In 2014 the Pennsylvania Department of Public Welfare tasked WINS with helping them create and launch a new campaign to enroll uninsured Pennsylvanians under the state’s unique approach Medicaid expansion. Specifically, WINS was asked to better understand the mindset of working poor PA residents when it comes to healthcare coverage (including barriers and motivators), assess the impact of some different ideas for Healthy PA campaigns, and provide guidance and recommendations for campaign optimization and launch.

The target for this work was specific – PA residents who earned too much to qualify for Medicaid, but not enough to afford insurance on the exchanges (or via their employer). In order to find these participants, WINS employed a variety of innovative recruitment methods, including visiting community food banks and health centers in rural areas of the state, and utilizing social media and CraigsList postings to locate potential participants. We conducted 6 focus groups in various parts of Pennsylvania, capturing sentiment from rural, urban, and suburban communities.

Our research found that these individuals view health-care related promises with a high degree of skepticism. They’d been promised affordable healthcare when the ACA was passed – and were disappointed and frustrated when it hadn’t materialized. We found that use of the term “affordable” without specific context was a lightning rod – since many had received unsubsidized quotes from the ACA exchange that were far too expensive to be realistic.

In the groups, we listened to stories of the hardship involved with being uninsured, sacrificing personal wellbeing in order to afford basic essentials like food, water, or electricity. And we were able to understand, at a deeply personal level, the challenges faced by these individuals in their everyday lives.

Ultimately, the research underscored the importance of running an enrollment campaign that bridged the “affordability gap” by making direct cost comparisons to staples that these individuals purchase in their day-to-day live (e.g. groceries). Further, by comparing the cost of subsidized health insurance to everyday grocery items, the DPW could leverage an experience common among this population, to inspire hope and interest in enrollment.

The Healthy PA campaign launched in 2014, and initial enrollment data was extraordinarily positive. While the State Department of Public Welfare had targeted a 10% eligible enrollment in the months after launch, the campaign resulted in more than 100,000 individuals enrolling in the program – almost 20% of the eligible population and fully twice the expected number.