Martin Hickey had just found out he had a really bad month.

A board member of New Mexico’s health exchange, Hickey was at his desk, combing through December’s new enrollee numbers. Initially hopeful that enrollee targets would be met, Hickey instead found himself staring at a sheet of bad news: only 17 percent of 18 to 34 year olds had signed up in New Mexico in December, about 5 percent lower than compared to other nearby states.

“They’re slow to sign-up here in New Mexico,” Hickey said. “I was not particularly happy with that.”

Particularly worrying for Hickey was that New Mexico had just awarded a contract worth more than $6 million to BVK, a Wisconsin-based PR firm, for a campaign targeting young adults.

“BVK started off sleeping,” Hickey said. “They missed the December enrollment period. The campaign didn’t grab you. They were just too measured.”

Hickey found that unacceptable, because like many of his colleagues across the country, he knows that a key factor for the success of his state’s exchange is dependent on signing up young adults. And with millennial support for the affordable care quickly evaporating, according to a recent Harvard study, Hickey and his peers have a tough job in front of them.

Millennial Marketing Key to Shoring Up Exchanges

Getting younger, healthy adults into the various exchanges has long been considered crucial to the success of the Affordable Care Act. It’s a big reason why the Individual Mandate was inserted into the law, as healthy participants in the exchange should help dilute the overall risk for insurers, and hopefully keep premiums lower for everybody.

“They are a very important demographic in California because they represent a quarter of the state,” said Covered California Information Officer Larry Hicks. “They balance the insurance pool and that keeps prices low.”

But the challenge, Hicks added, is that these adults “feel they are invincible and may not yet be financially stable.”

To help reach a demographic that may not even want health insurance, let alone be able to reliably pay for it, Covered California has taken the lead on a national marketing campaign focused on where this demo lives: online. Called Tell a Friend, the campaign is utilizing social media, six hour telethon style videos on YouTube, celebrity endorsements and parody videos to reach millennials.

“So far, in the first two months, 22 percent of our new enrollees have been between the ages of 18 and 34,” Hicks said. “And that trend is going up in our December numbers.”

The website also links to other states’ exchanges, or the federal exchange for states that opted out of offering an insurance marketplace.

One of the main messages of the Tell a Friend campaign is that young adults are still susceptible to illnesses, accidents and diseases.

“We’re trying to pierce that veil of invincibility and tell them this is important to them,” Hicks said.

Yet, despite the national reach and high visibility of the campaign, it’s unclear how successful the campaign is in prompting young adults to sign-up for care. While more than 900,000 people have viewed a video spoof of Snoop Dogg’s song Drop It Like It’s Hot that promotes the new exchange, only about half that number in total have actually signed up for coverage in California.

“We think the message is getting through,” Hicks said. “The enrollment ends March 31st, and we are finding success in this campaign.”

Ease the Sense of Risk

Social media and high-profile spokespeople may help reach the target audience, but Warren Schirtzinger thinks the message can be better tailored to motivate millennials.

Schirtzinger is the managing director of High-Tech Strategies, a Seattle-based firm specializing in emerging technologies. He said that while millennials may be perceived as being “plugged-in but tuned-out” to the health-care message, they have similar concerns to their older counterparts.

“They’re going to wonder if this is going to work,” Schirtzinger said. “There’s a definite sense of risk. ‘Did I get the right doctor, did I pick the right plan, is this program going to be around?’ A celebrity or catchy hashtag doesn’t ease a risk averse point of view.”

“I just don’t think you can make health care sexy,” Schirtzinger added.

The good news for government is that it is in a unique position to alleviate concerns about risk.

“There are certain things that governments and big organizations can do that others can’t,” he said. “If the state can somehow guarantee the exchange or the plan. … If they can back the campaign with the trust worthiness of the state, that can help lower the perceived risk for everything.”

That message of trust might seem like a tough sell after the disastrous rollout of the federal health exchange website, but Schirtzinger said millennials are more likely to forgive that tech-train wreck.

“Millennials are used to technology; they grew up with it,” he said. “They know there’s no such thing as a flawless rollout.”

And while several recent polls show millennials have a strong distrust of power, politicians and their parties, they overwhelmingly see government as a potential instrument for positive change. Schirtzinger believes the opportunity is there to get millennials motivated to join the program.

“You always see a sequence of people to buy-in to any type of program or big idea [and then the rest follow],” he said. “It’s a spectrum of acceptance. Millennials are no different.”

Staying on the Horse

Nationwide, there’s a lag in young adult enrollees. While they make up about 40 percent of the eligible population, according to the Centers for Medicare and Medicaid Services (CMS), only about 25 percent have enrolled.

“We expect that percentage to increase,” CMS’ Gary Cohen said on a recent call with reporters. “Many of them … want to shop around, they haven’t been insured before.”

The Obama administration has also reported a surge in new young adult enrollees nationwide as the website has improved and word of mouth has spread about discounts and subsidies offered to young people.

According to the U.S. Department of Health and Human Services, less than 50,000 had enrolled in November, while more than 250,000 had enrolled by the end of December.

In New Mexico, Hickey is hopeful the next three months will be better than the last two.

After the slow marketing start, Hickey said the company, BVK, has come back with a revamped campaign that includes TV, radio and billboard spots. The campaign, Hickey said, will focus in part on that risk aversion and explain why new enrollees will be able to trust the exchange.

“Things take time and move slowly,” Hickey said. “We have to figure out how to sell this idea that single, healthy, young people should get covered. We have to explain that this is peace of mind, that the tradeoffs of cost are worth it.”

Whatever changes or tweaks states make to their health exchange marketing plans, the good news is there will only be more public awareness as the March 31 enrollment deadline approaches.

Hickey believes that approaching deadline will help motivate many millennials to get covered.

“If it’s not central to their social life, they procrastinate,” Hickey said.

John Sepulvado  |  Contributing Writer

John Sepulvado is from Southern California. He enjoys writing, reading and wants to take up fishing.