As the Obama administration's health overhaul sputters in its opening weeks, insurers and advocacy groups are pursuing a new strategy in the quest to get millions of young people to sign up for health insurance: They're appealing to their mothers.
In one cheeky campaign, AARP is urging mothers to send e-cards to their children reminding them to sign up. One e-card reads, "As a reward for signing up for health insurance, I'll defriend you on Facebook." Another group, Organizing for Action, is seeking to steer holiday conversations toward health care by encouraging parents to have "the talk" with their adult children. And a Colorado group is promoting an ad featuring a hapless young man who calls his mother from the golf course: "Yo, Mom, do I got insurance?"
Recruiting enough young people is a major goal of the Obama administration because insurers need healthy customers to offset the cost of caring for those with expensive medical needs.
The goal carries even more urgency now that insurers are considering a proposal by President Obama to let people, many of them healthy, stay on their existing policies for another year. If fewer of those people buy insurance in the new marketplaces, signing up young people without insurance will be even more crucial. Young people also account for a major chunk of the uninsured. About 40 percent of the estimated 41 million uninsured people nationwide who are eligible for coverage are between the ages of 18 and 35, according to the administration.
Even as supporters are enlisting mothers in the effort to sign up their adult children, critics have mounted an equally aggressive and well-funded campaign urging young people to "opt out" of coverage. Opponents use many of the same marketing tools as the law's supporters, reaching out to young people on social media and through web videos.
Advocacy groups and insurers are expected to make a major marketing push beginning in early December, when the Obama administration has said it expects the malfunctioning federal health care website to be working better. They have their targets set on two major deadlines: Dec. 23, when insurance must be purchased for coverage beginning on Jan. 1, and March 31, when the open enrollment period will end.
Beneath the marketing campaigns' playful language is a deeper truth: When it comes to making major life decisions, many people — especially young adults — still turn to their mothers for help. More broadly, women make about 80 percent of the health care decisions for their families, according to the federal Labor Department.
"It's the cutest phenomenon ever," said Lynn Quincy, a senior health policy analyst at Consumers Union, who stumbled on the significance of mothers while conducting a focus group of men and women last year about how well people understood the language in their insurance policies. When asked who they turned to for advice about health care, the overwhelming answer was their mothers. "These people could have husbands, they could have fathers, they may have a nurse who lives next door, but they're all going to their moms," she said.
Of course, the administration and advocacy groups are also reaching out directly to young people themselves, collaborating with outlets like the comedy website Funny or Die, initiating social media campaigns, handing out fliers at concerts and sponsoring a video contest aimed at getting young people to sign up.
"People need to have heard about it a couple of times, and frankly from a couple of different sources," said Jon Carson, the executive director of Organizing for Action, the nonprofit group that grew out of President Obama's 2012 campaign organization. He said mothers represented just one avenue that they hoped would help persuade a young person to enroll. The recently posted video is part of a campaign, called Healthcare for the Holidays, that seeks to arm parents with talking points when they see their children at family get-togethers.
This approach may resonate especially well with the so-called millennial generation, which came of age in a recession and may still financially depend on their parents, say some experts.
"Millennials love their parents and they count on them for advice," said Morley Winograd, the co-author of three books on the millennial generation. He noted that this might sound surprising to baby boomers, who famously rebelled against their parents' generation. But millennials "assume that their parents have more worldly experience, and know about things like money and health insurance," he said.
Mary Babich, the mother of two children in their 20s without insurance, said she had been pestering both of them to sign up. "They look at it as just government bureaucracy — as almost akin to filling out their taxes," said Ms. Babich, who lives in Wisconsin. She paused, and added, "The sad thing is, I've always done both of their taxes."
The mother-knows-best strategy isn't entirely new. In 2007, when Massachusetts introduced its health care law, officials mailed greeting cards, timed for Mother's Day, to the parents of young men between the ages of 18 and 26. Market research had shown this group was among the most resistant to buying insurance. "The idea was to trigger a phone call from the parent to the child to say, 'Hey, by the way, do you have insurance?' " said Kevin J. Counihan, who served as chief marketing officer for Massachusetts's health insurance marketplace at the time. "We made the hypothesis that we could best reach the young men through their mothers."
The effort, Mr. Counihan said, was a moderate success: Many parents decided to pick up the bill for their sons' health insurance. And more often than not, "we found they bought the most expensive plan because apparently nothing was too good for Johnny." Mr. Counihan is now chief executive of Connecticut's state marketplace and said he was still targeting the mothers of young men by focusing on churches and community groups where they are likely to be members.
Insurers are also taking note of this influence. Shaun Greene, the chief operating officer at Arches Health Plan, a health care co-op in Utah, said he was surprised during a recent televised call-in when he fielded several calls from parents who quickly handed the phone to their children. "At least three of them had their kid by the ear," he said, explaining: "My son or daughter needs insurance. Talk to them."
A certain level of concern is just part of being a parent, said Nicole Duritz, who helped develop the AARP campaign. "I'm a mom and I'm constantly worried about my kids, and making sure they're making good decisions," she said. "And health insurance falls into that category."
That's certainly true for Lynne Jackier, of Ithaca, N.Y., who has been helping her 24-year-old daughter look into buying health insurance on the state marketplace. She also has a 26-year-old son who recently moved to California and is also uninsured.
"I feel like, as parents, it's our responsibility to get them to look at this now," Ms. Jackier said.
Her daughter, Rosie Simon, works as a nanny in Westchester County and said she had been uninsured since graduating from college a few years ago. Although Ms. Simon said that she had heard about the changes coming under the health care law, she added that her mother had been persistent in making sure she signed up. Last weekend, during a visit home, the two sat down at the computer and took the initial steps of completing an application on New York's marketplace.
Without insurance, Ms. Simon said she often delayed going to the doctor when sick, or leaned on her parents for help. Ms. Jackier, who is on Medicaid and so can't cover her daughter through private insurance, said she had become accustomed to the frustrating conversations. "She'll get sick and I'll say, 'You have go to the doctor,' " Ms. Jackier said. "And she'll say, 'Well, I don't have insurance.' "
The family had a scare when Ms. Simon recently developed a serious kidney infection. Her parents paid the bill, which cost a few hundred dollars. It wasn't ideal, Ms. Simon said, but "I'm still their baby."
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