DES MOINES, Iowa -- The television ads show a series of medical mishaps: a man kicking the wrong leg in a reflex check, a urine sample bottle that won't open for a frustrated patient and a blood pressure cuff letting out a strange noise when the doctor presses the plastic bulb.
After each scene, a narrator says: "Things don't always work like they're supposed to. Good thing the government exchange website isn't the only place to buy health insurance."
A Midwestern company not participating in the federal health insurance marketplace next year launched the ads recently in Iowa and South Dakota. They poke fun at the technical problems that have plagued the federal government's enrollment website.
Wellmark Blue Cross and Blue Shield, which has headquarters in Des Moines and Sioux Falls, S.D., is simply trying to make sure consumers know they can buy insurance directly from the company rather than go through the federal government, spokeswoman Traci McBee said.
"They're designed to get attention through humor," McBee said. "That way they can hear the message that there's more than one place to shop."
While many insurers are running television spots at the moment promoting their products and often directing buyers to their own websites, this exact kind of messaging has not been seen in other states.
Elizabeth Wilner, vice president of Kantar Media, which tracks advertising, said that in general, she has seen more aggressive ads coming from small insurance outfits seeking to pick up business, while many bigger insurance companies have been careful to avoid directly knocking the Affordable Care Act, perhaps opting for caution as they see how the law will unfold.
Wilner said the Wellmark ads were the most direct she had seen commenting on the federal insurance enrollment website.
"The Wellmark ads are the only ones we've seen so far that explicitly make fun of the federal website," Wilner said.
Though Wellmark's ad campaign appears unique, insurance brokers and companies in numerous states have tried to attract customers by creating websites that mimic those of the online health insurance exchanges created by the federal government or individual states. In some cases, including California, they have been hit with cease-and-desist orders.
Iowa Insurance Commissioner Nick Gerhart said his staff had reviewed the Wellmark ads and found nothing inappropriate. He said his focus was on efforts to deliberately mislead customers, like ads that falsely claim to be offering policies compliant with the Affordable Care Act.
"Those are the ads that are going to hurt people the most," Gerhart said.
Wellmark is the largest insurer in Iowa and South Dakota, with about 2 million members in both states. The company announced earlier this year that it would not participate in the federal exchange for 2014, but said it would join in 2015.
Officials have offered current customers the option to keep existing plans through 2014 or buy new plans that meet the federal guidelines laid out in President Barack Obama's health care law. But those who buy insurance from Wellmark -- or any insurer not operating on the government exchanges -- cannot receive federal subsidies available to people with qualifying incomes under the law.
Federal officials with the Centers for Medicare & Medicaid Service did not respond to specific questions about the Wellmark campaign.
Obama's health care overhaul is designed to reduce the number of people without health insurance, both through an expansion of Medicaid and with new health care marketplaces where people can shop for private coverage and apply for government aid to pay premiums.
Iowa is one of 36 states using the federal government's insurance enrollment website. Since the Oct. 1 launch, the federal site has been plagued by technical glitches. Obama pledged to improve the site by the end of November.
One Wellmark competitor raised questions about the Wellmark campaign. Cliff Gold, chief operating officer of CoOportunity Health, which is providing insurance on the federal exchange for Iowa, said the ads were misleading because they don't tell people about opportunities for premium assistance.
"They leave people with the impression that going to their website is an alternative to going to the government website, which is not true if they are eligible for a subsidy," Gold said. "I do think that it does not serve the public interest."
To receive subsidies, which vary by income, people must have incomes between 100 and 400 percent of the federal poverty level -- or between $23,550 and $94,200 annually for a family of four.
McBee said the company has provided information about the Affordable Care Act and the potential benefits associated with it in other print and radio ads and communications with customers. She said if people call in and ask about subsidies, Wellmark directs them to the federal site.
"It's really about education and making sure people know all their choices," McBee said. "We very supportive of many parts of the Affordable Care Act. But we want to make sure people know their options."
But state Sen. Jack Hatch, a Des Moines Democrat who is supportive of the health care overhaul and has criticized Wellmark in the past, took issue with the ads.
"They've said more about the Affordable Care Act in one advertisement than in seven years of health care reform," Hatch said. "They've been so silent because they want it to fail. Now they realize it's a competitor."