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Thu March 6, 2014
Shots - Health News

Selling Health Care To California's Latinos Got Lost In Translation

Originally published on Fri March 7, 2014 7:59 am

It's been decades since the advertising industry recognized the need to woo Hispanic consumers. Big companies saw the market potential and sank millions of dollars into ads. The most basic dos and don'ts of marketing to Latinos in the United States have been understood for years.

So when officials started thinking about how to persuade the state's Spanish speakers, who make up nearly 30 percent of California's population, to enroll in health care plans, they should have had a blueprint of what to do. Instead, they made a series of mistakes.

For example, one thing health policy experts love about Obamacare is that no one can be denied coverage for a pre-existing health condition. Covered California, the state's health insurance exchange, made this a selling point in almost all its Spanish ads. But that doesn't resonate with Latinos. Many have never had insurance, never considered it.

Bessie Ramirez is with the Los Angeles-based Santiago Solutions Group, a Hispanic market research firm that has consulted for large health care clients like HealthNet, Cigna and Blue Cross.

She says another problem is that all the early TV ads end with a web address for Covered California in Spanish — no phone number or physical address. She says that completely misses how Hispanics like to shop, especially for a complicated product like health insurance.

"Hispanics are heavily on the Internet, and they're growing very fast on the Internet, however they're not transacting on the Internet," Ramirez notes. "They transact on a personal basis. Hispanics will wait to go to a 7-Eleven until 11 o'clock [if] at 11 o'clock they know that [their friend] Juan is on duty."

Covered California's biggest mistake was perhaps simply translating ads developed in English into Spanish. Think of Got Milk?, the long-running English-language campaign. At worst, a literal translation into Spanish could be a rude reference to breast milk. At best, it just falls flat. That's what happened with Covered California's first Spanish-language ad.

The ad features a series of people looking directly into the camera saying, in Spanish, "Welcome to a new state of health. Welcome to Covered California."

Ad experts say that was an obvious misstep.

"To say we're in a new state of health for California, it's grammatically correct to translate it literally, but it doesn't have the same nuance or cuteness that it does in English," says Roberto Orci, CEO of Acento Advertising in Santa Monica, Calif.

He found one of the state's follow-up ads just boring — the music, the message and the man in the ad.

"This guy was stiff as a board and ... seco, which in English means dry," he says.

If the product is chicken nuggets or milk, it might not matter to anyone but the company if Latinos buy it. But if Latinos don't buy health insurance, it matters to everyone.

On average, Latinos are younger and healthier than the general population. The premiums they will pay if they sign up help cover the health care costs of older, sicker Californians. That keeps premium costs down for everyone else.

That's why Covered California is sweating the numbers. Just 6 percent of people who enrolled in Covered California health plans last year speak Spanish as their first language. The state is worried how far that number is from the number of Spanish speakers.

"We don't think we've done a good enough job yet," says Peter Lee, executive director of Covered California. "Relative to our ambitions and our aspirations we don't stack up well enough yet, and so we're going to be doubling down."

The state spent almost $5 million on its Spanish-language ad campaign last year. It plans to spend more than $8 million in the first three months of this year. Covered California has upped its market research efforts and has vowed to adjust its creative messaging. This time around, it will put a lot of emphasis on ads where people can go to get help in person.

"Even from day one, we thought Spanish speakers would need in-person help," Lee says. "How important that is has really crystallized over the last three months."

The final deadline to sign up for coverage this year is March 31. It's not clear if Covered California can come up with a more effective marketing campaign before then.

This story is part of a reporting partnership among NPR, KQED and Kaiser Health News.

Copyright 2014 KQED Public Media. To see more, visit http://www.kqed.org.

Transcript

DAVID GREENE, HOST:

This is MORNING EDITION, from NPR News. Good morning. I'm David Greene.

LINDA WERTHEIMER, HOST:

And I'm Linda Wertheimer.

The clock is ticking on the Affordable Care Act. With less than a month to sign up for coverage through the new insurance exchanges, advocacy groups, insurers and state and federal officials are ramping up efforts to fill the gaps. One population where enrollment still lags: Latinos.

Later today, President Obama will make an appeal to Latinos in a town hall meeting, which will be broadcast by major Spanish-language media outlets. The challenge is a particular problem in California. Its insurance exchange, Covered California, has been hailed as one of the more successful rollouts of Obamacare. But it has not worked so well with Latinos.

