Crunch time for health law exchanges
Open enrollment begins Oct. 1
A calendar on the office wall of senior White House communications adviser Tara McGuiness counts the days until marketplaces under the sweeping health care law championed by President Barack Obama open in states nationwide.
McGuinness and others working to insure the uninsured have fewer than 10 weeks until open enrollment in state and federally managed insurance exchanges begins on October 1.
Then they'll have just six months to educate as many people as possible about the Affordable Care Act, a 2010 law that for many is just a political attack line.
"The Affordable Care Act has been this abstraction, it's been for many just defined as a political football between Democrats and Republicans without a real tangible effect on their day to day lives," said a senior White House official on a recent conference call with reporters.
As open enrollment approaches and more aspects of the divisive law take effect, the official said that so-called political football is deflating.
"The abstraction is evaporating. It's going away, because the facts are now being translated into benefits for real people," the official said.
The administration's goal is twofold. It wants to continue efforts to convince the eight in 10 Americans who have health coverage that they're already benefitting from Obamacare.
Then it aims to convince uninsured Americans that purchasing insurance through health exchanges is easier and more affordable.
To accomplish the first goal, Obama has been engaged in a constant campaign since his signature domestic initiative became law to remind people about its benefits.
This while Republicans in the House of Representatives have voted to repeal the law more than three dozen times, and are now trying to leverage broader questions about the measure as an issue in the 2014 midterm elections.
Obama on Wednesday called GOP-inspired repeal votes "meaningless" exercises that weigh down the political process, and said he welcomed any proposed alternatives based on "concrete ideas."
The Obama push
Obama's latest push against critics came last week when he surrounded himself with every day Americans at the White House to tout the cost benefits of his plan.
Today, because of the Affordable Care Act, insurance companies have to spend at least 80% of every dollar that you pay in premiums on your health care, not on overhead, not on profits, but on you," the president said.
"If they're not spending your premium dollars on your health care, at least 80% of it, they've got to give you some money back," he said.
The White House estimates more than 8.5 million people have received rebates, but even Obama acknowledged many may not know it was due to regulations implemented under Obamacare.
As the insurance exchanges get closer to reality, those kinds of events by Obama and his Cabinet become more frequent.
This week, Obama is kicking off a series of speeches about the need to refocus political efforts on the economy, something the White House sees as linked to health care reform.
In the run-up to October 1, Health and Human Services Secretary Kathleen Sebelius is planning one or two trips a week to talk about enrollment.
And behind the scenes, administration officials are using the health care battles of the past as lessons about how to make new insurance exchanges a success.
"We know from CHIP and Massachusetts and other health policy projects that for individuals who really need care that they are counting down the days just like me to when the exchanges open," McGuinness said.
"For folks who are about to lose their house because they've been unable to find insurance, we won't have to work super hard to find them. They're going to find us. But we know from Massachusetts in particular, we're going to have to create an intensity of outreach to young people in particular to 18 to 35 year olds," she said.
Filling the premium pool
The nonpartisan Congressional Budget Office estimated that roughly seven million people will purchase insurance on the exchanges during the first six-month open enrollment period.
If too many of them are older or unhealthy, then monthly premiums will likely skyrocket. If that occurs, that high profile part of the law will be viewed as a failure.
"The law would not be judged a success if the exchanges fail," said Drew Altman, president and chief executive of the Kaiser Family Foundation, a private, non-profit health care research organization.
According to Altman, success will require the government to make sure the exchanges are up and running on time, that early glitches are few and relatively minor, and that people can enroll at an affordable price.
"The biggest thing of all will be that when the exchanges are up and running, people who enroll in the exchanges view the premiums as not only affordable but the insurance they get is a good deal, is a good value," he said. "That's the real test."
To pass this test, the administration figures roughly 40% of exchange consumers -- 2.7 million if the CBO's estimates are correct -- need to be between the ages of 18 and 35.
Younger and healthier premium pools will keep overall costs lower and ease the financial hit to the program when it does pay benefits.
Through publicly available data, administration officials believe they have a pretty good idea of the target audience.
In the administration's calculus, the population of younger, uninsured Americans skews slightly more toward African American and Hispanic males living in urban areas. A third of that population lives in California, Florida or Texas, and the administration believes many will qualify for government subsidies to purchase insurance.
To reach the desired audience, officials are getting their message to places where young Americans already go for information. That means launching social media campaigns and doing interviews with magazines like Cosmopolitan, whose readership skews toward the target age bracket.
It also means encouraging friends, family and community groups to act as "validators," or trusted conveyors of the administration's message. And it means forging partnerships with artists and celebrities who have credibility with younger audiences.
This week, Obama joined a meeting at the White House with a star-studded group of volunteers who are interested in helping promote Obamacare.
'Funny or Die' involved
Attendees included singer Jennifer Hudson, actors Kal Penn and Amy Poehler, and representatives for Oprah Winfrey, Alicia Keys, Bon Jovi, YouTube Comedy, Funny or Die and the organizations that put on the annual Grammy and Latin Grammy awards.
Funny or Die president of production Mike Farah said the president's message about health care reform resonated with everyone in the room.
"There were obviously some really accomplished people in the room, but they all started out as struggling artists," said Farah, adding most people there had a story about being uninsured.
Funny or Die makes 25 or 30 original videos a month, and its audience consists mostly of younger viewers.
The White House hopes by incorporating the message of enrollment into videos it already makes, Funny or Die can help make the message go viral.
The administration is aided in its efforts by an array of independent groups.
The president's former campaign organization, now called Organizing for Action, is spending upwards of seven figures over the course of the summer for commercial time on cable stations to help educating people about the health care law.
The ads promote success stories about how the law impacts average Americans. By placing them on channels like Bravo, the group can target mothers who have outsized influence on their children's decision to purchase insurance.
Enroll America, a nonpartisan group focused solely on maximizing enrollment under the health care law, already has staff in 10 states where uninsured populations are highest.
With an advisory board that includes representatives from across the health care spectrum as well as consumer groups, community organizations, and charities, Enroll America will have more than 200 employees by October 1 working on a campaign geared toward connecting those seeking insurance with a plan available on their state marketplace.
Local effort in states
In states that chose to run their own exchanges, the effort is much more local.
Kentucky will be doing outreach for its exchanges at bourbon festivals in the fall, while California has partnered with Spanish-language television outlets to reach its state's uninsured youth, nearly half of whom are Hispanic.
A senior administration official said the effort is targeted and strategic.
"I think the enrollment strategy is both an effort to meet the needs of the uninsured but also the best political strategy as well, because once it's out there, once millions of people are enrolled, once states have programs up and running, it'll be very hard to put the genie back in the bottle," Altman said.
Some skeptics question how the administration will be able to convince young, healthy Americans -- often called "young invincibles" in health care conversations -- to spend money every month on insurance they may never use. But officials believe they can reach their goal of 2.7 million people if they can overcome two main obstacles.
"At the core of the obstacles is affordability and access and we've created a system that addresses that," a senior administration official said, pointing to government subsidies that help address affordability, and the redesigned Healthcare.gov that is intended to address ease of access.
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