- Ad Title: “Faces of Change: A Skeptic’s Story on Health Care Reform”
- Ad Sponsor: Obama for America
- Issues of Focus: Health care reform and the pre-existing conditions provision
- Type of Advertisement: Issue advertisement featuring an uplifting personal appeal
- Release Date: March 2012
- Length: 31 seconds (full version is 3:22)
Script: I criticized the Affordable Care Act, and then I got the news that I had breast cancer. When you’re uninsured there’s no hope. I thought I would just fall right off the face of the earth. One of my dear friends discovered the Pre-Existing Condition Insurance Plan, PCIP. Ten days after applying I had health insurance and I’m in treatment for stage-three breast cancer. The very thing that I criticized is going to save my life.
Analysis of “Faces of Change: A Skeptic’s Story on Health Care Reform”
Elia Powers, University of Maryland
Shortly after his inauguration, President Obama began pushing for health care reform, one of the key components of his domestic agenda. After a bruising battle with congressional Republicans and months of selling his legislation to the general public, Obama signed the sweeping health care reform package into law in March 2010. The Patient Protection and Affordable Care Act, among other things, requires almost all individuals who are not already covered by insurance plans to obtain health insurance or pay a penalty.
Another key provision essentially prevents insurance companies from denying health coverage to individuals with pre-existing conditions. Knowing that people with serious illnesses are costly to cover, health insurance companies had commonly dropped some of the patients from insurance coverage who were in most need of care by cancelling their insurance or never accepting them in the first place. Those who remain covered often pay an exorbitant amount of money on the individual insurance market. The U.S. Department of Health and Human Services released a report in January 2011 showing that anywhere from 50 to 129 million (19 to 50 percent) of Americans under age 65 have some type of preexisting condition, including heart disease, cancer, and high blood pressure. The report showed that up to one in five Americans under the age of 65 with a pre-existing condition – 25 million individuals – is uninsured.
The pre-existing conditions provision of the health care law proved far less controversial than the individual mandate. Health insurance companies though predictably complained that they would be shouldering an undue burden by paying the high price of insuring everyone, especially those with significant health issues, unless the individual mandate was part of the reform package. A November 2011 Kaiser Family Foundation poll found that the requirement which prohibits health plans from denying coverage based on pre-existing conditions had a 67 percent favorability rating (including 47 percent “very” favorable), as compared to the least popular element, the individual mandate, with a 63 percent unfavorability rating (including 43 percent “very” unfavorable).
“Faces of Change: A Skeptic’s Story on Health Care Reform” is one of the Obama campaign’s 2012 presidential advertisements that shines the spotlight on the health care reform law. The video was released amid uncertainty about the law’s future. The ad was released in March of 2012 as the United States Supreme Court heard oral arguments in a much-anticipated case that centers on the health care law’s constitutionality. With his signature piece of domestic legislation under duress and the presidential campaign beginning in earnest, President Obama went on the offensive to explain how the health care law has positively impacted the lives of many Americans and will continue to help many more Americans well into the future. The New York Times reported in late March 2012 that in stump speeches, Obama “stuck to his oft-used campaign lines extolling the benefits of the law, reminding the audience that people with pre-existing conditions could no longer be denied coverage.” The Obama campaign created a new health care app designed to inform voters how the law personally benefits them. The campaign also produced a three-minute video arguing for the necessity of the law and created a web site with personal testimonies of people who have benefitted from health care reform. The “Faces of Change” site includes policy videos that amount to campaign advertisements. There’s a video for every aspect of the law, from extending health insurance for people under 26 to keeping costs down for seniors. The video reviewed in the following analysis focuses solely on the issue of coverage for people with pre-existing conditions.
Coming on the heels of the Supreme Court oral argument and several years of fiery debate about health care reform, the “Faces of Change” advertisement assumes that viewers are generally familiar with the controversy over the law known as “Obamacare.” There is no assumption, however, that viewers have paid close attention to the specific provisions of the law. The Kaiser poll found that more than 18 months after health care reform was enacted, the public still does not know what the law entails. More than 40 percent of those surveyed were unaware of the law’s most popular provision that requires health insurers to release straightforward benefit summaries. More than half think the law includes a new government-run insurance plan, and one-third think the law allows a government panel to make decisions about end-of-life care for people on Medicare.