As April Dembosky of member station KQED tells us, marketing missteps have been part of the problem.

APRIL DEMBOSKY, BYLINE: The advertising industry figured out how to woo Hispanic consumers decades ago. They found a way to translate the appeal of American products to a different culture.

(SOUNDBITE OF MACDONALD'S ADVERTISEMENT)

UNIDENTIFIED GROUP: Hey, McNuggets. Me Encanta.

DEMBOSKY: Yet, last year, when California officials started thinking about how to persuade the state's Latinos to buy health care plans, they made a series of basic marketing mistakes.

Here's an example. One thing health policy experts love about Obamacare is that you can't be denied coverage for a pre-existing condition. Covered California made this a selling point in almost all its Spanish ads.

(SOUNDBITE OF ADVERTISEMENT)

UNIDENTIFIED WOMAN: (Spanish spoken)

DEMBOSKY: But that message doesn't resonate with Latinos. Nearly 60 percent of the state's uninsured are Latino. Nearly one in three Latinos in the state is uninsured. And many of them have never had insurance, never considered it. So few have ever worried about pre-existing conditions.

Another problem is that the ads end with a Web address for Covered California.

(SOUNDBITE OF ADVERTISEMENT)

UNIDENTIFIED WOMAN: Covered ca punto.com.

DEMBOSKY: Bessie Ramirez is from the Hispanic market research group Santiago Solutions, near Los Angeles. She says failing to include a phone number or a physical address completely misses how Hispanics like to shop.

BESSIE RAMIREZ: Hispanics are very heavily on the Internet, and they're growing very fast on the Internet. However, they're not transacting on the Internet. They transact on a personal basis. Hispanics will wait to go to a 7-11 until 11 o'clock, because at 11 o'clock, they know that Juan is on duty.

DEMBOSKY: Perhaps Covered California's biggest mistake: They simply translated ads from English into Spanish. They ignored the importance of cultural relevance. Think of this long-running English-language ad.

(SOUNDBITE OF ADVERTISEMENT)

UNIDENTIFIED MAN: Got Milk?

DEMBOSKY: At worst, a literal translation of this catch phrase into Spanish could be a rude reference to breast milk. At best, it just falls flat. That's what happened with Covered California's first Spanish ad.

(SOUNDBITE OF ADVERTISEMENT)

UNIDENTIFIED MAN: Bienvenidos.

UNIDENTIFIED CHILDREN: Hola.

DEMBOSKY: Roberto Orci and I are in his office, watching this ad. Orci is the CEO of Acento Advertising in Santa Monica.

(SOUNDBITE OF ADVERTISEMENT)

ROBERT ORCI: Come on in. Welcome to a new state of health. Welcome to Covered California.

To say that we are in a new state of health for California, it is grammatically correct to translate that literally, but it doesn't have the same - the little nuance or cuteness that it has in English.

DEMBOSKY: He says a follow-up ad was just boring.

(SOUNDBITE OF ADVERTISEMENT)

UNIDENTIFIED MAN: (Spanish spoken)

DEMBOSKY: Boring music, boring spokesperson.

ORCI: This guy was as stiff as a board and seco, which in English, means dry.

DEMBOSKY: It might not matter to anyone but the companies if Latinos buy more milk or chicken nuggets. But if Latinos don't buy health insurance, it matters to everyone.

On average, Latinos are younger and healthier than the general population. The premiums they pay help cover the health care costs of older, sicker Californians. And that keeps premium costs down for everyone else.

That's why Covered California is sweating the numbers. Just 6 percent of people who enrolled in health plans last year speak Spanish as their first language. The state was hoping for as much as five times that.

PETER LEE: We don't think we've done a good enough job yet.

DEMBOSKY: Peter Lee is the executive director of Covered California. He says the state plans to spend more than $8 million on a brand new campaign. This time, the ads will tell people where they can get help face to face.

LEE: Even from day one, we all thought Spanish speakers would be much more apt to want help in-person. How important that is is really crystallized over the last three months.

DEMBOSKY: It's not clear if there's enough time for the new campaign to make a difference. The final deadline to sign up for coverage this year is just weeks away.

For NPR News, I'm April Dembosky, in San Francisco. Transcript provided by NPR, Copyright NPR.