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Covered California Executive Director Peter Lee unveils the rendering of one of a dozen murals the agency commissioned across the state, as paint-spattered artist David Garibaldi stands by. (Ana B. Ibarra/California Healthline)

The marketing blitz is on.

Californians are getting barraged with online pop-up ads, radio spots and television commercials, all aimed at persuading them to sign up for Affordable Care Act health plans during this year鈥檚 open-enrollment season.

, the state鈥檚 Obamacare exchange, is wielding a monster marketing budget that devotes $45 million to ads, including $18 million for TV and $8 million for radio. The agency is so flush with marketing dollars that it also spent $100,000 for a dozen freshly painted murals across the state, most of which have nothing directly to do with health insurance enrollment.

Covered California鈥檚 marketing riches contrast starkly with the advertising budget for the federal health insurance exchange, . The feds have slashed ad dollars to $10 million, down from $100 million last year.

The huge discrepancy reflects conflicting attitudes toward the ACA, commonly known as Obamacare, said Gerald Kominski, director at the University of California-Los Angeles Center for Health Policy Research.

鈥淎 $10 million advertising budget for healthcare.gov, which supports exchanges in 30-something states, is 鈥� in keeping with the goal of this administration to destroy the ACA,鈥� he said. 鈥淐alifornia鈥檚 budget reflects a different approach to the ACA, which is that it is an important source of insurance.鈥�

Other health care experts say marketing is not the best use of money now that the exchanges are a known commodity, especially in California. They suggest the dollars could be better used for things like reducing premiums.

鈥淚t鈥檚 a waste of taxpayer money,鈥� said Sally Pipes, the president and CEO of the in San Francisco, which advocates for free-market policies.

鈥淎ll of this money being used on murals and bus tours and TV ads, etc., it鈥檚 not going to change the number of enrollees that much. It would be better to save money and reduce taxes so that people have lower tax burden.鈥�

California is one of 11 states, plus the District of Columbia, that operate their own health insurance exchanges. The remaining 39 states use the federal site.

In addition to cutting its ad budget, the federal government reduced grants for 鈥渘avigators,鈥� individuals and organizations that help people enroll, to $37 million, down from $63 million last year. Covered California will devote $6.5 million to navigators. It鈥檚 not a perfect measure, but judging purely by population, these investments in navigators do not seem significantly different.

Altogether, Covered California plans to spend $111.5 million on marketing in 2017-18, which includes navigators, ads, staff salaries and more.

Covered California leaders and consumer health advocates say the agency鈥檚 sizable marketing budget is necessary because of recent federal moves to undercut the Affordable Care Act. The Trump administration shortened the enrollment period to 45 days in most states and stopped paying insurers to provide a that helps many low-income consumers with their out-of-pocket medical costs.

鈥淚t sounds like a lot 鈥� but it鈥檚 a very legitimate expenditure,鈥� said Betsy Imholz, director of special projects for .

The federal government鈥檚 $10 million investment in advertising is 鈥渞idiculously inadequate鈥� by comparison, she said. Covered California will spend that amount on online ads alone.

There have been so many policy flip-flops in Washington, D.C., and so much misinformation that some people may be confused about whether the law is even in place anymore, she said.

is magnified by the fact that consumers nationwide may be served by different Obamacare exchanges with different rules.

For instance, Californians who purchase their individual insurance through Covered California or on the open market will continue to have three months, until Jan. 31, 2018, to enroll in plans for next year. People who purchase their plans through healthcare.gov have until Dec. 15.

Ed Haislmaier, a senior research fellow at the conservative , said the feds鈥� advertising cuts simply reflect the needed transition from promoting the exchange as a new option to maintaining it as an established program.

鈥淕rowing awareness is not going to magically get desired people to enroll,鈥� he said.

The U.S. Department of Health and Human Services (HHS), which runs the federal exchange, explained that it cut advertising in part because it did not seem to be working to boost first-time enrollment. For 2017 plans, first-time enrollment and total enrollment fell by 500,000 people to 12.2 million. Covered California has about 1.4 million enrollees.

HHS plans to use its smaller budget like YouTube videos and targeted ads on search engines, called search advertising. It will also focus on emailing and calling healthcare.gov consumers directly to remind them of the Dec. 15 deadline.

So far, neither the confusion nor the smaller advertising investment seems to have stopped people from signing up. About had selected healthcare.gov plans as of Nov. 11, which represents a stronger start than , when about 1 million people picked plans during the first 12 days.

In California, 48,000 new consumers had signed up for exchange plans as of Nov. 14, slightly ahead of the same period last year, when 39,000 consumers picked plans. These figures don鈥檛 include existing enrollees who renewed their plans.

Kathy Hempstead, a senior adviser at the , said Covered California usually performs better than others in enrollment, which probably has something to do with its marketing efforts. 鈥淐overed California has become a brand,鈥� she said. 鈥淗ealthcare.gov hasn鈥檛.鈥�

Peter Lee, Covered California鈥檚 executive director, said he believes that spreading the word about open enrollment creates a risk pool that includes both healthy and sick people.

鈥淵es, marketing costs money, but marketing means more people sign up, and the people that sign up are healthier and help lower premiums,鈥� he said.

Covered California commissioned this Sacramento mural as part of its marketing and outreach efforts to promote the open-enrollment period for 2018 coverage. (Ana B. Ibarra/California Healthline)

Advertising likely helped lower premiums by 6 to 8 percent in 2015 and 2016 because it helped create a more balanced risk pool, according to a recent produced by Covered California.

Covered California鈥檚 $111.5 million marketing budget is nothing new. Last year, it spent $99 million on marketing, and $122 million the year before that.

This year, as in some previous years, Lee paraded across the state in a colorful charter bus promoting the start of open enrollment. He touted the 12 new murals, and echoed the primary message of : Life can change in an instant due to unexpected injuries, such as falling off a ladder.

One mural painted outside an AltaMed clinic in East Los Angeles features people dancing, running and exercising around a doctor. A mural painted outside La Familia Counseling Center in Sacramento shows a woman holding a bowl above her head, out of which flow children riding bikes and a basketball player.

How much the murals, the tour bus or the television ads will help cut through the confusion, let alone increase enrollment, is unclear.

鈥淚 don鈥檛 know if marketing will be able to address how complex this open enrollment will be,鈥� said Kevin Knauss, an insurance agent in the Sacramento area.

Kaiser Health News senior correspondent Anna Gorman contributed to this report.

This story was produced by聽, which publishes聽, an editorially independent service of the聽.