The “Faces of Change” advertising campaign rightly assumes that many Americans remain skeptical about the health care law. Kaiser found that its respondents were more likely to have an unfavorable view of the law (44 percent) than a favorable one (37 percent). Rather than playing to its political base and preaching to the converted, the Obama campaign’s “A Skeptics Story on Health Care Reform” video targets health care skeptics and those who are undecided – the so-called swing voters who receive so much attention during the general election. The choice to feature Spike Dolomite-Ward in the advertisement illustrates the Obama campaign’s attempt to appeal to middle-of-the-road viewers. In the full-length video she asks aloud, “What’s available for middle-class Americans who are uninsured?” Dolomite-Ward explains in the full video that she was a registered Democrat who “like so many Americans got frustrated with what was happening in Washington” that she re-registered as an Independent. Dolomite-Ward continued: “I stopped listening and missed some very valuable information,” which is shorthand for saying that she – like many Americans – began to tune out the rancorous debate over health care reform and missed key facts about what the law entails. She assumes the role of the Obama campaign mouthpiece and fact checker when she says of her health insurance plan, “I pay premiums just like everyone else. It’s not a government handout.” The latter line counters the common assumption that some people view “Obamacare” as expanded government run amok.
The video assumes that people remain open to changing their mind about the health care law and can be swayed by personal appeals. Scholar Ron Burnett argues that time is a crucial element in the viewing experience and that at no point are viewers’ positions frozen. Maria Elizabeth Grabe and Erik Page make the case that politics is a visual platform and that presidents must actively shape the public-opinion environment while in office. Through the “Faces of Change” advertisements, the Obama campaign is seeking to shape public perception of health care reform at a crucial moment for both the law and his re-election campaign.
Specifically, the Obama campaign is using this series of advertisements to make the claim that Obama’s first term in office has been defined by landmark legislation. Whether or not the law stands, Obama has positioned himself as a politician who is willing to risk political capital to push through a controversial law that he believes will benefit the country in the long term. The Obama campaign is priming viewers—a way, Grabe and Bucy argue, the news media help establish the criteria that viewers use to evaluate political candidates and institutions. This definition can also apply to videos and other forms of media created by the candidates themselves to influence viewers. As Grabe and Bucy argue: “Priming applies to evaluations of candidate character as well as issue positions. Interestingly, priming effects are most likely to occur among people who are highly knowledgeable about political affairs.” While the “Faces of Change” video does not assume that viewers are knowledgeable about the health care law, the advertisement might have the strongest influence over viewers who are familiar with the legislation and the political firestorm surrounding its passage.
Rather than inundate viewers with graphics, statistics or matter-of-fact interviews with health care experts, the creators of “Faces of Change” opted for simplicity. The video sticks to a simple playbook: Focus on a relatable subject with a compelling story to tell. Dolomite-Ward explains in the three-minute version of the advertisement that her family always carried health insurance. But during the recession, she explains, her husband lost his job and the family decided that health insurance was too costly. Dolomite-Ward was without any coverage when she learned that she had breast cancer. A friend told her about the Pre-Existing Condition Insurance Plan, which makes health insurance available to people who have struggled to find health insurance due to a pre-existing condition. Dolomite-Ward said that 10 days after applying for the program, she had coverage once again. At the time of the video’s release, she was undergoing treatment for stage-three breast cancer. As she explains, “It’s been the smoothest experience I’ve ever had with any health insurance company.”
The 30-second advertisement begins with Dolomite-Ward informing us that she criticized the Affordable Care Act. At the start of the video her eyes are closed and the camera is intentionally blurry. Her face becomes progressively blurrier until she is no longer visible. This fade to fogginess signifies that Dolomite-Ward used to be lost in the fog – she wasn’t thinking clearly about the need to reform the health care system and the ways in which the Affordable Care Act might benefit her. She let her disapproval of American politics cloud her better judgment about the merits of the health care law.
