange—anticipates that $24.8 million will be available to the state in 2013 to pay for navigators and in-person assisters who will help people enroll in the exchange, with the funds coming from appropriations from state lawmakers and from federal grants.

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