At the New York Times, amazingly, "Talk of Penalty Is Missing in Ads for Health Care":
New York’s health exchange slogan is “Today’s the Day.” Minnesota has enlisted Paul Bunyan. Oregon held a music contest, and California stresses the “peace of mind” that will come with insurance.Cost effectiveness? Heaven forfend we can't have that!
The state and federal health insurance exchanges are using all manner of humor and happy talk to sell the Affordable Care Act’s products. But the one part of the new system that they are not quick to trumpet is the financial penalty that Americans will face if they fail to buy insurance.
On state exchange websites, mention of the penalty is typically tucked away under “frequently asked questions,” if it appears at all. Television and print ads usually skip the issue, and operators of exchange telephone banks are instructed to discuss it only if asked. The federal website, now infamous for its glitches, mentions the penalty but also calls it a fee, or an Individual Shared Responsibility Payment.
The euphemisms and avoidance of any discussion of the penalty are no accident, both supporters and critics of the law say. While the mandate for all Americans to buy health insurance — with a penalty if they do not — was the linchpin of the Supreme Court decision upholding the law, and is considered the key to its success, poll after poll has found that it is also the least popular part of the program.
State exchange operators say that they are not trying to hide the penalty, but that their market research has taught them that, at least in the initial phase, consumers will be more receptive to soothing messages and appeals to their sense of collective responsibility than to threats of punishment.
“We feel that the carrot is better than the stick,” said Larry Hicks, a spokesman for Covered California. “This is a new endeavor. We want people to come in and test our wares.”
But there is also the dirty little secret of the penalty: It is a bit of a chimera, because the federal government cannot use its usual tools like fines, liens or criminal prosecutions to punish people who do not pay it. The penalty is supposed to be reported and paid with the income tax returns of those who do not buy insurance, but the government has not said how it will collect from those who owe it but do not pay it, though the law allows it to deduct from any income tax refunds.
“It might be that they want to be positive,” said Michael Cannon, director of health policy studies at the conservative Cato Institute. “But it’s also the case that an informed customer is not their best customer.”
And for many healthy middle-class people, a side-by-side comparison might suggest that it would be more cost-effective to pay the penalty than to buy insurance.
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