The “Faces of Change” video plays the emotional card. Grabe and Bucy write that much of social behavior involves recognition of and responses to emotional cues. We pay attention to facial expressions and sense how we should respond. Hariman and Lucaites explain the importance of emotional images in evoking strong opinions and social relationships with the viewer. Close-ups in particular convey strong emotional cues – they can prompt us to question a subject’s honesty and invite us to get inside their heads.
The creators of the “Faces of Change” advertisement give us several opportunities to get inside Dolomite-Ward’s mind. At the outset of the video, we see a close-up of her sleeping (or at least with her eyes closed). Ominous music plays during this sequence, which indicates we are about to learn of Dolomite-Ward’s nightmarish scenario. The next frame shows someone writing “Stage 3 breast cancer” on a medical form. Dolomite-Ward is next seen wearing a bandana on her head, a visual cue that she is recovering from cancer treatments. She then says: “I thought I would just fall off the face of the earth” as the video shows two children holding hands. Dolomite-Ward shares her deepest fears that she won’t be alive to care for her children.
Not quite halfway through the video the music changes from foreboding to uplifting. We see someone searching on the computer for information about the Pre-Existing Condition Insurance Plan. This is yet another example of the advertisement using very concrete visuals – from showing a screenshot of the PCIP plan to someone writing “Stage 3 Cancer” on a piece of paper. The video combines linear storytelling with straightforward visuals in an effort to keep the viewer focused on the specific message at hand about the necessity of the pre-existing conditions provision. With a tremendous amount of noise surrounding the health care debate, the editorial decision to keep the message simple reinforces the Obama campaign’s theme that the reform of health care is likewise simple, easy to comprehend, and even easier to enforce.
The advertisement ends with more concrete visuals: Dolomite-Ward with a full head of hair lauding PCIP. She receives an injection as part of her cancer treatment. She is shown sleeping once again, but this time she looks peaceful and not blurry – an indication that she is now thinking clearly and is comfortable with her position on the health care law. The final visual is of Dolomite-Ward smiling, hands on her chin, looking slightly off camera. The slogan, “Change is Your Health Care in Your Hands,” appears on the screen. In keeping with the themes of simplicity and literal interpretation, the visual of Dolomite-Ward’s head resting comfortably in her hands matches the message that with the health care reform law, individuals can take health matters into their own hands because they have access to insurance that doesn’t disappear due to a pre-existing condition. The full-length video ends on an equally optimistic note: Dolomite-Ward says because she has health insurance she will be able to keep her house and afford to send her children to college.
Who is Talking About the Ad and the Issue
While the issue of health care reform has received a tremendous amount of national attention, the pre-existing conditions provision is not typically at the center of debates, nor is it the focus of news articles. In fact, it is often mentioned as an afterthought, as is the case in a Washington Post article about a poll showing that voters believe Obama as doing a better job on health care than Mitt Romney. The article mentions in passing that “voters might support a candidate who tries to eliminate lifetime caps and denying coverage for preexisting conditions, along with closing the donut hole for Medicare and allowing young adults to stay on their parents’ insurance, even if they don’t like Obamacare.” An article from ABC News focuses on the controversy surrounding Romney’s comments on The Tonight Show that “You’ve got to get insurance when you are well and then if you get ill, you are going to be covered.” The Obama campaign lambasted Romney for being out of touch with the majority of Americans. A campaign spokeswoman responded that “Only in Mitt Romney’s world of tax cuts for billionaires and elevators for his cars would denying health care coverage to Americans with pre-existing conditions make sense. But to most Americans, ensuring insurance companies don’t discriminate against people with pre-existing conditions means the difference between solvency and bankruptcy and life and death.”
