Getting People to Make The Right Choice Under the ACA: The Most Important 'Sales Pitch' of Obama's Presidency

52 Pages Posted: 26 Aug 2014

Date Written: August 24, 2014


One of the most important goals of the Patient Protection and Affordable Care Act (ACA) is to increase insurance coverage through the creation of private individual insurance markets in which consumers are guaranteed access to affordable health insurance. The success of these new markets depends on the robust enrollment and retention of relatively healthy consumers to help spread financial risk and keep insurance premiums affordable. Enrollment, in turn, depends on the government’s ability to generate consumer interest, to ensure that consumers have the information they need to make informed shopping decisions, and to convince them to buy now. Despite rhetoric about consumers being forced to buy insurance, the reality – as made clear by a majority of the Supreme Court and by this year’s enrollment numbers – is that consumers really do have a choice about whether to purchase insurance or not. It is up to the federal government and participating states to convince consumers to make the right choice.

This article considers this enrollment goal as a challenge in effective selling. This article draws on a modern theory of effective sales, which establishes a framework for understanding why certain techniques yield greater sales success and describes the skills and characteristics a successful seller should have. Using this theory, the article critiques the design of the new virtual health insurance markets (the exchanges), as well as the governments’ initial outreach efforts. Admittedly, government officials face significant barriers in generating enrollment, especially among healthier populations; these include consumers’ low health literacy, the complexity of the insurance product, the challenge of making latent needs active, and the fear and skepticism of certain groups based on prior bad experiences. But such barriers can be overcome by adopting modern sales techniques that emphasize relationship building, consumer education, and the incorporation of consumer-centered, health literate practices that empower consumers to make informed buying decisions easily. Some of these principles are reflected in the existing choice architecture of the ACA, as well as in state implementation decisions. Unfortunately, there are also plenty of examples where the federal government and states have failed to incorporate effective sales and health literate practices in their outreach and exchange design. These failures led to initial enrollment numbers that were lower than expected, and they could jeopardize reform going forward if not corrected.

Suggested Citation

Clark, Brietta R., Getting People to Make The Right Choice Under the ACA: The Most Important 'Sales Pitch' of Obama's Presidency (August 24, 2014). 17 Journal of Health Care Law & Policy 3 (2014), Loyola-LA Legal Studies Paper No. 2014-41, Available at SSRN:

Brietta R. Clark (Contact Author)

Loyola Law School Los Angeles ( email )

919 Albany Street
Los Angeles, CA 90015-1211
United States
213-736-1494 (Phone)
213-736-3769 (Fax)

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