By Allison Barnes and Rob Cronin

Recently on Jimmy Kimmel Live, the show’s film crew took to the streets of Hollywood to find out what people thought of the Affordable Care Act (ACA).  While the responses were entertaining, they underscored the confusion seen in a recent CNBC poll, and this recent NPR story.

At WCG, we’ve worked to make sense of this by taking a closer look at the online conversation surrounding the ACA. This post is the first in a series aimed at shedding light on that all-important conversation. Using our analytics capability, we looked at four types of online media: news, blogs, forums and Twitter. Our analysis covered the previous year and included over 8.5 million references to the federal health law. We used a statistically significant random sample to arrive at key metrics.

To get started, we looked at the ACA conversation from a standpoint of what’s being discussed, how it’s being discussed, where that discussion is happening and the overall volume of conversation.  (Note: For a more detailed view of the conversation data and trends, click on the infographic and slides below.)

 Affordable Care Act from W2O Group

Looking at the volume of online conversation (the image at the top of the infographic), you’ll notice that conversation spikes are tied to political activities. This is a key data point as politically-oriented communications have consistently dominated the ACA conversation. Even the most recent spike seen at the far right of the graph is driven not by news of the health insurance exchanges (as anyone watching news coverage might reasonably have thought); that’s Senator Ted Cruz’s filibuster effort on Capitol Hill.

Kimmel is at his best when simply asking Joe and Jane Public which they prefer: Obamacare…or the Affordable Care Act. WCG’s analysis of language, sentiment and media channels used in the ACA conversation can help explain why the average person even sees this as a choice. First, our data shows the ACA conversation is dominated by Twitter and the consistent and frequent use of one word: Obamacare. Second, Obamacare does not have a high-level of association with the ACA – the terms “affordable” and “act” do not appear in top 15 keywords associated with mentions of Obamacare. And last, ACA mentions that include the term Obamacare are twice as likely to be negative, which of course was the intent of those who coined the term as a pejorative alternative to the “Patient Protection and Affordable Care Act”.  It also helps explain why “Obamacare” is seen as something different and not all that attractive by folks on Hollywood Blvd. and beyond.

However, when examining data from the most recent quarter, there are signs of change. Over the past three months, a rise in the use of Obamacare has coincided with a 5-6 percent increase in overall neutral to positive sentiment. Could this be a reflection of ACA supporter’s efforts to de-politicize the term? Whether its causation or correlation is unclear.

The infographic’s “Conversation Focus” identifies what topics are being discussed. In conversations mentioning Obamacare, it shows more than half of the mentions make no reference to specific components of the law at all. The majority of these general mentions are negative in tone and are most often characterized by political attacks to defund or repeal the law. Other components of the ACA in the Obamacare conversations were also majority negative, including the federal insurance mandate and Medicaid expansion. Keeping the ACA conversation broad and negative is not exactly a recipe for helping Jimmy’s interviewees boost their understanding.

Conversely, in conversations mentioning the Affordable Care Act, most of the conversation was about specific components of the law. Discussion of Medicaid expansion and the federal mandate were about evenly split between negative and neutral to positive.

In both conversations—with and without mentions of Obamacare—mentions of healthcare exchanges and pre-existing conditions were neutral to positive. This points to a contradiction that’s been raised many times before – consumers who are against the ACA overall but in favor of some of its key tenets. And here is where Mr. Kimmel has performed yet another  public service by coming up with a more broadly-accessible metaphor to help explain the ACA: “…it’s like the opposite of a (Chicken) McNugget.” (See: 20 and 2:44 of the segment).

It is important to note that our data also does not take into consideration the developments of the last several days surrounding the government shutdown and the launch of the healthcare exchanges. These will no doubt have a very large impact on the ACA conversation.

For now, it’s fair to say that ACA supporters have their work cut out for them. Conservative efforts to use the term Obamacare and Twitter have clearly influenced the overall conversation online and helped them to rebrand the ACA to their liking.

What are your thoughts? Please check out the infographic and slides and share your comments and questions below.

Rob leads WCG’s digital health practice. You can reach him at and robcroninny. Allison is an associate in WCG’s analytics practice. You can reach her at and allisonnbarnes.