No articles were found that specifically mentioned the “Skeptic’s Story on Health Care Reform” video, but several articles mentioned the “Faces of Change” campaign, including a Washington Post article that claims that Obama misrepresented his mother’s dispute with her health care provider when she was hospitalized with terminal cancer.
The “Skeptic’s Story on Health Care Reform” video posted to YouTube had received just over 40,000 page views as of April 2012. The comments are overwhelmingly complimentary of Obama, as one might expect given who is visiting the president’s YouTube page. Several commenters note that the health care law, if passed earlier, could have saved a loved one’s life. Others note that it’s about time for a change to the status quo and that America is just now beginning to catch up with other countries on health care reform.
 United States Department of Health and Human Services, “New Report: 129 Million Americans with a Pre-Existing Condition Could be Denied Coverage Without New Health Reform Law.” Accessed on April 13, 2012 from http://www.hhs.gov/news/press/2011pres/01/20110118a.html.
 Kaiser Family Foundation, “Kaiser Health Tracking Poll – November 2011.” Accessed on April 10, 2012 from http://www.kff.org/kaiserpolls/8259.cfm.
 Helene Cooper, “Health Overhaul is Backdrop as Obama Returns to Stump.” The New York Times. March 31, 2012. Accessed on April 10 from http://www.nytimes.com/2012/03/31/us/politics/on-the-campaign-trail-obama-is-mute-on-supreme-court-hearings.html.
 Byron Tau, “Obama Campaign Launches Health Care Web App.” Politico. March 21, 2012. Accessed April 5, 2012 at http://www.politico.com/politico44/2012/03/obama-campaign-launches-health-care-web-app-118214.html.
 Byron Tau, “Obama Campaign Releases Health Care Video, Website.” Politico. March 22, 2012. Accessed April 5 at http://www.politico.com/politico44/2012/03/obama-campaign-releases-health-care-video-118318.html.
 Obama for America. “Faces of Change.” Accessed April 2, 2012 at http://www.barackobama.com/health-care/stories.
 Kaiser Family Foundation.
 Kaiser Family Foundation.
 Ron Burnett, Cultures of Vision: Images, Media, and the Imaginary (Bloomington: Indiana University Press, 1995), p. 6.
 Maria E. Grabe and Erik P. Bucy, Image Bite Politics: News and the Visual Framing of Elections (New York: Oxford University Press, 2009), p. 4.
 Grabe and Bucy, Image Bite Politics, p. 88.
 Obama for America. “Faces of Change: A Skeptic’s Story on Health Care Reform.” Accessed March 30, 2012 from http://www.youtube.com/watch?v=BlVz5rmsqTA.
 Grabe and Bucy, Image Bite Politics, p. 19.
 Robert Hariman and John L. Lucaites, No Caption Needed: Iconic Photographs, Public Culture, and Liberal Democracy (Chicago, IL: University of Chicago Press, 2007).
 Jonathan Bernstein, “Repeal or No Repeal, Health Care Still pLays Well for Obama,” Washington Post, April 10, 2012. Accessed April 13, 2012 from http://www.washingtonpost.com/blogs/plum-line/post/repeal-or-no-repeal-health-care-still-plays-well-for-obama/2012/04/10/gIQADvip8S_blog.html.
 Devin Dwyer, “Obama Campaign: Romney ‘Out of Touch” on Pre-existing Conditions,” ABC News, March 28, 2012. Accessed April 12, 2012 from http://abcnews.go.com/blogs/politics/2012/03/obama-campaign-romney-out-of-touch-on-pre-existing-conditions/.
 Glenn Kessler, “The Road We’ve Traveled: A Misleading Account of Obama’s Mother and Her Insurance Dispute,” Washington Post, March 18, 2012. Accessed April 13, 2012 from http://www.washingtonpost.com/blogs/fact-checker/post/the-road-weve-traveled-a-misleading-account-of-obamas-mother-and-her-insurance-dispute/2012/03/18/gIQAdDd4KS_blog.html?tid=pm_pop.
 Obama for America, “Faces of Change: A Skeptic’s Story on Health Care Reform.”