A P.S. on WellPoint

Deconstructing the insurer’s grassroots campaign

Let it be known to friend and foe alike that WellPoint was at the health reform table. The ill-timed rate increases it heaped on policyholders across the land may well have tipped the balance in favor of reform—but the company is hardly a loser in what came out of Congress Sunday. WellPoint’s grassroots were as crucial to that outcome as its grasstops—the corporate frequent flyers who racked up miles going in and out of Washington. Word came on a listserv the other day that Anthem Blue Cross, whose parent is WellPoint, had moved its field forces into action with a CODE BLUE alert. Even though the phone lines of the wavering members of Congress were busy, Anthem urged its grassroots to keep calling. Undoubtedly they did.

There is, of course, nothing unusual about this. Every health care advocacy group and its cousin have been doing that. Deconstructing WellPoint’s grassroots campaign—a slick, soft-sell, inoffensive approach—tells us what, in the end, worked well for the company and its industry brethren. Perhaps it offers a glimpse of what might happen as reform heads toward implementation.

Last April, The Sacramento Bee announced that WellPoint, which has thirty-five million customers nationwide, was about to muster a grassroots army to tap when the fighting got tough. It made three million computer-generated phone calls to test the public’s appetite for reform, and connected with 140,000 people—66,000 of which said they would like to receive information and take part in any company-sponsored town hall meetings. Those folks may have formed the nucleus for the company’s efforts. The Bee got it right when it reported that: “WellPoint could have the most to lose, particularly if the government decides to offer its own health plan because the company’s profits depend heavily on individual health insurance policies.”

A WellPoint vice president told the paper that it wanted to make sure its customers are aware of its positions. “The public is not always well informed,” she said. Indeed they are not, and WellPoint embarked on a campaign to educate them. Each week, the company sent health reform updates to its grassroots network, recapping the important events that took place—Obama’s latest pronouncements, the comings and goings of Congressional committees, Harry Reid’s unveiling of the Senate bill, and so on.

Since June, I have monitored these missives, as WellPoint carefully and methodically informed the Health Action Network and urged them to make their voice heard in Washington. The updates are non-alarmist, non-threatening, and factual. When the storm broke out over the company’s rate increases, WellPoint calmly noted that Congress had announced it would look into the California rate hikes proposed by Anthem Blue Cross, and the letter sent to the company by HHS Secretary Kathleen Sebelius, asking it to justify its increases. A week later, it reported that Anthem agreed to delay the increase until May 1. In early March, WellPoint told the network that insurance CEOs had been “invited” to appear before a House committee. The company didn’t hide the bad news, a tactic which couldn’t help but build credibility with the grassroots.

Yet woven into the updates, however soft and subtle, were the company’s messages. At the top of the Health Action Network home page appeared a message the company wanted its soldiers to send. When it looked like the public plan option might have legs, WellPoint told the messengers that the Health Action Network “supports building a strong, sustainable private-sector health care system and opposes creating a government-run health plan.” When insurers devised a new strategy for opposing reform and attacked the bill’s lack of meaningful cost controls, WellPoint told the grassroots that the bill does not address underlying health care costs,” and asked them to tell Congress to pass one that does. Campaign Desk has repeatedly pointed out that lack of cost containment is a serious shortcoming that could jeopardize reform, just like how runaway medical costs have imperiled reform in Massachusetts.

In November, before the first House vote, WellPoint urged the grassroots to take action because “forcing individuals to purchase coverage through the government reflects a sharp departure from the current system, and we believe Americans should have the choice of not buying coverage through the government exchange if they choose not to do so.”

The legislation allows Americans to buy insurance outside of the state exchanges—and, what’s more, lets companies continue selling their existing policies with skimpy benefit packages. In other words, Congress grandfathered in the low-benefit Tonik policies, a staple of WellPoint’s business model.

A thread running through all the updates is findings from various polls, which had showed all year that roughly half of all Americans dislike reform. The endless poll results no doubt reinforced or perhaps even contributed to other negative opinions among those receiving the updates. Another part of a grand strategy, perhaps?

In December, one update told of a Washington Post-ABC News poll, “indicating 53 % of our fellow Americans understand that their personal costs will increase under this proposal and only 37 % believe that their personal health care will improve.” WellPoint called for the Senate to “set aside this version of health care reform and construct a proposal that has broad and deep public support… Congress needs to hear from individuals.”

When all was said and done, the public option eventually disappeared, and the legislation preserved the private insurance system. WellPoint will continue to expand its market for individual policies, and will cross state lines in order to do so. Only time will tell whether the changes mandated by the bill—for example, restrictions on underwriting for medical conditions, and consumer protections associated with selling policies in states other than those in which a policy is written—will crimp WellPoint’s business style. But if they do, they can always count on a Health Action Network or something like it to make the crucial calls.

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Trudy Lieberman is a longtime contributing editor to the Columbia Journalism Review. She is the lead writer for The Second Opinion, CJR's healthcare desk, which is part of our United States Project on the coverage of politics and policy. She also blogs for Health News Review. Follow her on Twitter @Trudy_Lieberman.