How to Insure a Country, 160 Characters at a Time – Part 3


This is the final installment of a three part series introducing the Mobile Commons Enroll text message content library and highlighting some of the conceptual and technical challenges we faced during its development. Meeting these challenges required building scientific and practical insights into the library’s design — both for the individual messages and the set as a whole. We’ve learned quite a bit and think the outcome well worth the effort.

This post was written by Benjamin Stein, CTO & Co-Founder of Mobile Commons, and Mark Hunter, MPH PhD(c) Health Services & Policy Analysis, University of California, Berkeley.

What To Say and How To Say It

No use in sugar coating it: there’s virtually nothing simple about the Affordable Care Act. When even experts find the complexities of today’s healthcare environment challenging, it’s crucial to keep the consumer’s perspective in mind. To do this, imagine just a single person trying to understand what the law means for them. What would they need to know? What kinds of questions would they have? What sorts of answers would they find most helpful?

Sometimes giving the most helpful answer is hard. In part 2, we addressed the problem that different types of people are bound to have different types of questions. That means the library needs to anticipate different types of answers.

But our problem today is even more basic. Many of the questions just don’t have simple answers, and the law’s complexity is to blame. It requires consumers to know some material that is really complicated. And, it’s deeply intertwined with our equally complicated health system. Early on in the process of developing the library, we realized that these things would impose restrictions that would affect not only the content of the messages, but also their form. Both what we should say, and how we should say it.

That’s why we think that of all the difficulties a mobile outreach campaign for the ACA faces, the law itself is the largest one.

Tailoring the Messages for the Most Impact

Here are a few ways we improved the content library to address some of these challenges:


  • For English & Spanish Speakers: Like the delivery of health services in general, mobile outreach materials must be culturally and linguistically appropriate. Out of the box, our text messages are available in both English and Spanish. It’s also easy to customize messages to link clients to other language-specific materials such as may be found on exchange websites.
  • For People of Different Educational Backgrounds: Each message has also been subject to a multi-part test for readability to ensure that it’s grade-level appropriate. Unsurprisingly, the more education you’ve received, the likelier you are to be insured. The uninsured are about twice as likely as the insured to have not completed high school. [SF1] So, no matter what we say, we need to keep the messages clear, direct, and readable.

The Political Environment

By this point, most people will be aware – if only vaguely – that health reform is afoot. As a social reality, opinions about the law’s merits are divided and there is considerable room to dispel misconceptions. We think it’s possible to help consumers better understand how the ACA affects them without touching political 3rd rails.

For example, consider the “public option.” Some consumers may seek out coverage because they (incorrectly) believe that getting insurance through an exchange means that they’re being covered by the state. Others may have antipathy toward “government-run” health care and may avoid exchanges because they (incorrectly) believe that only public plans are available. Both groups should know the facts: Medicaid is a public program and the plans available through the exchanges are offered by private insurers. Because the exchanges are part of a broader health system, we’ve built in a “just-the-facts” approach to help dispel falsehoods and promote a more reasoned understanding of their value.

Simplifying a Confusing System

For those of us familiar with insurance, the concept of a premium, or of a physician network, makes sense. But for a great many people – some of whom will be wholly unfamiliar with plan selection – these concepts don’t have an intuitive interpretation. Messages in the education module of the library define these terms by relating them to real-life, commonplace, activities. This makes them more concrete and easier to understand. For similar reasons, messages about exchange implementation – things like eligibility requirements, subsidy levels, and the like – don’t just copy and paste from the federal register. We strip away the abstract technical presentation in favor of a simpler, more relevant, message.

Relevance is really about avoiding extraneous information. Because the law is so complicated, a natural tendency is to try to explain all of its detail in the hopes that consumers can find for themselves what applies. That’s not a very effective approach. We know that too much choice and too much information can be overwhelming. We all quickly tune out details that don’t seem relevant to our lives. That insight lead to a more balanced content library. We scrapped messages that tried to relay too much and made sure that what remained was immediately useful and engaging.

Wrapping Up: Encouraging Enrollment in Your Communities

Our goal with the content library was to create a series of easily comprehensible messages that could inform anybody about the ACA’s essential elements. We wanted our target reader to be able to use the knowledge she gained from our messages to make an informed and responsible decision about heath insurance, regardless of her educational background, her language, her political affiliation, or her insurance history.

In many ways, the actual form of a text message was one of our greatest allies in achieving that goal. Texts are by their nature short (at most 160 characters), so there’s no room for long elaborations and codas. We were obligated to be both concise and clear. Texts are immediate, and there’s almost a guarantee that they’ll be read. People exchange dozens (or hundreds) of text messages a day, so we could engage in a prolonged conversation with our users without being perceived of as invasive.

If you or your organization is working to drive insurance signups in your communities, we believe that our content library can be a tremendous asset. To learn more about Mobile Commons Enroll, contact us

And thanks for reading!

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